Healthcare Reform - Medical Justice

Defensive Medicine and Disposable Helmets

August 15, 2024April 6, 2011 by Jeffrey Segal, MD, JD

Jeff Segal, MD, JD, FACS

A lot has been said and written about defensive medicine. Some pundits have stated, “If I’m a patient, I want you to practice defensive medicine.”

This is where the misunderstanding begins. There is universal agreement that doctors should do what is reasonable to keep patients safe. Period. Doctors agree. As do patients and attorneys.

But, defensive medicine is different. Defensive medicine has a different purpose. It includes tests, referrals, and procedures focused primarily on keeping doctors out of the courtroom.

Some will argue “Wait a minute. Shouldn’t a doctor do everything possible to prevent a problem?” Here’s where an analogy helps.

Real Reform or Just Whack-a-Mole

August 15, 2024March 9, 2011 by Jeffrey Segal, MD, JD

Last week, the NC State Senate approved changes in the state’s medical malpractice laws; including provisions to give emergency room doctors more protection against lawsuits (changing their malpractice standard from ordinary negligence to gross negligence) and a cap non-economic damages for patients at $500,000 (economic damages and medical payments would not be capped). The proposal now moves to the State House for consideration.

Supply and Demand, Healthcare Style

August 15, 2024February 23, 2011 by Jeffrey Segal, MD, JD

As we consider ways to improve health care and its costs in this country, perhaps we should be thinking of physicians as the valuable economic resource to society that they are. We clearly have an impending shortage of physicians to address the demographic tsunami – Baby Boomers entering Medicare age. And the lead time to train adequate capable physicians to address this trend is measured in years, not months. The fewer physicians available to take care of the public, the more expensive care will be. We should be doing all we can to make the practice of medicine inviting, so there are enough talented individuals to deliver care…. Makes sense, doesn’t it?

Informed Spousal Consent: A Great Idea Worth Spreading

August 15, 2024February 18, 2011 by Jeffrey Segal, MD, JD

Jeff Segal, MD, JD, FACS I was thumbing through General Surgery News recently and read an article espousing a great idea; an idea worth spreading. Philip Schaurer, MD, and Jim Saxton, Esq. wrote about adding a spouse’s name to the informed consent document. Informed consent, of course, is a process, and not a document. But, … Read more

Your Mother Was Right

August 15, 2024February 18, 2011 by Jeffrey Segal, MD, JD

Michael J. Sacopulos, Esq. Doctors are busy, enough said. The problem is too many doctors are not getting enough sleep. According to a recent New England Journal of Medicine (NEJM) article “sleep deprivation adversely affects clinical performance and impairs psychomotor performance as severely as alcohol intoxication”. There are currently work/sleep regulations in place for first … Read more

Senate Fails to Pass First HCR Fix

August 15, 2024December 1, 2010 by Jeffrey Segal, MD, JD

On Monday, September 29, 2010, the U.S. Senate made two attempts to repeal a relatively minor but unpopular aspect of the Healthcare Reform laws. Though both Democrats and Republicans agreed that the aspect was an unwarranted burden on businesses, they could not agree on either of two bills devised to reform the reformation. The offending aspect, which requires that those who pay out more than $600 per year to any one entity must file a 1099 form, was intended to provide an increase in revenues by increasing compliance with an existing tax law which already requires the filing of a 1099 form under the same circumstances.

Surgeon Sentenced to Jail Time (HIPAA = Need To Know)

August 15, 2024November 2, 2010 by Jeffrey Segal, MD, JD

In classified environments, information is only available on a need-to-know basis. If you have no official business pertaining to a file, then you don’t need to know. Healthcare professionals should consider HIPAA to be a similar environment.

