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Granted, this is just an anecdote, but it is hard for me to believe that, if this could go on for years, it is the only actual case of corruption in the state (or in many other states).
According to the Hattiesburg American headline, “Attorney Minor, two judges to be sentenced Thursday.” The Attorney, Paul Minor, was first charged with bribery in 2003. He and the two judges were found guilty of eleven counts.
Minor was convicted of guaranteeing $140,000 in loans to Whitfield in 1998, then using cash, a third party and a backdated promissory note to try to conceal the fact that Minor paid off the loan. Whitfield awarded Minor’s client $3.6 million in a lawsuit. The Mississippi Supreme Court later reduced the award to $1.6 million.
Minor was also accused of guaranteeing a loan of $24,500 to Teel the same year. Prosecutors said Teel “forced through” a $1.5 million settlement in one of Minor’s cases before his court.
Why is this relevant to medmal concerns? Because, according to the story,
Paul Minor, who amassed a fortune from asbestos, tobacco, medical malpractice and car safety litigation, was found guilty in March on charges ranging from racketeering to bribery. He faces up to 95 years in prison when he is sentenced by U.S. District Judge Henry T. Wingate.
It’s good to be back in my part of the blogosphere. Today I noticed a couple of medmal-related posts from KevinMD. Kevin posts on Defensive Medicine in the News, that two recent articles confirm his own conviction that “defensive medicine” is a way that medical malpractice litigation is costing everyone. The articles are, “Lawsuits Change Medical Practices,” and “Don’t Underestimate Defensive Medicine.” They are both well worth reading.
The other post at KevinMD links a story in the Boston Globe that “Weis won’t appeal jury’s verdict.” He quotes Weis, who lost his lawsuit against a couple of doctors he accused of malpractice:
In my case, obesity nearly led to death. Corrective major surgery always has risks, but a patient should never be viewed as the bad guy when problems occur that could be prevented. Never let doctors blame you for having elective surgery as they get paid handsomely and have the right to refuse.
It is true that a doctor who agreed to perform a surgery should not blame a patient for making a decision he agreed with. At the same time, no surgery is risk-free and that’s the way the jury saw it in this case.
But it is also worth pointing out that doctors are, in fact, opting out of certain high-risk fields because of medical malpractice concerns–leaving patients worse off than they would be if medmal risks were not so great. Mammogram readers are just one example of this trend. Spreading the idea that doctors are fair game simply because they have agreed to practice risky medicine that patients want seems like an effective way of producing a society in which no one is willing to help patients in dire straits.
Since the main blogger for the Keane Insurance Group (that’s me) will be going out of town for a week, blogging will slow for awhile. The Medmal blog will resume at the very end of July and the beginning of August, continuing the conversation about medical malpractice issues as they are found in the news and in the blogosphere.
FoxNews ran a story today entitled, “Bluetooth Technology Allows Heart Monitors to Contact Hospitals Automatically.”
A study published Tuesday in Inderscience’s International Journal of Electronic Healthcare found a wearable “Telemedicine” Bluetooth heart device is able to send text messages to local hospitals when the heart shows signs of extreme distress.
The Bluetooth heart monitor regularly records a patient’s electrocardiogram (EKG), and sends levels to the patient’s cell phone, but also checks the signals for signs of sudden cardiac failure, and if a problem is detected, alerts the nearest medical center with a text message.
Thulasi Bai, a professor at the Sathyabama University in Tamil Nadu, India, told FOXNews.com the Bluetooth monitor gives patients at risk for heart failure a chance for more mobile lifestyles.
“Before, the doctor has to determine the information, but with this, everything is truly automatic and immediate care can be given to the patient,” said Bai, who began testing the model two months ago along with her senior professor S.K. Srivatsa.
The difference between this wearable heart monitor and other previously developed ones is that this device not only transmits information to the doctor through Bluetooth, a wireless network used to transfer information, but it is also designed to read the EKG levels carefully enough to know if the heart is actually suffering an attack before sending the message, Bai said.
