Medical Malpractice News and Views


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

The Brave New World of Genomic Testing.

June 07, 2021

An organism’s genome controls its destiny.  This is as true for the human genome as it is for the genome of the Covid-2 coronavirus.  It was less than 20 years ago that scientists first sequenced the human genome.  The project took nearly 15 years and cost over $2 billion.  Today, due to tremendous strides in computing power and other technical advancement, genomes can be sequenced in a matter of hours and for only $100.00.

Experts assess potential of whole genome sequencing in food safety | Food  Safety News

The Covid-2 pandemic has been both a curse and a blessing.  The curse part is obvious.  The blessing part is less obvious to the general public.  The vaccines, which are being administered around the world, were developed in record time and have an extremely high degree of effectiveness.  Researchers were able to achieve these results using the sequenced genome of the virus.  In the “old days,” researchers working on a vaccine for a virus had to have a sample of the virus with which to work.  For Covid-2, the labs used only the genome; they never had and did not need actual virus to create a vaccine.  The lessons they learned and the capabilities they developed in this quest for a vaccine will be invaluable in many other areas going forward.

Researchers involved in genomic sequencing think its potential is almost beyond understanding.  It has already begun to spark a revolution in many fields of human endeavor.  More are on the way.

Cheap genomic sequencing will allow each individual to have his or her genome sequenced.  This will allow doctors to identify genomic mutations which have the potential to cause illness in the future.

The name given to this concept is “personalized medicine.”  It is the opposite of “one size fits all” medicine.  For example, a medication which works for some patients does not work for others.  Genomic sequencing may be able to tell in advance which patients will benefit from a particular medication and which will not.  The medication can then be given only to those likely to receive a benefit.

Crispr technology, which involves changing and substituting genes, may allow defective genes to be replaced with healthier ones.

We are apparently close to machines which can detect the presence of many cancers from a single drop of blood.

As new viral outbreaks occur, we can detect them in real time, monitor spread and develop treatments and vaccines.

Further afield, advocates suggest that genomic sequencing may revolutionize food safety.  Animals and plants can be sequenced and, using the genomic information, illnesses can be avoided and new breeds of organism can be created.

Fasten your seatbelts.  Every revolutionary technology creates upset.  That is why it is called revolutionary in the first place.  We may not always like the changes that are brought about by genomic sequencing.

Posted in drug companies, genetic testing, Health Care Costs, healthy living, medical research, science news, Vaccines |

Health Care Rationing Is Here And Always Has Been.

May 31, 2021

Very few words stir more passion when discussing health care than “rationing.”  It sounds terrible.  It conjures up images of loved ones being denied life-saving treatment.  It gives rise to attention-seeking politicians claiming there are “death panels” coming for you and your grandmother.  A phrase with the same meaning, but not the same emotional overtones, is “resource allocation.”  Either way, they mean the same thing; rationing is here and has been as far back as you care to look.

Rationing - Ohio History Central

Here is an excellent article on the necessity of rationing health care and the ethics involved in that process.  I will borrow liberally from it in my discussion below.

Rationing occurs at two levels.  The first is the macro level.  Societal resources are finite while the needs which must be addressed by those resources are limitless.  There is only so much money to go around.  Bridges must be built.  Armies (perhaps) must be funded.  Schools must be built and teachers paid.  Healthcare is just another social need, which must be paid for out of limited funds.  Most people probably don’t even think of macro allocations when considering rationing of health care, but it is clear that decisions made about macro allocations must, of necessity, affect health care availability and decision making at the individual level.

The second level of rationing is the micro level where decisions are made in individual cases.  This is what people think of when they think of rationing.

Sometimes, the rationing takes place in such a way that no one even recognizes it as rationing.  When a doctor treats a patient in the ICU, for example, the doctor must decide how much of her time to devote to that patient.  The doctor has other patients and has a life away from the hospital as well.  As a matter of course, the doctor rations her time with each patient based on a number of factors that probably change from patient to patient and from day to day.

