- Del Meyer, MD - https://delmeyer.net -

From Bureaucrats & Other Professions

A LESSON FROM TEACHERS: In a remarkable twist, our Governor is handing out $350 million in bonuses to teachers at 4,800 public schools for raising their students’ Stanford 9 test scores. The teachers say this $591 bonus is nothing short of a bribe, suggesting that they have been holding out against their students. Hundreds of teachers have been forwarding these “bribes” to scholarships and charities. . . . Meanwhile, a health insurance company has stated that they would reward doctors for improving the patient’s health care, rather than reward them on yesterday’s emphasis of saving costs. Shall we give these “bribes” for medical student scholarships? . . . A patient of mine who teaches for the San Juan Unified School District requires a morning dose of Xanax before facing her classroom of students. Because the many rules essentially prevent her from maintaining order to teach effectively, she is no longer interested in having her children learn anything. Her sole objective is getting through the school day without an injury or having violence erupt. . . . A doctor from one of the IPAs told me his challenge is getting through the work day navigating the rules of the IPA, insurance carrier, Medicare, and hospital as smoothly as possible. He can no longer be too concerned about the patient. . . . Is this the leveling of the professions?

MARKETING OR SALES: Southern California Physician describes a course titled Practice Promotion 101. Howard Bronson, a marketing director for Practice Builders, states that confusion over sales versus marketing will defeat a physician’s outreach efforts. He reminds us that sales activities and materials are practice oriented; marketing activities and materials are patient oriented. Selling is preoccupied with our need to sell our professional services. Marketing is aimed at pointing out to our patients how our services will meet his or her needs. . . . A good reminder for us to maintain patient oriented thinking.

BRINGING ANATOMY INTO THE DIGITAL AGE: Joseph Paul Jernigan, a convicted killer, donated his body to medical science after his execution. His body was lightly embalmed and air freighted to Denver. There, scientists contracted by the National Library of Medicine performed MRIs and CTs and froze the body solid. The NLM had been looking for an average man who died on schedule before disease overtook him. After sawing his body into four pieces, the scientists encased the chunks in blue gelatin and began to slice, milling from the feet to the head. After 1,877 cuts, the cross sections were digitally photographed. The photos were collated with the CT scans and three-dimensional-imaging technology brought the data to life. After months of work, the scientists emerged with 15 gigabytes of data that constituted the Visible Human Male, the most accurate human anatomical model ever seen. Jernigan now lives, according to the New Yorker, on thousands of Web sites.

DOES A CHAPERONE PREVENT SEXUAL ACCUSATIONS? In 1995, Dan Alexander, MD, an internist in New York, saw a patient for a variety of acute complaints. Although she was asked, the patient did not divulge her current psychiatric treatment. Her therapists testified that the diagnosis was histrionic personality disorder and that she had not cooperated with treatment. In 1998, the patient filed a malpractice suit, claiming multimillion dollar damages, and caused an inflammatory front page article to appear on the Jamestown Post-Journal headlined “Lawsuit Alleges Malpractice, Molestation.” Two years later, the patient voluntarily discontinued the suit, with prejudice. However, after the article appeared, four other patients filed complaints against Dr. Alexander, some related to examinations which were performed five years previously. As a matter of office policy, Dr. Alexander always had a female chaperone, who was a health care professional, present during breast and pelvic examinations. At the hearing, the chaperone testified that she observed nothing unusual or improper in the examinations. However, the Hearing Committee rejected her testimony because of her “obvious interest in the well-being of the respondent after working closely with him for several years,” and upheld Dr. Alexander’s de-licensure in New York. Dr. Jane Orient, Executive Director of the AAPS, feels that it will be extremely difficult, if not impossible, for any physician to have a fair opportunity to defend charges of such inappropriate conduct.” The complete brief is posted at www.aapsonline.org.

PRESCRIBE PAIN RELIEF, GO TO PRISON: In 1996, investigators arrived, guns on hip, at the Salt Lake Headache Clinic of Dr. Robert Weitzel, demanding patient’s charts, and a witnessed urine specimen. When the urine sample proved to be clean, the investigators interrogated staff, acquaintances, patients, and reviewed Medicare billing records and practices. When these all passed muster, they descended on the hospital and found a nurse who felt there were five questionable deaths in the winter of 1995 and 96. A physician was found who rendered an opinion that the care was not standard comfort, end-of-life care but constituted “active euthanasia.” In September of 1999, Dr. Weitzel was arrested on five counts of murder, had to post a $100,000 surety bond, a $25,000 cash bond, despite the fact that two of the bodies exhumed had no detectable levels of morphine and the third had levels commensurate with the amount prescribed. He was then de-registered by the DEA and has been unemployed since. Dr. Weitzel sold his home, liquidated all his assets and went into debt to pay legal bills. He was unable to recruit witnesses in Utah because of the defamatory publicity. Out of state witnesses were threatened and harassed. The prosecutor’s witnesses were paid as much as $40,000 for their testimony with one asserting that administering morphine every three hours rather than every four hours would cause blood levels to rise inexorably. Everyone was stunned – including the prosecution – when the jury returned a verdict of guilty on two counts of manslaughter and three counts of negligent homicide. When given a sentence of 1 to 15 years in prison, one juror stated, “I didn’t know he’d go to prison.” The charts in question and a summary of the legal events are posted at www.weitzelcharts.com. Dr. Weitzel can be contacted atraw1md@qwest.net.

MEDICARE REGULATIONS: Philip Alper, MD, FACP, an internist in Burlingame and Medical Director of the First Data Bank Corporation, refers to Medicare’s assault on oncologist John F Kiraly III, MD, (reviewed in this column recently) in his column in Internal Medicine World Report. Ironically, he had just read congressional testimony by Michael Mangano, Acting Inspector General of HCFA claiming that such things do not happen. “Provider concerns relating to inappropriate investigations and audits are unfounded and both HCFA and the OIG are reaching out to provider groups to reassure them, claiming physicians and other health care providers are not subject to criminal or civil penalties for honest mistakes, errors, or even negligence.” Dr Alper then refers to his experience with former HCFA administrator Gail Wilensky at a meeting when he described the corrosive effects of Medicare regulatory activity on physician morale. He was told “our pain is not real because what upsets us is not happening.” We have selected an example of professional homicide for each issue of this column this year. It’s difficult to comprehend that congress and bureaucrats don’t understand or even believe the results of their legislative and regulatory actions.

DRAGON NATURALLY SPEAKING: I have decided it is time to get serious about the medical version of dragon NaturallySpeaking voice software on my computers. My consultations, office calls and e-mails are voice dictated right into my desktop or laptop computers and files are synced in an electronic briefcase on diskette from one to the other. This is my first VOICES column voice dictated. I’m projecting that my voice will last many years longer than my fingers running on a keyboard. I think I just figured out how to delay my retirement by 25 years. The benefits and efficiencies of the telecom age are phenomenal.