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There are some organizations that are so pompous that they flaunt fairness at every turn. One of the major offenders is Kaiser. After getting blasted for their transplant program and being caught in lies, they were involved in the infamous "Is the EHR record system any good?" fiasco. One of their own sent a blast email stating the problems with the system and the wagons circled. The whistleblower was placed on paid leave. He recently has been asked to meet with the people at Southern California Kaiser. He was told he could not bring an attorney or advocate, he could not have access to the tapes of the meeting nor could he tape the meeting himself. Since all his rights were removed he declined to attend. His status is now on unpaid leave. He was not told about that either and had to find out via the media. This is typical of Kaiser and its inherent lack of care for fairness to its employees or members.
Two articles the same day show the same side of the coin. Time.com put out a story on the wars between community hospitals and physicians over imaging centers and ambulatory surgical centers. In Wichita, Kansas, the CEO of a two hospital system says he can no longer afford to subsidize Medicaid and charity care after losing his outpatient radiology and surgery to the more up to date and efficient physician ones. There are about 130 specialty hospitals compared to over 1500 community ones but that doesn't include all the physician owned surgical centers and radiology sites. Most of the hospitals are ortho or cardiac. The Wichita cardiac specialty cardiac hospital is typical. The physician came to the hospital to collaborate in building a specialty hospital. The hospital CEO could not see further than the tip of his nose and said we want it all. The physicians then built the hospital. Wichita now has five specialty physician hospitals and 12 surgical centers to go along with 10 free standing (8 with physician owners) radiology suites. The hospitals that the infamous CEO controls continues to have an active ED and cardiac program. CMS is now stepping in and will reduce payments to outpatient radiology units and more to hospitals for the more complex exams. The same is true for ASCs. They may be paid at 62% of the hospital outpatient department for the same procedure, a ridiculous rationale. Both should be reduced equally.
In the Dallas Business Journal there is an article regarding specialty hospitals in the area are seeing more patients with insurance than the uninsured or Medicaid. In Texas, about 6% of the hospitals are specialty. The specialty hospitals are making more money per capita than the inefficient community ones.
There is another problem in the world of transplants. The liver transplant program at USC has a high one year death rate, twice as many as expected. This started in 2003. USC has admitted a problem and have hired an outside consultant to help find and correct the problem. As of now the Tenet run clinical program is blaming the problem on the patient selection. The program has had significant internal turmoil of the patient selection as well as money and conflict among the staff with fears of retaliation if problems were reported. The program is also having problems in communications with the patients who have died families. They must be taking stonewalling lessons from Kaiser. Outside physicians who have studied the charts of some of the patients who have died would never accept them into the program. One even had Hepatitis C, a contraindication to transplant. Top
In Canada medical marijuana may be legally used for those with grave and debilitating disease. In a study at Dalhousie University in Halifax it was found in the small number of patients that marijuana either smoked or taken orally relieved pain, increased appetite, gave a sense of well being but slowed thoughts. There were no adverse reports of serious side effects. The authors called for more studies with randomized placebo studies. Top
As of the start of this year nuclear medicine becomes part of the Stark Law. This means that those in specialties like cardiology may be at risk. Cardiologists may no longer refer to themselves for procedures that utilize radionuclear particles. This Stark requirement can be overcome by utilizing the "in office" exception. As long as politicians are regulating the medical profession, there will be smarter people finding the loopholes.
In California, AB 2868 has created more doctors. The new doctors are physical therapists with doctorate degrees who can now use the title but still must identify themselves as physical therapists.
In North Carolina, the insurers are starting with rationing again. They feel they are paying too much money for physicians ordering imaging studies. The insurers will begin requiring pre authorization again. This will delay diagnosis and treatment as well as put the patient in the middle. The physicians will need to hire someone to talk to the clerk at the insurer and say "Mother, may I?" This will cost the physicians money and time and therefore less time per patient. The insurers will determine if a test is medically necessary, overriding the physician's medical expertise. At least United is paying for procedures if the physician sticks to his guns and talks to an employed physician at the insurer. Top
The 2005 malpractice damages in Tennessee came to $119 million. The plaintiff won in only 16% of the cases and these were in settlement not trials. This does not take into consideration the millions of dollars that the defense attorneys got paid to make sure more money wasn't taken out of the money needed for healthcare. It doesn't account for the more millions of dollars that are lost due to physicians ordering more tests than necessary so they won't be sued.
Florida is unique in not requiring med mal insurance for physicians but instead requires them to hold $250,000 in reserve. Hospitals can either force physicians to have insurance or allow them not to. Most do not want to rock the boat especially with those physicians in high demand like neurosurgeons. A neurosurgeon, Dr. Jacques Farkas in Palm Beach had a mishap during back surgery on a patient. The drill he was using inadvertently hit a retractor and slipped out of his hands severing some nerve fibers. This happened in 2001. He has since claimed bankruptcy and under the Florida law can keep all he has and will have except for approximately $16,000 that will go for attorney fees. There will be nothing left for any prior patient who has filed but not collected. His estate is worth over $2.6 million. Dr. Farkus has played the hand dealt him. He has played it with the rules of the state he lives in. What he did may not be moral but it is legal. Should the state change its laws to require all physicians to carry insurance. The answer depends on the cost of that insurance and the med mal rules of the state. Top
The Wall Street Journal on December 26th had an article about the lack of privacy in large institutions. The article cited Kaiser and Stanford. The thrust of the article was the inclusion by a Stanford therapist of her notes in the medical record of a patient. The patient was later involved in an accident and found that all had her medical records and her psychotherapy records. Stanford and the therapist both state they did nothing wrong. But, they did. The therapist specifically told the patient the records were not going to be released and then states she was justified putting them in the medical record. Ignorance is not an excuse. Kaiser does not separate out psychotherapy notes either. They feel it is too difficult and at time may need a lawyer to review the record. This will drive up costs. It makes no difference what the law states. If any of this happened at a physician's office or community hospital a different tune would have been sung. Top
The UPI had a story on dialysis centers in New York state. They were found to be the worst in the country with type 2 Diabetes. The report also showed that throughout the country the national chain centers provided better care than independent providers. New York does not allow the national chains to operate in their state. 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.