Malpractice insurance premiums may shut down the emergency room at Centre Community Hospital as the clock ticks on physician's insurance coverage that expires after Feb. 28.

Centre Emergency Medical Associates (CEMA), which staffs the hospital's emergency physicians, are awaiting a quote from the Pennsylvania Professional Liability Joint Underwriting Association (JUA), which insures the group.

Theodore Ziff, director of emergency services, said he is optimistic that JUA will offer malpractice insurance to the doctors, but would not guarantee that the offer would be one the doctors could afford.

"We have nine days to decide whether we can afford the premiums or can't afford them," Ziff said. "We're hoping we will get something close to what it was six months ago."

CEMA expects to pay between $650,00 and $700,00 in premiums for the 12 months ending in September. A year earlier the premium was $200,000.

Ziff said physicians are not pleading poverty, but higher insurance premiums make it harder to recruit and retain quality physicians.

"Our intent is to keep practicing here," he said. "We have a significant and huge commitment to this community."

Ziff said physicians cannot operate without malpractice insurance and the community needs to be informed of the gravity of the situation.

"What the public must understand is this is a real crisis and they should contact their legislators to enact meaningful change in regards to medical malpractice," he said.

Malpractice insurance premiums have skyrocketed in recent years and some insurance companies have backed out of writing malpractice policies altogether. Pennsylvania physicians have found it increasingly difficult to find and afford malpractice insurance.

Currently, no insurance companies write new policies for the state's emergency room physicians. Last year, CEMA almost closed the emergency room and was forced to seek coverage from JUA after Medical Inter-Insurance Exchange dropped them and stopped doing business in the state. JUA is a last resort for physicians and charges higher premiums than private insurance companies.

The hospital's president, Thomas Murray, said the situation reflects a national crisis that is exacerbated by large court settlements, which are more likely in urban areas like Pittsburgh and Philadelphia.

"It's an entitlement philosophy," Murray said. "It's like Powerball and getting a chance of winning something big."

Murray said legislators did a nice job last year by outlawing venue shopping, in which litigants file a claim where the chances of a high monetary award will be more likely. Legislators, he added, also helped alleviate the crisis by getting rid of a law that allowed award seekers to get damages from the hospital's insurance if a doctor's coverage was not enough.

Murray said he would like to see a cap on damage amounts, but to do so would require changing the state's constitution.

"If we have to change the constitution, that's a big deal," he said. He added, however, that if physicians are forced out of practice because they cannot afford or get malpractice insurance, that is also a big deal.

The hospital reduced its reliance on outside insurance carriers by forming their own insurance company last year along with 30 other non-urban hospitals in the state, Murray said.

In the 1999-2000 year, the hospital paid $473,796 in premiums, but paid $1,187,217 for this year's coverage, said Herb Wilson, risk management and patient safety officer.

The Associated Press contributed to this report.