Pediatricians in private practice are adversely affected by progressively rising malpractice insurance premiums in the order of 15 to 20% per year. Insurance costs are the third largest cost for a physician operating a private practice. Only payroll and cost of office space are higher.

The rising premiums threaten the existence of our "small businesses". If the pressures get too great, the physician will consider limiting the services offered or retiring from practice all together. The result reduces access to services for patients and a setback for our health care delivery system. It is the patients who ultimately pay.

Experts say that the way the current tort system operates resulting in progressively larger awards to patients with progressively rising cost of malpractice insurance over the years is the principal cause of the liability crisis which physicians, patients and states face at the present time.

The American Academy of Pediatrics Committee on Medical Liability and the Committee on State and Government Affairs makes the following recommendations:

• $250,000 cap on non-economic damages. California has had such a law since 1975. Insurance premiums have not increased in California as they have in other states. States which have a cap are said to have 12% more physicians than those without.

• Mandatory offsets for collateral sources to prevent "double dipping".

• Limit attorney fees so that less of a percentage is retained as the amount of the award goes up. Patients would get a greater portion of the jury award or settlement.

• Periodic payment of future damages over $100,000. This would allow physicians to stay in business at the same time the patient's harm is compensated. It is also a more stable situation for insurers.

• Reduction in the statute of limitations for minors.

• Implementation of alternative dispute resolution programs.

• Expert witness reform. Require a current valid and unrestricted medical license in the state in which the witness practices. The witness must also be certified by the relevant board recognized by the American Board of Medical Specialties or a board recognized by the American Osteopathic Association.

The American Academy of Pediatrics, Hawaii Chapter supports SB757, relating to Medical Tort Reform.

Hawaii should not become a liability crisis state with subsequent loss of physicians from private practice and resulting loss of access to care for patients.

February 23, 2005