Benjamin Rush
Through the power and prestige of his position
he got patients to pay him to make them worse
and then got richer by suing someone for complaining
He was one of the founding fathers of the United States of America. His signature is on the Declaration of Independence, right above Benjamin Franklin's. He was the most prominent physician in the country, as prominent as George Washington and Thomas Jefferson, and was called the “Father of American Medicine” and the “Father of American Psychiatry.” He was the first to advance the idea of free public schools so he also was called the “Father of Public Schools Under the Constitution.” And he was a pioneer in women’s education. What could there be to criticize?
He was supremely confident of his own opinions and decisions and shallow and unscientific in practice. He thought nearly all ailments could be cured by bloodletting, and made a great deal of money with that and mercury purging, two practices that everyone but patient knew would make them worse. Thomas Jefferson wrote of a friend, ""When I visited him I saw that they were killing him by bleeding and mercury. . . "
Politics and prestige
instead of safety
is not new in medicine
The medical community no longer supported antiquated practices like bloodletting, but Rush had “no patience for pathology, laboratories and experimentation because these activities took the doctor away from his primary job: the care and treatment of patients.” According to Rush, the opposition to bloodletting “was wholly political,” and evolved from “the prejudices and errors of our countrymen."
He tried to get written into the Constitution language that would guarantee the freedom to practice medicine in whatever way a practitioner desired just as there was language guaranteeing the freedom to speak: "Unless we put medical freedom into the Constitution, the time will come when medicine will organize into an undercover dictatorship to restrict the art of healing to one class of man, and deny equal privileges to others. The Constitution of this Republic should make a special privilege for medical freedom as well as religious freedom." He tried to make it illegal for the members of his profession to band together to restrict practices they thought to be harmful.
Physician / Statesman
During the yellow fever outbreak in 1793, in which thousands of people died and many times more fled the city, an English pamphleteer named William Cobbett, in "Peter Porcupine's Gazette," constructed tables that elucidated the increase in mortality in September after the “Pennsylvanian Hippocrates,” as he called Rush, practiced bloodletting there. Other critics backed up the accusations with similar tables. Cobbett claimed that Rush was bleeding people not because of any scientific findings that supported the practice, but because Rush wanted to be at the helm of something great.
Rush sued Cobbett for what he said. A jury awarded a verdict of $85,000 in damages to Rush - a huge sum at the time. It so ruined Cobbett that he had to flee to England. With all of the criticism of public figures that appeared in that famous Gazette, it was a physician, with a lawsuit, who managed to silence voices trying to protect the people.
As time went on it became clear that Cobbett had been right, but we the people were prevented from learning that. To cover it up his correspondence remained unpublished for about 200 years. Even back then when things went wrong in medicine, it was kept silent.
Rush believed that Luke 10:19 authorized him as a medical savior, “Behold, I give you the authority to trample on serpents and scorpions, and over all the power of the enemy, and nothing shall by any means hurt you.” Considering the verse a promise, Rush viewed his work as God’s divine decree, even though his own family had been hit hard by the fever. They and his patients were given treatments that made them worse. When someone criticized him for it, he got rich by suing them into silence. He truly is a picture of how healthcare professionals respond to criticism from victims of error and abuse and negligence in medicine today. Rush never managed to convince his friend, Thomas Jefferson, that doctors do less harm than good, but he did succeed in stopping the people from talking about how to protect themselves from the harm the doctor was doing.
* * *
Sixty years later in England when John Snow compiled maps and tables showing that people getting water from one water company were dying of cholera while people getting water from a different water company were not, no one sued him. He was not criticizing doctors. He was criticizing water companies. And so he was able to continue his work and change the course of history. If he had criticized the practice of a doctor or a hospital in the same way, even today, he would be sued into silence. Since no one sued him to silence him, the field of "public health" came about as a result of his work. He is called the father of epidemiology. Today people found careers on gathering statistics that show what is good and what is bad for public health in the same way that John Snow did. But they still cannot track the success/failure rate of a doctor.
How much safer would we be if the work of William Cobbett had made him the father of an area of study that constructs tables of patient outcomes that show the success rate of various doctors, various methods and various hospitals? It still is the case that patients cannot complain about doctors and nurses publicly. Doctors and nurses can complain about patients in ways that prevent them from being able to get treatment, ways that actually can result in physical injury. They literally telephone each other and warn each other not to diagnose and treat a patient when that diagnosis could be used as evidence against a colleague who was negligent or abusive. But patients cannot warn each other about the practitioner who was negligent or abusive. If they do they get sued like William Cobbett. Patients who have been sexually abuses cannot even find who to complain to. When they try to they find that the only organizations that exist are on the ones that represent caregivers. There are no organizations advocating for patients. The stories of Dr. James Burt and Dr. Vikas Kashyap are not "one-offs." They are the way the world is for patients.
Cobett complained that Dr. Rush's care might have been what killed George Washington. How could journalists or anyone else search for and share information to get to the bottom of that, or anything else that might protect patients from someone like Rush when he sued people for doing so? They couldn't so they didn't. They still can't.
Patients think that someone is watching out for them. They think that someone out there must be looking for warning signs and listening to complaints. The people who appear to be doing that share the perspective and interests of healthcare providers over and above the interests of patients. That's why cases like Dr.Arthur Richard Schramm fester year after year.
Patients need to be able to speak without getting sued. And they need an organization that shares their perspective over and above the perspective of the providers when things go wrong.