Hippocrates' Modern Colleagues
by Ron A. Virmani, MD
On September 1,
1995, Presbyterian hospital called me to their imposing corporate Board Room in
Charlotte, NC and dropped a bomb on me. They
said they were summarily suspending my hospital privileges at 4 pm that day!
Suspension from a
hospital is a kiss of death for any physician! I
knew that I would never be able to deliver any more babies nor take care of women who
needed gynecologic surgery. The future
of my family went bleak in front of my eyes.
I knew that they had
been reviewing my charts for several months now.
But I had no idea that they would not even give me a chance to present my side
of the story with regard to any of those charts before taking such Draconian action. This was truly a stab in the back.
“We do not have to
tell you what the charts are.” Said
then CEO of Presbyterian hospital and chief of ob-gyn.
They simply stated that I had 24 “problematic” charts, as determined by
the peer review committee.
I had received my M.D. from New Jersey Medical
School in 1985 and finished my ob-gyn residency from Temple University hospital in
1989. I had come to Charlotte in 1990
and become a member of Presbyterian hospital medical staff as an ob-gyn physician.
On December 1994, I had a surgical mishap. Inadvertently, I punctured the external iliac
artery in a patient during laparoscopy. This
was unfortunate but a known complication of such a procedure. I immediately proceeded to laparotomy. I summoned a general surgeon and a
cardiovascular surgeon to assist me with the repair. The patient went home after a few days stay in the hospital. My malpractice insurance company as well as
several independent reviewers determined that I met the standard of care in this
case. However, citing business reasons,
the insurance company later decided to settle the lawsuit for 300K.
Following the incident, Presbyterian hospital went
on a fishing expedition of my charts from over a two year period. Most of these charts had been filed in the hospital archives as
having had no problems with them. Anyway,
a departmental “peer review” committee headed by Dr. X somehow managed to label
24 of them “problematic” out of my 102 charts reviewed.
Did Dr. X have more experience than I as an
ob-gyn? No, we both finished medical
school and residency in same years. The
difference is that he is a good old Southern boy trained at Chapel Hill while I am
India born, with my residency from Philadelphia.
He was later promoted to the position of the chief of the ob-gyn department.
Although I repeatedly asked the hospital for an
independent external review of my charts, the hospital did not grant that simple
request. The Medical Board of North
Carolina asked an experienced ob-gyn physician from Charlotte, Dr. Y to review my
cases. He as well as several other
reviewers found my charts to be within the standard of care.
According to a letter circulated by Dr. Z in
October 1998 among the hospital’s medical staff, I was the first physician to be
suspended in 20 years at Presbyterian hospital!
Was it just a coincidence that I was the first ob-gyn physician of Indian
origin at Presbyterian hospital? I
decided to do a little research starting with the local courts. I found out the following facts, which are true to the best of my
Dr. A injured a patient’s bladder while
performing laparoscopy. The jury found
him negligent and awarded the Plaintiff $100,000. (92-CVS-16674)
Dr. B performed a laparoscopic surgery in October
1993 at Union Memorial Hospital. An
injury to the intestine was not recognized at this time. Patient presented later with abdominal
abscess and died. (Union County
95 CVS 01325) Dr. B performed another
laparoscopy in November 1994 at which time a bowel perforation was not recognized. She died of sepsis. (Union County, 96 CVS 00992) Presbyterian
hospital had no problem subsequently giving Dr. B privileges in ob-gyn department.
Dr. C performed a laser laparoscopy on a patient
in 1995 (99- CVS-5141). The patient
complained of abdominal pain on December 2 and 3, the physician prescribed stool
softener. On December 4, she fell down
and the husband had to carry her. An
exploratory laparotomy and hemicolectomy was done. Suit also named Nalle clinic.
Dr. C kept a patient on ovulation induction for one year, after which an xray
revealed her tubes to be blocked. (99-CVS-1540)
Dr. D performed a laser laparoscopy in September
1991 on a patient and perforated her small bowel.
She underwent multiple subsequent surgeries and became unable to eat and
drink. She was placed on TPN
(intravenous nutrition). The suit also
named Bradford Clinic and PHAC. (94-CVS-11679)
Dr. E performed a laparoscopy on a patient who
died from overwhelming sepsis six days later. (97-CVS-1707) Dr. E also failed to respond to nurse’s
pages for another patient in labor in August 1989.
The infant suffered severe physical and neurological injuries. (92-CVS-11209)
Dr. F failed to manage fetal distress during labor
in 1992, the parties named (Dr. F and Mintview ob-gyn) settled for $5M in May 1995.
Drs. G and H were performing a hysterectomy at
Presbyterian hospital, while managing a labor patient at Carolinas Medical Center in
September 1995. They failed to respond
to fetal distress in time. The baby was
born with zero apgars and died 16 hours after birth.(96-CVS-9576)
Dr. J failed to assess fetal distress in February
1987. The result was severe physical and
neurological injuries. (96-CVS-7927).
