Wednesday, September 3, 2008

Reducing healthcare costs

I have been waiting patiently to hear the presidential candidates set forth their positions regarding patient safety, physician discipline and tort reform. (I have all but given up on immigration.)

It seems to me that the national discussion on tort reform ended when the Bush (43) administration commissioned the study that concluded the failure to discipline bad doctors was a core problem (as opposed to frivolous lawsuits).

Organizations that purport to care about patient safety and high quality of medical care are frankly nothing more than lobbying organizations and political action committees (PACs) that are designed to protect the financial interests of their clients (medical care providers, corporations and pharmaceutical companies).

1. American Medical Association (AMA) -

a. The AMA controls state medical societies and physicians must be members of the county and state medical societies in order to be members of the AMA. But what is the attraction to become a member? In that way, the AMA operates as a pyramid scheme!

The public is led to believe that members of the AMA are physicians who care primarily about patient medical care? The public has (again) been misled.

Perhaps membership with the AMA reveals a physician's primary professional concern - being sued for medical malpractice. What about patient care and being a better practitioner?

There is a strong financial component to the business relationship between the physicians and the malpractice insurance carriers and the state medical societies (Illinois: ISMS & ISMIE).

In Illinois, until insurance oversights and regulations were put into place in 2005, ISMIE completely controlled medical malpractice insurance premium rates and actually charged non-society members an extra premium amount to obtain the malpractice coverage. The 2005 medical malpractice law mandated malpractice insurance changes that would lead to decreased premiums and competition.

(The law also provides for non economic damages caps and the creation of the Illinois Medical Disciplinary Board - neither of which have materialized.)

b. The AMA actively enables "bad doctors" by endorsing and advocating the concept that if a physician/surgeon testifies in court for a medical malpractice plaintiff then the physician/surgeon is "practicing medicine" by virtue of the testimony.

The AMA does not prevent physicians from testifying for defendant doctors. But, the AMA does not even support the treating physician testifying on behalf of his or her own patient!

Okay, the AMA actually does more than just endorse the concept that physicians cannot testifying against a defendant doctor. It is one thing for the AMA to reject the idea of peer review discipline and state disciplinary procedures. But, it is quite another thing for the AMA has a litigation group within the AMA that represents defendant physicians sue the expert witnesses that testify against them!

c. The AMA routinely promotes political positions that are far left of liberal.

d. I do not know what percentage of physicians chose to belong to the AMA and its soldier county and state agencies. However, I completely understand why Carle Clinic Association orthopedic surgeon Dr. Chris Dangles devotes considerable time and money to the lobbying organizations and PACs.

Whereas a good surgeon might devote his time and efforts to perfecting surgical technique, a "different type of surgeon" might prefer to dedicate his resources to groups who actively protect "bad doctors" from their own negligence.

2. state medical societies -

see above AMA discussion. In Illinois, the Illinois State Medical Society is replete with lobbying, political and related assistance for "bad doctors"

a. Capitol Medlog
ISMS introduced Capitol MedLog – an electronic notebook of the Illinois General Assembly’s deliberations and activities on legislative issues relevant to Illinois physicians and patients. Capitol MedLog’s timely updates and in-depth analyses of the legislative process are not available to the general public but are available for members only.

b. Illinois General Assembly
The ISMS lobbying team is recognized by Springfield lawmakers as the best resource for information on medicine and health care delivery. Every legislative session ISMS is in the middle of the crafting and review of hundreds of legislative proposals. Your medical society regularly provides public testimony in the State Assembly and goes on record with the Illinois physician opinion. The advocacy doesn’t stop with the legislation. ISMS is also connected with the key state agencies and they strive to monitor and improve the regulatory process and remove bureaucratic hassles.

c. Federal Affairs
Many of the issues Illinois doctors face are national in scope and ISMS plays a role in crafting sound federal policies. Working with the American Medical Association, ISMS works to assure that Illinois’ health care interests are well represented at the national level.

IMPAC, the Illinois State Medical Society Political Action Committee, is a separate, voluntary, nonpartisan, not-for-profit committee that supports candidates who share the views of the medical profession.

Hmmm. Why doesn't ISMS have a PAC or lobbying resource for patients who are injured by medical error? ISMS could advocate for no fault malpractice insurance and an effective medical disciplinary board.

