Medical Malpractice News and Views


Welcome to our blog where we discuss current issues in medicine and law. We welcome your comments.

The Medicare Advantage Trap

March 18, 2024

More and more eligible Americans are signing up for Medicare Advantage plans.  And why not?  Celebrity spokespeople promise low to no premiums and benefits not available under traditional Medicare.  It sounds almost too good to be true.  “Get the benefits you are entitled to.  Call now and an insurance specialist will take your call and explain this wonderful offer to you.”  Of course, as you should know by now, there is no such thing as a free lunch.

Medicare Advantage (Part C) health plans

First, just a quick reminder of how Medicare Advantage works.  The companies that participate in the Medicare Advantage market are usually existing health insurance companies.  Pretty much all the big names in health insurance offer Medicare Advantage plans.  The federal government pays these companies a fixed amount per year to care for each eligible person they sign up.  The amount depends in part on a number of factors, including location of the enrollee.  The company is required by law to provide coverage for certain services.  Any money it does not spend caring for the enrollee, it gets to keep.

Clearly, there is an incentive for the company to keep its costs low.  This usually involves limitations on enrollees that they do not face in traditional Medicare.  In traditional Medicare, the enrollee can see almost any doctor or go to any hospital they choose.  They can see a specialist without getting permission first.  Things are quite different for the Medicare Advantage enrollee.

One of the most common forms of controlling costs is to set up a network of doctors and hospitals, who have agreed to give the Medicare Advantage company favorable rates.  Enrollees are required to go to doctors and hospitals who are “in network” or pay extra.  In some places, the networks may be large with lots of options from which to choose, but in other locations there may be few choices available.  Suffice it to say, you may have to change doctors from time to time as the company changes its network of providers.

Another common way of controlling costs is to require prior permission before any significant medical treatment.  Permission may be slow to arrive or may not arrive at all.  It is a frequent complaint against Medicare Advantage companies that they often deny needed care and force their enrollees to either file an appeal or to go without needed care.  Some hospital chains have decided not to accept the enrollees of certain Medicare Advantage plans because of high rates of denials and slow payment of bills.   Some doctor groups are similarly refusing to accept some Medicare Advantage patients.

These limitations may not be very important to you, if you are still relatively healthy when you sign up for a Medicare Advantage plan.  You don’t need a lot of medical care so these restrictions don’t interfere with the care you need or at least don’t interfere much.  It is when you get sicker and need significant care that these restrictions really start to bite.

Well, “OK”, you say, “I can always switch over to traditional Medicare, if I get sick and start having problems getting the care I need.”  Not so fast.  This is where the Medicare Advantage trap gets in your way.  Yes, once every year, during the open enrollment period, you can either change Medicare Advantage plans or leave Medicare Advantage altogether and sign up with traditional Medicare.  Traditional Medicare must take you and cannot charge you extra premiums because you are now sick with a major health problem.  So far, so good.

The problem is that traditional Medicare does not cover all of your care.  It has co-pays and deductibles.  Enrollees are expected to pay 20% of the cost of their treatment after reaching a certain point.  For that reason, most people signing up for traditional Medicare, also sign up for a “Medigap” policy that covers these co-pays.  If you sign up for a Medigap policy when you first sign up for traditional Medicare, the Medigap insurance company cannot charge you extra because you are sick or have a major medical condition.  This is not the case, however, if you are coming to traditional Medicare from a Medicare Advantage plan.  If you are coming from a Medicare Advantage plan, the Medigap insurer can take your health status into account and, if you have a major medical condition, you can expect to pay extra for the Medigap insurance.  For many people, the extra charge is too much and they can’t afford to leave the Medicare Advantage plans.  They may switch to another Medicare Advantage plan, but they will never be able to afford to switch to traditional Medicare, regardless of how problematic Medicare Advantage is proving to be.

As I have written before, Medicare Advantage may be the best option for you, but look before you leap.  There are substantial trade offs that you must make in order to receive the benefits they promise you.  There is no free lunch and you may find yourself trapped in Medicare Advantage when you get really sick.  Take your time and be careful when making your initial choices.  They may end up being life-long choices.

Posted in Doctors, Fee for Service, Health Care Costs, Health Insurers, Hospitals, Medical Costs, Medicare |

Maybe, Just Maybe, Science Will Save Us From The Superbugs

March 11, 2024

Superbugs!  That is the name given to antibiotic resistant bacteria.  Because of our indiscriminate use of antibiotics, more and more bacteria are developing resistance to them and posing an ever greater threat that we will be forced back to the bad old days before antibiotics when bacteria killed wide swaths of the population, especially the young and the infirm.  Already it is estimated that superbugs kill 5 million people a year and that this number will increase to 10 million by the year 2050.  10 million a year is one person every three seconds.