We saw rationing at the height of the Covid pandemic.  Ventilators were in short supply and not everyone who might have benefited from being on a ventilator had one available to them.  ICU beds and even regular hospital beds were sometimes all in use when a new Covid patient arrived at the hospital.  The new patient was often placed in the emergency department or even in an empty cafeteria until a bed could open up.  Even more critical than the shortage of beds was the exhaustion of the health care providers themselves.  Some got sick and died.  Those that managed to make it to work every day were overwhelmed by the workload.  Some patients certainly died as a result of the scarcity of medical equipment and medical care.

The article I cited has an enlightening discussion of the various principles, which have been suggested for rationing health care.  When you look at them, they are based on reasonable arguments but each of them has some flaws and none solves the problem that we as a people recoil from the death of identifiable patients.  We are much more accepting of large numbers of impersonal deaths, as shown by our willingness to avoid those steps which might have saved a hundred thousand lives or more during the Covid pandemic.

Among the suggested principles are (1) Utilitarianism (Get the most bang for your buck, the greatest societal good); (2) Egalitarianism (Everyone gets the same chance at the scarce health care maybe by using a lottery system to decide who gets treated); (3) Prioritarianism (One example would be to give priority to young people).

While rationing of health care is a necessity and already occurs in both obvious ways and ways which are not so obvious, we cannot agree on how to do it in a way which avoids controversy.  Rationing is at odds with many basic human emotions.  Even when we accept the idea of rationing, rationing always looks better and fairer when it is your family member, who is receiving the scarce treatment, and it is someone else who loses out.

The debate over rationing is not going away anytime soon.  You can expect it to flare up from time to time before returning to a smoldering glow.  On those occasions when it does command the headlines and politicians are trying to make hay with it, remember that rationing is inevitable and look for the person proposing the fairest solution.  Don’t let them just decry rationing and not explain how they would allocate scarce medical resources, including money.

 

 

Posted in Health Care Costs, Medical Costs, medical ethics, Rationing, Secrecy |

Do I Have A Medical Malpractice Case? Part 2

May 24, 2021

Last week I began the discussion of the necessary elements of an economically viable medical malpractice case with a review of the standard of care issue.  This week I will address the remaining elements.

Ask The Writer: Is it alright to use multiple question marks? - The Writer

Proving a breach of the standard of care is only the first step in a successful medical malpractice case.  After proving a breach of the standard of care, you must prove that you were injured as a result and that your injury would not have occurred in the absence of the breach of the standard of care.  This is another area where the defendant provider has a big advantage.  How is that so?

You are being treated by a medical provider because there is something wrong with you.  You have a medical issue.  These issues are frequently complicated.  The provider almost always argues that whatever happened to you was going to happen anyway or had already happened or was just a bad result that was no one’s fault.  In addition to your expert on the standard of care, you must produce one or more experts to testify that the breach of the standard of care caused you an injury.  The defendant will also get to bring to court one or more experts to testify that the defendant’s conduct did not cause the injury you are complaining about.

All these experts cost money.  If a case has multiple defendants, the plaintiff will need to hire multiple standard of care experts and perhaps multiple experts to testify on medical causation.  In the simplest cases, the cost of experts and depositions runs at least $35,000.  Many cases easily exceed $100,000 in costs.

If I take your case, I will advance the costs.  If I am successful in getting a recovery for you, I will first subtract my fee, which will usually be 40% of whatever I recover.  I will then reimburse myself for the costs I have advanced.  If I am not successful, I get no fee and will not ask you to reimburse me for the costs I have advanced.

In the event of a settlement, which is what you should want to happen, each side bears its own costs so your costs come out of your recovery.  Let’s assume a simple case with a $100,000 settlement.  After deducting the fee of $40,000 and reimbursing costs of $35,000, there is only $25,000 left for you.  If the costs are higher, there is even less for you.

If the case does not settle and goes to trial, your situation is different.  In the first place, doctors and hospitals win 85% to 90% of all cases that go to trial, even when the facts for the victim are strong.  Doctors and hospitals win so often because juries find it difficult to accept that doctors and hospitals kill and injure people.  If you lose at trial, you will owe the defendant provider its “taxable” costs.  These are a subset of actual costs but will usually be no less than $20,000 and can be far in excess of that.  You will also owe the county for the fees it paid to the jurors.  Depending on the length of the trial and the number of alternate jurors, this amount will usually be between $5,000 and $10,000.  In the event you win at trial, the defendant will owe you your “taxable” costs, which will mean more money for you in addition to the money awarded by the jury for damages.

