New Blow to Maternity Care: Less Malpractice Coverage

Doctors and hospital administrators say an insurance cooperative’s decision to pull malpractice coverage from obstetricians who treat poor pregnant women as emergency patients will worsen Orange County’s existing maternity health-care crisis.

“I see the rumblings of fewer physicians taking calls for these patients and a bigger burden on other doctors in the emergency rooms,” said Barbara Patton, assistant administrator at Fountain Valley Regional Hospital and Medical Center.

The Physicians’ Interindemnity Cooperative in Glendale notified its policyholders in a certified letter dated July 20 that they will drop malpractice coverage for most doctors who treat new pregnant patients in a hospital emergency room, said Dr. Sabri M. El Farrar, chairman of the trust’s executive board.

“These doctors are faced with patients who have a nine-month history they know nothing about,” El Farrar said. “They have a higher risk of a lawsuit that can range in the multimillion-dollar mark.”

The cooperative’s decision, which would apply to about 50 doctors in Orange County alone when it takes effect in October, was the result of an increasing number of maternity patients seeking treatment in the emergency rooms of private hospitals after they have been turned away from public hospitals, El Farrar said.

In Orange County, the situation for poor pregnant women is further complicated by the fact that three private hospitals that had accepted some of these patients have dropped their state Medi-Cal contracts. When more of those patients began turning to UCI Medical Center in Orange, hospital officials in June enacted a controversial policy to divert pregnant women elsewhere when the hospital’s emergency room and maternity ward were full.

Doctors at UCI Medical Center will not be affected directly by the cooperative’s new policy because UCI has its own medical insurance plan, hospital spokeswoman Susan Meister said.

But she said the policy could ultimately affect UCI’s plan to build a network of hospitals that could help lower the high number of maternity patients.

“We need hospitals in the network which have doctors willing to treat these patients,” Meister said. “But without such insurance, doctors cannot afford to take care of these women. It’s definitely going to have some sort of effect.”

The new policy could be “devastating,” said Dr. Charles W. Plows, president of the Orange County chapter of the California Medical Assn. “These doctors will be penalized without insurance,” he said.

The state has to give immunity to such doctors and protect them from lawsuits, Plows said, or hospitals must provide umbrella insurance to protect their staff from liabilities.

El Farrar said the change in malpractice insurance policy is directed at doctors who are required to be on emergency room call as part of retaining staff privileges. It will not affect doctors who perform voluntary services in the emergency room, he said.

Doctors who treat indigent walk-in patients without pay are protected under the state’s Good Samaritan Law, which protects physicians from liabilities during emergencies, El Farrar said.

The cooperative, a nonprofit organization made up of doctors who provide insurance for themselves, has lower coverage rates than insurance companies, El Farrar said. The cooperative’s decision was researched by its counsel and determined to be legal, he added.

The cooperative has about 900 members statewide, a third of whom are obstetricians, El Farrar said.

Bernard Feldman, chairman of the department of obstetrics and gynecology at United Western Medical Center-Santa Ana, said the policy may become a test case.

“Covering obstetrics takes a large chunk out of insurance companies. Other companies may try doing the same thing if they are allowed by the state,” Feldman said.

Obstetricians pay a range of $45,000 to $70,000 in insurance coverage, hospital officials and doctors said.