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Birth-injury program may bar entrants

Posted on Oct 30, 2006

Birth-injury program may bar entrants Board member says moratorium would be 'very disheartening' BY BILL MCKELWAY TIMES-DISPATCH STAFF WRITER Oct 29, 2006 A state program for injured infants may bar future entry because of mounting costs and obligations to nearly 100 children who have been promised lifetime medical care. Discussions over the past month among the medical community, insurers, health plans and families served by the program are focusing on an end to new entries, which could save as much as $30 million a year in cost obligations. But a moratorium also would effectively end the 19-year-old Birth-related Neurological Injury Compensation Program's role as a workable alternative to medical malpractice litigation against hospitals and obstetricians. And families currently in the program are concerned that continued financing of the program may be in jeopardy, threatening help for their children. "I don't think that this moratorium is being pictured as a relief to the families already in the program," said David Keeler, who has kept up with negotiations and is a parent of a disabled child. "Most of us just see it as yet another delay tactic by the doctors, hospitals and insurers to really fix the program's multitude of problems." Whatever the changes, they will affect every hospital in the state that provides birthing facilities and every doctor in the state, each of whom pays fees ranging from $250 to more than $5,000 into the program. Melina Dee Perdue, a Roanoke hospital executive and chairman of the birth-injury board, declined to comment on specific elements of the negotiations. Nor would the Medical Society of Virginia. At week's end, the program posted on its Web site minutes of a recent meeting specifying the moratorium alternative, and a state society of obstetricians is querying its members about what impact a moratorium might have on medical-malpractice insurance rates. The program, which does not use state funds, bars malpractice suits by families of injured children against doctors and hospitals that voluntarily participate in the program. In return, eligible children, who typically suffer from severe cerebral palsy and will never lead independent lives, are promised lifetime medical care beyond what is paid by insurance or other government programs. Without the program, hospitals and doctors could lose protection from malpractice suits, and families could be forced to rely on court judgments or on Virginia's already stressed Medicaid waiver system, which provides therapy and nursing help. "It would be a very disheartening prospect for families with children who suffer devastating injuries at birth," Dr. Susan Lucas, a retired obstetrician who was recently named to the birth-injury program's board, said of a moratorium. Financial studies show the program has provided about $53 million in nursing, housing and medical benefits to program children since the program began in 1988. But Lucas and other sources said that there is little support for continued acceptance of children into the program, especially among insurers and some health-care providers who are paying about $20 million a year into it. Those payments have helped boost program assets to about $147 million at the end of last year; but that is $132 million short of what is needed to pay the lifetime costs of current children as well as those who are now eligible and are expected to gain entry, according to financial studies. When the program began, it was hailed as a model system of compensation that would be duplicated across the country, especially to address high-cost birth-injury litigation. Only one state, Florida, has copied the program. There, the state implemented cost safeguards, excluded premature infants from help and implemented stringent, mandatory notification procedures. Those provisions don't exist in Virginia, where insurers who sought the legislation to avoid malpractice pay-outs now pay more than half the fees that go toward program operations. Lucas predicted last week that "there will be a hue and cry" from obstetricians if they are forced to pay into the program to offset the cash shortage but fail to get protection from suit. "Why would anyone pay into something that provides them no benefit?" she asked. "It's a business decision."