Medical Liability Monitor February 2023 issue highlights

February 7, 2023 by matray

Below are some headlines and article synopses from the February 2023 issue of Medical Liability Monitor. To read the articles in entirety, please subscribe today.

NY Governor Vetoes Bill Expanding Wrongful Death Damages, Legislature Rejects Medical Liability Compromise
After much speculation and delay, Gov. Kathy Hochul vetoed a bill expanding recoverable damages in wrongful death claims. She first asked legislators to amend the bill to exempt medical liability claims from the changes that would be made to New York’s 176-year-old wrongful death statute. Hochul had until Jan. 30 to sign, veto or let the measure expire due to inaction …

Social Inflation Adds As Much As 11% to Malpractice Losses
Social inflation accounted for somewhere between $2.4 and $3.5 billion, or 8% and 11%, of all medical liability losses incurred by a composite of physician-focused medical liability insurers between 2011 and 2021, according to new research from The Doctors Company and Moore Actuarial Consulting …

Private Equity Changes Workforce Stability in Physician-Owned Medical Practices
New research reveals private equity firms that acquire physician-owned medical practices experience greater replacement of the workforce and rely more heavily on advanced practice providers — such as physician assistants and nurse practitioners — than physicians. The study is the first to characterize the shift in workforce composition following private equity acquisition …

Iowa Political Leaders Signal Intent to Enact Hard Cap
In her annual Condition of State address on Jan. 10, Iowa Gov. Kim Reynolds signaled that enacting a hard cap on medical liability damages would be one of her priorities during the next legislative session. The state already caps noneconomic damages at $250,000 for most medical malpractice cases. There is an exception for those involving permanent impairment, disfigurement or death, for which there is currently no cap ...

Nearly a Quarter of Inpatient Visits Had an Adverse Patient Safety Event
Almost a quarter (23.6%) of the inpatient hospital visits in Massachusetts during 2018 had at least one adverse patient safety event, and almost a quarter (22.7%) of those patient safety issues were preventable, according to a new study from Mass General Brigham and CRICO, the medical professional liability insurer for the Harvard medical community and its affiliated organizations ...

Emergency Medicine Organizations Take Issue with AHRQ Report On Misdiagnosis Rate in the Emergency Department
Nine organizations representing the specialty of emergency medicine (EM) sent a letter last month to leadership at the Agency for Healthcare Research & Quality (AHRQ) expressing concerns about of a report it had published, entitled Diagnostic Errors in the Emergency Department: A Systematic Revie. According to the organizations, “the report makes misleading, incomplete and erroneous conclusions from the literature reviewed and conveys a tone that inaccurately characterizes and unnecessarily disparages the practice of emergency medicine in the United States ...”

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A.M. Best Affirms A+ (Superior) Rating of the Cooperative of American Physicians’ Mutual Protection Trust for 16th Consecutive Year

February 3, 2023 by matray

The Cooperative of American Physicians, Inc. (CAP) announced that its medical professional liability coverage product, the Mutual Protection Trust (MPT), has earned a Financial Strength Rating of A+ (Superior) from A.M. Best for the 16^th consecutive year.

Among several notable acknowledgments, A.M. Best recognized MPT’s “cost-effective medical professional liability services,” with a “favorable market position in California as the second-largest provider of physician professional liability coverage in the state.”

The rating reflects MPT’s ability to meet ongoing coverage and contract obligations for more than 12,500 of CAP’s physician members. MPT’s outlook was reaffirmed as stable and its strong financial flexibility, capital strength, and sound invested asset base were highlighted as part of the rating.

“Since 2006, MPT has received an A+ rating from A.M. Best, a demonstration of our ongoing prudent financial oversight and strength on behalf of our physician members and their practices,” said CAP CEO Sarah E. Scher. “As so many California physicians recognize and rely upon MPT’s protection, CAP continues to experience significant growth.”

A.M. Best also acknowledged the financial strength of the Cooperative of American Physicians Insurance Company, Inc. (CAPIC), which earned a rating of A- (Excellent). CAPIC is a wholly owned subsidiary of CAP and provides reinsurance and other benefits to its physician members.