While the story focuses on the positives of preventing deaths, Dr Wes points out, that there will be consequences:
the implications of such technology are not trivial. Would resources exist to respond to all the messages received? What would the battery drain be on such a cell phone device for such monitoring? How does one confirm that the device is not sending a false signal? What are the steps after a message is received – call the patient or do we just send the ambulance to reduce the “door-to-balloon” time? Who will man the telephone 24/7? How will they be paid? Are funds best allocated for damage control like this, or prevention of the heart attack in the first place?
Related to these concerns, and perhaps among them, would be the medmal question of liability. Would phone operators and other people involved be regularly sued every time a person is not saved from death? Would the decisions made by corporations be motivated more by “defensive medicine” concerns rather than by what makes the most sense? Or, alternatively, will the technology not be implemented at all for anyone due to fears of medical malpractice litigation?
All these questions may seem far away, but, like other technological developments, it could possibly happen overnight. Even if the technology is not going to be implemented soon, the concerns expressed by Dr. Wes mirror the concerns doctors have about technological change that is going on now–such as medical records.
Panda Bear, MD has posted a nice long entry (“A rambling conversation with a lumbering Asian Bear-Mammal”) that includes a great deal on the medmal situation doctors find themselves in.
Protestations of various oleaginous lawyers and policy experts to the contrary, litigation and more importantly, the threat of litigation has a profound impact on how medicine is practiced in this country and its increasing cost. While the actual cost of payouts in malpractice suits is fairly trivial compared to the huge amount of money changing hands in the medical industry, the behaviors engendered by the threat magnify the cost tremendously. Can I quantify the percentage of care we deliver that is wasted on so-called “defensive medicine” (that is, medical practices designed primarily to protect us from frivolous suits)? Of course not. One man’s defensive medicine is another man’s justifiable dilligence. On the other hand as I have eyes I can see that we spend a great deal of money in the hopeless quest for perfection, perhaps the worst place to spend money as the incremental increase in health this buys us is hardly worth the tremendous cost to achieve it.
Panda Bear, MD writes a lot more about the price of litigation in terms of “defensive medicine” as other issues related to medical malpractice concerns. His post is well worth your time. I think many people, when they think of the cost of unnecessary litigation, only think of what is paid out, not of the costs of trying to avoid such litigation.
Doctor-Patient Relationship is An Endangered Species is not a blog about medmal rates or any issue related to medical malpractice–at least not as far as I can tell from what Dr. Ben Brewer writes. But I can’t help but think that this should be considered a factor.
One of the joys of being a family doctor is the relationships that I’ve developed with my patients over the last 10 years. It’s the source of energy that keeps me going after a night up delivering babies or a day of business hassles. The sense of being needed and contributing to the fabric of the community is the best job satisfaction there is.
My patients have pulled the family van out of a snowy ditch, towed my old Honda Civic to town when it broke down, shingled the roof, put windows and doors on the house, installed a new fridge after lightning zapped the house last month, and brought food to the office.
Probably not every doctor had such nice tales to tell, but I don’t find it hard to believe that there has been a dramatic shift.
Having a long-term personal physician who knows your medical condition as well as your quirks and your family is a rarity these days. With an ever-shifting array of preferred providers and insurance panels, plus a proliferation of retail clinics, staying with one doctor for long may seem like a throwback to another era. The relationship between physician and patient, like the family farm, is endangered. In some places, I’d say it’s already extinct….
The doctor-patient relationship started to go downhill when patients stopped paying their own office bills for routine care and third-party insurance and Medicare became the driving forces. That was before my time.
Now primary-care doctors are pressured to churn patients through the office, to the detriment of relationship-building and possibly the health of their patients. At the same time, patients may have to switch doctors because of changes in their insurance.
