December 1, 2004 News





State Boards


Does anyone remember Donna Shalala?  She is now the president of the University of Miami.  She will seek the legislature to grant sovereign immunity to physicians at Jackson Memorial.

The St. Petersburg Times reports that rural Florida physicians are leaving the state and those who remain are shutting down their high risk procedures.  This includes OB.  A study showed a 51% cutback in hospital surgeries and 47% cutback in ER call.  Also there was a 61% cutback of normal deliveries and an53% cutback on C-Sections.  

In Florida, the attorneys may ask their clients to waive the statutory percentages in med mal cases.  The state passed an amendment to limit attorney fees.  In California, this is illegal and will probably be ruled so in Florida as well.

The Boston Globe reports that malpractice verdicts in Massachusetts have leveled off.  However, rates for physicians have continued to rise.  They also state that Massachusetts juries awards plaintiffs twice the national average in verdicts.  Living in her own world, the director of the medical board suggests that the drop in settlements have gone down due to less events.  There are no signs of proof of that.  There is proof that when physicians talk to patients, the amount of suits decrease.  There is also the disproportionate verdicts affecting the high risk specialist more and causing them to drop the high risk procedures.

President Bush has again stated that malpractice reform will be a goal of his administration with California as the example.   

There are several malpractice stories coming out of Maryland.  The first is a study commissioned by the Maryland Hospitals Association that shows the entire state economy is impacted by the lack of meaningful malpractice tort reform.  The early retirement or leaving the state of physicians coupled with the loss of all medical staff will cost the state $171 million this year and up to $295 million next year in lost business sales.  

The other Maryland story is the physicians in Western Maryland are leaving their practice for a week to come to the Capitol to lobby for malpractice reforms.  Obviously the plaintiff attorneys and their Democratic legislative lackeys think the protest is wrong. Some of the medical staffs are making the carrying of malpractice insurance optional.  This will not be allowed by the governing boards of the hospitals since the risk would then be transferred to them. 

Several months ago a group of physicians were going on strike to protest the malpractice rates.  Governor Ehrlich talked them out of it.  With the crisis still unable to be resolved a five person surgical group will stop doing medical practice as of January 1.  This leave only three surgeons for the area who cannot possibly cover the ED.  Patients will need  to be transferred for care.  Many physicians in the state are planning on not paying their next malpractice bill due on December 1.  

Governor Ehrlich of Maryland has promised to try to reduce the 33% malpractice premium hike.  In other words, he has promised nothing.  The Governor and the head of the state's senate and legislature met and agreed to nothing.

In Illinois some of the Democrats have begun to state they are willing to consider meaningful med mal reform including caps if it is is tied to  insurance reform and the weeding out of frivolous lawsuits, both laudable goals. 

In the meantime the southern Illinois hospitals are losing their physicians and credit ratings.  One hospital lost 40 physicians in the last two years. The hospital lost a neurosurgeon, urologist and Orthopod and has not been able to replace them.  The remaining neurosurgeons have stopped doing intercranial surgery, so have dropped off the trauma panel. Two other hospitals in the area have lost 80 physicians each.  A hospital in Alton, Illinois has lost 33 physicians which caused an operating loss and a downgrade in their bond rating.  

Virginia Mason Hospital in Seattle has announced that an error by the hospital staff killed a patient.  The announcement is part of the new openness of mistakes that people are advocating.  The patient accidentally had a cleaning solution given intravenously instead of contrast for an x-ray.  

In Tallahassee, Florida, the malpractice situation continues to rear its ugly head.  This time the payments by a large OB Group caused them to fire three midwives.  The North Florida Woman's Medical Group who deliver the majority of the 4000 babies born at Tallahassee Memorial Hospital will do their own deliveries.  In Florida, midwives are not allowed to work except under a physician's supervision.      Top


I don't understand it but the Congress believes they will run a deficit this year.  Since Medicare and Medicaid is 25% of the budget the Congress will consider lowering payments to all providers of care except physicians to save money.   

The consumer advocates who went to court in Tennessee to allow more people to be covered under the TennCare program have stopped their advocacy.  The Governor has called their bluff.  He has stated if you want more than the state can afford you will get nothing.  The advocates have backed off and allowed the Governor to more time to finalize any changes needed to keep the plan a reality. 

Kaiser has made two announcements.  The first is that they will start in their non-California locations to accept HSAs into their plan.  The second is is that they made a net profit of $1.3 billion last year.  Not too shabby for a non-profit or for any company. 

The number of C-Section in the US is continuing to grow.  The study in a British Journal states the sections are for non-medically necessary reasons.  This was especially true in women over 34 years old.  The reason given was control and convenience.

In Ohio, a new study showed the HMOs are getting a smaller percentage of the patients but making more money.  This is consistent with other published reports in other states.  The HMO population has dropped about 15% since 2002 and the HMOs increased premiums in 2003 and make their highest profits ever the same year.

The California Nurse's Union staged a one day walk-out throughout the state to protest the sensible delay in the going to the more strict nurse patient ratio.  There are not enough nurses in the state to comply with the stringent ratios and several hospitals have closed stating that the ill thought out bill was one of the reasons for the closure.  

The People's Republic of Massachusetts are slow learners.  After California defeated the Proposition of requiring the pay or play healthcare option as anti-business, the anti-business stat of Massachusetts is bringing it up. They hope that another tax on cigarettes plus the requirement of business to pay for healthcare insurance will cover the costs of all the state's citizens.  This is a laudable goal but has only been done in the United States in Hawaii.  The Governor is against the bill.        Top 


It's a new newsletter so the top of the pile is Drew/King.  The public who have no clue as to the mismanagement and ineptitude at the hospital have spoke at a protest of closing the Trauma Center.  They don't realize that when a hospital has a trauma center, they also have hospital patients.  You must be able to treat both elements.  Drew/King can not.  Those in charge of the rally are the same ones who lead the charge in all idiotic rallies and who love publicity.  The local congressperson and Jesse Jackson.

