MISTAKES – Can We Avoid Them or just Cover Them Up? It’s been said that doctors can bury their mistakes; attorneys can lock up their mistakes; but architects can only advise their clients to grow bushes and vines.
A patient was brought in by her husband with recurrent green phlegm and exacerbation of her wheezing. He asked if we “could take her lungs out, clean them real good, and put them back in?” He appeared to be a reasonably industrious blue collar worker, a sort of nuts and bolts type of man. The government may be right. Most individuals really would be unable to make their own health care decisions. But after reviewing the proposed 240-page Health Security working draft, some of us are not convinced the civil servants have a superior ability.
UC officials are proposing salary hikes averaging 21% for executives at the system’s five medical centers. Hospital executives are to receive increases of as much as $60,000 with a total of over $700,000 for 25 executives according to a copy of the proposal obtained by the Bee (11/13). The SF Chronicle states that the average UC hospital director currently makes $118K to $154K. According to Medical Economics, 25% of us now make less than $100K. Relman, in the NEJM, has been telling us that administrators make 20-24% of the health care dollar (physicians are at 19%). We can hear it now, “My son, the Administrator!”
Recent Forbes headlines: “FDA’s David Kessler wants to liberate us from greedy corporations. Who will liberate us from the FDA?” Kessler was bemoaning the unsubstantiated claims for vitamins in the market place. “It is time to do what needs to be done.” One of our own senators is trying to make sure he doesn’t do what he wants to do. “In the end, I’m a doc,” Kessler told People magazine. His Chicago Law School Professor Richard Epstein recalls Kessler vividly: “He was a good student. . . You knew he wasn’t going to spend his life poking around people’s openings.” Being a Bush appointee, he derided his chief after Bush lost the election, did a chameleon according to Kim Pearson of Food & Drug Insider Report, was the only one who refused to return the formal request for resignation sent to all political appointees, was desperate to be retained, not reappointed, because he knew he could not survive another congressional approval process. Now Clinton officials state, “He’s grating already.” Surgeon General Koop told 3000 plastic surgeons that the FDA investigation (of breast implants) “smelled …there is more than meets the eye” with the authors alleging “feminist politics and Nader influence imposition on private practitioners – to allow reconstructive implants for mastectomy patients but not for cosmetic purposes – is obviously irrational in pure medical terms… Maybe Kessler should be looking for new openings,” concludes FORBES… In a companion article, the same authors, Peter Brimelow and Leslie Spencer, suggest “As Congress mulls plans for taking over the American health care system, it might first take a fresh look at what politics has already done to the drug industry.”
Science (221:1788) reports the drug companies employ about 36,000 scientists, about twice the biotech industry. Twelve firms alone have announced they will trim 18,000 jobs by 1996, including roughly 500 PhD scientists. The downsizing appears to be driven by three factors. One is the failure of lead products. The second is loss of revenue due to shrinking tax credits and larger Medicaid rebates to states. Original rebates were $3.4 billion and recently were increased to $6 billion. (Isn’t that illegal for the rest of us?) The third and biggest damper is the threat that the government will impose price controls on drugs as part of the Clinton Administration’s health care reform. This has unnerved Wall Street and led to a decline in public investment in biopharmaceutical firms. The drug pipeline looks barren according to analysts… I guess we won’t have to learn a new antibiotic every month in the future.
Getting back to those mistakes – we all make them. Some more than others. This may be a product of dealing with sicker more complicated patients, a stressful day, or invalid patient data. To admit to mistakes can be construed as humility, or in a hostile situation, an admission of guilt. A Professor of Surgery once remarked that he’d hate to see the number of his mistakes buried in the local cemeteries. There was an actual case in this community in which a chief of medicine told a colleague, “If you had admitted you made a MISTAKE, you would still be practicing and we would not have had to suspend you.” The attorney had advised that in this hostile situation, since out side review had supported his care, not to admit to MISTAKES since there was no documentation of MISTAKES. This destruction of medical practices is made possible by PEER REVIEW that is biased. Let’s keep it honest and not give immunity to hospitals and physicians doing incompetent review… I understand that Surgery Professor no longer admits to his mistakes that are buried.
George Roche, President of Hillsdale College, the institution that does not accept any government aid and does not allow it’s students to accept government aide, was in town recently giving a number of business and professional people a historical review. His title was “Ideas Have Consequences.” All received a copy of his recent volume One by One. He pointed out that in the eighteenth century there was a professor at the University of Glascow, Adam Smith, who was researching the IDEA of freedom and turned to the colonies. Meanwhile there was a man named Thomas Jefferson who was toying with the IDEA of limited government. These two IDEAS produced an economic and industrial explosion that would have been impossible in any other system. Hence, Adam Smith’s title, Wealth of Nations … In our era, we have seen freedom curtailed and oppressive governments collapse, with GATT held back because it won’t work until many governments’ subsidies are reduced, with numerous governments looking for a way to privatize industry, farming, and medical care, we have lost sight of the two IDEAS that gave us an enviable standard of living and health care while other nations are searching for ways to implement our high standards.
The Justice Department settled their health care fraud case with MetWest laboratories (along with MetPath) with payment of $40 million for intentionally submitting claims for unnecessary tests. Physicians were cautioned that they could be held responsible for the laboratory doing more tests than they ordered.
ABC’s 20/20 reported on December 3, 1993: A child who was 6 months in the hospital on IVs was discharged to continue home infusions. When the parents were told their insurance was running out they asked for the statements. After a year, they found out that the home infusion company, Critical Care America, was charging their insurance company over $3000 per day totaling about $100,000 per month. Another example that when health care is free at the point of delivery, costs are exorbitant and nobody is in charge. It takes a massive amount of time and energy, extending over years, to just research one claim. They found 3,000% markups. We again conclude that there should never be an insurance benefit in which the patient is not financially responsible out of his or her own pocket for a minimum of 10% so that there will always be an evaluation of the cost/benefit analysis at the point of service. If the patient has co-insurance, there still must be a minimum, slightly painful, out of pocket expense to continue the point of service evaluation process. The usual $25, $100, or $200 copay would have no effect on $100,000 gouging. It has to be a percentage so that the patient, even before he sees the statement, has some idea of the total cost… Which reminds me, have you noticed how you’re always asked to let a home care company see your patient after discharge? And when their evaluation comes back for your signature to make it legitimate, how many additional items they think need to be done? I once counted 29 separate items. Have you ever tried to find out what they charge your patient’s insurance company? With all of us trying to cut costs, with hospital census down, why are health care costs continuing to increase? Are our home care companies doing what the home care company on 20/20 was doing? Are we going to be held responsible for signing the order and the next MetWest type Medicare Fraud will involve us?
John Stossel, also on 20/20, reports on the Congressional Record, an alleged verbatim report, that the record is mostly Fake. In fact, it can be changed if the congressman doesn’t like the first Fake record or find that it has MISTAKES in it to make it a more acceptable Fake. They conclude that Congress is wasting $469 per page and doesn’t seem to be able to keep from wasting with anything they touch… If we ever let congress destroy the health care we provide our patients it would be the most critical of all MISTAKES, one that cannot be buried or even covered with bushes and vines.