60 Minutes recently featured a story on Senator Tom Coburn. He’s an ob-gyn family physician from Oklahoma who also delivered babies. He vowed to serve only two terms. He intended to be a citizen-legislator and return to full-time medical practice upon retirement from the Senate.
Senator (Dr.) Coburn was recently diagnosed with prostate cancer. Because of that, he’s retiring from the Senate two years earlier than intended.
For years, Dr. Coburn delivered babies when he returned to Oklahoma for the weekend. Senator Coburn ruffled a few feathers in D.C. by calling out “pork” in bills when he saw it. For example, he was the town crier – drawing attention to the Alaskan Bridge to Nowhere. This irritated some of his senator colleagues. The payback was an ethics investigation to see whether his weekend practice of delivering babies constituted a “conflict of interest.”
Coburn was mainly interested in keeping his skills up-to-date. He was delivering babies for free. He paid his professional liability premiums out of his own pocket.
In May, 2008, Senate Ethics Panel sent a strongly worded ‘final determination” memo threatening Coburn with Senate censure if he did not stop delivering babies for free. Dr. Coburn was working at Muskogee Regional Medical Center, and in 2007, that institution changed from a public to a private institution.
Coburn still did not understand what the conflict of interest was. Coburn’s spokesman, John Hart, wrote:
“Just as parents don’t choose him hoping to sway his vote, parents don’t choose to receive his services at a particular hospital because Dr. Coburn has somehow endorsed that hospital because he is a senator…”The committee has shown us zero empirical evidence to back up this flimsy claim.”
Has Sen. Leahy provided an improper endorsement to Warner Brothers for appearing in Batman?” Hart asked. “Will millions of Americans now see Batman not because it features stars like Christian Bale or the late Heath Ledger, but because Patrick Leahy, a distinguished U.S. senator, has offered his illustrious endorsement to this motion picture?
“If Sen. Coburn can only deliver babies for free at a public hospital, shouldn’t Sen. Leahy only be allowed to donate his notable thespian skills to a public entity like PBS?”
…Hart estimates that Coburn has delivered dozens of babies since last receiving an ultimatum from the Ethics panel in 2005. Coburn has received no compensation for his work and paid “tens of thousands of dollars” out of his own pocket for medical malpractice insurance and other costs related to his medical practice, Hart said.”
At a medical meeting in 2010, Senator Coburn said he had stopped delivering babies because his medical malpractice premiums were too high – particularly in view of the fact he received zero income for the deliveries. It’s unclear whether the Senate Ethics Committee forced the issue further.
Even when a doctor wants to provide free or reduced fee care for patients, challenges loom. The Anti-kickback statute (AKS) prevents providing any inducements for referrals. Providing free care to Medicare or Medicaid patient might be interpreted as a “loss leader” for more expensive services, even if you are not the direct beneficiary.
From Dept. of Health and Human Services:
[W]here the Medicare and Medicaid programs require patients to pay copays for services, you are generally required to collect that money from your patients. Routinely waiving these copays could implicate the AKS and you may not advertise that you will forgive copayments. However, you are free to waive a copayment if you make an individual determination that the patient cannot afford to pay or if your reasonable collection efforts fail. It is also legal to provide free or discounted services to uninsured people.
It does not appear that Dr. Coburn will practice medicine again. That’s a pity.
Dr. Tom Coburn is not an Ob/Gyn. His residency at the University of Oklahoma was in Family Practice which typically has 4 months total of Obstetrics. Many FPs use OB to build their pediatric practice. They are not fully trained in all aspects of Ob/Gyn and it is an affront to every Ob/Gyn to call Dr. Coburn one.
I stand corrected. Dr. Coburn is a family physician trained doctor who delivers babies. Over 30 years he delivered 4,000 babies in an under-served area – Muskogee – which has a current population of 39,000. He also did one year internship in general surgery. regardless of how he was originally trained, given how many babies he has delivered, he was probably reasonably competent.
