March 10, 2003 -- E-Mail Illuminates Doctors' Protest over Malpractice


This is a far different picture of the New Jersey docs' strike against
ruinous malpractice premiums than we saw on "60 Minutes" last
night.(3-9-03) As insurance companies try to recover their Wall St
losses by jacking up premiums, docs are torn between their dual
identities as protectors of patients' well-being and guardians of
their own welfare.

Why do the leaders of the movement to limit malpractice awards attack
patients' suits, instead of attacking cost-saving measures in
hospitals, like speedup, short-staffing, too few beds, and using
under-trained workers? These are the main causes of the 98,000 deaths
per year from medical mistakes. Why don't these leaders attack
managed care plans for reducing reimbursements and denying proceedures
for patients?

Limiting malpractice awards is high on the corporate agenda. Bush
opened the campaign with a big speech at a Pennsylvania hospital
recently sued by the widow of a man who died when a breathing tube was
placed in his esophagus rather than his windpipe. The hospital had
failed to make the routine checks to avoid this mistake, and then
lied. Rather than apologizing to the patient's wife, Bush attacked
malpractice suits saying they increase the cost of healthcare and
decrease its accessibility.

But, the push to limit malpractice awards is not directly based on
today's imperatives. Only one in eight mistakes make it to court,
only one in 16 get awards, and adjusted for inflation, awards have not
risen. In fact, malpractice claims account for only 0.5% of health
costs! If it's true that malpractice claims are such a small part of
healthcare costs, why then are the medical industry, business, and
government so desperate to limit malpractice awards?

Business is on the verge of a serious health crisis, brought on by
rising costs, reduced profits, rising budget deficits, rising
unemployment, an aging population, and the need for open-ended
warfare. They are planning huge health cuts and restructuring of
Medicare and Medicaid to severely ration healthcare. They know these
cuts will cause large numbers of deaths and injuries, and want to
protect themselves beforehand by limiting medical malpractice awards.

Many, many of us will be faced with the same choices as the doctors,
saving society or saving ourselves, as business and government
eliminates the "middle class," that is, people who work but also have
a high enough living standard to permit relatively stable lives. Only
by allying with those we serve can we get the upper hand.




New York Times, March 10, 2003

E-Mail Illuminates Doctors' Protest

By ANDREW JACOBS

Wear white lab coats at public appearances. Punish uncooperative
colleagues. Above all, make sure patients experience colossal
inconveniences.

A month after thousands of New Jersey doctors staged a work stoppage
to protest rising malpractice insurance rates, a series of e-mail
messages between doctors and protest organizers making those and other
recommendations offers an intriguing glimpse into the strategies and
sentiments that drove the five-day job action.

Most of New Jersey's 20,000 physicians canceled routine checkups and
rescheduled elective surgery during the week of Feb. 4 in one of the
nation's largest walkouts ever by doctors. Emergency rooms were
inundated with patients, and a mass rally in Trenton drew 4,000
doctors and extensive media coverage. Another walkout is planned in
Connecticut later this month, and on March 11, busloads of New York
doctors are expected to demonstrate in Albany.

The e-mail messages, distributed by the Foundation for Taxpayer and
Consumer Rights, a consumer group opposed to the doctors' demands,
reveal the intense frustration and anger felt by physicians in New
Jersey, many of whom blame trial lawyers, Democratic legislators and
greedy patients for their skyrocketing insurance premiums. In the
messages, lawyers are referred to as "prostitutes" and "blood
suckers," and doctors who refuse to participate are called "scabs" and
"parasites."

Representatives of the Consumer Rights group declined to say how they
obtained the e-mail messages, which were in an Internet forum used by
doctors.

In the weeks leading up to the protests, physicians were advised that
wavering colleagues should be threatened with a loss of referrals, the
financial mainstay of many private practices. "You are either with us
or against us, there is no in between," the vice president of the
Hudson County Medical Society, Steven P. Shikiar, warned in a message
that went to 1,500 physicians.

The main goal of the campaign, he and others said, was to make
patients feel the effects of the work stoppage through increased
bureaucracy and postponed treatment. "Cause confusion and
inconvenience," Dr. Shikiar wrote. "Let them know that this is the
health care system of the future if it is not fixed now."

