DANVILLE — Mandatory expert testimony prior to filing a grievance is one of two reasons medical malpractice lawsuits have declined steadily in Pennsylvania since 2003, according to a recently released report.

While filings in the commonwealth fell 39 percent in the past seven years, they increased 60 percent in the Columbia-Montour judicial district, according to an Administrative Office of Pennsylvania Courts report.

That’s because a second 2003 change by the state Supreme Court required medical malpractice actions to be brought only in the county where the alleged mistake took place.

The Columbia-Montour judicial district is home to Geisinger Medical Center, in Danville, and Bloomsburg Hospital.

Before the state Supreme Court enacted the changes, attorneys representing plaintiffs would shop around for venues likely to be more sympathetic, said Frank Trembulak, executive vice president and chief operating officer of Geisinger Health System in Danville.

“The counsel would try to take the case to Philadelphia or Wilkes-Barre,” he said.

Statewide, there were 8,195 medical malpractice filings from 2000 to 2002, an average of 2,731 per year. There were only 11,722 in the next seven years, an average of 1,674.

In the Columbia-Montour judicial district, there were 43 filings from 2000 to 2002, when attorneys could seek other counties in which to initiate lawsuits. Bound to filing in Columbia-Montour, those filings totaled 160 in the next seven years, a 60 percent increase.

Only two of 23 Columbia-Montour filings in 2009 went to trial, with juries ruling twice in favor of the defense.

“The sustained decline in the number of medical malpractice actions filed ... is an encouraging sign,” said Chief Justice of Pennsylvania Ronald D. Castille. “The downward trend is the product of a direction we set seven years ago to address a complex and challenging issue of concern to all Pennsylvanians.

“In the recent health care debate nationally, there is an insistent call for reform of the handling of medical malpractice cases within the judicial system.”

Most importantly, Castille said, “Justice for our citizens is still being delivered where patients are truly injured by medical mistakes.”

Northumberland County Judge Charles Saylor said he has about the same number of medical malpractice cases on his docket, though many are older just making their way to trial.

However, he was not surprised by the Administrative Office of Pennsylvania Courts report because the two steps put in place by the Supreme Court are making a difference, he said.

The first change required attorneys to obtain a certificate of merit from a medical professional that establishes the medical procedures in a case fall outside of acceptable standards.

“This requires someone who is bringing a medical malpractice claim to file a certificate that basically certifies that it has been reviewed by an expert,” Saylor said, “that there is merit to the case being filed and it is going forward. It’s requires expert testimony.”

Potential cases can now be dismissed at an early stage and eliminate cost and expense, Saylor said.

“The big change is the frivolous will be weeded out early,” Saylor said. “It would limit the number of cases being filed.”

Many medical malpractice cases involve jury time, on average at least five days, Saylor said, and reducing the number of cases lowers the burden and expense on the court system.

Extra steps hospitals are taking can also be attributed to the decline, said Dr. J. Lawrence Ginsburg, vice president of medical affairs at Evangelical Community Hospital in Lewisburg.

“It’s pretty much in the last 10 years or less that all the emphasis and data and learning of patient safety has occurred,” Ginsburg said. “Both physicians and all providers are working really hard to learn more about and provide care.”

Many hospitals and physicians in Pennsylvania moved into self-funded insurance programs because tort reform litigation was on the rise, Trembulak said.

Tort reform refers to proposed changes in the civil justice system that would reduce litigation or damages. Tort is a system for compensating wrongs and harm done by one party to another person, property or protected interests.

“Pennsylvania was the poster child for a bad environment,” Trembulak said. “A lot of insurance agencies withdrew from Pennsylvania and forced hospitals and physicians to move into self-insured programs. A fair number of those have done that.”

There has not been a big commercial insurance market in the state for some time, Trembulak said. He does not believe a robust commercial market will return until other changes are made, too.

The insurance premium varies by specialty for the physician, location and experience. Trembulak compared it to automobile insurance.

“If you live in Northumberland County, the premium calculation is different than in Center City, Philadelphia,” he said. “The same vehicle will have a higher rate, but different cars will have different rates.”

Because of these high rates, and while many Pennsylvania hospitals are great educational facilities, Trembulak said, many medical school students graduate and leave the commonwealth.

“Pennsylvania is one of the states that educates the highest number of physicians,” Trembulak said. “As they graduate, there’s been an increase in the number that leave the state because it is not physician-friendly. Physicians in private practice, because of the economic downturn, can not afford premiums, especially in rural areas, and given up and moved to other states.”

Filings decline 57 percent in Northumberland County between 2000-2002 and 2003-2009, according to the report; and 50 percent in the Snyder-Union judicial district.

While the numbers have dropped across Pennsylvania, the Geisinger official said there is more than can be done.

“I think we’ve seen an improvement in malpractice in the state,” he said, “but there’s still plenty of opportunities to further improve the process.”