Friday, Sept. 5, 2003 | 11:25 a.m.
RENO -- Despite warnings that doctors were leaving or closing their practices due to the rising cost of medical malpractice insurance, the state board that oversees medical licenses says there are more physicians with active licenses now than there were at the end of 2001, when the medical malpractice crisis began.
The news came Thursday as the Washington-based advocacy group Public Citizen, citing a recent General Accounting Office report, said the malpractice crisis was manufactured by medical organizations.
Larry Lessly, executive secretary of the state Board of Medical Examiners, reported Thursday there were 4,375 active licenses for physicians as of this week, compared with 4,347 in December 2001.
However, the current number of doctors was below that in December 2002, when 4,537 physicians had active Nevada licenses.
Despite the decline from that number, Lessly said there was not a mass exodus of doctors from Nevada, as many claimed. He said the number of physicians has remained about constant.
There was no breakdown in the number of physicians who have active licenses in Clark County, he said.
Public Citizen referred to a report by the GAO, the investigative arm of Congress, that challenged the statements that doctors were pulling out of five states that were suffering from a medical malpractice crisis, including Nevada.
The GAO report, issued Aug. 29, said: "In Nevada 34 OB/GYNs reported leaving closing practices or retiring due to malpractice concerns; however confirmatory surveys conducted by the Nevada State Board of Medical Examiners found nearly one-third of these reports were inaccurate. ... Random calls (by the GAO) made to 30 OB/GYN practices in Clark County found that 28 were accepting new patients. ... Similarly, of the 11 surgeons reported to have moved or discontinued practicing, the (medical examiners) board found four were still practicing."
The report also found there has been a reduction in emergency room on-call surgical coverage in Clark County that that has created an "access problem." It noted that the trauma center at University Medical Center was closed briefly when physicians stopped practicing there.
The General Accounting Office study said medical provider groups in some states manufactured a crisis of access to care to get lawmakers to change the laws to protect physicians more from medical malpractice suits.
But the past president of the Clark County Medical Society said the malpractice crisis is not manufactured.
"This is a real crisis with real numbers and real people," said Dr. Raj Chanderraj, the society's past president and chairman of the Clark County Health Access Consortium. "The fact that premiums shot up so high that some doctors left or stopped doing certain procedures is not disputable."
Larry Matheis, executive director of the Nevada State Medical Association, said about 100 physicians either left the state, closed their offices or retired in the last 18 months.
"It's not how many leave but it's those in the high medical specialties that leave," said Matheis, who said that shortages have cropped up in the area of OB/GYN, among certain surgeons and in trauma center doctors in Southern Nevada.
"There has been a disproportionate impact," he said, in the types of physicians that are pulling out or giving up their practices. He said there are fewer physicians coming into Nevada than in the past, despite the rising population.
Chanderraj questioned the GAO's claim that a random telephone survey of obstetrics and gynecology practices in Clark County showed a wait time of just three weeks or less for an appointment.
"I'd like to know the parameters and the time frame," Chanderraj said Thursday. "When did they call? Did they say they needed someone to deliver their baby or that they needed a gynecologist? There's a difference in availability."
Dr. Ikram Khan, a surgeon who served as liaison between the Nevada Medical Liability Physicians Task Force and Gov. Kenny Guinn, said statistics and numbers can made to fit different viewpoints.
"One has to look at the source of the information and the mechanism for collecting data," Khan said. "(The GAO) may be saying one thing, but the doctors and the patients here know what's really been happening."
Khan said not only has the crisis been real, but that it's far from over.
"We are in the middle of a wait-and-see scenario," Khan said. "The effect of the new (medical malpractice) law has not been felt yet because the insurance companies are challenging it in court. And while everyone's standing around pointing fingers the community is suffering."
Senate Minority Leader Dina Titus, D-Las Vegas, said the report at the Medical Examiners Board confirms her suspicion that there was no mass exodus of physicians. She said a "small vocal group" of physicians tried to use "scare tactics" to get the Legislature to approve the inititiative petition for changes in the malpractice law.
While she said the number of physicians is not growing as fast as the population, she added, "That's not any different from in the past. Every year we have not kept up with growth."
While Public Citizen says the report by the GOA backs up its stance that the medical malpractice crisis was manufactured, Matheis said the study showed the problem with retaining some specialists. He said the report did not go into depth about the problems facing the medical community or access to care in Southern Nevada.
Public Citizen identifies itself as a nonprofit consumer advocacy organization. Matheis said the group is supported by trial attorneys who are trying to stop medical malpractice reforms in Congress.
Guinn called a special session of the Legislature in 2002 to deal with the medical malpractice crisis. Lawmakers responded by passing a bill that capped damages for pain and suffering and making other improvements. That was supposed to help bring down insurance prices.
But doctors said that was not enough and asked the 2003 Legislature to adopt a law similar to one in California to further protect physicians from costly malpractice suits. The Legislature declined; the issue will be on the election ballot in November 2004.
Jim Wadhams, lobbyist for insurance companies, said the malpractice rates have been "relatively stable" in recent months. But he added the premium is still high.
While the number of physicians may be stable or slightly higher, Wadhams said, there are 5,000 people moving into Clark County a month. That's 60,000 additional residents without any increase in physicians, he said.
The testimony before the Senate Labor and Commerce Committee during the 2003 Legislature, Wadhams said, showed no one "really knows who is practicing on any street corner. They may have an active license but they may not be practicing here."
Some in the medical community, he said "took advantage of the price spike" to push their agenda.