Proposed legislation that would dramatically increase the cap on awards for pain and suffering in medical malpractice cases would intensify a doctor shortage in Nevada, opponents say.
Voters nearly 20 years ago approved the cap on noneconomic damages when medical malpractice insurance rates skyrocketed in the state, threatening retention and recruitment of physicians.
If Assembly Bill 404 becomes the law, “I can only imagine that premiums would skyrocket again from what they are currently, making it unfeasible for a small practice like mine to really be able to afford coverage,” Dr. Howard Baron, a Las Vegas pediatric specialist treating digestive disorders in children, said Monday.
But supporters note that despite the changes made two decades ago, Nevada remains near the bottom in terms of physicians and specialists per capita.
“The changes that were made came at the sacrifice of victims’ rights and did not achieve any of the stated goals over the course of the last 20 years,” said attorney Justin Watkins, a member of the Nevada Justice Association representing trial lawyers and a former Assembly member.
The bill would raise the limit on the noneconomic damages such as pain and suffering a plaintiff can recover to $2.5 million from the current limit of $350,000. It lengthens the statute of limitations and applies it retroactively. It repeals a provision limiting an attorney’s contingency fee. It removes the liability limit on emergency care at trauma centers.
State ranks 45th in U.S. for active physicians
A statewide medical malpractice crisis began in the early 2000s when the dominant malpractice insurance carrier pulled out of Nevada. With their premiums increasing fivefold, some 30 OB-GYNs left Clark County, according to an analysis by the Nevada Hospital Association. Other specialties, including neurosurgery and emergency surgery, limited their practices. University Medical Center closed its trauma center for 10 days.
The state continues to rank near the bottom for number of physicians per capita. It ranks 45th in the nation for active physicians, and falls below the national average in 33 of 39 physician specialties, according to the hospital association.
Watkins said that he doesn’t believe there’s a correlation between damage caps and doctor retention, but cited Legislative Counsel Bureau data that four of the top five jurisdictions for doctors per capita in the U.S. are states that do not have caps.
“The reality, I believe, is that this is a multifaceted issue as to why we have a problem in retaining doctors,” he said. The reasons include the lowest Medicaid reimbursement rates in the country, a low-ranking educational system, and no medical school in the Las Vegas area until recent years.
‘We don’t want history to repeat itself’
But doctors say that improvements to the state’s medical infrastructure, such as growth in graduate medical programs, could be undone if the bill becomes law.
UMC CEO Mason Van Houweling said, “The future of Nevada’s health care industry hangs in the balance, and I fear that AB404 would erase much of the progress we’ve made in providing Nevadans with access to world-class care.”
He noted that skyrocketing medical malpractice rates two decades ago caused the UMC Trauma Center to temporarily shut down for the only time in its history.
“Nevada’s health care delivery system is at risk once again, and we don’t want history to repeat itself,” Van Houweling said in a statement to the Review-Journal.
The Nevada State Medical Association and the Clark County Medical Society have urged doctors to oppose the measure.
Baron, the Las Vegas gastroenterologist, said the medical malpractice crisis 20 years ago caused a senior partner to retire at age 43 and his practice to scale back, even though it was the only practice of its kind in the entire state.
The proposed legislation was a source of consternation in the doctor’s lounge of Las Vegas hospital at lunchtime Monday, he said. “This is on the forefront of the minds of most physicians in Nevada,” he said.
The legislation is scheduled for a hearing Tuesday before the Assembly Judiciary Committee, the bill’s primary sponsor.