Yves here. Thanks in large measure to the diligent reporting of the Health Care Renewal blog, as well as more recently the deep digging by Eileen Applebaum and Rosemary Batt on private equity’s major incursions into healthcare, we’ve been able to keep tabs on the corporatization of medicine and its detrimental effects on the quality of care. These changes have been implemented by MBA beancounters over the objections of practitioners. In cities where it’s viable to keep solo or small group practices, like New York City, some can keep serving their current patients. Some retire early. Some are able to morph their practices outside the insurance paradigm (like endocrinologists who become “anti-aging” specialists who dispense human growth hormone) and again escape corporate minders. Others like IM Doc flee for small cities where the big hospital system tendrils have yet to reach. But the net result of all of this is fewer patient-driven practitioners. Given the importance of the placebo effect alone, this shift hurts outcomes.
The latest post at Health Care Renewal reports on an important measure to restore more power to doctors: a proposed California bill to prevent health care administrators from practicing medicine. Oddly I’ve read nothing in the press about it. I strongly recommend circulating this post to everyone you know in California and urge them to urge their state Assemblyman and Senator to support this measure. Update: I was remiss in not flagging the bill number, SB 642, and a link to its text.
By Roy Poses, MD, Clinical Associate Professor of Medicine at Brown University, and the President of FIRM – the Foundation for Integrity and Responsibility in Medicine. Originally published at Health Care Renewal
Health Care Renewal presents a guest post by Dr. Gene Dorio. Dr Dorio is a geriatric physician from the Santa Clarita Valley in California, providing house calls to older adults. He has been an advocate and whistleblower for his community leading several causes from attempting to preserve the hospital Transitional Care Unit for seniors in 2006, to today trying to allow admission of teens to the psychiatric unit.
He is President of the Los Angeles County Commission for Older Adults, an elected Assembly Member of the California Senior Legislature, serves on the Triple-A Council of California, and member of the Santa Clarita Valley Senior Center Advisory Board.
For 5 years, Dr. Dorio served on his hospital’s Medical Staff Executive Committee in several leadership roles including 3 years as Chairman of the Department of Medicine.
Doctors are highly trained medical professionals trying to survive in a complex sociopolitical system. We have been pawns utilized by hospitals and government for our knowledge and skills, yet more recently expected not to have a voice or opinion.
As a physician in private practice for 40 years, changes in the past 10 years have been difficult. It was hard for me to hear non-medical business administrators force cut-rate medicine compromising evidence-based patient care.
I was elected to the hospital Medical Executive Committee (MEC) seven years ago with the hope from the inside I could improve threats against patient care. This did not succeed and the fury coming from the hospital intensified as the self-governing MEC was swallowed up by the Board of Directors and Administration.
Doctor voices protecting patients diminished, and many whistleblowers were left to defend themselves from bullying and attacks.
Lies and insults persisted, and the only power I had was knocking out keyboard articles to social media as a shield. Throughout the country, there were scant physicians in the same situation, so we networked the best we could to survive. “Never give up” was our mantra.
Periodically murmurs could be heard, but it was always muffled.
This year in California, a law was introduced in the State Senate to keep hospital administrators from “practicing medicine without a license.” Most doctors don’t know about it, but of course the state hospital association is diligently fighting it.
It can be seen here.
At the end of April, I was asked to testify at the State Senate Health Committee, and this is what I provided:
Good morning Mr. Chairman and members of the California Senate Health Committee.
My name is Gene Dorio, and I am a geriatric physician in Santa Clarita serving my community for 34 years.
Until two years ago, I was on staff at a local hospital which is a non-profit, but run like a for-profit hospital. For 5 years, I served on the Medical Staff Executive Committee in several leadership roles including 3 years as Chairman of the Department of Medicine.
During my time there, I witnessed administrators use manipulative, clandestine tactics to capture each voting facet of the health facility, including the Board of Directors, contracted physician groups, and the Medical Staff so business people could make patient-care decisions.
At my hospital, business community members were appointed to the Board of Directors and provided lucrative contracts in exchange for their vote. Bankers were given hospital accounts; a real estate agent was given property to rent; and a doctor was given space for a dialysis unit.
Exclusive Contracts were signed by physician groups for emergency room care, radiology, and operating room anesthesia. The hospital could not technically practice medicine, but they coerced these groups with the threat of severing contracts if they did not adhere to their orders, or vote as told. Needless to say the administration got their votes, while the Medical Staff became only a shell of a self-governing body once devoted to improving patient care.
Eventually, the Medical Staff was taken over too, and our policies were changed to bring in more revenue—even when it was terrible for patients. My patients are geriatric, and at times clinging to life. Nonetheless, staff started to leave daily notes on my charts forcing me to discharge patients even though they were not ready to leave the hospital. These notes included a printed statement “Not a Part of the Medical Record” which was removed later by the Medical Records Department erasing hospital culpability.
Hospital administrators also knowingly wrote orders without doctor consent for Palliative Consults, to place patients on hospice care which financially benefits the hospital by getting them out of the hospital for care.
They also made decisions about medications patients could receive. They decided not to use insulin pens as they were too expensive, and instead jeopardized diabetic patient care using multi-source insulin vials which are less precise and easily contaminated. The presiding CEO was released from their previous hospital after violating State Medi-Cal laws substituting inferior anesthesia in the labor and delivery department.
Hospitals also hold regular “throughput” meetings for physicians, where they publicly display the number of referrals, expensive tests, procedures, and overall revenue that each doctor is generating. They talk about productivity and efficiency—not the quality of patient care.
Because I tried to advocate for my patients, my hospital privileges were constantly in jeopardy. Typically, privileges are renewed every two years. For me, it was every 4 months.
If hospital administrator actions were truly to improve healthcare for our patients, I would have no qualms. But instead through abusive tactics and bullying, they interfere with physician decision-making, and ultimately increase administrator salaries, bankroll retirement portfolios, and yearly bonuses.
SB 642 is an important step to removing hospital administrators from practicing medicine without a license. Their surreptitious plans taking over a non-profit hospital for their own personal benefit must be thwarted by this law.
Patients have entrusted physicians to be guardians of their health. We are professionals that have taken a solemn oath to provide care in the best interest of the patient. Therefore, SB 642 will serve Californians by putting medical decision-making back into the hands of patients and their doctors.
I have never testified before a legislative body, but this is where my keyboard has brought me. There needs to be more voices fighting for patient care diminishing hospital administration power. Doctors must be part of the balance providing better healthcare to citizens of our country, but we must hear you speak!
Follow that mantra, “Never Give Up!”
Gene Uzawa Dorio, M.D.