October 1, 2003

"Dying for Help: Are Patients Needlessly Suffering Due to the High Cost
of Medical Liability Insurance?

Presented by: Dr. James J. Tayoun,

1332 Ritner Street

Philadelphia, PA 19148

Chairman Burton and distinguished Ladies and Gentlemen of the committee,
I thank you for your concern and interest into the malpractice crisis
affecting America.

My name is James Tayoun; I was born and raised in Philadelphia where I
currently practice surgery. I am a Board Certified General Surgeon and
Board Certified Vascular Surgeon in private practice. I am Chairman of
the Department of Surgery at St. Agnes Medical Center and Burn Center. I
am Director of Vascular Surgery Fellowship at Philadelphia College of
Osteopathic Medicine and serve as the president of the Politically
Active Physicians Association.

I started my practice in 1997 and purchased Medical liability insurance
for \$28,789.02. In one year the same policy with no claims increased to
\$44,080.40. I changed companies in 1999 for a savings of \$50.00 paying
\$43,980.40. This increased in the year 2000 to \$54,639.60 followed by
another increase in 2001 to \$65,414.85. In short, just from 1997 to
2001 my insurance increased over 500%. By the year 2002, with two claims
made but dropped by the plaintiffs, my insurance went to \$133,437.69.
Adding insult to injury my insurer also informed me they will no longer
be offering insurance forcing me into what is called a "claims made
policy".

At this point in my career, I researched other areas where I could
obtain affordable insurance. I found I could get insurance from the same
company that left Pennsylvania for \$34,000 by moving my practice ten
minutes from my present location into New Jersey. If I moved my practice
twenty minutes into the state of Delaware, my rate was quoted at
\$7,500. How can it be the same surgeon, performing the same procedures
but in different states face such a dramatic fluctuation in malpractice
insurance?

The malpractice system is now propelled by runaway verdicts causing
increases in frivolous lawsuits. This cause private insurance carriers
to leave the state allowing for the few remaining to gouge the captive
market of physicians. With this plight we turned to our elective
officials for help. In Pennsylvania this was met with pessimism at
first, followed by small attempts at relief. The legislative assistance
was too little and too late. Because of that physicians in Pennsylvania
realized that we can no longer stay on the sidelines and allow others to
direct our profession. So in July of 2002, we formed the Politically
Active Physicians Association (P.A.P.A.).

Tayoun, 2

P.A.P.A. believes in preserving access to high quality healthcare. We
will accomplish this goal by educating our elected officials and
patients. We are now doing this by supporting those candidates who
believe in this philosophy. In one year PAPA has grown to 5000 physician
members and has now opened membership to non-physicians in the form of
P.A.P.A. Auxiliary.

P.A.P.A. is recruiting a physician captain at every hospital in each
municipality where we now have chapters. The captain will help inform
and organize the physicians at their designated hospital and will
connect with other captains through the county coordinator responsible
for that region. P.A.P.A. is providing information and training to help
members better educate their patients on the crisis effecting their
access to quality health care. P.A.P.A. has formed a PAC, which now
distributes literature supporting candidates who have won P.A.P.A.'s
approval. These candidates fully understand the nature of the crisis or
have shown that understanding through their actions in elected office.

Pennsylvania has eight medical schools and is home to world renowned
universities training doctors in all specialties. Despite this great
resource for developing young physicians, the state of Pennsylvania has
dropped in rank from 12^th^ in 1996 to 41^st^ in the nation by the year
2000 for retaining young physicians. The age of the average practicing
surgeon in Pennsylvania is now 50 years old. It takes a new surgeon
approximately 15 years of practice, with the support of senior
physicians on staff for guidance, to become seasoned, thoroughly
competent and to skillfully meet any emergency.

To understand the crisis of no young physicians staying in Pennsylvania,
P.A.P.A. sent a survey to 150 hospitals throughout the state requesting
the age of the youngest physician in several different categories. The
following charts represent the youngest physician actively on staff at
32 hospitals who responded.

Chart One represents the youngest general surgeons. Philadelphia's Mercy
Hospital youngest surgeon is 54 years old. Philadelphia Mercy Hospital
is located in a poor rural neighborhood. When a physician in
Philadelphia does the same job as a physician in the Mayo Clinic, the
Philadelphia physician is penalized by Medicare for being in a heavily
populated region and their reimbursements are greatly reduced. I ask
you, why should a young physician take a position where they will earn
substantial less than most every other area in the country, and have the
highest malpractice premiums?

Chart Two represents the youngest neurosurgeon. Out of the 32 hospitals
responding only 15 had neurosurgeons actively on staff. Lower Bucks
Hospital's youngest neurosurgeon is 55 years old, with Philadelphia
Mercy Hospital and Mercy Fitzgerald, both in poor areas coming in a
close second, with their youngest neurosurgeons being 54 years old. The
malpractice cost have skyrocketed 1500% while reimbursements have
decreased steadily from Medicare and private insurers. Again, I ask why
would a young physician stay in Pennsylvania?

Tayoun, 3

Chart Three represents the youngest urologist from the 32 hospitals who
responded. 19 of the youngest physicians are over the age of 40, with
Charles Cole Hospital's youngest urologist being 62 years old.
Physicians have struggled for years to make ends meet with the
continually decreasing reimbursements and climbing cost. Any reasonable
person can see there are no young physicians choosing to set up practice
in Pennsylvania.

Chart Four represents the youngest ENT physicians. Charles Cole is again
hit hard with their youngest active physician being 59 years old. There
are only 21 ENT's under the age of 40.

Chart Five is the most frightening. Of the 32 hospitals responding only
4 have a trauma surgeon available. If you have an auto accident in
Pennsylvania, and your loved ones in the car, I pray its near one of
these few hospitals that can still perform emergency trauma surgery. The
youngest trauma surgeon at Robert Packer Hospital is 48 years old, but
they count themselves as one of the lucky few, for having this skilled
individual available for patients.

These numbers reveal the destruction of the very foundation of medical
care being offered in Pennsylvania. Once this base is removed, there is
no possible way to build or continue world renowned medical care,
training and education. Our state and nation loses.

The present tort system offers no solution. It punishes the innocent
patients and doctors. The current system offers no improvement to the
way medicine is practiced. It raises cost by increasing the amount of
tests and consults ordered, many which are not clinically necessary, but
will protect you from losing a frivolous law suit.

It is time for you to mandate by legislation patients need not to have
their doctors forced out of practice because they can not afford
existing premiums. We need the most obvious fact turned into
legislation; caps on non economic damages.

I have watched excellent physicians leave the hospitals at which I
practice. I have watched hospitals decrease services to the communities
in which they serve.

And the one fact, I ask you all to note that is going unnoticed, is
physicians can leave but patients can not. Pennsylvania has the second
oldest population in the country. The senior citizens do not have the
resources to follow their physician across state lines. It is the
elderly and needy throughout America who will suffer.

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