Doctors seek to work with no insurance

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Doctors at Montgomery General Hospital are asking administrators to let them work without malpractice insurance because they cannot afford a statewide 33 percent increase in premiums.

The doctors say the rates are so high now that they also are considering whether to discontinue high-risk procedures or to close or move practices out of state.

"I look at these options myself," said Dr. Brian Avin, a neurologist with admitting privileges at Montgomery General. "I don't go to the emergency room anymore. I've cut back on treating the indigent. We've cut back on Medicaid. That hurts. I went into medicine to do all of those things."

Gov. Robert L. Ehrlich Jr., a Republican, yesterday described the price of medical-malpractice insurance in Maryland as a "very serious" issue. He also said that without reform, the state could lose its "very best medical providers."

However, Mr. Ehrlich and state lawmakers have been unable to strike a deal to address the cost of malpractice premiums.

Mr. Ehrlich wants a long-term approach to reduce costs and has opposed calling a special session of the legislature to approve a plan by Senate President Thomas V. Mike Miller Jr., Prince George's Democrat, to create a temporary state fund to reduce premiums. Some doctors call the Miller plan a stop-gap measure that would increase payouts in lawsuits.

Meanwhile, the Maryland State Medical Society said this week that as many as 40 percent of the state's physicians will close or relocate if premiums are not reduced.

Dr. Avin said he supports the Montgomery General doctors who are asking the medical staff's executive committee if they can practice without insurance, although he was not at the meeting on Tuesday night, when they voted on the plan.

Montgomery General does not give admitting privileges to physicians unless they have malpractice insurance. But doctors want the hospital to drop the requirement because, they say, high malpractice-insurance rates are driving them out of business.

Hospital administrators say the board of directors must make the final decision.