Illinois passes controversial medical reform         

New measures regulate insurance rates, cap injury awards, increase consumer information 

[AUG. 26, 2005]  ALTON -- Flanked by physicians, patients, hospital administrators and legislators, Gov. Rod R. Blagojevich signed critical legislation Thursday to address the growing cost of medical malpractice insurance. In an effort to improve patient access to health care, the new law caps monetary awards for pain and suffering, gives the state the authority to more aggressively regulate malpractice insurance companies' premium increases, increases the ability of Illinois regulators to enforce physician practices, and allows consumers to learn about previous judgments or complaints against any physician licensed in Illinois.

"During my State of the State address, I called for medical malpractice reform because we can't make health care more accessible or more affordable if we can't keep doctors in our state," Blagojevich said. "As governor, my top priority is making sure that people have health care. And, over the past three years, we've made sure that nearly 330,000 working parents and their children received the health care they need. I'm proud of that, but without doctors, we don't have health care. Today, with this legislation, we're taking a major step forward to make sure that doctors keep practicing in Illinois and people get the medical care they need."

Senate Bill 475, sponsored by Sen. James Clayborne Jr., D-East St. Louis, and Rep. Dan Reitz, D-Sparta, limits the amount a jury can award for personal pain and suffering to $500,000 from physicians and $1,000,000 for hospital judgments. While these limits were higher than some had advocated for, they represent reasonable restraints on the awards that can be made to victims of malpractice. With award ceilings established, insurance companies, self-insured health care providers and physicians will be able to better plan for the monetary costs associated with malpractice awards. To reduce frivolous lawsuits, the bill also requires that before a case can be brought against a physician or hospital, another doctor must certify that the action has merit and should be brought to court.

"This was a reasonable compromise that required all sides to give a little in order to ensure we could bring a final resolution to a medical crisis that has not only plagued the Metro East, but is now affecting communities all across Illinois," said Clayborne, Senate sponsor of the legislation. "This is not just a bill about caps. We now have state law that includes important insurance reforms and provisions giving patients greater access to information regarding their doctor and medical care."

"With the help of doctors, hospitals, patient advocates and legal experts, these reforms were crafted to provide much-needed protections for doctors and hospitals, while providing for tougher disciplinary standards for the bad doctors," said Reitz, sponsor in the House. "I am proud to have worked with all the parties involved to be part of the solution to this problem. I applaud the governor for joining the General Assembly in approving this historic legislation and look forward to the positive results for our region's health care."

"We thank Governor Blagojevich for recognizing the urgent need for litigation reforms that will keep doctors in Illinois and preserve access to medical care for our patients," said Craig A. Backs, M.D., president of the Illinois State Medical Society.

"Illinois' unbearable medical litigation crisis forced me to actively look outside of this state to practice medicine," said Andrew A. Roth, M.D., an obstetrician-gynecologist practicing in Lombard. "The signing of this legislation allows me to stay and take care of my patients."

Other provisions of the measure increase the state's ability to moderate the costs of malpractice insurance and reduce incidents of malpractice by more aggressively disciplining physicians when warranted. The law also creates opportunities for ordinary Illinoisans to access information about an individual doctor's medical experience and qualifications, as well as bringing new information to consumers about the doctors licensed in Illinois.

Insurance code changes

Senate Bill 475 makes it possible for the state, for the first time, to deny medical malpractice rate increases. In addition to eliminating a requirement that the business climate in Illinois be deemed "noncompetitive," the Department of Financial and Professional Regulation will also collect and make available actuarial data relied upon for pricing by every medical malpractice insurer.

If a company files a request for medical malpractice rate increases of more than 6 percent, public hearings on the proposed increase will be mandatory. For lesser increases, the Department of Financial and Professional Regulation can conduct public hearings to determine whether the rate increases are justified. This provision was drafted to subject premium increases to greater public scrutiny.

By increasing the information that is publicly available, the law intends to make the malpractice insurance business more attractive to companies that have felt closed out of a state where one company collects over 60 percent of the medical malpractice premiums. Increased competition should stabilize insurance rates.

Professional regulation

The new law also makes changes to the way physicians are regulated and the Medical Practice Act is enforced. Two additional public members, who are not physicians, will be appointed to the Medical Disciplinary Board, which reviews citizen complaints and disciplinary actions against licensed doctors.

Several changes in the law give Medical Enforcement Division staff additional authority to prosecute violations and discipline doctors. The law increases the statute of limitations from five to 10 years, so the Department of Financial and Professional Regulation will be able to prosecute "pattern of practice" cases to discipline doctors who have multiple simple negligence cases in which no single case rises to the level of gross negligence. The law also makes it easier for investigators to gain access to evidence when a case is opened because of actions by a court, insurance company, medical facility or another state's medical board.

More investigators will be hired to increase disciplinary oversight of doctors. Investigators will have increased authority to demand case files when a mandatory report of a legal judgment, hospital disciplinary action, criminal or civil conviction, or insurance settlement is received by the Department of Financial and Professional Regulation. The law also makes it easier for prosecutors to develop cases based on a longer period of a physician's potentially dangerous or inappropriate medical care.

