The direct liability costs are represented by the inordinately high
liability insurance premiums paid by all Oregon medical professionals.
These premiums are a major cost of doing business in the Oregon
medical community. Just as in any other business, the only alternative
for the medical community is to pass their costs on to their customers. In
this instance they must recover their costs by higher billings to their
patient customers.

 The indirect costs are even more substantial and permeate the
entire medical care delivery trade. Unneeded tests, redundancy in testing
and over-cautious pathology requests are made for the sole purpose of
attempting to limit potential liability. For the same reason, extremely
expensive imaging such as CAT scans and MRI’s are routinely ordered
in lieu of much less expensive x-rays, even though the latter would
often suffice. These extreme and often unnecessary expenses are too
often incurred solely to defend against potential tort actions.

 Medical liability premiums are indexed to the potential risk of
lawsuits for each procedure performed and the number of those
procedures performed. Physicians routinely limit their scope of practice
by the cost of the liability insurance menu relating to specialties
including obstetrics, neurology, orthopedic procedures, emergencies,
acute trauma and other critical care services. Too often those services
simply become unavailable because the physician cannot afford the
insurance costs of performing only a few such procedures and because
alternative sources of the service are not available.

 This is particularly true in many rural areas of Oregon. The
state already pays a portion of the medical liability insurance premiums
for certain practitioners in some rural areas to help the communities
maintain their practices. Funding for the continuation of that critical
program is uncertain in this budget environment.

 The certain result of the loss of these rural practices is that many
patients in critical need of medical services must travel long distances to
obtain those services. The travel is not only burdensome and expensive
but the inherent delay in obtaining critical medical services may be life
threatening.

 Moreover, unnecessary and prohibitively expensive equipment
upgrades are too often driven by tort liability concerns. Perfectly usable,
functional and adequate equipment is routinely abandoned because
newer updated medical equipment could provide marginally better
outcomes. This reality results in accelerated depreciation of the medical
equipment requiring much higher charges per procedure in order to
recover investment costs. The reality is that much of this high priced
equipment is not available in rural communities because the case
volume simply cannot pay for the accelerated costs. The only alternative
 is to discontinue the services provided through the use of the equipment.

 All responsible medical professionals understand and accept the
essential need to be held responsible for their errors and omissions that
cause economic damages to their patients. However, what is making
medical services unaffordable in Oregon is the absence of any limit on
court awards for non-economic damages such as pain and suffering.
The premiums for liability insurance against awards for tens of
thousands of dollars in economic losses is affordable. Insurance against
awards for tens of millions of dollars in non-economic pain and
suffering is not affordable.

 Establishing a fair cap on non-economic medical liability has both
significantly reduced costs and improved the availability of medical
service in other states. These states have experienced large net increases in both the number and quality of physicians and other medical professionals practicing in their states.

 At the same time Oregon has experienced increasing costs,
decreasing quantity and quality of service and net losses in the number
of medical professionals practicing their professions in our state. The
percentage of those losses is uniformly higher across the rural
communities and appears to be accelerating. Specialty services are no
longer available in many communities at any price.

 It is past time that Oregon follow suit in passing medical liability
tort reform. We know that a significant bipartisan majority of legislators
in both chambers will strongly support medical liability tort reform
legislation. We have good reason to believe that Governor Kitzhaber
would sign a reasonable medical liability tort reform measure. It is past
time for the Senate Democrat leadership to exercise some responsibility
and allow a vote on this critically needed legislation.

Remember, if you do not stand up for rural Oregon, no one will.

Best regards,

Doug