A Chance to Cut is a Chance to Cure

So far, so good, right? After all, we're told by the plaintiffs' bar that the medical malpractice crisis would go away magically if the medical profession would just police its own, and that's exactly what happened here. Can you imagine what a trial lawyer would do with the peer review committee's conclusions if the hospital did nothing and had been sued for Poliner's work afterwards?

The suit alleges that doctors who were competing with Dr. Poliner for patients accused him of poor patient care, and that Dr. Knochel (chairman of internal medicine) and Presbyterian relied on the competitors rather than independent reviews to conclude that Dr. Poliner's right to perform catheterizations and echocardiograms should be suspended.

In May 1998, Dr. Knochel forced Dr. Poliner to quit doing catheterizations while the hospital reviewed his work.

A month later, a peer review committee of doctors, most of whom competed for patients with Dr. Poliner, summarily suspended his "cath" and "echo" privileges at Presbyterian. In November 1998, the hospital's medical board voted to restore Dr. Poliner's privileges after a number of nationally recognized cardiologists in a hearing stoutly defended the quality of Dr. Poliner's work. However, the medical board also upheld Dr. Knochel's earlier decision to suspend Dr. Poliner's privileges.

"From time to time, hospitals and members of the medical staff leadership must make decisions relating to patient care and safety, and these decisions sometimes affect an individual doctor's privileges at that hospital," the hospital said in a statement.

Doctors and lawyers in Florida have taken the tort reform fight to a new level -- dueling ballot initiatives.

On Nov. 2, Florida citizens will vote "yes" or "no" on three proposed constitutional amendments that address medical liability issues. Early polling shows that all of them are likely to pass.

The ballot box battle comes a little more than a year after the Florida Legislature passed a $500,000 noneconomic damages cap that doctors say won't prevent premium hikes that are forcing them to leave the state, retire early or forgo high-risk procedures.

To solve the problem, doctors are proposing a constitutional change that would limit the amount that trial lawyers could collect in medical malpractice lawsuits so that injured patients get a bigger chunk of awards.

Trial lawyers are proposing two constitutional amendments. The first -- commonly referred to as the "three-strikes" rule -- calls for stripping doctors of their medical licenses if they have three medical malpractice judgments against them. The second amendment would let patients see medical records and reports connected with "adverse" incidents, including documents generated during peer-review procedures.

The doctors' proposed amendment would reduce accountability for health care negligence and incompetence, said Patti O'Regan, a nurse practitioner and a board of governors member for Floridians for Patient Protection, an advocacy group formed to put the trial lawyers' amendments on the ballot.

If lawyers' share of awards was limited, patients would be forced to pay lawyers by their hourly fees, she said. Patients who don't have enough money to pay those charges wouldn't have access to the courts.

"Only the wealthiest Americans, such as doctors, will be able to find and pay for attorneys to take their cases," O'Regan said. "The safety net of contingency fee arrangements is the only access middle-class and poor Americans will have to the court system."

The physicians' amendment "would act as a total ban on medical malpractice cases because you wouldn't be able to find a lawyer to take a case," said trial lawyer Susser. "It takes so much money to fight these people."

Under Amendment 8, physicians would lose their licenses if they had three strikes against them, including final court judgments, final administrative agency decisions or binding arbitration. Lawyers say patients would be safer because doctors with repeated judgments against them wouldn't be allowed to treat patients....The proposed amendment would do what the Florida Board of Medicine has been too afraid to do, O'Regan said. "It gets rid of doctors who refuse to learn from their mistakes and improve their service to patients," she said

But doctors counter that the amendment would not accomplish that goal. Instead, they say, it would exacerbate the existing medical liability problem. Fearing that they could lose at trial even though they have a solid defense, doctors would be more likely to settle malpractice or negligence cases instead of taking their chances before juries, physicians say.

Under Amendment 7, patients would be able to review medical records associated with adverse medical incidents involving facilities and health professionals. Patients' identities would not be disclosed.

A more open system, trial lawyers argue, would prevent errors from being swept under the rug and would help patients make more educated choices when picking physicians.

"Peer review isn't working," O'Regan said.

Limiting attorney fees 74%
Taking away a medical license after
three judgments against a physician 78%
Allowing patients to see records
tied to adverse incidents 75%

"I don't care to belong to a club that accepts people like me as members"

Why am I worth so little when I do my job right, and worth so much when I make a mistake?

