Patients in rural Illinois will have to travel farther for specialty medical care, and health-care costs will rise even faster in the wake of Thursday's Illinois Supreme Court ruling on medical-malpractice caps, three Springfield doctors predicted.
"It's a sad day," said Dr. Lawrence Smith, a nephrologist who is president of the Sangamon County Medical Society.
Added Dr. Casey Younkin, an obstetrician/gynecologist at Southern Illinois University School of Medicine, "No one's ever shown that malpractice cases improve medical care."
But Randy Wolter, a Springfield lawyer who represents patients in malpractice cases, said the doctors' fears are overblown.
The ruling might lead to higher out-of-court settlements, he said, but few malpractice lawsuits go to trial.
"I just think this will lead to more reasonable negotiations, certainly for the injured party and maybe for everybody," Wolter said.
Even without caps, state requirements and other factors guard against frivolous malpractice lawsuits, he said.
"There aren't any," he said.
Recruiting doctors
Dr. Ronald Romanelli, an orthopedic surgeon at Orthopedic Center of Illinois, said the caps stuck down by the court helped recruit new physicians because they had fewer worries about skyrocketing malpractice premiums. He said he worries that it will be harder to attract the best doctors to Springfield.
Smith agreed, but Younkin said the fact that most Springfield doctors are members of large group practices will blunt the impact of future increases in malpractice insurance coverage.
Four doctors in a private OB/GYN group that Younkin belonged to joined SIU's physician group in 2003, in part because of skyrocketing malpractice insurance costs at the time.
In the wake of Thursday's court ruling, Younkin suspects specialists in smaller downstate communities will restrict the procedures they perform, and specialists in Springfield - obstetricians in particular - will end up serving patients traveling from even greater distances.
SIU obstetricians already have pregnant patients who drive three hours for appointments, he said.
"I think we're going to get busier," he said.
Defensive medicine
Romanelli said the ruling also will lead doctors to practice more "defensive medicine," in which they order tests or procedures that might not be essential, but might help protect against malpractice judgments.
But it's difficult to quantify the amount of defensive medicine that goes on, Smith and Younkin said.
It's also hard to prove the caps reduced defensive medicine while they were in place, said Dr. Thomas Pliura, a LeRoy doctor who also is a lawyer.
The bipartisan Congressional Budget Office has estimated that tort reform at the federal level would reduce national health-care spending on defensive medicine and other costs by 0.5 percent, or about $11 billion in 2009. The savings are relatively small because many states already have implemented tort reforms, according to an October report from the CBO.
Because of conflicting evidence across the country, it's difficult to predict how Thursday's decision will affect patients and doctors in Illinois, said Heather Morton, legislative analyst for the National Conference of State Legislatures.
"I don't know that anybody has been able to definitively say what the impact of caps has been," she said. "Everybody has a position, and there are numbers to support both positions."
Fight will go on
Both sides of the medical malpractice debate say the new state Supreme Court ruling simply means the fight will go on.
The court ruled Thursday that lawmakers went too far onto judicial turf in 2005 when they approved caps on medical malpractice verdict payouts for pain and suffering. It's the third time the high court has tossed out such caps.
Opponents of the caps praised the court, but said there's more work to be done. That's because the caps were linked with insurance reforms, which trial lawyers say were the real reason the price of malpractice insurance has come under control in Illinois.
The reforms forced large insurers to share data with competitors and strengthened state oversight of insurers. With the caps gone, however, so are the reforms.
Keith Hebeisen, former president of the Illinois Trial Lawyers Association, said Thursday that passing new reforms without caps will be a challenge.
Cap supporters said they will regroup.
House Minority Leader Tom Cross, R-Oswego, said he'll try to push a constitutional amendment allowing caps.
"If we can amend the Constitution to give us some ability and authority to cap, then I think you have to look at that," Cross said.
-- Brian Feldt
Ruling based on separation of powers
CHICAGO (AP) - A divided Illinois Supreme Court ruled Thursday that caps on some awards in medical malpractice cases violate the state's Constitution.
The court said lawmakers could re-enact some of the measure's provisions, just not the limits on what malpractice victims could win in court. The law, passed in 2005, had limited awards for pain and suffering in malpractice cases to $500,000 when defendants were doctors and $1 million against hospitals.
The law also gave state regulators more power to review and change malpractice insurance rates, investigate complaints and punish bad doctors.
The court said the legislature's caps violated constitutional separation of powers provisions by infringing on the powers of the judiciary.
Chief Justice Thomas Fitzgerald's majority opinion said the court wasn't persuaded by caps in other states.
"That 'everybody is doing it' is hardly a litmus test for the constitutionality of the statute," Fitzgerald wrote. Justices Charles Freeman, Thomas Kilbride and Anne Burke joined the decision.
In a partial dissent, Justice Lloyd Karmeier said it's the court, not the legislature, that is violating separation of powers by second-guessing state lawmakers' attempts to reduce health care costs. Justice Rita Garman joined in the dissent.
Justice Robert Thomas took no part in the decision.
The ruling came in a test case involving Abigaile Lebron, now 4 years old, whose family sued a hospital and a doctor claiming medical negligence caused the girl's brain damage when she was born in 2005. The case hasn't been resolved.
