“Why should I care about how much my doctor has to spend for insurance? Doctors make WAY more than I do, so can’t they afford it?” “In Chester County, PA, there isn’t a single fulltime neurosurgeon on staff at any of the county’s five hospitals, which serve 450,000 residents. There used to be six fulltime neurosurgeons in the county – before rising premiums drove them to other positions and other states. The last fulltime neurosurgeon to leave would have been forced to pay $283,000 for a single year’s coverage.

That neurosurgeon’s departure forced the closing of the county’s only certified trauma center at Brandywine Hospital – so now, patients who require immediate neurosurgical intervention must be transported elsewhere. While a helicopter can generally get a patient from Point A to Point B within the ‘golden hour’ of optimal care, sometimes weather makes flying impossible. So far, we’ve heard reports about six patients who’ve tragically died because a neurosurgeon wasn’t immediately available at a Chester County hospital.

It’s not that the hospitals in Chester County haven’t TRIED to recruit neurosurgeons – they’ve been trying for years. It’s that medical liability premiums in PA are so high in comparison to other states and that the possibility of being sued is so certain that no one (in his or her right mind) wants to practice there.”

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  • Anonymous

    “So far, we’ve heard reports about six patients who’ve tragically died because a neurosurgeon wasn’t immediately available at a Chester County hospital.”

    This statement makes me chuckle.

  • Anonymous

    I wonder if Ms. Rovito took the time to check her facts for this story, as she admittedly hasn’t for others:

    “In a posting on the Web site for the Politically Active Physicians Association (PAPA), Donna Baver Rovito admitted that the list of “Disappearing Doctors” she maintains and that is the source of the oft-cited number of doctors who have supposedly left Pennsylvania because of high medical malpractice insurance rates is fundamentally flawed – because no one checks to make sure the claims are accurate.
    Confronted with yet another erroneous listing, Baver Rovito admitted, “I simply don’t have the resources to personally check out each piece of information which is e-mailed to me.”
    Despite the fact that no one checks to make sure that the claims are correct, the doctors and others who want to restrict an injured parties’ ability to collect fair compensation for their injuries continue to cite them anyway.
    Unfortunately, this is not the first time that a claim central to the doctors’ argument that caps are needed has been based on unverified anecdotes rather than hard data. Nor is it the first time that the anecdotes that have proven to be false upon full inspection.
    Doctors have long claimed that Pennsylvania is facing an exodus of doctors. However, according to the Pennsylvania Department of Insurance, the number of doctors has been increasing over the last three years, with approximately 1,000 more doctors paying into the state’s mandatory MCare system than just three years ago. This new information supports the findings by the General Accounting Office (GAO) that the number of physicians per capita in Pennsylvania has increased in the past few years (Scranton Times, 11/28/03).”

    CJD

  • TXMed

    CJD,

    That same article also makes the tired claim that insurance companies raised rates in response to huge market loses, even though because of government regulation and the way insurance is priced those numbers certainly don’t add up.

    From Physciannews:

    The number of residency spots in Pennsylvania has increased and the MCare figure includes Residents, despite the fact they’re certainly not fully practicing physicians.

    “Pa. has seen a temporary increase of nearly 1,000 doctors in training during the past two years – included in the MCARE count, but few of whom are staying in the state after they complete their residency.

    That last figure, according to Foreman, accounts for the press reports that quote the PMS as “admitting” that Pa. had gained 800 physicians since 2002…Only 17 percent of residents, for example, remained in Pa. in 2003, while the decline in Pa.’s ability to retain them is accelerating, according to Foreman.”

    AMA statistics, which only list full time Pennsylvania physicians, who are board certified or eligible, are probably a better indicator of the actual number of doctor’s providing patient care in Pennsylvania.

    “Foreman says the numbers substantiate the claim that Pa. is losing doctors in the aggregate: the state lost a net 214 active practicing physicians in 2002 and another net 290 in 2003. The state experienced its first ever net loss of 145 active practicing physicians in 1999, reversing 20 years of substantial physician growth in Pa., averaging more than 700 physicians per year.”

    The number lost isn’t shocking, what is, is the fact that not any year data was collected prior to 1999 had Pennsylvania lost physicians.

    Is this becuase there’s a glut of doctors? No data shows that. The AAMC says since the early 1990s we’ve needed to INCREASE medical school enrollment. So physicians aren’t fleeing a crowded work place. If the numbers show it and physicians are saying one of the reasons they’re leaving is high malpractice costs…well, what more is there?

  • Anonymous

    Sorry, but in PA that is exactly what did happen. Well, underpricing in the chase of investment dollars coupled with the failure of the investments. Check out Reliant and (I forget the name of the other one). “Gross financial mismanagement” was I believe the term the PA Dept. of Insurance used.

    Government regulation won’t change losses on the float. If you’re referring to the requirement that a percentage be kept in bonds, then you’re still talking investment losses given the extremely low rates of interest over the last 5 years which only recently let up. Not coincidentally, more companies are once again writing malpractice policies in states with and without “tort reform”.

    Additionally, considering PA’s overall population growth is miniscule (3.4% between 1990-2000), it’s unsurprising that some physicians leave. What was the percentage growth in physicians in that period?

    The fact is, no one is “fleeing” PA. No one may be coming there, but physicians rarely pick up and move due to malpractice costs. They may not initially choose to locate there, however. And of course, without knowing the earning potential, cost of living, etc. in PA v. similar locations, you can’t even attribute it solely to malpractice costs. What’s more, the fact that rural areas have trouble keeping physicians is an issue dating back to the existence of physicians.

    In short, the info is at best incomplete.

    CJD

  • Elliott

    Ms Rovito is spinning so fast that we may as well call it for what it is – a bunch of lies. How many people have been saved because their head injuries were life flighted to a higher volume trauma center with better outcomes? What about the fact that there are quadruple the number of life flight services available in Chester County compared to before? If you have ever had the unfortunate need to compare quality of care in an urban setting to a rural setting then you know that the impossibility of offering service at some of these locations although dooming some has undoubtedly saved others by giving them higher level care sooner.

  • Greg P

    There are situations such as an expanding epidural hematoma where having a local neurosurgeon can be lifesaving – having a surgeon an hour away in a major trauma center makes for a good organ donor.

  • Elliott

    I have no doubt that not having a neurosurgeon immediately available can mean death. BUT, she says there are six patients who tragically died because no neurosurgeon was available. Even looking beyond the fact that, I think, if you delve into that statement, you will conclude Ms Rovito is a liar, it doesn’t take into account the other side of the ledger – people who lived (or had less disability) because they got better care sooner due to being life flighted out of Chester County. That benefit is not just extended to neurosurgical patients who, weather permitting, go to a bigger facility, but also extends to people who are now life flighted for other reasons because that service is more readily available in general. There are plenty of other non-neurosurgical conditions that it makes sense not to treat in Chester County.

    Here’s a question for anybody familiar with healthcare services on this blog. If you found that you or a loved one had a life-threatening or complex condition, where would you want the surgery to happen? Under what circumstances would you, by choice, have neurosurgery done in Chester County (if a neurosurgeon is ever recruited) or Southern Illinois as opposed to Philadelphia or Chicago? Since I doubt a neurosurgeon can survive in a rural area on emergency surgery on hematomas alone (or other procedures where there is literally no choice), that means that they have to be able to see patients for more routine work. Most knowledegeable people are going to resist going to a neurosurgeon located outside a major center. Malpractice insurance may be part of the mix of reasons why noone practices in Chester County, but if it was the only, or even the main, reason then there would be no neurosurgeons practicing anywhere in the state.

  • Anonymous

    Exactly Greg P:
    There are cases were the surgical intervention needs to be IMMEDIATE not an hour from now in an urban trauma center. Elliot is all about spin.

  • ismd

    “So far, we’ve heard reports about six patients who’ve tragically died because a neurosurgeon wasn’t immediately available at a Chester County hospital.”

    Actully, CJD and Elliott, these figures are true. These families came forward at a press conference held on the steps of the Chester County Courthouse. My hospital in South Jersey has also seen debility and possibly death (no families have told us of a mortality, but we have heard through the grapevine that there was – but HIPPA prevents us from knowing) secondary to lack of neurosurgical coverage. Our one and only neurosurgeon no longer operates on heads due to exorbitant malpractice premiums. He’s an excellent surgeon who could have cared for these patients without going to Philadelphia.

    “you will conclude Ms Rovito is a liar”

    Elliott – I know Donna Rovito personally. You are so far off the mark with that statement, you should be sued for libel.

    “Since I doubt a neurosurgeon can survive in a rural area on emergency surgery on hematomas alone (or other procedures where there is literally no choice), that means that they have to be able to see patients for more routine work. Most knowledegeable people are going to resist going to a neurosurgeon located outside a major center.”

    NOT TRUE!! Our neurosurgeon has survived quite nicely in a Philadelphia suburb. He’s had great outcomes, and there has been no need to go into the city. And, yes, even smart knowledgable people had their operations done by him. Your statement is soooo stupid.