As you can see, a case with a settlement value of $100,000 does not make economic sense.  Unless a case has a probable value in excess of $300,000, it is difficult to justify the costs which will have to be invested and the risk that you will end up owing the defendants and the county many thousands of dollars.

Prospective clients often tell me that they don’t really want to go to trial.  They are sure that whoever harmed them will want to make a quick settlement.  They are almost always wrong.

Doctors and hospitals have liability insurance to pay for any cases they lose.  The insurance policy for a doctor usually gives the doctor the right to consent to settlement.  If the doctor won’t consent, the insurance company cannot settle the case, no matter how badly it may wish to settle.  Since any settlement results in the doctor being reported to the Medical Board, doctors are understandably reluctant to give consent.  Many of them are also offended that you would even think of suing them after all they did for you.  Many refuse to give consent out of a belief that they didn’t do anything wrong and are likely to win at trial.  Even if the doctor gives consent, the insurance company will almost always want to play hardball and to delay resolving the case to put as much pressure on you as they can.  They know that if they go to trial, they are likely to win.  They also want to discourage future suits, so they stonewall plaintiffs.  When they do finally get around to settling a case, they offer only small amounts in settlement.

The only way to tell if your case is one which makes economic sense, that is one in which the potential recovery exceeds the risks of filing suit, is to take your case to an experienced medical malpractice attorney.  The attorney will review your records and evaluate the injury you suffered.  He or she may send your records out to a provider in the same specialty as the potential defendant.  If the standard of care reviewer is prepared to testify that the provider fell below the standard of care, the attorney may send your records to other experts to get opinions about medical causation and future damages.  The attorney will do everything necessary to determine if your case is one which makes economic sense for you and for the attorney.  Everyone has to be on board and have a good understanding of what the attorney is going to do and the chances of success.

Unfortunately, most of the people who contact me do not have an economically viable medical malpractice case.  There may be many reasons but the most common is that the damages are not large enough to justify the investment of time and money the case would require.  It is a sad commentary on our civil justice system that only people who suffer big injuries can afford to sue.  Those who suffer small injuries or who make a good recovery from their injury will not usually be able to find a qualified medical malpractice attorney to represent them.  Fairness would seem to require that even those with small injuries caused by medical malpractice should be compensated for those injuries.  Sadly, that is not how our system works.

 

 

Posted in Arizona Medical Board, Doctors, Hospitals, Lawsuits, Malpractice costs, medical errors, Medical Malpractice, Medical Malpractice Case Value, medical malpractice cases, medical malpractice lawsuits, medical malpractice lawyers, Medical Negligence, plaintiff, Valuing Damages in Medical Malpractice Cases |

Do I Have A Medical Malpractice Case? Part 1

May 17, 2021

This is a question I hear on an almost daily basis.  In order to answer it, we must first discuss what is meant by  “having a medical malpractice case.”  There is a lot of ground to cover and I am going to take two posts to cover it.

Ask The Writer: Is it alright to use multiple question marks? - The Writer

Technically, anyone who has been injured by medical malpractice has a malpractice case which could be pursued in court.  However, a malpractice case which has a chance of being successful in court requires quite a bit more.

Medical malpractice cases are among the most expensive and complex cases an individual can have in our civil justice system.  They exist at the intersection of law and medicine.

In order to prove that you have been the victim of medical malpractice, you must start by proving that the health care provider in question fell “below the standard of care.”  The standard of care is that minimum standard which would be observed by a similar health care provider in the same or similar circumstances.  If you are scratching your head at this point and asking, “What in the heck does that mean?”, you are beginning to appreciate the nature of the problem.

