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A new story appeared today backing up a post last month about Texas. According to the Austin American-Statesman,
Many parts of the state that have had doctor shortages are seeing new physicians arrive, Opelt said. Beaumont once had to fly some trauma patients to other cities for treatment because the city didn’t have enough trauma surgeons, Opelt said. Now, enough surgeons have moved to Beaumont to handle the caseload.
Jon Opelt is the executive director of Texas Alliance for Patient Access. He was interviewed for the story, “Doctors clamoring to come to Texas, creating backlog of applicants.” The reason for the “clamoring” is quite straigtforward, according to the article, “the state’s limits on malpractice lawsuits have generated a surge of doctors, including specialists, . . . which is helping bring more doctors to areas of the state that don’t have enough.” For example:
Dr. Kevin H. Brown, who started practicing obstetrics in Round Rock in May, applied for a Texas license the same day in September as his obstetrician wife and partner, Ingrid W. Brown. It took six months for his license to be approved; his wife is still waiting for hers because of a paperwork delay, he said.
Brown said that his wife was able to get a temporary license and that their practice is helping alleviate Round Rock’s shortage of obstetricians. . .
Brown said he and his wife paid $130,000 a year for both of them to have malpractice insurance in Georgia. Now, they pay a combined premium of $82,000 a year, he said.
“It was a $24,000 raise for each of us before we even got started,” Brown said.
Already, I see signs on the attorney side of the medmal blogosphere that people are insisting that we haven’t gathered hard evidence that proves the quality of medical care has increased for Texans. And there are dark hints that only low quality doctors would want to move to the state where liability is capped. But common sense tells you that an increase in the availability of medical care means more options for consumers. Furthermore, every doctor has to have medical malpractice insurance. There is no reason that quality doctors would not want that “raise before they even get started” that waits for them in Texas.
It has been all over the news that, “The New York State Insurance Department Tuesday approved a 14 percent hike in New York’s medical malpractice insurance rates.” I’m sure this was necessary to keep medical malpractice insurance companies afloat, but it isn’t necessarily good news for the medmal industry. After all, the real profit in virtually all industries is found in having many customers. With doctors moving to Texas at a rapid rate, it is hard to see how the number of doctors in New York won’t decrease.
According to The New York Sun’s “‘Worst of Both Worlds’ Hits Insurance,”
In the first double-digit increase in at least five years, the New York State Insurance Department increased medical liability costs by 14%, the highest annual increase since 1993. Doctors warned that the increase in malpractice insurance costs amounts to a crisis that will be passed along to patients in the form of higher fees and to businesses in the form of higher health insurance premiums for their employees.
New York’s medical malpractice premiums already are among the highest in the nation, and the latest increase may contribute to mounting political pressure to come up with a policy change to provide some relief.
As an aside, we can add to that pressure the issue of national security. A recent columnist at Townhall.com, recently wrote that medical “costs can be dramatically cut through continued tort reform efforts.” The column however, was primarily about Al Qaeda. It seems that the doctors recently arrested in Britain are a direct result of economic pressures related to health care forcing the United Kingdom to greatly need to import medical care. So Ken Blackwell writes in his “Al Qaeda Raises the Bar in Health Care Debate,”
The news from London and Glasgow brings a striking reminder that Al Qaeda is willing to exploit any national weakness.
In the case of the British, it’s an ongoing physician shortage brought on by the inherit shortcomings of their government-run health care system. The shortage allowed Al Qaeda operatives to legally enter the country and quickly become trusted members of its National Health Service.
Foreign doctors are given top priority and almost immediate entrance into Great Britain. In fact, they make up nearly 40% of all British doctors.
Back to the issue at hand, in their “Skyrocketing MedMal Rates Send a Message” the Empire Center for New York State Policy lays out the obvious smoking gun that this hike was the consequence of some extraordinarily high medmal payments in court.
As documented in this study by the Manhattan Institute’s Center for Legal Policy, the level of medical malpractice premiums in New York can be linked directly to the state’s large malpractice litigation awards.
I haven’t seen much comment in the Medical blogosphere (due to shock?). But Kevin MD did point out a news story that we are seeing signs of the shortages one would expect. According to the Syracuse Post-Standard’s story, “Malpractice rate hike hits local health care,”
“In Oswego County, there is no longer an obstetrician who will take on high-risk pregnancies, and attempts to get someone to come to that county to do that have not been successful,” said Gerald Hoffman, executive vice president of the Onondaga County Medical Society, which serves Syracuse and Central New York.
For expectant parents, that can mean a 45-minute drive to the hospital in good weather – far longer in bad weather – and added risk to both mother and child.
The situation is troubling, patients and those in the medical profession say, and it’s likely to get worse.
Medical malpractice issues involve court cases, but there are other potential problems that relate to medmal and can sometimes hurt your practice or make it more likely that you will be sued.
In fact, this threat is so persuasive that businesses have been formed to offer customers protection from it. I’m referring to being badmouthed on the internet. Kevin, M.D. links a story and points out that, “This is strongly applicable for physicians as well, who might have to weather online attacks from disgruntled patients.”
The story is about how people can protect their good names.
She sued for defamation and won an $11.3 million verdict, but the attacks only got worse. In December, Scheff turned to ReputationDefender, a year-old firm that promised to help her cleanse her virtual reputation. She no longer dreads a Google search on her name. Most of the links on the all-important first page are to her own Web site and a half-dozen others created by ReputationDefender to promote her work on teen pregnancy and teen depression.
