By: Jean Johnson for Medtech1
We know our medical practitioners hold great power. Yet, we believe they are not above the law – or at the very least, regulation. Indeed we think, as we tuck our children into bed at night, that the medical world regulates its members and that we can trust our physicians and surgeons and dentists.
| Be informed when picking a doctor:|
Ask surgeons about their education, practice history, and the number of cases they’ve worked on – those with more experience typically have better outcomes.
Ask about patient death rates during and after given surgeries.
Check with state licensing boards for any disciplinary actions or restrictions.
Don’t be afraid to ask questions and do your research, it’s your health or a loved one’s health that is at stake.
Not so – at least in Oregon where between 1989 and 2000 Jayant M. Patel M.D. practiced over 10 years before investigators finally found him responsible “for gross or repeated acts of negligence.” Translated that means Patel did things like perform a colostomy backwards so the patient could not relieve himself, leave an 8-inch metal clamp in someone’s abdomen and severed a tube between a patient’s kidney and bladder.
Indeed, after Patel left the country for Australia in 2003 and his patients started dying, the Australian press dubbed him “Dr. Death.” Now the Portland Oregonian has joined the foray. “If a shoddy surgeon like Patel can’t lose his Oregon medical license for negligence, no doctor can,” the paper stated in the recent editorial.
According to Jim Kronenberg, chief operating officer of the Oregon Medical Association, who commented on the Board of Medical Examiners that upholds Oregon’s Medical Practice Act, the board could have revoked Jayant M. Patel, M.D.’s medical license “if they wanted to spend the time and money, and match the resources of what I understand is a relatively wealthy physician.” Instead, the Board and Kaiser Permanente merely placed restrictions on Patel’s ability to practice in Oregon. Undeterred, Patel went off to Australia with six highly favorable reference letters from Oregon colleagues and wound up chief of surgery at a rural hospital that has a hard time getting doctors.
It’s ironic that Oregon, the state that spawned national legislation in 1986 creating the National Practitioner Data Bank – a clearinghouse for information on malpractice suits as well as disciplinary actions for incompetence or misconduct – is the same state in which Patel was essentially allowed to practice highly irresponsible medicine without appropriate sanction.
The idea behind Oregon congressman Ron Wyden’s National Practitioner Data Bank was that the nation needed a way to track unethical physicians and dentists who avoided censure by skipping across state lines and setting up shop where their misdeeds were unknown. The National Data Bank is not open to the public, and according to the American Medical Association the “clamor” to have it otherwise is unfounded. Data in the bank, the AMA contends, is “flawed and should not be used to measure a physician’s competence.” Instead the arm of the medical profession recommends using physician profiling systems that have been established in half the nation’s states to date.
How well do state rosters serve the public? If Oregon is any indication, not very well. Visitors to the Web site discover that, yes they can get information about disciplinary actions taken against physicians, but there is no mention of how Joan Q. Public might go about doing that. Also the site informs passersby that “the Board does not give out information about complaints, since all complaints are not valid and a licensee’s reputation could be harmed unfairly.” The site also directs those interested in finding out if a specific health care provider has been sued to “write the Board a letter requesting a malpractice search on the doctor. There is a $10 fee for this service.” It goes without saying, of course, that the only way to locate any information is to have a particular physician or dentist name. There are no rosters available that might for example, list those in a particular field that have histories of malpractice concerns.
The problem is, says Lisa McGiffert of the nonprofit Consumers Union who works on health care disclosure issues, “It’s pretty common understanding in the medical world that what gets measured, gets done, and I think that the American public does not know that doctors and hospitals are not looking.” McGiffert continues to explain that if the medical world did a better job of tracking outcomes, careless errors that result in thousands of deaths would decrease.
Medical director for quality at Providence St. Vincent Medical Center in Portland, Steve Gordon, M.D., agrees with McGiffert. “As the recent Patel case shows, the community needs to know that dangerous doctors do not operate on patients,” Gordon said. But, “getting rid of these bad apples is just the tip of the iceberg.” Not very comforting talk from the quality control man at the helm in one of the nation’s major metropolitan hospitals.
Still progress is inching along. In New York where hospitals now compile data on bypass surgeries, several surgeons received restrictions against doing the operations and now confine their practice to less delicate matters. In the first three years following the restrictions, associated death rates fell 41 percent. Similarly after Congress required federal Veteran’s hospitals to track rates of surgical errors beginning 1986, VA deaths from major surgery fell 27 percent and non-fatal injuries dropped 45 percent.
After such promising results started coming to light, the American College of Surgeons began its own tracking system in 2001 with 18 participating academic and private hospitals. The cost of enrolling is $35,000 annually as well as hiring a full-time nurse to collect data. Still said Scott Jones, director of the ACS program, “it’s a significant amount of money, but if they deflected two complications, they’d pay for it.”
Despite the rise of tracking programs and the public outcry for a look at their health care providers’ records, considerable resistance against glass windows remains within the medical world. Chief of surgery at Portland-based Legacy Health Systems, Mark Kestner thinks surgeons might be reluctant to take especially serious cases in which outcomes are questionable. “Does disclosure change the way you practice?” said Kestner. “The answer, I would have to think, is yes, just because you’re afraid.”
The Consumer Union’s McGiffert, though, thinks the trade off acceptable. “So much of this information is secret, kept from the public,” she argues. “I really wish the medical community would embrace this concept of accountability and improvement.” So do the patients in Oregon and Australia that suffered under Jayant Patel’s scalpel.