Following a trend that is reshaping health care across the state, a number of doctors at Southeast Georgia Health System are “deselecting” privileges, opting out of some surgeries and procedures they consider to be high-risk for malpractice litigation.

The deselection phenomenon has already left the Brunswick hospital unable to treat one common injury, even though there are doctors on staff who are qualified to do it.

“I don’t think anybody will see jaw fractures,” said the hospital’s chief of staff, Dr. Bill Grubb. Patients may have to be transported to Jacksonville, 70 miles away, for treatment.

Jaw fractures are commonly suffered by indigent and uninsured patients who tend to get hurt in auto accidents or street fights, Grubb said.

The repair procedure, which is particularly difficult and often damaging to the patient’s appearance, carries with it the threat of malpractice suits against the surgeon who performs it.

“You can bill whatever you want,” Grubb said, “but you’re not going to get paid. You are going to get sued.”

The problem goes deeper than jaw surgery, doctors at the hospital say.

It is only a matter of time before other areas, notably obstetrics, neurosurgery and vascular surgery, begin to feel the squeeze of deselection, which has already affected smaller hospitals across the state.

But the cure for these ills is a matter of debate.

Last week, a group of 12 state senators prefiled legislation for next year’s General Assembly session that would cap non-economic damages - awards for pain and suffering and for the prolonged medical care that some patients require after an injury - at $250,000.

Rep. Jerry Keen, R-St. Simons, introduced a similar bill into the House last year. That measure died before it reached the floor, but Keen said he and other supporters of changes in tort litigation - involving private or civil actions - were gearing up to push the measures again in 2005.

“You can definitely know that tort reform will be on the House for a vote,” Keen said. “As for what will happen, I don’t know.”

Tort overhaul bills like these aim to stop rising malpractice premiums by ending multimillion dollar “jackpot” jury awards that some believe are driving up the cost of medicine.

Malpractice premiums are rising by as much as 50 percent a year in some areas, and doctors are dropping services as a result.

Paid medical expert witnesses act as hired guns for trial lawyers and push jury awards higher, Grubb said.

“We’re just being eaten alive by these people,” Grubb said. “It’s a feeding frenzy that’s going on”

In a survey conducted by the state in 2003, 14 percent of Georgia physicians said they had stopped performing certain high-risk procedures over the past year. The previous year, 18 percent of physicians said they had stopped procedures.

“The person that suffers at the end, is really the patient,” said Dr. Mark Hanly, a pathologist at the Brunswick hospital who serves as vice president of communications for the Medical Association of Georgia.

Hanly said he has been in contact with “10 or 20” local physicians in the past two weeks who were considering dropping some procedures because of escalating malpractice premiums.

Already, he estimated, about 20 percent of the area’s OB/GYNs were no longer delivering babies.

Dr. Anna Cabeca, a local OB/GYN, said she has delivered a lot of babies over the past five years, but she stopped the procedure this year.

Though she has never been named in a malpractice suit, the threat of malpractice suits that she and other physicians face is “placing a cloud over the enjoyment of practicing,” she said.

Cabeca said she plans to resume delivering babies next year because she loves doing it. But she wants to keep the volume of deliveries lower than it was previously, which could present her with a problem.

“The cost of malpractice insurance requires you to keep up a certain amount of deliveries each month,” she said. “Essentially a low-volume practice would not even pay for itself.”

While no one disputes that malpractice premiums are on the rise, some say the approach taken so far by state legislators - capping damage awards for victims - is treating the wrong part of the problem, while hurting real victims of medical malpractice.

“If you’re going to deal with an insurance issue like high premiums, then why aren’t we talking about insurance reform?” asked Allison Wall, executive director with Georgia Watch, a consumer advocacy group based in Atlanta.

Insurance companies, Wall said, have convinced state legislators that greedy trial lawyers and jackpot awards are responsible for rising premiums.

Just 18 physicians are responsible for $50 million, or 40 percent, of malpractice payouts in Georgia since 1991.

Wall said the state needs to weed out these problem physicians, then reform its insurance system, which allows insurance companies to raise rates with little or no review by the state’s insurance commissioner.

Other states have lowered premiums by forcing insurance companies to get approval from a state insurance commissioner before raising rates, she said.

No matter what approach legislators take, all sides agree that access to health care, especially in smaller markets like Brunswick, is at stake.

“If nothing happens, then communities like ours are going to see a reduction in services provided,” Hanly said. “This is not a financial issue, this is an access to care issue, that people in our community don’t have access to a lot of services that are available in bigger cities.”