“They created Sue-Scheff.net,” she said. “They created SueScheff.net. They created SueScheff.org. . . . They created my MySpace account, for God’s sake. I didn’t know how to do any of this stuff.”
You can read the whole story at MSNBC.com, “Calling in pros to refine your Google image: Search engine has given rise to the online identity management industry.”
The fact is plenty of attorneys turn away potential clients. It isn’t unrealistic to think that some of these will turn to blogs and bulletin boards for “justice.” And these, in turn, could produce negative reinforcement, when someone googles a doctor’s name.
What follows isn’t exactly a medical malpractice story, since a medmal situation typically involves patients against their doctors. But it is related and demonstrates the problem with an atmosphere of fear intruding in the doctor-patient relationship.
From the New York Times, “Keeping Patients’ Details Private, Even From Kin,”
An emergency room nurse in Palos Heights, Ill., told Gerard Nussbaum he could not stay with his father-in-law while the elderly man was being treated after a stroke. Another nurse threatened Mr. Nussbaum with arrest for scanning his relative’s medical chart to prove to her that she was about to administer a dangerous second round of sedatives.
The nurses who threatened him with eviction and arrest both made the same claim, Mr. Nussbaum said: that access to his father-in-law and his medical information were prohibited under the Health Insurance Portability and Accountability Act, or Hipaa, as the federal law is known.
Mr. Nussbaum, a health care and Hipaa consultant, knew better and stood his ground. Nothing in the law prevented his involvement. But the confrontation drove home the way Hipaa is misunderstood by medical professionals, as well as the frustration — and even peril — that comes in its wake.
Government studies released in the last few months show the frustration is widespread, an unintended consequence of the 1996 law.
Hipaa was designed to allow Americans to take their health insurance coverage with them when they changed jobs, with provisions to keep medical information confidential. But new studies have found that some health care providers apply Hipaa regulations overzealously, leaving family members, caretakers, public health and law enforcement authorities stymied in their efforts to get information (read the rest).
So why the extra zeal? You would think that medical personnel would want the family members to be there to help in some capacity. The answer is irrational fear. As the GruntDoc commented, “Seriously, what did they expect? A hundreds+ page law by lawyers for lawyers, about medicine, with the threat of major fines, loss of billing abilities, and they wonder why healthcare workers have become close-mouthed?” He also adds that the executive summary of the legislation is eleven pages long.
The New York Times story seems to back him up.
Some reports blame the language of the law itself, which says health care providers may share information with others unless the patient objects, but does not require them to do so. Thus, disclosures are voluntary and health care providers are left with broad discretion.
The unnecessary secrecy is a “significant problem,” said Mark Rothstein, chairman of a privacy subcommittee that advises the Department of Health and Human Services, which administers Hipaa. “It’s drummed into them that there are rules they have to follow without any perspective,” he said about health care providers. “So, surprise, surprise, they approach it in a defensive, somewhat arbitrary and unreasonable way.”
There are some claims that some medical personnel are “hiding behind” the law, but the examples they give of problems (not having birthday parties or making friends phone parents because the staff fear repercussions if they give away information over the phone) do not, in any way, sound like they have anything to do with medical competence.
Medical staff simply see a big hammer about to fall on them and are afraid.
Dr. Wes, in a post on “On Radiation Risks and What’s Appropriate,” points out a recent article in the New York Times: “With Rise in Radiation Exposure, Experts Urge Caution on Tests.” He writes
Although I’ve commented on this before, it’s good to see that others are taking notice about the potential problems with excessive use of diagnostic imaging.
But he takes issue with part of the article. While reporting that patients can question their doctors about the necessity of a test, the article states,
Doctors should be familiar with the radiology college index of appropriateness criteria, which rates the imaging procedures for some 200 medical conditions. Dr. Morin suggests asking the doctor ordering the test about its rating for a given condition.
Scores range from 1 to 9, he said, and “if the number turns out to be 1 or 2, you should look for some other exam.”
To which Dr. Wes responds,
Whaaa? Wow, I learned something new… I now have to remember the contents of a 22-page document to see if a test is appropriate or not. I even learned there’s a downloadable PDA version of the software, just to make it easy! So watch out docs, patients now might be asking you to consult your PDA while writhing in pain from an acute abdomen: “Gosh, is it acute appendicitis or a kidney stone? Let me check my handy PDA to see if I need to order this CT scan. Gee, there it is! Hot damn, he’s a 9 on my handy-dandy xray scale! Okay, Wilma, take him away!”
He goes on to say that appropriateness is a judgment call and that different doctors are going to have different opinions about the liability verses the need for certain tests. “Just ask any emergency room doctor versus the obstetrician selecting a screening test for a preganant mother – each have a different take on the short- and long-term liability risks of such tests.” He says he has never seen a doctor in ER “whip out his PDA–and for good reason: “especially when he’s under an ever-mounting pressure to see more patients in less time while trying to never miss a diagnosis for fears of significant liability retribution”
I’m surprised that he didn’t criticize the article for never mentioning the fear of a medical malpractice lawsuit as one reason for the excessive testing. Dealing with the medmal factor might be more effective than a palm device.
As mentioned above, Dr. Wes has written more himself on “The Radiation Risk of CT Scanning.” Also, I can’t pass by a chance to alert readers to this story about miscommunication, “Communications.”
