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The West Virginia job action is over. A new ones is coming in New Jersey. On February 3, 2003, a week long curtailment of all elective procedures will begin. The state medical society can not for obvious reasons sanction the work stoppage but can sympathize. The Governor doesn't like the idea of a work stoppage. It might mean he actually has to do something to spur the legislature into action.
West Virginia still has to contend with the declining applications for medical licenses. It has dropped about 25% in the past five years. The amount of licensed physicians remain stable but this doesn't state how many are actually practicing medicine.
To make matters worse, the West Virginia state run malpractice fund is on its way out. The state fund removal will coax the State Medical Society to form its own malpractice fund assuming the state lawmakers pass some tort reform. Until it goes out of existence, the state is attempting to raise the ante by considering also insuring hospitals, clinics and other health care providers than just physicians. The Senate "forgot" to work with the physicians in this proposal. The physicians want to keep their mutual insurance only for physicians.
In Pennsylvania, where a work stoppage was averted by the new Governor promising to ask the legislature for reforms, has an enlarging problem in finding malpractice insurance for the primary care physicians. The non-academic practices are finding it hard or impossible to recruit new physicians. The graduating residents are leaving the state. Also a constitutional amendment to limit non-economic damages has been introduced.
The Pennsylvania Governor has opted for a new state Office of Health Care Reform to be led by a former banker. This is on top of another committee on the short term solution to reform. The new Office will have a small budget and no power but will report directly to the Governor.
The Mississippi surgeons are not happy with the tort reform laws that were recently passed by the legislature. Some are going on a month leave of absence, as did their brethren in West Virginia. In the Mississippi Coastal area the premiums continue to climb and physicians are losing their hospital privileges due to loss of malpractice insurance. The twelve surgeons covering four coast hospitals have gone on an extended leave of absence. All surgical patients will be sent via ambulance to other hospitals in other states. Other physicians have closed their offices in sympathy with the cause.
Some of the legislators in this tort lawyer governed state are not happy campers. They however still don't get it. One intelligent legislator stated the doctor's should read the New Testament. He doesn't realize the doctors are Jewish. A new bill has been introduced to make ED physicians employees of the hospital to be covered by the hospital's insurance. This just flips the liability to the hospital and not solve the underlying problem.
In Florida the liability task force recommended non-economic damages be limited to $250,000. The task force also recommended immunity be given to ED physicians and all malpractice cases be subject t mandatory mediation within 120 days of filing a claim.
Some physicians in Florida are tired of waiting for the legislature to act. They have decided not to practice for two days. The majority of physicians in Palm Beach County will not be seeing patients for the two days. Approximately 800 physicians went to the conference on malpractice reform. One of the things they were told by an insurance representative is even if the caps are passed and given the blessing of the courts, malpractice premiums will only be decreased by 16%. This will continue to make others in the state leave or go bare.
Within the past week two Bradenton surgeons lost their medical liability insurance and cancelled all their surgery. This left about 50 people out on a limb who were scheduled for elective surgery. The two were not going to go bare or put up a $250,000 bond.
In Nevada, the first state to experience the closures due to malpractice premiums, the climate is getting better. A physician owned insurance company lowered premiums for some OBs because some hospitals were willing to share risk. The rate decrease by about 20 OBs will be offset by a increase for other OBs. The amount paid is dependent on the volume of babies delivered. Those who deliver more than 125 children a year pay more due to the higher risk of being sued. Those OBs that delivered under 125 babies will get am increased premium of 12% but will now be able to deliver 224 babies.
In the past year 76 medical practices in Nevada have closed their practices due to the malpractice situation. An additional amount are either considering closing or in the process of closing their practices. The closed practices include 19 OBs and an additional nine have discontinued OB.
The OIG has been asked to comment regarding hospitals paying malpractice premiums for physicians. They stated that while the action may not fall into any safe harbor, they will take into consideration the malpractice climate in the state. The hospitals would also need to limit the subsidy to limited amount of time, have the physicians pay what they currently do, limit the payments to those currently on the active staff, not relate the amount paid to the amount of referrals to the hospital, and have the physicians give up certain litigation rights. This last one bothers me since I have no clue what it means.