Oxford-led study shows how AI can detect antibiotic resistance in as little as 30 minutes | University of Oxford

The rise of the antibiotic resistant bacteria did not occur overnight.  It is the result of years of foolish use of antibiotics by farmers, industry, doctors, hospitals, and individuals.  Instead of recognizing the importance of antibiotics and doing everything in our power to assure that they continue to be effective against the bacteria that cause significant illness, we have wasted their power and virtually guaranteed that they would become useless.  We made the rise of the superbugs inevitable.

We always assume that science will save us by developing another antibiotic that will replace one that has lost its effectiveness.  So far, science has not disappointed.  It has come through for us time and again, but the superbugs are nothing if not persistent and there are trillions of them.  There are only so many ways to kill bacteria and scientists have already thought of most of them and have incorporated them into existing antibiotics.  There aren’t many avenues left.  Maybe it’s time for something completely different.

How about viruses?  For countless millennia, viruses and bacteria have been at war.  Some viruses evolved to prey on certain types of bacteria.  They are called bacteriophages, or phages for short.  Researchers are now trying to identify which phages are effective against which superbugs.  Bacteria have some defenses against these natural enemies.  After all, they have been warring for a long time and if the bacteria did not have defenses, they would have been wiped out long ago.  So far, however, the research has suggested that a combination of phages and antibiotics are a one-two punch that the superbugs cannot resist.

There is still a long way to go in perfecting our ability to use these natural predators in a safe and effective way.  In the meantime, use existing antibiotics wisely so they don’t lose their effectiveness any sooner than absolutely necessary.  Here is a good resource on the wise use of antibiotics.

 

Posted in antibiotic resistant bacteria, blood infections, Doctors, General Health, science news, Sepsis |

Arizona’s Notice of Claim Statute

March 04, 2024

Arizona has inherited the ancient common law doctrine of sovereign immunity.  Without its permission, you cannot sue it or any other state.  Like the other states, Arizona has waived its immunity, but it has done so with some limitations.  One of these is that, before you can bring an action against the state or a subdivision of the state or a state employee, you must first serve a Notice of Claim.  Arizona’s Notice of Claim statute, A.R.S. Section 12-821.01, sets forth the requirements of the notice.  It is a highly technical statute and, if its requirements are not followed to the letter, you lose your right to sue the state, its subdivisions, and any of its employees who injured you while acting in their capacity as state employees.  While the legislature will permit you to sue the state and its employees, it does not want to make it easy to do so.  The Notice of Claim statute is a trap for the unwary.

Former County Attorney alleges corruption of former officials – Parker Live

The stated purpose of the Notice of Claim statute is that it gives the state an opportunity to investigate claims against it and to settle those which are meritorious.  Given that the state almost never accepts one of these claims without forcing the injured party to sue, this statement of purpose by the legislature is highly suspect.  More likely, the intended purpose of the statute is to allow the state to throw out as many claims as possible for failing to meet the statutory requirements.

The very first requirement is one which catches many victims off guard and disposes of many claims.  Arizona has a two year statute of limitations for personal injuries.  This means that an injured victim can file suit up to two years after the event giving rise to the injury and still get her day in court.  Not so if the claim is one against a state entity or employee.  A Notice of Claim must be served on the appropriate officials or employees within 180 days of the event giving rise to the claim.  I cannot begin to count the number of times someone has come to me with what seems like a strong claim only to find that it is against a state entity or employee and that the event occurred over 180 days ago.

The second requirement is that the Notice contain facts “sufficient to permit the public entity, public school or public employee to understand the basis on which liability is claimed.”

The third requirement is closely related to the second.  The Notice must state a specific amount for which the claim can be settled and “the facts supporting that amount.”  These two parts of the statute have spawned a lot of litigation as the state routinely claims that the amount stated was not sufficiently specific or that the plaintiff did not include enough facts for it to understand the nature of the claim and to determine if it is worth the amount plaintiff is willing to accept in settlement or both.

The fourth and final requirement also trips up many would-be plaintiffs.  The Notice must be served on the “person or persons authorized to accept service for the public entity, public school or public employee as set forth in the Arizona rules of civil procedure . . . .”  It cannot be just mailed.  It must be hand-delivered and it must go to a specific person, who will usually be different for each state entity.  If you serve the Notice on the wrong person, or don’t serve it on all the persons who should receive it, you will be tossed out of court.

