Many Florida physicians began their work stoppage on May 2. This was the date of the final session of the state legislature. The surgeon's decision to stop elective surgery puts the kibosh on mammography in some hospitals and OB/GYN in others. With no general surgical back-up it would be malpractice to do the cases. Governor Bush will not let this legislative session finish without a budget and a resolution to the malpractice crisis. He supports malpractice caps for non-economic damages.
The Florida legislature has finished their session without passing any malpractice reform. The Democratic Senate failed to agree with the House version of caps. I hope they like the Capitol because their will be a special session called by the Governor to deal with the issue. The good thing for the legislators is they get significant extra pay for this special session, an incentive to not get the work done during the regular session.
The Florida Health Chief asked the physicians to return to work. In Jacksonville about 100 physicians have halted all elective surgeries and office hours. The area has opened the hurricane crisis center to help people find physicians. The surgeons have left various hospitals so that hospital A may have general surgeons but no OBs and vice versa for hospital B. In the first week of the slowdown, surgical procedures are down by about a third and many patients needed to be transferred. A large number are going to those hospitals with some governmental immunity.
The Miami, Broward and Palm Beach county surgeons are considering the same slowdown or stoppage. Some physicians are starting an educational process for their patients explaining physicians will leave the state if they can not make money.
The surgeon who is the head of the Florida Medical Assn. has quit practice to protest the med mal crisis in the state. He has had one minor payout in 1984 and is paying over $250,000 for insurance.
So far nine of the 100 physicians in Florida have stopped their walkout and returned to work. Their short term pocket book was more important than their long term one.
Governor Bush has just call the legislature back into special session to force malpractice rates 20% lower and tort reform. Bush vows to continue to call them back all year if necessary if they do no pass legislation that resolves the issue. There goes the Europe trip.
One legislator, Representative Connie Mack a Republican, has recommended legal fees in all personal injury and malpractice cases to $75,000. That won't work but maybe it will get the legislature to consider sliding scale malpractice fees as in California.
In Virginia there is problems with an insolvent insurance carrier and puts both the physicians and attorneys on the same side. The Insurance Commissioner wants Reciprocal Insurance to stop paying claims due to financial concerns. The company insures about 2000 Virginia physicians and 5000 attorneys. The company is a reinsurer who is running out of money.
The Pennsylvania Governor's mouth is moving so we know there is a lie coming out. He now states that a malpractice fix is on the way. Earlier in the year he said the fix would be quick and take care of the problems. That didn't happen so the physicians have begun their work slowdown. Now the Gov is asking the physicians to go back to work as normal and "trust us" to do the right thing by you. In a state so grounded in tort lawyers, this will not happen unless the Governor pushes hard, something Rendell is not anxious to do. In a recent rally some physicians carried a picture of the Gov. on an ace of spades. Sadaam Rendell.
The trial lawyers are using photos of their own. They are sending weekly to each legislator a packet with pictures of a victim of malpractice. The attorneys are winning the battle of the individuals but the physicians may be winning the battle of the big picture. Pennsylvania is unique in that there can be no caps unless there is a change in the state constitution. This would require passage at two sessions of the legislature and finally a statewide referendum.
Please see New Legal regarding Pennsylvania.
New Jersey is back at it. The physicians have rallied again in Trenton for malpractice reform. The State Senate has passed a bill but the House has not taken up the matter as yet.
The Texas legislature will have a special election in September of the Texas voters regarding the malpractice caps. The early election was picked to keep voter turnout low as most general elections are in November.
The Missouri physician exodus is beginning. The malpractice insurance premiums are doubling and the reimbursements are static, a lethal combination. The high risk procedures are being performed less often and some are moving across the river to Kansas. Kansas has a state sponsored malpractice plan and lower rates. Missouri has only two malpractice companies that will write insurance on all specialties. A bill in the state Assembly would limit lawyer fees and prevent moving of cases to favorable venues. The bill covers both medical and general business so the governor will veto the bill. If the bill is amended it will die in committee. Two neurosurgeons are leaving Independence resulting in the closure of the trauma center. St. Joseph in Independence already closed it's trauma because its one of its neurosurgeons went to Kansas.
An interesting part of the Missouri situation is the state had a cap of $500,000 on non-economic damages until a court of appeal case in January 2002 stated the caps could be applied for each occurrence of malpractice. In a recent trial the judge stated there were twelve occurrences for each of three providers.
Illinois physicians rallied in Chicago for federal legislation to cap non-economic damages. It is strange that they would picket at Daley Plaza. Daley, a Democrat, would certainly kick the physicians out as he was a pawn of the attorneys.