Claims Consultants: Why, When and How to Refer a Physician to Litigation Stress Coaching

February 3, 2023 by matray

by Gail Fiore MA, MSW

Every Claims Consultant will recognize this: as much as 80% of attorney-client communication is consumed with emotional and psychological issues – often fruitlessly.

Lawyers may be very skillful at practicing law, but they’re not trained to deal with the kinds of stress-related issues many of their clients are facing. Ninety-five percent of doctors in medical malpractice litigation report having symptoms of emotional disequilibrium such as anxiety and PTSD. Of the remaining 5%, most are in denial.

Regardless of the intensity of the case, the client is going to feel stressed – apprehensive, wondering if you really understand their situation, questioning if you are doing all that can be done, wondering if they can trust you. The high level of stress may also interfere with the client’s professional judgement and patient relationships, possibly increasing their risk for an additional medical error.

How should a Claims Consultant deal with issues related to Litigation Stress?

The first step requires recognition that Litigation Stress or Med Mal Litigation Stress Syndrome is a common occurrence that can be very effectively addressed through Litigation Stress Coaching – designed to help an emotionally overwhelmed physician-defendant become a more effective witness, cooperative collaborator in the case and a more competent practitioner.

What’s the best way of approaching the subject with a reluctant or emotional client?

Experience shows that the physician-defendant is typically more amenable to Litigation Stress Coaching when it’s presented as a tool for building a "stronger case.”

When approaching the physician-defendant it is key to do so with a respectful attitude and empathetic understanding, seeing them as healthy, strong and resourceful; they are not weak or lacking in some way. Having litigation stress is a normal response to an abnormal situation.

Also, it’s important to approach the person with genuine concern and authenticity – be as real as possible in the moment – genuine empathy is more valuable than any brilliant insight or psychological acumen.

Try to put yourself in their shoes, attempt to view events from their frame of reference, and avoid comments that may be perceived as judgmental; for example, don’t try to address whatever impact the stress may be having on their job performance.

Make them aware that there is a very good resource for emotional support – called Litigation Stress Coaching – that’s non-reportable, totally confidential, and covered by their liability insurance. Remind them that this is coaching, which is a short-term process that’s specifically focused on the issues unique to litigation. It’s not psychotherapy.

Point out that, since this is a common occurrence, a lot of people have had experience with it and have gotten good results in a relatively short amount of time.

If they are open to it, you may want to initiate a referral and offer to follow up with them.

Be prepared to hear resistance, ranging from: “I don’t have time,” to “how will it look if anyone finds out,” from “there’s nothing wrong with me” to “the situation is hopeless.”

The most important part of a response is to be supportive and not challenging or judgmental. They are facing litigation and litigation stress coaching will make them a stronger defendant. It’s helped many other physicians in the same situation.

With all the time and energy they’re already spending with lawyers and litigation prep, this could actually save time, helping them focus and deal with the issues more efficiently.

When someone expresses hopelessness, it may be cause for greater concern. It might be helpful to mention that many physicians enmeshed in nasty malpractice litigation feel suicidal and ask if they ever feel that way. Ask them to bring a family member or significant other – someone they trust – into the conversation. It may be necessary for you to notify someone and make sure that they are getting help.

Claims consultants are in a unique position – and can serve as a valued counselor to physicians at a time when they need it most, rather than being viewed merely as a point of contact. Sometimes physician-defendants need more than just a lawyer and claims consultants can steer them in a more productive direction that produces better outcomes.

Gail Fiore is president of The Winning Focus, LLC, which works with physicians and other professionals coping with stress, anxiety and other emotional issues during litigation. She can be reached via www.thewinningfocus.com.

MagMutual Announces 6.5% Dividend

January 31, 2023 by matray

MagMutual Insurance Co. announced it will return a 6.5% dividend to its policyholders this year.

According to the Atlanta-headquartered insurer of medical liability, the payment marks 24 years of dividends and more than $370 million in financial rewards MagMutual has returned to policyholders since its inception — with more than half of those rewards being paid in the past six years.