If he delivered 4000 babies he is probably more competent than an Ob/Gyn three years out of his residency. I knew a general surgeon who did the urology in a community who had no urologist. I think he was as competent and knowledgeable as the average urologist (back then), but he should not be referred to as an obstetrician.
Really Mr RICHARDSON? Is that the best you can come up with in criticizing a physician who has VOLUNTEERED (do you know what that means?) his expertise in delivering babies in an UNDER SERVED area? Either you are ignorant of the training of family practice doctors who go into small towns and practices all aspects of medicine or you know nothing of the economics of medicine which prevent specialists from going and surviving in small towns let alone under served areas of America! It is an affront to every GP and family practice doctor in this country who deliver and assume the risks of the majority of the deliveries in rural American. I for one got the gist of the Senate investigation and subsequent loss to the patients of Muskogee. Don’t rock the boat and expose what the American People are sick of…A congress that wastes money on frivolous investigations and burdens us with more and more bureaucracy !! Douglas D. Dedo, M.D.
I like to ask ‘Dave ‘ how many babies he has delivered and what is his competency level is ?? And how long he has been practing any form of medicine and whether or not he has done any public service for free ???
I bet Dr,. Coburn is better qualified than many OB trained physician in many aspects.
A podiatrist really has no business commenting about the skills of a general practice physician and his/her ability to perform normal deliveries. Except for one salient fact: Congress and Government has made enormous advancements against medical practitioners precisely because we snipe at ourselves, rather than getting together to fight these kinds of affronts and attacks Government perpetrates against us.
Pete Stark is mercifully no longer in Congress. But he singlehandedly destroyed American medical practice inside of 10 brief years. Instead of fighting him, we shrunk into-ourselves and started sniping at each other to try to grasp whatever he didn’t already destroy.
We could have formed an all-practitioner medical-lobby to fight him. Instead, he successfully made us feel ashamed that we earned a living by making people better.
I understand the desire to maintain qualifications and skills. Even podiatry has registered nurses who now want to perform foot and ankle healthcare that we ultimately and historically have covered.
None of this would be a problem if Government had not successfully reduced our reimbursements to a non-increasing paradigm that never goes up, even in the face of inflation and high costs of medical education. For physicians, Congress also “felonized” routine business relationships that other businesses take for granted, including law firms.
The “war” against Dr. Coburn is an expected Congressional reaction to their shared hatred of physicians. It is utterly un-surprising.
Whenever I read these snipes, it makes me sad. We need to get beyond this. Somehow.
Michael M. Rosenblatt, DPM
I was drawn to this issue as our Tennesssee Medical Associaton provided us with a Geust Speaker on, “The Dark Side of Peer Review,” Specifically L.R. Huntoon, M.D., Ph.D., F.A.A.N. Association of American Physicians and Surgeons www aapsonline.org
Further I am myself a survivor of papillary/follicular carcinoma of my thyroid gland.
I too am saddened!
Please refer to
“The Dark Side of Peer Review”
L.R. Huntoon, M.., Ph.D., F.A.A.N.
Association of American Physicians and Surgeons
http://www.aapsonline.org
Midwives and NPs will supervise and perform deliveries, not doctors, as time moves forward and more CMS and OCareRegs are implemented. 1 in 6 New Jerseans were on Medicaid in 2012, and that number has risen to 1 in 4 in 2014 – a direct effect of OCare and MCD expansion under Christie. Who will deliver the babies in this increasing population of “poor”? I have to think NPs, not doctors.
I’m familiar with statistics that indicate that somewhere around 15,000 physicians have been the targets of sham peer review, and that somewhere around 20% or 3,000 of them ended their own lives subsequently. I myself have experienced it, and what the nationwide medical community needs to understand is that this is becoming standard operating procedure for the administrative lords of hospital medicine, in dealing with physician they see as either competitors or potential whistleblowers. The peer reviewing physicians often don’t even know that they are being used in this way, as the information they received is stacked against the physician under review. Often the reviewed physician has a zero-loss malpractice history and was respected in his or her medical community before the sham peer review was launched.
