"Those who cannot remember history are condemned to repeat it." Santayana

In 19th Century Vienna Dr. Ignaz Semmelweis was humiliated for proposing that handwashing could save lives. The bias he suffered we now now address with due process. We seek a Medical RICO Act to permit our profession to respect due process in the public interest.

A history of the Semmelweis Society by Dr. Waite follows:

10 July 1993

Dear Colleagues,

The evidence that medical peer review is abused is overwhelming. my belief is that it is the natural consequence of giving the peer review immunity in the face of great competition for medical business. Doctors by nature are competitive, egotistical, and often arrogant. This assemblage of physicians has many doctors who have gone through two or more training periods before you could get your license to practice medicine in this country. Many are thus extremely well qualified and more skilled than the doctors who grew up and trained in this country. If you are sympathetic and willing to listen and to work hard you are the worst kind of competition, one that is more skilled than I am. You generate a fear that I will lose business to you. Often my worst fears are realized and you do just that. The citizens like your care.

How does an established physician in the community deal with this threat? All too often the easy, quick, and elegant way to get you out of my turf is to use medical peer review. Many of you came to this country with the concept it has laws that give you a right to an impartial, just hearing on disputes. We have a model Constitution the envy of many societies. We have a Bill of Rights like a few other countries do.

The rampant abuse of medical peer review, with its immunity, then is used against you and its devastation is complete, you are powerless to fight it and I hear " but this is America" it can't happen here. !!!!

What does happen? While your accusers select the judge, or hearing officer, and they put their friends on the jury. Hearsay evidence is allowed. Hence any unsubstantiated evidence is admissible, and often sought out in large volume to increase the cost of defending against trivial charges, untrue charges, and illogical charges all with the plan of bankrupting you. The verdict is in before the hearing ever begins. The process is semi-judicial, thus you have no subpoena power, you have no right to compare your results to the other doctors on the staff. After all you are on trial, they are not. Secret documents that come from the quality assurance committees etc. will be seen for the first time. The charges to defend against are vague often. How do you fight shadows? Now during the deliberation phase after the trial the local doctors do not have to limit their consideration to just the evidence heard during the hearing. Since they all know, you or have heard of you, many charges or concerns they have will be considered, even though you do not know about them.

This is a kangaroo court.

This is immune at the insistence of the AMA and established doctors. There self interest are often overwhelming. They usually feel it will never happen to them. It will not as long as they are on the committees.

VERNER S. WAITE, M.D., INC.
8221 EAST THIRD STREET
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The now president of the AMA, John Clowes, can be heard on a commercial tape, acknowledging more than 80% of medical peer review is done for economic reasons. 

Still the AMA and organized medicine at the state levels have indicated no desire to change the system or remove the immunity. It is up to the outraged victims of this system to change it by vigorous action of our own. No one is going to do it for you. The lawmakers can change it by mandating outside doctors to sit in judgment, not the local doctors. In exchange for an unbiased jury we will give up our right to sue. The right to sue is an illusion for most of us for we do not have $500,000.00 to go to Federal Court. In Federal Court there is no immunity. If you get before a jury with the type of activity that occurs in medical peer review you may well win. This will be after five years of great anguish and a ruined reputation.

The idea of a data bank on peer review abuses appeals to me. However the data accumulated must be factual and not lead to the ruination of honest peer reviewers. Some honest peers do exist.

I believe the problem can be solved. Those who have suffered a medical peer review have little to lose. It will not go away if we do not become angry activists. Pressure from this organization, the Union of American Physicians and Dentist, The Association of Physicians and Surgeons, and The American College of Legal Medicine can probably be obtained. They are of the opinion the process is a deadly wrong. Elective representatives in this country are all too often the pawns of groups who give them the most money to get reelected. They should be actively lobbied even so.

I wish the Semmelweis Society to go out of business. Until it is not needed we are doing what we can to combat this problem. I have testified on the problem and will do so. I think this process can not stand vigorous exposure. Logically we should be able to get the Bill of Rights, the 6th Amendment for doctors.

Thank you.

Verner S. Waite MD FACS
Executive Secretary, Semmelweis Society

List of items and concepts to mention to Sacramento Committee on peer review.

