Medical Peer Review -- The Semmelweis Society

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Corporate Perspectives: Enron Medicine

Dr. Katz on corporate control of medicine.

Corporate Cherry Picking.

Rich and poor and uninsured.

Corporate socialism. Social corporatism.

There is always profit.  The use to which it is put determines the quality of the care:  If the profit is not re-cycled to those who treat patients, then care suffers--morale is too low to retain doctors, there is not enough equipment, etc.

Profit As Python:  Relentless

Eventually even a 'small profit' squeezes money availble for care--just like inflation.  That calculation is one reason why it is immoral to run medicine as a corporation paying dividends and profits to unconcerned shareholders.  Patients are not customers making free choices when they are in pain or afraid.  We should not disregard their feelings by calling them 'customers in a product line.'

If competition for 'market share' (private medicine), ambition for promotion (government medicine), rank (military medicine), or a sinecure with the same Tri-Care industry with which a military hospital commander is writing contracts (conflict of interest under Tri-Care) drives doctors away, patients' choice and care suffer. Meanwhile, patients-as-taxpayers pay for sub-standard care, as wards are understaffed in some HMO-controlled military hospitals (Tri-Care contracts are with for-profit HMO's) and as private doctors refuse to accept the below-market payments offered under penny-pinching Tri-Care contracts. These contracts are a false economy for taxpayers and a boondoggle for HMO's, because the taxpayer is paying (thorugh lawsuits paid by the U.S. Treasury instead of by private malpractice insurance premiums paid by the HMO) for the HMO to continue to make its profit through understaffing its hospitals. (Nonetheless, administrators now claim they are essential because they, too, are 'clinical'.  Everyone wants to be a doctor without going to medical school. Everything is being done in the name of 'quality'.) We must end this Enron Medicine: It is a shell game.

Such considerations are the subject of this site. Although it is written by doctors, it is for both doctors and patients, because at the end of the day, we are all patients.

While we may sound cynical about attorneys, we depend on them to enforce the rule of law which makes our society worth defending.

What is 'fair' peer review?  If you are a patient or a doctor, fair means unbiased review by disinterested peers.  If you are a payor working for an insurance company, hospital, government, or HMO, then fair means something like 'below-budget', 'less expensive than last year', 'more profitable to stockholders', 'less expensive for taxpayers', etc. 
     The insurance companies were once 'non-profits'.  Now, the Blue Cross companies frequently advertise and their stock prices are quoted on the radio.  Isn't holding such stock the moral equivalent of taking blood money?  As for the HMO's, they go one step further, with their gag clauses and de-listing and coercing of physicians. Meanwhile, the government 'sleeps with whomever' it can, and chooses to 'cohabit' with conflict of interest whenever possible, as when it contracts (Tri-Care) with for-profit HMO's, ignores its own rules for competitive bidding, and coerces its physicians (1) with poorly-staffed facilities so the HMO can keep up its profits.  These contracts are sometimes negotiated covertly by commanders already retired on Active Duty, doctors who no longer treat patients, who are not trained in finance, but who know a good deal when they see one--because they leave government service only to work with the same types of companies with which they recently wrote or enforced contracts prejudicial to patients and physicians.  It's an old story called conflict-of-interest and corruption--these doctors usually collect a specialty bonus fraudulently, as they dare not take night call or to see a clinic full of patients to justify receiving their specialty pay.  President Eisenhower called it the 'military-industrial complex'.

HMOs Stalk Patients' Rights;
The industry must not be allowed to wiggle its way out of
accountability to the ailing.
by Jamie Court - The Los Angeles Times, June 10, 2002
-----------------
Jamie Court is executive director of the Santa Monica-based
Foundation for Taxpayer and Consumer Rights (FTCR).
E-mail: jamie@consumerwatchdog.org.
-----------------
California HMOs are slyly attacking the new patients' rights laws
touted by Gov. Gray Davis as the toughest in the nation. The
industry can't be allowed to undermine the two pillars of HMO
patients' rights it has targeted effective state regulation and legal
accountability.

In the latest assault, Kaiser Permanente convinced an
administrative law judge to rule that the state's HMO regulator
could not intervene in most patients' quality of care problems.

The dangerous reasoning grew out of Kaiser's aggressive legal
opposition to a $1.1-million fine levied against it after three
patients with ruptured abdominal aortal aneurysms died after
their access to treatment was blocked by Kaiser's unresponsive
telephone call system or its over-capacity emergency rooms.

Newly uncovered internal documents have proven the systemic
nature of Kaiser's problems, although these were not introduced
as evidence in the case. In a program Kaiser claims to have
ended, the company's telephone clerks who handled patient
calls were paid financial bonuses to limit doctor appointments,
to not transfer calls to nurses and to hang up quickly. For its part,
Kaiser has contended that its patients' quality of care is its
doctors' problem, not the HMO's.

The state medical board, which regulates doctors, says it has no
authority to address systemic quality of care and access to care
problems at HMOs or in doctor-run medical groups; the board
leaves those problems to the HMO regulator, the Department of
Managed Health Care.

Kaiser now is seeking to turn this crack in the law--the lack of
regulation of doctor-run medical groups--into a gaping loophole.

For the largest HMO in the nation to hide behind its doctors, who
work only for Kaiser, is like an auto manufacturer claiming it is
not responsible for the design of its exploding gas tanks
because its workers built them.

Fortunately, the Department of Managed Health Care rejected
the administrative law judge's decision, saying, "California's
reforms are a beacon to the nation and we will not turn back the
clock." Department Director Daniel Zingale also urged Kaiser to
reconsider its "legal strategy of arguing that limitations on patient
protection laws render this case unenforceable."

Now, Kaiser can decide whether to pursue its case in state
Superior Court, where a similar ruling could undermine the
authority of the agency created in 2000 specifically to enforce the
California HMO reform package.

Kaiser and other HMOs supported much of this reform
legislation to quell a public backlash at the time; now they must
begin to live within those laws rather than continually try to
obstruct them.

Ironically, Kaiser's litigiousness over the company's rights
contrasts starkly with HMOs' evisceration of the legal right
extended to their patients in 1999. The mandatory binding
arbitration agreements HMOs have forced their patients into as a
condition of enrolling have become a means of disemboweling
the HMOs' legal accountability to the individual.

Until the state's "right to sue" law, most patients could not
recover damages when HMOs harmed them. Effective in 2001,
the liability law gave all patients that right when their HMO
interfered with the quality of their care but did not specify in what
forum. Currently, there is no public record of any patient using
the law. Forced arbitration has prevented cases from coming
before judges, which keeps case law beneficial to patients from
developing.

Without such precedents to determine the scope of HMOs'
liability, the industry is evading accountability on yet another front.

Legislators must focus their attention on the efforts by HMOs to
weaken the state's patients' bill of rights--even the sneak attacks.
----------------
The above op-ed was printed in The Los Angeles Times on
June 10, 2002.
--------------------------------------------------------------
The Foundation for Taxpayer & Consumer Rights (FTCR)
http://www.consumerwatchdog.org/