Dr. K delayed performing a c/section after
unsuccessful vacuum extraction of a baby with much fundal pressure. The baby was born with birth asphyxia and skull fracture. The jury awarded Plaintiff 23.2 million. The hospital settled separately for $6M. (95-CVS-13212)
These cases are only the tip of the iceberg of
adverse events involving Presbyterian physicians.
I know of no disciplinary action whatsoever, let alone suspension, against
these physicians by the hospital. They
kept practicing at Presbyterian hospital. In
fact, some of them sat in my judgment.
I have spent eleven long years in the courts and a
million dollars in legal fees. I have
been living one hell of a life. Any
semblance of normalcy has disappeared. I
think it is quite a simple question and would like YOU to answer it. DID
THE HOSPITAL DISCRIMINATE AGAINST ME? Feel free to drop me a note at
Board Certified Obstetrician and Gynecologist
4626 Charlestown Manor Drive
Charlotte NC 28211
(Phone) - 704-362-5702 (Fax) - RVBABY1@YAHOO.COM
year struggle against discriminatory peer review by
by Ron A. Virmani, MD
|Is There a Fix for U.S. Medicine|
For thousands of years, medicine was variously
practiced as black magic, witchcraft and a form of art. Starting with the renaissance, it became more
of a science over a period of many centuries. Here
I am referring to Western medicine, specifically the U.S. brand of medicine. A
completely new phenomenon took place in this country in the 1960’s and 70’s. Medicine became big business. Fueled by unparalleled technological advances and human greed both
at the same time, the scope and cost of medical system shot through the roof.
Nobody paid any attention to this phenomenon at
that time. The concepts of resource limitations and fiscal discipline did not
exist. Medical insurance companies wrote
generous checks, always with a smile. Doctors,
drug companies, hospitals and anybody associated with medical system made oodles of
money; some would call it obscene. Human
organs were taken out of people’s bodies by the millions and lab tests were ordered
all as a lucrative business. The lawyers
got on the gravy train by suing physicians. There
was some awakening when medical insurance costs started soaring and malpractice
insurance became high. Government and
managed care industry stepped in to check this runaway process in the 1980’s.
But the system is still spiraling out of
control today. Forty five million Americans lack basic health insurance. Physicians in many states are quitting
medical practice because they can not afford the malpractice insurance costs. Some are paying more than $200,000 this year
in malpractice premiums. Let me quote
from a poignant letter from one Dr. Herman Solomon, of Wichita, Kansas, who decided
to retire recently, in the American Medical News, published by AMA: “Even in my dreams, I did not think that I
would not be working now, but the nightmares of Medicare and managed care awoke me. Now that I am almost 65, my biggest concerns
are about personal care for me, my family and the general future population. Our system is broken. Managed care hasn’t solved our problems,
and I don’t expect the federal government to fix them either”.
Contrast that despondent tone with the happy
faces of 24-year old graduates of pharmacy schools, who are getting job-offers for
$90,000 this year, plus all benefits and signing bonuses too! Also by comparison, a pediatrician (MD), who
is about 30 years old after 4 years of sleepless medical school and 3 years of
grueling residency, may get a $60,000 salary.
How did we get into this mess? A main reason for the state of medicine today
is an empty think tank of the past. This
essay is intended to provide some fuel for this tank.
One - Medicine fights nature
The medical system goes to great lengths to fight nature. In 1983, I was a medical student. A 78-year old semi-conscious lady with chronic lymphocytic
leukemia was admitted to the hospital with pseudomonas sepsis. The nature in its own wisdom is trying to end
the life of the poor lady in a painless way. The time has come; the old must give way to the young. The limited and precious resources of the
universe must cycle from one generation to the next. This is the plain law of nature.
However, enter the wonderful medicine of modern world. It declares that death is unnatural. It must be fought against with every available
resource. So the poor lady gets an IV in
the arm and is placed on antibiotic coverage. She
gets stuck many times a day for blood tests. She
spends a couple of weeks in an obtunded state of mind.
After a couple of weeks, she develops bacterial peritonitis and is transferred
to the intensive care unit. Her blood
pressure is unstable, so a Swan-Ganz catheter is put in to manage fluids. She is taken for an operation that reveals an
abdominal abscess that is removed. However,
a few days later, her condition does not improve and her heart begins to fail. She is “coded” several times at great
expense but ultimately succumbs.
To me, this whole process is a senseless exercise. The lady spent 30 days in misery, thanks to our advanced medical
technology. Her relatives also spent the
30 days in equal misery. Somebody paid
30,000 dollars for her so-called “medical care”. Ultimately we all share that cost. Some thousand pounds of garbage was generated in these 30 days. This legacy will be left on this planet for
future generations to clean up and suffer the consequences of polluted water and air
Two - Medicine does not deliver what people really
In 1985, I had just finished my acting internship in an
inner city university hospital. A young
black man – an IV drug user comes to the hospital and is diagnosed with
staphylococcus endocarditis. He is
treated at public expense for six weeks in the hospital – at a cost of say $20,000. He goes home and returns in two weeks with
the same problem. This happens again and
again. The nature in its own wisdom is
trying to deal with an abnormal and unhealthy way of living. But the medical system decides to intervene. The cardiologists get busy doing echoes of
his heart and writing esoteric papers about vegetations on the valves. The infectious disease people cite profound
references on how to best treat his infections.
