News Capsules (Fall 2002)

Obstetricians Forced Out of Business

"Doctors who specialize in delivering babies and treating pregnant women are closing their offices, leaving states such as Florida and New York, or abandoning their profession because they can't get liability insurance, even at sky-high rates.

" 'One New Jersey specialist, without a legal blemish on his practice record, was finally able to secure insurance at the cost of $300,000 a year,' Dr. Thomas Purdon, president of American College of Obstetricians and Gynecologists (ACOG), told United Press International.

" 'We are in a crisis situation,' Purdon said at the annual meeting of ACOG.

"Organization leaders issued a 'Red Alert' warning that without relief from state and federal legislation, many rural areas will be without obstetricians.

"Not only are doctors leaving the field, but hospitals are closing their maternity wards. Purdon said the 'ripple effect' was reaching into academic institutions, where recruiting experts to teach obstetrics and gynecology could be hamstrung as well.

"ACOG leaders cited Florida, Mississippi, Nevada, New Jersey, New York, Pennsylvania, Texas, Washington and West Virginia as being most in danger of losing obstetric care because of difficulty in getting insurance.

"For example, in Florida obstetricians have an average cost that exceeds $200,000 a year for insurance premiums if they practice in populous Dade (Miami) and Broward (Fort Lauderdale) counties, said Purdon, professor of obstetrics and gynecology at Arizona Health Sciences Center, Tucson.

"In Nevada, Purdon said, 70 obstetricians in the Las Vegas area are about to leave the state because of the withdrawal from the market of one of Nevada's largest liability insurers.

"'In Mississippi, a pregnant woman in Yazoo City, which has a population of 14,000, has to travel 150 miles to get prenatal care,' Purdon said. 'When a woman has to travel that far to get care, she isn't going to get care...' "

( Wires, May 7, 2002)

Medical Insurance Price War Hurts Coverage for Doctors

"Huge jury awards in medical malpractice cases have reduced the ability of insurance companies to continue physicians' coverage. But experts say there is a second factor operating in decisions by some insurance companies to raise rates or get out of malpractice coverage. That centers on the price war between insurers that developed in the early 1990s.

"In order to attract more business at that time, insurance companies sold malpractice coverage to OB-GYNs and other specialists who are frequently vulnerable to suits at rates that proved inadequate to cover claims.

"Some of these carriers had rushed into malpractice coverage because an accounting practice widely used in the industry made the area seem more profitable than it really was.

"A decade of short-sighted price slashing led to industry losses of nearly $3 billion last year.

"Jury Verdict Research --- which collects data on jury malpractice awards --- says its research shows malpractice awards have climbed 175 percent in seven years. However, some doctors are beginning to acknowledge that the conventional focus on jury awards deflects attention from the insurance industry's behavior...

(Wall Street Journal, June 24, 2002;

Waiting Lists in Spain

In response to public outcry over the deaths of some patients waiting for surgery, Spanish Prime Minister Jose Maria Aznar has called for reforms to curtail waiting lists for surgery in Spain's national health system, reports the British Medical Journal.

Extra evening surgery sessions will be added at a number of public hospitals, and some patients will be operated on in the private sector at government expense.

Between July 1996 and March 2000, the number of patients waiting more than six months for an operation decreased by 96 percent (from 53,822 to 1,908 patients). And the average waiting time fell from 210 days to 61 days, with an overall reduction of 70 percent.

"Celia Villalobos, the new minister of health, said that the plan would be funded by the savings generated by the increasing number of approved generic drugs, which are considerably cheaper than trade compounds."

(Xavier Bosch, "Surgeons work evenings to cut Spanish waiting lists," British Medical Journal, June 10, 2000; For text see; For more on health issues, see


Boston Physician Awarded $4.2 Million

"A jury recently awarded $4.2 million to a physician who says she suffered a 'character assassination' in the wake of a patient death, according to the Associated Press (AP).

"Lois Ayash, M.D., had filed a libel and defamation lawsuit against the Boston Globe and the Dana-Farber Cancer Institute, in Boston, claiming that she was scapegoated following the death of Betsy Lehman, a Boston Globe health columnist. Lehman died after receiving an overdose of chemotherapy drugs, which were inaccurately prescribed by another physician.

"Following Lehman's death, the hospital reprimanded Ayash for not discovering the overdoses sooner. She was laid off a year later.

"The jury found that Dana-Farber and its head, David Livingston, had not defamed Ayash, as she claimed, by suggesting she had covered up the overdoses. It did, however, breach her contract, violate her privacy, and retaliate against her after she filed suit. 'It also found Livingston intentionally interfered with Ayash's job at Dana-Farber,' said the AP.

"Ayash also claimed that the Globe had libeled her by a 1995 article that said Ayash had countersigned a medical order that resulted in Lehman's death. 'The article described her as the 'leader of the team' of doctors at Dana-Farber responsible for Lehman's care.'

