Laura Crafton M.D.
July 4, 2003
Federal Trade Commission Hearings
June 10, 2003
I was in attendance during the discussion of the utilization of "physician extenders" such as nurse midwives, nurse anesthetists, physical therapists, etc. The topic being considered was that of utilizing these professionalís services without the supervision of a physician. This represents the acceptance of lowering the standard of care from the traditional level of a trained physician to that of a nurse.
I was deeply concerned when I heard David Hyman state that a study of the cost to risk ratio should be considered. He stated that, "Possibly a savings of $50,000,000 in the training of physicians may justify accepting the increased occurrence of patient death at a rate of 1 in 400 cases."
To place matters in perspective; if I, or any other physician, had one patient in 400 die, we would expect to be investigated and probably lose our licenses to practice medicine. Likewise, one unjustified death could result in a $50,000,000 lawsuit against those involved. These costs are passed on to the consumer.
I know of two young women who died while undergoing cesarean section in a five-year period with a nurse anesthetist involved with the failed attempts of saving these womenís lives.
Consider the cost to train a physician. Around $80,000 of government subsidies goes to residency training programs for each year of residency spent in physician training. My training would most likely have cost the government around $480,000. I have never had a pregnant patient die while under my care nor do I have any malpractices judgments against me. I know of over 80 physicians who no longer practice their chosen profession due to the corporate practice of medicine. This represents around $32 million of taxpayer dollars.
Hospitals support physicians who have an assembly line approach to medical care. The more patients pushed through the system, the more money generated.
Physicianís lost their right of protection by the law against antitrust and racketeering when hospitals and their lawyers maliciously abuse the Health Care Quality Improvement Act of 1986.
Physicians who are in
direct competition and those who have been preferentially compensated by
their local hospitals sit in judgment of wrongfully accused physicians.
Due process is often ignored. A multitude of careers and lives have been
destroyed by the abuse of the system.
Marcus Welby would have been pushed out of the way to make room for physicians who donít spend as much time with individual patients, preferring to sacrifice quality for quantity. He, most likely, would have been accused falsely, under go a process of review, and have his resignation extorted from him to avoid being reported to the National Practionerís Databank.
People seem to not understand that a physician relies completely on having privileges at a hospital in order to care for critical and surgical patients. It is a far cry from being merely fired, pack up your family, pray that your patients find adequate care, and move on with your life. The devastation is far reaching from distraught patients who are losing their physicians to physicians, their spouses, and children who must accept that all of their efforts and training have been wasted.
State Attorney Generals and US Attorneys boast at all of the fraud and patient abuse they have and are prosecuting. I propose these are efforts of correcting the symptoms while the underlying disease thrives. This is a disease of greed and placing self-interest ahead of the best interest of the patients.
There is a long standing theory that a physician will not place his self interest in accumulating wealth ahead of the ethical and appropriate care of his patients in order to build a good reputation. This no longer appears to be case. The physicians who complain about substandard care and are patient advocates are labeled as disruptive and their careers are sacrificed. Physicians who remain at these hospitals in the wake of the carefully orchestrated physician extraction recognize that their practices and families stand in jeopardy of losing everything as well if they speak out.
A decision must be made. The result is an approach to patient care as an end to a means. The more patients seen, the more patients admitted to the hospital, results in the more money generated. These are the preferred physicians. When they want their competition eliminated, the hospitals either use a potential report to the National Practitionerís Databank to extort a resignation from that physician, or they proceed with a series of steps designed to appear like a review of a physicianís performance. When in all actuality, the decision to eliminate him has been made before any review is initiated. The hospital appoints physicians known to "play ball" to sit in judgment of the accused physician. Even if the conclusion is that no standard of care has been compromised, the Board of Trustees can overrule any descending opinions.
I beseech you to consider urging enforcement of the existing laws against antitrust and racketeering. Reform is necessary to prevent unfair panels from sitting in judgment of physicians who are being ousted from their practice of medicine. May God give you guidance in how you chose to respond to these matters.
Laura Crafton M.D.