Brewer spells out some drawbacks about this shift that has taken place. It seems to me that he might add a couple, the likelihood to litigate and the likelihood for juries to award high penalties for non-economic losses. After all, medmal attorneys readily admit that they get patients in their offices who want to sue over alleged malpractice when the real issue is a lack of communication. Now, medmal insurance companies even provide doctors with training on how to communicate with their patients so that they make litigation less likely. If one accepts that interpersonal communication is important to avoiding such conflicts, then an environment in which “primary-care doctors are pressured to churn patients through the office, to the detriment of relationship-building and possibly the health of their patients,” does not sound like it is conducive to communication.
The irony would be that the demand for managerial efficiency in the office is actually more costly in the long run.
I’ve put on my amateur economist hat before and predicted that out of control medical malpractice lawsuits will result in fewer doctors. I don’t mean that doctors will become more expensive because they pay higher medmal rates, thought that is also a problem. I mean that at some point you reach the place where no one wants to practice at any price because no amount of money is enough to compensate you for the chance that you still might lose everything.
The Crescent News just ran a story that provides anecdotal confirmation. In “Paulding Hospital to close birthing unit,” we read,
Another factor in the cost of maintaining the birthing unit is the escalating cost of malpractice insurance premiums. Adkins said that about 10 years ago in Paulding County, there were at least five family practitioners who had OB privileges at the hospital. In 2005, there were none because of the cost and instability of the liability insurance market.
He said Ohio has been listed as a “Malpractice Insurance Crisis” state.
If you read the whole article, you will see that there are other issues in play. But even so, we should at least be aware that communities in marginal situations loose medical options faster than than they would otherwise due to medical malpractice costs.
Kevin MD has continued blogging with a couple of more posts about medical malpractice concerns.
The first questions he raises is, “Do electronic medical records raise malpractice risk?” This sounded counterintuitive to me, but the article he links–”Will an EHR affect your malpractice risk?“–raises concerns I had not thought of.
One issue that Kevin himself quotes is the idea that new theoretical access to data will result in increased liability. As the Medical Economics article states,
Waldren says that when doctors get EHRs, “there’s an expectation that they have access to data outside the four walls of their practice.” They worry that if they have access to results, say, from a lab test that another doctor ordered, they could be held liable if they don’t integrate those results into their own EHRs, he says. Basch says this liability could even extend to an online request for advice from a colleague, if it includes a patient’s name.
Kevin MD doesn’t seem to think there is much positive to be gained as far as medmal worries are concerned. And an anonymous commenter spelled out a pretty scary scenario:
The physician has a limited amount of time that can be spent in the care of any one patient. The attorney has screened for a damaged, sympathetic client and has by comparison unlimited time to comb through medical records. The incredibly vast reams of data, most clinically meaningless, allow any tale to be spun for the jury.
I can’t imagine that we won’t see more electronic record-keeping in the future. However, this is worth keeping in mind when one hears criticisms of the entire health system for not already having completely switched over to EHR.
Kevin MD also linked the Surgeonsblog on videotaping surgery and its implications for medmal. He’s not very positive. Video allows for all sorts of groundless suspicions to be raised by someone looking for trouble carefully reviewing the video. Furthermore, being watched can actually obstruct the best practice on the part of the doctor simply due to the pressure. Not many perform as well when they feel they are under scrutiny. The entry is well worth reading.
Kevin, MD has posted about communication and medical malpractice today, linking an article in the online Medical Economics magazine that is about avoiding medmal litigation.
In his post, “Controlling patients’ expectation,” he mentions “a core tenet of risk management,” which is to communicate realistic hopes and fears about a test or treatment by taking time to engage in some conversation about what is reasonable. According to the article, “Are You Raising False Hopes? What you say about treatment risks could come back to haunt you,”
“The surprised patient is often an angry patient who mistakenly assumes that a bad outcome shouldn’t have happened and his doctor therefore must have done something wrong,” says [San Francisco GP and JD Dan] Tennenhouse, who lectures on healthcare legal issues at the University of California, San Francisco, and in Kaiser Permanente facilities. “So he sues for malpractice, but the root of the lawsuit is in the informed consent process.”