In my case I was both competition and a potential whisteblower. I had been a credentials chief, president of my medical group and also had a good reputation and a zero-loss malpractice history. Other means of eliminating the competition were tried first, but when they didn’t work the sham peer review followed. I fortunately prevailed in Fair Hearing Committee, especially since the details of a peer review are non-discoverable in litigation.
After this, however, the same accusations plus several others were sent in three separate reports to the State Medical Board, and one to the NPDB. The Medical Board, 4 years later had cleared all the accusations off their books in my favor and even refuted the NPDB report, which nonetheless stands. Because of the length of the process of completing the investigation process, I was unable to join insurance programs from 2010 to the summer of 2014. The rumor mill in the town made it unprofitable to practice there eventually, and I had to change states as the new kid on the block. The disadvantages of being undercapitalized and the stress of the battle led to life threatening illnesses both for me and for my wife, and eventually to bankruptcy. We are, however, recovering slowly on all fronts. The legal battle against the entities guilty of libel against me has been very difficult and rendered more so by the fact that the hospital’s counsel, which represented it against me in Fair Hearing, and who probably was consulted with regard to the prosecution of the peer review process as well as the complaints to the State Medical Board and NPDB, happens to be the Chairman of the Board of Directors of the involved hospital, who oddly enough reserved the right to accept or reject the findings of the Fair Hearing Committee at the Board level. It probably doesn’t help that the corporation owning that hospital has a U.S. Senator on its Board.
Fortunately my case and several other has attracted the attention of some documentary film makers, who are committed to bringing the travesty of peer-review-gone-wrong to the awareness of others outside of medicine. The director is one Kathleen Mazzola, and the producer is Romey Stuckart. The film is still being shot and additional funding is being sought. I ask physicians and others interested in bringing this plight of good physicians to the public to let this be known. I’ve sent a copy of this blog to the film makers.
Professionally,
Scott R. Nelson, D.O.
Dr. Nelson has joined the most unfortunate brotherhood/sisterhood of American medicine is a victim of sham peer review and has the scars to prove it. Our hearts go out to him. Sham peer review is the malignant epistemology of personal greed, envy and political manipulation. Ostensibly, peer review is in place to protect the public. In actual practice it can easily be used as a perversion and destroy talented people because they happened to be successful or stepped on the wrong toes. Sham peer review is a political and personal war entering medicine. It is a child of over-regulation, political liberalism and lawyer-speak.
Dealing with sham peer review is its own complex subject that requires more than a brief discussion on a blog. But there is also a need to separate out the goals of fighting sham peer review into specific cohorts. As a victim of sham peer review, you need to perform that personal analysis sooner rather than later. We already know that some victims have ended their lives as a result of the damages caused by sham peer review. That fact makes this separation all the more important:
1. Awaiting justice: Sometimes you may have to wait your entire life to achieve justice and despite that constant and resource consuming effort, you might still not achieve that goal.
2. Punishing the guilty: This comes under the auspices of revenge. Human history, especially of war has proven that revenge is not an easily achieved goal and can also come with personal and family destruction.
3. Going on with your life and improving your situation as much as possible: This feature again goes back to the Karpman Drama Triangle, because it seems like the only realistic way out of sham peer review. (The KDT consists of a behavioral loop with connecting features of the “perpetrator, victim and rescuer.” When you enter it, you automatically shift positions in it and none of them represent adult, constructive or emotionally healthy choices.)
Any victim of SPR needs to conduct a personal and familial evaluation of whether or not they intend to step into the KDT. Certainly while you are fighting against SPR, you become part of it. But you may eventually have an option to leave it, which means constructing a real future for yourself and your family.
Once you give up on the KDT, you also give up on revenge or punishing those who caused this catastrophe against you. Instead, you resolve to change your life to accommodate a healthy personal and financial future. This is not a matter of forgiveness. Rather it is a matter of where you intend to best apply your own personal, financial and emotional energies. George Herbert said it best: “The best revenge is to live well.”
