I think if I had done this five or six years ago, I'd have been taken out and lynched." So says Robert Wachter in the News Makers column of Feb. 23 (p. 60), referring to his new book Internal Bleeding: The Truth Behind America's Terrifying Epidemic of Medical Mistakes.
Wachter may think he is joking, but history confirms his notion. When Lowell Levin, Ed Weiner and I wrote our best-selling book, Medicine on Trial, in 1988, it was met with an onslaught of hatred and threats from many quarters in the medical establishment. The American Medical Association issued an "adverse commentary alert" to its member units throughout the country suggesting state and local affiliates do all they could to discredit the book.
One state affiliate even went so far as to ask Yale University, where Levin was a distinguished faculty member, to review his tenure and status. Fortunately, we had thick skin and evidence to support our claims. The book went on to sell more than 150,000 copies, and more than 80% of the studies we cited were later referenced in the Institute of Medicine's To Err Is Human report 11 years later.
The real tragedy is not the vitriol the established medical world has for heretics, but that they ignore the evidence and the findings. Little was done after our book was published 16 years ago to improve medical quality and, frankly, little has been done since the IOM report five years ago.
Maybe Wachter's book will spark a little more action, but if I were him, I'd be watching my back.
People's Medical Society
True tort payouts larger
Your article on malpractice payouts reflects some significant misinterpretations of the Aon Risk Services study ("Paying up," Feb. 9, p. 26).
The Aon study demonstrates that our current tort system is a very inefficient means of providing compensation for professional negligence. Approximately 60% of the payouts on the 17,071 hospital closed claims went to someone other than the injured people. Nineteen percent of those payouts went to defense attorneys and for other defense costs. The other 81% were paid to plaintiffs and their attorneys. Under prevailing contingency-fee agreements and after paying expenses such as plaintiffs' expert fees, the actual plaintiffs are unlikely to have received more than 40% of the total payouts.
The article incorrectly assumes that a state designated by the American Medical Association as in crisis over physician liability would also be a hospital liability crisis state. In fact, in many states the liability laws are more favorable to hospitals than physicians or vice versa.
Further, the article's author apparently did not recognize the significance of the Aon study limiting included losses to $2 million per occurrence. In other words, the portion of any payout (defense costs plus indemnity) of more than $2 million was ignored in the Aon analysis. This decision by Aon results in an understatement of the actual losses suffered (especially for hospitals) and hides the impact of damage caps on loss experience and insurance costs.
Vice president of legal affairs
University Health Care System
Who is playing politics?
It is very interesting that you chose to reference a New York Times editorial criticizing the Bush administration for allegedly politicizing science (Modern Healthcare's Daily Dose, Feb. 24). Is it not a fact that your action to choose this particular viewpoint of the issue was politicizing the issue?
You assume the New York Times is an unbiased resource of information. We know better, and I am disappointed that you waste our time playing the media game of innuendo.
Chief financial officer
Muenster (Texas) Memorial Hospital
Medicaid profits rare
In a piece posted Feb. 24 on modernhealthcare.com, "Medicaid managed-care plan sees profits rise," Laura Benko reports that "Amerigroup Corp., Virginia Beach, Va., saw its year-end and fourth-quarter profits rise substantially thanks to acquisitions and stabilizing medical costs." I want to point out that "big profits" are definitely not a trend for Medicaid managed-care plans, which have been struggling hard for years to meet their budgets and comply with stringent regulatory requirements laid down by the governmental agencies and oversight bodies.
It's true that after years of toil, plans are finally seeing some kind of cost stabilization. But that has not turned into profits for most plans partly because-as the article hinted-plans must reach a minimum scale of operations to realize any such benefits. Medicaid managed-care plans in my home state of Pennsylvania are still trying to come to grips with the huge amount of shortfall in aid from the state Department of Public Welfare.
Plans probably realize that if they do not expand to friendlier states and increase economies of scale, they probably won't stay afloat for long.
Health policy fellow
Health Policy Institute
University of Pittsburgh
In the story on interventional cardiac care in your Jan. 12 issue ("Taking it to heart," p. 28), it is stated that the nearest heart surgery center to Pocatello, Idaho, is 21/2 hours away. This is untrue. I work for two cardiovascular surgeons located in Idaho Falls, about 50 miles north of Pocatello. Not only has the heart program been in Idaho Falls for more than 10 years, but more than 90% of the coronary artery bypass surgeries are performed while the heart continues to beat.
Too bad Portneuf Medical Center in Pocatello has not supported our program to save its patients a long drive to Utah and have high-quality surgery far closer to home.
Physician office manager
Idaho Falls, Idaho
Proud Hoosier RNs
Regarding the item in the Feb. 16 Outliers column (p. 36) about a new license plate for registered nurses in Pennsylvania, you should know that the Indiana Organization of Nurse Executives sponsored an RN license plate that debuted in January. More than 700 were sold in 2003 before the plates were even manufactured. We are proud to be nurses in Indiana, too!
Vice president of nursing
Memorial Hospital of South Bend (Ind.)