A spectacular failure of a state medical board

http://scienceblogs.com/insolence/2013/09/20/patients-endangered-by-failure-of-medical-boards/

by tokenadult • 13 years ago

56 68 13 years ago

coldcode• 13 years ago

Yet another reason to avoid Texas. Sadly I live here. I think our politicians probably go elsewhere for medical care.

npsimons2• 13 years ago

This is why every time someone here says "hey, move to Texas, it's better!" I just have to shake my head. Sure, nowhere is perfect, but between the school boards in Texas and the medical board, plus the unconstitutional laws still on the books against electing atheists, I just can't see myself living there. Yes, I know Austin is a tech mecca of the midwest, but there's a cultural problem in the whole state that stories like these point to.

Zigurd• 13 years ago

Republic of Texas. It's a win-win.

angersock2• 13 years ago

"unconstitutional laws still on the books against electing atheists"

Point to any recent cases where that's been used to actually prevent an election. Every state has stupid laws on the books, seldom enforced.

As for the school and medical boards, while there are some mistakes that get made, coverage like this makes it more likely, not less, that things will get fixed.

"cultural problem in the whole state" is painting in really, really broad strokes, and inaccurate ones at that.

abarringer• 13 years ago

“If you want to be happy for the rest of your life…try moving to Texas..” --Mike Huckabee Facebook post 9-10-2013

He didn't say the reason why is because your life would be radically shortened by a non-invasive surgery so you wouldn't have time to be sad. Maybe that was implied?

talmand10• 13 years ago

You can find reasons to not live anywhere. But you can also find reasons to live everywhere.

I'm generally a pessimistic person but I dislike these overly negative generalizations at states and/or groups of people. I personally have lived in four different states and liked them all. I think I could enjoy living in any state.

Well, except for California, forget that noise.

w1ntermute• 13 years ago

I'm sure Texans are happy to allow the free market to sort this problem out.

jerf• 13 years ago

That doesn't sound like an unregulated system.

That sounds like a system where the regulation didn't work.

One of the reasons I'm much less gung-ho about regulation as the answer to everything is that I acknowledge that case exists, and must be considered carefully rather than unconsciously assumed away. Regrettably, this complicates things compared to a world in which we could just assume the problem away, but we don't live in that world.

Those who could have stopped it had their ability to do so regulated away: The board’s mandate, spelled out in the Medical Practice Act, recognizes a doctor’s license as a hard-won, valuable credential. Doctors’ rights are to be protected at every step of the process. The board can’t revoke a license without overwhelming evidence, and investigations can take months, with months or years of costly hearings dragging on afterward. (Quote is trimmed a bit; a justification follows, but is a prime example of how regulation failed to consider an edge case and then made damned sure everybody else was obligated to fail to consider it as well.)

masklinn5• 13 years ago

That doesn't sound like an unregulated system.
That sounds like a system where the regulation didn't work.

No, it's a system where all regulatory authority and ability has been willfully destroyed over the last decade.

http://www.texasobserver.org/anatomy-tragedy/

But in the past 10 years, a series of conservative reforms have severely limited patients’ options for holding doctors and hospitals accountable for bad care. In 2003, the Republican-dominated Texas Legislature capped pain-and-suffering damages in medical malpractice lawsuits at $250,000. Even if a plaintiff wins the maximum award, after you pay your lawyer and your experts and go through, potentially, years of trial, not much is left.
The Legislature has also made suing hospitals difficult. Texas law states that hospitals are liable for damages caused by doctors in their facilities only if the plaintiff can prove that the hospital acted with “malice”—that is, the hospital knew of extreme risk and ignored it—in credentialing a doctor. But the Legislature hindered plaintiffs’ cases even more by allowing hospitals to, in most cases, keep credentialing information confidential. In effect, plaintiffs have to prove a very tough case without access to the necessary hospital records. This is an almost impossible standard to meet, and it has left hospitals immune to the actions of whatever doctors they bring on. Hospitals can get all of the benefit of an expensive surgeon practicing in their facility and little of the exposure. This has freed hospitals from the fear of litigation, but it’s also removed the financial motivation for policing their own physicians.
The medical malpractice cap and the near-immunity for hospitals snapped two threads from the regulatory web. What remained was the Texas Medical Board.
But the Medical Board wasn’t designed to be an aggressive enforcer. It was mostly designed to monitor doctors’ licenses and make sure the state’s medical practitioners are keeping up with professional standards. The board’s mandate, spelled out in the Medical Practice Act, recognizes a doctor’s license as a hard-won, valuable credential. Doctors’ rights are to be protected at every step of the process. The board can’t revoke a license without overwhelming evidence, and investigations can take months, with months or years of costly hearings dragging on afterward. The protections make some sense. The Legislature doesn’t want the Medical Board taking a doctor’s license—and livelihood—unnecessarily or based on flimsy or frivolous claims. But the result is that unless a doctor is caught dealing drugs or sexually assaulting patients—or is convicted of a felony—it is difficult to get his or her license revoked.
What all this means is that the Texas Legislature has committed the state to a policy of medical deregulation—a free-market system in which doctors can practice as they please with limited government interference. Only their consciences, and those of their fellow doctors, limit them.

