Note: Abortion Malpractice is seriously underreported. Women's health is threatened daily by unregulated abortion "clinics." Priests for Life brings this article to your attention because of the fact that of the five medical mishaps reported here, one of them was a botched abortion. However, the fact that the procedure was an abortion is not mentioned. Even the photo caption masks the full story by stating, "Dr. David Benjamin allowed Guadalupe Negron to bleed to death following surgery at his Queens, N.Y., clinic. He was convicted of her murder in 1995." We make no assertion that anyone in particular is to blame for this curious avoidance of explicit reference to abortion; we simply point it out.
The paramedic who arrived on the scene was so disgusted by the filthy, disorganized conditions inside that he spoke out publicly about it.]
THROUGHOUT AMERICA there are thousands of doctors-working in hospitals, clinics and private offices-who hurt and even fatally injure patients through incompetence or carelessness yet remain in active practice. It is almost impossible for the typical patient-you and me--to find out who they are.
"There are between 620,000 and 650,000 licensed physicians in the country," says Dr. Ted Lewers, a kidney specialist in Easton, Md., and a board member of the American Medical Association (AMA). When asked how many of them could be categorized as incompetent, unscrupulous or impaired, Dr. Lewers replied, "Very few-5 to 10 percent." But that could mean 1,000 to 65,000 physicians who pose significant risk to patients.
The risks are very real:
· In Denver, Richard Corbett Leonard, 8, died during a routine ear operation because the anesthesiologist allegedly fell asleep.
· In Tampa, a surgeon amputated the wrong lower leg of Willie King, 52, a diabetic.
· The wrong lung was removed from 59 year-old Benjamin Jones Jr. in Fort Worth Tex.
· Guadalupe Negron, 33, bled to death after her uterus was cut by a doctor who was still operating while appealing the revocation of his license.
· In Boston, Betsy Lehman, 39, was killed when a doctor prescribed a dose of an anticancer drug that was far too high.
"You can go into the offices of two different doctors, side by side, and see an impressive wall of framed diplomas, says Dr. Sidney M. Wolfe, co-creator with Ralph Nader of the nonprofit Public Citizen Health Research Group. "But you have no way of knowing whether one is supremely competent and the other has a pattern of misdiagnosis, mistreatment, incompetence. Information that might guide you exists, but much of it is secret, even to doctors."
How, then, can you figure out if a doctor is okay or questionable? Who has the information? Is it secret? Why?
The route to finding answers is complex. We'll lead you through the maze. But please keep in mind that this report focuses on incompetent, impaired doctors. It is not an indictment of the vast majority of physicians, who are conscientious, hardworking, trustworthy, reliable and dedicated to fulfilling the Hippocratic Oath to "abstain from harm." Day after day, they provide patients with medical treatment that meets the highest standards of care.
Still, it is in the public's interest, as well as the medical profession's, that the questionable doctors be identified. That goal is supported in varying degrees by such groups as the AMA, the American Board of Medical Specialties and "watchdog" organizations such as the Public Citizen Health Research Group.
HOW BAD IS THE PROBLEM?
How likely are you to be hurt by a physician? A detailed report about doctor-caused injuries was contained in The Harvard Medical Practice Study, published in 1990. Dozens of expert researchers in medicine, law, economics, statistics, policy analysis and peer review analyzed health care in New York State in 1984. Their findings were based on patient and physician and surgeon interviews, hospital records, peer reviews, insurance claims and malpractice suits. The results showed:
· Of an estimated 2.7 million patients hospitalized in New York State at the time, 98,609 (or 3.65 percent), suffered injury attributed to medical intervention rather than their underlying disease. (An example would be a cancer patient dying from an overdose of chemotherapy.)
· Of those medical injuries, nearly 28 percent resulted from negligence. (An example would be if a physician failed to order a biopsy after seeing a chest X-ray with a detectable lesion.)
· Of the medical injuries, 69 percent were caused by errors.
· More than 13,000 (about 0.5 percent) of the total 2.7 million patients died at least in part as a result of those injuries.
This means that for every 1000 patients who entered the hospital, five died at least in part as a result of poor care. Although these findings do not encourage confidence, the situation can be reversed, according to Dr. Lucien L. Leape of the Harvard Health School of Public Health. He contends that most doctor-related injuries "are due to errors and are, therefore, potentially preventable."
But, again, the dilemma for patients lies in how to detect which doctors to avoid. Isn't there some list or government agency keeping an eye on bad doctors?
WHO HAS THE NAMES?
The government does have a very restricted the names of more than 80,000 physicians who were involved in malpractice suits, were disciplined by state medical boards, lost hospital privileges or had adverse reviews regarding membership in professional societies. It is the National Practitioner Data Bank (NPDB). Only hospital medical boards and similar health-care providers can check the information in the data bank. Doctors can check on themselves but not other doctors. "The NPDB was developed because it was very difficult to get information about bad doctors and hospital mishaps", says Dr. Stephen B. Permison, deputy director of the Health Resources and Services Administration which oversees the data bank. "Medical boards, medical societies and insurance companies clammed up."
Even if you had access to the NPDB, there is no guarantee that it has the full story on questionable doctors. The law says that all of the nation's 6374 hospitals are required to supply the NPDB with the names of any doctors whose privileges have been suspended for 31 days or more. But more than half of the nation's hospitals have never listed a single doctor.
