Thursday, January 08, 2004

Bush and GOP push bogus malpractice 'crisis' with dubious witnesses

Dr. Robert Zaleski a Wheeling, W. Va., orthopedic surgeon was one of two dozen surgeons to walk off the job in January to protest his state's high costs of malpractice insurance arguing that "frivolous lawsuits" were driving up insurance premiums and forcing physicians to leave the state.
It appears that Zaleski may be more a source of the problem than a victim of it. Between 1987 and 2002, according to the West Virginia Board of Medicine, patients filed 14 lawsuits against Zaleski, eight of which resulted in payouts that together came to $1.7 million. In a 1985 lawsuit (one not among the 14 reported to the Board of Medicine), he admitted in a deposition to being addicted to prescription painkillers for a substantial part of the time that he was operating on people in the early 1980s. Not only was he a drug addict, but to maintain his Percodan habit, Zaleski allegedly wrote prescriptions for other local addicts.

In February 2001, responding to local doctors' allegations of 'lawsuit abuse", the Charleston Gazette undertook a computer-assisted analysis of more than 2,000 medical malpractice claims reported to the West Virginia Board of Medicine. The paper determined that far from being in a state of crisis, West Virginia ranked 35th in the country for median malpractice payouts. The paper also found that both the number of malpractice claims and the dollar amounts of the settlements and verdicts had actually declined between 1993 and 2001.

Last July, congressional Republicans launched hearings featuring testimony of a West Virginia doctor named Dr. Samuel Roberts. Roberts, one of only three doctors who testified, told the committee that he could not afford the insurance to continue delivering babies, and claimed that this year, "I will have to stop, leaving seven counties around me with no family physician delivering prenatal or maternity care." Roberts omitted some critical facts that might have explained some of his insurance woes: In 1987, he pleaded guilty to five counts of cocaine possession and was sentenced to five years probation, according to the Charleston Gazette. In response, the state suspended his medical license for a year, though it later reduced the penalty to five years of supervised probation. A year after his dire threats of doom to Congress, Roberts is today still practicing medicine.

In a speech at Little Rock Jan. 26, President Bush pointed out Dr. Sara McBee of Fayetteville and said that she'd stopped delivering babies because of rising insurance costs that were "a direct result of too many junk lawsuits." Bush was promoting his legislation to restrict medical malpractice lawsuits. He told the crowd:
"Sara McBee is here. There's Sara. She's from Fayetteville, Arkansas. She practices family medicine. She was delivering between 80 and 100 babies a year. Now, there's a soul - a good soul, who loves life to the point where she's willing to take her talents and deliver babies. It must be an unbelievably satisfying profession to bring life to be.
"And yet, in July of 2002, her insurance premiums had more than doubled. See, the litigation culture made it nearly impossible for her to practice her love. I say nearly impossible, because she wouldn't break her commitments to expecting patients and hung in there for a year. But her premiums continued to rise, and Dr. McBee has stopped delivering babies, as a direct result of too many junk lawsuits. And that's not right. That's not right." (Applause.)
Bush did not mention (although he knew it, according to McBee), that a medical malpractice suit is pending against McBee by a couple who say their child was born with brain damage and multiple disabilities because of mistakes by the doctor.

Monday, January 05, 2004

Doctor: improve Patient Safety to reduce malpractice costs

The current medical liability system works poorly for patients and physicians. Steep increases in malpractice premiums lead to physicians practicing "defensive medicine," which in turn contributes to rising health care costs, in addition to patients' enduring unnecessary medical procedures. Meanwhile, large numbers of Americans continue to suffer preventable medical injuries.
"Physicians must use their abilities to make care safer and injuries rarer, by developing, evaluating, and implementing safety improvements," said Stephen C. Schoenbaum, M.D., senior vice president at the Commonwealth Fund. "More active work on the part of physicians to improve care and reduce harm is clearly in the best interest of the public and physicians."
Physicians must play an active role in developing and implementing systems to improve patient safety, according to an article published in the Jan. 6 issue of Annals of Internal Medicine.
In "Malpractice Reform Must Include Steps to Prevent Medical Injury," The Commonwealth Fund and the Urban Institute say that focusing solely on capping malpractice awards -- the solution most commonly promoted by physicians in the current debate -- leaves out the largest problem: patient injury.

Sunday, January 04, 2004

American hospitals and doctors delivering unsafe health care

Jan. 5,2004 - Donald Berwick says our nation's world-class hospitals and doctors are delivering health care that is unsafe and unreliable. But his call to dismantle the system makes the medical establishment uneasy -- because he used to be part of it, according to a Boston Globe article on health care.

A respected voice in health care analysis, Berwicks vision is remarkable and he says attainable:
When you wanted to see your doctor, you would call in the morning and get an appointment that afternoon. And it would start on time, not an hour and three outdated People magazines later.
You would maintain control of your medical record, rather than needing a subpoena just to get a peek at it.
Hospitals would have genuine one-stop registration, and every employee would be trained to have the customer-service touch of a Ritz-Carlton concierge. No one would ask you to wear one of those open-backed johnnies.
Waiting would be kept to a minimum, because the hospital will have embraced flow management, anticipating rather than just reacting. There would be no visiting hours in the intensive care unit, since any family member could visit at any time.
Medication errors -- overdoses, allergic reactions, and other adverse responses -- would be all but eliminated by the universal adoption of computerized drug-ordering systems. Hospitals would impose a zero-tolerance policy for workers failing to wash their hands, a move that could save upward of 10,000 lives a year.
Communication and patient-advocacy systems would put an end to horror stories like the one involving the 5-year-old boy who died at Children's Hospital last year because each of his many doctors assumed another doctor was in charge.

Inexperienced Surgeons pose Gastric Bypass Risk

January 5, 2004 - A growing collection of research suggests that this increasingly popular gastric bypass surgery operation commonly used for weight loss can have a hidden risk: inexperienced surgeons. "Gastric bypass is the hottest thing in surgery right now, unfortunately some of that is economically driven," said Dr. Steven Rothenberg, a surgeon at Presbyterian/St. Luke's Medical Center in Denver. "The thing that made it take off is that now it can be done laparoscopically." Surgeons promote laparoscopic surgery to patients as safer than traditional more invasive surgery. And it is -- in the hands of experienced doctors.

But the gastric bypass is so difficult, according to physicians who have tracked the results of their cases, that patients of surgeons who have done fewer than 70 to 100 operations have complications more often -- and a greater chance of death from those complications. Some fear that surgeons are rushing into the field for economic reasons without adequate training. Some hospitals allow surgeons to operate after only one weekend seminar.