Also on a quasi-federal level, the anti tort reform people are bringing their case to Sen. Bill Frist's Tennessee. They recently stopped their national motorcade in Nashville to publicize their opposition to the proposed tort reform laws.
New Jersey physicians are still posed to strike. The strike is to be open ended and by all those who agree with the premise. There are no concerted agreements in order to avoid the antitrust title. Most elective surgical procedures will be cancelled as will routine OB check-ups. Most physicians will see those they deem to be an emergency.
The New Jersey Trial Lawyers are attempting to strike back in the same way they do in the courtroom, pity and not facts. They staged a meeting of those harmed by physician errors to speak to the media on why there should be no cap on non-economic damages. All the speakers stated they are victims and as such have no life. They do not state that after just compensation they need to get on with their life. An attorney stated that since one of his clients was injured at birth and if you calculate the worth at $13 per hour, he should have been awarded $8 million and not the $500,000 he received. What the attorney did not state was the limit is on non-economic damages and not future earnings. The attorney did not state it was he who could have gotten more but that he settled for the policy limits. The meeting started by tossing the PR person for the State Medical Society from the room.
Georgia has found that 1 in 3 OBs have stopped delivering babies due to malpractice fears and premiums. The $250,000 cap on non-economic damages is to introduced in the legislature next week. Also about 11% of physicians will discontinue ED backup.
A new state has been heard from. Some Illinois physicians want greater tort reform. In the tort lawyer backed Democratic Legislature, this will not happen. Illinois has a statute that allows punitive damages. This is a terrible law since I have heard of no situation where someone goes out of their way to maim another person. almost all malpractice actions are either simple negligence or bad outcomes without negligence. Originally there was a cap on punitive damages but the Democratic controlled Supreme Court knocked that one out. Top
The Lee County Florida trauma center continues to make the news. The electorate declined to pass a special sales tax to fund the center. Individuals in the community pledged money to keep the center open. A new referendum to get money for the center is probably doomed due to the potential need for a 2/3 vote to pass the tax. Since the state's plan is sure to fail, Memorial Hospital has come up with it's own plan. The new plan would make the Hospital a special district which would allow the hospital to seek funds on property by the use of a special election. All money would go only for trauma services. Top
The People's Republic of Massachusetts has enacted a new Medicaid law requiring a $2 per week co-pay for each prescription med. This is an increase from a $0.50 co-pay previously. The problem is that pharmacists are prohibited from withholding drugs to Medicaid patients even if no co-payment is forthcoming.
The legislators is this socialist state have put on a $1.30 tax for each non Medicaid prescription filled. The pharmacies have posted notices in their stores stating that the tax is in place and the consumer will need to pay. They are also instructed that if they don't like it to call or write their legislator. The chief Socialist Attorney General Reilly has accused five pharmacies of misleading customers about the tax. He states the tax is on the pharmacy and the pharmacy is passing the tax on to the consumer. This is true but not relevant since in the end the consumer pays. The letter accusing the pharmacies "urges" them to stop misleading consumers. As long as the pharmacy does not state that they are required to collect the tax from the consumer, there is no problem. The Chief Socialist also got his comeuppance when he stated the pharmacists could not charge the tax to those with prearranged co-payments. The Department of Insurance said that they could charge the tax. All the state's pharmacies except eight are charging the tax. Some of the state's socialistic legislators are threatening to enact legislation to force the pharmacies not to pass the tax along to managed care patients and refund money already collected. Perhaps these idiots never heard of ex post facto or believe that the state is above the Constitution. Top
The fight is full swing. In Colorado, hospitals are losing money to physician owned free standing centers. The hospitals are retaliating by giving discounts to insurance companies that will not contract with the free standing centers and by forming joint ventures with physicians. The hospitals would not do this prior and are now forced into it due to their prior greed.
The main fight is in Ohio. In Columbus there is a backlog in the ORs which lead physicians to put up their own more efficient surgical centers. A new ASC will open this fall with others on the drawing board. This is in the face of the threats by the area hospital systems to ban physician investors from their medical staffs. This has led to the AMA asking the OIG to review the hospital's requirement for admitting patients in order to get staff privileges. The hospitals have also gone to the state legislature to make referring patients to hospitals where one owns a portion illegal.
