[PLUG-TALK] Malpractice in the real world

Keith Lofstrom keithl at kl-ic.com
Tue Sep 7 13:09:42 PDT 2004

Ditching the abstract 10,000 foot rhetoric for now, let's get down
to a real case.  Dr. Kim Webster is an internal medicine doctor who
is one of the most knowledgable in Portland on the multi-system 
chemical interplay in the human body.  Give him a patient with a
bunch of wierd symptoms that don't fit any standard diagnosis, and
as often as not he will find some chemical imbalance that usually
can be cured with dietary change, habit adjustment, or sometimes 
medication.  My wife referred patients to him a lot.  Some of you
have problems like that.  Dr. Webster might have helped you. 


Past tense.  A few years ago, Dr. Webster was assigned a teenage
patient with severe emotional problems.  Dr. Webster referred the
young man to a psychiatrist ("referred" in medical lingo means
arranged for another specialist to take the case, cleared the deal
with the insurance company, and strongly suggested to the patient
that they see the other doctor.  "committed" means use the cops
to see that it happens.  Judges [lawyers], not doctors, commit).

Well, the young man refused to see a shrink.  Dr. Webster prescribed
anti-depression medicine.  The young man didn't take the pills.
Then the patient attempted suicide.  Put the gun in the mouth,
pulled the trigger, and survived.  Barely.  Much crippling damage.  

When the legal fracas ended, Dr. Webster was dinged for $4M
dollars, allegedly to support the crippled kid until death. 
It destroyed Dr. Webster's small practice, he can no longer get
individual malpractice insurance ("one strike and your out")
and he is now working for a largish group as staff physician,
no longer available to the 95% of physicians and patients in
the Portland area that are not associated with the large group
practice.  In other words, he had to do the equivalent of joining
Microsoft.  He can no longer offer his skills to a world that
cannot take responsibility for its own so-called sympathy.

Now, I cannot give you hard numbers on how many patients this has
killed, because there is no clear binary knife I can apply to separate
outcomes.  But I can say that a few of my wife's patients might have
lived if Dr. Webster's wisdom and skills were still publically
available, and that dozens of other practices were also deprived of
his skills.  Medical malpractice rates noticably jumped in the area,
which caused at least one of my wife's colleagues, Dr.  Rosemary
Otis, to leave her practice and go study software, with the hopes
of getting a software job (Dr. Otis has a family, and cannot put
in the 80 hour weeks necessary to survive as a female doctor in
Portland).  So the cost of this one judgment is a few dozen
hard-to-pinpoint dead patients a year, at least two fewer generally
available physicians and probably more, one programmer without a job
(Dr. Otis is a smart cookie and will take yours), and an atmosphere
of distrust that makes every physician in town silently avoid
troubled people like that teenage boy. 


Now, make a single-number national statistic out of that.  I can
say that when a North Carolina ambulance chaser targets an internal
medicine physician, this is the outcome.  When he targets an OB, the
results are far more tragic, because OBs can do so much more for the
health of the population.  These shysters are monsters, NOT heros.


Keith Lofstrom           keithl at ieee.org         Voice (503)-520-1993
KLIC --- Keith Lofstrom Integrated Circuits --- "Your Ideas in Silicon"
Design Contracting in Bipolar and CMOS - Analog, Digital, and Scan ICs

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