anigbrowl4• 13 years ago

That doesn't sound like an unregulated system. [...]

Those who could have stopped it had their ability to do so regulated away:

It's the doctors & hospitals who are the regulated parties. The Medical Board are the regulators. Stripping them of their authority effectively leaves the medical practitioners unregulated.

You're arguing that one group of meddling bureaucrats were hobbled by another group of meddling bureaucrats. Think through it again.

speeder• 13 years ago

This is actually a case of opposite of free market.

Like the article said, if it was easier to people fire him when he was still a student for example, without fear of being sued, this would be averted.

Also the licensing system is broken (ie: license is mandatory by law, law says hospitals can trust the license, licensing organization is broken and give broken licenses... what to do? Good hospitals will expend money to research the guy, but the average hospitals will trust the law, that says that if the guy has a license, he has right to be licensed...)

masklinn5• 13 years ago

This is actually a case of opposite of free market.
Like the article said, if it was easier to people fire him when he was still a student for example, without fear of being sued, this would be averted.

That makes no sense. How would more free market yield less suits exactly? What would the mechanism for righting wrongs be, smashing people's heads in without court interference?

wging• 13 years ago

I recommend reading the source article for this blog post, instead. It's well-written and far more detailed.

rickmatt• 13 years ago

Okay, who else correctly guessed the state?

tokenadult• 13 years ago

It looks like this doctor hires one of those reputation management firms, as most Google search results from searching his name are just medical directories that don't point to any of his surgical mistakes or the belated regulatory sanctions he has recently encountered. It's remarkable how well quacks can protect their reputations online even after patients die.

AFTER EDIT: As suggested by another comment in this thread, if you'd like to learn all the gory details of this quack surgeon's career, see the original Texas Observer reporting on him,

http://www.texasobserver.org/anatomy-tragedy/

which ought to rank higher in a Google search on his name than it does.

Echo117• 13 years ago

That link currently ranks at #4 for me in a Google search of Christopher Duntsch, no quotes.

auctiontheory• 13 years ago

One of my favorite words: iatrogenic.

fsckin• 13 years ago

The $250,000 limit on medical malpractice suits in Texas is bullshit. Protecting doctors from frivolous lawsuits is fantastic in theory, but if make a grave mistake, you should be held accountable. 'License to Kill' isn't that far from the truth. It's expensive, but you can literately kill people and get away with it.

Here's my story:

We saw two doctors in Texas, both were convinced that my wife had advanced bowel cancer. The second doctor confirming the diagnosis was the Worst Day in my life.

We had no idea the doctors had colluded behind our backs, negating the exercise of getting a 'second unbiased opinion'. We had gone to a separate chain of hospitals and got the first diagnosis regurgitated to us.

She went in for a laparoscopic bowel resection surgery and woke up with:

* A nasty scar from pelvis to belly button

* Temporary ileostomy bag (her worst nightmare, requiring another surgery to remove, more nasty scarring)

* Hysterectomy (Sterilized, no kids yet)

* News that the previous diagnosis of cancer was incorrect.

* New diagnosis: Endometriosis (Can be treated without surgery in most cases)

The doctor was practically in tears when he broke the news to me.