In Dayton and Cincinnati heart hospitals are the hospital d'jour. Several new for profit physician owned hospitals are going up in Cincinnati with excellent results. The new Dayton MedCath Heart Hospital is also doing well financially and in the quality arena. These hospitals do well financially since they do not have to subsidize money losing operations. Top
An article by Dr. Zigelman, a medical practice consultant, is critical of the concept of paying for quality indicators. He believes, as do most practicing physicians, that there is more than one way to do something. This variance is what makes up the art of medicine. He goes on to talk about the 1%-2% of bad physicians. He states that many of them shine on statistical quality measures since they are charismatic and their patients love them. He also gave an example of how good physicians can get into problems. If a physician uses diuretics for high blood pressure instead of the hospital quality measurement of beta blockers, he could end up in difficulty. This is true even if it has been shown that diuretics are better than beta blockers for certain heart patients. Top
A physician in Charlotte, West Virginia is not bright. Dr. Charles Ferree wrote a letter to the judge in a case he was called for jury duty that he would not report and would be seeing his patients. This was not a smart thing to do. Judges get a little testy about things like this and the judge held the doctor in contempt. He is not seeing patients since he will be in jail for the next ten days. He has also been ordered to seek counseling or go to jail for an additional thirty days. Being granted a medical license never inferred brains or common sense. After his release his medical partners granted him a few days to be with his family. He was told he could return to work whenever he was ready. Top
Cedars-Sinai of Los Angeles spent a bloody fortune on a computerized entry and ordering system. They have now put it to sleep and it may awake again, or not. The problems were that it was the direct cause of medical errors, the thing it was supposed to prevent and it was too much work. Approximately 400 physicians asked the hospital to hit the delete key. Top
Kaiser Permanente will post the methodology used in their physician payments, including financial incentives on its website. This is a settlement of a 1999 law suit filed against Kaiser for false advertising and other violations of state law. Other parts of the settlement requires the call centers do not give financial compensation to limit or deny access to care and the posting of the HMOs treatment guidelines. Top
Tenet has decided to help their tarnished image by decreasing the amounts they are charging the uninsured. They will now discount prices for them as they do with the insured patients and they will cease placing liens on homes to collect the overpriced debt. This is to help with the ten law suits against it by Latino Los Angelinos for price gouging. Tenet also stated they are paying alot of money for charity care. They are providing the care but their figures are inflated since they use full charges when they know that is not the case.
In Georgia the DeKalb Medical Center has stopped straight salaries to their physicians. They are now going to pay on a productive basis. All in the country know that hospitals can not run physicians and they can not run practices efficiently. They are now moving the practices to a private practice model. Top
In a story that in fact is a non-story an OB in Kentucky has been sued for emotional distress. He branded a uterus following a hysterectomy with the initials of his alma mater, University of Kentucky. It is standard practice and the patient knew that the physician was going to mark the sides of uterus in some manner after it was removed. She did not know the type of the markings, which truly makes no difference unless she attended Louisville University. Top
In California, the attorneys for Drs. Moon and Realyvasquez, the two physicians who have been accused of unnecessary surgery in Redding, have been notified that they will be sued by about 300 patients. How can that be? The bottom feeder slime-ball trial attorneys (excuse me Consumer Attorneys) are using every method they can think of to get cases including web advertisements on Google and other sites. Many of the potential suits stem from the unknown. Patients wonder if they really did need the surgery or cardiac procedure that they had. Most will also add the charge of corporate fraud to their cases in order to get to Tenet, the hospital where these procedures took place. It is also interesting that damages for fraud are not limited to the $250,000 malpractice limit on non-economic damages. You think there might be a correlation?
Dr. Moon is losing his malpractice coverage and so is closing his practice. No charges have been filed against him by either the feds for Medicare fraud or by the state medical board. Since he is covered by a claims made policy any law suit filed after the end of January will be not covered by insurance. Top
DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the time of publication. Nothing in this article constitutes legal advice. Readers should consult with their own legal counsel before acting on any of the information presented.