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.
Lynne Myers, the hospital's vice president of planning, marketing and business development, said the executive committee is discussing the issue and could make a recommendation by November to the hospital's board of directors.
"We're very concerned about this in light of physicians' limiting or closing their practices," she said.
Doctors complained about malpractice premiums last month after insurance regulators approved a 33 percent rate increase for Medical Mutual Liability Insurance Society of Maryland, which insures about three-fourths of the state's doctors. The increase brought the cost of premiums for some doctors to more than $150,000 a year.
The average medical malpractice settlement in Maryland has increased to $410,546 from $216,727 in the past four years, according to a study by Medical Mutual Liability.
Doctors at Prince George's Hospital Center in Cheverly say they might stop providing nonemergency procedures by Nov. 15 to protest the rising premiums.
The doctors also are waiting for a ruling from the hospital's board of directors on whether they will be allowed to reduce their minimum liability from $1 million to $300,000 per incident, said Bob Howell, a hospital spokesman.
Physicians from the Washington County Hospital Association in Western Maryland threatened to discontinue nonemergency procedures, such as biopsies and hernia repairs, but backed off after meeting with Mr. Ehrlich.
Michael Preston, executive director of the Maryland State Medical Society, a physicians trade group, said yesterday the group does not approve of discontinuing surgeries in response to the "medical-malpractice crisis."
"Physicians understand that their No. 1 priority has to be the patients," he said. "We have specifically said that we cannot condone" discontinuing surgeries.
Dennis O'Brien, a spokesman for the Maryland Trial Lawyers Association, said Monday that insurance companies, not lawyers, are responsible for the skyrocketing premiums.
He also said malpractice insurances rates would decrease if the number of malpractice cases also declined.
"Tighten up the industry," he said.
Robert Redding Jr. contributed to this report.