Thursday, January 29, 2009

Doctor Recruitment and Retention Action Plan 2009

Recognizing the mounting healthcare crisis facing our state, Representative Jon Riki Karamatsu (D41-Waipahu, Village Park, Waikele), Chair of the House Judiciary Committee, has introduced a healthcare package comprised of eight bills, each addressing different issues that medical professionals have faced over the years, and cite as reasons for the increasing doctor shortage and rising cost of care in Hawai‘i.

The eight bills, collectively called the Hawai‘i Doctor Recruitment and Retention Action Plan (HI-DRRAP) 2009, cover issues ranging from a comprehensive task force study and strategic plan to the re-establishment of the Patient Compensation Fund.

Those proposals include:

* Re-establishing the patient compensation fund
*Changing the make-up and duties of the medical claims conciliation panel
*Creating a cap on non-economic damages, tax credits for physicians serving in rural areas, a tort cap for specialty doctors such as neurologists
*Amending the duties of the Hawai‘i healthcare primary incentive program
*Convening a task force to develop a comprehensive strategic plan
*Establishing an office of state coordinator of health information exchange in order to advance efforts to create a statewide health information exchange network

“Healthcare is an essential component in our society because it affects everyone,” said Rep. Karamatsu. “We cannot afford to continue losing doctors, especially for the under-served and rural areas of the state, and tort reform is not the only answer. That is why we decided to introduce such a diverse package.”

“Physicians play an important role in our healthcare system in Hawai‘i and the House Health committee is exploring a wide variety of options that support our local doctors,” said Rep. Ryan Yamane, Chair of the House Health Committee. The bills are expected to first be assigned to the House Health Committee.

In the 2008 legislative session, a tort reform measure failed to be voted out of the House Judiciary Committee.

“I’m optimistic that we will make progress on this issue in the House this year,” said Rep. Karamatsu.

Establishes a $750,000 aggregate and $250,000 individual cap on non-economic medical malpractice damages, and allows for a $3,000,000 cap on non-economic medical malpractice damages when gross negligence is involved. Also establishes caps on attorney fees.

Re-establishes the Patient Compensation Fund in the state of Hawai‘i so that the state’s healthcare providers can have stable and reasonable surcharge rates that are sufficient to fairly compensate legitimate victims of medical malpractice.

Creates a medical malpractice task force who shall review all of the various reasons that makes it difficult for doctors to be able to afford to live and work in Hawai‘i and explore alternative solutions, including those used in other states and on a national level. Requires the task force to develop a strategic plan and present it to the 2010 Hawai‘i State Legislature.

Establishes medical malpractice insurance rate caps for highly-needed specialty doctors such as neurologists and neurosurgeons.

Creates a tax credit on medical malpractice insurance rates for physicians willing to serve in rural/under-served areas in the state.

Amends the composition and duties of the Medical Claims Conciliation Panel (MCCP), increases the filing fees, allows for evidence and statements from MCCP hearings to become admissible to jury hearings and establishes a benevolent exemption prohibiting signs of sympathy from being perceived as admissions of guilt.

Revises chapter 321-1.5, Hawai‘i Revised Statutes, primary health care incentive program, by adding health information technology, health information exchange and a doctor exchange database to their list of duties.

Creates an Office of State Coordinator of Health Information Exchange within the Department of Health to coordinate local efforts, identify funding sources, and integrate state health programs and eventually the National Health Information Technology Network (NHIN) for the State of Hawai‘i.


Anonymous said...

This is so rediculous. It does nothing to address the widespread competency problems in the Hawaii medical profession. Read about my case and that of another person:

I very strongly oppose any bills to limit medical liability and/or make it harder to make claims against medical providers, after the medical incompetence me and another person have endured in Hawaii for more than 18 months now after contracting severe relapsing infections that won’t go away, and none of the Hawaii doctors were willing to work on identifying the infection. I have had first hand experience with what is wrong with the medical profession, and I will share it with you.

