Sunday, August 15, 2010

Harvard Law Review Mate: Obama Narcissitic, Lazy, Being Groomed From Beginning

Obama's tuition payments, and admission with poor grades remain a mystery.He may have been sponsored by Saudi elements.

Unlike organized medicine, the AAPS is doing something to oppose Obamacare by filing a lawsuit in federal court. It has survived the summary judgment phase, and should be supported.

I do not believe the argument will work. The law forces people in repose to act to buy a product.

Well, the government does that a lot. It forces duties that are detrimental to the public, the time to fill out tax forms, jury duty, registration for the draft. These have been upheld by the Supreme Court. The attorney believes the vote will be 4 to 4 with Kennedy casting the deciding vote to overturn the law.

I support the aims of the organization and its actions, even if some members do not have mainstream views.

Thursday, August 5, 2010

AMA Study: Medical Malpractice Ubiquitous and Has Big Impact on Clinical Care

The solution is to allow the adverse third party to sue the lawyer for legal malpractice. It appears 90% of claims are weak, and the filing of a weal claim is legal malpractice. The lawyer will argue, the lawyer cannot have a duty to the adverse party. It would make his job impossible. This is not true. The lawyer has dozens of duties to the adverse third party, enumerated in the Rules of Civil Procedure, of Evidence, of Conduct, in hundreds of precedent setting case decisions.

From Medscape Medical News

Malpractice Threat to Physicians Pervasive, AMA Study Finds

Mark Crane

August 5, 2010 — More than 42% of physicians have been sued for medical malpractice at some point in their careers, and more than 20% were sued at least twice, according to a new American Medical Association (AMA) report.
An average of 95 claims were filed for every 100 physicians — almost 1 per physician — the AMA's Physician Practice Information survey of 5825 physicians, fielded in 2007 and 2008, found.
Despite the pervasive threat of litigation across 42 different specialties surveyed, two thirds of claims are dropped or dismissed, and physicians prevail 90% of the time in cases that go to trial, the study found. Still, the costs to physicians in terms of malpractice premiums and to the entire healthcare system resulting from the practice of defensive medicine are quite high. Average defense costs per claim range from a low of $22,000 among claims that are dropped or dismissed to a high of more than $100,000 for cases that go to trial.
"Even though the vast majority of claims are dropped or decided in favor of physicians, the understandable fear of meritless lawsuits can influence how and where physicians practice, when they retire, and how often they practice wasteful defensive medicine," AMA Immediate Past-President J. James Rohack, MD, told Medscape Medical News. "This litigious climate hurts patients' access to physician care at a time when the nation is working to reduce unnecessary healthcare costs.
"Unfortunately, there are no real surprises in this study for us," said Dr. Rohack, a cardiologist in Temple, Texas. "It reconfirms the need for a solution to our current tort system. If the nation is ever going to control the rise in healthcare costs, we have to eliminate wasteful defensive medicine spending."
Other highlights in the report include:
  • Nearly 61% of physicians aged 55 years and older have been sued.
  • There is wide variation in the effect of liability claims between specialties. The number of claims per 100 physicians was more than 5 times greater for general surgeons and obstetricians/gynecologists than it was for pediatricians and psychiatrists.
  • Before they reach the age of 40 years, more than 50% of obstetricians/gynecologists have already been sued.
  • Ninety percent of general surgeons aged 55 years and older have been sued.

Sunday, August 1, 2010

Never Events: Trojan Horses for Death Panels

These are errors in care that are so outrageous, they should never happen. Should they occur, the payment authority has no obligation to pay for the work done. In the case of psychiatry, these are unjust. Patients who want to kill themselves cannot really be stopped 100% of the time. As to patient elopment, if there are escapes from high security prisons, mental health units should not be held to any higher standard of security. Medicare and Medicaid began denying treatment for these preventable complications. The assumption is that they all stem from clinical error, which are 100% avoidable.

In a study of surgery, factors such as the severity of symptoms, complexity of comorbidity both affected outcomes, and were  beyond the control of the clinician. (Arch Surg, 145: 148-151, 2010). These very sick patients were more likely to develop post-operative pneumonias.

What will be the effects if these never events are permitted to be used as a pretext to not pay for expensive and complicated care?

1) denial of Care. Clinicians will refuse to perform procedures on patients with severe symptoms or complex comorbidities, because of the greater chance of a never event;

2) government entities and their agents, wealthy, powerful insurance companies will  be unjustly enriched at the expense of smaller health care providers;

3) further defunding of health care, and shrinkage of availability, especially to very ill, complicated patients;

4) ironic increases in never events, as these are covered up, and the factor cluster analyses needed will not be done to make system wide changes necessary to prevent them in the future;

5) the non-payment represents a Fifth Amedment taking without a fair hearing;

6) punishment of a person for the intentional acts of another, such as elopment or suicide, violates procedural due process rights;

7) the non-payment may violate the ADAAA rights of severely ill people.