All hospitals have to pull their weight on uncompensated care

Tim Walters filed this op-ed piece Saturday in the Cleveland Plain Dealer: All hospitals have to pull their weight on uncompensated care. Seems MetroHealth, the nationally recognized public hospital in town, is in perilous financial condition. It is the largest provider of uncompensated health care in the state of Ohio, and if it goes under, Walters wonders what will happen to indigent patients whose medical home is MetroHealth, not to mention everyone in the community who relies on MetroHealth's unique capabilities (the area's only Level I trauma unit, trauma burn care, etc.).

Walters' answer: Before this happens, how about all the hospitals in the area stepping up to the line and shouldering their fair share of charity care? Of course, hospitals with emergency departments have their EMTALA obligation to screen and to stabilize, but the lion's share of ED admissions and nonemergency charity care is coming from MetroHealth, not University Hospitals (can you spot the ED -- or the maze you have to solve -- on their interactive map?) or the Cleveland Clinic (same question).

5th Circuit's decision in Poliner is out

Total win for Presbyterian/THR/
medical-staff docs. HCQIA immunity for money damages held to apply to emergency suspension decisions during the fact-investigation phase of the peer-review process. Judge Higginbotham's opinion for a unanimous panel is here. It looks bullet-proof to me . . . . Pretty amazing saga, which I am sure won't be over until there's a petition for reconsideration/rehearing en banc: from a $360-million jury verdict to a remitted judgment for $33 million (still amazing for peer-review case) to $0.

Trying to Save by Increasing Doctors’ Fees

Trying to Save by Increasing Doctors’ Fees

That's the headline in this morning's New York Times' story about health plans (including Medicare) that are going to try to gin up some extra compensation for primary and preventive care in the hope that it will reduce more costly acute care down the road. Could it be? The dawning of the Age of Common Sense? Stay tuned . . .

Making Malpractice a Criminal Matter

The Wall Street Journal's Law Blog has an entry today on a criminal case brought against a physician at the Harvard School of Public Health. The case is described a little more fully in the Boston Globe. According to the Globe story, the physician -- Dr. Rapin Osathanondh -- was performing an abortion on a 22-year-old woman who died during the procedure. Dr. Osathanondh was subsequently charged by the state medical board with unprofessional conduct, on the basis of these allegations:

The board alleged that Osathanondh had placed the patient under sedation without any means to monitor her heart rate, blood pressure, or the oxygen level of her blood. The board said the doctor had no qualified person assisting him while Smith was under anesthesia. The only other person in the room was an office worker who had no CPR or other training in lifesaving procedures.

The board added that Osathanondh "failed to timely initiate a call to 911," "failed to maintain an adequate airway," and "failed to adhere to basic cardiac life support protocol."

Osathanondh also allegedly made a variety of false statements to board investigators, telling them that he had administered Smith oxygen and monitored her oxygen levels and that his office worker was certified in lifesaving procedures. He allegedly tried to deceive investigators by expanding the size of his treatment room and bringing in new equipment, which he maintained was there at the time of the abortion.

While it is rare for allegations of medical malpractice to be channeled through the criminal justice system, it's not unheard of. There's a point at which ordinary negligence shades into gross negligence (which can still be handled in the tort system) and at which gross negligence evidences the kind of recklessness that qualifies as a criminal offense. I am not competent to have an expert opinion about what happened in this case, but the cries of outrage about this case resulting in a criminal prosecution are a bit overdrawn. Extreme negligence -- multiple departures and wild departures from the standard of care -- if proved, can properly be a matter for the criminal justice system whether the defendant is a nightclub owner who locks the fire exits (resulting in hundreds of deaths after a fire breaks out) or a member of the medical profession.