If what Mr. Rehberg et al says about the hospital's practices is true, the motivation in coming forward is irrelevant. Wouldn't the practices be illegal?

As noted in the preamble to the proposed regulations, the exclusion provision does not require a hospital to charge everyone the same price; nor does it require a hospital to offer Medicare or Medicaid its "best price." However, hospitals cannot routinely charge Medicare or Medicaid substantially more than they usually charge others.

The state plans to move 1 million low-income Georgians on Medicaid into HMO-like organizations - a cost-cutting tactic representing one of the biggest changes in the government program's history.

The plan, unveiled Monday, is being pushed by Gov. Sonny Perdue as a response to spending increases of 10 percent to 12 percent a year in Georgia Medicaid.

Georgia had a voluntary HMO program in the 1990s for Medicaid, but the effort proved unsuccessful at attracting a large number of people willing to enroll.

Abstract:
Background : Motor vehicle collision-related blunt thoracic aorta injury (BAI) is rare and highly lethal. Vascular disease as related to advancing age potentially subjects older adults to increased risk of BAI; the mechanisms associated with such injuries may be different as compared with younger adults. The goal of the present study is to test this hypothesis using population-based data.

Methods : The 1995 to 1999 National Automotive Sampling System data files were used. The National Automotive Sampling System is a national probability sample of passenger vehicles involved in police-reported tow-away crashes. BAI was defined according to the Abbreviated Injury Scale codes. Among those with BAI, information on occupant (age, seating position, restraint use), collision (collision type, delta-V, vehicle intrusion), and outcome characteristics were obtained and compared according to age.

Results : The overall incidence of BAI was 6.8 per 10,000 occupants and there was a steady increase in the BAI rate for advancing decades of life. The proportion of occupants with BAI who die at the scene of the collision is relatively consistent across all age groups (~85%). Among those who survive to receive medical care, ultimate survival is lowest among those aged 60 and older. Near-side collisions were responsible for more BAI among older adults than other age groups (50% vs. 20.6%, p <= 0.05). Older adults sustained BAI in collisions with lower delta-V values compared with younger persons (p <= 0.05). Conclusion : Older adults have the highest rate of motor vehicle collision-related BAI, and their injuries tend to occur in less severe collisions. A high level of suspicion for BAI among older adults should not be reserved for high-energy collisions only.

Charles Rehberg is learning that being an industry whistle-blower has an ugly side.

First came the private investigators, who showed up at his medical office parking lot as he was leaving work on the evening of Aug. 9, blocked his pickup and, he says, threatened him and his family.

Then this week came the lawsuit from the hospital system that hired the private investigators. It accuses Rehberg of racketeering and fraud, among other things.

"This sort of thing doesn't usually happen to a CPA," said Rehberg, an accountant who manages Albany Surgical, a general surgery practice.

For the 44-year-old Rehberg, nothing has been usual in the year since he and a prominent doctor at Albany Surgical, John Bagnato, decided to investigate the financial practices and political power of nonprofit hospitals.

The two men spent much of 2003 poring over tax returns, financial statements and databases on nonprofit hospitals, first in Georgia and then nationally. They came to believe that Albany's Phoebe Putney Health System and scores of nonprofit hospital systems throughout the nation were overcharging patients without health insurance and then aggressively seeking payment --- thereby violating their charitable obligation.

The information they gathered --- and delivered to famed Mississippi litigator Richard Scruggs in March --- was the catalyst for a series of lawsuits filed this summer against hospital systems that now total 45.

Langley said he hired former FBI agents, working for an Arizona private investigation firm, to help the hospital determine who in Albany was sending anonymous faxes containing derogatory information about Phoebe Putney. The faxes mentioned, among other things, executive salaries, a Cayman Islands account, and political and business connections.

Those faxes, titled "Phoebe Factoids," were sent to local business leaders and politicians....

A lawsuit alleging racketeering and fraud followed two days later, accusing Rehberg and unnamed other defendants of trying to inflict "economic harm" on Phoebe Putney.

The hospital system contends it traced the "Phoebe Factoid" faxes to a phone number at Albany Surgical --- and to a number used by Rehberg. Langley claims the faxes contained falsehoods and innuendo.

