Linked Notes 8

In 1926, Sinclair Lewis was offered and declined a Pulitzer Prize for Arrowsmith (1925), a novel tracing a doctor's efforts to maintain his medical ethics amid greed and corruption.

WELL INSULATED
Victims screaming at the top of their lungs cannot get complaints heard. When they go to the police they are told, correctly, that there are no witnesses in healthcare. The police believe that there is no point in investigating such cases (until they figure out how I guess that will be true). State medical board investigators often are retired police officers who are supervised by other retired police officers. Their training and inclination is no better. No incident reports are filed outside the hospital in spite of mandatory reporting laws. Licensing boards have nothing to work with other than the expert deflections of people in medicine (see "wall of silence"). The boards themselves are composed mostly of doctors who carry the same prejudices and wear the same blinders as everyone else in healthcare.

One of the safest things a sociopath can do, other than resist the inclination to injure people, is to get work in medicine.

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Ohio State Medical Board
Here is the state medical board’s mission statement:
To protect and enhance the health and safety of the public through effective medical regulation

One of their published goals is:
Prohibit persons from practicing medicine whose violations are so egregious as to forfeit the privilege

They license medical doctors, doctors of osteopathic medicine, doctors of podiatric medicine, anesthesiologist assistants, massage therapists, cosmetic therapists, and acupuncturists.

So you would expect that, with 22 investigators, they would help patients who report rape or assault or such like. But we cannot find instances in which they have disciplined doctors on the basis of any complaints from patients.

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Investigators
*In fairness to the investigators, if any were hired who are motivated and intelligent, for how long could they continue to invest themselves in these tasks knowing that their work is for naught? If they do find the witnesses, they won't testify. If they do find diagnostic evidence, it will carry no weight. If someone did file an incident report, it will have been filed internally and the hospital won't be able to "find" it. Sometimes cases are not given to investigators until years after the incident occurred and the trail is too cold anyway. Whether or not the investigator makes an honest effort to discover anything must remain confidential under Section 4731.22(F)(5) of the Ohio Revised Code. For sheer sanity anyone would have to become an automaton who filled in blanks and moved on.

I am told that there are 22 investigators. Almost every question I ask about them cannot be answered because of confidentiality. However, I do know the name of the one investigating my complaints. I was able to find out that he is a retired police officer. When he was a police officer he wasn't smart enough to be an investigator. He tried to become one and screwed it up so badly that he was demoted. That is something that is not done lightly. Demoting him reduced his pay and reduced his retirement benefits (so he needed to work during retirement). A former colleague of his told me that he couldn't write a parking ticket without screwing it up. I'm also told that back at police headquarters when they learned he had become an investigator with the State Medical Board, in the office there was spontaneous, collective laughter.

He has a high school degree and no medical training. It was up to me, a patient, to explain the medical aspects of the case to him. I still was figuring it out myself. When he went to investigate the case, he asked the questions I asked him to ask (or so he told me) and no others from what he told me. So I was running the investigation. And I didn't know how. What patient would? More details of this (that I wasn't supposed to be able to find out) are covered elsewhere.

The whole process seemed design to stymie and placate me rather than either protect other patients or achieve justice. He did not even find the paper trail that I told him about. So I got the documents myself and sent them to him. Months later when I telephoned his superior I was told, with exasperation, that I'd buried them in a stack of documents. It was twenty pages, but apparently that was too much for them because they later said they were closing the case. So I reduced the 20 pages to a one page graph. With that in hand, they have decided to give it another look.

What patient other than me other can take the time to stay on top of them like this to see if they do their job? They are in serious need of monitoring by a watch dog group.

I am doing this not merely for my need for justice, but also as a test case. The citizens of Ohio need someone to figure out and explain how and through whom to get justice. The citizens of the country need someone to figure out and articulate why mandatory reporting laws are useless. The State and Federal Government need to see some examples of why current systems don't function. Ohio courts need someone to point out the inequity of liability limitations that make it so that someone with an MD can commit blatant violence against a patient and be protected by statutory limits on liabilities while the victim of the violence is not protected and can be subject to unlimited liabilities merely for speaking about it.

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Scrutiny
Yes, on their board they have a few citizens who are not MDs and I suppose that is supposed to be scrutiny. But they are loaded down with reams of papers they are supposed to review. They are not scrutinizing the organization. They are helping it deal with paperwork.

I asked people at the board several times "What constitutes sufficient evidence" without getting answers better than "It depends" or "It's different for different cases," which means either that they act arbitrarily in the absence of standards or they have never bothered to figure out what their standards are. When I ask questions like "What percentage of cases result in discipline" they don't know. Most of the questions I asked had answers deemed confidential under law. So I'd re-ask them in different ways until, in some cases, I hit on answers that would not be confidential if they knew the answers. But they were not organized in a way that would allow them to figure out the answers. In one case I was told to call back in a couple of years when a new computer system "might" make it possible to figure out the answer.

There should have been statements that already had been prepared to answer some of these questions just for their own internal functioning. This is an organization operating with insufficient self-awareness and woefully inadequate oversight from any external authority.

