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President's Page
October 2004
Get Involved:
The Reality of Politics in Medicine
2004 DCMS PresidentOnce again legal issues are threatening medicine, just when we were moving past our successes of last year. In case you didn’t hear, a federal district court jury awarded a Dallas physician $366 million for restraint of trade after a peer-reviewed investigative process regarding issues of quality and potential patient safety at Presbyterian Hospital. I do not know the facts in the case against Presbyterian Hospital and its chiefs of internal medicine, cardiology, and the cardiac cath lab, and thus, I will not presume to know the best verdict. However, I do know this—our legal “lottery style” civil justice system has gone mad. At a million dollars a year, the award represents 366 years of income. This hardly can be defined as “restraint of trade.”
Although this case is not medical malpractice, it represents a severe threat to our already challenged ability to police our own profession. We already have been accused by plaintiff lawyers, legislators, and some of the public on our inability to deal with issues of quality, competence, and behavior. Because of this the Texas State Board of Medical Examiners has been given a broad mandate to expand its responses to alleged poor behavior by physicians. Hospital systems such as Baylor and Texas Health Resources continue to spend millions of dollars to develop the “quality transformation” needed to put metrics on outcome data. The hospital systems need the metrics to help identify problems and change the behavior among their physicians and hospitals.
What physician wants to be the next victim of the legal process when we try to advocate for patient care? We should not have to cower in financial or emotional fear when we need to modify a physician’s behavior. Like many of you, I serve on my hospital staff’s credentials committee. I also chair a physician’s relations committee that deals with the problem physician. We already assume legal recourse with almost every restriction of privileges or decisions that are reportable to the National Practitioner Data Bank. We struggle to follow the complex legal pitfalls of the entire due process in our staff bylaws. For fear of repercussions, we now may face wanting not to make any decision against a colleague, and that is, indeed, a travesty for patient safety.
This outrageous decision highlights several other developments related to legal issues that dictate the need for renewed activism. Your own DCMS has a hearing in December to try to recoup $500,000 spent defending a civil suit that has lasted 10 years, brought by a physician fighting his censure and expulsion from DCMS for unethical behavior. This type of discipline should be medicine at its best. Instead, we have to consider the risk to your society before taking on any patient complaints because the time and cost may be tremendous. Baylor Health Care System, among others, is being sued in the civil courts by a tobacco plaintiff’s lawyer whose allegations relate to charges on noninsured patient care, when Baylor last year spent more than $180 million on charity care and collects only 5 cents out of every dollar charged for uninsured care. Does a system like Baylor just say no to the noninsured and close the ER?
In the 2003 legislative session, we did pass House Bill 4 and Proposition 12, and organized medicine was the key. We now have retiring legislator Steve Wolens, Mayor Laura Miller’s husband, about to be full-time lobbyist in Austin, paid by plaintiffs’ lawyers. As he has stated, his goal is to undo Proposition 12.
On a national level the crisis escalates. A plaintiff’s attorney, John Edwards, is running for vice president. He has made millions of dollars winning medical malpractice cases. In his book, he prides himself on his ability to make money by using his oratorical skills to manipulate the jury. The US House of Representatives has passed malpractice reform three times, only to have the US Senate defeat the measure by fewer than 10 votes each time. Key senators are beholden to large amounts of money and support from trial lawyers.
What does all of this mean? It’s simple. Gains made in last year’s efforts are at risk. Not only do we risk losing momentum on malpractice reform, we are at increasing risk for losing our ability to improve the delivery of medicine to the poor souls whom Senator Edwards apparently feels so strongly about. His preference for “improving” patient care should remain in the courtroom as opposed to thwarting organized medicine’s attempted intervention from the White House.
Again our ability to work together is being tested. Only through political action can we continue to fight the increasing threats from medical malpractice. It is clear that the broader problem of our civil justice system and its egregious awards to lawyers need to be addressed.
Our call to action is for you to become active in our political process as individuals through communication to legislatures and patients, and through your vote. Our call to action is about being a part of organized medicine. Your Dallas County Medical Society, the Texas Medical Association, and the American Medical Association, and their associated political action committees, need your support. They are effective and with increased support, can be a powerful force to affect change. This is critical.Remember: Our ability to practice medicine and to improve patient care is at risk. Election campaigns are in full swing and our future is at stake.
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