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SUNNY Temp: 94 °F Wind: NW at 4 mph Sunday, September 28, 2003 SECTIONS Home Page Local News Sports Business Obituaries Life Opinion - Politics AP News Weather Classified Archives Site Map EXTRA HomeLife Magazine Joy Magazine Tempo A & E RogueValleyAutoFinder RogueValleyHomeFinder Real Estate Showcase Wellness Connection Newspaper in Education Prime Times Outdoor Journal Personals Movie Times TV Times E The People CLASSIFIEDS Find a Car Find a Home Find a Job Find Everything E SOUTHERN OREGON Automotive Communities Entertainment Publications Recreation Calendar ABOUT US FAQ What's New Advertise Home Delivery Classified Ad Employment Contact Us Media Kit Email Story to a Friend May 18, 2003 Dr. Michael Potter, a Medford neurosurgeon, almost lost his malpractice insurance after a jury awarded a patient $1.4 million. Had Potter lost his insurance, neurosurgical care in Jackson County would have been dramatically reduced. Mail Tribune / Bob Pennell The domino effect When a Medford neurosurgeon nearly loses his malpractice insurance, the effects spread far beyond him and his patients A seven-figure malpractice judgment nearly toppled a critical component of Southern Oregon’s emergency health-care system. A few months after a jury awarded one of Dr. Michael Potter’s patients $1.4 million, the Medford neurosurgeon was informed that he would lose his malpractice insurance at the end of June. Without insurance, Potter would have been forced to stop working as a neurosurgeon and taking calls at hospital emergency rooms. Potter’s departure would have left just three neurosurgeons in Medford to handle emergency room trauma. They said they could not cover the emergency room every third night and do sophisticated brain and spine surgeries during the day. "If you’re up all night operating, it’s pretty hard to give quality care the next day," said Dr. Jeff Louie. "If you have to do an emergency surgery during the day, you have to cancel all your clinic work." Advertisement Neurosurgery coverage for emergency care was on the verge of collapse when Potter’s insurance company reinstated him after he filed a written appeal, backed by letters of support from others in the medical community. Physicians say Potter’s experience reflects the fragility of a regional health-care system stung by high malpractice premiums and low Medicare payments for treating seniors. "If you pull one member out of a specialty team, the whole structure comes tumbling down because the work he was doing is shifted to the remaining members of the team," said Dr. Eric Overland, a Medford pulmonologist. Overland also serves as a board member of Northwest Physicians Mutual Insurance, a physician-owned company that provides malpractice coverage for about 40 percent of Jackson County physicians — including Potter. "The burden on physicians is becoming more than just offensive. It’s becoming unbearable," said Dr. Elliott Meyerding, a general surgeon who serves as director of trauma care for Medford’s two hospitals. Neurosurgeons perform a critical role in emergency care. Accident victims often suffer head injuries that cause bleeding inside the skull. Only neurosurgeons have the training and experience to open the skull and relieve pressure that can kill or cause permanent brain damage. "It’s not just head injury," Potter said. "We treat many people who don’t have trauma, but come in with acute hemorrhaging into their head." Potter, Louie and two other neurosurgeons are covering emergency rooms at Medford’s two hospitals, but Meyerding said the regional trauma-care system needs one more neurosurgeon to provide adequate trauma care without overtaxing the physicians. "Four is not sustainable for the long term," Meyerding said, because neurosurgical patients have complex medical problems that require extensive time commitments from physicians. "If the current workload for the four continues, something will change," Meyerding said. "And it won’t be for the better." The most likely scenario would require some trauma patients to be flown out of the Rogue Valley if there aren’t enough neurosurgeons to provide adequate coverage. That already happens in other communities, such as Klamath Falls, where no neurosurgeon is available. Transporting patients could mean that some critically injured people will lie on a gurney in an airplane or a helicopter instead of a local operating room. "Someone who might be salvageable if you could get them into surgery will have to take a two- or three-hour detour and they might not be salvageable," Potter said. The crisis in neurosurgery developed suddenly. Last summer, six neurosurgeons were working in Medford. Their numbers began to shrink when Dr. Douglas Kirkpatrick retired in December. In midwinter, Dr. Thomas Purtzer lost his malpractice insurance for neurosurgery after several lawsuits were filed against him. Purtzer shifted his practice to pain management. Potter was told his insurance would not be renewed a few months after a jury decided that he had been negligent when he operated on a Grants Pass man in 1997. The jurors voted to give James Winkle $251,000 in economic damages and $1.225 million in non-economic damages. In a recent interview, Potter said James Winkle had a history of spinal problems before the surgery. Potter said he discussed two possible surgeries with Winkle, but gave Winkle a consent form for only one procedure before he went into the operating room. Potter performed the surgery Winkle had not consented to, based on his assessment of Winkle’s spine. When Winkle developed pain after the operation, he sued. Potter acknowledged he made a mistake in failing to have Winkle sign a consent form for both kinds of surgery. "I know we did the right thing, based on our experience, but the paper trail suggested we’d said one thing and done another." Purtzer’s departure from the neurosurgical ranks — and Potter’s non-renewal notice — left physicians wondering how to manage what looked like a 50 percent reduction in staff. "We went from six to four to potentially three in three months," Overland said. Hiring more neurosurgeons would be the obvious solution, but recruiting competition is fierce. When newly minted specialists look for a place to start their practice, two factors work against Oregon: rising malpractice premiums and low payments from Medicare, the federal health-care program for seniors. Oregon physicians’ malpractice premiums have been climbing steadily since 1999, when the state Supreme Court removed a $500,000 cap on non-economic damages (also known as "pain and suffering" awards). Oregon Medical Association records indicate jury awards have jumped 65 percent since the cap came off. Physicians say their malpractice rates have skyrocketed to keep up with rising jury awards. Neurosurgeons, for example, now pay Northwest Physicians Mutual about $62,000 per year for basic coverage ($1 million per occurrence, $3 million per year), and many buy additional protection. Trial lawyers and some consumer activists say juries should have the power to determine a cash value for pain and suffering because there’s nowhere but the judicial system for people to have their cases heard. Oregon’s low Medicare reimbursement means that physicians earn less for treating seniors than physicians in metropolitan areas in populous states such as California, New York and Florida. Physicians who might be interested in Southern Oregon for its quality of life find they simply cannot afford it. "Neurosurgeons have been recruiting hard," Meyerding said, "but they just can’t compete." Physicians worry that neurosurgery care here could deteriorate dramatically if any of the four Medford neurosurgeons still working chooses to leave practice. "We are losing neurosurgeons as a direct result of this malpractice problem," Meyerding said. "If it doesn’t get fixed, it will degrade our ability to deliver care in our community." Reach reporter Bill Kettler at 776-4492, or e-mail [email protected] Printer Friendly Version Email Story to a Friend Subscribe Archive: Click to Search Mail Tribune Home Local News | Sports | Business | Obituaries | Life Opinion - Politics | AP News | Archives | Site Map E Southern Oregon | Classified Copyright © 1997-2003 Mail Tribune. All rights reserved. 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