“Paying dividends reflects our commitment to our PolicyOwners, who we put first in everything we do,” said William S. Kanich, MD, JD, MagMutual executive chairperson. “We are proud of our record of consistent payments to them, which is an important part of the overall support we offer as a mutual insurer of long standing.”

“The fact that we have increased dividends while most companies are taking them away is a sign of our ongoing financial strength, which our team has worked hard to achieve,” said Neil Morrell, MagMutual CEO. “The successful management of our company means we can support policyholders both financially and with innovative insurance products for years to come.”  

AM Best Assigns “A” Credit Ratings to MMIC Risk Retention Group, Inc.

January 25, 2023 by matray

AM Best has assigned a Financial Strength Rating of A (Excellent) and the Long-Term Issuer Credit Rating of “a” to MMIC Risk Retention Group, Inc. (MMIC RRG). The outlook assigned to these Credit Ratings is stable. MMIC RRG is a sponsored risk retention group of Constellation, Inc., the parent company of MMIC Insurance, Inc., which is the lead member of Constellation Insurance Group.

The ratings of MMIC RRG reflect the consolidated balance sheet strength of Constellation, which AM Best categorizes as strongest, as well as its adequate operating performance, neutral business profile and appropriate enterprise risk management.

The rating assignment level reflects MMIC RRG’s role as a member of Constellation. Explicit support is provided to MMIC RRG through participation in a quota share reinsurance program with MMIC Insurance, Inc. In addition, MMIC RRG is fully integrated into Constellation’s operations and strategic plans, including a centralized management structure.

Constellation sponsored the formation of MMIC RRG in 2011 to meet the geographic expansions needs beyond its licensed territories. Constellation specializes in providing medical professional liability insurance to physicians, clinics, hospitals and other healthcare facilities, ancillary healthcare providers, long term care facilities and also offers self-insured retention options.

AM Best Removes From Under Review with Positive Implications, Upgrades Credit Ratings of MDAdvantage Insurance Co. of New Jersey

January 24, 2023 by matray

AM Best has removed from under review with positive implications and upgraded the Financial Strength Rating to A (Excellent) from A- (Excellent) and the Long-Term Issuer Credit Rating to “a+” (Excellent) from “a-” (Excellent) of MDAdvantage Insurance Co. of New Jersey (MDAdvantage) (Lawrenceville, NJ).

The outlook assigned to these Credit Ratings is stable.

The ratings of MDAdvantage were previously placed under review with positive implications in August 2022, following the announcement that it had entered into a definitive agreement to be acquired by MAG Mutual Insurance Co. The ratings action reflects the completed acquisition effective Jan. 1, 2023, and MDAdvantage’s inclusion as a member company under the MAG Mutual Holding Co. rating unit, which has a consolidated balance sheet strength level of strongest, as well as adequate operating performance, a neutral business profile and appropriate enterprise risk management.

MDAdvantage is considered part of the MAG Mutual rating unit based on operational support, strategic importance to the group’s strategy and explicit support provided through an intercompany reinsurance pooling agreement. MDAdvantage is fully owned by MAG Mutual and the parent maintains full management control for the company.

Mutual Insurance Company of Arizona Declares $15 Million Dividend

January 17, 2023 by matray

The Mutual Insurance Company of Arizona (MICA) recently announced that its Board of Trustees has declared a policyholder dividend of $15 million to be allocated among current members as of Dec. 31, 2022, the record date. The dividend will be distributed in February 2023.

For policyholders insured by MICA for a full three-year period ending on the Dec. 31, 2022 record date, the dividend represents approximately 18% of their 2022 annual earned premium. Members current as of the record date who were consecutively insured less than the full three-year period will receive a pro-rated amount. Additional information regarding the policyholder dividend distribution for each member will be available on the member portal at www.mica-insurance.com in early February 2023.

“We’re proud to be able to reward our policyholders who share in MICA’s mission and entrust us to protect them in the practice of medicine,” said Edward G. Marley, MICA president and CEO. “MICA was organized as a mutual insurer in 1976, a specialized structure that offers us the ongoing ability to share the company’s financial success with our members.”