The students and resident physicians are merely using him as a medium to
learn. All these people have no real
interest in this person. If they meet
him on the street, they will avoid him in all ways possible. However, the system dictates that they show
genuine interest in him while he is in the hospital.
So they end up providing “medical care” for him even though they do not
really “care” for him. Interesting
concept. Isn’t it?
All this is practicing medicine from the ivory tower. Nobody will step outside the hospital and see where the man lives. What he eats.
What he does with his life. That
is where the problem lies. This man
never had a healthy environment to grow up in. The
fact that now the society decides to spend fifty thousand dollars to treat him does
not change his prognosis. Who really
benefits from this mindless process? We
know that the money actually goes to various components of the medical system.
Let this man go. Take
all that money and change the face of the slum.
Give these neglected men and women homes to live in. Give them jobs. Give them a life to be proud of and you will
have provided them with real health care. They
do not need the ultra-modern medicine of the university hospital – the respirators,
the cardiac monitors, the dialysis units, and the codes – that is a complete waste
Medicine of today is essentially “One size fits all”. No matter who you are, what your resources
are, what your life-style is, the medical answer is the same. This does not happen in other walks and
necessities of life. If you are hungry
and have five dollars, you buy a hot dog from the street vendor. You do not eat an elaborate meal in a trendy
restaurant. But if you have a heart
attack, you get the same million-dollar treatment as if you were a king. Of course, you can not pay, so the general public foots the bill. Although I believe that all citizens should
have access to basic health care, it is not economically feasible for everybody to be
considered candidates for heart bypass and other tertiary medical care of today.
Three - Modern diseases are mostly social in origin
In 1988, I was a senior resident in the department of
obstetrics and gynecology at Temple University Hospital in Philadelphia. After I finished my duties one afternoon in
the hospital, I started driving towards my apartment.
Just a couple of blocks down, a lady flagged me down and I decided to give her
a ride. She looked disheveled and
pitiful. Once into the car, she asked me
if she could give me oral sex for ten dollars. I said that I was not interested. Then she asked me how about for five dollars. I told her no. She did not want to ride any further and I dropped her off.
As I drove off, I realized that she was probably a drug
addict. Still, my heart was filled with
extreme sadness. I felt very sorry for
her. It was an irony to me that in the
U.S., one individual such as Oprah was worth a billion dollars and another had to
offer herself as a sex object for a mere 5 dollars!
This was a vivid example of polarization of resources in our society.
One of the manifestations of social inequities or
polarization of resources is poverty. Out of poverty, emanate a multitude of problems
(and medical diseases) ranging from violence, drugs, rapes, school shootings,
sexually transmitted diseases, obesity, cancer, infectious diseases, psychiatric
On the other hand, many other diseases are symptoms of
excess resources. Thirty percent people
in this country are obese, that figure goes up by 1% every year. Obesity generates a gamut of diseases like
high blood pressure, heart disease, diabetes, osteoarthritis, certain cancers etc.
As the process of polarization of resources grows unchecked
in our society, the social ills will grow and so will the medical woes. Indeed, polarization of resources is a worldwide phenomenon and we
shall talk about that below.
It would be intuitive to most of us that the medicine
practiced on this planet should be compatible with the long-term survival of this
planet. Is that indeed the case?
It is my belief that this planet is facing three problems of
immense magnitude as we embark on the 21st century:
Polarization of resources: As has already been mentioned, the disparity between the haves and
have-nots in the world is huge, inhuman and unconscionable. This is not only true of one nation versus
the other but also inside a given nation. This
keeps on getting worse by leaps and bounds. The
economy has become “global”, which is great for those who import one dollar of
consumer goods, sell it for fifty and pocket the profit. But most people on this planet see themselves
as sliding off the level of subsistence. Life
has become utterly frustrating and desperate for many people in this world. Timothy McVeigh’s actions, although not
excusable, were meant to convey that message. Not
only are the real jobs shrinking, but also the jobs left are essentially meaningless,
such as typing medical manuscripts or collecting toll.
