James Lett II, M.D., medical director of three nursing homes, will carve out time this year to serve, pro bono, as president of the 8,000-member American Medical Directors Association. "That's one of the wonderful things about AMDA; it's a volunteer organization," says Lett. "No one gets paid. People do this because they're passionate about long-term care."
Lett, a resident of Carmichael, Calif., a Sacramento suburb, was chosen to lead the organization at its annual symposium in March in Orlando, Fla.
He is a graduate of the University of Kentucky College of Medicine and completed his residency in family practice at Franciscan Medical Center in Dayton, Ohio.
His wife, Cheryl Phillips, M.D., is an AMDA past president.
"We actually met through AMDA, and decided that just knowing each other wasn't good enough," Lett says.
All the tools
Lett brings both clinical skills and "what I call Kentucky wisdom" to the job, says Tom Kraus, undersecretary of the California Department of Veterans Affairs. "He understands human nature and what you have to do to get people to change."
Kraus, based in Sacramento, runs three long-term care facilities with a total of 2,000 beds. He says he hired Lett to help impart the physician leader's dedication to long-term care as a specialty to 25 VA-employed physicians.
"That's how I've used him and hope to continue to use him to bring our doctors up to those standards," Kraus says.
Lett says the medical malpractice insurance crisis has hit the long-term care industry just as hard as it has other areas of healthcare. It will be his most urgent problem as AMDA president.
Typically, the duties of a medical director of a long-term care facility are not covered by a physician's personal med mal insurance policy, Lett says. Coverage is most often provided by the medical director's facility, yet many facilities have been hard-pressed to find coverage that is affordable.
"There are some facilities paying $7,500 a bed a year for malpractice insurance," Lett says. "That's not sustainable."
As a result, some nursing homes have elected to run without liability coverage, which also leaves medical directors uncovered. As with physicians and hospitals, the med mal problem in long-term care varies in intensity state by state.
"Florida is probably the worst of them at this time, (followed by) Texas," Lett says. "California has become bad even with the hailed MICRA laws. Unfortunately, the courts have allowed an end-run around them.
"It is a huge issue for our members," he continues. "If the facility does not have insurance, that typically means your medical director doesn't have coverage. What that means is you can't get a physician to be your medical director, and by law, to be licensed by Medicare, you must have a physician (as) medical director.
"Physicians, as much as we love long-term care, are simply going to leave," Lett says. "We've done some recent surveys that have shown we have at least 5% of our members who have dropped at least one of their medical directorships at one or more facilities. When you're considering the universe of long-term care facilities, those are really big numbers."
Lett says the AMDA supports pending federal legislation to set a national tort cap of $250,000 on damages for pain and suffering but sees that as only one of several necessary steps toward reform.
"That is an avenue we think needs to happen, otherwise you have to deal with 50 states and the District of Columbia to deal with this, and that's just too difficult to do to get a remedy," Lett says.
No solo performer
Lett says he has eschewed working as a solo practitioner and has opted to join the 200-physician Sutter Medical Group based in Sacramento, in part because of the med mal liability problem.
Lett also sees part of his role as AMDA president as trying to put a face on long-term care.
"None of us wants to age and, in fact, live in a country and a culture that literally worships youth and beauty," he says. Another common fear is that of getting old and going into a nursing home.
Lett says part of his job will be "to show that there are people in long-term care who are caring and who will try to help you to live out the rest of your days."
"Successful aging isn't always about keeping your golf score to a 10 handicap," he says. "It can be a lot of different things. It's about compassionate and loving care at a time in your life when you're not able to provide for yourself. Sometimes successful aging is finding a place where you can live the best you can live with what has happened."
James Lett II, M.D.Age: 54
Education: University of Kentucky College of Medicine
Residency: Franciscan Medical Center, Dayton, Ohio
Practice: Private physician, post-acute and long-term care, Sutton Medical Group, Sacramento
Leadership: President of AMDA, medical director of nursing facilities