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Benjamin Rush Notes:
[one good reference on Benjamin Rush is
http://www.samford.edu/schools/artsci/scs/lewallan.htm]

During the revolutionary war, Rush secretly campaigned for the removal of Washington as commander in chief.

In April 1777, after some months in Congress, he became surgeon general of the armies of the Middle Department of the Continental Army. Less than a year later, in February 1778, he resigned because of a controversy over the administration of military hospitals.

In "The Rush Light" Combett compared the doctor’s neglect of experimentation to an ugly old hag who despised beauty.

Thomas Jefferson wrote about the patient of another doctor, "When I visited him I saw that they were killing him by bleeding and mercury. . . "
"Jefferson's Secrets, Death and Desire at Monticello" by Andrew Burstein, Basic Books 2005, pg 27.

Rush attributed all fevers to "convulsive action," otherwise known at that time as "morbid excitement," a latter day way of saying "nervous breakdown" or "depression."
"Jefferson's Secrets, Death and Desire at Monticello" by Andrew Burstein, Basic Books 2005, pg 50.

Rush wrote, "Opium has a wonderful effect in lessening the fear of death. I have seen patients cheerful in their last moments, from the operation of this medicine upon the body and mind." It was cheaper than alcohol and extremely easy to obtain.
"Jefferson's Secrets, Death and Desire at Monticello" by Andrew Burstein, Basic Books 2005, pg 268.

If you yourself want to research another story along this line, Sauerbruch is yet another physician who managed to continue working even though doing a great deal of harm.

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Unlinked Information Parked here temporarily:
Sitting next to me as I write this is an article in the New York Times headlined "Catholic Group Receives 1,092 New Sex Abuse Reports." Do you know why you don't see such stories about medicine?

Not everybody goes to Catholic Priests, but everybody goes to healthcare. Where do you think there is more sex abuse? Current patient safety spokespersons have a habit of repeating that they don't believe that people go to work to do a bad job. Of course, some people do. Whether or not that was their original intention, once there they find temptations, and not necessarily lascivious ones.

Do you know the crime rate in medicine? That is, the rate at which healthcare workers commit crimes against patients? Not the error rate. Not the rate at which things innocently, or negligently, go wrong. But the rate at which assault, rape and homicide are committed against helpless patients by doctors and nurses and other healthcare workers?

In its first paragraph, the article in the New York Times talks about an annual survey released about the church's procedures for handling and preventing abuse by clergy and employees. Do you know why there is no such release about procedures to prevent abuses in medicine?

Even JCAHO thinks:
"All information reported to the system must be legally protected from disclosure (including by subpoena, discovery, introduction of evidence, testimony, or any other form of disclosure in connection with a civil or administrative proceeding under federal or state law or under the Freedom of Information Act)."

So crimes are kept quiet and not reported to the police.

What's the difference between God and a doctor?
God doesn't think he's a doctor.

(alternative answer: God doesn't play doctor with the world.)

Robert M. Wachter, a professor of medicine, chief of the medical service and chair of the patient safety committee at UCSF Medical Center, has long been known as a pioneer of the hospitalist movement. He is coauthor of the book below.

INTERNAL BLEEDING: The Truth Behind America's Terrifying Epidemic of Medical Mistakes
Written by Robert M. Wachter and Kaveh Shojania
Rugged Land, Hardcover,
460 pages, 6 x 9, 978-1-59071-073-9 (1-59071-073-8), May 2005

Wachter is a hospitalist, a term coined by him and Dr. Lee Goldman in the New England Journal of Medicine. Hospitalists are hospital-based, generalist physicians who take charge of a patient's care from the moment they are admitted to the day they are discharged. There are a lot of people who play a role in inpatient care -- nurses, technicians, specialists, social workers, pharmacists, managers, etc. -- and it is the hospitalist's job to provide the continuity, to know his or her patient's case thoroughly, and to serve as the orchestra conductor and the patient's advocate. There are now about 10,000 hospitalists in the USA.

Disclosure
Lately people are saying that in medicine there is emerging evidence of greater openness to disclosure, that physicians in a recent survey in the United States and Canada generally endorse the importance of disclosing harmful errors to patients. The survey asked about "errors" and assumed physician awareness of them. There is no appreciation for rationalization, self-serving ways of interpreting evidence, and the general ability of healthcare professionals to believe that they are good, well-meaning people who have done the right thing and created the best outcomes patients can expect. Like Dr. Benjamin Rush, one of the founding fathers of the United States, at one time called the Father of American Medicine, who got rich making his patients worse with bloodletting and mercury purges during plagues. When someone pointed out that the death rate increased wherever he practiced, he sued them to silence them. Practices in modern medicine are not always interpreted anymore scientifically by the practitioners, and the blindness of the mindset is, if anything, worse. Patients need sources of protection that do not require healthcare professionals to be saints. Just look at the refusal of that community even to recognize the problem of abuse.

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According to H.L. Mencken, all human progress, even in morals, has been the work of men who doubted current moral values.

Why was there no discipline for the doctors and staff and hospital administration
who refused to report Dr. James Burt while he ruined one life after another?
 

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Silence versus Patient Safety
Loyalty versus Patient Safety
The White Wall of Silence versus Patient Safety
Blacklisting Patients
Freedom of Speech for Patients
Medical Complaints - How to

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