Proof of the standard of care is the cornerstone of a medical malpractice case.  If you cannot prove a breach of the standard of care, you cannot win.  The standard of care is almost never written down.  It is what health care providers say it is.  It differs from specialty to specialty.  In other words, what a trained and experienced cardiologist might do may be different from what a family practice doctor would do in the same situation.  You have to prove that a reasonable provider in exactly the same specialty or area of practice as the defendant would have done things differently than the defendant.  Put another way, if any reasonable provider in the same specialty as the defendant would have done things the way the defendant did them, you lose.

The standard of care being what providers say it is gives them a big advantage.  Since it is not written down, it gives health care providers room to argue about what the standard really is.  As the plaintiff, you have to prove what the standard of care is in your case.  You do this by bringing in an expert witness in the same medical specialty as the defendant to testify that no reasonable provider in that specialty would do what the defendant did.  The defendant gets to come in an say that what she or he did was a good example of the standard of care.  The defendant also gets to call their own expert witness to testify that lots of providers do what the defendant did.  As you can see, the defendant gets two witnesses to say the defendant complied with the standard of care as compared to your one.  To win at trial, the jury has to decide that your one witness is more believable than their two witnesses.

I will cover medical causation and the remainder of the analysis next week.

 

Posted in Arizona Medical Board, Doctors, Hospitals, Lawsuits, Malpractice costs, Medical Malpractice, Medical Malpractice Case Value, medical malpractice cases, medical malpractice lawsuits, medical malpractice lawyers, Medical Negligence, plaintiff, trial, Valuing Damages in Medical Malpractice Cases |

“The Hip Bone Is Connected To The Thigh Bone.”

May 10, 2021

Our bodies are beautiful machines that evolved over millions of years to keep us alive and healthy.  My practice requires me to do a lot of studying about the human body.  I am continually amazed as I come into contact with the autonomic processes that go on behind the scenes.  For example, our kidneys have to excrete just the right amount of water to keep our sodium levels within the normal range.  Our immune systems keep constant watch for foreign invaders.  The autonomic system watches and controls our blood pressure, our heart rate, our respiration rate and so many other bodily functions that we take for granted and almost never notice.  If even one of these processes stops working properly, we will get sick and may even die.  But like finely tuned machines, most of the time they just keep on working exactly as nature intended.

Autonomic Nervous System | SpringerLink

Even though these systems have been developed over millions of years and almost always work just fine (at least while we are younger), we can and do often make things hard on them.  My title for this post is intended to emphasize how all the systems in the body are interrelated.  If we let one fall into disrepair or damage it through abuse, other systems will feel the effects.

I am reminded of this on nearly a daily basis in my general science reading.  We live in a world quite different from the one our bodies evolved to handle.  For millions of years, our ancestors had to work hard to find enough food to keep body and soul together.  They evolved to take maximum advantage of every calorie they could find.  Calories that were not needed were stored as fat for next week or next month when they might not be able to find enough to eat.  If their bodies lost too much weight, the system would go into economy mode by slowing its metabolism to make energy use more efficient.

Fast forward to today.  Today, thankfully for most of us, getting enough to eat is not the problem.  The problem is just the opposite.  We eat too much food and much of it is highly processed and rich in fat and calories.  Our thrifty bodies dutifully store the extra energy as fat and resist our occasional efforts to slim down.  The fat stores go beyond that necessary to get through the next month or so of lean times.  The fat starts to clog our arteries.  It begins to put extra stress on our heart and lungs as we have to move all this extra weight around.  Some of the fat is stored in the liver and interferes with its function.  We become even more sedentary and our hearts and lungs, which need motion and exertion, lose their ability to do their jobs properly.

As I remarked in a different post, every step we take away from the environment in which our bodies evolved, takes us further into the unknown where our bodies don’t work as well as before.  For example, that immune system standing guard on the lookout for invaders doesn’t have much to do in our increasingly antiseptic world.  The result is a rise in autoimmune diseases in which the immune system gets confused and attacks its own body.  Think Type 1 diabetes and rheumatoid arthritis.

While there are a few “back to nature” types, they are in a minority.  Most of us do not want to go back to the bad old days of our ancestors.  On the other hand, we really should be careful not to let the modern world destroy the ability of our bodies to keep us healthy.  That means moderation.  Moderation in the foods we eat and the amount of those foods.  Moderation in what we drink.  Moderation in activity levels.  Get up off that couch.  Start moving that body and maybe it will be able to take care of you for a long time to come.