The above publicity seeking people had the usual effect-nil. The supervisors did what they needed to do and voted o close the trauma unit.  The supervisor in whose district the maligned hospital resides, did her usual political fence sitting and abstained from voting.  The Board did encompass an amendment from the fence sitter to have as a goal the eventual reopening of the trauma unit.  Maybe now the politics can be left behind and the hospital be allowed to do its job.

At the same time as the rally by the uninformed, two physicians who studied the trauma service as Drew/King have stated that the care the patients received were poor to marginal.  The problems were the same as in the hospital-not enough nurses and ICU beds, poor documentation and a flawed method of correcting problems.

I congratulate Robert Wood Johnson Hospital in Hamilton, New Jersey.  They have become only the fourth hospital to win the coveted Malcolm Baldridge Award for Quality.  

The AMA will lend its support to the specialty hospitals in their war with the American Hospital Association.  The AMA will not only back physician owned specialty hospitals but also the elimination of CONs.  The AMA believes in the free competition between entities that leads to better and cheaper services.

In the war between specialty hospitals and the American Hospital Association, MedPAC released part of a report glommed onto by both sides.  The American Hospitals state the report shows that specialty hospitals are not more efficient and they tend to transfer sicker patients to other institutions.  The specialty hospitals found that the report showed that specialty hospitals did not impact the bottom line of the community hospitals.  They also state the specialty hospitals have a significantly shorter length of stay and higher but not significantly costs per discharge.

In a South Dakota study purchased by the AHA, the hospital study showed that physician owned hospitals were profitable and did good pay procedures.  The study somehow found that the community hospitals were having access problems but they don't state in the story what the problems are. 

Modern Healthcare, a magazine for hospitals, states that the AMA may side against the AHA on the issues of specialty hospitals.  The California Medical Association has already taken a strong stand for competition and against economic credentialing.  The case by the AHA was dramatically weakened by the recent closure of the specialty heart hospital in Wisconsin.  The hospital couldn't make it on a competitive basis, which is the reason for survival of the fittest. 

At California Hospital in Los Angeles the nurses have discovered a covert camera system installed by the administration in nurses lounges.  The administration stated they installed the cameras this summer for security and had not gotten around to putting put signs notifying people about the cameras.  It was to discourage thefts in the nurses break rooms and lounges.  A unrealistic story.  It reminds me of the time that one of my hospitals put up a two way mirror with recording and sound equipment.  They would have the public meetings in the room at a time when the public was not in favor of the hospital increasing in size.  When the scheme was found and the administrator confronted at a medical staff meeting, his response was "Ok, you found us out.  What's next on the agenda." 

Another California hospital closed December 1.  This was the last of the downtown San Jose hospitals, the 91 year old San Jose Medical Center.  About 500 people will become  jobless due to the closure.  It was also a regional trauma center.  The cost of retrofitting the hospital as required by the state seismic laws would have been over $100 million. 

Kansas City hospitals are getting smarter.  They have asked the physicians to join them in building outpatient facilities.  The hospitals are realizing they are dead meat without the outpatient business and that business has fallen for the first time.  Physician owned businesses are getting the larger piece of the action.  

Emory University lost a patient.  The patient was found two days later dead in a bathroom in a little used part of the hospital.

Still in Georgia, the Phoebe Putney Hospital, the same one that started the non-profit charging too much to the uninsured, is again under investigation.  This time by the state for Medicaid fraudulent billing practices.  When they tangled with the Albany Medical Center they got more than they bargained for.    Top


Speaking of the AMA, a recent report  showed that membership is continuing to decline.  They lost almost 4000 member in the past year alone.  In the past eight years the organization has lost almost 50,000 members.

The Association of American Physicians and Surgeons at their last annual meeting gave an award to Steve Twedt of the Pittsburgh Post Dispatch for his articles on the disruptive physician in whistle blowing.  The also voted to outlaw sham peer review by hospitals and to allow all physicians whether employed by the hospital or not to be covered under whistleblowing and patient advocate protections.

A new report in Physician Compensation has shown more hospitals are paying more money for on call work.  The hospitals are paying either on a per case or per shift basis.  The former pay rate is between $60 to $ 3809 and the latter is $100 to $2000. 

Modern Physician has come out with a report that 40% of private practice physicians spend the equivalent of one day a week managing the business. This is something that over 3/4 of those private practice physicians found challenging or extremely challenging.  

In a fascinating story that could only happen in California, the entire 19 person anesthesia group at El Camino Hospital resigned.  They cited unreasonable administrate demands over billing and forcing the anesthesiologists to take all insurers the hospital took.  The contract deadline came and the anesthesiologists left.  Some of the anesthesiologists continue to work at various surgical centers.  Some of the physicians at El Camino have cancelled or moved their cases to other institutions because of the unknown quality of those hired. In an interesting turn El Camino staged a wholesale raid on Washington Hospital, on the other side of the bay. They hired eight anesthesiologists without the Washington CEO knowing about it.  The CEO had to scurry to find three temporary anesthesiologists for the start of surgery on Monday.  This sounds like the start of another Ventura Community Hospital fiasco case.  I might add, on a personal note, that this CEO in one of his former CEO positions called me into his office and threatened me with bringing in another urologist if I didn't do more surgery at his hospital.  It didn't work. I stayed.  He didn't.    Top

State Boards

A recent article in the Ft. Worth Star Telegram discusses the poor work done by the Texas medical board.  The board does not agree with the physician comments that the board is inconsistent, arbitrary and there is no avenue for appeal.         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.