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Prepared Witness Testimony The House Committee on Energy and Commerce
The Medical Liability Insurance Crisis: A Review of the Situation in Pennsylvania
Subcommittee on Oversight and Investigations
Julia W. Johansson MD
Ladies and gentlemen, thank you
for the opportunity to speak to you today. My name is Julia Johansson and
I am a physician specializing in OB-GYN at Abington Memorial Hospital.I am also a life long resident of Pennsylvania.I am here today to discuss my reasons for leaving my home, how my leaving
will affect my family, my patients and the group in which I practice. I feel it is important to tell
you something about me, so that you may understand what a difficult decision
leaving has been for me.I was born
at Holy Redeemer Hospital in Meadowbrook, Pennsylvania.The only time I have lived outside the state was to attend
College in Boston to pursue my undergraduate degree.After graduation I returned home to the house I grew up in.I married a boy who lived 1 mile away and I attended and graduated from
Temple University School of Medicine.While
at Temple I rotated through Abington Memorial Hospital and so enjoyed the
experience that it was one of only two residency programs to which I applied.Thankfully I was chosen for the residency program in OB-GYN.While at Abington I came to know the members of the group to which I now
belong very well.As a matter of
fact, members of my group delivered each of me children.When my partners offered me a position with the group I was ecstatic.It was truly my dream job.My
family was thrilled that I had landed a position so close to home since my
family still lives in the house I grew up in and my in-laws still live in Bucks
County as well.I looked forward to
spending the next 30 years of my life practicing at Abington. That all changed last year.While I knew that Southeastern Pennsylvania was a fairly litigious area
when I first started practicing, only a scant 6 years later the situation has
gone from bad to worse and then to intolerable.As a matter of fact, I cannot think of an OB-GYN that I know who has not
had a lawsuit filed against them.Most
times, these physicians talk in terms of the number of lawsuits they have
outstanding rather then if they have pending litigation. Some within the legal community
will have you believe it is only the "bad" doctors who get sued.I am here to tell you that some of the best, most respected Doctors I
know have lawsuits filed against them.I
am not saying that there are not legitimate lawsuits, there are, but it seems to
me that when so many OB-GYNs are being sued they cannot all be malpractice.There is a difference between a bad outcome and malpractice and in the
ridiculous situation we find ourselves in a lawsuit does not even require a bad
outcome in order to be filed.Malpractice
attorneys will have you believe that they file these suits to weed out the bad
doctors.At the rate things are
progressing in Pennsylvania all doctors will be weeded out.It seems to me that trial attorneys are creating a dust bowl within the
medical community with physicians fleeing the states decimated by the scourges
oflegal abuse,the ever decreasing reimbursements and soaring medical malpractice
insurance premiums. About a year ago my husband
noticed I had become crankier and, believe it or not, I tend to be a pretty
upbeat person.We have had long
discussions on the looming malpractice crisis here and how it only seems to
change for the worse.I am working
longer hours, seeing more patients in part to cover the increase in malpractice
insurance and have had my earnings decreased over the past year.And still the workload increases as more doctors leave the
area and entire groups disband or discontinue the practice of Obstetrics.My 2 year old always asks, "Where are you Mommy?" and invariably my
answer is, "Work".Even my 12
year old, who has a very active life of her own, has become annoyed at the
amount of time I am spending at work.I started to notice that I could not take the time to get to
know my patients on a more personal level, as I had been able to do in the past.This personal approach helps me to tailor their treatments to their
lifestyles, beliefs and culture. In my practice we have gotten so busy that
people sometimes have to wait as long as 3 months for their regular exams.Those patients with problems can get inserted into an already overbooked
schedule.Today, for example, I
have reduced the number of patients I will see in order to speak to you. Of
the 50 patients I was scheduled to see, about 30 have been rescheduled.They will be inserted in my already full schedule over the course of the
next week. So there I was, 5 years into my
practice and my dream job seemed to be slipping away.I was working more, making less, practicing defensive
medicine and not having the opportunity to spend as much time as I would have
liked with my patients, my family or my friends.My husband suggested that maybe we needed to relocate for our own peace
of mind. I do not think people
understand how truly devastating it is to be named in a lawsuit.I cannot tell you how many times I have heard people say,
"I'm not really suing the doctor, I'm suing the insurance company."I agree that people should be fairly compensated for legitimate
malpractice but the non-economic damages have gotten out of hand, especially in
Philadelphia.If a lawsuit gets to
trial it is like the plaintiff has won the lottery.Even if the doctor is not at fault, juries award large sums of money
because they feel sorry for the plaintiff and they hope that if their turn comes
the jury will be equally generous.It
bears repeating, that bad outcomes are not necessarily the result of medical
malpractice.As a result, an increasing number of physicians and insurance
companies have elected to settle cases even though there may be no fault on the
part of the physician.It is these
attitudes that have cemented my decision to leave the area. Although my leaving the area
will not have a far-reaching affect or cause some catastrophe, it has affected
all those around me.My parents, to
whom I have always been close, tell me that they feel as if their
"children", meaning my husband and our children and I are being ripped away
from them.While my mother cannot
bring herself to speak with me about our move, she has written to you directly
to express her feelings and, I am sure, the feelings of thousands of members of
other families across the Commonwealth as their sons and daughters, fathers and
mothers, and grand daughters and grand sons say good bye. The members of my practice have
told me that it will be a great loss to them when I leave.We are actively trying to recruit a replacement but we have been
unsuccessful thus far.It is nearly impossible to find someone who wants to start
practicing in Pennsylvania given the hostile environment that awaits him or her.I do not think they will find a suitable replacement before I leave,
which will place an even larger burden on the remaining members of my group.I also feel sorry for my patients.They
have come to know and trust me.Given
the intimate nature of OB-GYN this is not insignificant.Now they will be forced to find another doctor with which to build a
trusting relationship. They will likely face longer wait times to be seen as
well. If something is not done to
change our current situation, in the not too distant future it will not only
become impossible to recruit new physicians to practice in Pennsylvania, it will
begin to affect training programs as future doctors will not choose to train in
a state where they will not practice.And
the distant future looks even darker as the dust bowl spreads and our best and
brightest choose not to pursue careers in medicine at all. In short I am leaving Pennsylvania to practice medicine in a less hostile environment.I hope to be able to make a comfortable living while practicing effective rather than defensive medicine in a place where I can get to know my patients well and not live with the constant threat of a lawsuit.I understand that there is no utopia but I want to enjoy the practice of medicine again as much as I had before.If you do not act to establish medical review boards to decide if cases have merit, and meaningful tort reform to place caps on non-economic damages the dust will spread and cover the entire country. Thank you for your
consideration.
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