Abington Memorial Hospital is an independent, not for profit, community teaching, tertiary care hospital that has served our community for 89 years. We are the only accredited trauma center in Montgomery County and the third largest admitting hospital in the Philadelphia area behind only Thomas Jefferson University Hospital and the Hospital of the University of Pennsylvania. Our emergency trauma center treated more than 65,000 patients last year.We are also the largest obstetrical hospital in eastern PA having delivered more than 4500 babies last year. We are the largest employer in Abington Township with more than 4600 employees. This makes us the third largest employer in Montgomery County. 

For the past 4 years it has become progressively more difficult for our hospital and our physicians to obtain affordable malpractice insurance. In fact, Abington Memorial Hospital has seen its medical liability insurance premiums increase over the past four years from $6 million in the year 2000 to $8 million in 2001, to $19 million in 2002 and now to an astounding $23 million dollars this year. During the same period our physicians in the "high risk" specialties of orthopedic surgery, neurosurgery, general and trauma surgery and obstetrics have seen corresponding increases in their annual premiums. 

In Pennsylvania, one cannot legally practice medicine without malpractice insurance. The physicians who provide vital trauma services at Abington are all in private practice! They each pay their own malpractice premiums. In the last several years several large malpractice insurers in PA have gone bankrupt and a number of other companies have ceased writing insurance in our State. In a number of cases, outstanding physicians-of the caliber that you and I would choose to care for our own families-and in many cases with NO adverse legal awards against them-were unable to obtain commercial insurance. If they were quoted premiums, they were so high as to be unaffordable. If a physician is unable to obtain a commercial quote in PA, one turns to the Joint Underwriting Association but historically their quoted premiums are often 1.5 -3 times a comparable commercial rate. In some instances the JUA quoted rates that were in excess of $250,000-per physician per year! 

Despite an offer by our Hospital to offset a portion of the premium, our orthopedists felt they could not afford the quoted rates. Also, by late December, our neurosurgeons had not received a commercial quote.It became clear that without these necessary trauma specialists we could not meet the staffing requirements of the Pennsylvania Trauma Systems Foundation and therefore notified the State and the Foundation of our plans to suspend our trauma designation. We ceased operations as a designated trauma center on December 21^st. This decision was painful. We have tried for years to improve the service we provide to our community and the closure of our trauma center was a calamitous step backwards.The following thirteen days were the most trying of my professional career. We feared that we would not be able to provide critically needed services for a trauma victim. 

Had it not been for the intervention of then Governor-elect Rendell, I suspect our trauma center would have remained closed for much longer than thirteen days. The creation of Gov. Rendell's Task Force, in conjunction with his pledge to create short and long term solutions to this intractable problem were enough to bring our doctors back to work. But to date, we have -if you will-- an I.O.U. that will require legislative support and possibly a State constitutional amendment. The latter could take as long as 3-4 years to obtain.We endure a crisis that is shared by physicians and hospitals in a growing number of states across this nation: the inability to obtain affordable malpractice insurance. Changes are clearly necessary and one that demands immediate attention is the placement of a ceiling on non-economic damages.

What are the consequences of the circumstances described above?

• Our community members suffer by the loss and potential future loss of a vital health care service: care for the victims of trauma. During this period ambulances were diverted to other hospitals from Abington and patients who arrived on their own were, in some cases, transferred elsewhere.

• Abington Memorial Hospital now spends $17 million more on malpractice insurance premiums than it did four years ago. How many new nurses could be hired with $17 million dollars?

• Our employees openly express fear for the security of their jobs as do the staffs of our many private practice physicians. It is an emotionally trying time for those providing health care in Pennsylvania and many other states.

• Fifteen members of our medical staff have chosen to retire earlier than planned or have chosen to practice elsewhere for reasons directly related to the cost of their insurance. This includes the loss of our previous chief of neurosurgery who is now practicing in NC. Another neurosurgeon has moved to Ohio. Two obstetricians have moved to New England and a third, who will be testifying before you later today, will be moving to Utah.Although we often emphasize those practicing high-risk surgical specialties, the crisis clearly affects primary care physicians as well. Data obtained from the Pennsylvania Medical Society indicates that more than 500 physicians have chosen to leave Pennsylvania for reasons directly related to this crisis. In addition approximately 100 have chosen to retire early. This does not include those who have altered their scope of practice and chosen to practice gynecology only and no longer deliver babies or those choosing to practice, for example, non-operative orthopedics. These circumstances create a significant access to care problem for our patients.

• Possibly of even greater consequence than the loss of a number of physicians, is the growing difficulty in recruiting young, well-trained physicians to practice in PA. We have FIVE medical schools in the Philadelphia area with many residency training programs.Yet in the high-risk surgical areas most trainees choose to leave our state. All of us suffer the consequences when we cannot recruit an adequate number of well-trained physicians and surgeons. 

Lastly, it is emotionally devastating to practice in constant fear of being sued. All of us, I believe, practice defensive medicine-in fact, more so than ever before. This clearly drives up the cost of health care. Also the time required to document every risk and potential hazard at the time of every office visit (I am not referring to "informed consent" prior to major procedural intervention) clearly detracts from time spent with patients. This is wrong. Also, we hear so often, that suits without merit are usually dismissed. Please realize that the time and dollars spent defending even a frivolous lawsuit are quite significant. Also, the emotional burden of being named in a suit is very real! 

Patient safety must be foremost. Mistakes are made and patients should be compensated for injuries caused by proven negligence. However, bad outcomes often do not reflect bad care. There must be some meaningful balance to all of this so that our patients can continue to receive the excellent medical care that they have come to expect. 

Members of the Committee, throughout our country there are warning signs of a collapsing system. Physicians in Nevada, and West Virginia have, for periods of time within the past year, stopped practice. Just last week physicians in New Jersey demonstrated in their State Capitol. To preserve access to care, I respectfully urge you to take appropriate action. Meaningful NATIONAL tort reform is necessary, critical and appropriate from the perspective of patients, physicians and hospitals. It is not appropriate for individual states to compete for medical talent based on the cost of medical liability insurance. There really MUST be a level playing field. I urge you to correct this problem now. 

THANK YOU VERY MUCH!I will be glad to try to answer any questions that you may have.