Michael M. Rosenblatt, DPM
I am a board certified OB/Gyn who practiced over 30 years, delivered over 4500 babies and was involved in providing indigent care part and full time for over 25 years. I was an Ob/Gyn residency program director for 3 years and was on the medical faculty of 2 medical schools at different times. Ob/Gyns get 18 months of OB training in residency and 18 months of Gynecology. FPs who plan to do OB get 6.
Our species has survived because the process of birth works ok most of the time on autopilot whether there is medical personnel there or not. A family practitioner can do normal OB just fine. It is the 5-10% of the time when things get very high risk very fast that the benefit of experience and training is needed, like if the placenta won’t come out, the mother is hemorrhaging and a hysterectomy is needed to save her life. This is out of reach for an FP. In this case, every second counts.
I also spent over 20 years involved in the process of hospital quality assurance, the review of problem cases, that arise in any hospital in an effort to improve the quality of care. What would you make of a Family Practitioner who calls an OB for help, saying “I’ve put these forceps on 6 or 7 times and I just can’t get the baby out.” There is no good solution to that and it is the OB’s liability if he helps which he would. Not even the “good Samaritan law” helps you in this case in our litigious society. This is inexperience and the inability to anticipate problems. This was a real case. Mothers and children are hurt by such events. This is not to say Ob/Gyns don’t make mistakes or get in over their head. They just have more experience and tools to try to find a way out. Absolutely anything can happen during a labor and birth.
Virtually everyone reading this blog will agree that those with more focused training are generally better qualified to manage focused problems when they graduate a program. On average, that conclusion is correct.
How things play out in the real world depends upon, well, the real world. If a family physician with obstetrics training moves to an under-served community, everyone benefits. That doctor will likely have significant volume, improving his safety record. Hopefully, he/she knows enough to transfer out high-risk pregnant moms before there’s a problem. And the community now has someone around to provide care compared to no-one. As your post correctly notes, seconds count. And, the difference between an experienced family physician with 4,000 deliveries under his belt and a helicopter is significant.
I agree this scenario (high volume practitioner practicing in under-served area) is substantively different than a family physician who does one birth a month and lives in a major metro area
I agree with many of the professionals above. I am a female, solo practitioner in a semi-rural community. Everything was going well until I became a whistleblower against our local hospital in 1996. Since that time I have been the target of the Washington State Medical Board. Recently I did my own audit of the Medical Board and found that a female physician like myself in solo practice in a rural setting has a 284% higher risk of a Medical Board sanction than one who is not. My statistics were verified by two forensic accountants. It is time to unite, gather our strength and pressure Congress to pass a Federal Law that when a doctor is faced with a Statement of Charges for sanctions, he/she has the right to a civil trial by jury. Making this problem as open and transparent as possible is the only way to expose corruption. One thing Medical Boards underestimate is the commitment patients have to their physician. I can be reached at 360-825-1389 if anyone wants to start working on this with me.
Dr. Ballard correctly reports that any person who decides to take on a whistle-blower’s role is subject to sanctions and disciplinary action on multiple fronts. The best way to become a whistleblower is to wait until you are retired and can’t be touched. I became a whistleblower on a podiatry issue of a false and defective study by OIG blaming the podiatric profession on what we call “routine foot care” or treatment of fungoused nails. Not surprisingly, that is a common treatment among the elderly.
OIG even threatened to sanction those DPM’s who turned over data to them in good faith! Thus, a DPM who was alleged by the study to have voluntarily turned over “defective or fraudulent” data on their own treatment patterns could have been at risk of prosecution. This was intolerable on every front.
I dissected and thoroughly trashed the “study” and reported that to many venues, up to and including publishing it and sending the publication to local Medicare Intermediaries. I let OIG know about each and every instance of transmission.