Posted in General Health, health, healthy living, Obesity, obesity epidemic, Type 1 Diabetes |

The Continuous Glucose Monitor and Type 2 Diabetes.

May 03, 2021

The latest marketing campaign directed at Type 2 diabetics is intended to sell them continuous glucose monitors (CGM’s).  Since there are estimated to be over 30 million Americans with Type 2 diabetes, there are a lot of potential customers.

Continuous Glucose Monitors for Young Children with Type 1 Diabetes

For those with Type 1 diabetes, glucose monitoring is a matter of life and death.  They are not able to make any insulin on their own and must frequently test their blood to know how much insulin to give themselves to keep their glucose levels in a proper range.  Too high a glucose level over a long period of time will result in permanent injuries, including diabetic retinopathy and diabetic peripheral neuropathies.  Blindness and limb amputations may follow.  If blood glucose gets too low, even for a short period of time, it can cause the patient to lose consciousness, to go into a diabetic coma and even to die.

Type 2 diabetics, on the other hand, still make some insulin.  Generally speaking, however, their bodies don’t react to it as well as do persons without diabetes.  Their blood glucose levels tend to spike after eating and then decline.  Some Type 2’s even have to give themselves supplemental insulin as their bodies do not make enough.

The old fashioned way of checking blood glucose levels is through the use of a finger stick.  A drop of blood is then placed on the end of a test strip.  The other end of the strip is inserted into a device, which analyzes the blood and displays the blood glucose level in a window.  This is the gold standard and is extremely reliable.

Continuous glucose monitors, on the other hand, have a small probe, which is inserted into the patient’s body, often into the upper arm or the abdomen.  It senses, not the blood glucose level itself, but a closely related level of glucose in the fluid between the cells.  The glucose between the cells lags behind blood glucose and is usually somewhat different from it.  When blood glucose is on the rise, the interstitial glucose will be lower than the blood glucose.  The faster blood glucose is rising, the greater the gap.  When blood glucose is dropping, the interstitial level will again lag behind but now will be higher than blood glucose.

Type 2 diabetics do not need to check their glucose levels multiple times a day, as do Type 1 diabetics.  Since their bodies are making some insulin, they only need a general idea of how they are doing.  They should check their blood glucose at least once a day and adjust their diet and activity levels accordingly.  Those Type 2 diabetics who must give themselves insulin may need to check blood glucose more often.

The problem with continuous glucose monitors is primarily one of cost.  Testing actual blood glucose through a finger stick costs around a dollar a day.  Continuous glucose monitors, on the other hand, are expensive.  It is reported that, without insurance, the annual cost of a CGM is between $1,000 and $3,000.  New models, however, are coming on the market that bring the cost way down.  These are being marketed heavily on television.

This is another example of expensive technology or expensive medication being marketed directly to patients, who may not really need it and who are in no position to truly judge the merits of the product.  When we wonder why we spend so much on health care and get so little for it in return, the marketing of CGM’s should come to mind.  One thing you have to say for it is that the drug and device industry knows its market and is ruthlessly successful in pushing its message.

Posted in drug companies, General Health, Health Care Costs, Health Insurers, Medical Devices, Type 1 Diabetes, Type 2 Diabetes |

“Blame The Patient”

April 28, 2021

“Blame the patient” is Play #2 in the medical malpractice defense lawyer’s playbook.  Play #1, of course, is “Deny, deny, deny.”  “Blame the patient” is #2 because it is so effective.  It plays into the human nature of the members of the jury.

Stop the Finger-Pointing: How to Avoid Blame Culture on Your Project Team |  Adobe Workfront

Psychological studies have shown that jurors, like all the rest of us, try to make sense of the world around them in a way that minimizes psychic distress.  This has profound implications when jurors hear a medical malpractice case.

