By Susan Horsburgh
Updated February 17, 2003 12:00 PM

Volunteer fireman Mark Raphael was at his mechanic’s job in Bay St. Louis, Miss., on Jan. 28 when his radio crackled with an emergency call. There had been a car accident. Within seconds he realized that the vehicle described matched his family’s Mazda. Racing to the scene, he found his wife, Elizabeth, unconscious and their daughter Brailey, 6, with facial cuts so deep they exposed her skull. Rushed to the ER, “my little girl was terrified,” says Raphael, and his wife required surgery for a broken leg.

There was just one problem: There were no surgeons. A dozen of them on Mississippi’s Gulf Coast had walked off the job Jan. 26, in protest against the high cost of malpractice insurance. A helicopter had to airlift Elizabeth, 31, to Hattiesburg, while Brailey made the two-hour trip by ambulance. She went home Feb. 1, but her mother, though now conscious, remains hospitalized with head injuries. Raphael, 32, has taken a leave from work and sleeps in his wife’s room to avoid a hotel bill. “The doctors say she’s going to be normal,” Raphael says, “but there’s nothing normal about the situation my family’s been put in by this doctors’ strike.”

Add the Raphaels to the casualty list of an escalating crisis. Ballooning malpractice premiums have physicians across the country rallying, petitioning and quitting their practices. More than 5,000 New Jersey doctors walked off the job Feb. 3, following similar strikes in Nevada, Florida, West Virginia and the monthlong action in Mississippi. “The system is melting down,” says American Medical Association president-elect Dr. Donald Palmisano. “Physicians are struggling to figure out how they can stay in practice.” Doctors renewing policies this year face hikes of up to 100 percent, with annual rates for high-risk specialties such as obstetrics and neurosurgery topping $200,000 in some areas. With 12 states in crisis, according to the AMA, and 30 more in trouble, President Bush weighed in, calling for an end to “frivolous lawsuits” and a $250,000 cap on pain-and-suffering payouts.

Who’s to blame? It depends where you’re standing. Doctors and insurers generally fault greedy attorneys; lawyers claim insurers are raising doctors’ premiums to make up for huge losses in the stock market. Bush’s damages cap, says Mary E. Alexander, president of the Trial Lawyers of America, would enrich insurance companies, do little to help doctors and penalize “the child with brain damage as a result of poor medical care or the young man who is quadriplegic for the rest of his life after surgery.”

In Mississippi, especially, the malpractice headache has grown into a migraine: In-state insurance companies refuse to sell malpractice policies and the handful of out-of-state companies still offering insurance to Mississippi doctors typically demand six-figure premiums. That’s because the country’s poorest state has become a target of jury-shopping trial lawyers. For instance, tiny Fayette, site of a spate of anomalous multimillion-dollar payouts, is known as the home of “jackpot justice”; there are more trial lawyers registered to practice at the town’s Jefferson County Courthouse than there are residents of Fayette. The state put a $500,000 cap on noneconomic damages last summer, but doctors say it’s too little, too late. They’re retiring early, leaving the state or lowering their risk by no longer delivering babies—disastrous in already underserved rural towns.

In the poor rural community of Cleveland, Miss., the only ob-gyn clinic was forced to close last summer when its doctors, Brad Baugh and Mark Blackwood, lost their malpractice insurance. The day before the doors shut, patients—including pregnant women nearing their due dates—packed the waiting room for checkups, unsure if the clinic would open again. “The tears were too many to count,” says office manager Lee Tedford. “The nearest ob-gyn care is 45 miles away, and a lot of patients don’t have transportation. Rain or shine, they walk here for their appointments.” Baugh reopened his clinic 10 days later, after he arranged quarterly insurance through a special doctor-run company that offers emergency coverage, but his future remains uncertain.

Gulfport ob-gyn Dr. Don Gaddy has opted to do without insurance altogether. After May 16, when his premium will double to just over $100,000, he plans to ask his patients to sign a release stating that they will not sue him. “We have been in this community for decades,” says Gaddy, 46, whose father and uncle started the practice in the 1950s. “People know us. That’s why I feel I can do this.”

While the professionals debate the complexities of reform, the fine points are irrelevant to most patients. Marcia Petersen, who has a family history of breast cancer, fears she has a lump, yet her crucial twice-yearly checkup was postponed last week because her specialist joined the Mississippi walkout. “I don’t care how they fix it,” says Petersen, 47, an Ocean Springs, Miss., homemaker, who was referred to an alternate doctor. “I do care that they fix it soon.”

Susan Horsburgh

Alice Jackson Baughn in Gulfport, Gabrielle Cosgriff in Houston and Giovanna Breu in Chicago