In Detroit, Michigan, Hutzel Woman's Hospital, a high risk pregnancy institution, banned all transfers of non insured patients unless their illness is one that definitely can not be handled locally. They will continue to see those who come directly to the hospital.
Washington State has joined the fray. Physicians went to the Capitol to show their support for malpractice reform in their state. There were about 375 of the physicians at the rally. In the usual standoff the House passed a bill for tort reform but the Democratic Senate has denied the action. This means another year of inaction if no special session is called.
New York physicians were asked to protest their malpractice rates and only a few showed up. They don't deserve much slack if they can not speak for themselves. Top
The Nevada Medical Board wants the physicians of the state to do competency exams every ten years. This is not done anywhere else in the country. I am not sure how one asks a dermatologist about how the kidney functions and have it germane to his/her practice. I can foresee physicians taking the exam and then retiring when they don't pass. I can not see the older experienced physician being humiliated by taking the exam at all. The Board states that this is part of it's mandate to insure that only competent physicians practice. I believe all know that the ability to take and pass a test has no relation to the ability to practice. The proof is in the medical boards where some board certified physicians are not good doctors. This test would only be given to those not re-certified by their specialty and those who do not practice at hospitals. Doctors who practice at two or more hospitals would be exempt. Top
There is now about 3/4 year left prior to the dreaded nurse staff ratios going into effect in California. The ratios will be 1:1 in trauma/ ICU and 1:6 on med/surg units. These ratios can not be attained for several reasons, the main one is that there are not enough nurses. This will cause the hospitals to either go against the law, which they would not do or cut back the available beds to meet the ratios. This would decrease the number of beds available and increase the waiting times for elective treatments. With smaller numbers of beds available, there will be lower revenues for the hospitals and therefore less money to pay for nurses. A vicious cycle. The same thing is true in the long term industry where ratios are also mandated. Again there will be less beds available for the public. There is no question that there are minimums below which greater problems with patient safety occur. The amount is unknown and varies from hospital to hospital and unit to unit. It should get interesting when the public finds out about these artificial ratios and why their waits for procedures or to get into an extended care facility are longer. It will be equally interesting when the California Nurses Association comes demanding for more money for decreased work and the hospitals have decreased revenue. Top
This is the subject of the new quarterly newsletter.
Also see New Legislation
In Lebanon, Tennessee, a group of physicians representing about half of the only hospital in the community are going to attempt to build a hospital with a surgical center and imaging to compete with their current hospital. The reason for this the the pending sale of University Medical Center by Tenet will increase the cost of care in the county. To date, the doctors are only discussing the matter and have not yet gone for land, financing or the required CON. The local pols are in favor of a new hospital in this fast growing area.
In Cincinnati, Ohio, a physician is committed to creating better heart care in the community. He wants to do this by building a new heart hospital. By building the new hospital the volumes of heart patients should increase and the nurses and physicians should become more proficient. He likens this to trauma hospitals where the care is much improved over the older system of trauma going to the closest hospital. He wants this to be a cooperative effort among all the players in the community. Currently, there is not one hospital in the area that can claim to be a true center of excellence because their volumes are too low.
The University of Colorado have had to close some of their operating rooms due to a shortage of anesthesiologists. The physicians are voting with their feet and opting to work with no call or weekends in plastic surgical offices and surgical centers. If the hospitals wants them back they need to compete. Yes, I said the "C" word.
Aurora Health Care in Milwaukee is having its physicians boycott the cardiologists who are going to belong to the staff of competing specialty hospitals. Aurora Denies this and states that the physicians may refer to whoever they want. If you believe that, I've got a great bridge to sell you. The hospitals have also removed the physicians from all panels and any committee work that decides on equipment. I will assume the cardiologists will resign from the Aurora hospitals so they will not have to do night call at an institution that doesn't want them. One of the two new heart hospitals is a joint venture between a different Health Plan and the physicians. Another new cardiology hospital is a joint venture between MedCath, a private company, and cardiologists. Both new specialty hospitals will have EDs. Top
Yale Hospital has decided to stop their foreclosing on homes to collect medical bills. They will also forgive $84,000 owed by 170 people for more than five years. The state Attorney General filed suit against the Hospital for it's practices. The suit states that the hospital failed to tell patients regarding donated charity funding. This started with a Wall Street Journal article called Heartless Hospital. Top
In Orange County Florida the County Commission appr9oved $1.9 million to help defray expenses at the Orlando Regional Medical Center. The trauma center needs $5.8 million to stay in business. The surrounding counties that utilize Orlando Trauma will pay another $1.9 million combined. The money is to be used for 18 months of subsidy of private neurosurgeon's pay to work at the unit. This would increase each neurosurgeon's cut to $4000 per day from $1500 per day. The neurosurgeons also have a 30 day drop clause in their new one year contract that will be used if the legislature doesn't come up with malpractice reform.
