Updating previous report --see related article below on the Medlaw.com home page.

13 ED MDs quit over compensation issue

Thirteen gastroenterologists of the Loxahatchee, FL, Palms West Hospital quit practicing at the hospital February 1, when their demands for $1,000 per day on-call stipend were refused by the hospital. As reported in a prior January article, the hospital was one of three cited for failing to treat an uninsured patient with internal bleeding.

Area papers report that out of 92 gastroenterologists in the county, fewer than 20 treat emergency cases, and most of the debate originally centered on payment for call. Following the citation, which treatened the three cited hospitals with loss of all federal reimbursement for failure to have specialty services on call, the rhetoric changed somewhat to talk of "fear of getting sued" by emergency department patients.

A real "smoking gun" disclosure about the real fear of suit, however, surfaced in the Palm Beach Post on February 2, when the paper revealed that most of the county's specialists had dropped their malpractice insurance, allegedly due to costs. Florida is one of the few states that specifically allows physicians to "go bare" and practice without liability insurance.

Many states do not specifically require physicians to carry malpractice insurance, but most hospitals outside of Florida require physicians to maintain specific levels of malpractice coverage through approved insurers. Without physician insurance, hospitals fear that they will become the "deep pockets" defendant in liability claims against any physician.

In states with government run patient compensation systems, such as Wisconsin and Nebraska, which handle catastrophic losses, laws generally require physicians to maintain minimum levels of underlying insurance to quality for state protection.

With federal EMTALA and Florida state legal requirements that mandate hospitals to assure that on-call physicians are available to back-up the Emergency Department in providing assessment and care to emergency patients, questions about the legality of stipends for being on-call, and prohibition against collective actions by physicians under Federal anti-trust laws, the actions of the physicians to avoid call and the "coincidence" of virtually all specialists deciding "individually" to go without insurance coverage, the situation in Palm County is starting to resemble an old-fashion shoot-out between physicians and hospitals that could be an indicator of things to come across the country where all hospitals are potentially facing variations of the same theme.

On the physician's side, the Florida law on insurance seems to be an extra advantage over most states, and the fact that the physicians' may be able to practice successfully without hospital privileges gives them an advantage, but if courts or regulators find that there is "collective action" by physicians, major lawsuits and even potential criminal charges.

On the hospital's side of the battle, federal law doesn't give the hospital any option of allowing specialties to avoid being on-call.

While it remains uncertain who will win this shoot-out, a lot innocent patients may die or be injured before the matter is resolved, and some physician practices and hospitals may close in the process.