April 15, 2005 News






The University of Miami is trying again.  Last year they were rebuffed by the Florida legislature to have their malpractice claims capped.  They are trying again this year along with six other teaching hospitals.  The hospitals are all med schools and are a mixture of private and public institutions.  Public hospitals have immunity and a $150,000 cap on liability.  The hospitals are to be expected to be more open about mistakes and be more proactive in training to prevent mistakes.  Of course, they should be doing this anyway.  The matter is being fought by the mean spirited trial lawyers.

Still in Florida, the legislature is considering a bill that would require malpractice insurance for licensure.  The physicians would either have to get the insurance or prove they could pay $750,000 by putting the money in escrow or having letters of credit from banks.  Since most physicians in the state could not put up that kind of money or pay for insurance, there will be a mass exodus from the practice of medicine in especially south Florida.  Currently, the physicians must post a notice stating they do not have insurance and state they will be able to pay $250,000 in one event or $750,000 in multiple events.  

The largest med mal insurer in Massachusetts has decided not to raise rates for the coming year..  There have double digit increase the previous three years.  The insurer has done better financially and there have been less claims.  Helping this also is the reduction by 50% the interest rate insurers must pay the insured.   

There seems to be less enthusiasm for allowing the videotaping of births since the tapes have been used in med mal cases against the physicians.     Top


Two physician groups in Miami have combined to form their own health insurance company.  In a short time they have annual revenue of $66 million and 1000 physician with 7300 members.  Why, one may ask would they do this.  To get rid of those that stand in the way of patient physician care.  The companies are PSOs.  The main problem to date is, as usual, the hospitals.  They don't want to give the new PSOs the same discounts they give the HMOs.  So the PSOs use different hospitals that will give them the discounts.

It seems ridiculous that CMS is planning on reducing the payments to physicians taking care of Medicare patients by approximately 5% per year for the next three years and then turn around and give a 5% raise to to HMOs that ration care to the seniors.  The reason for the raise is that the HMOs started to drop out of Medicare.  I wonder what will happen when the physicians finally catch on and begin to do the same.

TennCare will find out soon if the Governor's plans can go into action.  The appeals court will rule as to the power of the district court to scrutinize the plan. The appeals court is expected to rule prior to the district judge issuing his ruling.  Both parties agree the judge does not have the power to restrict any cuts but does have the power to make sure the enrollees have protections in place for appeal.  They disagree on whether or not the plan should be kept on hold until the final authentication of the appeals process.       Top


Maybe I should have a separate section for Drew/King, the worst hospital in the country.  After all there problems, it was recently announced that three patients died at the hospital in February due to negligence.  One was from the erroneous placement of an endotrachael tube causing one lung to collapse.  Another was a seven hour delay in the transfer of a person from the med surg unit to the intensive care unit.  The third was a patient that may have not received the right medication and where the anesthesiologist did not respond to a code blue.  The health department stated that in none of the three deaths were community standards met.  

After the above story, another one in the LA Times told of another act of negligence at the hospital.  A patient hooked up to a cardiac monitor deteriorated and died after the nurses did not notice the patient's condition going downward. The nurses state they did not hear the alarm.  The system was in good working order.  The nurses weren't.  I don't understand how they can pay the families of all the screw-ups and continue to stay in business.  The liability pay outs have to be huge.   This hospital deserves to be closed.

The LA County Supervisors are now considering breaking the Drew medical school off from the King hospital.  They believe that hospital reform may go faster if there is no med school.  The med school would be partnered with another school.  Of course, the supervisors are paying millions to consultants to run the hospital and have not talked to them about their ideas. I have no idea why any person would want to receive training at this school and hospital.  When they come out they will be known as poorly trained.   

California hospitals continue to attempt to comply with the unreasonable nurse patient ratios but are failing.  The hospitals are hiring as many nurses as they can from registries or asking for overtime, but they still fall short.  Some are closing beds or holding patients in the ED for a long time to maintain the correct ratio. 

The New England Journal of Medicine has an article regarding specialty cardiac hospitals versus community hospitals.  The conclusion is there is equal care and outcomes in both.  The AHA is using this as fodder to show there is no need for specialty hospitals.  They tend to forget that this is only one type of specialty hospital and the raw data actually statistically favors specialty hospitals.  After the raw data the researchers at the University of Iowa added other factors to make the results equal.  The article, of course, does not state the underlying reason for the specialty hospitals in the first place.  That is the refusal of community hospitals to work with their medical staff in a cooperative manner. 

The CEO of HCA has come out in favor of physician ambulatory services as long as they are not hospitals.  He believes that hospitals can compete or partner with physicians in ambulatory services which he believes are a natural extension of their offices.

The Chamber of Commerce, dominated by businesses, not individuals, has endorsed the continuation of the moratorium on specialty hospitals.  The Black Chamber of Commerce has also endorsed the continuation of the moratorium but for perceived racial and economic reasons.   

A physician attorney for a large hospital consulting company has stated on line that economic credentialing by hospitals is OK.  He defines the process correctly as one that uses non quality concerns to allow physicians on their staff.  He implies that the hospital should remove physicians that compete with the hospital.  Remember, he and the company he works for are paid by the hospitals.

A story shows what can happen when a hospital thinks they are above and not the equal of physicians.  Beth Israel Hospital in Boston lost two or half of its neurosurgeons to nearby Tufts.  Why?  Because Tufts was willing to devote resources to the special equipment the physicians need to move forward in their field.         Top


The chief medical officer for Medicare has been placed on paid leave after the Maryland Medical Board accused him of faking his required CME activities.  Dr. Sean Tunis is also a part time ER physician in Maryland and as such need to maintain his license requirements. He was supposed to obtain 50 hours of CME every two years.  He admitted falsifying the actual courses since he could not find the actual documents certifying that he attended the course. CMS has appointed an interim CMO.   

Medical schools are beginning to drop non essential courses from their curriculum.  One of the first to go is ophthalmology.  Schools are required to teach medicine, surgery, OB/GYN, and psychiatry.  As money dries up other disciplines do as well.  The schools that do teach ophthalmology are using FPs and not ophthalmologists to do the teaching to save money.  

Locum tenens practices are increasing as more physicians want to practice less.  There are about 30,000 physicians now working as locums.       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.