Had I been in practice, I’m certain that I would have faced excess examination of my claims and other possible OIG generated attacks. That said, I did obtain outstanding support from the APMA, our National Organization. They were terrific. I should also state that podiatry has a good reputation of being supportive of our female practitioners.
By chance (and his hard work), there is a podiatrist (of all people) who has taken on Sham Peer Review and has tried on numerous times to not only change the law, but also helped a number of victims in substantial and surprisingly effective ways.
As a matter of disclosure, I do not work for him, although I have assisted some of his clients. His name is Richard Willner, DPM and he can be reached at: The Center for Peer Review Justice. He did not ask me to post this and is not aware that I have. If you are a victim, you could find it to your benefit to contact him.
Michael M. Rosenblatt, DPM
Excellent post. Great ideas here. Legislation to help physicians and surgeons regain our civil rights indeed would be most helpful to save US medicine and surgery. We need unionization or some power to keep conscientious hospital medical staff members speaking up in behalf of our patients. Good doctors practicing top level, super standard medicine and surgery but ruffling administrative feathers can be subject to sham peer reviews too readily. We need access to regular posted charges and trials by jury rather than allowing internal sham “peer” reviews or secret Kangaroo Courts confabulating nonsense, changing cases and charges each day, hiding medical records and critical data from Peer Review Committee members, changing meeting dates, etc., and — the ultimate insults — send rogue charges to state medical boards, even if thrown out by them, and the NPDB. Medicine is a profession whose practitioners have sacrificed their civil rights ever since the misnamed “Patient Safety ” or Health Care Quality Improvement Act of 1986 passed from Waxman and was reinterpreted by the Courts in favor of hospital business instead of medical science and clinical integrity from practicing physicians. Meanwhile, perhaps Physicians Health Service organizations and the Center for Peer Review Justice might collect the names of the physician suicides due to unsubstantiated rogue hospital charges and help us publish some of the most wicked peer review cases. In my case, a hospital black suit doctor (no longer in a powerful position) abused his authority by suspending me from hospital staff in Feb 2013 claiming that one neuroborreliosis, CNS Lyme, patient ENT and I cured of facial palsy vertigo and unilateral deafness with 4 weeks of iv ceftriaxone in Nov 2012, 3 months ago, had multiple sclerosis instead! He charged me with wrong diagnosis even though case had seropositive Lyme because there were oligoclonal bands in the spinal fluid. This toxic medical executive collected a 2nd healthy case with latent Tb who, 3 months before, had headaches while taking high dose oral rifapentine and isoniazid. He alleged that the patient had Tb meningitis and needed 4 Tb drugs to treat Tb meningitis even though the spinal fluid and lungs showed no Tb microorganisms on smears or cultures. Neither the well patients nor any internal or external experts believed these charges of “wrong diagnosis” but it cost me over $10,000 to fight these libelous assaults onto my clinical expertise and medical integrity. State Board fortunately removed the charges shortly after the allegations left the hospital.
We need more heroes in this nation like Senator Tom Coburn. We the people thank you for your dedication and human services. Although Senator Bill Frist, MD, had good intentions under Bush, he bowed to political pressure and expanded government Medicare to include Part D, payment for prescription drugs to be included in health insurance plans. Your tax dollars at work to subsidize poor lifestyle and behavioral choices. Now opiates are dispensed like candy, at the taxpayer’s expense, and we lose too many folks in the prime of life from heroin and opiate overdoses. We must stop socialist healthcare and the war on doctors. We need national heroes that won’t tolerate the foibles of socialism and/ or crony capitalism. Any wise Tea party folks? Where are you, Dr Ben Carlson? Senator Marco Rubio?
I agree with Katherine, we need more Heroes like Dr. Coburn. How many of us can boast of offering free services after a point of time? He was not at all guilty of any conflict of interest, just because a hospital went from the government control to private hands, it does not changes the fact that he delivered babies with out charging even a single penny. Infact he paid a lot of money from his own pocket.
Just wish that this hero recovers fast and he goes back to the senate!