  • Anonymous

    “These families came forward at a press conference held on the steps of the Chester County Courthouse. “

    So ismd, are you saying that a layperson CAN actually diagnose whether someone would or would not have died if they had received adequate medical care? I thought juries weren’t qualified to understand that sort of thing? And are you arguing that a person, no matter where they live, has a right to have a neurosurgeon immediately available?

    “but we have heard through the grapevine that there was -”

    If someone who disagreed with you supported their claims with that, what would you say to them?

    “Our one and only neurosurgeon no longer operates on heads due to exorbitant malpractice premiums.”

    How much are his premiums and how much does he make? If you expect us to sympathize with him, you better give us some details. Have you protested at the Dept. of Insurance for not more tightly regulating Frontier and Reliant? After all, the solvent insurers had to pick up their bad debts.

    Chester County is a 700 square mile county, with a population of some 430,000. How many neurosurgeons do most counties of that size geographically and population wise have? That doesn’t sound much like a Philly suburb.

    Have you really never heard of “an expert is always 20 miles away” syndrome? Lots of people think that the doctor, lawyer, dentist in their hometown is no good because if they were they’d be practicing in a big city.

    Considering Ms. Rovito herself has admitted that she doesn’t check her facts before she posts them, what is so outlandish about questioning them here?

    CJD

  • Elliott

    Here are the 6 (7?) cases. You can decide for yourself how much is spin and how much is reasoned argument. http://www.hcmsdoctors.org/Politics/Pennsylvania%20Updates/July%205,%202005.htm

    Here is a more balanced look at the situation.
    http://www.physiciansnews.com/cover/205.html

  • ismd

    “but we have heard through the grapevine that there was -”

    That statement was made because I can’t prove or disprove that there was a fatality in that particular case. I also qualified that by saying that HIPPA prevented us from knowing the outcome.

    “So ismd, are you saying that a layperson CAN actually diagnose whether someone would or would not have died if they had received adequate medical care?”

    No, I’m not saying that. But the neurosurgeons in Philly informed the families of that – but I guess that since that knocks down your argument, you’ll find some way of twisting these words around.

    “And are you arguing that a person, no matter where they live, has a right to have a neurosurgeon immediately available?”

    I don’t know what you imply by that statement, but the answer should be yes.

    As far as questioning Ms. Rovito and the posts she writes, you most certainly can raise that as an issue as long as you refrain from calling people liars. That’s what I object to – that these posts and comments can’t be kept civil, and by name calling, you try to make points without proof. And, despite the misquote from the newpaper article, she does check her facts.

  • Anonymous

    “No, I’m not saying that. But the neurosurgeons in Philly informed the families of that – but I guess that since that knocks down your argument, you’ll find some way of twisting these words around.”

    So while normally we have to hear that medicine is a science, and there are no guaranteed outcomes, this unknown neurosurgeon who allegedly reviewed the records of every one of these patients can say with absolute certainty that these people would have lived? C’mon, let’s be serious here, ismd. And stop accusing me of twisting your words. If I was twisting them, I wouldn’t quote you.

    “I don’t know what you imply by that statement, but the answer should be yes.”

    I’m implying nothing, I’m asking a simple question. And you answered yes, that a person should have a right to immediate neurosurgeon access. Which is a little surprising, because that’s going to take a lot of neurosurgeons in a lot of rural areas. And those neurosurgeons better be prepared for a pay cut, because a lot of rural areas can’t afford to pay much.

    “That’s what I object to – that these posts and comments can’t be kept civil, and by name calling, you try to make points without proof.”

    I agree with the first part and have so far, I think, been very civil with you. But I cited you to Ms. Rovito’s own words, so if that’s not proof, I don’t know what is.

    CJD

  • ismd

    CJD,

    One last comment before I head to the office. I objected to Elliott (not you) calling Donna Rovito a liar. That statement was not directed at you. I will defend Donna to the death, because she is a true champion for healthcare reform, not just tort and judicial reform. Her comments were taken out of context in that article, and twisted (forgive the use of that word) to “prove” a bogus point.

  • Elliott

    ismd, it is my feeling that when someone enlists grieving families in support of their cause that they better be damn sure of their facts. Ms Rovito has shown herself to be less than diligent in fact checking in the past. There is little evidence other than anecdotal statements by some named and unnamed neurosurgeons that these deaths were avoidable because of delay in reaching treatment. I don’t consider that anywhere the standard of proof I require to believe a person with a political agenda. There is no evidence that the availability of a neurosurgeon in Chester County would have shortened the delay appreciably (the neurosurgeon needs to be called, be available, needs to arrive, and a surgical team needs to get ready. (Some of those hospitals lost neurosurgeon coverage years ago even when there were still somen left practicing in Chester County.) There is no evidence that tort reform would change anything. So Ms Rovito uses the most tenuous chain of reasoning to push her political agenda and it all starts with the tragic outcomes. She uses those families to make an emotional appeal. I call that uncivil and, perhaps this is too academic of me, but using that amount of faulty logic, I call lying.

    Finally, even though I do not expect an advocate like Ms Rovito to acknowledge counterarguments such as the possibility of better outcomes in a major center, I would expect that those looking to understand the issue would consider that possibility (rather than throwing out a single, unverifiable, irrelevant data point of a successful, practicing neurosurgeon in the Philly suburbs who, incidentally, manages to pay his skyrocketing malpractice insurance rates which was my other point).

  • dr john

    Neurosugical residents graduating from 2000 to 2004 in Pennsylvania:
    Penn – 1 of 10 stayed in Pa.
    Jefferson – 5 of 12
    Temple – 3 of 7
    Pitt – 2 of 13
    Penn State – 0 of 5
    AMA Masterfile

  • Anonymous

    Dr. John, where’d they go? And does the place they went pay more than they could have gotten in PA?

  • ismd

    Elliott,

    Ms. Rovito did NOT enlist the Chester County families, nor was she involved in the press conference. The families came forward with their stories. I ask you, however – it’s not OK for doctors and their advocates to enlist “grieving families”, but it’s OK for ATLA to parade grieving families around the country with their dog and pony shows to show how “bad doctors” maim and kill and disfigure and… To borrow from your own statement, that’s uncivil, emotional and makes ATLA a bunch of liars.

    What is verifiable is that there are documented delays in treatment due to lack of neurosurgeons in many local hospitals. These delays lead to death and morbidity when there didn’t need to be any. There is no proof that neurosurgeons in major centers have any better outcome in neurosurgical EMERGENCIES than those surgeons in community hospitals.

    And, as I mentioned in an earlier post, the neurosurgeon at my facility stopped operating on heads (he still does spine work) due to the exorbitant additional cost to his malpractice policy.

  • Anonymous

    “What is verifiable is that there are documented delays in treatment due to lack of neurosurgeons in many local hospitals.”

    That’s true for all rural areas, isn’t it? When a state only puts out, according to Dr. John, 47 neurosurgeons a year, aren’t shortages in rural areas a given considering that some will move out of state, and many who stay will want to work in population centers where they can make more money?

    “And, as I mentioned in an earlier post, the neurosurgeon at my facility stopped operating on heads (he still does spine work) due to the exorbitant additional cost to his malpractice policy.”

    And? What conclusions are we to draw from this? What solutions should be implemented to get him to start doing head work again?
    How much did he save? What’s his total insurance costs out of pocket? How many claims has he had? Telling us this without additional facts makes it hard to do much with the info. Or maybe it was just meant to be informative?

    CJD

  • Donna Baver Rovito

    Is the “accused” permitted to join the party?

    The information about Chester County’s lack of neurosurgeons wasn’t drawn from my falsely maligned “Disappearing Doctors List,” (interestly, the reporter who started the whole fake flap abut the list’s accuracy isn’t spreading trial liar propaganda in Pennsylvania anymore…I guess his paper got tired of having their headlines proven 180 degrees off the mark….) but from detailed research conducted by…of ALL things….a LAWYER.

    Numerous press accounts have been filed about these tragedies, all of which have followed the loss of the Level One Trauma Center at Brandywine Hospital, in a suburban Philadelphia county that was MORE than qualified to handle any trauma – before it lost the personnel required to keep it open, of course. So for anyone to suggest that perhaps Chester County residents are BETTER OFF being transported to a Level One Trauma Center an hour or two away instead of having the same level facility in their own backyard is either ignorant or dishonest.

    I suppose we’ll call the folks at NBC-10 liars, too, for posting this report:

    NBC 10 (Philadelphia)
    Patients Worried About Lack Of Neurosurgeons In Chester County
    Brain Surgery Patients Must Be Sent To Other Counties
    May 26, 2005

    There are no more full-time neurosurgeons in Chester County and some people say that is a dangerous situation.

    There are a few neurosurgeons who cover some of the Chester County hospitals part-time, but there are no more trauma centers in the county.