After the Notice is served, the state entity has 60 days in which to decide whether to accept it or not.  They almost never do.  The Notice is presumed denied after 60 days has passed without an acceptance, unless it is specifically denied before that.

A companion statute requires that all actions against the state, its entities or employees be brought within one year from the time of the event giving rise to the action.  This means that after the Notice of Claim is filed, the plaintiff has until the one year anniversary of the event to file suit.  The two year statute of limitations for personal injury does not apply.

There is an exception for minors and others under a disability.  The 180 days and the one year limitation period do not begin to run for them until they reach the age of majority (18) or until the disability is lifted.

There is one final exception.  If a reasonable person would not realize he or she has been damaged and the cause or condition that caused the damage, the Notice of Claim period does not begin to run.  This may happen from time to time but there will almost always be an argument by the state that the period ran more than 180 days before the Notice of Claim was eventually filed.

If the state argues that the Notice of Claim was not filed in time, that issue must be resolved before trial and as soon as possible.

You may think that this is pretty straightforward but these requirements are the subject of appellate case after appellate case as the state routinely argues the requirements of the statute were not met and the trial courts agree.  There may be questions about who is an employee or agent of the state.  For example, doctors participating in residency programs through the University of Arizona are considered state employees.  In a very recent case, someone sued a county for actions taken by the county sheriff.  The appellate court held that the claim failed because the county is not responsible for sheriffs, who are elected officials and should be sued on their own.

The bottom line is that if you have been injured by a state employee or anyone who might even remotely be considered to be a state employee, get to a lawyer as soon as possible and get legal advice.  It will take time to investigate and prepare a Notice of Claim, if one is required, so you better get to the lawyer in time for the necessary investigation to be completed.  I cannot even consider taking a case requiring a Notice of Claim that arrives in my office less than 45 days before the expiration of the 180 day period.  It is just too risky.  Don’t lose your right to sue because you failed to comply with the Notice of Claim statute.

 

Posted in Lawsuits, personal injury lawyers, Statute of Limitations, trial |

The Impaired Physician

February 26, 2024

Doctors are only human.  They are prey to the same frailties that plague the rest of us.  Like the rest of us, some of them become addicted to alcohol or use narcotics or other substances that can affect their judgment and performance.  Unfortunately, when this happens, their human frailty can affect the health of those of us who are or who become their patients.

Injection Drug Use and Wound Botulism | Botulism | CDC

If you think you are unlikely to encounter an impaired physician, you are wrong.  Current estimates are that 10 to 15% of physicians will experience impairment due to alcohol or drugs at some point during their careers.  Many of the same character traits which draw them to medicine and which help them become successful physicians are the same traits that predispose them to depression and substance abuse.  Physicians often find it difficult to admit to human failings, even to themselves.  They will vigorously deny any suggestion that they have an impairment problem.

Over the years I have been practicing law, I have seen a number of instances of impaired physicians harming patients.  I am sure that what I have seen is only the tip of the iceberg, however.  The statistics suggest that there are far more impaired physicians causing far more harm than ever comes to my attention or to that of the Arizona Medical Board.

Although I am frequently critical of the Arizona Medical Board, I do congratulate them on the diligence with which they approach the impaired physician.  Once an impaired physician is identified, the Board does a good job of getting them away from patients, suspending their license to practice, and of assisting them to get off substances and to return to treating patients responsibly.

The big problem for the Board, however, is recognizing the impaired physician in the first place.  Unless the Board receives a complaint, it has very little way of knowing a physician is impaired.  Many impaired physicians go unreported.  Not only are impaired physicians adept at hiding their impairment, they can count on the reluctance of those around them to report suspicions they may have, especially if the person with the suspicions is a nurse or other health professional who is rungs below the physician in the pecking order.  Those who report a doctor for suspected impairment can expect retaliation, if the allegation is not substantiated by testing.  Sometimes, friends of the impaired doctor may retaliate, even when the allegation is substantiated.  Many nurses and other health care professionals decide that it is just not worth the hassle or the risk to report their suspicions of impairment and choose to look the other way.

If you encounter a physician whom you suspect may be impaired, get away from that person as quickly as possible.  This is what you should do no matter how simple you may think the doctor’s care for you may be.  An impaired physician need not be a heart surgeon to cause you harm.

You are under no obligation to report your suspicions to anyone and there are any number of excuses you can offer for wanting to change physicians.  On the other hand, if you believe your suspicions are well-founded, you do the public a service by reporting impaired physicians.  As in all other matters medical, be alert.  Trust but verify.