• There is abuse of the peer review process occurring on a large scale in California
• The exact reverse of the intent of peer review laws is occurring. Politically entrenched incompetents are destroying enlightened competitors.
• Hospitals are regularly using peer review to punish whistle blowers who expose policies not in the public interest, for economic reasons, not bad medicine.
• There is an abundance of instances where economic motives are obviously at play in peer review, and a paucity of instances where "bad medicine" was the reason for the peer review. We have repeatedly requested information on the frequency of "good faith" peer review and have had no response from AMA, CMA, JCAHO, and CLM. We strongly suspect there is NO data on this, only assumptions.
• Doctors are not trained to do peer review. We are accustomed to decision by fiat. "My way is the only acceptable way" Peer reviews are regularly begun with pure fictional charges. It is as if doctors had never heard of the scientific method.
• A lawyer skilled in searching for the truth is therefore absolutely essential.
• Specific written charges are critical so the fiction can be seen, and thus combated and not conveniently changed.
• Destruction by delay is an effective weapon. Time constraints must be inserted to stop keeping the accused from simply withering away. Recall it takes five years to get into court after all hospital remedies are exhausted.
• False accusations should be apologized for in public once discovered. Slander is still effective in destroying anyone's reputation. A doctor's reputation is his most valuable asset.
• The access to the courts is quite limited, there is a "rule of non review" of medical matters.  Assuming doctors are honest is contrary to medical history
• The public's right to good medical care should not be jeopardized by continuing to allow monopolies of the entrenched incompetents to destroy competitors. Free enterprise in medical care would reduce the costs if hospitals can be made to compete fairly and unfair practices exposed, and thus change encouraged, now the voices for change are eliminated by "bad faith" peer review.

SEMMELWEIS hopes to present ways to avoid the web of entrapment in abuse.

Honorable Richard A. Gadbois
Judge, Central District Court
Santa Barbara, California

Dear Judge Gadbois,

8221 EAST THIRD STREET
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(213) 632-7105 e (213) W2-59M 14 January1991

I wish to make you aware of the nearly total dishonesty of medical peer review.

There appears to be an assumption that medical doctors, and hospital boards of trustees are inherently honest. After five years of gathering data we can conservatively conclude that 90% of medical peer review is done for only economic reasons. An honest peer review is a true rarity. This is quite consistent with the long history of medicine. It is confirmed by the record of what was suffered by Lister, Pasteur, Semmelweis, Galen, and on and on.

What has changed recently is the immunity granted medical peer review. Now one may have a kangaroo court with no fear of restraint. Hospitals have been placed above the law. The courts use the "substantial evidence rule" rather than an "independent judgment rule" to evaluate the evidence. We can demonstrate that substantial evidence is whatever lies one wishes to put on paper.

Hospital bylaws are uniform in the corrective action section in stating, "this is a semi-judicial proceeding, and the rules evidence do not apply". Physicians have essentially no rights that they would be entitled to if they were caught selling heroin. An adverse peer review presently means you will never again have hospital privileges. HMOs will not have you, you will not be able to obtain malpractice insurance. It has serious effects.

There would seem to be a major flaw in a system were envious colleagues can manufacture ludicrous lies and destroy the most skilled and compassionate physician on the staff. This is precisely what is occurring. The main offense is this individual is the busiest physician in that department. Incompetent doctors are no economic threat and rarely a peer review subject. Incompetents who refer to those in power are certainly not subject to review.

Medical peer review needs to be done on an objective data driven basis. It has not developed beyond the stage of the "good ole boys" maintaining their monopoly. The courts, unfortunately maintain the noncompetitive system, thus prices do not come down, new physicians can not come into the area. All rather cozy.

Years ago Santa Barbara drove out the premier heart transplant surgeon as a totally incompetent surgeon. Not a rare story, and not in the best interest of the people of Santa Barbara.

Yours truly,

Verner S. Waite MD FACS
Executive secretary, Semmelweis Society

QUESTION/ANSWER SESSION

SAN FRANCISCO - October 5, 1990

w/ John Lee Clowet M.D.

Chief of the House of Delegates
American Medical Association

Available on commercial tape

AMA President in 1993

DR. VERNER S. WAITE: I am Dr. Waite. my question is to Dr. Clowe. If the AMA has been found to have released a monster with its immunity provision, that you have insisted upon, is the AMA willing to rein the monster in.

JOHN L. CLOWE: That's a very good question. Yes, we are.

DR. WAITE: What kind of evidence does it take for you to realize that there is a monster. We have heard speaker after speaker, here today, refer to this. I'll be saying the same thing. What kind of evidence does the AMA need to rein this monster in?

R. CLOWE: I don't know how to answer that. Give me an example.

R. WAITE: 10,000 physicians in the United States destroyed maliciously by their competitors. 10,000 Patrick cases, purely malicious. Economic. only 100 cases found to be true honest peer review. Now what do you do?

R. CLOWE: You have put me on the spot.

R. WAITE: It doesn't seem like much of a spot. Could you consider reining the monster in under those circumstances?

R. CLOWE: I tell you what I will do. That is a very interesting point that hasn't been pushed very far.

R. WAITE: I have pushed it for four years to the AMA.

R. CLOWE: And it has not gotten anywhere at the AMA, as you know.

R. WAITE: Of course not. They keep insisting on immunity.

R. CLOWE: Yeah. But I will bring it back into our meeting and see if I can get an answer for you. And, I will get back to you.

R. WAITE: Like the lawyers' hypothetical question, those figures are not hypothetical.

CLOWE: I know they are not. You are absolutely right. And I will see what we can do about why 'the AMA has dragged their foot on this. I have no idea.