    If somebody needs brain surgery on an emergency basis, the hospitals there have to send the patient somewhere else. That means precious time can be lost and lives can be lost.

    On Jan. 27, 2004, during a snowstorm, 54-year-old Larry Hanft was trying to dig out his car when suddenly another car smashed into him. An ambulance rushed him to Brandywine Hospital.

    “They said they would have to take him to Crozer-Chester Medical Center because they didn’t have a neurosurgeon on staff and he had to be operated on to relieve the pressure on his brain,” said Nancy Hanft, Larry Hanft’s wife.

    Hanft said that her husband was not airlifted to Crozer-Chester because the weather was too bad, so he was taken by ambulance. A little over two weeks later, Larry Hanft was dead.

    “From what I’ve been told, the critical hour — if he had been operated on in the first hour to relieve the pressure on his brain, he would’ve had a fighting chance,” Hanft said.

    Beth Harpham’s family faced a similar tragedy when her father hit his head and bled into his brain.

    “There is a possibility we could have had surgery with a good outcome, but we never explored that possibility that day because it wasn’t an option, because there was no neurosurgeon here,” Harpham said.

    “People in Chester County can be in danger, or are in danger. When the specialists they need are not here to provide the care when they need it, their health is in jeopardy,” said Dr. Fred Himmelstein, the president of the Chester County Medical Society.

    Neurosurgeons have left Chester County hospitals in recent years, so some legislators are calling for a cap on malpractice awards for pain and suffering, which could bring down the huge malpractice insurance rates the doctors pay.

    Prepared information for Press Conference – May 26, 2005
    from ROBERT B. SURRICK, ESQUIRE            

    In the Fall of 2004, Robert Surrick met with Dr Frederick Hellman, Medical Examiner of Delaware County. Surrick was investigating information about the deaths of 3 Chester County residents who had been transported out of county because of the absence of a neurosurgeon in Chester County. The information had been given to Surrick when he was speaking to the medical staff at Taylor Hospital on September 23, 2004 by Dr. Allen Gabroy, Senior Trauma Surgeon at Crozier Chester Medical Center. Dr. Hellman read from a file about a 17 year old who was recently in an automobile accident who sustained head trauma. He was taken to Brandywine Hospital and then medevaced to Crozier Chester Medical Center. It was over two hours from the time of the accident until a neurosurgeon was available. The teenager died at Crozier Chester.

    After speaking to the medical staff at Ephrata Memorial Hospital on November 30, 2004, Surrick was informed by neurosurgeon Dr. Perry Argires and his father, also a neurosurgeon, that in the recent past, there were two cases of Chester County residents transported to Lancaster General Hospital because of the absence of a neurosurgeon in Chester County. Both patients died. Agires senior and junior told me and the Physicians News Digest that “their outcome would have been different if they had been treated within that window of opportunity.”

    On November 28th, 2003, at approximately 5:30 A.M., Joseph Harpham, age 83, a former pilot for Eastern Airlines, fell while going to the bathroom. His wife, Jo, heard him fall and asked “are you alright.? He said “no, I hit my head”. She called 911 and he was taken to Chester County Hospital, arriving at approximately 7 A.M. There was no neurosurgeon available. At approximately 9 A.M., he began to lose consciousness as a result of a subdural hematoma. Chester County Hospital then put him in an ambulance for transport to Hahnemann Hospital after telling his wife “we have no neurosurgeon available.” The weather was very bad and the helicopter could not be used. It tooktwo hours for the ambulance to reach Hahnemann, a distance of 33 miles. At approximately noon, when he reached Hahnamann, Joseph Harpham was unconscious and becoming unresponsive. The neurosurgeon told the family that surgery could be performed but the patient, by now, had significant brain damage. The family made the excruciating decision against surgery because their father/husband had a living will and would never have wanted to live “as a vegetable.” He died at 8 P.M.

    Joseph Harpham is described by the family as a very vibrant, alert man until the fall on November 28th and photographs taken shortly before his death reflect this.

    On January 27, 2004, at approximately 6 A.M., Larry Hanft, age 54,  was walking to get his car which had been stuck in the snow the night before when he was struck by an automobile. He sustained head trauma resulting in a subdural hematoma. He was admitted to Brandywine Hospital at 0635 A.M. There was no neurosurgeon available. Two hours post trauma, at 8:45, Brandywine put him in an ambulance for transfer to Crozier Chester Medical Center where a neurosurgeon was available. Weather prevented the use of a helicopter. He was admitted to CCMC at 9:30 A.M., 3 hours and 55 minutes post trauma. A craniotomy was started at 10:30 A.M. Larry never regained consciousness and died two weeks later. He is survived by his wife Nancy and three children. The widow is clearly grief stricken to this day.

    from the CountyPress.Online
    Surrick Says The Lack Of Drs. Now Causing Deaths
    05/24/2005

    As executive director of the Politically Active Physicians Association (P.A.P.A.), I call upon Gov. Rendell, the appropriate committees of the state legislature and the County Commissioners of Chester County to conduct a thorough investigation into the deaths of a number of Chester County residents who apparently died as a result of the absence of neurosurgical care in that county.

    Physicians at Crozer Chester Medical Center and Lancaster General Hospital have confirmed five deaths, some teenagers, from head trauma after being transported from Chester County. I confirmed the death of a 17 year old who was 2 hours from time of automobile accident in Chester County to Crozer Chester Medical Center in Delaware County with the Medical Examiner. When head trauma occurs, time is of the essence (usually less than one hour) for neurosurgical intervention to save the life of the patient. These Chester County residents were deprived of this highly imperative emergency lifesaving medical care. The following facts reveal why this is happening.

    In 1999, there were 6 full time neurosurgeons covering the five hospitals serving 450,000 residents of Chester County. Today there are no full time neurosurgeons left. The situation in the rest of Pennsylvania is almost equally grim. For example, in 1996, there were 214 practicing neurosurgeons in the state. From 1985 to 1996, the neurosurgeon growth rate in Pennsylvania was 4.5 percent a year. The standard recommended ratio between neurosurgeons and population is one neurosurgeon for every 65,000 people. Pennsylvania, with a population of approximately 12 million, should have at least 185 neurosurgeons. Today there are only 152 with some surveys showing only 141 who are mainly clustered in the cities. (Source Pennsylvania Neurosurgical Society, The Chester County Medical Society and American Association on Neurological Surgeons and the Congress of Neurological Surgeons). That is a loss of 63 or perhaps 73 neurosurgeons in just 9 years.

    The situation is seriously exacerbated by data from the American Association of Medical Colleges who report in a 2004 study that the percentage of Pennsylvania-trained neurosurgical residents who plan to stay and practice in the state is “zero”. The established neurosurgeons are leaving and/or retiring and there are no neurosurgeons coming behind them.

    The last full-time neurosurgeon in Chester County left Brandywine Hospital when his medical malpractice insurance premium hit $283,000. He is now practicing in Texas.

    The Medical Board statistics reflect between May of 2002 and November of 2004, 5,600 doctors in Pennsylvania were sued, many of them neurosurgeons.

    I will be happy to confer with representatives at any level of government and turn over the information I have.

    Robert B. Surrick
    Executive Director, P.A.P.A.

    (FYI, Surrick is no longer the executive director of PAPA)

  • Anonymous

    Ms. Rovito, your most recent posts don’t support the claims you made in the original article either. I don’t think you’re a liar, however. I think you’re a lobbyist doing your job, and probably a pretty good one at that.

    But let’s look at your claims.

    “From what I’ve been told, the critical hour — if he had been operated on in the first hour to relieve the pressure on his brain, he would’ve had a fighting chance,” Hanft said.”

    This statement is a far cry from this claim that you made:

    “So far, we’ve heard reports about six patients who’ve tragically died because a neurosurgeon wasn’t immediately available at a Chester County hospital.”

    In fact, none of the stories you link support the claim that these people died solely because a neurosurgeon wasn’t available in Chester County.

    Nor does any of your information support the claim that medical liability premiums or the possibility of being sued is the reason Chester County doesn’t have neurosurgeons. Unless you are saying that literally every area without a neurosurgeon doesn’t have one for those reasons. Now, undoubtedly PA has malpractice issues and a lack of specialists in rural areas, but the reasons for those are many faceted and rural areas lack specialists across the country, and the reasons are not simply lawsuits.

    Also, simply because a lawyer is your source doesn’t make it valid. Lawyers are not a monolithic group all with the same goals in mind anymore than physicians. The facts make things true, not the source.

    CJD

  • Elliott

    Thank you Ms Rovito for joining the conversation. As I understand your chain of logic it goes like this:

    1. Death caused by unavailability of neurosurgical coverage.
    2. Unavailability of neurosurgical coverage due to doctors leaving Chester County due to high insurance malpractice rates.
    3. If you can mitigate malpractice crisis through passage of tort reform legislation then,
    4. Malpractice crisis wanes and rates come down.
    5. Doctors return to Chester County preventing avoidable deaths due to subdural hematomas and other neurological emergencies better treated locally rather than medevacced.