One can hardly imagine that one can somehow fulfill life by typing a
doctor’s dictation for the rest of life. It
is easy to see that medicine practiced as today contributes to the problem of
polarization. The CEO of a managed care
company makes several million dollars a year and an office medical assistant makes $8
an hour. A preemie baby is kept in the
neonatal intensive care nursery at the cost of $2000 a day, that money ends up going
to the super-specialist physicians and manufacturers of medical equipment and drug
Pollution and depletion of resources: The
Western civilization is depleting nature at a rapid rate. In the U.S., six trees are cut down for each
person every year. Deforestation, urban
sprawl, loss of habitat of all natural forms of life has reached alarming
proportions. Hundreds of species have
become extinct. Still, the West shows no real understanding of the issues but is
driven by insatiable greed. What moral
right does 5% population living in the U.S. have to 30% resources of the world? What moral right does the medicine have to
cage thousands of animals in its labs and conduct experiments on them everyday? Do we have any moral superiority over other
species? The message of the Western
civilization that it is ok to kill other animals so a human life can be saved or
prolonged by a few minutes is going to backfire on the humans. Every week I receive so many medical journals
and magazines, I can hardly read any. They
all end up in the trash. If I did manage
to read some of them, I would lose my health because I would not have any time to
engage in sports activities. I cringe
every time the nurse draws up half the medicine from a $50 vial and discards the
rest. The medical trash includes
polyvinyl chloride plastic, paper, batteries, discarded equipment etc. Its incineration leads to emissions of
dioxins and mercury as well as furans, arsenic, lead, cadmium and generation of ash
which needs to be treated as hazardous waste.
The Population Explosion: Anybody can see that this planet can not house the present 6
billion inhabitants with any sense of human decency. It is projected that there will be 2 billion more people on this
planet in the next 25 years. Reducing
(or at least containing) population is the crying need of the hour in this world. The nature and its resources can not take
abuse at a breakneck pace as it is going on now, thanks in good part to modern
medicine. By prolonging life to an
absurd extent, the medicine has completely upset the natural balance. Much more emphasis is placed on ‘saving’
a life than ‘ending’ it in a dignified way as if one is so much morally superior
to the other. The fact is that life and
death are both equally important aspects of the cycle of nature. When a physician, Dr. Jack Kevorkian, came
along to mitigate the human suffering and end lives of diseased patients in their
terminal stages, they prosecuted him and put him in jail for life. While the state of Oregon has a law allowing
people to end their lives in a dignified manner, the U.S. State Attorney General Mr.
Aschcroft is going to challenge that in the Supreme Court. Abortion has become a dirty word. Many state governments do not pay a few
hundred dollars for abortion but have no qualms paying a hundred times as much for an
(unwanted) pregnancy carried to full term and delivered. Many such pregnant women are abused because
of the unwanted pregnancy. Many develop
complications of pregnancy. Many infants
born of these pregnancies end up in NICU (Neonatal Intensive Care Unit) costing up to
half a million dollars. Further, many of
these unwanted children are subject to abuse. Many
may actually wind up in prisons and cause further drain on the public exchequer.
As one can see from the above discussion, the medical system
is not helping, rather it is exacerbating the problems existing on this planet.
The national price tag for medical care was about
300 billion dollars in 1985. Now it
stands at 1.4 trillion dollars. For 280
million inhabitants of this country, this breaks down to about $5000 a year per
person. The Gross National Product (GNP) of this country is $8.4 trillion. The medical expenditure thus now stands at a
horrifying 17% of GNP. It is still
growing in absolute terms as well as a proportion to GNP and there is no end in
sight. Both the managed care and the
government have tinkered with it but have been unable to contain the problem.
The cost of medicine should be more compatible with the
life-style of people. Otherwise people
are consuming more then they are producing.
This is precisely what has been happening for the last forty years and getting
worse every day. The present generation
is living on borrowed money from the next generation.
Not only that, a country like U.S. has the power to draw up resources from the
third-world countries. Which really
means that we are consuming worldwide resources at a very high rate to practice our
extremely wasteful way of medicine. This situation is bound to implode.
Who really deserves medical care? How much medical care does one deserve? These are the questions that must be answered
because after all, for somebody to receive medical care, somebody has to work for
providing it. This list of providers
include doctors, nurses, health professionals in general and also the society at
large. The major health care provider is
really the environment – the nature, the plant and animal kingdom that are being
brutally exploited by the medical technology. The
environment, the water and the air supply are being polluted by industries
manufacturing medical equipment, drug companies producing drugs and chemical
companies producing other items like oxygen, paper, x-ray films, nuclear material and
what have you. All this leaves a heavy
scar on the only and wonderful mother we have, the nature.
The person who receives the fruits of this medical system
should be able to understand and comprehend various costs and other aspects of
medicine. Secondly, he or she should be
able to repay to the system by undoing all the damages when he or she gets well. True that there are going to be some
chronically debilitated persons whose medical costs are going to have to be borne by
the society. But we can’t afford to
have the whole society turn into a chronically bedridden society. This is happening right now with the
increasing geriatric population and a medicine that has the power to prolong a
perfectly useless and functionless life. The job of nursing in a nursing home can not be much fun.
