By MICHAEL SEBASTIAN

Journal Reporter

The simple solution for "Illinois' most trying time" in medicine is follow the example of neighboring states, said Dr. Kris Narasimhan, emergency room doctor at Lutheran General Hospital (LGH) and president of the hospital's medical staff.

Wisconsin has drawn six obstetrician-gynecologists (Ob-Gyns) from LGH. These doctors have reportedly fled Illinois to practice medicine under cheaper insurance premiums. In Wisconsin, Ob-Gyns pay $23,677 in yearly medical liability premiums, while the same doctor in Cook County pays $230,428 annually.

"The premiums are driving us out of business," said Dr. Brian Locker, an Ob-Gyn at LGH, and member of the OB Crisis Coalition, a group of Northwest Suburban doctors working to increase awareness of the issue.

Illinois' premiums have skyrocketed in the last several years. The medical community believes these sharp increases are to account for the high priced malpractice lawsuits leveled against doctors. The medical community insists that insurance companies are hiking rates because of the unlimited amount of dollars a plaintiff can win for pain and suffering -- considered non-economic damages.

Because Illinois has eliminated punitive damages from medical malpractice suits, many doctors in Illinois, including Narasimhan, believe excessive, non-economic damage awards are a jury's way of dolling out punishment to a physician.

In Wisconsin's case, it has joined 21 other states in placing a cap on non-economic damages. Juries cannot award a plaintiff more than $410,000 for pain and suffering, a number adjusted for inflation. The American Medical Association (AMA), like Narasimhan, is a strong supporter of such caps. Citing a Stanford University study, the AMA said that caps "reduced the likelihood that a physician will be sued by 2.1%. Within three years, premiums in direct reform states declined by 8.4%."

Wisconsin differs from many states with caps since it features, among other reforms, an insurance pool -- contributed to by doctors and other medical professionals -- that covers added costs over the cap in a lawsuit. Many doctors ansd attorneys, who often fall on the opposite side of this argument, agree insurance pools are effective.

"Without the insurance pool, [Wisconsin's] malpractice premiums would not be as low," said Chicago-based attorney Bob Clifford, who is considered by many to be the most successful trial attorney in America.

For Narasimhan, caps -- and perhaps an insurance pool -- would deliver a solution to what the medical community is calling a "crisis" in Illinois.

At least one voice from the other side of the issue believes this isn't a "crisis" at all.

"I don't know if you could use the word 'crisis,'" said attorney Terry Lavin, of Lavin and Nisivaco Law Offices in Chicago. Lavin is the immediate past president of the Illinois State Bar Association (ISBA). He has argued cases for both patients and doctors.

Lavin noted that premium increases in Illinois have begun leveling off, and that caps -- of all things -- certainly won't solve the problem.

"The ISBA position is that caps on damages in malpractice conditions are not appropriate because they infringe upon people's rights for just compensation and there is no empirical data to demonstrate that there would be a meaningful decrease in malpractice premiums that would justify infringing on someone's rights," explained Lavin.

The federal government seems to agree at least somewhat with Lavin's statement about a lack of empirical data.

In summer 2003, the U.S. Congressional Budget Office released findings on this issue from the General Accounting Office (GAO) that determined, "A lack of comprehensive data at the national and state levels on insurers' medical malpractice claims and the associated losses prevented us from fully analyzing the composition and causes of these losses."

Despite the conclusion, both sides of the issue have used the GAO's report to push their cases. And just as the medical community mentions study upon study to back their position, so too does the American Bar Association (ABA).

For example, a June 2003 report by the think tank, Weiss Ratings, Inc. said, "Caps on non-economic damages have failed to prevent sharp increases in medical malpractice insurance premiums..."

Another report the ABA provided the Journal indicated the nation's largest medical malpractice insurer, GE Medical Protective, admitted, "Non-economic damages are a small percentage of total losses paid. Capping non-economic damages will show loss savings of 1.0%."

GE Medical Protective's statement echoed the GAO's 2003 findings. Citing a 1993 report from the U.S. Office of Technology Assessment that summarized the insurance issues in the 1970s and 1980s, the GAO said, "The report concluded that caps on damage awards consistently reduced the size of claims and, in turn, premium rates for malpractice insurance...More recent studies have reached similar conclusions...a cap on non-economic damages and a ban on punitive damages -- would together reduce premiums by one-third..."

However, "Savings of that magnitude would not have a significant impact on total health care costs. Malpractice costs amounted to an estimated $24 billion in 2002, but that figure represents less than 2% of overall health care spending."

The legal field does, however, for the most part, recognize that doctors are suffering from high insurance premiums. "I'm on the doctors' side," Lavin remarked, "the doctors are getting shafted by their insurance companies."

According to Lavin, the insurance companies support the caps to save money in a lawsuit. "But would it save doctors money?" He questioned.

Lavin stressed that the insurance industry should be closely examined to help reduce premiums. After all, Major League Baseball and insurance are the only two industries void of the federal government's anti-trust laws, he noted.

"There ought to be oversight, strict oversight of the Illinois Dept. of Insurance," Lavin explained. Malpractice insurance companies wishing to increase rates over a set number should have to defend the rate hike with data, he continued.

Lavin also questioned the medical community's outcry over the issue and the media's response.

"The overwhelming majority of claims are anecdotes and the doctors are making arguments that are based on confidential data that they've never supplied," he said.

"The media relies on these anecdotes. The media talks to doctors, but doesn't look at the actual studies."

The doctors at LGH have painted a grim picture. Regardless of anecdote, though, LGH has lost at least 17 Obs. Six doctors have left the state, while 11 switched to gynecology, opting out of delivering babies in return for cheaper premiums.

Ten out of the hospital's 15 general practitioners have stopped delivering babies.

According to Locker, one percent of Illinois medical students are entering obstetrics. In the past, roughly eight to 10% of medical students in the state entered obstetrics.

Lavin and Clifford both acknowledge that doctors are paying large sums for insurance premiums. Both attorneys have worked for a solution. Clifford is part of a group assembled by Gov. Rod Blagojevich to examine the issue. Lavin spent the last four to five months unsuccessfully negotiating with doctors and insurance companies to reach some conclusion.

"These doctors need help," Clifford stated. "Their premiums are raising, their revenues are falling and no is doing anything about it.

"How can we address the solution?"