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03-27-04 Insurance costs remove local doctors from delivery business

By Shelley Grieshop

MARIA STEIN — Two more area doctors have decided to quit delivering babies, bringing to light a pregnancy crisis in the Grand Lake St. Marys area.
   “Honestly, it wasn’t as much a decision for us as a mandate,” said family practitioner Dr. Tom Schwieterman. “Within 10 seconds of getting the latest malpractice insurance quote, it was a no-brainer.”
   Schwieterman, 36, who shares office space in Maria Stein with his brother, Jim Schwieterman, 42, said escalating malpractice insurance costs means the end of a 113-year era of delivering babies for the Schwieterman family of physicians. Tom Schwieterman’s great-grandfather started the practice back in 1896.
   The brothers’ absence on the maternity floor — and the growing absence of many of their colleagues — means many local expectant mothers may have to leave the area for prenatal care.
   The two doctors, along with their father, Dr. Don Schwieterman who retired in 1997, have brought more than 5,750 babies into the local community, they estimate. Sadly, their last delivery will take place in September, said Tom Schwieterman, as he leafed through a worn, black datebook marking each patient’s due date.
   “Emotionally, this has been a very difficult decision for us,” added Jim Schwieterman. “But our real concern is for our patients who are left searching for doctors who still deliver babies.”
   In 2002, the American Medical Association (A.M.A.) identified 18 states, including Ohio, at crisis levels for high medical liability insurance rates, which threaten public healthcare access. Skyrocketing rates for malpractice insurance has forced many doctors out of the obstetrics business and other high-risk fields where lawsuits are frequently filed.
   The Schwietermans have never been sued for a delivery. But that apparently doesn’t make any difference to insurance companies, they said. Their group insurance rate six years ago was $32,000; this year’s quote: more than $78,000.
   “If I could just break even (delivering babies), I would do it,” said Jim Schwieterman, a family doctor for 13 years. “It’s a tremendous honor and privilege to be part of the delivery process.”
   The crisis circle appears to start and end with insurance companies. Here’s what is happening, according to the AMA: Malpractice rates have risen due to the growing size of jury awards in civil suits; obstetricians in turn must raise their delivery rates to pay the high premiums; however, insurance companies refuse to pay the whole amount physicians must codege their patients in order to make a profit.
   Some officials feel the answer is to put a cap on jury awards and review only cases with true merit. Others believe the threat of liability suits help keep physicians on their toes, even though less than 40 percent of those who file malpractice suits ever win, according to the AMA. Legislation on the issue in Ohio remains pending.
   State Sen. Jim Jordan, R-Urbana, said the healthcare system desperately needs reforming. The rural public — particularly areas like Mercer and Auglaize counties — suffer the most, he said, unlike metropolitan areas where doctors are more plentiful. Jordan suggests a tax deduction for individuals who provide their own medical or health savings account for minor medical treatment, with insurance maintained only for catastrophic medical needs.
   “It would work like this: you set aside money for health purposes and draw down on it when you need it. The money left at the end of each period is yours,” Jordan explained. “You would use it like a debit account.”
   But he warned, “Any type of healthcare change is not going to happen overnight.”
   Jordan said he is convinced the malpractice crisis is Ohio’s third priority behind terrorist threats and taxes.
   The threatening doctor shortage is trickling into maternity wards locally. Following the Schwietermans exit from obstetrics, Mercer County Community Hospital, Coldwater, will have only three doctors under contract to deliver newborns — all obstetric/gynecology (OB/GYN) specialists.
   “At the moment we’re trying to recruit OB/GYN’s,” Community Hospital CEO Terrence Padden said Thursday, with concern in his voice. “I think it’s time for young families in the community to take action, get to their congressional delegates and speak their minds. Something’s got to be done. Where will it end?”
   Padden said a task force has been formed within the hospital and will meet April 14 to discuss recruitment strategy.
   However, the money used to try to fix the problem could be better spent, he said.
   “We’re forced to take money away from other areas of the hospital and use it to attract more doctors so insurance companies can put money back in their pockets,” Padden said.
   The Coldwater hospital averages about 350 births per year, Padden said.
   “That’s about one woman each day that discovers she’s pregnant. That’s a beautiful thing if you’re middle class, have a good income and a reliable car,” he said.
   But many mothers don’t fit that bill, he said. Some have little or no insurance, an old car they can’t rely on, and likely will have to travel 50-plus miles to find a doctor and a hospital, Padden said.
   In 2000, Community Hospital welcomed 351 babies; by 2003, the numbers dropped to 339. The numbers declined more drastically at Joint Township District Memorial Hospital, St. Marys. Doctors there delivered 69 less babies in 2003 than in 2000.
   The Schwietermans say they’ll miss delivering babies. One of their patients, Laura Pleiman, a young mother who was delivered by Dr. Don Schwieterman, mourns the communities’ loss.
   “I know a lot of women who’ll be afraid to go further away to a doctor they don’t know. Then there’s always that fear that you won’t make it to the hospital in time,” said Pleiman, whose three children were delivered by Dr. Tom Schwieterman.
   Financially, the Schwietermans say turning away deliveries won’t be a burden, although they do admit babies nearly always mean future patients.
   Tom Schwieterman hasn’t given up the fight. He has written letters to senators, congressmen, Gov. Bob Taft, even President Bush, he said.
   His father knows this was a tough decision for his sons.
   “The whole thing’s a hard pill to swallow,” said the senior Schwieterman. “Five years ago this would be hard for me to accept. I still fear, though, for the health of the people of our community.”


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