Even in the hospital these days, people don’t come to the
hospital, get better, say thank you and leave. But
they come in to stay for a long time; they survive with the least amount of functions
remaining and die a slow prolonged death unable to repay anything to the society that
works around the clock. How many people in this country today are simply surviving in
a vegetative state in the neurological intensive care units and other similar places? The resident physicians, nurses and many
other medical personnel lose their sleep, children don’t see their parents for
days. How can young mothers breastfeed
their children if they are working 100 hours a week training as a resident physician? Young men and women working the night shift
in the hospital forego normal living and healthy sex because they are caught up in
the insane process of keeping bodies alive with no function or further utility. All in the name of medicine!
The medical system forces the most up-to-date technology on
everybody irrespective of his or her ethical and religious beliefs or ability to pay. Let us say that I have a child born with a
severe case of osteogenesis imperfecta. The
medical system of today is going to put this baby in the neonatal intensive care unit
and try to prolong its life as much as possible.
Then they are going to bill me $100,000 for the 3 months till the baby dies. I would not have the power to say that I do
not want all this heroic medicine, the baby is going to die anyway; and I would
rather send my $100,000 for the children in Ethiopia.
Such thinking on my part would be so politically incorrect as to earn me the
title of “child-abuser” if not “child-killer”.
The system, both medical and legal, will let loose its wrath on me because of
The medicine practiced today is TV medicine. It has to be spectacular. Never mind the 40 million people, who do not
have health insurance in this country, never mind the 30% unemployment of black youth
in the inner cities, the priority of the system is to go ahead with million dollar
artificial heart transplants. There have
been many people who have tried to get their message across against the drawbacks of
high technology. Unabomber was one of
them. Although his methods were
questionable, he had a valid message.
Research is the buzzword of modern medicine. Millions of people are directly and
indirectly involved in cardiovascular, genetic, drug research etc. One may imagine that all these people who are
assiduously trying to find a key to better health for others must themselves be
healthy people living a healthy life. Has
it occurred to anybody that a 9 to 5 sedentary job of working with test tubes and
writing papers is far from an active and healthy way of living? The task of most
research is inherently boring, unrewarding and mundane that it turns many researchers
into smokers, alcoholics and drug users – thereby destroying their health. To suggest that any of this research will
actually benefit human body and mind is far-fetched.
Instead of paying one person $50,000 a year to conduct
research on alcoholism in the inner city, we could pay the same amount of money to 5
individuals for gainful employment and the problem of alcoholism would not arise in
the first place. After all, why do
people drink or use drugs? Because after
years of unemployment, social security checks and finding nothing worthwhile in life
to do, one is most likely to turn to drugs, sex and alcohol as a way of having some
minimal enjoyment of life. When these
people come to the hospital with liver disease, the medical system preaches to them
not to abuse substances and sends them back home without any opportunity of making
anything out of life. Then the system
sets up an alcohol research lab with a million-dollar investment to study their liver
disease. Instead the same money could be
utilized much more wisely to improve the living conditions of the people who turn to
drugs and alcohol as an escape from their miserable life.
I question the drug research going on in this country and
the West because its only objective is to make money for the drug companies. It lacks the breadth of vision necessary for
a better planet. There was a time when
medical research pushed the idea of feeding children formula milk as one superior to
breast milk. Now it is well known that
breast milk transmits many immunoglobulins to the child protecting them against
asthma and allergies. There was another
time, medical researchers with tobacco companies stated that smoking did not cause
Now we have research going on with gene therapy, cloning and
such. I have apprehensions about this
sort of research because instinctively this is too much interference with nature. Secondly, if everybody wanted a designer
baby, who is going to pay the huge bill?
The Western society is hopelessly caught in the trap of inactivity. This is the key of many modern diseases
including the leading cause of death in the U.S. – the cardiovascular disease. There was the wonderful invention of TV, which made people sit on
their couches. Then came video games,
which made the children physically less active. Then came Internet, both adults and children now spend more time
sitting on their posteriors. The same is
true of the workplace. The agrarian and
industrial society became white collar and people now sit in their cubes in front of
The clothing people wear in the office environment are more
restrictive of body movements. They wear
neckties that restrict blood flow to the brain.
Women wear high heels that adversely affect the health of their feet.
The Center for Disease Control (CDC) recommends that adults
accumulate 30 minutes or more of moderately intense physical activity on most –
preferably all – days of the week. A
recent study found that only 32% of the adults meet this recommended guideline. I suspect that these are senior citizens. Most of us modern day slaves are not able to
find the time or opportunity for such activity.
The corporations that run our lives on this planet have
imposed this sedentary lifestyle on us. The
corporations dictate that our clothes will be made in China and will be transported
to U.S. because it is “cheaper” that way. The
corporations dictate that factories will prepare our food and we shall consume that
in fast food places. All this, so we can
sit on our desk and do perfectly unnecessary things in life, such as sue a physician,
market new drugs, run hospitals, merge two corporations etc. Instead, if all of us got up and started
jogging under the blue skies, I can assure you that we shall be in far better health.
