Fighting medical malpractice reporting
I mentioned in posts earlier today how I had difficulty understanding group reactions, and yet how deeply group behavior is embedded in our makeup: humans are social animals, and group identity is basic.
Thus we get the football hierarchy at Penn State closing ranks to protect a pedophile, because he’s a group member and the victims were not—just as the Catholic church continues its practice of covering up for pedophile priests; just as the police routinely protect fellow officers who clearly are doing wrong. And why? Because the miscreants are members of the group (whether football organization, church, or police) and the victims are not.
I watched a pretty good yakuza movie the other night (Street Mobster) and started looking at it in terms of group-oriented behavior. The protagonist, for example, in an argument before others chooses not to back down: very important choice, and very much made with an eye to group reaction. Indeed, sometimes it seems that most of our behavior is governed by group membership: we act to be within the group, we disdain those who are not in the group. It’s evident everywhere.
In the case of medical malpractice, the actions of physicians to protect their malpracticing members are obvious and frequent. Doctors will not discipline other doctors (except rarely) because those doctors are members of their group, and the injured patients are not. “Loyalty” is never to ethics, principles, or the law—”loyalty” is always to a person or a group, and the immediate test of loyalty is for the boss or group to order one to do something wrong to prove that s/he is loyal. A person who goes against the group for reasons of the law, or ethics, or morals, or conviction proves that s/he is “disloyal” and fair game. So doctors will not testify against one of their fellows, regardless of the harm caused.
This suggests to me that all surgical procedures should be videotaped and recorded, using multiple cameras. First, keeping a good record should help advance medical science. Also, detailed records can determine causes of things that went right or wrong. And finally, an objective recording of what actually transpired can keep doctors from having to testify against a fellow: they can just roll the tape. (This is similar to laws in many states that require videotaping police interrogations—a side benefit is that this procedure totally stops false claims of police abuse, just as videotapes of surgical procedures should end spurious accusations of malpractice.)
So physicians who fight malpractice generally fight to keep malpractice suits out of the courts—those physicians are not truly interested in ending malpractice, simply in protecting members of their group. What physicians generally do not address is how to reduce the incidences of malpractice.
Here’s an amazing story. Note the role of the American Medical Association in protecting the malpracticing physician. Marian Wang writes in ProPublica:
An agency within the U.S. Department of Health and Human Services that maintains a discipline and medical-malpractice database reopened it for public access yesterday, two months after the agency had first taken the database offline.
The National Practitioner Data Bank contains information used by hospitals, insurers, and licensing boards to track doctors’ records, check prospective hires, and make other decisions. A publicly available version of the database — which removed confidential identifiers such as doctors’ names and addresses — had long been used by reporters and others interested in patient safety. In the years it was online, journalists could reference the database and, with additional reporting, could at times identify doctors with uniquely long histories of being sued or disciplined for medical malpractice.
Then, two months ago, the government cut off public access — a decision that was sharply criticized by a number of researchers and journalism organizations.
What was behind that decision? Apparently, one Kansas doctor with a trail of malpractice suits.
A public records request by Sen. Charles Grassley and the New York Times turned up documents about the decision that shows that the agency closed the database days after the doctor, Robert Tenny, complained to the government. Thanks to the database, he told the Health Resources and Services Administration, or HRSA, he was about to get unwanted attention in his local paper.
We culled through the documents and pulled out some interesting snippets that give a glimpse into the backstory behind why the public database was temporarily shut down and why — even now — the restored database has some new restrictions.
A brief timeline:
Aug. 16 - A local newspaper reporter requested a comment from a neurosurgeon, Robert Tenny, through Tenny’s attorney. The reporter, Alan Bavley of the Kansas City Star, was working on a story about doctors who have went undisciplined despite histories of malpractice allegations. He had used both the public database coupled with publicly available court records to do his reporting. . .