 

Posted in Arizona Medical Board, disclosure of medical mistakes, Doctors, health, Hospitals, medical errors, medical ethics, Medical Malpractice, medical mistakes, Medical Negligence, Nurses, Secrecy |

Medical Tourism – Almost Always A Bad Idea

February 19, 2024

As you can probably guess, medical tourism is the name given to the practice of going to a foreign country for medical treatment, usually because it is cheaper there.  One of the most common treatments sought by medical tourists is cosmetic surgery and one of the most common places American medical tourists go is Mexico.  There are always risks associated with cosmetic surgery but they are much higher in Mexico.

Travel to Mexico for high-quality medical care - Medical Tourism - YouTube

Americans are nothing if not cost conscious.  Look at this advertisement.  Who could resist?  Affordable health care with a nearby beach and margaritas to boot.  What could go wrong?  The answer is plenty.

Mexico is plagued by shortages of medicinal drugs and some medical equipment.  In response to these shortages, some clinics resort to purchases on the black market.  They may also resort to trying to stretch the medications they do have by using a single vial to medicate two or more patients.  Last year, practices like this led to the deaths of 12 Americans who went to Mexico for cosmetic procedures and came home with aggressive fungal infections that attacked their brains.  The Centers for Disease Control has documented 14 probable and 10 possible cases of fungal meningitis among people who went to Matamoros, Mexico last year for cosmetic surgery.

The fungus is one which is common in the environment.  Those who have studied this outbreak believe the fungus was probably introduced into the spinal column through the use of epidural anesthesia, a procedure in which anesthetic agent is injected directly into the cerebrospinal fluid that bathes the spinal cord and the brain.  Normally, the blood/brain barrier keeps intruders such as this fungus out of the spinal fluid and the body handles it without much difficulty.  That is not the case, however, if the fungus is introduced directly into the cerebrospinal fluid.  Its introduction through epidural anesthesia makes the most sense.  This is where the frailties of the Mexican medical system can cause these outbreaks.

When you go to a foreign country for a medical procedure, you place yourself at the mercy of whatever healthcare system that country has.  In the United States, we have strong regulation and are vigilant about drugs and medications used on patients.  It would be very unusual, although it does occasionally occur, that you would receive a counterfeit drug here.  This is far more common, however, in foreign countries, especially if the country’s regulatory agencies are weak or if the system is corrupt.  Sadly, both are true of Mexico’s health care system.

Because their treatment occurred in Mexico, when the tourists fell ill after returning home, it was hard for their doctors to get the information they needed to diagnose the problem.  Although the doctors were pretty sure they were dealing with a fungal infection, it was difficult to pinpoint the particular fungus and different fungi respond to different treatments.  To top it all off, this particular fungus is highly resistant to most anti-fungal treatments.

Victims would report a headache one day and have a stroke the following day.  Early treatment would have helped but doctors in south Texas, where most of these people were from, had no way to identify those who had received epidural anesthesia in Mexico and were most at risk.  Public service announcements brought some people in for treatment, but for many the realization that they were very sick came too late.

In addition to the risk that you will receive a medication purchased on the black market or that a needle or other instrument used in your procedure will be contaminated, there are many other risks associated with medical procedure in foreign countries even under the best of circumstances.  Here is a post from last year on some of the other risks of medical tourism in Mexico.

An epidemiologist with the CDC recommends that, if you do go to a foreign country and have a medical procedure there, be sure to tell someone on your return so that, if you fall ill, doctors will have a head start in trying to figure out what is wrong with you.

Posted in antibiotic resistant bacteria, blood infections, Doctors, Health Care Costs, Medical Costs, Medical Devices, medical errors, meningitis, Pharmacies, Plastic Surgery, science news |

Doctors Who Steal

February 12, 2024

I have been writing lately about medical ethics, which are sometimes more ignored than followed.  The following are instances of doctors being greedy and trying to steal from insurance companies or from Medicare and Medicaid.  It doesn’t matter who you are or what you earn or what is your level of education.  Money can be tempting and some doctors, for a variety of reasons, find the temptation to be irresistible.  And remember, this is only the tip of the iceberg.