The nature did not design us to sit in windowless offices in
tight panty hoses and type away. We were
meant to get up in the morning to the chirping of the birds, feed our cattle, till
our land and interact with the elements. We
were designed to run and jump and catch and lift heavy loads. We were meant to have sound bodies so we
could have sound minds. How sound can a
body be if it needs to be hauled everyday for two hours by a two ton SUV that runs on
oil imported from thousands of miles away?
We live in our suburban homes and grill twenty-ounce steak
to consume at one sitting after our sedentary day at work. We ride our comfortable lawnmower to cut our
grass. When our waistline expands and
cholesterol rises, we ask our physician to put us on cholesterol-lowering medication. We demand that the insurance (meaning other
people) pay for that. Still when we have
a heart attack at the age of fifty, we run to the hospital to get a quadruple bypass. And if by chance, something goes wrong with
that, we find the best lawyer to sue the pants off everybody in town. Are we a little spoiled? I would say that this is the height of
Litigation is another area which is spiraling out of
control. I am aware of bad baby cases where the jury has awarded 23 and 100
million dollars. While each case may
have some merit, the total effect of the litigious climate is a demoralization of
medical providers and eventual demise of medicine. The median jury award doubled from $500,000 in 1996 to $1 million
in year 2000. In March 2002, a Florida
jury awarded $78.5 million in a brain-damage case. One wonders if that person was worth that much money without the
brain-damage? St. Paul has already
pulled out of the malpractice insurance market, leaving 40,000 physicians hanging. PHICO Insurance company is in liquidation. Malpractice awards are likely to keep getting
bigger until the medical system slowly collapses around us.
The medical insurance companies spoiled the American public
in the 60’s and 70’s. The workplace
provided insurance and the medical care was thus virtually free to the public. Everybody started feeling that they were
entitled to all available medicine and somebody should pay for it. Medicaid, Medicare and managed care
perpetuated the same entitlement feeling. Now
the public simply thinks that somebody should go to medical school at his or her
expense for 10 years and then treat them for free.
They do not think that way about lawyers or plumbers or buying a hamburger. But when they go to a physician, they want to
pay nothing. And should anything go less
than perfect, the public is ready to sue.
Frankly, I have trouble understanding the concept of medical
insurance. Assume for example, person A
is a healthy young individual. He works
diligently from 9 to 5, goes home, exercises, takes in fresh air, plays with his
children, keeps his heart and lungs in good shape.
But person B, a coworker, frequently works a couple of extra hours. He then hangs out with the boss and other
workers in a bar after work where they smoke and bond and what have you. Naturally, the boss thinks that B is better
worker than A. Soon B is on the
fast-track, gets many raises. After a
few years, B has a heart attack because of his life-style. So the insurance pays for his
hospitalization. Not only is B ahead in
the office rat-race, but also he receives huge benefit from the health plan. The insurance has essentially taken from the
healthy person and given to the sick one. It
has handsomely rewarded an unhealthy life-style.
Doctors can hardly spend any time practicing medicine today
because of the mind-boggling number of regulations of government, managed care
companies and other agencies. Each time
a physician gets sued, which is a standard fare these days, a huge chunk of life is
taken away from the physician’s life and his family.
I have spent more time in the last year on legal matters than reading medical
Should a managed care company deny a certain expensive
procedure, a lawsuit is ready. But after
all, we all have to pay for this extremely expensive way of medical care. Our attitude is one of arrogance and needs tough love.
As mentioned above, our whole existence and life-style are simply not
rational. They do not derive from the
nature of who we are and who we are supposed to be.
We have evolved into this ultra-greedy predatory creature that is hogging up
every available piece of resource on this planet with a vicious frenzy. Upon this frenzy is built the entire Western
culture, a part of which is the system of U.S. medicine.
We have no right to spend $5000 a year per person for
medicine alone. There are one billion
people living on this planet who do not make one single dollar a day. Do we have any shame?
What moral right do we have to cage, torture and traumatize
thousands of animals for our medical experiments?
The other species have an innate right to exist on this planet without having
to justify their existence by sacrificing for us humans.
A ninety two-year-old woman in the U.S. nursing
home has a heart flutter and she gets a pacemaker to live for another couple of
years. This places unnecessary stress on the nursing home workers as well
as the children and grandchildren of the woman. The medicine is essentially taking from the healthy and giving to
the sick. When is enough enough?
Our children are inheriting from us a huge national debt of
$5 trillion. That means every child in
this country has a debt of $20,000 at birth. The
children are also inheriting a world that is scarred from our acts of greed. The relentless drought in many parts of U.S.
is indicative of global warming as well as deforestation and urban sprawl.
How much fun are our children going to have to clean up our
stockpiles of weapons, medical and other waste?
