Just 5% Cause 50% of lawsuits
They are protected as though they are Saints
by Joel
In the USA Public Citizen analyzed data from the National Practitioner Data Bank and found that 4.8 percent of doctors in the United States (40,118) are responsible for 51.1 percent of all the reports made to the Data Bank and 53% of all damages paid.
According to the journal of Patient Safety & Quality Healthcare (volume 12, Issue 5, pg 48), when physicians had dozens of bad reports typically they were for a variety of types of malpractice. But physicians with hundreds of bad reports typically repeated the same mistake over and over and over.
That information is right there for any state medical board to access to protect patients from dangerous physicians. But that is not what state medical boards do. The community of physicians also could learn it just by listening to the patients seeking treatment for the injuries, but that is not what physicians do when patients arrive with iatrogenic injuries (see blacklisting). Instead of protecting patients, they protect each other.
Data in the databank covering the first 20 years of its existance reveals that only 1.8% of physicians were responsible for over half of the money paid out for malpractice claims. Treatment providers routinely say that the answer is to retrain doctors who are problems. Do you know when they have retrained such doctors? Never. Do you know when they will? Never. Unless we who are outside of medicine erect the means to protect patients from the doctors who are dangerous. When patients stop going to them, then they will get retrained.
This is not exclusive to the USA. According to an article in the British Medical Journal a similarly small percentage of doctors account for half of the complaints in Australia.
Keep in mind
According to Public Citizen’s report “Hospitals Drop the Ball on Physician Oversight. Failure of Hospitals to Discipline and Report Doctors Endangers Patients,” (links to their site) as of December 2007, almost 50 percent of the hospitals in the USA had never reported a single privilege sanction to the National Practitioners Data Bank (NPDB). One loophole to avoid reporting is the 30 day rule.
When peer reviewed disciplinary actions are sanctions that last 30 days or less, they are considered too trivial to warrant reporting the the NPDB. The result is that many disciplinary actions are imposed for only 29 or 30 days specifically to avoid having to report them.
By 2012, after the first 22 years of the required reporting, 46% of hospitals still had never filed a report. Anecdotally, it is believed that this is possible because of their imposing only non-reportable penalties. It strains credulity to maintain that in 22 years of required reporting there never was a problem worth reporting.
Before the Data Bank began collecting data the health care industry’s own prediction was that 10,000 reports per year would be filed, but during its first 17 years the average number of reports made annualy was only 650 or 1/16th of the number of sanctions that they themselves estimated that they should be reporting.
That is in line with the Health and Human Services study showing that 93% of what goes wrong in medicine is not reported anywhere ever (see Medical Reporting). Even with all the “failures” to report (“refusals” might be more accurate), what has been reported makes clear that there are over 40,000 physicians in the USA who are dangerous.
They are not the most dangerous physicians. They are the most obvious. But not only does no one protect patients from them, patients are not even allowed the means to figure out who they are.
As Pope Francis said, “There are often young men who are psychologically unstable without knowing it and who look for strong structures to support them. For some it is the police or the army but for others it is the clergy.” And for still other men and women it is finding a safe place for themselves in health care. Medicine vigorously protects its members, defining their victims as cranks and the injuries as frivolous, and protecting the reputation of the entire group by refusing to accept negative information about individuals in their group or statistics they do not like. It is a safe-haven providing support and protection even for its most unstable and most dangerous members.
To ask medicine to report them, or at least let the patient community find out who they are, would be failing to understand the most fundamental problem this site is about. The conflict of interest they have with that never will go away, ever, no matter how much awareness and improvement is made on all other fronts. They never will be in a position to gather or interpret such information objectively.
Specific Cases
Physician Number 94358, licensed in New Jersey, settled or lost 33 medical malpractice suits involving improper diagnosis or treatment without ever being disciplined by authorities in New Jersey.
Physician Number 64625, licensed in Pennsylvania, paid 24 medical malpractice claims involving improper performance of surgery without ever having been disciplined by Pennsylvania authorities.
A Vanderbilt University study found that doctors with worse records of malpractice claims in the past can be expected to have “appreciably worse claims experience” than other doctors in the future. Apparently health care professionals need a study to figure that out.
Solutions
Almost unbelievably, with all this information about all of the authorities in charge failing to protect patients from dangerous operators, the only thing anyone seems able to conclude is that those authorities need to do a better job. Even Public Citizen and the New York Times say that, frequently saying that the answer is more compassionate doctors.
What they are saying is that despots can run the lives of other people better than those other people can run their own. The belief persists in contradistinction to all the evidence to the contrary in and out of medicine.
These authorities have access to the information necessary to know which doctors are the most dangerous and yet they do nothing to protect patients from them. If patients had access to that information, do you think as many would get injured? A doctor who causes the same injury in the same way over and over, hundreds of times to hundreds of different patients, without ever needing to change the bad habit because patients keep coming, might have to clean up his/her act to keep them coming if patients were not forced to live in the dark.
The response of the medical profession to this is hatred, but not of the dangerous treatment providers. The most hated person in medicine is a patient with an iatrogenic injury. If you don’t know that, and you work in medicine, all I can say is Shame on You.
