Mandated Interpreters Close a Physician’s Practice

It is now considered the law of the land for physicians to provide free certified medical interpreters for any non-English speaking patient.

Brian A. Shaw, MD, President of the Fresno-Madera Medical Society, reports that Dr. Kwock, the son of an American-born Chinese immigrant, and his sister have served for 20 years as interpreters for family and community members requiring medical care. He recently was told he had to provide this service, at his sole cost, for all his patients.

The Office of Civil Rights (OCR) states that this has been the law since the Civil Rights Act of 1964. In 2000, President Clinton issued an executive order regarding this new interpretation.

According to the AMA News, “Policy guidance from the U.S. Department of Health and Human Services clarified that physicians who accept federal funds, such as Medicare and Medicaid, must provide language assistance at no cost to any patient with limited English proficiency.” In a letter to Dr. Kwock, the OCR stated that he “discriminated on the basis of race and national origin” when he failed to provide free interpreter services to a single patient, who then filed a complaint with the Fresno Health and Consumer Center. Dr. Kwock readily admitted that he does not employ a medical interpreter in his small private practice. The letter stated the chapter, section and verse of the law and 15 items of issue.

Dr. Kwock immediately complied with all issues and posted signs that all patients have the right to free language assistance. He received a “Resolution Agreement” from the OCR mandating expensive and time-consuming upgrades to accommodate every language spoken on the face of the globe. Dr. Kwock closed his practice. Another expensive vote against government bureaucracy.

A member physician once received a $140 bill for two hours spent interpreting a consult. The physician would eventually receive $95 from Medicare. He, too, is in the process of closing his office.

The additional $45 cost to comply with federal laws, more than what he receives for providing the service, reminds me of the patient who felt the government could certainly increase taxes to provide everyone with medical care, as the single-payer socialized medicine advocates would require.

I asked, “What if that required that the tax rate go to 100 percent?” He stated, “Sure, the wealthy can well afford to pay 100 percent of their income in taxes.” Wondering if he understood what percent “all of his income” meant, I asked him, “What if it takes 200 percent in taxes?” He said, “The wealthy can well afford to pay 200 percent of their income in taxes.”

And so the eventual collapse of our society may rest with the incompetence of our socialized education system being unable to educate people that 100 percent is the total. This gives credence to the single-payer purveyors or socialized medicine advocates who would make our entire health care system as incompetent or third world class as our educational system.

Hills Physician: the Largest IPA of all

The Sacramento Bee and the Sacramento Business Journal recently reported on the largest IPA in our area. Steve McDermott, CEO of Hill Physician, came to Sacramento in 1993 and purchased the ailing Mercy IPA Medical Group. By merging with Bay area members, it has formed the largest IPA group in the country, with 2,000 physicians and 350,000 patients.

Despite cutting costs and terminating 200 physicians in its early days, Hill was able to pay an average of $12,000 to each doctor for cooperating in this effort.

A New Boutique Hospital?

Stephen Kamelgarn, MD, the Editorial “guru” in The Bulletin of Humboldt-Del Norte County Medical Society, writes about the community’s dissatisfaction with the St. Joseph Hospital in Eureka.

This climate has prompted a number of surgeons to begin working on a “specialty surgical hospital.” This hospital would be used for elective procedures. It would not have an emergency department nor would it be involved in care for the medically under-insured.

After presenting both sides of the issues, he summarized his comments. “If the proposed new hospital will hold the St Joe administration’s feet to the fire, and force them to deal with the medical staff in an open, forthright and collegial manner, then I’m all for it. Perhaps, only the threat of the new hospital will do the trick, but I doubt it if past dealings with the administration is any guide.

“If, on the other hand, the new hospital dilutes and fragments an already precarious health care environment, then its construction will be a pyrrhic victory, at best, and we all will have lost.”

Collegiality, Where Are You?

Jerome Morgan, MD, a Santa Rosa urologist and member of the editorial board of Sonoma Physician, asks, “Collegiality, Where Are You?”

In 1971, when Dr. Morgan started his practice in Santa Rosa, Sonoma County Medical Association (SCMA) had about 100 members. They met in a small building across from the old graveyard near the Terrace Market. “We often had medical association dinners, friendships blossomed, and many were nourished and kept.”

Morgan was fortunate enough to consult at Healdsburg General Hospital, the old Petaluma General Hospital, the old Hillcrest Hospital, and Palm Drive Hospital. He came to know many of the doctors in these towns. These smaller medical communities clustered around their own hospital’s CME presentations and social gatherings. Even today, these physicians are fiercely loyal to their local hospitals.

After reminiscing about a number of events, Morgan wonders “Where have they gone?” And continues, “Over the years, SCMA has become less and less of a gathering place for Sonoma County physicians. Our collegiality, as I see it, began to decline in the early 1980s.

“At that time, Health Plan of the Redwoods was supposed to unify the medical community through the Individual Practice Association of the Redwoods. Money, politics, and business stresses eventually led to the breakup of these organizations.

“Redwood Empire Medical Group, Inc (REMGI) was introduced in those times as well. In my view, it split the physician community even more. A deep rift developed between Memorial Hospital physicians and Sutter physicians — a rift that continues to this day. Managed care further divided us as greed and fear took their hold and competition in all ways turned ugly…

“Sonoma Country cannot afford to have Sutter doctors versus Memorial doctors, Santa Rosa doctors versus non-Santa Rosa doctors, specialists versus primary care. The physicians in this area absolutely need to recognize these facts and once again work and play together.”

Virgin Territory

Melanie Zaharopoulos, an editorial intern working for The Southern California Physician recently discussed teenage fascination with sex. By the time they graduate from high school, approximately 65 percent of teens have had sexual intercourse.

This is not terribly surprising in the United States, where the average citizen boasts more sexual partners per year than in any other nation. But it is risky. One in four sexually active teens contracts an STD each year, and almost 2 percent become pregnant. While the numbers are decreasing, specialists caution they’re still too high.

Originally conceived in 1996 as part of President Clinton’s Welfare Reform Act, abstinence-only education programs were part of an ambitious campaign to curb multigenerational dependence on public assistance. Classes combined moral training with self-esteem-building exercises, all aimed at tapering teen pregnancy rates.

While the $50 million program may have been beneficial to some, it raised a thorny question: Should the federal government legislate morality?

Educators in some states elected to drop the crusade to encourage sexual relations only after marriage from their curricula. But Reps Bill Archer (R-TX) and Thomas Bliley Jr, (R-VA) wrote a letter in 1998 to Peter van Dyck, the Maternal and Child Health Bureau official overseeing the program, “Ignoring marriage is inconsistent with the intent of the legislation, which is to send the unambiguous message that sex outside of marriage is wrong.”

With only their letter and a few steaming editorials published in heavily partisan papers, the program continued unchallenged — hardly a blip on the national radar screen until the 2000 presidential elections, when then-Gov. Bush decided to make it a cornerstone of his campaign. The Bush administration has taken a distinctly different approach to combating teen pregnancy, earmarking more than $27 million in additional funding for abstinence-only education programs.

However, things have gone less smoothly for President Bush: a federal judge in Louisiana ruled that abstinence illegally promotes religion.