Former 'Planet Money' co-host Jacob Goldstein talks about inflation and the Fed : NPR

  • A Michigan doctor has been charged in a scheme along with a pharmacist to create fake prescriptions for specialty drugs that could be diverted and sold.  The scheme allegedly netted the participants over $7,000,000.
  • Telemedicine doctors in the Pittsburgh area were involved in a kickback scheme in which they were paid for ordering cheek swabs that were processed at the laboratory of the scheme organizer.  Medicare was billed over $60,000,000 for the unnecessary tests.
  • A Maryland doctor was convicted of defrauding Medicare and health insurers by submitting false claims for over $15,000,000 for Covid testing at laboratories he owned.
  • A Tennessee doctor was convicted of prescribing narcotic drugs that he knew his patients did not need for medical purposes and in spite of signs that they were addicted.  He was put on probation by the medical board for overprescribing narcotics, but as soon as his probation was lifted, he resumed overprescribing.
  • A suburban Chicago doctor has agreed to pay Medicare over $750,000 in restitution as part of a settlement of a civil action against him for illegal billing practices.   When he removed multiple moles from a single patient on a single office visit, he would bill Medicare for each mole and represent that each was removed on a different day.
  • Doctors from Missouri and Texas have agreed to pay the Federal Government for accepting over $525,000 in kickbacks from laboratories to order testing to be performed at the labs.  They have also agreed to cooperate in the prosecution of others involved in the scheme.
  • A Kansas chiropractor has pleaded guilty to money laundering in connection with the government’s Covid loan programs.
  • A Chicago area pain doctor pleaded guilty to Medicare fraud and has been sentenced to prison.  She signed prescriptions for narcotics to be given to her patients when she was not in the office and had not examined them.  Upon her return to the office, she billed Medicare for the examinations that never took place.
  • A dermatologist who operates clinics in southeast Tennessee and north Georgia has agreed to pay the government $6,600,000 to resolve claims that he committed Medicare fraud by falsely claiming procedures performed on a single day were performed on multiple days, and charging for multiple office visits that never occurred.

This list can go on and on for pages and pages.  The dollars involved are astronomical.  The point of this post is simply to remind everyone that doctors are human beings like the rest of us.  They are subject to the same temptations and have the same frailties as the rest of us.  You should keep this in mind when dealing with doctors.  Just because a doctor says it does not make it true.  Be trusting, but not too trusting.  Use your common sense.  Get a second opinion before agreeing to any major surgical or other type of procedure.

 

Posted in Doctors, Fee for Service, Health Care Costs, Health Insurers, Medical Costs, medical ethics, Medicare, Pharmacies |

The Private Equity Investor Will See You Now, But Only For A Few Moments

February 05, 2024

On the whole, capitalism has been good for the United States.  Lately, however, the rise of private equity companies and their incessant search for centers of profitability has put the medical profession under great strain and our health at risk.

The Smash-and-Grab Economy – Mother Jones

Illustration:  The Smash And Grab Economy – Courtesy of Mother Jones

The basic rationale for private equity is that, through the choosing of wise investments, it can achieve returns substantially higher than those of the stock market.  Sometimes their tactics can be ruinous.  For example, a private equity company may buy a business with substantial assets, but which is not performing well.  The private equity company will usually use borrowed money to finance the purchase.  After gaining control of the company, it sells off the best assets, distributes the proceeds to itself as management fees, and leaves the company owing the money that was used to buy it in the first place.  The company, which was struggling even when it still owned it best assets, is now unable to continue to operate with the debt it is carrying and is forced to go bankrupt or to go out of business completely.  When organized crime strips assets from a company, it is against the law and its leaders go to prison.  There is no such law to prevent private equity from looting a business.  When it does it, its leaders get a fat bonus.

Another commonly used private equity tactic is to increase revenue by cutting costs and raising prices.  This is the tactic that has the greatest application to health care.  Cutting costs in this context almost always involves reducing staffing levels and asking the remaining employees to do more with less.  Doctors and nurses are “urged” to spend less time with patients.  In our fee for service world, every patient visit generates a fee.  The more patients a doctor or nurse sees, the greater the fees generated.  So, if at your next doctor visit, you feel a bit rushed, that may be the reason.

When private equity takes over a medical practice and has the opportunity to do so, it raises prices.  According to a study published in 2022 in the peer reviewed medical journal JAMA Internal Medicine and based on six years of data, when private equity took over anesthesia practices at a hospital or outpatient surgery center, they raised prices by an average of 26% over prices at facilities where independent practices provided anesthesia services.

Another tactic for generating more income involves a practice known as “upcoding.”  In order to standardize insurance and Medicare reimbursement, every medical service or procedure has been given a code number.  A simple office visit with a healthy, young patient has a different code number than a visit with an older patient with a number of chronic illnesses.  The visit with the older patient is more complex and its code number generates a higher reimbursement than the routine visit with the healthy, younger patient.  There have been repeated instances of private equity owners directing their doctor or nurse employees to use code numbers for more complex visits or procedures than would be appropriate under the circumstances.