Rehberg called the lawsuit against him "absurd." His Atlanta attorney, Robert Mulholland, said the charges were without merit and an attempt by Phoebe Putney to distract attention from its financial practices.

When asked by a reporter whether he had a role in the faxes, Rehberg referred the question to his attorney. Mulholland's response: "We don't discuss the substantive aspects of litigation until we're in court."

There have been other troubling developments. Albany Surgical's president, Dr. Christopher Smith, a longtime critic of Phoebe Putney's administration, said an electronic surveillance device was found within his practice's gray concrete walls. And Rehberg said there was an attempt in February to bug his house.

Some health law attorneys are skeptical that Scruggs' arguments will succeed.

"The behaviors they're targeting (billing and collection practices against the uninsured) are atrocious in some circumstances, but they're not illegal," says Gregg Bloche, a law professor of health law at Georgetown University. "The suits will fail."

Nor do they think there is an implied contract between hospitals and the government.

"That's never been recognized in the law," says Stuart Gerson, a partner at Epstein Becker & Green in Washington, D.C., who represents a hospital being sued. "The idea of an individual citizen, a taxpayer, seeking to enforce charitable obligations is, at least, a very novel argument that finds little support."

If any laws are being broken by the common hospital practice of allowing for-profit doctors to use their facilities, or if facilities are improperly steering business to trustees' companies, those arguments should be heard by taxing authorities or federal and state antitrust or anti-kickback regulators, Gerson says.

The lawsuits are renewing debate over the legal and ethical responsibility the nation's non-profits have to provide charity care.

"The IRS has never been really clear about what the grant of tax-exempt status means," says attorney John Reiss of the law firm Saul Ewing in Philadelphia. "It's never been clear that it actually commits you to providing any particular amount of charity care or anything else."

Two Dougherty County men who came down with West Nile virus a year ago might have been infected during treatment at a local dialysis clinic, the Centers for Disease Control and Prevention warned Thursday.

Then again, the agency said, they might have been infected elsewhere — but it warned that dialysis clinics should take care not to transmit the virus, just in case....

The men, it turned out, were both patients at the same clinic. They had both received dialysis on the same day in late August. In fact, they had both been treated on the same dialysis machine.

There was just one problem. The dialysis clinic, which was examined by investigators from the CDC and the Georgia Division of Public Health, appeared to have done everything perfectly. The investigators could not find a single breach of the infection-control practices that prevent patients from having contact with each other's blood. West Nile, which is primarily passed along by mosquitoes, can be transmitted by blood as well.

The nursing staff will check vitals Q shift. They will bring his food and scheduled medicines. You will feed and medicate him. You will bathe him, ambulate him, change him and his bed as needed. If he makes a mess, housekeeping will bring you a pail and bucket for you to clean it up. You may not restrain him. A family member must stay with him at all times. No leaving for eating or smoking. If you require the help of nursing for any of the above reasons the simulation is over and if you take him home you will sign out AMA

Relatives of a woman whose surgeon left a rolled-up towel inside her chest seven years ago have filed a lawsuit against the clinic where the surgery was performed.

Bonnie Valle often complained about an odd feeling in her chest in the years following a procedure at the Cleveland Clinic, family members said.

"She always said, ;On the left side, it feels like there's something there. It felt like something moved," said her daughter, Jeanne Clark....
When she died in June 2002, a day after her 60th birthday, Valle donated her body to the Northeastern Ohio Universities College of Medicine. During dissection, a faculty member discovered a green surgical cloth the size of a large hand towel behind her left lung.

It wasn't easy for Victor Ganderson, 61, to agree to GERD surgery in June. For four years he had stalled, researching treatment options and talking to his doctors. But it wasn't until the Columbia man watched -- live, via his home computer -- the operation being performed that he decided to go ahead.

Ganderson learned about the "webcast" through his job as a database manager at the University of Maryland Medical Center (UMMC). The surgery was broadcast live on the Internet, from what was billed as the Baltimore hospital's "Operating Room of the Future."

James Gammie, a cardiac surgeon at UMMC, said one patient traveled from Florida for mitral valve repair surgery after her husband found UMMC's Web page describing its minimally invasive surgical technique. "Many [patients] have said they watched the webcast," Gammie said in a telephone interview. "So I find that probably 50 to 60 percent of people who come to us now . . . are much more prepared." Gammie provided commentary during the mitral valve operation while another doctor performed the surgery.