    As I said above, I disagree in some part with each part of that argument and put together as a whole, I think it to be false. The compelling cases presented by the families notwithstanding, I inferred that Robert Surrick investigated each one of these incidents and sought out the family members in that process of investigation.

    If you want to convince me then do a side-by-side comparison. Compare the patients 127 who were medevacced plus the ones that were NOT in 2001 to the 662 who were medevacced in 2004, but would have been treated locally in 2001. Many of these would have gone to the Brandywine trauma center. Don’t show me that there were deaths because that’s an unfortunate result sometimes when a head meets metal, glass, or concrete. Show me that there were MORE deaths. After you have done that then show me a rural location that finds it easy to recruit. California can’t staff its ERs in rural communities and MICRA is the granddaddy of all tort reform.

    Show me the evidence rather than parading grieving families.

    ismd, I have not noticed the ATLA calling press conferences with family members in attendance, but I will gladly condemn the practice on that side as well. Some of my discomfort for the practice stems from who initiated the process; therefore, I’m relatively ok with WTC families or Iraq soldier families calling press conferences (whatever political point they are trying to make) because these, in most cases, seem to be more spontaneous than Mr. Surrick’s event was. In individual trials, the family memebers and the plaintiff are displayed. To the extent that this is exploitation, I am uncomfortable with it. On the other hand, it is part of the current system which the tort reform proposals that Ms Rovito wants passed do not improve upon in my opinion.

  • Anonymous

    Only Dr. Elliot and his lapdog co-shill for the trial lawyers bar could make a case for it being good that no neurosurgeons are available onsite to treat emergent patients. Anyone out there who believes this deserves to pay the price that comes with tort mania in this country.

  • dr john

    To anon 4:40 [A tip tells me that you're "Neckbrace" Edwards]:
    Don’t know where they went–just not Pennsylvania.
    Perhaps a few went to Delaware where reimbursements are better, largely because the state is much less in thrall to the lawsuit industry.

  • Anonymous

    In other words, Dr. John, you’re once again reaching conclusions without the necessary info?

    Good work!

  • ismd

    Anonymous 5:59 AM,

    Dr. John did his homework and reached his conclusion with the facts, those being that few neurosurgical residents stay in PA to practice, as he showed in his post. Because we don’t know where they went means that what he said isn’t true.

  • Anonymous

    The faulty conclusion is that they left due to the legal “climate.” Or that Chester County would have gotten them had more stayed. The latter may not have been his point, I concede.

  • Donna Baver Rovito

    To whomever suggested that I am a lobbyist doing my “job,” let me clear that up right away.

    I am not now, nor have I ever been employed by any organization which advocates for physicians, hospitals or even patients. I am a freelance journalist and private citizen who cares about having access to quality medical care.

    As a mother, I want access to care for my sons, and as a breast cancer survivor, I want to know that I’ll have access to the best doctors should my cancer recur. One of the first hints that a difficult situation was brewing here in Pennsylvania reached me in January of 2001, when the plastic surgeon who both diagnosed my breast cancer and then performed my reconstruction lost his coverage, and was therefore unable to operate for several months. It was shortly after learning this that I got involved in this fight.

    No one PAYS me for what I do – in fact, my lobbying efforts cost me money. No one’s ever reimbursed me for trips to Harrisburg or Washington (unlike certain victims with small children in wheelchairs who attended at least one rally I know of in Harrisburg’s Capitol rotunda – and YES, ATLA and its front groups DO exploit alleged malpractice victims to put a sympathetic face on their efforts to maintain their cash flow…the 16 foot tall wheelchair which toured the nation with a busload of “victims” was especially impressive), nor does any physician or other advocacy organization control or direct my message.

    As to checking for accuracy, one reporter, (who no longer works for the paper in which his falslehoods were printed) in partnership with one or two Democratic PA representatives, took upon himself the task of discrediting the Disappearing Doctors List because it was being used too widely to prove physician loss – I think that effort began after certain legislative leaders used the list on the House floor.

    The Disappearing Doctors list NEVER CLAIMED to be a statistical analysis – in fact, in its introduction, it was ALWAYS made clear that it was a collection of anecdotal stories about specific physicians who’d made a major change in their practice due to medical liability issues in our state, a regional snapshot of access to care.

    Those who opposed liability reform SAID that we said it was a data set for the number of physicians in PA, but that was patently false. It was always made clear that the information on the list was provided by physicians and other health care professionals within the state, and never claimed to serve as a device for counting the number of physicians we’d lost or for determining the total number of physicians actively practicing medicine in the state – which, for some reason, our state hasn’t been able to figure out how to do yet – which is, of course, the reason I started to keep the Disappearing Doctors list in the first place…

    In fact, there were and continue to be several different categories of affected physicians on the list – those who relocated out of Pennsylvania, those who retired earlier than planned, those who gave up medicine completely, those who were forced out of private practice into an employment situation and those who curtailed high-risk services to reduce premiums. Frankly, I never intended to COUNT the names on the list because I was concerned that it would be misinterpreted – which, of course, was a valid concern, considering how those numbers were eventually twisted. In fact, it was a reporter who first counted the number of names on the list. I always stated clearly that the list was, at best, an incomplete collection of anecdotes – clearly, the only names which were reported to me were reported by people who knew I was keeping a list.

    Ironically, the most serious accusations of alleged “errors” on the list came from a trial lawyer front organization in Pennsylvania which purported to be a “consumer” group and still tries to represent itself as such even though it has been proven that the group’s fictitious name is registered to the “Pennsylvania Trial Lawyers Association” and its offices were at the time of its incorporation located within the offices of the Philadelphia Trial Lawyers Association. In a letter to the editor which appeared in various papers in the state and which has been widely reproduced – as it was on this blog, yesterday, the author claims that I admitted flaws in the list on the PAPA website – which is ironic, since I clearly delineated those “flaws” and limitations from the moment I began to keep the list.

    I’ve just checked PAPA’s archives for every Liability Update I wrote during that time period, and, interestingly, I can’t find the “admission” I am alleged to have made. I suspect my alleged “admission” was inferred from my completely up-front and honest description of how the entries on the Disappearing Doctors list have always been derived – from doctors and other medical professionals.

    This is all pointless quibbling, though….those who oppose liability reform have claimed that those who support it are lying from the onset of this critical situation, and those of us who support reforms have, albeit in slightly nicer terms, said that those who OPPOSE it are lying. Of course, there will always be those who don’t let facts interfere with either their opinions or their propaganda, and I’ve long given up trying to convince those people that they’re living in an alternate reality….

    Of course, you can get the facts yourself. Had to find a new doctor lately? Had to wait six months for a screening mammogram? Or three months to see an orthopedic surgeon? Or six months to see a neurosurgeon? If your doctor’s office hasn’t volunteered that the reason you have to wait so long is because there are fewer doctors in that specialty in your area, ASK why you have to wait so long. I suspect that MOST of the time, you’ll get an answer similar to the one above. MANY physician groups in Pennsylvania are also operating with fewer members than they used to have, as doctors are retiring and remaining members can’t recruit replacements. I know of one cardiology group that’s been trying to fill two retired physicians’ positions for three YEARS…..

    Immediately to the left of this comment box, I’m looking at the first entry from “anonymous,” who, after reading that six patients died because of lack of neurosurgical coverage, said “This statement makes me chuckle.”

    I think that says it all, don’t you?

    And for Elliot, who still seems to think that it’s better to die in a helicopter on the way to a Level One Trauma Center than to be treated at a Level One Trauma Center in one’s own backyard, please do a little research. Level One Trauma Centers, one of which Chester County USED to have, are subject to unbelievably stringent regulations and protocols, and no facility, whether it’s in rural Pennsylvania (as is world-famous Geisinger Medical Center) or in Center City Philadelphia, is certified AS a Level One Trauma Center unless it can provide an extremely high level of care – including physicians in all specialties on call at all times.

    Brandywine Hospital HAD that level of care – until its last neurosurgeon was sent a bill for medical liability coverage for one year that would have cost him $283,000. Now he practices in Texas, where, incidentally, a constitutional amendment capping pain and suffering passed in late 2003 has reduced premiuims in that state by roughly 17% SO FAR. Did the others all leave because of their medical liability premiums? Frankly, I don’t know, although I suspect their premiums, coupled with better reimbursements elsewhere had something to do with it. Does it MATTER? Bottom line is that they’re gone – there used to be six, and now there are none. And the one neurosurgeon who’s providing PART-time coverage to five hospitals in Chester County also provides FULL-time coverage to hospitals in his OWN county – which, effectively leaves Chester County, NOT a rural area by anyone’s estimation, but a lovely, vibrant, growing suburb of Philadelphia, a neurosurgical desert….

