Fletcher, who is in private practice in Houston, had worked as a pediatric neurosurgeon in Houston since 1985, but quit his pediatric practice in January because of the increase in rates. His medical malpractice insurance premium is now $80,000 a year.

Although Fletcher still runs his traditional neurosurgery practice, he says he doesn't expect to continue for more than about five years.

Fletcher says there are only three full-time pediatric neurosurgeons in the Houston area because many, like him, have retired recently due to skyrocketing malpractice insurance rates for the high-risk profession.

"We're the only profession that can't pass costs on to the public," says Fletcher. "Most of the children I was treating didn't have insurance or were on Medicaid, so I was basically paying for the privilege of operating on them."

Fletcher says operating on children is the highest risk of all specialties, and with decreasing reimbursements from Medicare and Medicaid, it was no longer worth the cost.

"We, as doctors, are taking these increases on the chin, and I'm not sure I'll be able to afford it if the rates go up again," he says.

Fletcher says he has become frustrated trying to determine why his medical malpractice insurance premiums are rising at such an alarming rate. He says it's turned into a "blame game," with health insurance companies pointing to the increasing number of malpractice lawsuits and physicians blaming lawyers for filing frivolous suits.

Fletcher isn't alone in dealing with soaring medical liability insurance rates.

Dr. William H. Fleming III, president of the Harris County Medical Society, says the medical malpractice insurance rates for his family practice business doubled this year. He also blames the increasing number of what he calls frivolous lawsuits.

In Texas, one out of every four physicians had a legal claim filed against them in 2000, according to the Harris County Medical Society. Fleming says that out of all of these claims, 90 percent were closed with no payment made.

According to data from the Texas Medical Association, Harris County physicians are seeing malpractice insurance rates that are 60 percent to 130 percent higher than they were in 1999. And, 32.5 percent of physicians in Harris County surveyed by the Texas Medical Association say they are considering curtailing the types of services they provide.

Data shows that a neurosurgeon carrying $1 million of coverage is being quoted an annual premium of $114,000, a 110 percent increase from last year.

Obstetricians, for the same amount of coverage, will pay more than $62,000 per year on insurance to deliver babies, a 64 percent increase over the 1999 rate of $37,900.

"In Harris County and throughout Texas, it has become a challenge for some physicians to stay in practice," says Fleming. "With skyrocketing insurance rates and lower reimbursements from Medicare and managed care plans, some physicians will cut back on high-risk services or simply choose to wind down their practices. Either way, our patients lose."

Bad Medicine
Fleming says it's often the physicians dealing with the sickest and highest risk patients who have seen the largest jump in their premiums and who are changing the way they practice medicine.

Dr. David Hearne, a general surgeon who practices at Clear Lake Regional Medical Center, settled on a lawsuit in 2000 and has since watched his annual premiums rise from $24,000 to $72,000. He says he practiced for 28 years before being named in a lawsuit.

One of Hearne's patients filed a suit over a complication he says they acknowledged was a possibility before the surgery, but says he had no choice but to settle the case.

It's gotten so bad that Hearne says he and many surgeons he knows are considering closing down their practices due to the soaring costs of malpractice insurance.

"It has had a serious adverse impact on my practice, and I don't know how much longer I can survive," he says. "I'm taking it month-to-month right now, and if I can't bring in enough money, I'm going to have to retire soon or find something else to do in medicine."

While the reaction to increasing premiums are the most severe in South Texas and along the Texas-Mexico border, officials say Houston's already-full hospitals are shouldering the burden of the patients who must been seen by a physician.

As physicians in South Texas leave the industry or alter their practices, Houston-area hospitals are seeing more and more patients from areas outside of Harris County, adding to the already-overcrowded emergency rooms.

Ken Mattox, chief of staff at Ben Taub Hospital, says he receives a steady stream of phone calls from South Texas physicians asking him if he can take a patient who needs immediate emergency attention.

Mattox says fewer physicians are performing the risky procedures because they can't afford the insurance --and it's creating a serious burden on Texas hospitals.

He says this problem will affect everybody, and most people won't feel it until they are in need of serious care by a physician.

"There may not be room for you at the hospital because the physicians who would normally take care of you can't afford the insurance," Mattox says.