How is it possible that so many hospitals have not made a single report? Dr. Jack Lord, the American Hospital Association's senior adviser for clinical affairs, says there is a valid reason: "Hospitals have quality-assurance programs in which the behavior of physicians and clinical outcomes are monitored," he explains, "and the issues have been adequately addressed before getting to a stage which would require making a report."
On the other hand, Thomas C. Croft, director of the Division of Quality Assurance of the Health Resources and Services Administration, says: "When suspensions are put at less than 31 days, they do not have to be reported. We do not have the legal authority to get hospital quality-assurance records to determine how many 30-day or less suspensions there may have been to avoid reporting to the data bank. It would be valuable to see what the trend in suspensions has been over a 10-year period. Right now, all we can do is speculate."
CAN YOU GET THE NAMES?
Sen. Ron Wyden, the Oregon Democrat who introduced the legislation that created the data bank when he was a member of the House of Representatives, is preparing legislation to open it to the public. "When our citizens get into HMO programs," he says, "and have to choose between doctors, I think they should be able to get information from the data bank to help them make a sound choice."
But the American Medical Association, in a 1995 policy statement, said it "opposes all efforts to open the NPDB to public access." Why? "There is information the public can't use or interpret," explains Dr. Lewers. "It does not really tell you anything about a doctor other than he's listed, and you might jump to an unwarranted conclusion."
Dr. Ciro V. Sumaya, administrator of the Health Resources and Services Administration, supports some limitation of access to the information. "It could lead to pandemonium, misperception, to a lot of confusion for the public working with pieces of information," he says.
But two consumer advocates--Richard E. Vuemick, legal policy director of Citizen Action, a 3 million-member organization based in Washington, D.C., and Mike Donio, director of project for the People's Medical Society in Allentown, Pa.--say there is a strong public interest in having access to the data bank.
"We are not interested in sensationalizing or witch-hunting," says Donio. Vuernick adds: "What we want is to have the profession take the responsibility of removing bad doctors from patient contact. If a physician has an alcohol or drug problem, get him out of the arena, dry him out and get him back to where he should be. If he's a surgeon fouling up operations, retrain him. Don't wait until it happens for the 42nd time.
IS THERE A CODE OF SILENCE?
The AMA Code of Ethics says the doctors are obliged to report evidence of incompetence, substance abuse or unethical conduct. But critics such as Sandra Gainer--a registered nurse who is the associate director of the National Center for Patients' Rights, an organization based in New York City with more than 4000 members who believe they have been injured by doctors--say there is another code that comes into play: Silence.
"It is part of the medical establishment culture," says Gainer. "Doctors rarely report other doctors, nor do nurses and interns and pharmacists or anyone else in the entire profession. Those who do blow the whistle on other doctors risk retaliation."
In a Dec. 21, 1994, editorial in the Journal of the American Medical Association, Dr. David Blumenthal of Harvard referred to doctor errors and wrote: "Concerning medical error and its prevention, the profession has, with rare exceptions, adopted an ostrichlike attitude."
WHAT ABOUT THE MEDICAL BOARDS?
Medical Boards in most states license and certify physicians and also have the responsibility and power to discipline them by revoking licenses,
Presumably, a private citizen can ask a state's disciplinary agency to reveal the names of doctors who have been disciplined and for what reason. But Public Citizen reports that there are wide differences between state boards and the manner in which they respond. The best state boards keep a vigilant eye on doctors' behavior and performance. However, a doctor who loses a license in one state can move to another in which he also may be licensed without that board learning about any disciplinary action for months or longer, if ever.
(Public Citizen can provide a list of physicians in any state who have been disciplined by the state medical board or the federal government. It's available for $15. Specify the state you are requesting and write: Public Citizen Health Research Group, Dept. P, 1600 20th St., N.W., Washington, D.C. 20009.)
The American Hospital Association's Dr. Lord acknowledges that a better job has to be done. "Are we perfect in what we do in terms of taking care of people?" he asks. "No. But we're getting better."
"If physicians, nurses, pharmacists and administrators are to succeed in reducing errors in hospital care," says Dr. Lucien Leape of Harvard, "they will need to fundamentally change the way they think about errors and why they occur."
Meanwhile, as health-care consumers, we have to stay vigilant and do our homework. Remember that in dealing with the health care profession you have rights-including the right to ask questions and to expect and get answers. Your health may depend on it.
AVOIDING A BAD DOCTOR
Here are some questions to ask when choosing a doctor:
1) Has the doctor been disciplined or formally charged with misconduct? You can find out by calling or writing the state medical board.
2) Has your doctor lost hospital privileges? Ask the doctor.
3) Is the doctor board-certified? Check with the American Board of Medical Specialties. Call 1-800-776-2378 Monday through Friday, 9 a.m. to 6 p.m. Eastern time.
4) Has your doctor's malpractice insurance ever been canceled? Some state medical boards will tell you when a doctor has had insurance canceled (but most doctors can get insurance no matter how bad their record).
5) What does the AMA have on file about your doctor? The American Medical Directory, published by the AMA, lists the affiliations of its members. It should be available at your public library. For $60 the AMA will provide biographical information on as many as four physicians. Write: AMA, Department of Physician Data Services, Dept. P, 515 N. State St., Chicago, Ill. 60610.