Some consumer health advocates question the webcasts' value to consumers. Arthur Levin, director of the nonprofit Center for Medical Consumers in New York, said he thinks a surgical webcast serves more as a public relations tool for hospitals than as education for consumers.
"The important things that patients need to know about surgery are: What are the risks? What are the alternatives? That's the kind of information people need. They don't need to see someone else's stomach open," Levin said.

Dr. X: We are dissecting around Mrs. Smith's esophagus now with our retractor. This will allow us to get the fundic wrap around the back.
Dr. Y: Hey! Does that look like an NG tube to you?
Dr. X: Damn it! We've put a hole in the esopha...

Patients and their crises come and go non-stop at Vanderbilt University Medical Center.

So anesthesiologist Paul St. Jacques somehow has to keep up with four operating rooms at once -- good thing he can see through walls.

Anesthesiologists here routinely are responsible for four operating rooms at once.

Only now, as CBS News Correspondent Mark Strassmann reports, St. Jacques literally can keep an eye on all of them at the same time.

Attached to his goggles is a tiny screen, about the size of a fingernail, and there's a video-panel from each of the four on-going surgeries, real-time images of his patients and their vital signs.

Responding to a sixfold jump in the number of patients undergoing obesity surgery, a state public health panel yesterday recommended that Massachusetts hospitals and doctors adopt strict standards to reduce deaths and complications.

The report includes recommendations that hospitals and surgeons perform a high number of surgeries in order to stay in practice, which ultimately could force some smaller programs at community hospitals to close. Based on their review of medical studies, panel members said hospitals that do more than 100 surgeries a year, and surgeons who do 50 to 100 cases a year, have lower complication rates.

One guideline recommends surgery only at hospitals that perform 100 or more cases annually. Only 14 of the state's 24 hospitals that do obesity surgery perform that many, said Dr. George Blackburn, vice chairman of the panel and a physician at Beth Israel Deaconess Medical Center. The panel also recommended that hospitals adopt strict standards for doctors before allowing them to perform obesity surgery.

For traditional weight-loss surgery, during which doctors make a long incision, hospitals should have an experienced surgeon monitor a new surgeon for 10 cases. The hospital should then review the next 15 cases of the new surgeon, to make sure standards are met, before granting full privileges to the surgeon.

1. Establishment of Provisional Privileges (open WLS procedures)
• Completion of the (ASBS) American Society for Bariatric Surgeons essentials courses or equivalent
• Successful completion of 10 open cases proctored by a surgeon with full privileges for open WLS.

1a. Establishment of Provisional Privileges (laparoscopic WLS procedures other than
LAGB)
• Meets requirements for provisional open privileges
• Successful completion of 25 laparoscopic cases proctored by a surgeon with full
privileges for laparoscopic WLS (Category B).

2. Establishment of Full Privileges (open or laparoscopic WLS procedures)
• Review of first 15 independently performed cases by a committee that includes the chief of surgery at the surgeon’s institution and an experienced (>100 cases) weight loss surgeon; this committee may also include members of the institution’s Quality Assurance and Credentialing programs
• No substantial deviation in risk-adjusted outcomes from accepted norms and
benchmarks.
2a. Recredentialing of Full Privileges (open or laparoscopic WLS procedures)
• Maintenance of board certification or board eligibility. Credentialed gastrointestinal surgeons who are active staff member with full admitting privilege at facility obtaining bariatric privilege are eligible
• 100 primary or revisional WLS procedures within the previous 2 years (Categories B and D)
• Presence of a second weight loss surgeon on staff with either full or provisional privileges within the same program

(2004-08-03) -- Democrat presidential candidate John Forbes Kerry today announced that he has retained attorney, and running mate, John Edwards to file suit against the Democrat National Committee (DNC) over injuries related to an alleged "post-convention bounce."

"We had received certain assurances from top DNC officials that this celebration of my client's nomination would result in a 10-15 point bounce in the presidential preference polls," said Mr. Edwards during a news conference on the steps of a Boston courthouse. "Bounce implies vigorous upward movement. But my client's current polling numbers look more like a 'bump' or even a 'dip'."

Mr. Edwards, who like his client is also a U.S. Senator, brought many of the gathered journalists to tears with his dramatic description of the plight of Mr. Kerry's popularity.

