From the Clarksburg Exponent. Sun. Nov. 24, 2002. Nora Edinger. Many physicians ponder leaving W.Va. if malpractice issue is no.

CLARKSBURG -- As the state Legislature prepares to take on a vigorous debate over how courts should handle medical malpractice cases, a number of area doctors say they are more sick of doing business in West Virginia now than they were when the fight over rising malpractice insurance premiums began two years ago.

That scares Bruce Carter, whose work as president and chief of United Hospital Center in Clarksburg requires him to monitor the job-satisfaction of medical staff. He said the current business climate is spooking young doctors he wants to recruit, causing middle-aged ones to ponder bolting and older ones to retire.

"Your margin for error is now down to nothing," he said of one specialty in which UHC has been unable to recruit a second doctor for three years. Rough endings, beginnings Dr. Julian Gasataya is among those to go. Lumberport's only physician will close his general practice at the end of the month -- but not because he wants to leave his 3,000 active patients behind. Gasataya, 75, was informed earlier this month that his malpractice insurance policy will not be renewed in spite of the fact he has never been sued in nearly 40 years of practice.

Family members say the full-time physician's policy was canceled because his age put him into a high-risk category. "It's crazy," George Jackson of Gore said Friday after Gasataya told his 30-year patient he'd have to find another doctor. "I would come here as long as I could." Gasataya does not see any way that will be possible.

Upon learning of his cancellation about a week ago, the native of the Philippines immediately applied to a state-run malpractice insurance program set up recently to cover doctors in similar situations. On Friday, a quote of $29,000 per year came in. While that might be workable, he would also have to pay an annual "tail premium" of about $45,000 to cover his past medical activity. It would take five years to become "tail free." His wife, Tania Gasataya, a registered nurse and her husband's office manager, said that is more than they can afford. "This is a shock. We did not plan for retirement."

Carter is concerned that other Harrison County doctors are making those very plans, however. He said a growing number of physicians are considering retiring in their 50s because their annual income is being squeezed between increasing premiums and decreasing payments from government insurers such as Medicare. With few replacements on the horizon, Carter is afraid UHC is headed toward a shortage. "We have been looking for a second nephrologist (kidney specialist) for three years; we're entering our fourth year of the search," Carter said of the most pressing recruitment need. "This year, we have not even had one candidate."

Dr. James DeMarco, UHC's only remaining nephrologist, has been handling about 150 dialysis patients solo during that time. That is about 15 percent of the state's patient load. "You really just can't walk away from it. You just feel tremendous guilt," DeMarco said of why he has not had more than a day or two off at a time for four years. Although the New Jersey native deliberately chose West Virginia because he wanted a rural practice, he said he is growing both tired and irritated with increasing insurance premiums. His have doubled in the 10 years he has worked in West Virginia. Carter said backing up DeMarco is also difficult because there are few nephrologists nationally and even fewer willing to work in a rural location. That makes him all the more concerned, however, that UHC's chances seem to also be declining in more populated specialties, such as obstetrics and vascular surgery.

He said West Virginia's reputation as a litigious state -- the American Medical Association has labeled the state as among the four most critically in need of medical liability reform -- has been cited by prospects who have slipped away. Even home-grown doctors who are graduating from West Virginia University won't come on board any more, Carter said. "When we can't get these guys, how can we get the kid from California?" Stuck in the middle Area doctors in the middle of their careers are also questioning doing business in West Virginia.

Dr. David Waxman, an orthopedic surgeon who has practiced at UHC for 15 years, said he has given himself two years to decide whether to go or stay. His family is leaning toward the former but he's concerned about the investment he has already made in his practice here, particularly in his office building. "We're actively looking in Virginia," the Maryland native said. "If they (legislators) don't do something, people like me are going to leave. We'll say the bank can have our buildings." Waxman is particularly concerned about his premiums, which have doubled in spite of the fact he had no lawsuits until two cropped up a year ago. He is now paying about $52,000 per year and has had to let his practical nurse go as a way to cut costs. "It's a great place to raise a family but it's an absolutely horrible place to be in the business of practicing medicine," he said of making a final decision.

Dr. Richard Douglas, a neurosurgeon at UHC, is also on the bubble. As of Dec. 1, his annual premium will go up to $200,000, or nearly six times what it was just four years ago. A South Dakota hospital is wooing him -- sweetening the pot with a $25,000 annual insurance premium. "Why have other states in the country remedied the problem?" Douglas said of being caught between wanting to stay and economic reality. "Here, it's a free for all." Quickly calculating how many lumbar micro-disc surgeries he would have to do a year to pay off his new premium, Douglas said decreasing payments from government insurers make the new insurance rates an even harder hit. A few years ago, for example, he said government insurers paid $3,000-$5,000 for that common neuro procedure. Now, he gets $700-$800 for the same surgery. Married to a state native and looking forward to raising his 5 year-old in a small town, Douglas said he is trying to find a cheaper policy. "I'm even looking at Lloyd's of London."

Dr. Brad Hall, a co-owner of Medbrook Medical Associates, Inc., in Bridgeport, said he is also doing everything he can to stay. He is a third-generation Harrison County physician. But, not only is Hall concerned that his group practice's insurance premiums have doubled in the last three years, he is worried that Medbrook has been unsuccessfully trying to recruit a seventh doctor for a year. Like DeMarco, Hall said Medbrook doctors can only take vacations of a few days because it puts the staff that are left behind under too much pressure if they are gone any longer. He worries that, long term, the business will be unable to staff up to cover eventual retirements. "It's very disappointing. I should have been a vet."