All of this pressure by private equity ownership takes its toll on doctors and nurses.  Most of the people who entered the health care field did so to help others.  Being reduced to a cog in a giant machine is depressing and repugnant to them.  Many are choosing to leave the profession.  Some of them, however, are pushing back by using a traditional American tool.  They are organizing into unions to have negotiating power with their bosses.  The longest nursing strike in U.S. history took place in 2022 and involved 15,000 nurses in Minnesota who stayed off the job for three days.  There were 27 healthcare worker strikes in 2023, most of which involved nurses but some doctors as well.  Undoubtedly, there will be more labor unrest in this critical area.

Our health is too important to leave to market forces.  There has to be a better way and there is.

 

Posted in Doctors, Fee for Service, General Health, health, Health Care Costs, Hospitals, Medical Costs, medical ethics, Medicare, Nurses |

Universal Health Care, Please

January 29, 2024

The United States is the only major developed nation in the world not to have universal health care.  We are the richest nation in the world.  Other nations can afford it and so can we.  It is not only a the right thing to do, it makes good economic sense as well.

Countries with universal healthcare : r/AmerExit

No one should die because they cannot afford health care.  No one who works hard at a job and pays their bills should be forced into bankruptcy or into homelessness because of unexpected or large medical bills.  Seniors should not have to choose between the medicines they need and food to eat.  What kind of a society would allow these things to happen?

We already recognize many of these facts.  For example, we have enacted laws that require emergency departments to treat people in a medical emergency, regardless of their ability to pay.  We have created a system of Medicare to provide health care to seniors and some others but which does not cover all health care or all medication costs.  We have federal programs to provide health care to some but not all impoverished children and adults.  But there are many who cannot afford health care and who, for one reason or another, are not able to benefit from the care programs we do provide.

The way in which we are paying for health care for some of the most impoverished is about as inefficient as can be.  If you develop a life-threatening emergency, or any emergency for that matter, you can go to the emergency department and be treated.  Although you will be billed for the care, they cannot deny you the care, even if they realize that you will never be able to pay the bill.  After you have been discharged from the hospital, the cost of that health care does not just disappear into thin air.  Doctors have to be paid.  Nurses have to be paid.  The hospital has to pay to keep its doors open.  The cost of the health care provided to the indigent person gets divided among all of the other people who go to the hospital for treatment.  Their bills are higher because the hospital has to spread the costs of treatment among all those able to pay.  Even the most conservative fiscal hawk will concede this is a terrible and inefficient way to pay for indigent health care.

The inefficiency does not stop there, however.  Why do we insist that you allow your medical problem to become an emergency before we agree to treat it?  There are very few medical conditions that do not benefit from early treatment.  If you are forced to wait until your problem has reached the level of a medical emergency, the likelihood that the doctors will be able to completely cure you has gone way down.  Think about all the health conditions that afflict poorer neighborhoods in large part because the people who live there do not get regular preventive health care.  Heart disease, Type 2 diabetes, cancers, high blood pressure, peripheral nerve diseases, liver and kidney diseases, alcoholism, and drug abuse are all examples which, if recognized and treated early, would save the United States billions of health care dollars each year and make many people healthier in the bargain.

Even those who can afford to buy health insurance or those fortunate few who have health insurance provided to them as a benefit of their employment don’t escape the risks of our terrible health care delivery system.   They may be in plans with high deductibles or high co-pays or both.  A significant, chronic illness can overwhelm even the best health insurance plans and ruin financial lives as much as the illness ruins physical lives.

And yet we continue to balk at taking the final steps to universal health care.  The reason, of course, is money.  There are very rich and powerful forces that benefit from the system as it is today.  Any change which benefits American citizens by providing good health care to all threatens their financial model and is fought tooth and nail.  Take, for example, the issue of drug prices.  We pay the highest drug prices in the world.  For many years, the American people have made clear their desire that Medicare be allowed to negotiate with the drug companies over drug prices.  Despite the clear will of the American people, Congress would not act and, in fact, passed a law forbidding Medicare from negotiating.  Finally, last year Congress removed the roadblock, but required that the negotiations apply to only a few drugs every year.  Even so, the drug companies have gone to court to stop it.  It is as yet unknown how successful they will be, but they have expensive lawyers.