Let’s get the competency of the medical doctors up to reasonable standards FIRST, along with getting an effective medical board in place, BEFORE limiting liability is considered. Limiting liability will only encourage more neglect and incompetence in the medical profession in Hawaii. It is premature to consider liability limits when there are widespread competency problems in the medical profession, including an ineffective medical board, that need to be addressed FIRST.

Please read what happened to me and another infected person - it’s a horror story of medical incompetence in the state of Hawaii over the past 18 months:

I fell ill with a severe infection in August 2007 with extreme fatigue, fevers, headaches, bone aches, stomach problems, and other problems. A second person in contact with me fell ill a few weeks later with the same incapacitating infection. EIGHTEEN months later, we are still both infected with this horrible relapsing infection, and despite numerous visits to Hawaii doctors, NONE were willing to track down the infection. This is despite the fact that at least two people are infected, AND it likely came from a stream area on Oahu that had sewage pipes adjacent to it.

For the same infection:

I was told it was caused by medicine I was taking (Dr. Arthur Hori).

The second person was told it was caused by the medicine he was taking (Dr. Nordyke).

The second person was told to go home and rest (Dr. Nordyke).

The second person was told it was the stomach flu (Dr. Nordyke).

The second person was told it was mononucleosis (by Dr. Berman, a so called "infectious disease specialist") but the doctor didn’t even know how to do the test and two doctors (Hori, Nordyke) had to correct Dr. Berman’s mistake by doing the right tests that showed it wasn’t mononucleosis.

The second person was told it was typhus by a doctor (William K.K. Lau, a so called "infectious disease specialist") who did a test that’s inaccurate and not even supposed to be used anymore (weil felix). I had the correct test, the antibody test, which confirmed Dr. Lau’s mistake.

I was told by a doctor to have a sleep study (Dr. Alan Tice, a so called "infectious disease specialist") after he did a few tests that could not identify the infection. I never understood what a sleep study had to do with two people having the same infection?

I was told it was chronic fatigue by a doctor (Dr. Francis Pien, a so called "infectious disease specialist"). He impressed me so much as the most incompetent doctor I had ever seen in my life that I contacted the State of Hawaii, only to find my suspicions were correct - he already had FIVE complaints on file and the State NEVER revoked his license to practice medicine. I also later found that identifying chronic fatigue requires ruling out several other medical conditions by lab testing, WHICH HE NEVER DID. His case alerted me to the fact of how out of control the doctor incompetence can be in Hawaii without any action being taken by the State. He was also well aware that the infection started after a puncture wound by a stream, and that a second person had become infected. I think I should ask the state auditor office what happened with the Francis Pien case? Why weren't five complaints enough for the medical board to launch a comprehensive investigation of Dr. Pien? How many hints do they need to understand there is a serious problem?

The fiasco with all the complaints on Dr. Francis Pien alerted me to the fact that the state medical board was not capable of effectively investigating incompetence complaints and handing out appropriate punishment. I also found that the state withholds the complaint information from the public. So I have not filed a sixth complaint on Dr. Pien because it apparently would not be properly investigated, nor would the important information be shared with the public. So I have decided to use the public web sites where I can release the information that the public needs. Therefore, the state medical board (or whatever it’s official name is) has made itself irrelevant. Let’s get rid of it and refer people with complaints to the public web sites where the public can get the necessary details on the nature of the complaints - and that’s FREE - no paid workers needed, and it actually serves the public!

All four of the so called "infectious disease specialists" had at least one complaint on file with the state. Even I agree that one complaint is not enough to confirm whether there are serious problems, but the experiences noted above substantiate that there are serious problems in the category of "infectious disease specialists" in Hawaii, and what exactly is the medical board doing about it, or are they oblivious to the problems?

It was also noticed that medical doctors in Hawaii seemed to have great difficulty believing that two people were infected even though they were repeatedly informed of that. Why did that happen?

It was also noticed that medical doctors repeatedly didn’t understand fever, with excuses that the fever wasn’t high enough to do anything or wasn’t high enough to be a concern even though it was high enough to be ill from it. Where did the doctors learn about fever because they didn’t seem to understand it?

