It boils down to three things: availability, affordability, and quality of health care. As we go to press, the Florida Legislature is still struggling to agree on a solution, but patients are really beginning to understand that this crisis directly affects their access to high-quality affordable care. They're justifiably concerned that when they or their family need care, the best of medical treatment will simply not be there.

Sadly, as one of our state legislators has repeatedly said, we may not have tort reform until there is "blood in the streets." So we wait for our elected representatives to acknowledge the true gravity of this crisis. While we still may not have seen the "blood," there are growing signs that the system is desperately anemic and showing signs of early hemorrhage. Consider the following observations from Yank Coble, President of the AMA:

1) Aventura hospital in South Florida has stopped delivering babies. Due to skyrocketing liability costs, the obstetrics program lost $3.5 million over six years. In addition, seven other Florida hospitals have stopped offering obstetrical services; four others are reducing services.

2) Palm Beach Gardens Medical Center does not have a neurosurgeon to treat emergency cases. This lack of neurosurgical services is now threatening the level of care available in major trauma centers around the state.

3) In Orlando Regional Hospital, the average wait time for a woman seeking a mammogram has risen from 20 days two year ago to 150 days today. Too many radiologists simply couldn't find or afford medical liability insurance.

If access to care problems caused by the liability crisis were not bad enough, patients have also had to endure a misinformation campaign from the legal establishment. To help bring truthfulness back to the discussion of medical liability, the FMA has offered the following points:

Fiction: A cap on non-economic damages will keep doctors from being held accountable.

Fact: The current system is not working to reduce medical errors. Payouts that go out after an error is made do not help the patient. No amount of non-economic damages will reduce a patient's pain and suffering. Separate measures to reduce medical errors are needed to prevent pain and suffering. A cap on non-economic damages will allow patients to continue to receive appropriate health care, but will not make doctors less accountable.

Fiction: Only insurance carriers will benefit if a cap is implemented.

Fact: Insurance carriers in Florida are limited by law to a 5% profit annually. California's $250,000 cap never reduced premiums. However, their cap is the reason their premiums have gone up only an average of 167% since 1975 while the rest of the country has gone up an average of 505% and Florida has gone up 2,654%! Research shows that a $250,000 cap will produce rate stability. The reality is that the trial bar has the most to lose, and that explains why they are falsely trying to shift the blame for the current crisis to the insurance companies.

President Bush has made national tort reform one of his top legislative priorities.

"We have a lot of work to do on this important issue" he said recently to members of the AMA, "but I believe the job can get done. We're going to seize the moment to enhance reform and reach the vision that will improve health care. The problem doesn't start in the waiting room or the operating room; it starts in the courtroom. Patients should be able to recover their economic losses. Patients who are harmed by a physician should be able to collect non-economic damages... but for the sake of the system, non-economic damages should be capped at $250,000. Our nation has the finest medical professionals in the world. You are each living out a great calling; you show commitment. I appreciate the work that you do and I want to thank you for your skill and compassion. In the days ahead, I look forward to working with you to achieve these reforms."

These truths—from the national level, and from our own governor and the nonpartisan task force he appointed to study the problem—have helped us educate our patients these past months on the impact of the Florida liability crisis. And as we continue this battle on tort reform (because it will be a long fight, one that can't be declared totally won regardless of the outcome of this summer's endless legislative grappling), doctors must enlist the most powerful allies we can bring with us—our patients! The FMA has asked all physicians to discuss tort reform with at least one to two patients per day, and to give these patients phone numbers and addresses to email or write our state legislators. "We know what it is we have to do," says Dr. Coble, "and we all know what is at stake—nothing less than what we do as physicians—and the well-being of our patients."

From a patient's perspective, tort reform is becoming more and more personal. As physicians it is critical that we expand our patient advocate role to include educating our patients on tort reform. It is a realistic understanding of this issue by the general population, by our own patients, that will carry the day in resolving this crisis.

Jacksonville Medicine

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