3. American Association for Retired Persons (AARP) -

AARP is a very powerful lobbying force. I don't particularly understand the "United We Fail" campaign. The AARP website sets forth an ambiguous and vague platform, including:

Americans have a right to quality, affordable health care. Today, too many Americans don't get the health care they need, while paying exorbitant costs for insurance that covers too little. When the benefit of health insurance locks Americans into jobs or forces them to drastically alter their lives in order to afford the most basic of care, something needs to change. We can achieve that change if we work together. Divided We Fail.

It is just plain naive for Americans to think that that they should not have to pay any medical bills so long as they have health insurance. It is a waste of AARP lobbying time to have congresspeople sign on to the "United We Fail" platform. The out of control medical costs cannot be "fixed" by the United States Congress. (especially when "fixed" to the AARP apparently means pay all of my medical bills.)

So, how can we reduce medical costs?

1. Honesty and transparency in medical costs.

There should be "truth in pricing" as it relates to medical care.

Medical care providers should not charge different prices for the same service as a function of the health insurance provider. Currently, the medical care providers (i.e. physicians, medical groups, hospitals) enter into contracts with each healthcare insurance company. Those specific contracts set forth the financial amount that will be charged and paid.

2. Integrity and accountability for medical errors and negligence.

Health insurance companies should not pay for "never events." Medicare and other commercial insurance companies have finally had the guts to proclaim that certain events (hospital falls, infections while in hospitals, etc) simply never should happen.

But the refusal to pay for "never events" is only the first step. There should also be accountability and consequences for a "never event." Think: doctor discipline.

Medical care providers should adopt the "Sorry Works" philosophy and they should be backed by state legislatures.

Medical care providers should mandate peer discipline.

State medical disciplinary boards should discipline "bad doctors."

There should be no statute of limitations on discipline. Recall that the IDFPR (the closest thing that Illinois has to a medical disciplinary board) told me that they could not investigate Dr. Chris Dangles, an Illinois orthopedic surgeon whose testimony the IDFPR characterized as "of concern," because 4 years had passed since since the care and treatment. Of course, I still face additional orthopedic surgeries to repair Dr. Chris Dangles' care and treatment. (There's no SOL on how long it takes to repair the initial surgeries by Dr. Chris Dangles.)

Detailed information about physician discipline and civil and criminal litigation available to the public. All Attorney Registration and Disciplinary Commission information about me (allegations about mental health, depression and the kitchen sink) are on the ARDC website forever. The public does not even have to access the ARDC website to read about my history of depression. Unfortunately, there is no mention of the unnecessary orthopedic surgeries by Dr. Chris Dangles in my attorney disciplinary files.

My attorney at the time (William Moran of Springfield , Illinois) apparently thought that painful, repeated, unnecessary and disabling orthopedic surgeries would not effect my mental health, my ability to concentrate and properly practice law or even my ability to ambulate to hearings! Attorney Bill Moran did not permit me to mention the surgeries as being a factor in my diminished ability to practice law.

Mr. Moran's mantra to me was "make no excuses." Wow. In retrospect, my own legal counsel did not appreciate (or believe) that I was suffering and struggling. Mr. Moran did not appreciate (or believe) that I was doing my best under extraordinary personal injury. I was held to an incredible standard. I felt terrible that I let my legal clients down. I kept trying to do my best throughout the orthopedic surgeries by Dr. Dangles. At one point I even asked my psychiatrist to tell me if he thought I was not fit to practice law.

I think that is is reasonable for someone who is struggling through repeated orthopedic surgeries (and simultaneously trying to help vulnerable clients) to lose perspective of their capabilities. Again, I was held to an extraordinary standard to accept unconditional responsibility.

It is a shame that the standard applies only to the patients hurt by "bad doctors." The standard evidently does not apply to to the "bad doctor" in my situation. He accepts absolutely no responsibility.

I hope that writing this Blog makes the "story behind the story" clear to me. There has to be more to all of this than just
(1) I lose my ability to use my legs properly,

(2) I lose my law license,

(3) I have my mental health records on the public Internet,

(4) I survive cancer and multiple corrective orthopedic surgeries,

(5) I incur extraordinary debt as a copnsequence of the unnecessary orthopedic surgeries,

(6) I devote my current life to caring for an elderly, terminally ill parent,

(7) I lose my reputation to an extent that I can not obtain a job, and

(8) the orthopedic surgeon who performed the unnecessary surgeries and the people who contributed to the unauthorized disclosure of my mental health records
continue their lives with no accountability.

I am a descent, honest person. I believe in justice. I trust in God. All will work out.

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