BY GARY PERILLOUX

Daily Journal

Johnny Miles loves his hometown, but you couldn't get the doctor to go home again for good.

Not for all the money in Greenville.

"I'm sorry," said the 41-year-old Tupelo obstetrician/gynecologist. "But you couldn't pay me $20 million a year to go back. For the frustration - I couldn't do it."

Eleven years ago in Greenville, Miles answered an unreferred call on an expectant mother - someone for whom he hadn't provided prenatal care. The morning after she was admitted, Miles delivered her baby by Caesarean section. The child had cerebral palsy.

Four years later - while watching the "Geraldo" show - the mother called a number seeking parents of cerebral palsy victims. And an attorney came to her door.

Miles and his partner, Jimmy Beckham, reached a confidential settlement with the plaintiff after their insurer, the Medical Assurance Company of Mississippi, dropped plans to challenge the suit.

The hospital chose to fight the complaint. And in March, a Washington County jury returned a $12 million judgment against King's Daughters Hospital.

Miles questions whether the timing of the C-section would have any bearing on the child's cerebral palsy - a congenital neurological disorder marked by spastic paralysis.

A generation ago, the frequency of C-sections was perhaps one in 20 deliveries; today it's closer to one in four deliveries - or greater in some parts of the country. But despite more C-sections, the rate of cerebral palsy has stayed constant at about 1 percent of births, Miles said.

"Many times cerebral palsy is there and no matter what I do, I can't prevent it," he said. "A person has a right to sue me, I don't deny that, but if it's over an outcome over which I had no control - then that's frustrating for me."

Suit overload

Miles left the Mississippi Delta's largest city to practice in Tupelo before the Delta became infamous for juries awarding tens of millions of dollars in civil damages for challenged drugs and medical care.

Doctors who deliver babies in the Delta are disappearing. According to the Mississippi State Medical Association, one of two remaining obstetricians in Greenwood faces a $215,000 annual medical malpractice insurance bill - up from $19,000 five years ago. And the last practicing obstetricians in Cleveland are closing because they can't get insurance in that university city, forcing expectant mothers to look to overworked doctors in Greenville, Clarksdale and Greenwood.

In Tupelo, physicians also feel they're being second-guessed and sued at every turn without merit.

And they're taking action.

Dr. Mark Fletcher and his colleagues at the Tupelo Neurology Clinic quit admitting patients at North Mississippi Medical Center on July 1.

The act was one of self-preservation, said Fletcher, whose specialty deals with the treatment and diagnosis of such disorders as strokes, seizures and chronic headaches.

"The decision was made when we received the 15th lawsuit against us," he said of a 3-year period. The group formerly averaged one suit a year and is now averaging one a month. "The risk has become too great. Every time I go into the ER and see those patients, I'm opening up my risk. I can't buy enough malpractice insurance to cover my risk."

Fletcher and his colleagues will continue seeing patients at their clinic and in the hospital, but patients will have to go to the emergency room to gain admission to the hospital through other attending physicians.

It's a stop-gap measure Fletcher hopes will work until the state can work out some reasonable tort reform controls.

"The other option (to not admitting) is for some of us to leave," he said. "And I can assure you if any of us leave, they're not going to replace us. This is being done to limit our liability exposure and do as much as we can for patients. And I'm not going to say this is going to be the last limiting we're going to do."

Solutions

Terry Pinson, a general/vascular surgeon and laparoscopy specialist, hails from Hattiesburg and worries that the current spate of lawsuits, rising malpractice premiums and jury awards will weaken what's been up to now a good Tupelo medical system.

Pinson and other doctors have worked to establish North Mississippi Medical Center as a Level 2 trauma center. Following American College of Surgeons guidelines, the only way Tupelo could reach Level 1 is to be a physician teaching facility such as University Medical Center in Jackson.

Already the trauma designation is threatened by Tupelo now having just two neurosurgeons on call who can't cover the emergency room half of every month.

"I have family here in Mississippi, so I'm passionate about this issue," Pinson said. "If you drive through certain areas of this state and have a traffic accident, there's not going to be anybody to take care of you. And the majority of that is related to liability problems.

"We're at risk right now because of the liability issue of losing a significant number of physicians at every level - not only to cover trauma but at every level of the institution."

Even though a majority of medical malpractice cases don't go to trial, Pinson said the threat of suits and the pressure to reach a settlement exact a great cost.

"It's a personal issue," he said. "It's in your personal file in the national physician database if you settle the case."

Among the solutions the doctors would pose to the Legislature are:

* An arbitration panel to screen the merits of whether a medical malpractice case should go to trial.

* Reasonable caps on noneconomic damages, such as pain and suffering, and punitive damages.

* An end to "venue shopping," meaning a stricter limit on where cases may be tried or juries impaneled.

Doctors believe that such limits will rein in the trend toward huge jury verdicts, slow the cost of malpractice insurance, and allow them to continue practicing in Mississippi.

"I don't want to take away people's right to sue, but I think lawyers with the 1-800 numbers and showing up at your door is excessive," Miles said. "But it's going to come back to haunt us. There's going to be even more of a shortage of doctors."