The plaintiff, the patient, is asking the jury to find that the doctor or the hospital made a mistake that caused injury, or sometimes even death.  It is upsetting for jurors, or for any of us, for that matter, to believe that doctors or hospitals make mistakes that kill and injure people.  It is much more comforting to believe that they do not and that we can trust doctors and hospitals to get it right when they treat us or our families.

So how to explain what happened to the plaintiff?  This is where “blame the patient” comes into play.  If a juror can conclude that the patient acted inappropriately in some way, did something the juror tells himself he would never do, then whatever happened wasn’t really the fault of the doctor or hospital.  Whatever happened to the patient would not happen to the juror because the juror would never do what the patient did.  Now the juror has a comfortable way to view what happened.  Now the juror can decide the case in a way that won’t cause future worry about malpractice.

Some of the stories jurors tell themselves are truly mind-boggling.  For example, patient is sent home from the emergency department after coming in with a complaint of chest pain.  Patient arrives home and shortly after has a fatal heart attack.  Many jurors will refuse to find for the patient’s family on the grounds that the patient should never have gone home at all.  The patient should have known something was wrong.  The patient should have gone directly to another hospital and been checked out.  The juror tells himself he would never have gone home.  Therefore, the patient did not act reasonably in going home and his family should not win the case.

This theme repeats over and over: Patients should not believe what doctors tell them.  The jurors tell themselves that they would have gotten a second opinion, which would have discovered the problem.  The jurors tell themselves that, when told to come back next week, they would have come back the next day, which would have discovered the problem.  Jurors tell themselves that they would have gone on line and researched the prescription ordered by the doctor, which would have discovered the problem.

All of these explanations are inconsistent with human nature.  When dealing with doctors, we are sheep.  We are afraid of our doctors.  We are afraid they will be offended, if we question them or do not do as we are told.  We obey our doctors.  If the doctor says to come back next week, we don’t come back the next day.  Pretty much no matter what happens, we figure the doctor knows best and we wait to return in a week.

If the doctor in the emergency room tells us our chest pain is nothing to worry about and we can go home, we are not suspicious that they missed something.  Instead, we are happy.  We are grateful for the good news that we are not going to die of a heart attack.  We do not go to the next emergency department down the street.  We go home.

These psychological defense mechanisms, which we all carry around with us, help explain why doctors and hospitals win 85% to 90% of all malpractice trials.  Jurors want to do the right thing but human nature gets in the way and makes it difficult to find for the patient or her family.  It is a difficult problem, which is made even more difficult by the fact that jurors don’t even realize there is a problem.  Human nature is not going to change.  A good trial lawyer needs to take this into account when selecting a jury and try to get one which will be receptive to the argument that the doctor or hospital made a mistake, which injured the patient.

 

Posted in disclosure of medical mistakes, Doctors, heart attack, Hospital Negligence, Hospitals, Lawsuits, medical errors, Medical Malpractice, medical malpractice cases, medical mistakes, Medical Negligence, Medication Errors, plaintiff, Prescription Errors, trial |

The Coming (?) Telehealth Revolution.

April 19, 2021

The telehealth revolution is either coming or it is already here.  It depends on whom you ask.  Regardless of whom you ask, they will be quick to tell you that more is on the way.  As with any fast-growing field, there are many problems and many unanticipated consequences.

Our New Telehealth Services | Fenway Health: Health Care Is A Right, Not A Privilege.

A number of states changed their rules because of the Covid-19 pandemic to allow increased use of remote technology to deliver medical care.  The idea was that the pandemic was keeping many people at home, including those who needed medical care.  Even those who were willing to go out a little were reluctant to go to the doctor’s office.  Doctors needed to keep seeing patients but were reluctant to expose themselves and their staffs to infection.  Even in the absence of pandemic-related changes in behavior, there are many communities in which good healthcare is not regularly available.

The answer many states chose was to loosen the rules and to permit doctors and other healthcare providers to interact with patients who were sitting in front of their computers or looking at their phones from home.  The response was so strong and generally received so positively by the public that there is great pressure to make the changes permanent.

As those of you who are regular readers of this blog know, the availability and quality of healthcare in this country is largely driven by our old friend, money.  Residents of big cities get lots of hospitals and doctors.  Residents of small towns in the countryside get fewer doctors, fewer medical specialists and smaller hospitals that offer fewer services.