"I can hear John Kerry's popularity calling out to you from somewhere in the darkness," said Mr. Edwards. "A couple of weeks ago his popularity said, 'I'm fine." Just before the convention it said, 'I'm having a little bit of trouble but I'm doing okay.' During the convention speech, it said 'I'm having problems.' And after the convention John's popularity said, 'I need help.' But help was not on the way."

Dr. James Blume was the first West Virginian and the first osteopathic physician in the United States to win the National Country Doctor of the Year award, in 2002.

Gov. Bob Wise has named the rural Summers County physician a Distinguished West Virginian.

And, board certified in family medicine, Blume last year received the Off-Campus Teaching Award from the West Virginia School of Osteopathic Medicine.

Despite his accolades, Blume can't get medical malpractice insurance from the new West Virginia Physicians' Mutual Company formed by legislators to help state doctors find coverage.

Blume said the new physicians-owned company isn't doing what legislators said it would.

"Physicians in particular and citizens of the state in general have been sorely misled, as demonstrated by the recent turn of events in my career," he wrote in an open letter dated Monday.

The mutual's CEO, David Rader, said the company's underwriting criteria have been approved by the state Insurance Commission. Because of a capacity problem, it's not possible to accept all physicians who apply for coverage, he said.

For instance, about 1,400 physicians transferred from the state Board of Risk and Insurance Management to the mutual July 1. Another 100 physicians have applied and about half of those have been accepted.
"There have been a few declinations, 15 percent to 20 percent," Rader said

In his July 1 address in kicking off the mutual, (West Virginia Governor Bob ) Wise said the state must "guarantee . . . that every West Virginia doctor has access to reasonably priced medical malpractice insurance."

Some physicians would rather give up their medical licenses than pay $1,000.

More than 350 doctors told West Virginia's medical boards they would not renew their licenses after July 1, the day the state began assessing a new $1,000 fee per license to help fund a physicians mutual insurance company. But state officials said the doctors' decision not to pay has not greatly altered the number of doctors practicing in the state.

The West Virginia Board of Medicine said 309 MDs of the 5,575 with licenses said they did not want to renew. "Most of the people that chose to lapse their license were probably out of state," said Ronald D. Walton, the board's executive director. The licenses of another 70 MDs were suspended by the board, Walton said. As of July 22, 14 of those were reinstated after the physicians paid the $1,000 fee and $250 late payment.

Of 61 DOs who decided not to renew, "Most of those were out-of-state physicians who were not practicing in West Virginia anyway," said Cheryl Schreiber, executive director of the West Virginia Board of Osteopathy, which covers 850 doctors. "Of those, 25 of them told us the reason they're not renewing was because of the assessment."

The board also sent notices to 45 doctors, telling them their licenses were suspended as a result of nonrenewal. Schreiber said some have since paid the $1,000 assessment and a $250 late fee.

The assessment was started July 1 to help fund a physicians mutual insurance company, which was created by the state Legislature last year due to the medical liability crisis in the state. The company covers about 1,400 physicians. Some physicians are exempt from paying the assessment, including medical school faculty and physicians in the military.

The West Virginia State Medical Assn. was against the assessment, said Evan Jenkins, association executive director. But, he said, "The physicians mutual is important for addressing the crisis of insurance availability."

Jenkins said physicians are trying to adjust to the fee. "The reactions are mixed. Nobody likes to be told they have to contribute $1,000."

Doctors fresh out of medical school are working fewer hours compared to their predecessors, thanks to new rules that went into effect a year ago curbing duty time. But growing pains abound. Some medical students and experienced doctors are getting stuck with more work and hospitals are spending millions of dollars overhauling work schedules.

Most residency programs are in compliance with the new standards, according to the accreditation council. Since last July, it reviewed 2,019 programs — or about a quarter of total programs — and cited 5 percent for duty-hour violations. Nearly half of the offenses were for breaking the 80-hour week limit.
The accreditation council also allowed 75 surgical programs to extend resident work hours to 88 hours a week. So far, 53 doctors have filed complaints about work-hour breaches. Eleven cases were dismissed for lack of evidence.

The association also found that medical students — those not ready for residency — are working more. Early results from a survey of 488 students found that half reported finishing clerical work for residents and a quarter said they completed clinical duties.