In California, the Santa Paula Hospital in Ventura County has voted to move from a private hospital to one affiliated with the county health system. This move helps the bottom line and will allow the hospital to keep open its trauma center. this is the only trauma center between Ventura and Santa Clarita.
The California Senate states in a report that patients may wait hours or even days in the emergency room because specialist refuse to see the patients if payment is not guaranteed. The report recommends that this unfunded mandate be funded by counties and not the state. The state is broke but so are the counties. Top
The new healthcare national problem is Medicaid funding. The Feds are not increasing the money to the states and the states are utilizing the money for general fund purposes. The major funding cuts will actually increase spending by the states since physicians will not take the patients and the emergency rooms will need to pick up the slack. This will also cause longer waits and delays in care with sicker children who may have to be admitted. The state would then pay the hospital bill.
In view of the cuts in Medicaid Nevada pediatric surgeons stopped taking Medicaid patients. These patients will now need to be taken out of state. They will continue to see the ones they have and will take true emergencies only. Top
The Rocky Mountain Cancer Center in Boulder, Colorado is dropping about 400 cancer patients insured by Kaiser. Kaiser is not paying enough. The patients take up 25 % of the visits but only 7% of the revenue. The patients will now have to travel to Denver since there is no Kaiser facility in Boulder. Kaiser has hired two new oncologists since January and may be forced to send one to Boulder. Top
The Cincinnati area has been a focal point of low reimbursement. The area can not recruit physicians due to the low rate compared to the comparable areas in the mid-west. There is finally going to be a study conducted by the local business community. The problem is who collects the information. As of now, an insurance company is doing the collection. The physicians want an independent company to do the collection. It has gotten so bad the the physicians of the area have filed an anti competitive suit against the insurers of the area. This is now in the discovery phase after a judge denied an insurer motion to compel arbitration. There are fewer physicians in this area than in other cities of the same or similar size. Reason, reimbursement.
In the San Francisco Bay Area the physicians are making deals directly with insurers for PPO payments. The intermediaries are the local medical societies. The Union of American Physicians has had an IPA that has been doing the same thing for over ten years. The cuts out the need for an IPA or a large medical group. The large insurers are not likely to participate since they already have their statewide networks. The smaller insurers are very interested.
Speaking of health insurance, I had the pleasure of being in the audience when the CEO of eHealthinsurance gave a presentation. This is a for profit online insurance broker licensed in 49 states ( West Virginia has a law that there must be a physical office in the state). They have contracts with multiple carriers for the do it yourselfer. They also have bridge insurance to take the place of the expensive COBRA coverage that many are offered but few can afford.
The Denver Post recently ran an article stating that the Colorado physicians are taking less Medicare patients. This is the third year that the decrease has occurred. In a related area the Colorado Family Practice residencies have seen a 50% decrease in the past three years. Top
Pennsylvania has a law that pharmacies must sell drugs to victims of auto accidents at a 20% discount. The rationale behind this bill which passed in 1990 was faulty then and has not changed. The pharmacies usually ignored the law and balanced billed the patient the 20%. Now CVS with 350 stores in Pennsylvania has said that they will fill no more prescriptions for auto accident cases. This is the same company that is currently suing Massachusetts for their illegal prescription tax. Top
California is looking into why Western Medical Center is not looking to kick a neurosurgeon off its staff. Could the reason be that he brings to the hospital about $38 million per year? I'm sure no hospital would look at that over the quality of care provided. This neurosurgeon has been accused of unnecessary surgeries, lying to patients and malpractice. Dr. Chambi, the neurosurgeon in question, has been sued six times more than the average neurosurgeon in the country. It should be noted that Western Medical is a Tenet hospital. Tenet is also in trouble for the cardiology mess in northern California at Redding Medical Center. The doctor denies ever doing unnecessary surgery and the hospital also defends the physician. The Orange County Register did a major piece on the potential problems. Top
The New York Times has an article about a stupid attorney who did something you never do, ask a question when you don't know the answer. A physician who previously was a medical director for Humana and who quit after learning about the company, had denied heart surgical procedures. She now works to bring the horrors of managed care to the forefront. She stated Humana paid $488,000 for a statue in the lobby of Humana's Corporate office, the cost of a heart transplant. She later learned it cost Humana much more, $4.8 million and made that public. A Humana attorney found a judge who made her tell under threat of contempt who told her the cost of the statue. The informant was the brother of Humana's CEO. This major embarrassment to the organization may have been overlooked if it wasn't for the idiocy of the attorney. He should not have a job there for long. 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.