    An independent study conducted by the PEW foundation indicated that 25% of Pennsylvanians reported that they’d lost a doctor in the past 12 months BECAUSE of the medical liability crisis. The latest report from the PA Neurosurgical Association notes that NOT ONE of the neurosurgical fellows who will graduate from any of PA’s certified fellowships in 2005 plans to practice in Pennsylvania. Newest data from the AMA, which tracks residencies and fellowships throughout the nation, indicates that the number of residents who stay in Pennsylvania to practice has dropped from over 50.5% in 1994 to EIGHT PERCENT in 2004. The number of physicians under the age of 35 has dropped from 11.8% in 1991 to 3.4% in 2004 – compare that to the national average of 12-14%. Malpractice premiums aside for a moment, doctors get old. Doctors get tired. Doctors even die…who’s going to replace them? Right now, it looks like NO ONE….

    Advocates for the dysfunctional status quo can quibble and dissemble all they like, but that doesn’t change reality. Right now, there is no GOOD FINANCIAL reason for any physician to practice medicine in the state of Pennsylvania – reimbursements are up to three times higher in other states, medical liability premiums are sometimes one quarter what they are here, physicians are forced to work longer work weeks than the 80-90 hours they were previously working to make up for the colleagues who are gone, a three BILLION dollar unfunded liability in the state’s catastrophic insurance fund – now called the MCARE Fund – will fall upon the shoulders of PA physicians for the next 30-40 years unless the state comes up with another funding source, and the folks who oppose reform have accused PA doctors of everything from being liars to being greedy because they want to solve a problem that affects – or WILL affect in the future – all of Pennsylvania’s 12 million citizens.

    Wake up and smell the betadyne, folks…denying the problem isn’t solving it.

  • Anonymous

    CJD and Elliot,
    1.You have committed “ad hominem” fallacy in your argument against MS. Rovito. Whether she is a lobbyist or whether she has recruited the patients have no bearing on the veracity or validity of the cases. Stating that this is “exploitation” and that she is a “liar” are examples of the fallacy.
    2. Comparing this with any case in California will be difficult. The transfer by helicopter was hampered by bad weather and this occurred in a county with a population of 450,000
    without a neurosurgeon.Elliott, you have the burden of proof on that and not Ms. Rovito. And CJD, you have the burden of proof to show that these cases are just the usual cases in rural America. Ms. Rovito does not have to do the work on that issue, you do.
    So Elliott and CJD, give us proof on your claims.
    3. CJD, you stated Ms. Rovito did not prove her case yet you did not give us any evidence. You wrote,”In fact, none of the stories you link support the claim that these people died solely because a neurosurgeon wasn’t available in Chester County.” What is your basis for saying this?

  • Anonymous

    “I am not now, nor have I ever been employed by any organization which advocates for physicians, hospitals or even patients.”

    So you work to limit victims’ rights for free?

    “because it was being used too widely to prove physician loss”

    Actually, because it was being used incorrectly, since as you admit, is not a list of the doctors who have left. I believe you called it a “snapshot”.

    “Brandywine Hospital HAD that level of care – until its last neurosurgeon was sent a bill for medical liability coverage for one year that would have cost him $283,000.”

    Who was the neurosurgeon and who was the carrier? These claims mean little without details.

    “said “This statement makes me chuckle.” I think that says it all, don’t you?”

    All conclusions lacking fact have a humorous element to them. Kind of like your claims about Texas, in which you give only half truths. Some carriers have reduced their premiums 17%, but this was after increases of 150%. And, there is no evidence that the caps had anything to do with them, because as I’m sure you know, med mal claims tail a minimum of 3 years, and the law only recently went into affect.

    No one opposes reform, Ms. Rovito, they just don’t all agree that it should be done on the backs of the most grievously injured and financially helpless members of our society, which is where you caps advocates would have it.

    CJD

  • Anonymous

    Anonymous 10:43, are you really asking for proof that rural areas have trouble keeping specialists? I just want to clarify that before I go to the trouble, because it’s been the case as long as there have been physicians. My hometown of 300, county of 19,000 has no neurosurgeon, nor have we ever. Why? Because they would go broke. We don’t have a lot of specialties that you have to drive an hour away to get. We also don’t have a multiplex theater. That’s the deal with living in the sticks, and it’s a tradeoff many happily make.

    ” CJD, you stated Ms. Rovito did not prove her case yet you did not give us any evidence. You wrote,”In fact, none of the stories you link support the claim that these people died solely because a neurosurgeon wasn’t available in Chester County.” What is your basis for saying this? “

    The story she posted doesn’t support her claim anywhere in it. Seriously, are physicians, who love to remind litigants that there are no absolutes in medicine, really going to make that statement?

    CJD

  • Anonymous

    “Anonymous 10:43, are you really asking for proof that rural areas have trouble keeping specialists?”

    The county in question has a population of 450,000. It should not have trouble keeping specialists. As stated in the article, a population of 65,000 can support 1 neurosurgeon.You are claiming and implying that the situation in that county is not out of the ordinary and that this is “normal”. It’s not your typical rural place -it has a population of 450,000. Muskogee, Oklahoma with a population of 30,000 has 2 neurosurgeons and the county probably has a population of 60,000.

  • Anonymous

    PA ranks 51st in Medicare Physician Growth by state. It has lost 9.6% of its physicians compared such gains as 67.7% in AK and 50.6% in NM.

    The number of neurosurgeons and other specialties have seen an even greater reduction. Exactly how is this better for a state that will only see it’s elderly population rise with its corresponding increase in demand? If you are a non-believer in the positive effects of our health care system, please opt out.

    The Pew Charitable trust found the hostile liability environment is having an effect on the supply of specialists. Notice the word, environment, it is NOT the word salary or payout. If a physician stands a higher likelyhood of being sued (a terrible experience for a physician) then it should lead to a decrease in the number of residents willing to endure such a poor working conditions.

    With the deplorable error rate of 70% of suits dropped, dismissed or found for the plaintif, something is certainly amiss when innocent physicians must endure the awful experience of dealing with a broken legal system.

  • Anonymous

    What’s sad is that while physicians are great at identifying everyone else’s mistakes, they can’t seem to figure out why this “deplorable” system keeps happening to them.

    However, if you’re the anonymouse who is so sincerely afraid of being sued, and want to reduce that risk, you would do well to read this article by a physician who has studied the causes:

    http://www.law.duke.edu/shell/cite.pl?60+Law+&+Contemp.+Probs.+7+(Winter+1997)

    CJD

  • Anonymous

    Thanks Ms. Rovito for setting the record straight. Don’t worry about CJD and Dr. Elliot who are merely shills for the ATLA. They have been proven wrong many times before but will never admit they are wrong. CJD, in particular, is clueless as his laughable comments about Texas’ wildly successful tort reform initiative so amply demonstrate.

  • Anonymous

    Only someone with such a limited grasp of economics would call a 120% increase in his insurance rates “wildly successful”!! Listen, I’ve got some oceanfront property I’d like to sell you. Bargain basement prices!

  • Anonymous

    Umm, Texas’ rates DECREASED 17% after tort reform. Troll.

  • Anonymous

    Ummm, the company you’re referring to had INCREASED their rates 150% in the years prior. They went down 17% as the economy improved, in states with and without “tort reform.”

    I would imagine that the troll is the one without all the facts but with plenty of uninformed opinions.

  • Donna Baver Rovito

    CJD said: “So you work to limit victims’ rights for free?”

    I’ll see your smug pomposity and raise you ten…..

    So you work to propagate the trial lawyer fallacy that there IS no medical liability crisis, and, therefore, help to limit patients’ access to care for free?

    Likely not….I suspect that SOMEONE is being billed by the tenth of an hour for the posts you made at:

    CJD # posted by Anonymous : 11:35 AM
    CJD # posted by Anonymous : 1:23 PM
    CJD # posted by Anonymous : 4:56 PM
    CJD # posted by Anonymous : 11:15 AM
    CJD # posted by Anonymous : 11:19 AM

    Where to begin – so much propaganda to refute, so little time….

    Actually, lack of time being an ongoing factor in my life, this will be my last post on this particular issue. Clearly, CJD and Elliot aren’t going to change my mind about the facts and implications of the medical liability crisis, and clearly, since their primary purpose in life seems to be twisting and parsing words to squeeze all of the truth and meaning out of them, I’m not going to change theirs. I will, however, for the edification of OTHERS who are reading these posts, clarify a few issues, and possibly educate people on just WHAT IT IS WE LOSE when we lose a neurosurgeon…

    The name of the last fulltime neurosurgeon in Chester County, which IS, by the way, one of the five counties located in southeastern Pennsylvania and part of the “greater Philadelphia area,” i.e., not a “rural” area at ALL, was Dr. Samuel Lyness, the primary provider of neurosurgical trauma care in the county. He is now practicing in El Paso, Texas, and while I don’t have his actual malpractice bill at my fingertips, there were numerous press accounts of his departure and the reasons for it at the time – of course, I suspect that if Dr. Lyness were to personally post an entry about the premium he decided not to pay and why he left that Elliot and CJD and perhaps some others would call HIM a liar, too…..after all, his reasons for leaving the state would only be “one doctor’s opinion….”