Not only are the best hospitals found in the big cities, most of the top doctors are found there too.  Small towns often get what is left when it comes to doctors and some can’t get any doctors at all.

Telehealth or telemedicine is supposed to be a cure for this disparity.  Everyone with a computer can have access to the best doctors.  If you need an operation, you may still have to go to the hospital but most other care can be delivered from long distance.

Money is also the root of many complaints about telehealth.  Doctors are territorial.  They want to protect their turf from interlopers.  They have often spent a lot of time building up their practices and cultivating referral sources among the other doctors in the region.  This goes out the window when someone from another city, or perhaps even from another state, can solicit their existing or prospective patients.

As with brick and mortar stores that have difficulty competing with on line sellers of the same product, local doctors who must maintain physical offices are at a financial disadvantage when competing with a doctor or provider who only has an on line presence.  The frenzy that accompanied on line sales is now beginning to envelop telehealth for all the same reasons.  There is money to be made.

The local doctors forced to compete with the on line providers complain that the on line providers have financial advantages, that they are not as well-regulated as local doctors and that they are siphoning off the best and most lucrative patients, which makes local medical care more expensive for those who continue to see the local doctors.  On the other hand, the on line providers claim that they are providing care to those who cannot get it under the existing system.  They claim to be serving the underserved or the forgotten and helping to solve the problem of a nationwide shortage of doctors.  This battle between well-financed doctors and technology start ups will be fought in the media and at the state legislatures for the foreseeable future.

The prospect of money, of course, attracts fraudsters.  Some are just looking for identities to steal.  Some are engaging in the same fraud we routinely see in Medicare cases; they are overcharging for services they actually provide and/or charging for services they never provided.  Some are taking money in return for providing non-existent access to vaccines or for phony Covid cures.

Every new technology is disruptive to one extent or another.  Telehealth is a good example of such disruption.  Be careful how you use telehealth while the kinks are being worked out.  For that matter, always be careful, even when it appears the kinks have been worked out.

 

 

 

 

Posted in Arizona Medical Board, Board Certification, Doctors, Fee for Service, Fraud, General Health, Health Care Costs, Hospitals, Medical Costs, medical ethics, Medicare, science news, Vaccines |

Small Town Hospitals And The Profit Motive.

April 19, 2021

If you live in a small town, you probably have a problem obtaining quality health care.  Big cities get the big hospitals and lots of doctors practicing every medical specialty you can think of.  Small towns get what is left.  They get a small hospital, if they get any hospital at all, and not very many doctors.  If you need specialty medical care and you live in a small town, you may have to go to the big city to get it.  These problems are baked into the system and are structural.  There is not much anyone can do about it.  Things get worse, however, when the local hospital gets purchased by a group looking to make as much money as possible.

Free Dollar Sign Cliparts, Download Free Clip Art, Free Clip Art on Clipart  Library

The Wall Street Journal runs some excellent stories about the business of health care.  One of their most recent had to do with the problems of a small town in Wyoming after a firm controlled by a private equity firm bought their town hospital and merged it with another one it owned in a town 30 miles away.

There is a substantial conflict between the goals of private equity and the goals of a small town hospital.  To a certain extent, this conflict exists in all hospital settings, even when the hospital is owned by a non-profit company, but they are most pronounced in small town hospitals owned or controlled by private equity.  Fully 24% of the hospitals in the United States are owned by for-profit investors.

The goal of private equity is to make as great a return on investment as possible.  Private equity often uses debt aggressively to finance dividends and frequently sells off assets to either finance dividends or to reduce debt.  Private equity is attracted to small, rural hospitals because it perceives there is the potential to make a lot of money.  If you have to go to a small town hospital, you don’t want it to be run by someone who is trying to make as much money as possible.  You want it run by someone whose primary goal is to provide the best health care possible and who is not concerned with making a profit.

