rlbates's blog

There is an interesting article in the current issue of Arkansas Times (photo credit) on tort reform. It is written by Doug Smith and titled “Fewer medical malpractice suits, but is that a good thing?” It discusses Act 649 which was passed in 2003 as Arkansas’ attempt at tort reform. I recall how insurance companied were fleeing Arkansas in the years prior to this Act being passed. I have noticed that my malpractice cost has stabilized.

David Wroten, executive vice president of the Arkansas Medical Society, said there'd been a major change in the medical malpractice market in Arkansas, although, he said “We don't know all the reasons why.” Only a couple of companies were writing medical malpractice insurance before Act 649, he said, and now there are nine. Rates have declined “in some cases,” depending on factors such as the insured physician's specialty, but not across the board. The biggest physician malpractice carrier in Arkansas, by far, is State Volunteer Mutual Insurance Corp., with about 70 percent of the market. “Their premium increases have dropped to nothing, or 3 percent,” Wroten said. “Their claims have been cut nearly in half.” He said the reduction in claims was due in large part to Act 649's requirement that an “affidavit of merit” be filed within 30 days of the filing of a malpractice lawsuit. The affidavit, saying there's reasonable cause for the lawsuit, had to be signed by a physician practicing in the same specialty as the defendant. It was supposed to be a defense against frivolous lawsuits. Lawyers said there were already many such defenses.

I've been struggling to get a patient's insurance company to give consent for a panniculectomy. I have not been successful. I have appealed the initial reject. It was rejected a second time. There reasoning:

Upon reviewing the submitted information, I have determined that at this time "Excision, excessive skin and subcutaneous tissue; abdomen, infraumbilical panniculectomy" is not a covered benefit under the benefit plan. This determination is based upon the following plan language, found on pages (s) 74 and 125 of the member's Certificate of Coverage or Summary Plan Description:

"Excluded ..... Cosmetic procedures, including cosmetic surgery expenses, supplies, appliances and drugs, except for reconstructive surgery to repair accidental injury

Cosmetic Procedures -- services are considered Cosmetic Procedures when they improve appearance without making an organ or body part work better. The fact that a person may suffer psychological consequences from the impairment does not classify surgery and other procedures done to relieve such consequences as a reconstructive procedure."

I thought I had made it clear, both times, that this proposed panniculectomy was to be done at the request of the patient's dermatologist as the patient's chronic skin rashes/infection in the lower abdominal skin roll could not be treated adequately with conservative methods. How is the treatment of the patient's skin infection/hygiene issues cosmetic?

This is one of the headlines on the front of the local newspaper.  The article can't be read there without a subscription, but can be read here in full as it was reprinted on the AARP website.

Statewide, at least 11 small community hospitals receive some community support, typically in the form of sales taxes or millages, said Paul Cunningham, senior vice president for the Arkansas Hospital Association. Most of them have had local taxes approved within the last five or six years.

Nationwide, community hospitals are struggling under the weight of low reimbursement rates, high levels of charity care, increasing demand from an aging population, and difficulties recruiting doctors and other medical personnel to rural areas, said Rick Wade, senior vice president with the American Hospital Association.

I think this will only become ever more common as reimbursements are lowered or not paid (never events).   For all those who feel that medical care is a right and not a privilege, how do you propose to prevent hospitals and clinics from closing due to lack of funding?  It doesn't really matter about coverage, if there is no access, does it?  Massachusetts is finding that out. 

I have noticed several posts / articles on women (or the lack) in surgery.

Women in Surgery; The Differential: Medscape Med Students; Lucia Li; August 1, 2008

In one of my regional placements, I met a surgeon who said that “women are killing surgery”; what he meant was that as the majority of medical graduates are now women, most of them will shun surgery for its stereotypes. This will reduce the number of good candidates going into surgery, lowering its standards. Surgery needs to attract women for continued excellence in practice. I am uncertain about the benefits, or even the need, for positive discrimination, but educational initiatives which promote surgery as a realistic career option for women are vital.

WSJ article: Women Remain Scarce in Neurosurgery; Jacob Goldstein; August 14, 2008

WSJ article: For Female Surgeons, Barriers Persist; Jacob Goldstein; August 16, 2008

Mothers Don't Let Your Daughters Grow Up to be Doctors; posted by Fizzy, Mothers in Medicine Blog; August 18, 2008 [not just don't let them be surgeons, but don't let them be doctors]

I'd like to comment on the recent Boston Globe article on surgeons' outbursts and also on Maggie Mahar's post, Surgeons and Other Physicians: A Cultural Divide.  Both seem to be painting surgeons as the ogres or bullies of the medical community.  I'd like to think that I am neither.  There are better examples of surgeons than the Alex Baldwin character in the movie Malice. 

I agree it is not good form or good for the patient for these outbursts to occur, but generalizing to the point that most of your readers would think that 90% or more of surgeons behave this way is wrong. I have never thrown any equipment and rarely gotten angry to point of raising my voice or screaming in the OR. Each time I did, the nurse told me I was right.

I have witnessed some of the examples given in the article. Yes, those surgeons should be counseled and most likely should even be required to go to anger management classes. BUT maybe the reason for their anger should also be sought.

Was the faulty equipment putting the patient at risk? It is very frustrating to try three pair of scissors before you get one that will cut tissue or to have the electrocautery machine not work so the circulating nurse (bless her) has to go find one that does. Perhaps the hospital is at fault for not updating and replacing defective instruments and equipment.