Dr. Bouldin: Prior to taking office as governor, what were the rumblings or political chatter on the issues of the civil justice system and malpractice insurance?
Gov. Musgrove: There was a lot of rumbling that did not necessarily convert into facts. The reality of the matter was that in several areas of our state (particularly the Delta and other rural areas), we were seeing a migration of doctors. Doctors felt that it was difficult to practice in these areas and provide healthcare. The escalating malpractice premiums placed restrictions on providing good healthcare. There were no parameters on bringing civil actions in a healthcare setting, thus frivolous lawsuits. How do we put in place something that is fair and balanced, that gives the physician and healthcare provider some parameters to work in, but is also fair to the patient?
Dr. Bouldin: Besides medical malpractice, can you describe the business climate at the time you took office in 2000?
Gov. Musgrove: I have always argued and will continue to argue that we will have a better business climate, society, and healthcare arena if our people are better educated. If our focus and investments are on education, from pre-kindergarten to the university level, we would produce a lot of good things. I also thought we needed a fair playing field for whomever wanted to do business in Mississippi. The citizens of Mississippi are also entitled to a fair shake.
Dr. Bouldin: Can you describe the political pressure being applied during this timeframe?
Gov. Musgrove: I actually had dark hair before becoming governor, and now you see what color my hair is. The political pressure was immense. I tried to look past the political pressure, having good friends that seem to cover all spectrums. It becomes normal to say “no” to people you know and like, and say “yes” sometimes to people you may have difficulty working with. My guiding principle was what is in the best interest of the state.
Dr. Bouldin: Who would you say were the key players applying pressure?
Gov. Musgrove: There were physicians and other healthcare entities. Obviously, there were lawyers and litigants. There were also some business people. But the problem we were facing was in the healthcare arena. We were seeing some challenging numbers. What we did was focus on healthcare delivery and how it could be improved in a balanced way.
Dr. Bouldin: Would you say that healthcare delivery was the trigger point?
Gov. Musgrove: Absolutely, yes. Healthcare at that time was in dire straits. There were a lot of contributing factors that could applied. Malpractice premiums were escalating, and the number of frivolous lawsuits. There was no clear guidance to the doctors and to the healthcare arena on how to bring those premiums down or ways to do away with frivolous lawsuits and just deal with those that had merit.
Dr. Bouldin: I understand that you created a special task force. Can you elaborate on the composition of that task force and the agenda you set forth for them?
Gov. Musgrove: The two biggest voices were the ones of the lawyers (from the litigant side who represented patients or people) and doctors or other healthcare providers. I did not chair the task force but I spent a lot of time with the task force by attending every meeting. I felt that it was important for me to be there and to help calm down the intensity of the various sides to get to the real issue and try to find solutions.
Dr. Bouldin: Can you walk me through the special legislative session of 2002 and leading up to that session?
Gov. Musgrove: It is too much to describe. It certainly was the longest session we have ever had, which shows the intensity, the political pressure, and the varying positions that people took. Some opinions were that some things were sacred and should not be touched. There were others that said that we needed to change everything. With a real issue such as tort reform that is so complex, sometimes the solution is real and complex. So, what we tried to do was address what we thought were real key issues that were causing healthcare providers, doctors, and others from being able to practice with a reasonable amount insurance and malpractice expense. And I believe we were able to do that. But you know, the legislative process is like making sausage, it is a difficult process. At the end the day I believe what we did was not swing all the way to one side. I think the end result is that we got more guidance. It gave better parameters to follow. For the first time lawyers had to have medical expert opinions and give a 60-day notice to physicians that they had an issue with something they had done. This required a lawyer to do a better job of making sure he/she had a legitimate case before proceeding forward.
Dr. Bouldin: For our knowledge, how do special sessions work? Is it that your instructions are that you can not end until there is a solution?
Gov. Musgrove: Well, no. Sometimes you just have to stop the session or call it to an end. Having sat in on so many meetings and moving the solution down the road so to speak, I knew it was going to take a while to get there.
Dr. Bouldin: The law in 2002 established the Mississippi Medical Malpractice Availability Plan that was overseen by the Tort Claims Board. Tell us about the plan and the effect on the medical community.
Gov. Musgrove: One of the best things in that bill is that this plan helped keep doctors in practice. Despite some of the things outlined in statute, there were still going to be doctors over a period of time that could not get malpractice insurance or that the insurance was too expensive. The plan was state run with various doctors and others on the board. The Legislature provided some upfront money for that plan so that doctors who could not get insurance at a reasonable cost elsewhere could get insurance through the plan. If my memory serves me correctly, that plan stayed in existence for some time until the market and environment calmed down.
Dr. Bouldin: Can you expound on how the Joinder Rule may have been contributing to this crisis that you worked on?
Gov. Musgrove: As I mentioned, one of the problems that healthcare providers and doctors were facing was the number of frivolous lawsuits. In cases where several parties were being named in a lawsuit (e.g., a physician and a hospital), a person with a small percentage of fault could be obligated to pay the entire amount of the judgement. Prior to this session, lawyers did not have to have a medical expert to say who was at fault. Our bill limited non-economic damages and a placed a maximum 30% that you would be liable for. The bill in 2004 actually wiped all of that away and stated that any healthcare provider would only be liable for its percentage of fault.
Dr. Bouldin: Governor Musgrove, you started the initial tort reform process in 2002, but there was another iteration in 2004. What are your thoughts about the 2004 legislation?
Gov. Musgrove: In 2004 the Legislature went further than we did in two aspects. One being in the business community in terms of limiting punitive damages. Secondly, collectively looking at the pay outs on viable cases and placing a stairstep cap limit approach to a $500,000 cap total.
Dr. Bouldin: Is there anything else you would like to share with the medical community and others about this 20-year anniversary of tort reform and how it helped move Mississippi forward?
Gov. Musgrove: I do believe that it helped move Mississippi forward. As I said earlier, when we have complex issues sometimes the solutions are hard to find and do not please everyone. In 20 years, what we have seen is stabilization in insurance rates. It seems to me we have seen a reduction in frivolous cases. It seems as though the environment in Mississippi for providing healthcare is much better. Now, does that men we do not have problems in healthcare delivery today? I believe we do, and I spend a lot of time going into some other areas for which I have opinions, such as the expansion of Medicaid in Mississippi.
Even though we passed tort reform 20 years ago, we still have hospitals that are closing. Tort reform did not remedy the availability of healthcare delivery in a lot of our rural areas. It helps to stabilize it. There are other factors that come into play that makes it difficult. While we celebrate the accomplishment that helped the delivery of healthcare by the passage of the tort reform measure in 2002, we also need other solutions for the problems we face today. My encouragement and advice would be to continue to work in healthcare to make sure that we have good, adequate healthcare available for all citizens of Mississippi.