Even if you do not have to go to the hospital, you have a stake in it.  If there is a hospital in your town, it is often a major force in the local economy.  It provides good quality jobs and its presence is attractive to local employers and their employees.   It is important to the community that the hospital remain open and in good functioning order.  Private equity, on the other hand, may, and often does, close hospitals that are not making enough money.  It cuts corners and scrimps where it can and sometimes even where it cannot, if it thinks it can get away with it.

When the only hospital around closes, it has a big impact on the town and its residents.  The jobs and economic activity associated with the hospital are lost.  People have to go further to get their health care.  The effect is not just economic, of course.  According to the Journal article, research has linked higher rates of mortality due to time-sensitive conditions, such as stroke and heart attack, to hospital closures.  No surprise there.  If you have a time-sensitive condition, the longer it takes to get you to a hospital, the less chance you have of surviving your illness.

The small Wyoming town, which is the subject of the Journal article, is trying to build a new hospital to compete with what is left of its old hospital.  The old hospital lost many services when it was merged with the hospital 30 miles away.  The private equity firm which controls the two hospitals is trying to protect its investment by opposing the new hospital.  It is lobbying Wyoming’s elected officials to oppose loans to the new hospital without which it cannot be built. It claims the new hospital will not replace the lost services and that the existing hospitals are doing a good job of serving their communities.

To be perfectly frank, we in the United States of America should not even be having this discussion.  We are having it because medicine is a big business in which even the “non-profit” companies are trying to make money.  As a result, we pay more per person for health care than any other developed nation and get less for our money than anyone else.  When measured by health outcomes, we do a poor job of providing care.  We have many citizens who are uninsured and cannot afford care.  They are forced to wait until they are really sick and then they show up at the emergency room, where the doctors are legally obligated to treat them.  It is long past time that we join the rest of the developed world and provide universal health care to our citizens.

Posted in Doctors, General Health, Health Care Costs, heart attack, Hospitals, Medical Costs, medical ethics, Stroke |

Your Medical Records Access Is Changing

April 12, 2021

You have a right to see your medical records.  Recent changes in the law and in federal regulations are increasing your rights in this area.  Know your rights and take advantage of them.

Check Your Medical Records For Dangerous Errors | Kaiser Health News

If you have received medical treatment in the past couple of years, you have probably been invited to register to use a patient portal by your provider.  These portals have many uses.  You can schedule appointments, exchange messages with your provider and review your records.  These are all important and helpful actions and you should be sure to register and take advantage of them.

Perhaps the most revolutionary of these actions is the opportunity to see your medical records almost as soon as they are created.  You get to see what the doctor or other provider has written about you and about your visit.  New regulations, which just took effect earlier this month, prohibit most blocking of access to a patient’s records and require that you be provided electronic access to eight types of medical records.  These categories include histories and physicals, which are important in setting the stage for your treatment and identifying your chief complaint, consultant notes, procedure notes, imaging reports, laboratory reports, pathology reports and office notes of the provider.

As I have written before and as anyone who has looked at their medical records can attest, medical records often contain inaccuracies.  Somebody gets something wrong.  It may be a part of the history of your illness that you correctly described to the provider but the provider misunderstood or misheard.  It may be a diagnosis that someone erroneously made.  It may an incorrectly recorded test result.  In what can be a devastating error, the record may actually refer to a completely different person, who may have the same or a similar name.  Whatever it may be, once it is in your records, it tends to stay there and to be repeated over and over until it takes on the character of undeniable truth.

The almost real time access to your records provided by the new regulations gives you the opportunity to nip these errors in the bud, or to at least correct them before they can cause you actual harm.  You can ask that the errors be removed and the record corrected.  The provider, as a matter of law, has 60 days in which to respond to your request.  If the provider denies your request, they must notify you in writing and keep your request and their denial as part of your medical records.  It is important, therefore, that you put some thought into your request and make it clear and complete.  Be sure to carefully describe the record you contend is in error and what is needed by way of correction.

The world around us is changing fast.  Sometimes those changes are to our detriment.  Sometimes, as with the requirement for electronic access to your medical records, the change is a good one.  Take advantage of this change to review your records before some mistake you didn’t even know was there bites you on the rear end.

Posted in Doctors, electronic medical records, health, Hospitals, medical charts, medical errors, medical mistakes |