Following the February 2023 dividend distribution, MICA will have returned $715 million in dividends to its policyholders since inception, including $115 million in the last five years.

The MICA Board of Trustees has awarded policyholder dividends each year since 2005, however, because they are based on past performance they are not guaranteed for future periods.

Integris Group Appoints New Board Member

January 10, 2023 by matray

Integris Group recently announced the appointment of Gary DiDato, MD, to its board of directors.

“Dr. DiDato’s extensive and impressive professional background will bring a wealth of knowledge and insight to our Board of Directors,” said Stephen J. Gallant, Integris Group chief executive officer. “We look forward to working with him in the coming years and are confident his contributions will benefit our growing population of members and the company as a whole.”

DiDato is an anesthesiologist serving as a senior attending at Middlesex Health and as an attending anesthesiologist at Middlesex Endoscopy Center, Shoreline Colonoscopy Suites, Middlesex Center for Advanced Orthopedic Surgery and Guilford Surgery Center. DiDato is the vice president of anesthesiologists at Middletown, PC, located in Middletown, Conn., where he has been practicing since 2005. He is also the Department of Anesthesia chairman at Middlesex Hospital.

Medical Liability Monitor January 2023 issue highlights

January 9, 2023 by matray

Below are headlines and article synopses from the January 2023 issue of Medical Liability Monitor. To read the articles in entirety, please subscribe today.

Medical Professional Liability Premium Growth Slowed in 2022
The medical professional liability insurance industry experienced double-digit premium growth in 2021, driven by firmer pricing and a return to pre-pandemic levels of healthcare utilization, but those gains waned last year, according to a new report published by the Medical Professional Liability (MPL) Association. The industry’s premium growth finished strong in 2021 at 11%. It had averaged only 7% during the previous five years due to a combination of factors that included “a soft pricing environment that lasted for the better part of a decade, shrinkage in the number of independent physicians that purchase MPL insurance and a movement towards alternative insurance mechanisms such as captives.” The premium growth was driven by firmer prices in all sectors of the MPL market, the gradual return to pre-pandemic levels of healthcare utilization and a consumer price index that was running close to 7% — the highest rate of inflation since the early 1980s — while large-dollar “nuclear” verdicts continued to make headlines …

New Jersey Senator Introduces Medical Liability Noneconomic Damage Cap Legislation
State Sen. Nicholas Sacco last month introduced the New Jersey Medical Malpractice Fees & Civil Damage Act, a bill seeking to limit both noneconomic damages and attorney contingency fees in medical liability lawsuits. The proposed bill, S3343, would establish a $250,000 limit for recoverable noneconomic damages in medical liability personal injury actions, regardless of the number of healthcare providers involved. Recoverable noneconomic damages for medical liability actions resulting in a wrongful death, regardless of the number of healthcare providers involved, would be limited to $500,000. Similarly, civil liability for noneconomic losses in a personal injury claim against one or more healthcare facilities, collectively, would be capped at $250,000, while recoverable noneconomic damages for wrongful death claims would be limited to $500,000, regardless of the number of healthcare facilities involved …

Grieving Families Act Sent to New York Governor
A bill that would expand the amount of recoverable damages in wrongful death actions was delivered to New York Gov. Kathy Hochul on Dec. 28, 2022. The governor has 30 days to sign, amend or veto the measure. The Grieving Families Act passed both houses of the state legislature in June 2022. The bill would extend New York’s statute of limitations for wrongful death lawsuits from two years to three and a half, permit surviving family members to collect noneconomic damages for the loss of affection and let nontraditional family members seek compensation. Under the state’s current law, compensable damages in wrongful death actions are limited to economic loss only …

Emergency Dept. Misdiagnosis Accounts for 2.6 Million Patient Harms
A new report from the U.S. Agency for Healthcare Research & Quality discovered that about 5.7% of patients seen in the emergency department (ED) are misdiagnosed. Some of these patients suffer an adverse event due to the incorrect diagnosis (~2%), and some of these adverse events are serious (~0.3%). This translates to about 1 in 18 ED patients being misdiagnosed, 1 in 50 suffering an adverse event and 1 in 350 suffering permanent disability or death. These rates are comparable to those seen in primary care and hospital inpatient care ...

