MICRA Still Looms Large
When it comes to malpractice protection, California physicians have it pretty good. The 30-year-old shield against lawsuit abuse afforded by the Medical Injury Compensation Reform Act (MICRA) is heralded as a model for national tort reform. But MICRA is not impenetrable.

Golden State physicians need to make sure patients know what's at stake and they need to raise their voices against federal tort reform if it is crafted such that it would undermine the five-star protections they now enjoy.

About the malpractice landscape overall, Lawrence Clark, MD, a neurosurgeon and associate at Riverside Neurosurgical Associates, says: "Things are pretty good, but they could be better. Physicians are thinking, 'MICRA is great, but my premiums are gradually going up.'"

Larry Laster, senior medical malpractice underwriter at Fairway Physicians Insurance Co., Westlake Village, doesn't anticipate significant change. "Tort reform in California has withstood numerous attempts to dismantle it over the years," he says. "We don't see any new attempts that would fare any better, and as other states adopt tort reform statutes, MICRA gains more validity and staying power."

However, MICRA's existence doesn't prevent plaintiff attorneys from being creative, says Susan Penney, Esq., San Francisco-based legal counsel for the California Medical Association. "Through some legislative activity and the judicial system, there have been some attempts to end-run MICRA, primarily in the areas of informed consent and elder and dependent adult abuse. The plaintiff bar uses those to bypass, we believe, the limit on general damages, because if they establish 'recklessness,' they can win attorneys' fees. That can convert a $250,000 case under MICRA into a case worth double or triple that."

Philip R. Hinderberger, senior vice president and general counsel at Norcal Mutual Insurance Co., San Francisco, agrees: "Plaintiff attorneys have argued that multiple caps apply under certain circumstances and that nursing homes, HMOs and surgery centers are not covered. We expect a continued effort on the part of the plaintiff attorneys to find additional clever end-runs."

One challenge to keeping MICRA in place is a lack of familiarity among those deciding its fate. "The biggest risk to MICRA arises from the need to educate new members of the Legislature and the governor's office," Hinderberger says. "In 2006, it will be necessary to undertake a vigorous political action program. We can expect the plaintiff attorneys to mount a legislative challenge in 2007 or 2008 if they feel the medical community has not done a good job in that effort."

In the absence of a federal solution, states have stepped in. Most have statutes of limitation of two years for standard medical malpractice claims and more than half have limits on damages awards. In 2005, 48 states responded to what Upland urologist Victor Ching, MD, terms the "fevered calls for medical liability reform." The states introduced more than 400 malpractice-related bills in their legislative sessions.

"Solutions range from enacting limits on noneconomic damages to malpractice insurance reform to gathering lawsuit claim data for the purpose of assessing the connection between malpractice settlements and premium rates," Dr. Ching says. "In the past six months, 31 states passed more than 60 bills. The plethora of solutions proposed and the variety of aspects addressed demonstrate the diversity of the problem of medical liability insurance costs from state to state."

Malpractice Insurance Company Resources
The following list represents selected medical liability insurance carriers who serve Southern California physicians. Please contact them directly for more information about coverage, premiums and risk management programs.

Aon Physician Alliance
159 E. County Line Road
Hatboro, PA 19040
866/815-5776
www.aonphysicianalliance.com

Brown & Brown Inc./
HealthCare Practice Group
P.O. Box 9699
Brea, CA 92822
714/990-4430
www.hcpinsurance.com

CAP-MPT
333 S. Hope St., Eighth Floor
Los Angeles, CA 90071
800/252-7706
www.cap-mpt.com

Fairway Physicians Insurance Co.,
a Risk Retention Group
30699 Russell Ranch Road, Suite 200
Westlake Village, CA 91362
818/889-7399
www.thorsonins.com/program_medmal.php

Medical Protective
5814 Reed Road
Fort Wayne, IN 46835
800/4MEDPRO
www.MedPro.com

MedMal Insurance Services Inc.
150 N. Grand Ave., Suite 209
West Covina, CA 91791
626/869-0544

Norcal Mutual Insurance Co.
560 Davis St., Second Floor
San Francisco, CA 94111
800/652-1051
www.norcalmutual.com

ProSurance Group Inc.
2685 Marine Way, Suite 1408
Mountain View, CA 94043
800/310-4486

The Doctors Company
185 Greenwood Road
Napa, CA 94558
800/352-0320
www.thedoctors.com

The SCPIE Companies
1888 Century Park East, Suite 800
Los Angeles, CA 90067-1712
800/717-5333
www.scpie.com

Thorson Insurance Services
30699 Russell Ranch Road, Suite 200
Westlake Village, CA 91362
818/889-7240
www.thorsonins.com

Z Insurance Brokerage Inc.
8805 Research Drive, Suite 200
Irvine, CA 92618
877/469-4584