Review of the professional medical liability insurance crisis: lessons from Missouri.
OBJECTIVE
This study was undertaken to document and generalize the professional liability insurance (PLI) crisis.


METHODS
Data analysis from physician surveys, Missouri Department of Insurance, and court records.


RESULTS
In 2001-2002, many insurers stopped writing new and existing PLI. A survey found 1 in 7 physicians had their PLI terminated and/or application for new insurance denied. Average premiums increased 22% in 2001 and 60% in 2002. Accordingly, 50% of surveyed obstetricians took salary cuts, 18% secured loans, 9% liquidated assets, and 55% significantly limited their clinical services. An adverse court ruling caused insurers to double reserves. Incomplete data led the Missouri Department of Insurance to erroneously conclude a decrease in claim frequency and severity. In contrast, courthouse records and missing data sources revealed increased malpractice filings. PLI premiums continue to rise.


CONCLUSIONS
Many life-saving specialists are being forced out of business. Specialists are less willing to care for emergency and indigent patients for fear of liability exposure. Legislative enactments leading to meaningful tort reform, public support, and judicial restraint must occur to save health care.
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Women's Health, St. Louis University, MO, USA. samon01@earthlink.net
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D003675:Defensive Medicine; D019538:Health Care Surveys; D006801:Humans; D007344:Insurance Claim Reporting; D007351:Insurance, Liability / Q000592:standards* / Q000639:trends; D016365:Liability, Legal; D008318:Malpractice / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D008923:Missouri; D011216:Practice Management, Medical