    Brandywine Hospital was forced to close its Trauma Center on June 4, 2002 due to a lack of trauma surgeons, according to CEO R. Alan Larson, who cited “soaring malpractice premiums that are driving surgeons out of the state or into retirement.”
    Of course, I suppose it’s only CEO Alan Larson’s OPINION that he had to close his hospital’s trauma center due to skyrocketing malpractice premiums and a lack of surgeons, and there is, of course, no “proof” of that, just his word as CEO of the facility….so it’s probably a lie….

    It is a requirement for trauma certification that a neurosurgeon be available on call 24 hours a day. While Elliott touts the virtues of “better outcomes in a major center,” I suspect that he is merely unaware that Brandywine Hospital’s Trauma Unit WAS a “major center.”

    Elliott also questions whether or not there can be ANY possibility of quality medical care outside of whatever it is he considers a “major center.” Some of the best medicine in the country is practiced in tertiary care community hospitals, like Lehigh Valley Hospital in Allentown, which has, for several years in a row, received the some of the nation’s highest honors as a Top Heart Hospital. The Lehigh Valley, which the hospital serves, is roughly the same size as Chester County – about 450,000 people. People COME to Lehigh Valley Hospital from major metropolitan areas for open heart surgery.

    Elliott’s urban elitism seems obvious when he suggests that one can only obtain quality neurosurgical care in places like Philadelphia or Chicago. He also exhibits a blatant disregard for the vast majority of Americans who simply don’t have access to one of these vaunted “major centers.” MOST people have to take their medical care where they live – or as close to where they live as possible. And to suggest that it’s OK for needed services to NOT be available at community or regional hospitals because, hey, well, care would probably be better somewhere else anyway, is ridiculous….but, hey, that’s only MY opinion, which, since it is the opinion of only ONE person, and NOT a doctor at that, is probably a lie….

    Refusing to believe the obvious, Elliott said, “Malpractice insurance may be part of the mix of reasons why noone practices in Chester County, but if it was the only, or even the main, reason then there would be no neurosurgeons practicing anywhere in the state.” Well, we’re rapidly reaching that point, and if it weren’t for the fact that both community hospitals and other facilities in Pennsylvania are putting their OWN finances on the line to hire and pay malpractice premiums for neurosurgeons, there would likely be far less. All of the private practice neurosurgeons in the Lehigh Valley have either left the state or been forced to sell their practices to one of two local “deep pocket” hospitals.

    Two of the private practice neurosurgeons went to Ithaca, New York, where patients from the Lehigh Valley drive several hours to consult with them, because the wait time to see a neurosurgeon here in the Lehigh Valley is so long, but I suspect that Drs. Zupruk and Pollack, with whom I correspond regularly, are really, sneakily, still practicing in Pennsylvania and have likely lied about moving to upstate, New York (where they SAY their premiums are a fraction of what they were here in Pennsylvania – but, since I don’t have their actual malpractice insurance bills in my hand, they’re probably lying about that, too…..).

    The American Association on Neurological Surgeons and the Congress of Neurological Surgeons recommend that there be a neurosurgeon available for every 65,000 residents in a given area. In 1996, there were 214 practicing neurosurgeons in PA. Now there are 152, and while the population of Pennsylvania, about 12 million, hasn’t risen appreciably in that time, our population of SENIOR CITIZENS has risen dramatically (although US census figures are probably only one census taker’s opinion and should probably be considered lies….) and Pennsylvania now ranks second in the nation for senior citizens.

    Not a single neurosurgical fellow training in any of Pennsylvania’s certified fellowship programs plans to stay here to practice, according to a 2004 study conducted by the American Association of Medical Colleges – although whether they’re planning to practice here or not is only the “opinion” of these newly minted neurosurgeons, and therefore not admissible as scientific evidence…or maybe they’re just lying….Is the medical liability climate the ONLY reason they’re leaving? Certainly not – reimbursements are far higher in other states as well. Frankly, there’s a “perfect storm” of reasons for them NOT to stay here…and since “It doesn’t take a brain surgeon to figure that out!” is a staple of idiomatic English, one might guess that these new young brain surgeons are smart enough to figure it out…

    Elliott also said, about the “alleged” deaths of trauma patients in Chester County, “There is little evidence other than anecdotal statements by some named and unnamed neurosurgeons that these deaths were avoidable because of delay in reaching treatment. I don’t consider that anywhere the standard of proof I require….” This comment made me wonder whether Elliott really IS a lawyer, as I assumed from the tone of his posts. He seems not to want to accept that a qualified neurosurgeon or medical examiner can, with any degree of certainty, state that HAVING a neurosurgeon available is better for a trauma patient than NOT HAVING a neurosurgeon available, or that waiting LONGER for treatment is somehow better for the patient than waiting LESS.

    The sticking point here, for him, seems to be that it’s only one doctor’s OPINION that it would have been better for these patients to have been seen by a neurosurgeon in Chester County, rather than having been forced to undergo transportation and delay prior to treatment by a neurosurgeon at a trauma center elsewhere. I find that curious, since, when a doctor is hauled into court and accused of malpractice, it is ONE DOCTOR’S OPINION, i.e., the opinion of the plaintiff’s expert witness, which is sold to jurors by plaintiff’s attorneys as cold, hard, scientific fact.

    It is only within the past three years in Pennsylvania that expert witnesses were even required to practice in the same specialty as the accused physician, or that they be licensed to practice medicine in Pennsylvania at all. Prior to that, the opinion of a single retired pathologist was a perfectly acceptable scientific “proof” for most plaintiff’s attorneys in PA when accusing a board certified neurosurgeon or a respected obstetrician/gynecologist of negligence and malpractice. And even now in PA, since the advent of our Certificate of Merit, it is the opinion of ONE DOCTOR which allows a malpractice case to move forward through the legal process….so for Elliott to suggest that it is somehow unacceptable to him and to the legal profession to rely on the opinion of one doctor as scientific proof….well, it just makes me wonder, especially since there’s so much talk of “lying” going on here….

    CJD says: “none of the stories you link support the claim that these people died solely because a neurosurgeon wasn’t available in Chester County…..” Of course, there are no guarantees that some or all of these patients wouldn’t have died even if a neurosurgeon were readily available – such is the nature of medicine and trauma and human brains are frighteningly fragile.

    But there isn’t a qualified neurosurgeon in the COUNTRY who wouldn’t argue that their chances would have been BETTER with immediate care – and the poor people who died in transit had NO chance of survival…we’re parsing here, CJD, and that’s pointless…. CJD also references the Chester County situation as, ho-hum, “a lack of specialists in rural areas, but the reasons for those are many faceted and rural areas lack specialists across the country, and the reasons are not simply lawsuits.” I’ll say it again – Chester County, Pennsylvania is NOT a rural area. They have multiple Starbucks! (OK, my sister in law is probably lying about that….) And, hey, they used to have a trauma center…

    About the great state of Texas, which is proving our claims that capping non-economic damages does reduce premiums and improve access to care more every day, CJD has some of his facts wrong. So did I, actually – it seems the rate reductions since the passage of Prop. 12 are actually HIGHER than I believed… CJD says: “Kind of like your claims about Texas, in which you give only half truths. Some carriers have reduced their premiums 17%, but this was after increases of 150%. And, there is no evidence that the caps had anything to do with them, because as I’m sure you know, med mal claims tail a minimum of 3 years, and the law only recently went into affect.”

    What we’ve actually SEEN in Texas is this, according to Texas Congressman Michael Burgess, speaking in the House on Sept. 21, 2005, as published by the Congressional Record: “Madam Speaker, just a little over 2 years ago Texas passed a constitutional amendment that allowed for caps on noneconomic damages in medical liability lawsuits. And what has been the experience in Texas over those 2 years? Well, we have seen insurance and doctors come back to the State. Texas had gone from 17 down to two medical insurance companies, and now they are back up to 12. Not-for-profit hospitals have seen significant increases in the money that they are now able to invest in plants and equipment, money that otherwise would have gone for their self-insurance programs. And perhaps most importantly, the rates of liability insurance for Texas doctors has come down. Texas Medical Liability Trust has reduced rates three times since the passage of House bill 4 and proposition 12, 12 percent in 2004, 5 percent in 2005, and now a recently announced 5 percent decrease in 2006, and, coupled with that, a 5 percent dividend rebate. So that now there is a total of 27 percent insurance savings for Texas doctors in medical liability.”

    It wasn’t just a law that passed in Texas – it was also a constitutional amendment, which is why it HASN’T taken three years for premiums to fall….on June 11, 2003, Gov. Rick Perry signed into law House Bill 4, which contained sweeping tort reforms, including a $250,000 limit on noneconomic, or “pain and suffering” damages and a $750,000 overall limit per case. The public backed up the bill by approving Proposition 12, which allowed liability insurance premiums to immediately decrease by circumventing a possible 10-year wait for the state Supreme Court to determine whether caps were permitted under the Texas Constitution.

