Vital Times 2020 - 103

HISTORY OF ANESTHESIA

In a Time of Crisis, California
Anesthesiologists Took the Lead
and Made History
Mark Singleton, MD, FASA

O

ne of the first
collective actions
taken in early
March 2020 by California
anesthesiologists and
surgeons as a response
to the rapidly growing
concerns about the
COVID-19 pandemic, was
to cease elective surgeries
and procedures throughout the state. This was
not the first time that such a historic shutdown of
surgery was carried out by California physicians
in response to a crisis. In 1975, the crisis was the
sudden, breathtaking escalation in the cost of
medical liability insurance across the state that
immediately threatened the viability of medical care
here.
Larry Sullivan, who was to eventually become
CSA President (1999) and later ASA Director, was
then meeting the challenges of his first year at
a private practice group in San Jose, having just
finished anesthesiology residency at Stanford.
What a shock it was to receive the letter from the
Northern California Physicians Council announcing
that his malpractice insurance premium would
increase that year from $4,920 to $22,140! The
Council, representing five NORCAL County Medical

Associations, had been attempting to negotiate
with the Travelers Indemnity Insurance Company,
which essentially monopolized all malpractice
underwriting in the region. The Travelers Company
was applying this unbelievable 350% increase to all
Northern California physicians over four practice
" classes, " based on whether and to what extent
the practitioner's income derived from surgery or
anesthesia. Anesthesiologists and all surgeons,
including OB-GYN, were in the highest class and
were therefore hit with the largest dollar increase.
At this time, California anesthesiologists typically
earned somewhere around $50,000-60,000 (the unit
conversion value for billing was about $12), so this
additional cost of practice was inconceivable.

Larry Sullivan, MD

How did this become a sudden crisis in the spring
and summer of 1975? What led medical malpractice
insurance companies to issue such impossible

Annual Publication 2020

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