17 Comments

“Putnam General partially suspended King’s privileges after Dr. Edward G. Dawson, the late UCLA physician, completed an independent peer-review report that called King ‘a snake-oil salesman’ and a ‘criminal.'”

They partially suspended his privileges after determining he was a “criminal” “snake-oil salesman?”

Yes, and he sued them over that partial suspension, too. Given the extreme litigation risk of yanking a doctor’s privileges, and the readiness with which one (or ten) reviewers’ negative opinions can later be assailed as tainted or subjective, many lawyers would have advised them to consider leaving intact any subcategory of privileges for which they could not muster an overwhelming case in court, with every i dotted and t crossed.

Max, it is very, very hard for a small hospital to snip/yank a bad doctor’s privileges. To avoid litigation, they usually need (1) outside review with (as Walter says) every i dotted and every t crossed, and (2) help from much bigger guns (i.e. State Medical Boards). It can take years (because most Medical Boards are well-versed in CYA – it’s called “The White Wall”). In the meantime, people can and do die: http://drjshousecalls.blogspot.com/2008/08/well-now-i-guess-i-dont-have-to-sue.html

King is a troll, and it infuriates me that he is trying to ride the “Bad-Faith Peer Review” train. Commentary is here: http://drjshousecalls.blogspot.com/2009/02/one-good-reason.html

And HCQIA is simply bad legislation that needs a major overhaul.

In Florida, the plaintiffs’ bar convinced the voters to amend the state constitution so that peer review and privileging documentation is no longer privileged and must be disclosed to prospective and actual patients. An appellate court recently held that such documentation had to be produced at the request of a patient asked to make such a request by a physician involved in a credentialing dispute. The obvious effect of the amendment will be to discourage insititutions from pulling privileges, etc., so that docs like King can keep practicing.

Gee, it almost makes me think that the Florida plaintiff’s bar is more interested in insuring that there are lots of claims to pursue than improving the quality of care.

Smoke, I am doctor who was badly burned FOR REPORTING badness to peer review (I was fired after I intervened in a case being botched by another “more favored” doctor and faced down threats to report him to peer review the next morning). I was then left to fend for myself in the mire & muck of confidentiality & privilege (the governments I served dived under their desks). So let me say again that HCQIA is a law in desparate need of revision & reform.

What HCQIA did (passed as a knee-jerk response to another case in which a hospital peer review committee was accused of not playing fair) was to essentially give blanket immunity to hospital peer review committees – there were NO checks & balances . . . NO due process for doctors accused . . . and “good” & “bad” faith were in no way defined. Anonymous complaints were given credence. The Constitutional rights of doctors (privileges, once granted are a protected property right) were not given a second thought – on the premise that this was all for the public good – and hospitals ALWAYS act in the patient’s best interest.

Excuse me while I pause to do the cough that sounds like “BULLSHIT!”.

Good doctors can get caught up in this maze when they are targeted for retaliation (i.e. “bad faith peer review”) because they’re blown the whistle. And again, it is a MYTH that they enjoy any real protection under Federal law: http://drjshousecalls.blogspot.com/2008/05/woe-be-unto-whistle-blowers-this-one-is.html

Playing Devil’s Advocate, the Florida law was enacted to insert some accountablity and transparency into the process – for doctors and patients. You see, I know the frustration of reporting a doctor to peer review – or the Board (signing my name) – and later being told I have NO STANDING to receive updates or otherwise participate in the process – even as I am suffering retalitation for making the report. And I’ve got to tell you that a lot of badness can be hidden behind (and covered-up by) “confidentiality” and “privilege”. Apparently someone in Florida recognized that the peer review process amounted to a glorified witch hunt.

There are very simple ways to fix the law (guarantees of due process – particularly the elimination of anonymous complaints, outside review, defining good faith, penalizing bad faith, holding admnistrators to the same standards of conduct/ethics as doctors) . . . things that are (yes) more expensive on the front end, but that would pay off bigtime in the end . . . alas, no one is talking about them.

While we’re at it, we could use some tort reform. I’ll pause for the lawyers’ heads to spin.

Instead we are reduced to the “outraged soundbite” – with few people really understanding all the ins and outs of the problem.