In addition to the drug companies, the health insurance companies, the pharmacy benefit managers, the large hospital chains and some medical specialists would lose money, if the system were to change.  If change is ever on the horizon, prepare to be told that you will not get to choose your doctor, that you will have to wait for years to get elective surgery, that new drugs and treatments will dry up due to lack of incentive, that your life will be a living hell, and on and on and on.

We are getting closer to universal health care but we have a long way yet to go.  Please don’t give up the fight.  It is the right thing to do for all of us.

Posted in Doctors, drug companies, Fee for Service, General Health, health, Health Care Costs, Health Insurers, healthy living, Hospitals, Medical Costs, Medicare, Type 2 Diabetes |

Those Entrusted With Patient Care Need to Put Patients First

January 22, 2024

Over the past few years there have been an increasing number of stories about doctors who sexually abuse their patients.  Almost all are serial abusers.  They don’t just abuse one patient; they abuse multiple patients over the years until they either retire, die, or are caught.  What is truly troubling, and is the subject of this post, is that many of them are well-known, well-respected doctors, who work at leading hospitals or universities.  In many cases, the hospital or university has had complaints or reasons to investigate the doctors, but have done nothing.  Why not, you ask?  If you have to ask, you have not been paying attention.  The answer is, as it so often is, our old friend money.  When given a choice between money, prestige, and power or the welfare of its patients, most institutions will choose the money, prestige, and power every time.

David Newman case: Doctor indicted on sex abuse charges | CNN

Dr. David Newman was a superstar emergency medicine physician at one of New York City’s most prestigious hospitals.  He was the author of a book on the physician-patient relationship and had written several essays, which appeared in the New York Times.  He also abused women who came to the emergency department.  When he failed to sedate a female patient enough to make her oblivious to his groping her and ejaculating on her face, she immediately complained and sought DNA testing, which confirmed the assault.  As part of his plea deal, Dr. Newman, admitted to sexually abusing three other women in the emergency department.  There may have been many others for whom his efforts at sedation were successful or who were too embarrassed or frightened to report him.  How can a doctor get enough privacy at a busy emergency department to perform such acts without anyone even suspecting?  I suggest he cannot.  It is highly likely that people around him knew or suspected and decided to keep their mouths shut.  After he was accused of serial assaults, the hospital refused to release medical records which might substantiate the assaults until ordered to do so by the courts.  The hospital was protecting itself to the end.

Dr. Larry Nassar was employed by Michigan State University in its health system to treat students.  He was also a team doctor for USA Gymnastics, where he treated young female athletes.  He used these two positions to sexually abuse hundreds of young women over the years despite years of complaints about his behavior.

Dr. Richard Strauss worked in the health system at the Ohio State University from the 1970’s to the 1990’s.  During that period, he abused hundreds of young men under the guise of performing hernia checks after they suffered what were often unrelated sports injuries.  The law firm hired by the university to conduct an investigation found that coaches and administrators at the university knew for over twenty years that Dr. Strauss was sexually abusing male students but failed to take any action to stop him.

Dr. George Tyndall was a gynecologist employed by the University of Southern California in its student health program where he regularly abused young women.  He worked at USC for almost thirty years before being allowed to quietly resign with a large payout in 2017.  Complaints about Dr. Tyndall began in the 1990’s, but the university took no action.  Ultimately, the university paid out over $1 billion dollars to settle various class action suits arising out of its failure to deal with Dr. Tyndall.

Dr. Derrick Todd, who worked as a rheumatologist at the world-famous Brigham and Women’s Hospital in Boston, has been accused by over 120 women of conducting unnecessary breast, pelvic and rectal exams for his own sexual gratification.  According to the allegations, the sexual abuse took place over a period of at least 10 years.  Dr. Todd denies the allegations against him.  The allegations are working their way through the courts.

Dr. Robert Hadden was an OB/GYN at Columbia University’s medical center.  He has been accused of sexually assaulting hundreds of women over a 20 year period.  Columbia had been warned about Dr. Hadden early in that period, but took no action, which allowed him to continue to abuse women patients.  Even after he was arrested for assaulting a patient, the hospital permitted him to continue to treat patients.  Here is a link to a story about how Columbia protected Dr. Hadden and exposed women to the risk of sexual assault.  Dr. Hadden pled guilty to state charges and was convicted of federal charges related to sexual abuse.

These are just a few of the stories of doctors using their status and position to sexually assault patients.

