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In Jacksonville Florida a group of 45 OBs will limit services they provide starting May 2. The cause is the lack of general surgical backup in the community. They will no longer perform non emergency gynecology procedures. This covers 200,000 patients. The major general surgical group will stop doing elective surgery on May 2 due to malpractice concerns. Three of the 45 OBs in the group have given up OB due to malpractice concerns. May 2 is the last day of the current legislative session. One of the hospitals has discontinued screening mammography due to lack of surgical backup. The last pediatric neurosurgeon has also folded camp and moved.
The general surgeons represent about 1/3 of the general surgeons on call. They will stop seeing new patients but will continue to follow their post op patients until June 30 when their malpractice coverage ends.
Another general surgical group has followed suit in Jacksonville and will not practice after May 2. This group of four surgeons is paying $320,000 for its malpractice insurance, $100,000 more than last year. This leaves only 20 surgeons for the entire county and will further decrease ED and other specialty care.
In Orlando, Florida the last general surgical team at Winter Park Hospital has said adios to the ED. They were too busy with the patients so they quit the staff. The ED remains open but will not treat surgical patients. they will be transferred to another hospital where the same group along with others will do the surgery.
At Orlando Hospital where the Level 1 trauma center was to close due to the neurosurgeons quitting has a one month reprieve. The solution was to have the five counties involved contribute money to boost the pay of the private physicians staffing the trauma unit. If the state doesn't come up with a malpractice solution in the next month, this may fall apart.
The trauma surgeons at Daytona Beach's Halifax Medical Center be short all six surgeons as of June 1. The surgeons have given their notice. They are covered under the sovereign immunity but do not feel they have enough protection since Halifax has refused to guarantee the surgeons would not have to pay for awards over the immunity amounts.
Governor Bush stated he would disrupt the legislators summer recess and call them back into session if their is not a favorable resolution to the malpractice crisis by the end of the session, May 2. The House passed a bill with caps but the Senate rejected this. The conference committee should be interesting if the legislators want out of Jacksonville.
In Pittsburgh, Pennsylvania where the Democratic Governor's team has just said no to caps (see New Legislation) the physicians are closing their offices for a one week period April 30 to May 6. The physicians will congregate for a study of the malpractice issues. The physicians are now finding out that their Democratic Governor speaks with forked tongue.
About 2000 physicians met at Valley Forge and rallied for malpractice relief. It seemed that they now realize the treachery of their state leaders. The Republican lawmakers of the State were with the physicians.
In Nevada the ED at Desert Hot Springs was planning to restart operations. They had shut down due to lack of surgeons. The hospital had to hire a surgeon to work after their regular ones all quit the facility. The physicians who quit were offered higher pay to come back but the bond of trust had already been broken.
In North Carolina there may be some tort reform. Seventy two of the 120 members signed on to co sponsor a bill in the House to reduce jury awards, limit legal fees and bar the use of nursing home inspections in law suits.
Huron Medical Center in East Cleveland Ohio was losing its trauma unit due to the malpractice problems. The neurosurgeons terminated their contracts with the hospital. The neurosurgeons are consolidating their practices to areas that are more lucrative and with less uninsured patients. Then along came Jones!! The Cleveland Clinic rode up in their white hats to save the day. The Clinic promised their own neurosurgeons would cover the trauma service. The Clinic doctors should love that. This means the Clinic will need to hire more neurosurgeons.
In Gulfport Mississippi a group of five OBs and three nurse midwives will lose their present malpractice insurance on May 16. They have notified the hospital that they all will take a years leave of absence starting the day prior. This is predicated on no insurance that is affordable being present. The remaining four OBs have stated they will not be able to handle the load.
The Missouri House Committee has passed a bill that would limit non-economic damages in all personal injury cases not just malpractice. This has as much chance of passing as a salmon swimming upstream. However, it is a start.
In Washington State the physicians have set a tentative date for a walkout. This is May 22 and only for one day. The legislature will no longer be in session but this is a starting salvo in a war.
The American Hospital Association has stated that in the "crisis states" they are having significant problems recruiting physicians and medical care is suffering. They also state that their per bed malpractice charge is $11,435 in the "crisis" states versus $4228 in the states with caps. Top
Redding Medical Center, the Tenant hospital that got into hot water due to their main cardiologist and cardiac surgeon being accused of doing unnecessary procedures, will close their cardiac surgery program. It will look for new cardiac personnel for the program. The hospital will continue to do the non-invasive cardiology. There has been no formal accusations against any of the physicians. One of them lost his malpractice insurance and therefore his privileges and the other is on a three month leave. The hospital has also laid off about 150 of its employees due to a significant drop in occupancy rates.