When they work, they will find that half their paycheck disappears in taking
care of old people on Medicare. They
will find countless nursing homes with those old people in debilitated hopeless
states. They will also inherit countless
preemie babies requiring thousands of dollars worth of care every day. I certainly do not envy our future
The medical system in the U.S. was not founded on altruism,
humanitarian concerns or sound principles of economics. While some students might have gone into
medical school for idealistic purposes, by and large the medical system has pursued
money and glamour. How do we know that? Have you noticed that one still has a hard
time finding red-blooded white American doctors to practice in the inner cities and
rural areas? The white doctors who
control the medical establishment with their bureaucrat white male friends practice
and live in the suburbs. Rural health
leaders recently sent a letter to USDA to keep the foreign medical graduate program
alive so there will be somebody to work in the rural areas!
The basis of U.S. medical system has been greed and callous disregard
for the nature. Like other systems in
the U.S., medicine has grown to what it has been able to get away with. In its own self-interest and aided by religious right, medicine
has chosen to preach that all human life must be prolonged at whatever cost to the
society and the planet. If each human
inhabitant of this planet started spending $5000 per year on medical care, the total
bill would be 6.5 billion X 5000 = 32.5 trillion dollars. This
is essentially the same as the entire GWP (Gross World Product), which is 38 trillion
dollars. Clearly the situation is
unsustainable. Further, it is absurd to
think that there can be any human life on earth without a healthy flourishing of
other species. Medicine needs to dole out tough love in order to mitigate the
suffering of humans and the animal kingdom.
It is of great concern to me that the U.S. medicine, which is not
even appropriate or affordable for this rich country, is being exported to very poor
countries like India. India is soon
going to be the most populous country in the world.
However, most people there lack the basic needs of life. The infrastructure is poor. When then U.S. brand of medicine is
transplanted there, it is bound to exacerbate the problems of polarization,
population, pollution and depletion of already scarce resources; thereby resulting in
extreme social disruption. I guess
Thomas Robert Malthus will have to step in and create famine, wars and other
catastrophes so as to balance the conditions of overpopulation and utter chaos.
It is my belief that life on this planet is near extinction. The way the West spends the natural resources
on this planet is outrageous and we shall soon join the rank of dinosaurs. The 21st century is the final
The definition of medical care needs to change. Basic medical care should be made available
to all members of the society. There is
no need or justification for the wasteful high-tech medical care. I do not believe in advanced cardiac
resuscitation, organ transplants, saving one pound preemie babies or heroic efforts
to save lives. I do believe in
supporting the decisions of those who choose to end their lives for whatever reason. I believe in providing support for reasonable
cases of euthanasia and abortions. I do not believe that we should experiment on animals whether in
medicine or in cosmetics industry.
Medicine should be practiced with eyes open to society, the
environment and the nature. Medicine
needs to be in synergy with nature. When
an institution goes against nature, bad things happen.
We have already seen how priests abused children as Catholic Church maintained
its anti-nature stand of celibacy. The
nature is inherently benevolent. Sepsis
or kidney failure can be a blessing in disguise. We must learn to accept nature and live with it.
The medical system needs to be simplified. The present system of medicine is stressing people out beyond belief. It is taking a huge toll on human beings as well as nature. It is indeed creating the very problems that it turns around and treats. A futile exercise! Why create the problems in the first place?
Can this medical system be fixed? This reminds me of the story of the mice who
figured out a clever way to survive the attacks of the cat that was decimating their
ranks one by one. They decided to place
a bell around the cat’s neck. But then
the question arose who would bell the cat.
I pray for the fortitude for our country to rise to this giant task with the required wisdom, insight and humility. Upon this, rests the future of mankind.
|Does Medical Establishment Really Protect the Public?|
Let us say that you get sick and go to the
is there to make sure that you get good care?
Hospitals will point to their quality control
a patient is discharged, every chart goes through this screening. Most charts pass
this screening, but some charts get flagged according to pre-established criteria
such as prolonged hospital stay, death of the patient, excessive bleeding and other
These charts then go through a process called
“peer review”. The
medical establishment goes to great lengths to make sure that this is a secretive
fact, most states have passed laws to keep this process hidden from the public eye. In this process,
a few physicians selected by the hospital administration pour over the flagged chart
and decide if the chart met the accepted standard of care. If it did, fine. If it did not,
the reviewed physician faces consequences. The consequence
could be some advice, mentoring, being asked to take some additional training, a
reprimand, a temporary suspension or complete termination of his privileges.
In theory, this is an excellent concept. What better way
to police the health of the public but by the “peers” in the same discipline of
in practice, the “peer-review” process is where all dirty politics is played out. Why should a
physician criticize the sub-standard care of his buddy? And what is there
to stop him from criticizing the good care of somebody he does not like or care for? After all, the
process is highly subjective and there are no effective checks and balances against
abuse of the process.
Once the peer-review committee has spoken, all “fair” administrative
hearings are exercises in rubber stamping.
If the good old white boys of the hospital (many
hospitals are ruled by such white power elite) want to get rid of a minority
physician, it is simply a matter of giving him an unfavorable peer review and
throwing him out on the street. Once labeled a
“bad doctor”, this information gets entered in the National Practitioner Data
Bank and the career of the reviewed physician suffers an agonizing premature death. This is exactly
what happened in my case.
