In grade school, children play games of “Hide and Seek” and “TAG.” When they are found or caught, they say “Gotcha.” Then the child that has been caught must find and catch another one. One can hear shrieks of “I’m Gonna Getcha” and “I Gotcha.” Now adults are playing that game through the legal system. Only the “I’m Gonna Getcha” and “I Gotcha’s” aren’t verbalized. Just realized. Especially when they “Gotcha.”

Reuters, sent a release entitled: “Lawyers do a study, decide they’re needed.” The Int’l Assn of Defense Counsel bravely released the study “Law and Society Following the Demise of the Legal Profession.” They put a quote from Shakespeare’s “Henry VI” on the cover: “First thing we do, let’s kill all the lawyers.” The study concludes that if all 800,000 lawyers were eliminated, they would eventually return. Their absence would speak highly of the value of their profession more than their remembered presence. Society would want to return to the basic human needs for order and fairness. “Gotcha.”

A year or so ago when Carmichael had a large number of Peer Review hearings, we asked Dr. Verner Waite, President of the Semmelweis Society, for an article detailing his experience with Peer Review. We thank him for his frank comments about the darker side of medicine. The seven Peer Review hearings at that time did not appear to have much to do with Quality of Care. In some cases records were sought to make it a legally sanctioned professional assassination with immunity for all the perpetrators. That outside reviews of the charts upheld the quality of care didn’t matter. “Gotcha.”

A federal district court case sent a warning to hospitals seeking to expand into home-medical-supply business: Such moves could violate antitrust laws. The case carries important implications for the nation’s hospitals, which increasingly are venturing into other businesses such as home health care, nursing homes, and equipment leasing. William Kopit, a Washington lawyer states the case presents “an enormous legal risk” for hospitals that diversify because other juries might be less sympathetic to hospitals. Hospital officials have been nervous that courts might view these activities as illegal attempts to gain monopoly power in the health-care market… What if they also gain control of physician groups? Could physicians then also be subject to triple damages by being participants in the monopoly? “Getcha?”

Modern Healthcare (Cover story: Don’t Cry for Hospitals–Profits Peak by David Burda) states: “Surplus. Excess revenue. Money to reinvest…Call it any thing but profit…Hospitals are generating more of it than ever before. They don’t want to talk about it because they’re afraid someone will take it away.” In 1992, aggregate profits earned by acute-care hospitals were up nearly 19% from 1991 (the highest since 1983). Hospitals in every bed-size, ownership and geographic category posted aggregate profit margins in the black in 1992. The AHA’s hospital revenues and expenditures data (it doesn’t call the difference profit) for 1993 won’t be available until later this year, but based on its monthly survey of hospital samplings, “profits” could rise another 13% in 1993, the fifth consecutive year of double-digit jumps in profits… Since hospitals and their homecare and equipment companies are the single largest item in health care expenses, it looks like the profit percentages of these mostly nonprofit institutions look very similar to the health care inflation percentages. Have we found the reason for what congress and the president consider an unacceptable increase in health care costs? “Getcha?”

While healthcare administrators maintain and increase their salaries (20-24% of the healthcare costs), the AMA in a special study of physician salaries (19% of costs) reports that physicians in Sacramento have had double digit drops in income. “Gotcha.”

One of our hospitals sent out contracts to their physicians reducing the reimbursements for their health plan. “Gotcha.”

Grace-Marie Arnett, president of Arnett & Co. in Washington, D.C., wrote in The Washington Post opinion page that the Clinton plan creates a new “All-Payer Health Care Fraud and Abuse Control Program. The Clinton plan gets universal coverage with an intricate system of enforcement. Put simply, if you or your doctor don’t comply, both of you could end up in jail.” If that plan weren’t dead, the Feds could say, we’ll “Getcha.” Later this month we’ll know if the California Health Czar will be able to “Getcha.”

Rena Weeks won a $50,000 award against her former law firm Baker & McKenzie, the world’s largest law firm where she worked 3 months in 1991, for compensatory damage for emotional distress from alleged sexual harassment. The jury then awarded Weeks an additional $6.9 million punitive damage, twice what she had asked, based on the $69 million (of the $512 million in fees) that the attorneys kept available to finance operations. “It’s a great day for women in the workplace,” said her attorney Philip Kay as Weeks walk out hand in hand in boy girl fashion with Kay and associate lawyer Alan Exelrod. Careful boys or she’ll “Getcha” too.

Herb Caen (SF Chronicle) reports that the same night a skunk sprayed the Baker & McKenzie’s Palo Alto office where the involved atty practiced. The SPCA (which Caen renames Society for Prevention of Cruelty to Attorneys) apparently was summoned. “Gotcha?”

As we get more legalistic, everyone is out to “Getcha” and sooner or later everyone will be a “Gotcha.” Brigid McMenamin in a recent Forbes article entitled, In Bed with the Devil, points out that HMO’s feel the best way to control doctors is through Vertically Integrated Service Networks. Is it time we show our professionalism, do what’s best for the patient, and not have any entangling business alliances with hospitals, insurance companies, or the government? We have to get our house in order first, take over the leadership of health care reform, and control costs tailored for each patient. If not, they’ll “Getcha” if they haven’t already “Gotcha.”