Gregory Saracco likes where he lives, but thinks of moving all the time.
He settled in Wheeling, W.Va., 12 years ago mostly for the usual reasons: low crime rate, good schools, a great place for raising a family. But Saracco is a general and trauma surgeon and was also drawn to Wheeling's lush medical environment.
The city's two teaching hospitals meant a complement of top-flight doctors. Active in every specialty, they provided crucial support to Saracco's work, making it possible for him to do his job, and do it well.
"People were very fortunate here," says Saracco. "They didn't have to leave and go to a big city to get cutting-edge medical care." Note the past tense. Wheeling, like all of West Virginia, has in recent years become a medical hell. "It's all," Saracco says, "falling apart."
He is one of 18 surgeons in Wheeling who asked for 30-day leaves of absence starting Jan. 1 to protest the state's punishing tort system. Out-of-control jury awards in West Virginia, like in many other states, have pushed medical-malpractice insurance rates so high that doctors are fleeing.
The West Virginia version of the Hippocratic oath is: "First, pay crushing insurance premiums, then -- if you happen to still live here -- do no harm."
The number of general surgeons in Wheeling during past two years has gone from 10 to seven, and the possibilities for recruiting new ones are almost nil. "Everyone knows we have the worst malpractice environment in the nation," says Saracco.
Worse, during the past three years, Wheeling has lost all three of its neurosurgeons. A trauma surgeon like Saracco is the captain of a trauma patient's care, stabilizing him, then coordinating what he needs from specialists, like neurosurgeons. If, that is, there are any.
"If I get a patient with a head injury," says Saracco, "I can no longer give him definitive care." Head injuries go to Morgantown, W.Va., or Pittsburgh, both 50 to 60 miles away. A patient's crucial first hour can be spent in transit. "We're using up the hour,'" says Saracco.
Settlements from medical-malpractice claims average $250,000 nationwide. In tort-friendly West Virginia, settlements average $500,000, and in Ohio County, home to Wheeling, the average is $1 million. Trial lawyers can gobble up much of that money in contingency fees and expenses, making them the biggest beneficiaries of a system that is wrecking West Virginia health care.
Not so long ago, there were roughly 30 insurers licensed to provide medical-malpractice coverage in West Virginia. By last year, there were two major ones left, and they too were ready to pull out.
The state started extending insurance to doctors, but with premiums higher than any commercial insurance still on offer. Also, doctors must still buy a private policy, called a "tail," to cover claims from work prior to getting the state insurance.
So, West Virginia has preserved an onerous "tax" on practicing medicine. Saracco bought a "tail" for nearly $100,000 to be paid over three years. Last year, he paid $30,000 for his state insurance and $33,000 more for his "tail." As the state policy matures, the premium for it alone could grow to $100,000 a year.
West Virginia could solve its tort problem by adopting the sort of reform -- among other things, limiting noneconomic damages and bonanza payouts to trail lawyers -- adopted years ago in California, and pushed at the national level by congressional Republicans.
In the meantime, Saracco has to consider his options. Virginia beckons, where insurance rates are about a third as high. Or Indiana and California, which have enacted reforms. Or another option: A captain in the U.S. Navy Reserve Medical Corps, Saracco could go on active duty and forget all about trial lawyers.
"All I would have to do is to take care of patients," says Saracco. "That looks pretty nice right about now." It, after all, is why he moved to Wheeling in the first place.