I brought my family down to join a group practice
In October 1993, I started a solo practice. I was not under
the “protection” of the group any more. I began to be
treated differently from the other “native” doctors. Nurses gave me
stern looks at times and they would drag their feet carrying out my orders at other
would write notes behind my back, with their prejudiced slant on ordinary events. These notes were
quietly entered into my file, without any chance of defending any implied
As physicians, we all face occasional medical or
surgical complications in our practices through no fault of our own. On December 1,
1994, I was performing laparoscopy on a patient and the trocar inadvertently injured
the external iliac artery causing significant bleeding. I opened up her
abdomen, called general and vascular surgeons and repaired her injury. She went home. Such incidents,
though uncommon, are known complications of the surgery. Many other
doctors have had such incidents and have gone on practicing without a hitch.
However, in my case, the hospital used the
incident as a pretext and started doing a wholesale review of my charts from more
than a year prior. These
charts had already gone through the quality assurance process and had been filed away
without any problems being noted. Dr. James Hardy,
a Chapel Hill graduate, no more experienced than I, conducted this review, shrouded
in utter secrecy. Nobody
told me how many charts they were reviewing and what problems, if any, they had
On September 1, 1995, the administration summoned
me to the imposing large Board Room of the Presbyterian hospital in downtown
They told me that the hospital was summarily
suspending me as of 4 PM that day because of a “peer-review” of my 102 patient
charts out of which 24 were found to be “problematic”. I was stunned by
this revelation. I
had assumed that the hospital would give me a chance to defend and explain anything
that they considered “problematic”. This is how
things are always done in the hospitals.
“No” said Mr. Betzold, “We do not have to
tell you what charts are problematic or what the problems are.”
Suspension from the hospital like that is a kiss
of death for any physician. I sought legal
after two months of wrangling, the hospital would even tell me what “problems”
they had with the 24 charts. Turned out that
the problems were everyday things that happen to all ob-gyn’s. Several
independent ob-gyn’s reviewed my charts without any compensation and said the
charts met the standard of care.
Over the years, it became clear to me that I was a
victim of egregious discrimination based on my national origin. Doctors, under
the control of white power elite of administration, were eager to find faults where
there was none. And
of course, they did not have the courage to sit me face to face and simply ask me
questions about the cases, because they knew how foolish they would appear. A senior ob-gyn
physician, appointed by the Medical Board of North Carolina, also found my charts to
be within the standard of care.
The best ten years of my life have wasted away
right in front of my eyes.
My professional and personal lives have been devastated. I have vague
memory of happy pregnant women coming to my office for their care. I faintly remember
the last pink baby I delivered. The hospital has
not budged from its clearly discriminatory and unconscionable position. They have dragged
me from court to court and done everything to ruin my life.
After an unprecedented victory in the Fourth
Circuit Court of Appeals in
Unfortunately, the judge handling my case in the
district Court succumbed to esophageal cancer in 2004. Another judge
took over the case and simply tossed my case out. I am in the
process of appealing to the 4th Circuit Court of Appeals, I have no idea
if I shall ever get my day in the Court.
I recall the case of Dr. James Jeghers at Duke
university some years ago, where a patient died from the wrong heart lung transplant. I also recall a
botched delivery case of Dr. Alice Teague of
It is clear to me that the medical establishment
does not really protect the public but rather cleverly protects its own behind the façade
of public good. Abusing
the process of “peer review”, the conniving establishment can target anybody with
doctors, healthy competition, physicians who speak out for patient care – the
“whistleblowers” and the ones who are not beholden to them. If it is not
possible to find faults with the charts of a physician, the administration will
proceed to label the physician “disruptive” based on self-serving subjective
there on, the physician is made to undergo a battery of psychiatric evaluations. All this is
done in the name of public good but is indeed an abuse of public trust and public
You will never find a hospital administrator being subjected to psychiatric
It is unfortunate that the legal system, the
courts and the judges, do not come to rescue of the hapless victim, They leave
weighty matters of public good in the hands of hospital administrators who have not
spent nights and days on call with dedication to patient care like I have. They are simply
trying to shame, intimidate and banish a physician for their ulterior purposes but
under the false pretext of quality of care. Could it be that
the courts subscribe to the same club of good old boys?
The courts need to see through that veil. The peer review
system is broken. It
has degenerated to “buddy review”. Lawmakers also
need to take note. Unless
the medical establishment cleans up its act, the medical errors will not come down
and public will suffer.
The widespread nature of bad faith peer review is evident from the websites of
Semmelweis society, which is a national organization of the doctors hurt by such sham
websites are www.semmelweis.org and www.semmelweissociety.net. The society
is planning its national meeting in
A proud citizen of the
(Please note: Articles that appear on this web site may not reflect the opinion of the editorial staff.)