"The newspaper later printed a correction that stated Ayash had not, in fact, signed off on the medical order. However, it maintained that Ayash was head of the treatment team, said the AP. A superior court judge last year ordered a default judgment in favor of Ayash because the paper and reporter, Richard Knox, declined to reveal confidential sources."

(Associated Press, April 19, 2002)

Government Recovers Over $1.3 Billion From Alleged Fraud

"The government collected a record $1.3 billion during 2001 from health care fraud cases, according to the U.S. Departments of Justice (DOJ) and Health and Human Services (HHS). More than $1 billion of that was returned to the Medicare Trust Fund. An additional $42.8 million was recovered as a federal share of Medicaid restitution --- the largest return the government has seen since the inception of the Health Care Fraud and Abuse Control Program.

The passage of the Health Insurance Por-tability and Accountabil-ity Act (HIPAA) has helped the government's efforts to successfully detect and eliminate health care fraud to grow over the last five years. 'HIPAA made available much needed and powerful new criminal and civil enforcement tools and financial resources that permitted the government to expand and intensify the fight against health care fraud,' says the DOJ.

"In the last five years, total returns to the government topped $3 billion. Of that, $2.9 billion was returned to the Medicare Trust Fund. More than 2,000 defendants have been convicted for health care fraud-related defenses and over 15,000 entities or individuals were excluded from participating in Medicare, Medicaid, and other government health care programs. In 2001, HHS excluded more than 3,756 individuals."

(Dept. of Justice Press Release,, April 26, 2002; See also the July/August 1998 special issue of the Medical Sentinel entitled "The Police State of Medicine" at

Cloning --- From Dolly the Sheep to Humans

"The scientists who cloned Dolly the sheep said on April 11, 2002, they plan to seek permission to experiment on human embryos for medical purposes.

"In a move expected to raise concerns from some religious groups, the Roslin Institute will apply for a license to the Human Fertilization and Embryology Authority, the British government body that regulates embryo research...

"The Roslin Institute stunned the world in 1996 when it created Dolly, the first animal to be cloned from an adult cell.

"Since then, Britain, which has the world's most liberal policy on stem-cell research, has said the cloning of human embryos for research should be allowed to proceed under strict conditions.

"Cells taken from embryos within two weeks of fertilization are seen as potentially useful for research into finding a cure for debilitating diseases such as Parkinson's and Alzheimer's.

"Last year Britain became the first country explicitly to allow the creation of embryos as a source of stem cells..."

Critics of embryo cloning are concerned this is the first step on the slippery slope to reproductive human cloning.

(Macon Telegraph; Reuters, April 11, 2002)


Sweden Moving Toward Free Market Medicine

"Recently, policy-makers in Stockholm, the capital of Europe's most heavily socialized Scandinavian state, began implementing market-style reforms that may deprive national health care proponents of their favorite example.

"Between 1992 and 1994, even as the advocates of 'Hillarycare' in the United States were calling for wider government control of health care resources, the Health Services Council in Stockholm began contracting health services to private companies as part of an experiment to determine whether the private sector could perform better than the city's public health institutions. The result was an 'internal market --- a system of private health care providers within the larger public-financed system.

"Much of the pressure to experiment with privatization came from European Union regulations that forced reduced public taxation in Sweden.

"In every category, the experiment has been a success.

"For decades, Stockholm relied on an underperforming civic health service monopoly characterized by long waiting lists, chronic overspending and flag-ging quality. Since the experiment began, virtually every sector of Stockholm's health system has undergone some form of privatization...

"By the end of the experiment's first five years, all but one of the original 150 private contractors had survived and were flourishing. Likewise, by the end of the first year of its priva-tization, St. Göran's had shown significant improvements over its performance as a public facility...

"While opponents of the privatization reforms had predicted that the private sector, by seeking to make a profit for shareholders, would drive costs up and efficiency standards down, the opposite has in fact been true.

"Across the board, private contractors in Stockholm are operating with less staff on smaller budgets, while providing the same treatments to more patients than their public counterparts. As a pilot program for testing the potential effects of competitive market mechanisms on public health care systems, Stockholm's internal market has proven the ability of the private sector to dramatically outperform state-administered facilities by reducing costs, improving care and saving lives."

(A. Wess Mitchell, National Center for Policy Analysis, August 31, 2001,


Castro's 'Doctors Diplomacy' --- Free Medical School Tough Pill to Swallow

"They arrived in Cuba more than a year ago to a hero's welcome: eight U.S. medical students with oversized duffel bags who got misty-eyed as their flag was raised among 23 others at Havana's Latin American School of Medicine.

"Pioneers in a controversial program, they were the first to accept Fidel Castro's offer of full scholarships for students from disadvantaged families.

"But the emotional reception soon gave way to mundane realities to which most did not adjust. Rice and beans were served at the cafeteria almost every day. There were no toilet seats in the bathrooms. The students had to take a bus 45 minutes into the city every time they wanted to check their e-mail.

"Critics of Castro predicted the American medical students would not complete the rigorous six-year program. Opponents dismissed the scholarships as propaganda calculated to highlight disparities between the United States and Cuba in health care and educational opportunities for the poor.