Another doctor whose name did not appear on the e-mail message
proposed an even more radical step: to cease writing prescriptions for
inexpensive generic medications and write prescriptions only for
limited quantities so patients are forced to make multiple return
visits. "Don't call in Rx's. Make the patients pick up written
script," said the doctor, using the medical shorthand for
prescriptions. "The patient can pick up the script from a box outside
my office door where they can read a prominent sign explaining what we
are doing."

Dr. Shikiar, an Englewood surgeon who organized the e-mail forum, said
that many suggestions were made during a heightened emotional climate,
and most were quickly disavowed. "I tried to leave the discussion
open," he said in a telephone interview. "I don't think it's fair and
reasonable to look at one line out of one e-mail and draw any
conclusions."

Some ideas, like denying health care to lawyers, legislators and their
families, were immediately rejected, he said. Others, like a call to
boycott National Public Radio for what one writer called "a slant
against doctors" was simply ignored.

But some protest strategies - and the flinty language used by a
handful of doctors - has provoked a furor among those who oppose the
physicians' main objective, a $250,000 cap on "pain and suffering"
awards to victims of medical malpractice. Doctors were not seeking any
change in the other award category, which compensates malpractice
victims for lost wages and medical expenses.

Some critics cited a protest placard that compared legislators to
Osama bin Laden and a letter, distributed on the Internet by a North
Brunswick urologist, that likened a ranking state senator to Saddam
Hussein. Assemblyman Neil M. Cohen, chairman of the commerce and
banking committee, whose office was picketed by 80 doctors, said the
vitriol was excessive, and in the end, counterproductive. "The doctors
got carried away with themselves," he said.

Mr. Cohen, a Democrat who is helping to draft malpractice reform
legislation, said he thought that many physicians had been fed
inaccurate or incomplete information about the recent spike in
malpractice premiums. The rallying cry over jackpot awards, he said,
ignored statistics that showed a drop in medical malpractice lawsuits
last year. Of 205 cases that went to a jury in New Jersey in 2002,
physicians won 151; only 18 of the verdicts yielded judgments of more
than $1 million, far fewer than the "dozens" cited during the
protests. Those awards included damages for lost wages and medical
expenses, as well as for pain and suffering.

Mr. Cohen and others cite a study by the Medical Society of New
Jersey, the group that helped orchestrate the job action, that showed
that the $250,000 cap would lead to only a 6 percent drop in insurance
rates. He added that most doctors were not told about other factors
behind the increases in premiums, including investment losses and
other problems in the insurance industry. "I think they decided to go
with the $250,000 cap mantra because it fit nicely on a hat," Mr.
Cohen said.

A compromise on the malpractice awards issue appears to be in the
works. The current Senate bill includes a $300,000 limit on the amount
insurers would pay for pain and suffering, but also would create a $25
million fund each year to augment cases that juries deem catastrophic.
Even then, the award could be no more than $1 million. The so-called
excess award fund would be financed through a $3 payroll surcharge on
employees who work in the medical, legal and accounting professions.

Dr. Robert S. Rigolosi, president of the medical society, said he was
heartened by negotiations in the Legislature, adding that rumors of
another job slowdown were just that. "I think we're arriving at some
reasonable compromises," he said. "We can work through the differences
we have." Groups representing trial lawyers and consumer watchdog
organizations, however, remain opposed to any cap on awards.

In the continuing Internet forum discussion, many doctors are still
unhappy. In e-mail messages, some called the proposed compromise a
sellout and a few clamored for a second walkout. Overall, however,
there was widespread satisfaction that a profession known for its
political quiescence was able to draw so much attention to the
malpractice awards issue. Several doctors, feeling empowered by last
month's experience, vowed to unseat unsympathetic lawmakers during
next year's elections.

Dr. John M. Taylor, a plastic surgeon from Long Branch who made an
unsuccessful bid for the Assembly two years ago as a Libertarian Party
candidate, said running for political office alone had its benefits.

"There is nothing like a direct threat to a professional politician's
job by a well-funded challenger to set their pants on fire, even if
you don't win the election," he wrote.

He added that gathering petition signatures for the ballot would be a
"piece of cake." "Our waiting rooms alone," he wrote, "would provide
enough signatures within a week or two."