Attorney Ben Glass of Fairfax, VA shares some thoughts on the healthcare debate and the claim by some doctors that they routinely practice "defensive medicine" to avoid being sued.  He notes that medical malpractice law requires only that a doctor practice in accord with the "standard of care," which is simply the care that would be required by a "reasonably prudent physician acting in the same or similar circumstances. . . .When a doctor does or fails to do something required by the standard of care, then he or she is negligent. If harm results from that negligence, then he or she is responsible to the patient for that harm."

 

Glass says "Doctors and patients act as a team. The doctor does an assessment of the situation, takes into account the information reasonably available at the time, and recommends a treatment. The standard of care requires that a doctor explain to the patient both the risks and the benefits of the proposed course of treatment. Ultimately, it is the patient, being fully advised, who makes the decision as to the course of treatment."  So how is it all of these doctors are supposedly ordering tests and procedures that aren't medically necessary but are done to protect the doctor?

 

"Think about it. Anyone who says he or she routinely engages in defensive medicine is admitting that they practice outside the standard of care. They admit that they routinely engage in conduct that is, by definition in every state, medical malpractice. Indeed, they are admitting that in their discussion with the patient about the next step to take in their health care, they are lying when they disclose the risks and benefits of the proposed treatment."

"Second, any doctor who admits they engage in 'defensive medicine' is admitting they are engaging in insurance fraud. . . .  A health insurance company is generally bound by contract to pay only those claims that are reasonable and necessary to treat illness or injury. The practice of 'defensive medicine' is, by definition, an admission that two people are being lied to and victimized by fraud: the patient and the insurance company."

The Hartford Courant reported that a Connecticut law "intended to protect patients by making them aware of hospitals' errors has ended up making it easier for hospitals to avoid scrutiny." Currently, "under the state's 'adverse event' reporting law, hospitals are required to inform the state Department of Public Health when patients suffer certain serious unintended harm," but "public access to hospitals' adverse events has fallen 90 percent since the legislature redrafted the law" in 2004, and "hospitals now report a fraction of the mishaps they once revealed." According to the Courant, "that secrecy was written into the law after hospitals balked at the state's original adverse-event legislation, which gave the public broad access to reports of medical errors and accidents."

In a related piece, the Courant reported that even though "more than 1,200 adverse-event reports have been filed by Connecticut hospitals since the law was changed in 2004, including at least 116 in which patients died," only "about one in four are investigated, down from half of cases investigated before the law was revised." Although "the Department of Public Health launched investigations in most cases in which doctors performed surgery on the wrong body part or the wrong patient, as well as cases in which patients were killed or seriously harmed as the result of a medication error," Connecticut "officials investigated only about half the reported sexual assaults on patients, and half the cases in which sponges or other foreign objects were left inside patients after surgery."

 

Following these articles, CT Attorney General Richard Blumenthal called for "sweeping changes to the state's 'adverse event' reporting law for hospitals," saying "the law should be rewritten to promote greater disclosure of errors and accidents by hospitals and greater transparency to help patients evaluate medical facilities." In addition, Blumenthal "called for an increase in the number of state investigators, as well as statutory authority for his office to seek civil penalties against hospitals that do not comply with the law."

Blumenthal "said the vast majority of medical decisions and procedures are done correctly, but the minority that's driving down the state's high standards of care should be readily disclosed so the public can make 'informed decisions' about where they should seek care," the Connecticut Post reported. The attorney general stated, "We have now a culture of secrecy and concealment that is completely unjustified by any of the rationales given," adding that "the public needs as much information as possible from doctors, hospitals, and the state Department of Public Health." Blumenthal also stressed the "need for monetary penalties to hold hospitals responsible."

The Chicago Tribune reported on Dr. Michael Reinstein, "one of the most prolific providers of psychiatric care in Chicago-area nursing homes and mental health facilities, even as he is trailed by lawsuits and complaints."  An investigation "by ProPublica and the Tribune found that Reinstein has compiled a worrisome record, providing assembly-line care with a highly risky drug."  His "unusually heavy reliance on the drug clozapine -- a potent psychotropic medication that carries five 'black box' warnings -- has been linked to at least three deaths."  Records "also show he is getting government reimbursement for seeing an improbably large number of patients."  It was also reported that AstraZeneca paid him "$490,000 over a decade to travel the nation promoting its best-selling antipsychotic drug, Seroquel. In return, Reinstein provided the company a vast customer base: thousands of mentally ill residents in Chicago-area nursing homes."