Physician profiling website

Senate Bill 475 creates a new opportunity for Illinoisans to learn about the doctors who treat them. An Internet site will be created with access to background information about doctors. The site will contain data on the previous five years' history involving criminal convictions, malpractice awards, and disciplinary actions taken by the state of Illinois or reported by other states.

The legislation becomes effective immediately.

"With so much at stake, we cannot think that just because we passed this bill, our work is done," the governor said. "We have to aggressively regulate insurers so that we can increase competition and reduce prices, and we have to make sure that patients have the information they need about their doctors. Those are all critical elements to making sure this bill does what it is supposed to do. Everyone should have health care. I believe that very strongly. And that means having doctors available to help you."

Senate Bill 475 is part of Blagojevich's long-standing effort to make sure that more people get more health care and better benefits; protect coverage for those who have health care; and help hospitals, doctors and nurses provide better health care. Specifically:

• Best in the nation for providing health care to the working poor: Since Blagojevich took office, 313,000 more men, women and children have received health care through the KidCare and FamilyCare programs -- at a time when most states are not only not providing more coverage for the working poor, but also kicking people off Medicaid or significantly reducing their benefits. This year's budget included funding to add another 56,000 men, women and children. The Kaiser Foundation has ranked Illinois the best state in the nation for providing health care to people who need it.

• Fourth state in the nation to publicly fund stem cell research: Blagojevich and Comptroller Dan Hynes announced this month that Illinois became the first state in the Midwest, and only the fourth state in the nation, to commit public funds to the lifesaving work of stem cell research. By executive order, the governor directed the Illinois Department of Public Health to create a program that will award $10 million in grants to medical research facilities for the development of treatments and cures. Studying stem cells allows scientists and doctors to better understand what causes serious medical illnesses and conditions in hopes of discovering new ways to treat or even cure them.

• One of only a handful of states to protect Medicaid recipients: The budget signed by Blagojevich a few weeks ago ensures -- for the third consecutive year, despite facing budget deficits -- that Medicaid recipients maintain their health care, unlike states ranging from Missouri to Tennessee to Texas to Washington that are either kicking people off Medicaid or significantly reducing benefits.

• First state to develop a statewide small-business health insurance pool and program: Blagojevich and the Chicagoland Chamber of Commerce are developing a small-business health insurance program that will help small businesses reduce their costs by 10 percent to 15 percent and provide more health care for their employees. Illinois will be the first state to create a pool that businesses of 50 or fewer employees can join, saving money on the negotiated rate, administrative costs and broker fees.

• First state to make prescription drugs from Europe and Canada available: Under Blagojevich, Illinois became the first state to allow its citizens to purchase prescription drugs from Europe and Canada. More than 10,000 people have enrolled in the last few months alone to take advantage of lower prices -- 25 percent to 50 percent less -- for over 120 name-brand prescription drugs.

• Most comprehensive state response to fill gaps in the federal prescription drug benefit: The governor signed the Leave No Senior Behind legislation, which is Illinois' response to the federal Medicare prescription drug benefit. Because of the major holes in the federal program, the governor's plan fills in the gaps, so Illinois seniors will not suffer the same fate that face seniors in other states.

• First state to require pharmacists to dispense female contraceptives: In April, Blagojevich issued an emergency rule requiring pharmacists whose pharmacies sell contraception to dispense birth control to women with valid prescriptions. The governor's emergency rule became permanent this month. First lady Patti Blagojevich also launched a new website designed to help women learn how to have their birth control costs covered by their insurance companies. Additionally, seven leading contraceptives are now available through the state's I-Save Rx program at discounts of as much as 79 percent off the price currently charged at pharmacies in Illinois.

• Improving women's health programs: Blagojevich created the Illinois Healthy Women program to provide health care to women who otherwise would go without. To date, the program has served more than 100,000 women. The governor also sent a letter to the U.S. Department of Health and Human Services, seeking approval of his plan to expand the Illinois Healthy Women program to cover an additional 50,000 women. In addition, Illinois has dramatically increased the number of mammograms and cervical cancer screenings since Blagojevich took office.

• Signing lifesaving women's health legislation: Blagojevich signed into law several bills providing additional cancer screenings for women and expanding funds for critical cancer research. The laws require insurers to cover breast cancer screening earlier in a woman's life and to cover ovarian cancer screenings for at-risk women. A third law created a scratch-off lottery game to raise money for breast cancer research. A fourth law expanded a cancer research fund to include ovarian cancer research.

• Accessing nearly $2 billion in new federal health care money: Blagojevich signed hospital assessment legislation that will mean nearly $2 billion in new federal funding for Illinois hospitals. Last year, the governor persuaded the U.S. Department of Health and Human Services to approve a plan that meant nearly $500 million in new federal funds for Illinois hospitals. The new plan, which requires federal approval but was constructed with their guidelines in mind, means more than three times that amount.

• Reducing the nursing shortage: Blagojevich signed a package of bills aimed at reducing the nursing shortage in Illinois, including making it easier for foreign nurses to practice in Illinois. The state also eliminated the nurses' registration backlog this April and increased the amount available in grants for nursing training. This fulfills the initiative launched by the governor in his State of the State address to reduce the nursing shortage.

[News release from the governor's office]