One factor contributing to medical malpractice: Doctor-protection programs
I have repeatedly blogged how the Catholic church vigorously and knowingly protects pedophile priests, going to great lengths to keep them safe from detection and prosecution, even to the point of transferring them to new parishes (with new prey) when discovery is threatened. Indeed, bishops have agreed to stop this practice but then deliberately ignore their own agreements so as to provide the protection the pedophiles need. (See this post for an example.)
I do see, however, that this behavior seems common to all organizations: protect their members from those outside the organization at all costs—especially, it seems, if the outsiders are correct and the member is in the wrong. It’s a question of loyalty, as I’ve pointed out, and humans—as social animals—place a high value on group loyalty, much higher than the value placed on loyalty to principles and moral guidelines.
So the military covers up military crimes, the financial industry protects perpetrators of financial misdeeds, police forces protect aberrant members, and so on. Usually, at some point the misdeeds become so great that they threaten the group, at which point action is taken. But action is almost always delayed in order to hide the crime and protect the group: groups don’t like “outsiders”, even if (or especially if) they’re in the right and the group member is in the wrong.
It’s true for doctors as well. When doctors are caught in medical malpractice, the problem is finding other doctors who will testify. Difficult: doctors protect their own. And you’ll notice that many doctors (certainly not all: every group has members who are able to look dispassionately at the merits of individual cases, but these are almost always a small minority) feel that the best way to stop medical malpractice is to make it infeasible for victims to have recourse to the courts. These doctors spend all their energy attacking lawyers (“trial lawyers” can be said with a tone and inflection more commonly used with “serial rapists”) and trying to pass laws that prevent lawsuits or restrict awards regardless of harm done.
And, as in many cases of groups protection schemes, when a miscreant is eventually identified, typically by actions taken outside the group, the offenders are protected—the Catholic church transfers offenders to new locations, medical associations and licensing groups refuse to sanction members, and so on. This story, by Tracy Weber and Charles Ornstein, is typical:
Two years ago, drugmaker Eli Lilly pleaded guilty to illegally marketing its blockbuster antipsychotic Zyprexa for elderly patients. Lilly paid $1.4 billion in criminal penalties and settlements in four civil lawsuits.
But a doctor named as a co-defendant in one suit – for allegedly taking kickbacks to prescribe the drug extensively at nursing homes – never was pursued.
Last year, Alpharma paid $42.5 million to settle federal allegations that it paid kickbacks to doctors to prescribe its painkiller Kadian.
“Health-care decisions must be based solely upon what is best for the individual patient and not on which pharmaceutical company is paying the doctor the biggest kickback,” Rod J. Rosenstein, U.S. attorney for the District of Maryland, said in a statement announcing the settlement.
But the doctors accused of trading prescriptions for paid speaking gigs faced no consequences.
At least 15 drug and medical-device companies have paid $6.5 billion since 2008 to settle accusations of marketing fraud or kickbacks. However, none of the more than 75 doctors named as participants were sanctioned, despite allegations of fraud or of conduct that put patients at risk, a review by ProPublica found.
Reporters reviewed hundreds of pages of court records and interviewed current and former federal prosecutors, state medical board officials, attorneys for whistleblowers and, when possible, the doctors. For each doctor identified in a suit, ProPublica checked for state medical board discipline, penalties from the Medicare program and federal criminal charges.
In many of the cases, it appears that not even a cursory investigation was done to see whether the physicians had behaved inappropriately. . .