"Today, Nadege Loiseau, 26, of Lauderhill is one of only two Americans remaining from the original group that arrived in April 2001. The naysayers' skepticism only fueled her resolve to complete the program...

"Whenever she falls behind in physiology class, confronts congested phone lines while calling her parents in Lauderhill or hungers for the 'occasional steak,' Loiseau thinks of her 3-year-old son, Aaron David, and presses on.

" 'It's never crossed my mind to leave,' she said. 'My son keeps me going. When he's getting ready to go to college, I want to be able to say I can send him.'

"About five delegations of students from at least 11 states, from Oregon to Louisiana, have arrived since Loiseau's group. The Rev. Lucius Walker, founder of the New York-based Pastors for Peace, heads the stateside admissions process.

"Walker had hoped to have 100 American students enrolled in the Cuban medical school by now. However, only 50 have made the cut. Of those, 14 dropped out and returned home, Walker said.

" 'I think I overestimated the quality of the applicants,' said the Baptist minister whose group is known for flouting the U.S. embargo by bringing unlicensed humanitarian aid to Cuba. 'We get a lot of interest expressed, but not everyone is ready to go...' "

(Vanessa Bauzá, Orlando Sentinel, June 3, 2002)

Collectivists in Medicine: Physician Groups Seek New Oath of Hippocrates

"Three medical organizations in the United States and Europe have published guiding prin-ciples for physicians worldwide in the Lancet and Annals of Internal Medicine.

"The physicians' charter, a new medical oath of sorts, includes three fundamental principles and 10 professional responsibilities. The principles are: the primacy of patients' welfare, patients' autonomy and social justice.

"The professional responsibilities involve such concepts as a commitment to professional competence, increasing scientific knowledge and improving access to equitable health care.

"Thus 'social justice' in the context of health care is the just distribution of finite care resources regardless of financial or other considerations. It also entails 'promotion of public health and preventive medicine, as well as public advocacy....'

"Some physicians are criticizing the document for introducing the concept that physicians are obligated to consider not only the interests of the individual patient, but the requirements of society.

"They say it is really a call for equal outcomes between social classes and ethnic groups. Applied worldwide this would mean a massive reallocation of health care resources to the developing world, where there are few resources and more unmet needs. This would require eliminating resource-intensive medicine --- such as transplants and cardiac surgery --- in the developed world.

"Critics conclude that the charter is a political document that equates inequality with injustice, and would obligate physicians to become activists."

("Medical Profession-alism in the New Millennium: a Physicians' Charter," Lancet, February 9, 2002)

Belgium Legalizes "Mercy" Killings

"Belgium became the second country in the world to legalize euthanasia through a bill passed by parliament allowing doctors to take the lives of terminally ill patients under strict conditions...

"After two years of heated debate and a marathon voting session lasting two days, the House of Representatives adopted the law by a vote of 86 to 56, with 10 deputies abstaining. The Senate approved the motion in October.

"The Netherlands was the first country to legalize mercy killing in legislation passed in April.

"The parliament was split between the left-wing governing coalition, which supported the bill, and the center-right opposition, which opposed it.

" 'People aren't afraid of being dead, but they fear the process of dying,' Flemish Green Party Deputy Anne-Mie Descheemaeker told a packed Parliament chamber. 'I'm sure that having the option of euthanasia gives people the courage to go on day after day.'

"Conservative critics of the law said it was open to abuse and violated the sanctity of the right to life. They immediately threatened to challenge the bill in Europe's leading 'human rights' court after all the opposition's 100 amendments were rejected by the lower house.

"The Belgium law applies strict conditions for killing patients. For a mercy killing to take place, patients must be above 18 years of age, in 'constant and unbearable physical or psychological pain' resulting from an accident or an incurable disease, and fully conscious when they make the demand to die.

"Under terms of the law, expected to be enacted before summer, the demand to die must be made repeatedly by the patient and witnessed by a third party.

"Doctors have a duty to inform the patient of their state of health and possible treatments that could prolong life. If the doctor arrives at the conclusion no other solution is possible and agrees the demand of the patient is voluntary, he must get the approval of a second doctor for the lethal injection to be applied.

"In Denmark, minors will be allowed to kill themselves in extreme circumstances."

( wires, May 18, 2002)


Waning Enthusiasm

"The Kaiser Foundation's latest National Survey of Physicians indicates 87 percent of doctors believe that the overall morale of the profession has declined in the last five years. Although 53 percent say they would recommend the profession to a young person, 45 percent say they would not. More than three-quarters of those surveyed claim that managed care has had a negative effect on the way they practice medicine, but 63 percent admit that managed care has made some improvements..."

(Internal Medicine News, June 15, 2002)


This edition of News Capsules was compiled by Miguel A. Faria, Jr., M.D., Editor-in-Chief of the Medical Sentinel of the AAPS. It appeared in the Medical Sentinel 2002;7(3):71-74. Copyright©2002 Association of American Physicians and Surgeons (AAPS).