Neurosurgeons in the United States are facing annual insurance bills of up to $300 000 (£190 000; €306 000) a year.
Some surgeons are no longer performing high risk neurosurgical procedures in an attempt to lower their professional liability insurance costs, according to the results of a new survey. "Based on this survey data, it seems that brain surgeons are no longer performing brain surgery," says Dr Stephen Papadopoulos, president of the Congress of Neurological Surgeons.
The survey has been published in order to influence the debate currently going on in the US Congress over limiting awards that can be made to plaintiffs in malpractice suits. Last week the House of Representatives passed a bill which laid down that awards for pain and suffering would in future be limited to $250 000 and punitive damages to $500 000. The bill still has to go to the Senate.
The survey looked at changes between 2000 and 2002. Around half of surgeons who took part in the survey had had increases of up to 50% in their professional liability insurance costs. Thirteen per cent had had increases between 50% and 100%, while 19% have had increases in excess of 100%, with some neurosurgeons paying $300 000 a year.
It was carried out by the Congress of Neurological Surgeons, the American Association of Neurological Surgeons, and the Council of State Neurosurgical Societies, and was based on data from more than 700 neurosurgeons. According to the survey data, neurosurgeons in nearly all 50 states have had increases in their insurance costs.
The findings show that as a result of premium increases 43% of the surgeons plan to or are considering restricting their practice; 29% plan to or are considering retiring from practice; and 19% plan to or are considering moving their practice.
"The impact that this crisis is having on patients cannot be understated. Many neurosurgeons are no longer performing high risk neurosurgical procedures in an attempt to lower their professional liability insurance costs and minimise their risk of suit," said Dr Papadopoulos.
The congress says that because of increased liability risk, fewer neurosurgeons are covering hospital emergency rooms, and trauma hospitals are shutting their doors to neurological trauma and diverting patients with serious head and spinal cord injuries to other locations.
"What this means for the public is that our patients may be denied crucial neurosurgical emergency medical treatment or they will have to travel greater distances, even to other states, to get the care they need. Critical life saving time is lost while searching for an available emergency room," said Dr Roberto Heros, president of the American Association of Neurological Surgeons.
The association and the congress say that federal legislation is needed and are seeking passage of the Help, Efficient, Accessible, Low Cost, Timely Health Care (HEALTH) Act, which is modelled on California's Medical Injury Compensation Reform Act.
"[The Californian act] has brought stability to the professional liability insurance market, while at the same time fully compensating injured patients for their legitimate injuries. In a similar manner, passage of the HEALTH Act will ensure that patients and doctors nationwide will reap the benefits of this rational approach to solving the liability crisis," said Dr David Jimenez, chairman of the Council of State Neurosurgical Societies.
More information on the survey and on medical liability reform is at http://www.neurosurgery.org/socioeconomic/liabilityreform.htmlwww.neurosurgery.org/socioeconomic/liabilityreform.html