Last year, Congress passed HITECH, which tightened restrictions on healthcare privacy and increased penalties for transgressions. Unauthorized access to patient records can lead to jail-time. A surgeon working as a researcher at UCLA was sentenced to jail under the HIPAA. What happened? Here’s the rest of the story:

Huping Zhou, a cardiothoracic surgeon, was working at the UCLA School of Medicine as a researcher. His employment was terminated, but UCLA’s IT department didn’t block his access to electronic medical records at the same moment; it took the university some time to process retraction of the doctor’s authorization to the database. In that interrum, Dr. Zhou accessed and read his immediate supervisor’s medical records, as well as those of former co-workers. Then, over the next few weeks, his curiosity led him to remotely access of other medical records he was unauthorized to see, including those of celebrity patients.

Magazine Proves MD Ratings Are Questionable

August 15, 2024November 2, 2010 by Jeffrey Segal, MD, JD

We have long questioned the validity of physician rating systems. Not just one, or some, but all MD rating systems. Even if you put two doctors in an identical circumstance, notions that the comparison between them is significant is questionable. 5280 Magazine, a publication for the Mile High city, may seem to be the exception. In reality, they prove the point for us.

Seeing the cover, though it seems quite charming. Smiling physician, complete with lab coat. A critical mind might expect a negative, though. After all, naming the top 2oo+ doctors within a city of 8000 practitioners is certain to be exclusionary. When one delves in and reads the story, though, it seems the rare exception. They’re not taking patient critiques. Quite the opposite, they’ve asked physicians to rate each other, and even gone so far as to do so in a positive fashion. They ask area physicians which doctor THEY would most trust, within a given specialty. Certainly that’s a fair appraisal, right? After all, it’s physicians performing the ratings, looking for the best. What could possibly be more fair than that?

Their methodology may seem entirely free of malevolence, without bias. Thinking it through, though, reveals the flaws. It’s still a popularity contest, even though qualified physicians are performing the “appraisals”. When you ask someone who THEY trust the most, that’s still a subjective opinion, perhaps based on many irrelevant factors. Most certainly, though, the result will come from within those physicians the individual comes into contact with, and therein lies the fatal flaw. A physician who is a social butterfly is going to be known by more people. If his reputation is that of an expert of great renown, if he speaks or educates often within the field, that will make it seem all the more certain that he’s the one to trust most, the best. The contest continues to ignore the fact that there may be several better practitioners within the field who are simply less celebrated. Perhaps they’re simply too busy treating patients with their excellence to be giving lectures or blowing their own horn. Regardless of the reason, they’re less known than the social butterfly, and yet the well-known figure is the one likely to gain the most votes.

Tort Reform Is Dead. Now What?

August 15, 2024October 26, 2010 by Jeffrey Segal, MD, JD

More than a few state Supreme Courts have overturned tort reform laws in the past year. The concept is that everyone is entitled to a trial by jury, and that the courts, not legislature, should decide how much is enough. Oddly enough, the legislative branches are often opposed to tort reform as well. Whether we agree or not is irrelevant. Enough Supreme Courts have spoken that we concur that tort reform certainly in jeopardy.

What’s the next step? Do we just “stay the course,” continue the trend towards increasingly extensive defensive medicine? That is a waste of the physician’s resources as well as the patient’s time and money. The insurance companies can’t care very much for it either, since raising rates to compensate for such costs is easier said than done these days.

Other Concealed Faults of the New HCR; The Case For Universal Healthcare

August 15, 2024October 21, 2010 by Jeffrey Segal, MD, JD

When the new health care reform legislation was presented to the American people, one of the pushing points was that one could keep dependent children on one’s policy until they turn 26. But guess what? Not really. If your son or daughter’s employer offers health care of any kind, s/he MUST take it from the employer. It doesn’t matter if that coverage is horribly inadequate. It doesn’t matter if it costs an arm and a leg and still doesn’t actually cover anything. Yep, s/he still has to take it from the employer, and you cannot cover your child on your policy any more. That’s right, it is forbidden. So your young adult dependent MUST take the inferior coverage at the higher price. Think it’s not happening? All over the nation, companies are being sold similarly overrated policies as employers scramble to lower costs. Some do it because of economic conditions, some because they’re about to shoulder costs they didn’t have before the law, and some because reducing costs is what corporations do. Regardless, if an employer offers it, you’re stuck with it, no matter how inadequate it may be.

+ More