    One of my favorite economists notes that “Innumeracy is no excuse,” so I point out to anyone who doesn’t realize it that it takes a reduction of only 50% to wipe out a previous increase of 100%. Looks to me like Texas is well on its way, with only an additional 23% to go….but, of course, that’s only MY opinion, and….I’m probably lying…

    CJD both argues that it’s impossible for premiums in Texas to have dropped at all BECAUSE of the cap, at the same time he complains that premiums have “only” dropped 17%….which is, as we now know, several percentage points low….Which is it? Capping damages didn’t affect premiums at all, or capping damages didn’t affect them fast enough? But, of course, the Texas Congressman is probably lying, as are the doctors whose premiums have fallen….and the companies which have recently begun writing polices in Texas….

    Someone (yet ANOTHER “anonymous” – come on, folks, make up a screen name, just so we can tell you apart….) commented at 6:27 p.m. that the rates in Texas “went down 17% as the economy improved, in states with and without ‘tort reform.’” If that’s the case, then why haven’t rates gone down EVERYWHERE? Seems to me that the major national malpractice carriers should reap the benefit of an improved economy nationwide and should then reduce their premiums all over the place….oh, WAIT, payouts went up in Pennsylvania 13.5% in 2004….might risk of loss actually have something to do with premium setting? What a novel concept….but, of course, I’m probably lying about that…

    Moving on from Texas….CJD states: “No one opposes reform, Ms. Rovito, they just don’t all agree that it should be done on the backs of the most grievously injured and financially helpless members of our society, which is where you caps advocates would have it.”

    “NO ONE opposes reform”?!?!? Now who’s spinning? I actually RECEIVE ATLA’s “Protecting Your Rights” weekly e-newsletter, forwarded by a friend in the media, and it opposes every single reform BENEFICIAL to the practice of medicine that’s been proposed at any level. In separate newsletters in recent months that I recall off the top of my head, ATLA has opposed specialized medical courts, exempting vaccine manufactuers from liability so that they can manufacture enough to protect us from a flu pandemic (“If President Bush were really interested in protecting the public’s safety, he would not be calling for the elimination of important legal protections,” said ATLA President Ken Suggs. – it’s on the front page of the ATLA website. Better that we NOT have vaccine at all, so we can ALL die…of course, that’s only MY opinion and I’m probably lying about it…)

    They also oppose capping ANYTHING, including lawyers’ contingent fees, both at the national and state levels, and in Today’s Miami Herald, there’s a detailed story about how Florida’s trial lawyers are “getting around” Florida’s recently passed constitutional amendment limiting contingent fees.

    And for whomever accused me of exploiting the tragedies of others for my own political agenda because I passed along several news stories about a press conference attended VOLUNTARILY by family members of patients who died due to lack of neurosurgical care in Chester County….let’s visit the ATLA website to find out how to REALLY exploit victims….there’s a whole separate page devoted to “Faces of Medical Malpractice” broken down by state, and the first picture one sees is of a really adorable little girl, followed by the following claim: “President Bush and the medical lobby say that no victim of malpractice should ever receive more than $250,000, not adjusted for inflation. Ignoring medical errors and malpractice will not make the pain caused go away. Read about the real victims of medical malpractice—loved ones who are maimed or killed each year.”

    NO ONE opposes reform? WE exploit victims by helping them to tell their stories? Puh-LEEZE. You have to be impressed, though, at how blatantly they’re able to lie, right? The medical lobby says “no victim of malpractice should ever receive more than $250,000?” Really? Funny, all this time I’ve been promoting capping NON-ECONOMIC damages only, while leaving economic damages, the quantifiable ones that cover everything from medical expenses to lawn care, and everything in between, unlimited. Clearly, I must have been lying about that ALL this time….silly me….

    In addition, ATLA and its state affiliates support efforts at the state level to undo reforms which have been passed in those states….most recently in Georgia and Wisconsin and here in Pennsylvania, where a hard-fought measure to FINALLY make the whole joint and several liability issue FAIR now needs to be re-legislated.

    NO ONE opposes reform? How about the Democrats in the US Senate, who have filibustered every medical liability reform bill the House has sent them? (Add to that three Republican trial lawyers in the Senate who have ALSO opposed reform.) And just for the record, HR 5, the HEALTH Act of 2005, includes far more “tort reform” than just capping non-economic damages.

    But it’s impossible to debate the issue, it’s impossible for the amount of the proposed cap to be amended, it’s impossible to deal with the other issues covered by the bill….because a MINORITY of US Senators who, by the way, OPPOSE medical liability reform and receive oodles of campaign dollars from American lawyers to do so, won’t even let the bill reach the floor of the Senate….so, PLEASE, don’t try to tell me the “No one opposes reform.” If that were so, I could spend more time un-cluttering my house and doing mommy stuff and less time doing THIS….

    As to “achieving reform on the backs of the most grievously injured and financially helpless members of our society, which is where you caps advocates would have it,” if what ATLA tells people (see above) about capping ALL damages at $250,000 were true, which it clearly is NOT, as reading ANY of the state or national medical liability reform bills will immediately demonstrate, then maybe you could get away with that argument.

    However, since economic damages, outlined and testified to in court by actuarial experts (oh, WAIT a minute, that testimony would be only the opinion of ONE expert, wouldn’t it, and, according to Elliot, not meeting HIS standard of proof….), include not only past and future medical care and medicine and lost wages, but also lost potential wages – a lifetime’s worth, if necessary, lost professional opportunities, benefits and retirement plans a legitimately injured victim might have received if he or she had continued to work, home remodeling and special devices to make the patient as comfortable as possible, cooking, cleaning and other home services the patient can no longer perform, nursing care, physical therapy, psychological counseling for both patient and family, child care, transportation, specially fitted vehicles, lawn care and gardening, institutional care if required, and whatever other services are needed to make the injured victim as “whole as possible.”

    Can economic damages undo the damage that was done legitimate victims of malpractice? No, of course it can’t – but it can provide them with EVERYTHING THEY COULD POSSIBLY NEED to be as comfortable and productive as possible. It’s the plaintiff’s attorney and actuarial experts’ jobs to include all possible current and future needs in the demand for economic damages. If that’s done as it should be done, non-economic damages, which can’t be quantified and are generally awarded in wildly disparate fashion, are an add-on which really does little more for the patient than cover the lawyers’ 40% contingency fee and expenses, which are taken from the PLAINTIFF’s share of awards and settlements. In fact, on average, plaintiffs actually receive only 46 cents on every dollar paid out by medical liability insurers….the balance covers mostly legal expenses….which clearly shows why MANY PEOPLE oppose reform…

    And MANY of them, despite CJD’s claim that “Lawyers are not a monolithic group all with the same goals in mind anymore than physicians” are lawyers. Sadly, lawyers seem far better at generating solidarity within their own ranks than physicians seem able to do. For example, in 2004, according to the Center for Responsive Politics, which tracks campaign contributions, members of the sector identified as “Lawyers and Law Firms” contributed 74% of its total contributions of more than $181 million to Democrats – MOST of whom oppose any kind of tort reform. Since 1990, an average of 72% of lawyer and law firm political contributions, exceeding $679 million dollars, have gone to Democrats. The industry sector described as “health professionals” on the other hand, is a little less monolithic in its approach to political contributions – and FAR less prolific. In 2004, 62% of roughly $73 million in contributions from health professionals went to Republican candidates, MOST of whom (except members of the trial bar) support medical liability reform. Since 1990, 59% of health professional contributions of about $317 million went to Republicans….so it’s clear that there are many physicians and other health professionals who aren’t “marching in lockstep” with the party that seems to support their agenda. Of course, the FEC contribution figures as presented on the Center for Responsive Politics website are probably a lie….

    Are individual doctors more independent of the groups that represent them than lawyers? I have to confess to not KNOWING that answer, although, purely for purposes of getting the word out to legislators, the media and the general public about issues that affect medicine, and thereby affect the quality of and access to health care, I might wish that, instead of being the fiercely independent thinkers and scientists they are, doctors had more of a “herd” mentality. One longtime physician activist compared getting physicians to work together toward a single goal as “herding cats.” While lawyers might not be “monolithic,” they’re certainly more focused on working together as a group and a profession to achieve their personal and political agendas….I’m not saying that’s a BAD thing, either….although I’m probably lying…after all, I do that all the time, right…?

    OK, so you know I wasn’t LYING earlier in the post (which ran on far longer than I planned) when I said I’d let you know how much we lose when we lose a neurosurgeon…..the following are excerpts from an article in the most recent edition of Neurosurgical Focus, a medical journal which describes itself as follows: “…the first peer-reviewed, electronic, topic-based publication of the American Association of Neurological Surgeons, the internationally recognized spokesorganization of neurosurgery, the mission of Neurosurgical Focus is to present new ideas and techniques, as well as fundamental scientific concepts in a timely and accessible fashion. Implicit in this mission is the recording of clinical successes and failures and the teaching of scientific method, critical analysis, and the scholarly endeavor of peer review.”