There are many reasons why a woman or young man might not want to report that a doctor had sexually assaulted her or him.  They may fear embarrassment, ridicule, disbelief, or shame.  There is a clear power imbalance between a patient and a doctor.  Some of the accused doctors knew this and were quite brazen and open about what they were doing to their patients, almost daring them to report the assault.

When a doctor is permitted to serially abuse patients for years and years, there are almost always going to have been red flags to alert those in a position of authority that something is going on.  It is incumbent upon those in authority to be alert to those red flags and to protect the public from these predators.  They cannot, as they so often do, turn their heads and pretend not to see.

 

Posted in Doctors, Hospitals, Lawsuits, medical ethics, never events, plaintiff, Secrecy |

Hospital Secrecy Hurts Us All

January 15, 2024

Hospitals are complex business and healthcare organizations.  In large hospitals in metropolitan areas, there are teams of healthcare providers working around the clock and communicating with each other through the patient’s medical chart.  The wonder is not that errors in communication occasionally lead to a preventable error, the wonder is that it does not happen more frequently than it does.  In my experience, you cannot be in the hospital for three days without a preventable medical error occurring in your care.  Fortunately, most preventable medical errors do not cause significant harm to the patient.

Hospital - Wikipedia

Sadly, we have very little hard data about what goes on in hospitals.  For example, we don’t know how many patient deaths occur each year as a result of preventable medical errors.  The most common estimates are between 44,000 and 98,000.  The larger estimate is over two times the smaller one.  It is astonishing that our information is so scanty that hospital deaths due to medical mistakes can be so hard to pin down.  The reason our information is so scanty is that hospitals go to great lengths to keep secret what goes on inside their walls.

If you are injured while a patient in a hospital due to the fault of a doctor or a nurse, it is only on extremely rare occasions that the hospital will reveal that fact to you.  In almost every case, you will have to figure out on your own why you were injured and that it was not just one of those things that happens from time to time.  Since it is unlikely that you know much about medicine, it will be hard for you to figure out that you were the victim of medical malpractice.

In addition to keeping their mouths shut when they injure someone, hospitals have obtained protections from state legislatures in almost all the states that keep confidential most hospital investigations into patient injuries and most doctor or nurse discipline.  This is all protected under the rubric of “peer review,” the idea being that if these investigations can be kept out of the public eye, all of the participants will feel more comfortable reporting incidents and discussing what happened.  While that is the idea behind peer review, it often does not work to foster greater patient safety, but less.

It is an open secret that health care workers are reluctant to admit to having made a mistake.  They are only human, after all.  Who among us wants to admit to a mistake?  There can be serious consequences for a health care professional who admits to a mistake, or even worse, reports a colleague’s mistake.  A nurse in Tennessee who admitted that she made a mistake when withdrawing medication from a computerized drug dispenser, was prosecuted criminally when the patient to whom she administered the incorrect medication died.  Doctors who report other doctors often face either outright retaliation or more subtle forms in which their treatment of patients becomes the subject of hospital investigations.

The Joint Commission is an organization that accredits hospitals.  It encourages, but does not require, hospitals to report what are called sentinel events.  These are unexpected events that cause death, permanent injury, or serious, temporary injury to a patient.  Examples include surgery on the wrong patient or the wrong site, transfusion with the wrong blood type, overdosing a patient with radiation, and a foreign object left behind at surgery.  In 2022, 1,441 sentinel events were reported to the Joint Commission.  This is a ridiculously small number of the actual sentinel events during any given year.  If 44,000 to 98,000 patients are dying due to medical errors each year, those are all reportable sentinel events.  In addition to those unexpected events that cause death, there are many, many times more events that cause significant injury but not death.  Hospitals are not reporting their sentinel events.  They are sweeping them under the rug.

On those occasions when a hospital is sued and decides to settle the claim, it always insists on a confidentiality provision in the settlement agreement to keep the fact of the payment from the public.

Hiding mistakes hurts the public.  Only when mistakes are faced can there be steps taken to prevent the same mistake from happening in the future.  Paying lip service to improving the quality of care but taking steps that frustrate improvement does not make us safer.

Hospitals are big business, at least in most localities.  Whether they call themselves non-profits or not, they are in business to make money.  As a result, they most often make decisions on the basis of whether it is good for the bottom line rather than whether it is good for the majority of their patients.  When the choice is bottom line or patient, the bottom line is going to win.

Posted in disclosure of medical mistakes, Doctors, electronic medical records, Fee for Service, Health Care Costs, Hospital Negligence, Hospitals, Lawsuits, medical charts, medical errors, Medical Malpractice, medical mistakes, never events, Nurses, Secrecy |