Additionally, when I looked up the board certifications, which are readily available on the internet, for all four so called "infectious disease specialists", none had renewed their certifications, as highly recommended, in about TWENTY TO THIRTY YEARS!!! What is the medical board doing?? They’re not just asleep on the job, they’re COMATOSE on the job! Why haven’t these certifications been renewed by these doctors and why are these doctors still practicing with all the problems noted above??? I only started looking up this information because of all the problems that were encountered and I began to wonder why.

The state of Hawaii has a lot of house cleaning to do with its medical profession BEFORE it considers letting them partly off the hook on medical liability.

And let’s get to what probably nobody wants to hear. The medical doctors for the most part seem to have a business model that doesn’t work (practicing alone or in small groups and wanting a high salary). The so called "infectious disease specialists" noted above were practicing on their own, with no supervision or oversight or peers looking over their shoulder, and not surprisingly, look at all the problems that happened. It’s time the doctors face up to the fact that they need to start weeding out the deadwood from their profession and hastening the retirements that are overdue. And that can be done by requiring doctors to practice in larger groups where there would be pressure on those who aren’t performing. If the doctors can’t figure that out, then the state should require it. The doctors need to stop asking the State to give them special protection when we live in what is supposed to be a free market - if you don’t run your business right, you go out of business - government protection only encourages poor quality and bad business practices, and even worse in this case, bad medicine.

I strongly oppose 804 which very unfairly blames health care quality and cost problems on the tort system - just look at what happened to me. I oppose bill 805 which seems to allow penalty against injured people who bring suit. I oppose HB718 HD1 which would give malpractice insurance to self-employed doctors. I strongly oppose these for the reasons noted above. The state should not be encouraging self-employment when it is a bad business model that contributes to many problems, as described above. I oppose 1489. Did I read it correctly - it establishes a "Medical claim conciliation office"? I’m not sure that I found all the proposed bills that seem to place added restrictions on claims against doctors or give them state protections or that I fully understood the magnitude of restrictions and doctor protections being proposed. I oppose all bills which increase the difficulty of filing a claim against a doctor or restrict the amount of money that may be have to be paid out in a malpractice claim. I oppose all bills which increase the difficulty of filing a claim against a doctor or restrict the amount of money that may be have to be paid out in a malpractice claim. It’s not right, when there are still so many competency problems to fix in the medical profession first before considering any liability protections. The fact is, we wouldn’t need much of a tort system if the rest of the systems, such as doctor competency and medical board oversight, were working properly, but those systems have failed to work properly.

What kind of disaster are we proposing here - a bunch of bills that protect doctor’s "business as usual" methods despite the serious problems with their competency and current methods of doing business? This is crazy. The quality of health care will only get poorer than it already is. It looks like the State legislators are about to make an even bigger mess with these doctor special interest bills being shoved through.

The more the state gets involved in protecting the bad business practices of medical doctors, the lower the quality of medical care will be. Let the system work to weed out the bad business models, such as self employment, that don’t work here. And we need to focus and promote alternative medicine more when we’re in a small isolated place like Hawaii.

And I have to ask: Where is the leadership from our state lawmakers in improving the medical profession? All I see is the regurgitation of doctor’s special interests, which doesn’t serve the public. It’s absolutely shameful. If there were leadership, we would see bold new ideas like:

Require doctors to practice in larger groups in Hawaii, which forces oversight of basic competencies by their peers. This would result in a vast improvement in quality and would help weed out the non-performers, which by itself would cut malpractice insurance costs. The state medical board has failed at this.

Require a doctor to hand a patient an information sheet from a reputable source whenever they tell a patient they have a medical condition, such as the accurate and detailed information quickly available from WebMD for free. This would cut out the shenanigans performed now by Hawaii doctors, such as the "chronic fatigue" one. The state medical board has failed at this. The current shenanigans increase the cost of medical care and waste doctor’s time, and likely increase malpractice insurance costs.

Require any doctor identifying "chronic fatigue" or "fibromyalegia" in a patient to report it to the state. Let’s see how fast those lies go away when a doctor really has to put it on record that they gave an excuse term instead of doing their job of finding a serious infection. The state medical board has failed at this. This should reduce malpractice insurance costs.

