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It’s only a few blocks’ walk for Lucy Sabatino from her home on the 2200 block of Clarion Street to see her doctor at Methodist Hospital.
She cherishes the convenience, although she requires a cane to complete the brief journey. It could be worse, Sabatino figures.
Disgruntled physicians across the state are threatening to leave, and many have already left, because the skyrocketing cost of malpractice insurance in Pennsylvania.
For Sabatino, her concern is not whom to blame for the crisis — the lawyers, insurance companies or the doctors. Rather, she worries that she may not be able to get the medical attention she requires from her neighborhood hospital.
"It would horrible," Sabatino said. "Where would I go? I’m 77, I don’t drive."
Physicians across Pennsylvania would say Sabatino’s fears are legitimate if the state does not impose a cap on jury awards for pain and suffering in malpractice cases.
On Tuesday, 2,500 doctors, patients and supporters converged on the Capitol steps in Harrisburg, hoping to send a message to politicians about the importance of malpractice insurance reforms.
Many of the physicians carried signs and blamed the trial lawyers for skyrocketing premiums. Others reportedly stomped into legislative offices to state their case.
This follows a walkout last week, when many of Pennsylvania’s 46,000 doctors closed their offices and demanded the state address the same issue. Several South Philly physicians participated in these demonstrations.
Dr. James J. Tayoun Jr., a vascular and general surgeon with an office at 13th and Ritner streets, the chairman of surgery at St. Agnes Medical Center and a staff doctor at Methodist Hospital, participated in both. Tayoun is also president of Politically Active Physicians Association, a group leading the charge for reforms.
"This is mild compared to what is going to happen if the government doesn’t fix the present system," Tayoun said of the work stoppages.
He predicts doom and gloom, beginning with the doctor with a corner practice leaving and leading to the collapse of the neighborhood hospitals, which would eliminate jobs.
"The whole infrastructure is going to fall apart," Tayoun said.
Dr. Melvin Moses, chairman of Methodist Hospital’s department of surgery and of the hospital’s medical advisory committee, said the number of surgeons there has decreased from a dozen to four in the 13 years he has worked there.
Moses blames rising malpractice premiums, which he said have nearly quadrupled in the last four years for his surgeons. So far, he added, the loss of doctors has not impacted patient care.
"But we’re on a little bit of a ledge," Moses said. "If one of the four people left, then you would have a real manpower issue."
Other departments at Methodist have already taken the plunge. A year ago, the hospital eliminated its maternity ward because escalating insurance costs made delivering babies a money-losing venture.
Tayoun has been preparing for the worst for months. He recently received a license to practice in Delaware, where he said his annual premiums would be $7,500. Tayoun, who said he has never had a malpractice payout against him, had been paying $120,000 a year before his insurance provider left the state.
He has since been picked up by St. Agnes, but said he has been told that in two years, his premiums could be as high as they had been with his old company.
"I was using [Delaware] as a back-up plan," Tayoun said, "but the back-up plan seems to be moving forward."
Moses, 66, said he would consider relocating, too, if it were earlier in his career. He noted a disturbing trend: Only three orthopedic surgeons younger than 35 had been practicing in Pennsylvania, until one recently left.
"That’s scary," he said, "because the physicians of my generation don’t see the people coming through who are going to be replacing us."
Moses says most of his patients have been supportive of the physicians’ cause, but some disagree with the doctors.
Anna Marie Strunk, of the 200 block of McClellan Street, has mixed feelings after a visit last month to Methodist’s emergency room with a friend who was experiencing abdominal pains. She said she waited for eight hours in the ER before her friend finally was treated for what eventually was diagnosed as a ruptured ovarian cyst.
Strunk worked as an administrative assistant at Methodist for two years starting in 1990. She also held similar positions at Thomas Jefferson University and Pennsylvania hospitals, and she said she is familiar with the sums doctors pay in insurance because she often mailed the bills.
However, after her recent experience, she said she has less sympathy.
"I think a lot of them have forgotten what it is like to be the patient waiting in that area," Strunk said. "I don’t think they can relate to the patients to make them understand."
Moses responded that delays in the emergency room are not due to a lack of attending physicians but rather the increasing number of patients, many without insurance, who go to the ER for minor ailments.
On her way out of Methodist on Tuesday, Ida Mannino echoed a position argued by the trial attorneys that capping awards for pain and suffering would not be necessary if not for the number of medical mistakes.
"I blame the doctors," said Mannino, 82, from the 2000 block of Ritner Street. "They’re not careful enough."
Tayoun dismissed her opinion as "misguided." He said that response is typical of an attorney who is "angry that we are taking away his livelihood" if a cap is implemented.
California has legislation limiting jury awards for pain and suffering to $250,000. Since 1975, malpractice premiums there have increased 167 percent, Tayoun said; in Pennsylvania during the same period, the rates shot up 1,500 percent.
Former Gov. Mark Schweiker and Gov. Ed Rendell announced plans for a "short-term" solution to the malpractice insurance crisis that is driving physicians out of Pennsylvania in January after insurers dropped more than 1,000 doctors statewide.
Rendell has outlined a plan that includes a one-time reduction for physicians in high-risk specialties, like obstetrician-gynecologists and surgeons, whose premiums could drop as much as 50 percent.
Moses and Tayoun believe Rendell is sincere about reforming the system, but they are still waiting for a permanent solution.
"If you picture a wheel," Tayoun described, "they gave us four spokes of the wheel but we need six. So the wheel still won’t roll without the other two pieces."
Those last pieces, for Tayoun and many other physicians, is a cap on pain and suffering payouts.