It’s just an observation from the cheap seats, but the blogger-lawyers would rather whine and moan about cases like this – than use a case like mine to demonstrate what is wrong with the law and fix it.

Dr. Mary – Amendment 7 had nothing to do with protecting doctors’ due process rights and everything to do with allowing plaintiff’s lawyers and opportunity to go on fishing expeditions through records that were created under statutes that made the records confidential. The use of the amendment in a credentialing dispute is an unintended consequence. If there is a problem with immunity for peer review activities, the way to fix it is to ablosh that immunity, which Amendment 7 did not do.

Every physician I have talked to about Amendment 7 has told me the same thing: “This will make it make it much more unlikely that doctors are counselled or disciplined for their mistakes, because no one will want to create a record that can be used in subsequent litigation.” That may be good for a bad doctor, but it can’t be good for patients.

Snoke, again, you (and all of the other Florida doctors who are complaining about “Amendment 7”) don’t seem to understand that if the problems with HCQIA (the statutes that made said patient/peer review records confidential) had been fixed long ago, “Amendment 7” might never have found any momentum/support anywhere – much less have been passed. As I understand it, people were digusted with the smoke and mirrors act. Now doctors have more “unintended consequences” to cope with. Go fish.

And OBTW, in terms of doctor discipline, you should not “create a record” if you cannot back it up with facts – or sign your name. That’s where some good/real whistle-blower protection could come into play – if we had any.

Those same doctors who are so put out with the new Florida law have sat around on their duffs and allowed the “unintended consequences” (consequences that have harmed many) of HCQIA to fester and grow. It’s a huge problem in smaller hospitals – where cliques rule and doctors can be targeted for less-than-noble (i.e. economic) reasons. Of course, doctors are notorious for sitting back and doing a whole lot of nothing while good colleagues fry (or bad ones rape & plunder), as long as their own nest is comfortably feathered.

Doctors, as a profession, need to grow spines – individually and collectively – and get involved in the planning and conception of the laws that are (right now – even as we speak – have you taken a close look at the stimulus bill?) killing us.

Of course, the lawyers are making most of the rules.

Smoke, I love how you take a post about a litigious doctor and turn it into a commentary on medical malpractice lawyers. All roads lead to Rome, I guess.

Gee, Ron, sorry that you can’t see the relationship between a Florida constitutional amendment that makes it harder to deal with doctors that have quality of care issues and a post about the incredible difficulties faced by institutions that tried to deal with someone alleged to be such a doctor.

Some folks need a roadmap to Rome, I guess.

Smoke, I’m just wondering. Do you think Putnam Hospital knew it had a big problem before most of those 124 malpractices cases happened? From one of the posts I linked (if you bothered to read it):

“Here’s the other problem I have with Putnam County’s “pity our poor hospital” story. If a small-town hospital has a physician-behaving badly, somebody . . . usually nearly everybody knows it. The staff is small & close-knit (there are always “cliques”), and the medical disasters that are played out splash bits and pieces of refuse & gore on everyone involved. The doctors and nurses who clean up the messes get tired of being caught in the crossfire and/or having their names on bad charts. In all reality, within the hospital, privacy and secrecy are a myth (and in my opinion do not always serve the public good) . . . for all that the secrets (by law) must be kept. In other words, if Dr. King was indeed a problem, someone . . . probably many people . . . at Putnam knew it . . . and they knew it for several months.

Patients were caught in that crossfire – falling victim to both (1) malpractice and (2) the economic destruction of their local hospital now drowning in a sea of litigation.

I am convinced, more than ever, that malpractice reform must walk hand-in-hand with medical peer review reform. You’re not going to have one without the other. Physicians simply must do a better job of policing their own. The average Joe on the street (who thinks all doctors are rich) is just not going to buy into damages caps (and the like) unless we clean up the act.”

I suppose folks do need a roadmap to Rome.

Dr. Mary – So your defense of a counterproductive idea is “Doctors brought it on themselves?” How can you advocate whistleblower protection to encourage medical professionals to report subpar care while simultaneously defending a measure that makes such reporting suicidal?

