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
February 10, 2003
10:00 AM
St. Mary Medical Center, Sister Claire Carty Auditorium, Langhorne-Newtown Roads, Langhorne, Pennsylvania 

Mr. Gregory Wozniak
President and Chief Executive Officer
St. Mary Medical Center
Langhorne-Newtwon Roads
Langhorne, PA, 19047

I recognize that there are many opinions about the best way to solve the medical liability crisis and I am not here today to advocate one solution over another.Rather, I want to highlight the impact that the medical liability crisis is having on the ability of patients to access health care services.

St. Mary was founded in 1973 by the Sisters of St. Francis of Philadelphia.Our mission is to improve the health and wellness of our community with a particular emphasis on providing access to care for the poor and under-served. St. Mary has grown from a small, community hospital to a 287-bed full service medical center offering a wide array of patient care programs to a population of more than 400,000 in Lower Bucks County, Pennsylvania.These services include a comprehensive heart center, a primary stroke center, the county's only accredited trauma center, and Mother Bachmann Maternity Center, which provides obstetrical services to poor and under-served patients.Together, our medical staff, employees, and volunteers care for nearly 18,000 inpatients, more than 120,000 outpatients, and nearly 38,000 emergency room patients each year.

Like so many other communities across the country, the community we serve is growing older.Bucks County has the third oldest population in the Commonwealth of Pennsylvania, and Pennsylvania has the second oldest population - following only Florida.Within St. Mary's community, aging baby boomers, that is, those 45 to 64, and those over age 65 are the largest and fastest growing segments of our population.What does this mean for health care providers?Research shows that people over age 45 are two to three times more likely to use health care services than people under age 45, and that this need again doubles when they reach age 65.Unfortunately, our community has also seen an increase in the number of poor and uninsured families.

The result of these demographic shifts is an increase in the need for health care services.Over the last three years St. Mary has seen the number of people we care for increase by nearly 60%.Yet at a time when the need for health care services in our community is at its greatest and growing, our ability to attract new physicians or retain physicians already in the community is declining.

Over the last several years, many highly qualified physicians have left our community.And the cost and availability of medical liability insurance is one of the primary reasons physicians leave a practice. Our analysis shows that more than 50 Bucks County physicians left their practices last year. Some have relocated, some sought early retirement, and others changed their clinical practice in order to afford medical liability insurance.Orthopedists, OB/GYNs, and surgeons have been impacted the most.

Moreover, St. Mary, as well as other area hospitals and existing physician practices have experienced tremendous difficulty recruiting new physicians to fill the gaps caused by departing physicians and increased patient need.Although this is a significant and growing concern for St. Mary across all of our specialties and services, it is particularly true for our trauma program and the Mother Bachmann Maternity Center.

The St. Mary Trauma Center is one of only 26 designated trauma centers in the Commonwealth of Pennsylvania and the only one in Bucks County.Without the St. Mary Trauma Center, we would need to transfer patients to trauma centers in neighboring Philadelphia or Montgomery County by either ambulance or helicopter.In caring for the trauma patient, timeliness of treatment is a critical element.The outcomes for the trauma patient improve significantly if the patient is treated within the "golden hour"- the first 60 minutes - immediately following an injury.Transferring trauma patients decreases the timeliness of care and reduces the chances for a complete recovery.

Providing a high level of quality trauma care requires multiple physician specialties-specifically dedicated trauma surgeons, anesthesiologists, neurosurgeons and orthopedic surgeons and nurses-available 24-hours-a-day, seven-days-a-week.St. Mary has only two neurosurgeons on staff, the only two neurosurgeons practicing in Lower Bucks County. Both physicians have had significant challenges obtaining affordable medical liability insurance.If one of these physicians decides that he or she can no longer obtain or afford medical liability insurance, we will be forced to close the Trauma Center.

Over the last two years, as every medical liability renewal period approached, we faced the very real threat that we will have to close our trauma program because we won't have the necessary physicians to provide around-the-clock trauma care.During the last medical liability insurance renewal period, St. Mary was not sure it could keep its trauma unit open on January 1, 2003 because our orthopedic surgeons and neurosurgeons could not afford medical liability insurance.We made the decision to keep it open at 2 p.m. on December 31, 2002.The only reason we were able to keep it open was through the commitment and dedication of our physicians to their patients and the promise made by Governor Rendell of a short-term initiative to contain the cost of medical liability insurance. But this was only a stop gap measure - still being considered by our Pennsylvania General Assembly.

Both of our neurosurgeons have seen their insurance premiums more than double over the last two years. One is paying in excess of $280,000/year to maintain the ability to care for people.The only reason he is still practicing today is Governor Rendell's proposed short term solution which would provide a one year premium reduction of approximately $50,000.If a permanent solution is not enacted this year, it is not a matter of if, but when the trauma center will be forced to close.