Require a doctor’s board certifications be renewed every so many years as recommended. This will cut down on doctors not being able to adequately perform their specialty, which should reduce liability costs and result in less time wasted with repeat doctor visits. The state medical board has failed at this. This should definitely reduce malpractice insurance costs by ensuring minimum qualifications are maintained.

Require the state to publish the details of complaints filed against doctors, if the patients agree to it and allow the patients to black out the information they don’t want released. Require the State to give out the information on the public web sites also. The state medical board has failed at this. The possibility of having bad things in a public record may do more to increase medical care quality than any state bill could.

Require, before any medical doctor’s license is renewed in Hawaii, basic remedial training on recognizing infection, including fevers and rare infections, recognizing contagious cases, and how to assist patients with locating competent medical help outside the state of Hawaii if needed. My case would be the perfect example of what not to do.

The state of Hawaii government is not capable of fixing the doctor competency problems by passing doctor’s special interest legislation to protect their failed profession. It’s time the politicians take a leadership role and introduce my common sense, low cost measures noted above that will improve medical care quality in Hawaii and reduce malpractice costs by restricting the ability of doctors to engage in actions that lead to malpractice problems. It’s a simple formula: INCREASED COMPETENCY = LESS MALPRACTICE. How much more simple can it be?

Notice that all these measures are relatively inexpensive, very simple, and would serve the public, which is what you were elected to do. I hope someone in the state government can start taking a real leadership role on the medical profession, because the doctors haven’t done it and are only trying to protect their own self interests rather than fixing their disastrous profession. Nothing they have proposed will clean up the competency problems in their profession, which significantly contributes to malpractice costs. Look at the DLNR for some inspiration - in a time of budget crisis, they are proposing bold new ideas to revive the parks. Let’s see the same for the medical profession from our state leaders, because the leadership certainly isn’t coming from the medical profession.

How about going a giant step beyond this? Let's eliminate all government sponsored liability protections for doctors. Let's hold them fully accountable when mistakes are made. Protection only worsens the quality of care - just look at my case detailed above.

For the record, I have no claim against any medical person. I just want the disastrous medical profession cleaned up, which the doctor’s special interest legislation would not do, because it wouldn’t fix the competency problems so pervasive in the Hawaii medical profession. I, along with at least one other person, have lived the nightmare of incompetent doctors in Hawaii for a year and a half now.

And as a reminder of how costly our cases can become to the doctors in terms of malpractice, the public on Oahu is exposed to us since we live here, and we don’t know who may have been sickened from being exposed to us, because we don’t know what we are infected with or how it is spread, although it seems to be minimally contagious, but it is sickening and disabling.

And also for the record, I contacted the State Health Department around November 2007 and identified that no doctor could be found that would help with my infection case or the other known infection case. They sent me a letter stating that they provide no assistance with identifying infection and stated I should find a doctor. More than a year later, no doctor has been found. The Heath Department is totally oblivious to the lack of doctors in Hawaii who have the expertise and willingness to handle rare infection cases. I have since turned to ancient herbal medicine to help combat the infection. So, with a state Health Department oblivious to the real world outside their office door, it is even more essential that the focus must be on improving the competency of the doctors, which the doctor’s special interest legislation to reduce liability costs will not do. I have provided a copy of the state Health Department letter, attached, so anyone who doesn’t believe that’s what the state Health Department did for two rare infection cases: Yes, that’s really what they did. It’s unbelievable. They can use tax payer money to write you a letter stating that they can’t help you, but they can’t use tax payer money to actually help you.

I will happily provide more documentation to back up what I have stated if needed.

Please feel free to forward this e-mail to anyone who may be interested in the competency problems in the medical profession in Hawaii.

Thank you for taking the time to read this. I hope to see some leadership come forward from our state politicians on the medical profession in Hawaii and I hope I have given you some ideas on how to do that.

Lynn Schneider

986 Kanakou Place

Honolulu, HI. 96825

Jaz said...

When any form of medical malpractice happens, you should always approach a malpractice attorney to get the compensation to which you are entitled.