The doctor was paid $60,000. The anesthesiologist and hospital split the rest, and our insurance paid in excess of $150,000 for the first surgery that wasn't medically necessary. The ileostomy reversal was performed in another state and cost another $40,000. Insurance is still paying for emergency room visits a few times a year.

We eventually consulted with several lawyers, and none would take the case, even the scummiest bastard I've ever met who would probably take candy from a baby if given a chance to do so. They all came to the same conclusion:

"There is no question that you have been severely and permanently wronged. Due to complications, you will need regular emergency medical attention for the rest of your life. If we took this case to court, we would win it every time. Unfortunately, it is not worth it to us due to the $250,000 limit. There is zero chance they will settle, there is no incentive for them to do so. A trial will be long, drawn out, and eventually, you could owe us more than the jury awards."

Thanks, Republicans.

mikeyouse• 13 years ago

Tort Reform (essentially limited liability) is in direct conflict with the only corrective mechanism in the 'free market'. I've never understood why republicans support it so earnestly.

masklinn5• 13 years ago

Because republicans only care about free market for the votes and the ability to destroy governmental processes and rollback social progress it gives them.

They're as plutocratic as the democrats if not more so, and they're even more shameless about it.

mikeash• 13 years ago

The only way a person could possibly think that Republicans truly believe in the "free market" is if you only ever pay attention to what they say and never to what they do.

dragonwriter9• 13 years ago

Because "free market capitalism" is mostly using "free market" (in this context, the concept of minimally regulated markets with correction for actual unlicensed harm through legal action based on specific harms) more as a rhetorical device for selling "capitalism" (the organization of the economic system to favor holders of capital) than as a real end in itself.

sliverstorm4• 13 years ago

Perhaps because tort cases can wind up looking remarkably similar a lynch mob?

mtdewcmu5• 13 years ago

I think it's a pretty simple equation of doctors being in the party and tort reform appealing to the Reaganite anti-regulation, anti-government message. They probably aren't all that serious about it, though, because they trot it out at election time and then it goes away, at least at the federal level.

viggity• 13 years ago

There are two kinds of damages in a lawsuit, punitive and compensatory. Compensatory damages compensate for the actual wrong that was done and any corrective action needed (i.e. additional surgeries, physical therapy, lost wages, etc). Punitive damages are put in place as a punishment and to hopefully ensure that doctors/engineers/professionals are take more precaution when conducting their business.

It is my understanding that the 250K cap is on punitive damages only (at least in most states). I'm sorry that your wife was wronged and 250K does sound low to me, but the cap is there in general to prevent a runaway jury from awarding outlandish sums ($10-100 million) to punish a single person, because ultimately society in general pays that $10-100 million in the form of more expensive goods and services.

wehadfun2• 13 years ago

I think society pays a higher cost by keeping these bozos around.

fnordfnordfnord• 13 years ago

Protecting doctors from frivolous lawsuits is fantastic in theory,

In principle, we want everyone to be protected from frivolous lawsuits. The $250k limit for all practical purposes protects doctors from nearly everyone's lawsuit, frivolous or not. The absence of normal market forces in medical practice makes it even more important to have competent and strong oversight. We get none of that in Texas. Hey, at least malpractice insurance is cheap! (I wonder if it really is.)

OTOH, there are now very few reasons not to travel to another country for major health care, like surgery. Something bad may still happen, but you aren't likely to pay as much for it, and you might even be treated more fairly if it does.

talmand10• 13 years ago

I see a great deal of people to blame for your pain than just one group of politicians.

Was there nothing to be done about the two doctors colluding behind your back? Because that doesn't sound like medical malpractice to me, that sounds like fraud.

anigbrowl4• 13 years ago

Good grief, that's awful. I am so sorry.

mtdewcmu5• 13 years ago

With the exception of pain management clinics and anesthesiologists, the board doesn’t have the authority to inspect a doctor, or to start an investigation on its own.

Somebody's watching the medicine cabinet; they forgot about the knife drawer.

Buttons840• 13 years ago

Are there any resources for investigating doctors? Is there no ways for patients to save themselves from the next Hannibal Lecter?

A spectacular failure of a state medical board

Related Stories