Each year we provide care to approximately 1,400 trauma patients. Several days after our decision to keep the trauma unit open, an ambulance delivered a young woman to our emergency room. She had been involved in a very serious automobile accident.The trauma team immediately evaluated her condition.She was stabilized and taken for a CT scan of her head, spine, chest, and abdomen.The Trauma team quickly learned that she had a lacerated spleen, three lacerations on her colon, and a major abdominal wall tear.Within 30 minutes - well within the "golden hour" - she was in surgery to repair the injuries caused by the accident.Thankfully, the surgery was successful and she was discharged a week later.The injuries that this young woman suffered were life threatening.As with all trauma patients, time was critical.The additional 30 to 40 minutes that it would have taken to transport this patient to a neighboring trauma center could have resulted in very serious consequences.If the St. Mary Trauma Center had closed at the end of 2002, the dedicated trauma team that cared for this patient would not have been available.

Our trauma center is not the only service affected by the current medical liability crisis.In 1991, St. Mary conducted a health needs assessment focused on the needs of the poor in our community.The assessment identified the need for pre-natal and maternity care for low-income families in Lower Bucks County.In response to this need, St. Mary Medical Center established the Mother Bachmann Maternity Center in Bensalem, Pennsylvania.Since 1991, more than 1,600 mothers received pre-natal care and maternity services from the staff of the Mother Bachmann Maternity Center.

Mother Bachmann is the only program of its kind in Lower Bucks County that accepts pregnant women regardless of their ability to pay.Certified nurse midwives with appropriate OB/GYN back-up provide high quality care services.However, the current medical liability crisis has had a significant impact on this program and the program's long-term survival is threatened.As members of this panel know, OB/GYN physicians have been particularly hard hit by the medical liability crisis.During the past two years, we have lost 3 of the 4 OB/GYN physicians who provided physician coverage to the Mother Bachmann Maternity Center.Should the sole remaining obstetrical physician providing coverage continue to experience significant problems in obtaining affordable medical liability insurance, it will jeopardize the ability of the Mother Bachman Maternity Center to continue to provide care to under-served women and children in Lower Bucks County.Without physicians, the Mother Bachmann Maternity Center will be forced to close.

Last year, the Center delivered 197 babies, and in 2003 we expect to deliver 240 babies.However, numbers tell only a small part of the Mother Bachmann Maternity Center story.

Recently, a 35-year-old woman experiencing her first pregnancy came to the Mother Bachmann Maternity Center.She had fled an abusive relationship and was living in her car.She was four months pregnant and uninsured.She asked for help for herself and her unborn child.We provided her with pre-natal care, testing, vitamins, and social work services.She underwent postpartum depression screening for increased risk factors that too often accompany homelessness and domestic violence.We were able to offer her counseling at the Maternity Center.

This is only one of hundreds of success stories.We expect that there will be many more success stories - but only if we have the physicians, and in today's environment, many physicians are not able to provide care, because they don't have access to affordable medical liability coverage.

Although much of the national debate has focused on the cost and availability of medical liability insurance for physicians, the crisis has also had a significant impact on hospitals.Over the past two years, St. Mary's liability insurance costs have more than doubled.In the year 2000 we paid $2,133,000.In 2002 our insurance costs increased to $4,630,411.This increase is the equivalent to approximately 40 nurses who could be providing care to our aging population; or a state of the art radiation oncology unit to treat cancer patients.These increased premiums directly impact our ability to develop new programs and expand to meet the growing health care needs of our community.

Although our insurance costs continue to rise, we are very proud of our longstanding, proactive approach to ensuring patient safety and continuing improvement of the care and service that we provide.

St. Mary has established a full-time Patient Safety Officer and a Patient Safety Committee that involves hospital staff, physicians, and members of the community in patient safety initiatives.These resources are dedicated to continuously examining our systems and processes of care in order to improve patient safety and the quality of care that we provide.We established a dedicated patient safety hotline allowing staff members and physicians to report safety concerns and issues to the Patient Safety Officer.

St. Mary has also embarked on a number of initiatives to address medication safety.Our new system links numerous databases, helping us find known drug allergies and drug-to-drug interactions before they happen.We established pharmacy rounds for all intensive care patients to ensure appropriate medication protocols are being followed.We established a bar code system that ensures that the patient gets the correct drug, dose, timing and mode of administration. St. Mary has also incorporated patient safety information into our Patient Handbook, explaining to patients their role, responsibilities, and rights.

This is just a small sample of the numerous safety and quality initiatives underway at St. Mary.I am very proud of the time, energy, and effort that St. Mary physicians and clinical staff expend every day to improve the quality of care that we provide to our patients.

Members of the committee, on behalf of the St. Mary family, and in particular our current and future patients, I want to thank you for your time and consideration.This is a complex problem, but a problem we need to solve this year - before it is too late!Without physicians St. Mary Medical Center cannot deliver services to our community.

Thank you. I will be happy to answer any questions or provide additional information that you may need.

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