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OP-ED | We Need Balance in Connecticut’s Medical Malpractice Laws

by Dr. Gregory Shangold | Apr 4, 2013 1:41pm
(5) Comments | Commenting has expired
Posted to: Health Care, Opinion

In doctor’s offices, hospitals, and emergency departments across the state, there is a shortage of doctors and specialists.

Why is that? Connecticut’s medical schools do a great job of teaching students. But several state policies and laws are making it increasingly difficult to maintain a practice here in Connecticut. One area of concern focuses on the malpractice climate here. While other states have passed laws that encourage physicians to establish practices, our state has done little to address the growing concern. Just a few years ago, the cost of medical malpractice insurance was so high that some physicians were forced out of the state, or out of practice altogether.

To hear Connecticut’s trial lawyers, there is no problem. They say there are plenty of doctors.

But that just isn’t true. In emergency departments across the state, patients brought in with injuries requiring specialists like hand surgeons or neurologists may have difficulty finding them. The fact is that the risk of being sued is heightened in this situation.

In some cases, if an emergency patient can be stabilized, we send them home with instructions to make a follow-up appointment with a specialist.

If they can’t be stabilized, they may require transport to a larger hospital, adding more stress to an already difficult situation.

For those doctors with office-based practices, the cost of insurance can be high and the impact of a lawsuit, even one where the doctor prevails, can be devastating.

In 2005, the General Assembly passed legislation that requires lawyers to get a certificate of merit for their case before a medical malpractice lawsuit could proceed. That legislation was a step in the right direction and helped to prevent unfounded lawsuits from moving forward. But a proposal now being considered by the Judiciary Committee would water that requirement down — a step in the wrong direction.

Another bill being considered by the Public Health Committee would help address the concern over providing care in the emergency setting and bring on-call specialists back to the emergency departments across the state.

When people are injured or sick, they want to see a doctor. With more than 1.6 million emergency department visits every year in Connecticut and fewer than 100 lawsuits filed, we have to consider whose needs are being served. Without fairness and balance in Connecticut’s laws, seeing a doctor will become increasingly difficult.

The bottom line for Connecticut is this — yes, patients have rights. But one of those rights is to have access to the best care possible, whether in an office visit or an emergency. To get that balance the legislature needs to reject changes in the certificate of merit, and to support the proposal to help specialists in an emergency setting.

Dr. Gregory Shangold is the medical director at Windham Hospital.

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(5) Comments

posted by: michaelend | April 5, 2013  12:44am

Dr. Shangold,
According to the 2013 AMA Physician Characteristics and Distribution in the U.S., Connecticut ranks number 6 out of the 50 states and the District of Columbia in the number of doctors working in patient care per 100,000 population.  With only four states and the District of Columbia having more practicing doctors per population, how can you be making the claims you are?

posted by: Shangold MD | April 8, 2013  11:48am

Thank you for your comment.  The AMA statistic does not represent actual practice.  In Connecticut, many physicians have an active license but that does not translate into being accessible for patients at their time of need.  Firstly, this bill specifically addresses specialists on-call for emergency departments.  Many physician’s with a license are retired, practice in other boardering states but have retained a CT license, or work for an insurance company which is not uncommon in this state.  Also, many residents (physicians still completing their training) obtain an active license but do not remain in this state to practice.  Oncethe larger number in the quoted statistic is decreased to represent true practicing physicians available for on-call emergencies, these physicians are not equally distributed throughout the state.  Lastly, CT has one of the oldest average ages of practicing physicians. If this is not addressed at this time and new graduates do not seek to move or stay in CT, we will see further shortages.  All of this adds up to patients not having access to care when they need it.

posted by: michaelend | April 8, 2013  1:18pm

Dr. Shangold,
The AMA data break down the total number of doctors per 100,000 people and the “patient care” doctors per 100,000 people.  There are 437 doctors per 100,000 people in Connecticut, and 329 patient care doctors per 100,000.  There are 318 doctors and 243 patient care doctors per 100,000 in the United States, so Connecticut is way ahead of the national average.  Connecticut is completely in line with the other states regarding the age of its doctors (p. 51).  You are correct about the emergency medicine numbers.  In the U.S., 4.3% of the patient care doctors practice emergency medicine.  The percentage in Connecticut is 3.7%.

posted by: CTEDMD | April 10, 2013  12:14am

Thank you Dr. Shangold for your commentary. As an Emergency Physician in the state I completely echo Dr. Shangold’s sentiment. The lack of on call specialist and the exodus of our residents to states with better practice environments is a danger to our citizens and public heath system. Though the issue gets intentionally muddled by trial lawyers and politicians, this is an issue that the public should be aware of and gravely concerned about. If you are unfortunate enough to be in a bad accident and need care beyond that provided by an Emergency Physician, there is a very good chance there is currently no one available to provide it at many of our states hospitals. It’s time to change this and the public needs to be involved.
To answer Michaelend’s comments, the AMA statistics separate out “retired physicians” but do not separate out physicians with licenses who do not actively treat patients on a full time basis. This includes those retired with active licenses, researchers, those who work for insurance companies, and educators, all of which are disproportionally represented in our state. Finally, I’m not entirely certain, but believe that the AMA statistics also include residents and fellows of which our state has a large percentage, but whom leave our state after training at a rate higher than most other states. Regardless of the composition of the statistics though, the gross number of physicians in the state is completely separate from the on-call crisis detailed in this post. It makes no difference if the ratio of patients to physicians is 1-1 if the physicians are not available or are disincentivized by our legal system from taking call.

posted by: michaelend | April 11, 2013  12:51pm

My point is that there are only four states with a higher number of practicing doctors per population than Connecticut.  The AMA uses the same system for each state, showing the total number of licensed doctors in a state and the number of those doctors who treat patients.  There are 437 doctors per 100,000 people in CT, of which 329 are treating patients.  When the AMA compared the number of doctors per 100,000 people who treat patients, CT was the fifth best state.  Think about the citizens of Oklahoma, where there are 163 doctors in patient care per 100,000 people.  That is less than half the number in CT.  The data seem to show that CT is in relatively good shape when it comes to the number of doctors per population.