Shame on the profession
The universal response of the rest of the medical profession to patients with iatrogenic injuries is mendacity. I have talked to hundreds of injured patients. They cannot get treatment. They cannot get a record made. They get branded as cranks and liars. Pejorative notes about them are made in their charts. It radiates out and punishes injured patients for years to come.
No amount of regulation or accountability can fix this. Patients are on their own when things go wrong and even when things don’t. Caregivers have a conflict of interest with patients. They do better when patients do worse. They are the wrong people to have faith in. Dracula will never be a good caretaker of the blood bank.
A friend of mine had bleeding ulcers. It had reached the point at which he could not keep food down. So he had is wife drive him to the hospital. While being admitted he overheard they were getting ready to give him a blood thinner. He pointed out that he was suffering from internal bleeding. But they said this was their routine. They gave this to all their patients. How often must that be the wrong thing to do for patients. He had difficulty talking them out of it. Mere reason did not work. He finally had to say he would refuse all treatment if they did not relent. Sometimes that is the only course a patient can follow to prevent harm.
They put him on an IV of antibotics for a day. He still wasn’t able to keep food down, but they then sent him home with an oral antibotic. Both he and his wife are lawyers. They are smart, critical people, but it is difficult to second guess every decision that experts make for you. So they went home only to experience what should have been obvious. When you cannot keep food down, you also cannot keep oral antibotics down.
His condition deteriorated and he had to go back into the hospital where things continued to be run in ways that it would too charitable to call a comedy of errors. The ways were self-interested ones that streamlined processes and made it faster and easier for the providers. If his sister-in-law had not been a nurse, there is no telling what would have happened. She arrived and took charge.
Recently she had had to take charge of the care of her own sister. But she had not been forceful enough and did not manage to persuade people to come soon enough while her unconscious sister was deteriorating. When staff finally relented and came to appease the complaining nurse-sister, it was too late. Her sister had had a stroke and as a result now not only cannot work or take care of her own children, but needs care herself.
Even with two lawyers and an experienced and knowledgeable health care professional in the family, it was not possible to stay on top of the problems caused by neglect, indifference and the lack of accountability in medicine. I read about a doctor whose daughter was in the hospital and he finally didn’t just take charge, but did what needed to be done himself while waiting for the people he had called to come save his daughter. He says she is alive today because he did.
The nurse-sister didn’t do that. She did her best, but didn’t cross that line, and now could not feel more guilty for not having managed to save her sister.
This is how things will stay as long as the medical community can glide blithely along on the surface of an ignorant and faithful community of patients who, with no information to work with, have no choice but to roll the dice and hope things do not go badly as a result of the decisions patients have to make, like choosing where to go for help and whether to go anywhere in medicine in the first place.
We need to shift the paradigm and make available to patients enough information for the patient community to find its own way to safety. Patients need to understand, first and foremost, what the odds are of getting better versus getting worse if they seek care. Frequently, patients are better off living with problems than with seeking treatment.
The information necessary to make such determinations never will come from the vested interests in medicine. No one in medicine ever will report honestly. The little honest reporting that does leak out will not result in the authorities in medicine violating their own interests in order to protect patients except in rare circumstances. They will write new rules, institute new procedures, retrain practitioners and declare “Everything is Better Now” and believe in their hearts that they are objective now and lucid and above self-interest. Do not ever believe that.
Under Reporting
Everyone keeps expecting “transparency” or “a culture rich in reporting” or similar fairytale to come true and result in people in medicine behaving like saints who ignore their own interests. They never have, not as a group and not as individuals. Ever. And they never will. They are not even aware of the most important information that patients need. A willful blindness to the most serious dangers in medicine enforces itself every time colleagues and institutions are protected by treatment providers who simply will not believe a patient with an iatrogenic injury.
If you want a really good example of that, ask any of them what they know about the crime rate in medicine. They best answer I have gotten to that is “That’s another matter entirely.”
In a century and a half we have not even been able to get them to wash their hands enough. Isn’t it time to stop expecting them to behave differently in the future than they have in the past?
It Violates Their Interests
And Their Paranoias
Yet still no one looks beyond expecting authorities to force or persuade or motivate or educate people and institutions to behave in ways that violate their own interests. In the end people and institutions always pursue their own interests. We cannot change that. What we can change is the ability of patients to protect their own interests, which currently they cannot. As it says elsewhere on this site, if just 10% of patients become smart that will change everything.
No one in medicine ever has or ever will tell patients who the dangerous ones are. They don’t even report serial killers (see Majors for starters). And shame on you again if you work in medicine and you don’t already know that. When I write “Just tell us who they are,” about that issue it is only to point out that one easy the fix for just one problem as if they ever would do just that. But they never will.
The patient community will have to set up the means to identify the problems themselves in spite of the obstructions put in the way by the medical community. The 5% figure above includes only doctors. There also are facilities and treatments and nurses and other treatment providers about whom patients need to know more in order to protect themselves. To find out about them, the patient community needs to have something like Community Patient Agencies to gather the information no one in medicine ever will gather objectively enough.
What people are used to comes to be seen as what is normal and then as what is right. Habits formed by self-interested professionals trying to build careers gain an inertia that stands in the way of making the corrections necessary to save lives.
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Below are resources for the above information.