The article goes on to identify “ways that doctors inadvertently lead patients to expect too much from proposed treatment,” and to give “stratagems to set patients straight.”
These suggestions are well worth reading. Some of advice involves making sure doctors express statistical facts in a way the patient can grasp.
put expressions of relative risk such as “Drug XYZ reduces the chances of such and such disease by 50 percent” into context, he says. A patient may find this benefit compelling, but for a better understanding, he also needs to hear about the absolute risk. How many people in 10,000 normally contract the disease when untreated, and how many do so on the medication? Let’s assume the medication reduces the number from 2 in 10,000 to 1 in 10,000. A patient may have second thoughts about taking it, particularly if it comes with a high risk of debilitating side effects.
This series is only several months old, but in blog time that counts as a millennium.
The Surgeonsblog recently mentioned that he had posted about his ordeal in a medical malpractice case. Below are the links to the three posts. I quote a few highlights (and leave out a few things that are more raw than what I’d like search engines to find on this blog) but please read the whole thing carefully. It is a great (as in accurate and grim) account of the medmal litigation process.
One of the issues that comes out is that lawsuits are fearful things quite apart from monetary damage.
it hit me like… well, it hit me like a lawsuit. And it was only the first blow in a series that lasted over a couple of years, wrenching me back and forth, up and down, tearing me apart in every possible way. Robbing my sleep, souring my outlook, breaking my cherry in the most bloody of ways… At the time my dad was Chief Judge of the Oregon Court of Appeals. My brother was (and is) a very big-time lawyer. Neither of them ever understood how or why it was so deeply painful. “Why are you taking it so personally,” they’d ask, completely seriously. “It’s just the way the system works.”
Losing my virginity, part two.
Here we see it emphasized how doctors and lawyers act when involved in one of these cases. The only bright spot is his recollection of the hearing by the Oregon Board of Medical Examiners. The rest is a nightmare. Here is one minor example:
My next lesson in the way of the world was when the records arrived from the referring family doc. The last entry in his notes from the time of transfer was “Situation critical. Urgent surgery advised.” WTF? It had been a couple of years, but I knew I’d remember such a statement had it been in the notes I received with the patient. Poor Doctor FP: he must not have remembered that he’d sent copies of his notes with the patient at the time of transfer and that they’d be included in the hospital records. Clear as day, the son… had altered his notes later, to cover his ass once again. What did he care? I wasn’t in his area any more.
Losing my virginity, part three.
Again, there is a lot here to read; go do so. But I thought this description of how one’s life is disrupted by the “game” was really interesting (in an accident-on-the-highway sort of way).
Trial dates were announced, my schedule was cleared for that week, and then within a few days of the date, it was canceled and rescheduled. Once again my schedule would be cleared, once again the day would approach, and be canceled once again. It wreaks havoc with a practice, in obvious ways. Lawyers, conceivably, are no more stupid than the rest of us (well, there’s a bell-curve); I’m sure it was a game well-played. With each cancellation, there came notification that the amount of money being sought was lowered. Sometime after the prayer (that’s the official term for the amount of money in play: “prayer.” Hmm.) was lowered to well within the limits of my coverage, I heard from the “personal” attorney I’d hired. He wanted me to request settlement. Hey, wait a damn minute!! Much as the idea of being hammered on a witness stand frightened me, I’d long since gotten to the point of anger-fueled certainty that I’d prevail (well, that’s too strong a word: not certainty, but resolution to proceed), and settlement was the last thing on my mind. The reason, he told me, was that since I’d originally been sued for more than my coverage, if it were to go to trial and I were to lose, and if the judgment were for more than my coverage, then, having requested settlement, I’d be able to demand full payment by the insurer.
Normally, when I recommend an article offsite, I say, “enjoy!” or something like that. But that’s not exactly the right sentiment in this case. Still, you should read these posts.
