Macon, GA; Jamestown, NY; San Francisco, Santa Clara, and Orange California

In a recent issue of the Medical Sentinel devoted to Futility of Care and Duty to Die, Miguel Faria, Jr, MD, cautions us with a history lesson from Germany. Although Hitler issued his first order for euthanasia in Germany on September 1, 1939, the road to active euthanasia had been paved before the Nazis came to power. Physicians in the Weimar Republic as early as 1931, had openly held discussions about the sterilization of undesirables and the euthanasia of the chronically mentally ill. Before the Final Solution of the Holocaust was officially implemented, 275,000 German citizens had been put to death. Doctor Leo Alexander, an eminent psychiatrist and Chief U.S. Medical Consultant at the Nuremberg War Crimes Trials, in his classic 1949 New England Journal of Medicine article, described how German physicians became willing accomplices with the Nazis in Ktenology, “the science of killing.”

An article in the New Oxford Review reported: “People in the United States’ hospice programs are not dying fast enough to satisfy federal government auditors. Washington is conducting special reviews of hospice records and call for repayment of money spent under Medicare for patients who lived beyond the expected six months after they had enrolled in hospice care. . . . A dozen hospice programs have been notified by the Inspector General’s office of the Dept of Health and Human Services that they improperly spent $83 million caring for people who lived more than 210 days after enrolled for hospice care.”

Lawrence R Huntoon, MD, PhD, neurologist from Jamestown, New York, reviews and projects the killing fields of the future. The HCFA and Medicare accused him of providing medical care to a dead person. The patient was unable to convince Social Security, with identification in hand, that she was alive. It took his congressmen to convince the bureaucrats to resurrect his patient into their system. He then quotes Dr Marcia Angell, executive editor of the New England Journal of Medicine in a May 1994 article, who says that the legal presumption in favor of life, as applied to patients diagnosed with permanent unconsciousness, should be removed. Dr Angell suggested the next logical step would be to change the definition of “death” to include a diagnosis of permanent unconsciousness. A November 1, 1997, article in the British medical journal Lancet, took the next “logical” step by urging that such “dead” patients have their hearts stopped by injection so that organs could be harvested.

San Francisco Medicine has published a guest editorial by Cynthia A Point, MD, titled “California Dreaming.” She has this recurrent nightmare that you are very sick, and have just found out your doctor has left the area, and none of the other doctors are taking any new patients. So you go to your nearby hospital and find their emergency room on “divert” because they have no beds and you find the same situation at the next hospital you try. The local IPA is under FTC restriction to add new doctors to its panel. She then points out serious inequities in Medicare, which uses historical costs of care basis, and thus pays in SF about half that paid in Florida. She then suggests legislative solutions so the “nightmare” will not come true. (Maybe if we allow the nightmare to come true, the solution would come faster?)

James G Hinsdale, MD, FACS, president of the Santa Clara County Medical Association, states in his President’s Column that the issue that alarms him most in the forthcoming millennium is the MBC’s current 5-year trend in prosecuting physicians—in order to pull their medical licenses—-by using one single bad outcome to justify the legal action. Dr Hinsdale feels this tactic of “single incident prosecution” is wrong, abusive, and has to stop. He notes that physicians with spotless records are receiving complaints of “repeated acts” of negligence that refer to only one patient. He warns his society members, if approached by a friendly MBC investigator, to excuse yourself and then run, do not walk, to an attorney. “You are profoundly ill-advised to talk to an MBC investigator without having secured legal counsel.” He believes that the NORCAP insurance to cover your defense against the MBC is the best benefit of society membership.

Arthur D Silk, MD, Editor of the Orange County Medical Association Bulletin, asks in his editorial, “Why do we still pay hospital dues?” Isn’t it inane to contribute up to $200 to hospital staffs for the privilege of sending them patients from whom they make their corporate profits. How did we get into these topsy-turvy economics? He feels that in the days of charity care, doctors started contributing $10 or $15 a year so hospitals could provide this care free of charge. Now that hospitals have metastasized into megaliths headed by officers whose salaries exceed those of the highest paid physicians, they still need our patient referrals but they don’t protect our professional needs. Silk says it is time for doctors to reassess their financial priorities and make collective decisions so that hundreds of dollars they are now contributing to hospital staff coffers might be better used to maintain those organizations to which they must turn for professional survival. (You may contact him at bulletin@ocma.org)