Sunday, September 21, 2008

MN-01 : Will Davis Use a Mankato Case to Explain His Health Care Concerns ?

When FBI attorney and whistleblower Colleen Rowley announced that she would oppose John Kline for the Second District Congressional seat for the 2006 elections, voters knew that the Global War on Terrorism would be at the center of their campaigns.
When Brian Davis, a physician associated with the Mayo Clinic, announced that he was seeking to represent the First District for the 2008 elections, I thought that health care would be a prime issue.

Health care is not only a concern for voters individually, but its financial impact weighs heavily on businesses that provide employee benefits and on the Federal budget.

Every voter has questions regarding health care coverage and government involvement, but mine include :
-- How do we get to universal participation (Senator David Durenberger in leading the Minnesota Citizens Panel on Health Care Costs has stated that the resolution of the health care crisis is universal participation) ?
-- How to handle high-risk patients that have pre-existing conditions and unable to procure health insurance ?
-- Should Medicare be subject to means testing ?
-- How do we address the shortage of primary care physicians ? (Specialists – in fields like radiology, orthopedic surgery, cardiology, and other tech fields – take home 2 to 3 times the income of primary care physicians, and have more time off.)
-- How do we reduce the $98 billion a year in excess administrative costs as McKinsey and Company noted in their study ?
--- How do we improve effectiveness of personal physicians ? According to Paul Grundy, MD, Director of Health Care Transformation for IBM says a humanistic, patient-centered approach can cuts costs by 30% and improves outcomes by 20%.
-- And the immediate question of how to fund the Medicare trust fund that covers hospital stays that will start running out in 2011 and may be emptied by 2019 ?

Alas, Dr. Davis has not used the health care as a prime issue in his campaign. His website is extremely lacking in details but he did tell KAAL television "I'd like to see a greater transparency in costs so that individuals can become better informed consumers, I'd like to see us have tort reform, the cost of malpractice is driving doctors and hospitals out of business," says Republican candidate Dr. Brian Davis.

It is disappointing that Davis focuses on malpractice rather than the other aspect of health care.

Essentially, Davis is going down the same road that President Bush has traveled in his successful elections. Although Bush and the AMA used tort reform as a campaign issue, a General Accounting Office report indicated that the crisis was overblown. Malpractice rates were impacted by insurers' losses in their investment portfolios, inadequate reserves to pay claims and artificially low rates set during the 1990s when many companies vied to attract policyholders.

The American Medical News reported that 84% of liability companies reported in 2007 rates held steady or dropped while the lowest rates for internists ($3,375), general surgeons ($11,306), and Ob-Gyns ($20.626), are all in Minnesota. Besides Minnesota, states ranking in low tier are our neighbors -- South Dakota, Wisconsin, and Iowa.

That stated, malpractice is a serious problem.
But, is it as big as Dr. Davis implies ?

How many malpractice lawsuits may be settled out of court is not readily available, but last week a Blue Earth County jury found a physician liable.
Excerpts from the Mankato Free Press article : The jury’s unanimous award totaled $975,501. The jury awarded $118,001 for past medical expenses, $137,500 for bodily and mental harm, $420,000 for future damages and mental harm, and $300,000 for loss of future earning capacity.
“This was a horrific injury,” said Michael Djordjevich, the plaintiff’s attorney. During the baby’s delivery, her shoulder was injured. The injury, her lawyers argued, will cause lifelong limitations and significantly reduce future earnings. Djordjevich had shown jurors a radiology report that said measurements of the fetus were “suggestive of a macrosomic fetus.” Macrosomia is a medical term describing a fetus or newborn of excessive weight. He said accepted, published medical standards suggest a C-section be done with macrosomic fetuses.
Djordjevich also showed notes made by the obstetrician prior to the delivery in which she suggested she would order a C-section if the labor did not progress well. Djordjevich, using charts of the progression of the labor, said the obstetrician failed to follow her own plans by not ordering a C-section when the labor did not progress as quickly as it should have.

NOTE : The physician’s and family names were omitted in my excerpt but listed in the MFP story as I do not believe that is relevant to the discussion of medical malpractice.

Now, $975,501 is a lot of money … but is it outlandish ?
The $118,001 for past medical expenses is in line with the current Medicare philosophy of not paying for medical errors or mismanagement. The $300,000 for loss of future earnings amounts to less than $7,500 over a normal 40 year working career … if anything that seems small. The concern is that the shoulder, which was injured during the delivery, will experience lifelong limitations … without knowing the extent of the range of motion, it is quite possible that the child may be limited in career opportunities … such as becoming a physician such as Dr. Davis and thus deprived of earning a salary of $411,780 per year … which is more than what the jury awarded.
This jury members did their job … they listened to the testimony and rendered a verdict. In this case, the system worked ... even if my future health insurance rates eventually reflect this verdict.

Instead of crying for tort reform, Dr. Davis should acknowledge that mistakes are made and that is why malpractice insurance is warranted.
Instead of attacking trial lawyers, he should be promoting efforts to get other states to improve to Minnesota’s performance level. It’s not just blind luck that impacts malpractice insurance rates … it’s also by effective management. For example, Minnesota Medical Insurance Company (MMIC) has sponsored aggressive programs focusing on reducing malpractice risks, patient safety, communication, and quality which has attributed to Minnesota's low malpractice rates.
If patients did not have the remedy of lawsuit, the medical community may not be motivated to improve itself.

In July, I wrote about candidate Dr. Davis Prescription for Health Care.
Now, that Dr. Davis is the officially on the ballot, he should inform voters of his past and current relationship with the medical industry.
#1. Davis’ personal financial disclosure form indicated ownership in a pharmaceutical company. Will Davis sell the stock outright ? Senator and Doctor Bill Frist moved his investments into a blind trust and that did not stop a SEC investigation involving sale of his HCA stock.
#2. As a Co-director of the Prostate Cancer Program at the Mayo Clinic and as Vice President of the American Brachytherapy Society, have you ever been compensated (monies or trips) for educational lecturers, participation in seminars, and/or educational research grants from pharmaceutical companies ? From 1997 through 2005, drug makers paid more than 5,500 doctors, nurses and other health care workers in Minnesota at least $57 million. Another $40 million went to clinics, research centers and other organizations. More than 20 percent of the state’s licensed physicians received money.
#3. Will Dr. Davis release for public review his complete income tax records so that voters can determine if any compensation recieved as noted in #2 has been properly recorded ? The Schedule D will provide insight into investments in the medical industry.
#4. Lastly, will he support the McCain health care plan which will make employer-provided health care taxable income for employees (resulting in a average tax increase of $2870 in taxes), deregulating the health care insurance industry and potentially eliminating coverage for 20 million citizens ?

Just as Dr. Davis recommends "a greater transparency” so that individuals can become better informed consumers, voters need the same "transparency” to evaluate his candidacy.

Voters need to know if Dr. Davis will represent the AMA and the pharmaceutical and medical industry ... or the citizens of the First District.

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