    This in-depth piece, the entirety of which is available at http://www.medscape.com/viewarticle/515636, features a statistical analysis of the ENTIRE CAREER of a single neurosurgeon, Douglas B. Kirkpatrick, M.D., who practiced in first Utah and then Oregon for 26 years, before he “retired at the age of 59 years due to the frustrations arising from managed care, governmental intervention, and malpractice insurance costs….”

    Please pay special attention to both the number of patients whose health he affected over those 26 years as well as the number of people who live in the areas he served….my comments will be enclosed in parentheses…

    “Abstract – The author maintained prospective records on every patient he treated during the 26 years of his neurosurgical private practice. At the conclusion of his clinical career, he compiled this information in a formal database program and then analyzed the Results for totals, trends, and interesting conclusions, which are presented herein…”

    “I have kept exact records on every patient I have seen, treated, and performed surgery on during the 26 years of my career in private clinical practice. I have performed an analysis of these data, with interesting and specific Results that may prove helpful and/or interesting to other neurosurgeons….”

    “After completion of my neurosurgery residency in 1977, I joined another neurosurgeon in the full-time private practice of clinical neurosurgery in a moderate-sized city (population 60,000) in Utah. The county population at that time was 129,000, but the drawing area encompassed approximately 300,000 persons due to a large geographic area to the south. A major city of 300,000 with a university medical center (and eight other neurosurgeons) was situated 45 miles to the north. Over the first 13 years of practice, my home city grew to 80,000 and the drawing area to approximately 400,000 inhabitants. Three other neurosurgeons came to the county to share the workload….”

    (That makes 5 neurosurgeons serving an area of 400,000 people…an area which sounds more spread-out and has fewer residents than Chester County, PA.)

    “In 1990, after 13 years of practice, I moved to Oregon, to a city with a population of 45,000 and a practice serving the medical and neurosurgical needs of much of southern Oregon and northern California. There I joined a group of two other neurosurgeons and two neurologists….”

    (That’s two neurosurgeons for a city with a population of 45,000 – NOT 450,000, but 45,000…)

    “In my 26 years of private practice, I performed 14,960 formal neurosurgical consultations in 14,391 patients, for an average of 587 consultations per year ….Occasionally a patient presented with a totally different problem at a later date and this was considered a new consultation. This does not include follow-up visits in the office or patients seen briefly on rounds for my partners on weekends or at night….”

    “I have chosen throughout my career to interview and examine my patients personally and have not used medical assistants, nurses, or other aides for this Purpose. Each consultation typically takes approximately 1 hour of physician time….”

    “In my 26 years of practice, I performed 5578 neurosurgical operations in 14,391 patients for a “surgical rate” of 39%. This does not include lumbar punctures, shunt taps, Ommaya reservoir injections, or myelograms, but it does include carpal tunnel surgery, tracheostomies, and repair of major lacerations…”

    “These numbers correspond to a yearly rate of approximately 587 consultations and 215 operations. Pediatric (patient < 16 years old) consultations comprised 6% of the total patients and infants (patient < 1 year old) comprised 1% of cases..."

    “In this analysis, spinal surgery comprised 61% (that’s 3,402 spinal surgeries) of the operative workload, with cranial procedures totaling 23% (that’s 1,283 cranial procedures), peripheral nerve surgery 12% (that’s 669 peripheral nerve cases) , and miscellaneous surgery 4%…..”

    “Major craniotomies were most frequently performed for resection of mass lesions ( Table 4 ). (I may only be a layperson, but I’m pretty sure he’s talking about brain cancer here…) Intracranial hematomas were treated through open craniotomies 57% of the time and through burr holes the other 43%. (Intracranial hemotomas can kill unless the patient receives timely neurosurgical care…) Peripheral nerve surgery was performed most commonly for carpal tunnel syndrome or ulnar neuropathy… ( Table 5 ). (Thereby, reducing patients’ PAIN considerably…)

    “I recognize that neurosurgical practice varies considerably in different parts of the world [6,7] but I believe that my practice may well be similar to that experienced by many other neurosurgeons in private practice in the US. Unfortunately, the absence of comparable studies makes it difficult to know what really is typical….”

    “In my last 13 years of practice, I worked in a city some 250 miles from the closest university center. In this context it was not as feasible or prudent to transfer patients except those with extremely stable or special conditions, for example, unruptured giant aneurysms or stable vertebrobasilar artery aneurysms….”
    (And I’ll bet his patients were better off having him in their backyard, than waiting for transfer some “250 miles from the closest university center….”)

    “Traditionally, the typical neurosurgeon finishes his or her academic education and residency training at approximately 32 years of age, ((That’s a good TEN years after most people have begun their careers and started earning a living….)) depending on the directness of the training pathway and whether time was spent in research and/or a fellowship position….”

    ….”Unfortunately, the costs of malpractice insurance and office overhead make it difficult to reduce one’s practice on a graduated basis and some neurosurgeons find it necessary to close the practice completely, even though they might still be competent to treat many patients with straightforward spine and peripheral nerve disease….”

    “I consider myself fortunate to have incurred a relatively low level of malpractice claims (six lawsuits in 26 years, Table 6 ). Actuarial data indicate that the average neurosurgeon experiences a malpractice claim approximately every 2 years, and this rate may be increasing. My relatively low number of claims may be due in part to the location of my practice in small cities in the western US and in part to a generous portion of good luck….”

    During his 26 year career, Dr. Kirkpatrick took care of 14,391 patients and operated on 5,578 of them. He didn’t practice in a major metropolitan area during any portion of his career – yet look how many patients his skills and education benefited. How many lives did he save? How many people’s chronic pain did he relieve? His analysis doesn’t focus on the real HUMAN impact his career had on his patients, but I’m not afraid to extrapolate this far: he helped a LOT of people. (Of course, I’m probably lying….come to think of it, Dr. Kirkpatrick is probably lying, too, since he told me that he supported medical liability reform in Oregon, and everyone knows that all of us “tort reformers” are liars….)

    If Dr. Kirkpatrick’s career is “typical” of a semi-rural neurosurgeon, and he impacted the health of over 14,000 patients….then how much quality health care is lost when a decidedly NOT rural county loses five or six neurosurgeons? Or when a state loses 50 or 60?

    Or when all of the neurosurgical residents training in that state choose to take their abilities and training elsewhere? From 2000 to 2004, of the 47 brand new neurosurgeons who graduated in Pennsylvania, only 11 stayed here to take care of THEIR potential 14,000 patients – 36 of them went elsewhere. And of those in the 2005 class, NOT ONE is staying in PA…..

    If that doesn’t frighten you, then you’re made of stone, because it turns my knees to water whenever I contemplate where all of this is leading….(as well as considering that BOTH of my sons tend to lead with their heads….)

    ONE more brief comment that the old newspaper proofreader in me can’t resist….CJD said: “the law only recently went into affect.” Perhaps it was only a typo, but my Strunk and White (The Elements of Style, otherwise known as “The Bible” in journalistic circles) says that laws don’t go into AFFECT….they may, however, go into EFFECT. I’m sure that’s what he meant to say….but, of course, I COULD be lying…

    DBR

  • Elliott

    Just pointing out that it’s not an ad hominem attack to consider the actual argument that a participant in a debate makes, evaluate the chain of logic as deliberately fallacious, and then call that person a liar. An ad hominem attack would be to suggest that because someone is a lawyer, their arguments are inherently flawed. Of course, the joke is on Ms Rovito since I am not a lawyer.

  • Donna Baver Rovito

    Actually, Elliott, I think it was one of the many “anonymous”‘s who accused you of an “ad hominem” attack – it wasn’t me.

    I merely accused you of refusing to see the truth….i.e. trusting in a chain of evidence that’s “deliberately fallacious….”

    Gee, I promised my last post would be my LAST post, didn’t I? Guess that just makes me a liar…

    DBR

  • Anonymous

    As an attorney licensed to practice in Phila. I want to make it clear some of us are getting the message about the malpractice environment’s effects on good medicine. I hate to see so much emphasis on Caps when medical courts and complete reform are necessary, but change may have to be incremental. My life and the lives of many of my family members have been saved by local surgeons, and frankly I’m sick of the trial lawyer propaganda blaming everyone for the problem except the legal system itself. I want the best and brightest going into medicine, staying in medicine, and happy about practicing medicine. Anyone who thinks the current status of medicine reflects these goals is a fool, or worse.
    ATLA,PATLA or lawyers I hear behind closed doors seem more concerned with revenues than reimbursing a larger percentage of clients or really preventing medical error, things the current tort system fails miserably at. Both sides can manipulate stastics all they want, the current legal medical malpractice system sucks and it’ time to make sweeping changes to it. Making Rovito out as a liar or enemy of lawyers is counterproductive and only makes me more ashamed of my profession.

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