Improved Regulation of Maine Physicians: One Solution to the Medical Malpractice Crisis

Maine began regulating allopathic and osteopathic physicians around the turn of the century with the passage of two statutes, in 1895 and 1919, commonly referred to as the Medical Practice Acts. As originally enacted, these statutes provided for the establishment of boards, composed of physicians, and empowered the boards to examine and license all persons seeking to practice as physicians and surgeons within the state. The boards were also responsible for investigating complaints of noncompliance with, or violations of, the Acts' provisions, and for revoking licenses for such violations. The boards were left to undertake these licensing and review functions with little oversight from either the Legislature or the public. This system remained largely unchanged in Maine until the 1970's. With the onset of the so-called "medical malpractice crisis" in the early 1970's, national and local attention focused on the unavailability of medical malpractice insurance and the quality of medical care. Medical malpractice insurers were raising premiums drastically, restricting coverage, or leaving the medical malpractice business entirely. The primary reasons given by the insurance industry for these changes were the increasing number of claims and the increasing costs of settlement. Some questioned, however, whether the crisis was due instead to less competent physician practice and to ineffective self-regulation by the profession. State legislatures responded with various reforms in an attempt to ensure the availability of insurance. The predominant response was the enactment of reforms in the common law tort system of patient-injury compensation. The common belief was that limiting the number of claims and offering greater predictability would reduce the amounts paid by insurance companies thus creating a more viable market for their continued operation. Changes included limiting recovery amounts, creating medical malpractice screening panels, changing applicable statutes of limitations, abrogating the collateral source rule, and establishing arbitration systems. As part of these reforms, some state legislatures demanded that physicians increase their efforts at self-regulation. In 1977, the Maine Legislature responded to the "crisis" with the passage of the Maine Health Security Act. The Act provided a series of quality control measures and a variety of tort reforms in an attempt to avoid a crisis in malpractice insurance availability in Maine.