ATRF Publishes Annual ‘Judicial Hellholes’ Report, Medical Professional Liability Again Plays Determining Role
The American Tort Reform Foundation (ATRF) issued its 2022/2023 Judicial Hellholes report last month. The annual release documents abuses of the civil justice system in jurisdictions the pro-tort reform group says are among the most unfair and out of balance in the nation. The ATRF is a branch of the American Tort Reform Association (ATRA), an umbrella organization exclusively dedicated to reforming the nation’s court system via a network of state-based liability-reform coalitions. As every year, medical professional liability issues played a significant role in which regions received mention in the Judicial Hellholes report. Following is a summation of the medical liability portions of the annual report ...

Association Forms to Help Physicians Maintain Independent Practice
Recognizing the adverse impact private equity’s accelerating investment in physician practices has had on the cost and quality of patient care, a group of nearly 400 anesthesiologists from three states united last year to establish the nonprofit Association for Independent Medicine (AIM). The partnership intends to support physician-owned groups choosing to maintain their independent practice by providing them with resources, education and political advocacy tools ...

Clinicians Reluctant to Provide Telehealth Care to Older Adults
A national survey of doctors, nurses and other healthcare providers reveals that nearly 60% believe it’s “dangerous” to provide telehealth to older adults due to the age group’s medical complexities, while another 60% say telehealth is an unrealistic option for seniors with physical or cognitive challenges ...

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Mutual Insurance Company of Arizona Announces Executive Leadership Changes

January 9, 2023 by matray

Mutual Insurance Co. of Arizona (MICA) recently announced the following leadership changes in anticipation of retirements at key positions.

Effective Jan. 16, 2023, Sherry Haworth joins MICA as its senior vice president and chief operating officer. Haworth was most recently at PLICO, a MedPro Group/Berkshire Hathaway Co. that specializes in medical professional liability insurance, where she has served as president of its PLICO SW Division for the past seven years. Prior to her promotion to president, she held the position of senior vice president of operations at PLICO for three years.

“Sherry brings leadership talent in key operational areas, as well as a reputation for delivering exceptional policyholder service,” said Edward G. Marley, MICA president and CEO. “She will be working closely with Mr. Malpiedi during the first quarter of 2023 as she transitions to the role and as he prepares for retirement.”

Effective Jan. 23, Kristin Kenny joins MICA as its senior vice president and chief financial officer, a role vacated by Marley when he succeeded James Carland, MD, as MICA’s president and CEO in September 2022. Dr. Carland officially steps down from his position on February 3, and will continue as chairman of MICA’s Board of Trustees. Kenny comes from Physicians Insurance A Mutual where she has led its financial operations as senior vice president, chief financial officer and treasurer. Prior to assuming this role in 2017, she was vice president and controller at the Seattle-based insurer.

Erica Krobot, JD, joins MICA as its vice president of claims, effective January 16. Her most recent role was executive director, litigation counsel/risk at Banner Health, where she was responsible for providing strategic and operational leadership to the Claims/Litigation and Clinical Risk Management departments systemwide. Krobot will work with Phil Smith during this transition as he prepares to retire in March 2023.

Effective January 1, 2023, Holiday St. Andre has been promoted to vice president of human resources. She will work with Leon Kochan during this transition as he retires in March 2023. St. Andre joined MICA in 2016 and her most recent role was senior human resources generalist.

“On behalf of MICA, I welcome the newest members of our executive leadership team. Both Ms. Haworth and Ms. Kenny bring considerable experience in mission-based, physician-centric, professional liability organizations to these senior roles at MICA,” Marley said. “The MICA claim operation will continue to provide exemplary service under Ms. Krobot, who brings specialized MPL litigation knowledge, including earlier experience as a defense attorney representing physicians and other health care practitioners throughout Arizona, and we look to furthering our talent and administrative operations under the leadership of Ms. St. Andre. As we advance the mission that has served MICA’s members for decades, I look forward to working with the accomplished professionals at MICA as we embrace the challenges and opportunities ahead in our industry."