Dr. Mary – My point is that, if the problem at Putnam County Hospital was a failure to report Dr. King (even when the reports might have been protected from disclosure by confidentiality rules), a system in which no confidentiality is provided is only going to make things worse The ultimate effect of measures like Florida’s Amendment 7 is going to be doctors doing less “policing of their own.” This will likely result in more adverse outcomes and therefore more suits to file, which seems to be fine with the plaintiff’s bar.

Yes, Smoke, the truth hurts. A counterproductive measure (your premise – I’m not sure if it’s mine), is in force in Florida because doctors brought it upon themselves – with their apathy and their silence – and their collegiality (we’ll get to that).

How can I advocate whistle-blower protection? Are you seriously asking that question? If we had effective FEDERAL whistle-blower protection, doctors and nurses could come forth in these cases and sign their names and have NO FEAR. As it is, people like me are still being force-fed our whistles – and (let me tell you – as you clamor about doctor’s ethical responsibilites to patients) NOBODY BUT NOBODY GIVES A DAMN. You cannot have it both ways.

Besides, at this point, any medical whistle-blower protection would have to be legislated as well – and in Florida that would be in the context of Amendment 7 ( a law you say needs tweaking/eliminating anyway).

Respectfully, if you/doctors in Florida hate Amendment & so much, then I would suggest you get off your asses and start doing something – start talking – about the collateral damage cause by HCQIA. Because it’s not all about the plaintiff’s bar. Your current mess has its origins in the fact that HCQIA was not working to protect patients – or to give them the information they needed when they were hurt by bad doctors. And the “good doctors” on the medical & hospital boards were telling patients they could not help them with their problems.

Just ask Thomas Mansfield over at the NC Medical Board.

Speaking as a patient, I had a GOOD case for malpractice against another doctor (he drilled a hole in my face/skull in the wrong place – something that required surgical repair several years later), and I let it drop because I knew the hurdles were too high. Having been pulverized once already by a corrupt legal system, I did not want to subject myself to it again. But hell hath no fury like an angry/injured patient banging their head against the “White Wall” – and not everyone has the scars in their back to keep them from finding a good ambulance-chaser.

Let me tell you something else – in terms of fostering any kind of legislative change, blogging under an assumed name is not going to cut it.

The problem at Putnam County was the same problem that exists in hospitals all over this nation – doctors shield & protect their own – even when they are bad/Bad/BAD – and it’s not all because of fear (because I’ve seen hospitals deal pseudo-effectively with bad doctors) – it’s because we’re all taught to be “collegial” during our training. We’re taught to “go along to get along”. Then we find out – in a place like Putnam County – or (in my case) Randolph County – that we cannot do that and call ourselves doctors.

Then we are fed to the damned wolves.

If you want to continue, I would appreciate it if you would call me Dr. Johnson. “Dr. Mary” is not the way you would address me in person in any professional setting – and it feels like a put-down of sorts (i.e. talking down to the stupid little girl). Of course, I know you’re not trying to do that;)

Dr. Johnson – You have too many personal issues to make my discussing this topic further worthwhile.

Yes. Dr. Johnson has experience in this issues in which she’s talking about. That disqualifies her from speaking on the subject. Now, back to Smoke.

And mirrors, Ron.

Smoke, you use the despicable tactic of some of the other nameless cowards I’ve encountered in the blogosphere. You cannot really argue with what I’m saying – based on ten years of cold, hard, LONELY experience dealing with a fundamentally corrupt system of medicolegal oversight. You’ve got to resort to the ad hominem.

Oh, and you’re DAMNED straight I have “personal issues”. I am not alone. And that is kind of the point.

Dr. Johnson

I will respond one last time to you. You (and your cheerleader Ron) may not choose to recognize it, but others have experience in and knowledge of the issues involved in medicolegal oversight. I have spent years representing individual physicians and medical institutions in medical malpractive cases and before the Florida Board of Medicine, as well as advising them on peer review, confidentiality, and professional discipine and termination issues. As such, I believe I have an understanding of the competing interests in this area.

Regarding measures like Amendment 7, you are content to say, “Well, I had a bad experience, and the doctors have just gotten what they deserve.” This dismissive approach gives no consideration to the best interests of the patients, which was the point of my comments.

You are obviously very angry about your experiences. That anger seems to be a primary determinant of your position on these issues and nothing I or anyone else can say is likely to change your mind.

Best wishes for your future success.