A patient's promise to avoid a lawsuit

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Some doctors are trying to discourage malpractice lawsuits by having patients sign waivers agreeing not to sue them, and growing numbers are charging fees designed to help them pay for the rocketing costs of malpractice insurance.

In Trinidad, Colo., Dr. Stanley H. Biber, 81, says he hasn't performed general or orthopedic surgery for six months because he can't afford to pay $149,000 a year in malpractice premiums. If he resumed another specialty, transsexual surgery, the premiums would cost at least $250,000 annually.

Therefore, Dr. Biber said he is considering having patients sign contracts agreeing not to sue him, so he can be insured and have "some protection."

Dr. David Vastola, an intern in gastroenterology in North Palm Beach, Fla., says he began using waivers two years ago when his annual costs for malpractice premiums soared from $12,000 to $60,000 in one year, while his coverage plunged from $1 million to $250,000.

"So I added the waiver, and as a result of those contracts, patients agree not to sue me. ... It makes sense, because here in Florida doctors can't afford to stay in business anymore," Dr. Vastola said.

He estimates he has seen as many as 10,000 patients since he required that they agree not to sue him. "All but one patient signed," he said.

Michael Preston, executive director of MedChi, the Maryland state medical society, which represents 7,000 doctors in that state, said he doesn't know any physician who requires waivers, but added: "We hear a lot of interest in the process of charging patients extra fees. ... I'm sure physicians would be more aggressive in charging extras fees [for services that were once free] if they were not so worried" about legal issues that might be involved.

Some doctors are charging for telephone consultations and for completing disability or insurance forms. Here are some examples:

• A Rhode Island intern bills patients $2 a minute for phone consultations.

• Capitol Medical Group in Chevy Chase charges patients $15 for night or weekend calls if the pediatrician on duty thinks the call could have waited.