Another California Tenant hospital is in trouble. The San Ramon Regional Medical Center has been chastised by the Feds for improper staffing of some surgery and poor documentation. They were turned in by their nurses who want more money by forming a union but won't get it. The hospital is now in the stage of the plan of correction.
It's here. The new J&J drug coated stent has been approved and is now in use in hospitals. The money people say it's not for everyone but the cardiologists don't agree. The stent costs about $3300 and the hospital is reimbursed the DRG plus about $1500. The other companies with the drug stent are several years behind J&J in the pipeline. The stent will reduce re-stenosis by about 60-70%. Top
Illinois and New York suspended all smallpox vaccinations as did multiple hospitals after it was revealed there has been several deaths potentially related to the vaccine and other pericardial problems. It makes sense to discontinue the program that never was bright to begin with. The Congress finally decided on a pittance of money for each death or disability related to the vaccine. (See Recent Legislation). Top
LA County Hospital Downsize Cost Lives
Los Angeles wants to downsize the County hospital starting June. Legal Aid groups are fighting it in court and have the backing of physicians. The LA Times had a story telling about sworn statements by physicians that even at the current capacity lives were lost due to substandard care from lack of beds, especially in the ICU. The patients are stuck in the ED for days at a times and cannot get to the proper hospital floors for proper treatment. In March an outside physician found that up to 156 patients were crowed into 43 examining areas and hallways. The wait time to be seen is now up to about 16 hours. Patients arrive by ambulance must wait for hours just to transfer to from the ambulance gurney to one of the hospital's.
One would think that after a story such as this the Board of Supes would be embarrassed and do everything possible to help. Not in LA. The Board dropped plans to alleviate the overcrowding by building an overflow hospital in San Gabriel Valley, close two other hospitals and also close 100 bed at the LA County Hospital. There is a budget shortage. The old hospital is to be replaced by a new one in 2007 which is 150 beds smaller.
The Department of Health is also cutting between 1375 and 2475 jobs. This is to reduce the $804 million budget gap. They have also shut down 16 clinics. It should be interesting how much they have to pay for emergency room and hospital care in the other hospitals. Top
The HMO enrollment continues it's loss of membership in both the commercial and the Medicare portions. It is growing in the Medicaid arena. This is in direct opposition to the mid 1990s where HMOs grew both in numbers of people and HMOs per se. By 2001 HMOs had become static or had begun to decrease in enrollment. The reason was the better choices with PPOs and the lessening of the cost differential between the products. This decreased enrollment continued in every state but Minnesota. The largest decrease has been in the commercial plans with Texas dropping 29% enrollment. Medicare HMOs in 1994 had about 800,000 people, half of which were in Florida. By 1999 there were over 2 million enrolled. The numbers now are down by over 25%. This is from a combination of low pay from the feds and the physician no longer accepting the risk. The states continue to force the Medicaid recipients into HMOs but they are finding less providers willing to care for them. This will lead the Medicaid population back to the County Hospital and teaching systems. Some of the Medicaid HMOs have gone south leaving only one in any county. This means that those counties could not mandate HMO enrollment. This information has come from the American Health Lawyers Assn. and Allan Baumgartner. Top
The Massachusetts physicians are becoming more dissatisfied with their state's working conditions. This was true across the board in all specialties. Many of the physicians were contemplating career changes, especially the OBs and neurosurgeons. The physicians in training are also leaving the state after their training periods. Top
This will be the topic of my next tome coming out on June 1.
In Kirkwood, Missouri a group of Orthopods are bidding for a defunct HealthSouth surgical center. This would take procedures away from the local Tenet Hospital.
In Cincinnati a group of oncologists will compete with St. Elizabeth Hospital. They are building their own offices to provide oncology services a short distance from the hospital. This is a direct result of failed negotiations between the physicians and the hospital. The hospital is attempting to recruit more oncologists to use their facilities. The hospital's CEO is now worried about it's bottom line. He wasn't when the negotiations were going on and this could have been avoided. The physicians will continue their privileges at the hospital and treat patients there, if the patient requests treatment there. Top
Sutter Health Gets First Franklin Award
Congratulations to Sutter Health Sierra Region for winning the inaugural Franklin Award. This award is given out by the JCAHO and the American Case Management Assn. for their work in implementing clinical practice guidelines. This included all aspects of patient care. 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.