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It's had to believe but someone in South Dakota is really looking into potential conflict of interest. Up to now the South Dakota Med Board and the Medical Association has shared staff and had offices in the same building. They are now going to truly separate.
A California legislator asked for a report on the Medical Board of California two years ago. It was just completed. It faults the Board for not publicizing misdemeanors related to medical practice or those physicians referred to the Attorney General on their web site. The CMA has agreed with the former but disagrees with the latter since not all referrals come to prosecution. The report also recommends a $100 per year raise in the medical license fees, since there has been no raise for 11 years. The CMA believe the raise is not needed because of the inefficiency of the Board. The legislator will introduce a bill this year to correct some of the perceived problems. It now takes about 80 days to initially screen complaints, about 250 days to investigate, 100 days to prepare a formal accusation, and 513 days to go through all the hearings and legal process for a total of 2 1/2 years. It seems like a long time but when one looks at the potential for harm to the physician, it may not be. The public can be protected by the Board suspending the license immediately. Top
In a fascinating study of human nature CalPERS, the largest purchaser of healthcare in California had dropped Sutter hospitals of Sacramento from its Blue Cross HMO. This affected a total of about 33,500 consumers. Of that total, about 8000 went for a higher cost PPO that would include Sutter. An additional 3000 went to Kaiser and another 6600 went to Western Health Advantage. The latter two do not include Sutter. In all Blue Shield lost 50% of the Sacramento insured.
In a study on colon resection in Florida there were no differences in cost between Medicare HMOs and Medicare fee for service. The HMOs had shorter stays but higher costs.
UnitedHealth continues to ration care. They are making "centers of excellence" of their patients based on economics and not quality. They are then "asking" their primary care physicians to send the x-ray referrals to those areas. The insurer is using the American College of Radiology Guidelines which tell physicians which procedures are useful for diagnosing a problem. This puts the doctor between the rationing of the insurance company and the need for defensive medicine for the trial attorneys. Top
Rhode Island is not afflicted with the same exodus of physicians as its neighbors. They actually have a positive number. However 25% of the state's physicians intend to leave or quit within three years. The biggest gripe is the small amount of money being paid by the insurers. The discrepancy in those leaving and coming into the state maybe foreign physicians who take a residency in the state.
As I usually write about the People's Republic of Massachusetts and their anti business left wing programs, a new statistic came across my desk. It is the only state in the country that had a decrease of population in the past year. Might the two be connected?
Those physicians that work for the federal government under Title 42, as a special consultant and receive higher than civil service salaries are not entitled to whistleblower protection. Those who are Title 42 workers are not allowed any appeal rights during probation. This case came about when Dr. Jonathan Fishbein blew the whistle on nevirapine, an AIDS drug. The NIH then fired him for "poor performance". However, documents showed the Doctor was correct and there were patient safety rule violations and other problems. In spite of the flaws the drug was accepted.
A recent article in REPORT ON MEDICARE COMPLIANCE told of the problems EDs are having getting specialist coverage. The new laws allow physicians more latitude in how they will cover the ED and there is no more every third night rule. The hospital must take into consideration not only the number of physicians in any specialty but also how they are sub-specialized. The hospitals are either having to transfer more patients from community hospitals to tertiary centers, pay the specialists to take more call or hire hospitalists to see and admit the patients if necessary. Top
Delaware has put in a Merit Board to examine med mal claims prior to filing. For the past year there have been no problems for the filers getting the certificate of merit. There does seem to be a drop in the number of claims filed since the law took effect. One of the problems of the system is the anonymity of the physician signing the affidavit. The other quirk in Delaware is the requirement of unanimity of 12 people for a verdict for the plaintiff, one of only three states to have that requirement.
Maryland is finally going to have the special session on med mal. The problem is the money to pay for the portion of the premium. The Democrats wants it to be financed by a tax on HMOs and the Governor want it out of the general funds. The Governor also wants a reduction of the pain and suffering award and allow apologies from physicians and hospitals to be given without penalty.
The Maryland Senate and House are looking at different bills to resolve the malpractice problem in the state. The Senate has reopened their old bill with the lawyers in mind. The House is debating the Governor backed bill. Please see Legislation for the result of the special session) Top
Thank God for Drew/King. Each edition I can count on them to screw up and give me something to write about. This time it is the use of Taser guns to subdue aggressive psychiatric patients. Two years ago they were cited for using the Taser weapons without policies. They now have policies but not very good ones and not ones they follow. The latest is the third warning this year on the Taser problem. This one may cost them their federal funding. They do not take adequate steps in attempting to use less force to subdue a patient prior to the use of a Taser. After the latest warning, the Board finally reacted and banned all Tasers from the hospital.
Following the above story, the LA Times issued a story that in order for the hospital to stay open that the Board of Supes would have to be left out of the loop and delegate responsibility. In the past the Board has repeatedly stepped into the problems of the hospital for political reasons, a no no when you are attempting to raise the quality of care. This should take the place of the potential current reason for the hospital, to give jobs to political friends. Another problem of the hospital is it's civil service employees. They can not be fired until they go through long grievance processes and the supervisors don't document the problems. The experts also believe that the hospital can not continue its residency programs in this dysfunctional situation. They recommend that UCLA, another funded institution, help in the oversight of the hospital.
The Times then asked several questions of the Board. It was interesting that the Board member in who's district the hospital sits is the most pie in the sky of any of the Board. She needs to be replaced soon.
You knew there had to be more. Now the "hospital" failed another federal inspection and will probably lose its federal funding on January 19. The feds asked the employees how they would respond to mock drills and they could not answer. This was after two weeks of intensive training in the drills. One of the members of the Board said thy are getting rid of the incompetent hospital members. However, they are civil service and the hospital would be empty of staff. Believe it or not, even after all the warnings, the County Police arrived on scene with Tasers.
There is another LA hospital in trouble. This time it's the Doctor's Hospital which has been put on probation by the JCAHO for multiple violations in their lab. The hospital is attempting to make the necessary changes that would allow it to keep its accreditation.
In the specialty hospital lies between the two sides there may be some actual facts. In Dayton, Ohio, the HHS is studying how a specialty hospital is actually affecting the community hospitals. They are studying the data and interviewing the hospital CEOs, the latter will be nothing but unbelievable on both sides.
In an interesting story about Mr. Stanley Hupfeid, a staunch anti-specialty hospital person. He is one of the creators of the mega Intergris health in Oklahoma in the 19990s. He believes this is a life or death struggle for the hospital business and is on the committee of the AHA to ban the specialty hospitals. He states that if he were king he would force all physicians out of owning any hospitals. He also states he is a advocate of physicians but the physicians that know him state he is anything but. It was reported that he has told physicians that if they do something he didn't like that he would bury them. He denies stating that. He has lost about 16% of his heart business to a competing hospital that partnered with their physicians. This may be due to lack of true partnering by Integris with the physicians.
State of California regulators have checked a small sample of hospitals and found that most have flunked the old nurse patient ratio. This is more ammunition as to why the more restrictive ratios should be delayed. The state staff found that 15 of 28 hospitals flunked the ratio and an additional 3 had other violations. Those with violations needed to submit correction plans which included hiring more nurses via the registry. All agree that these nurses that are not familiar with the hospital are not ideal but they have little choice. 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.