Sunday, March 12, 2006


Predatory litigation and abuse of legal procedures generally is a major problem in obstructing and making more costly good health care provision in the USA. And a large part of the blame has to rest with judges who allow and reward lawyers for such abuses. So it is good to hear of one judge cracking down on legal abuse. The article below is written in a very colourful style but what it reports does seem refreshing

Aetna Insurance, perhaps the US's largest, and most profitable health insurer has the litigation manners of a whiney four-year old gone too long without a nap. In essence, a Federal Judge, so to speak, last Tuesday March 7th, 2006 took them aside, pulled their pants down to their ankles, and whacked them solidly, and repeatedly, on their bare butt... Publicly..

Aetna, being sued by Cavitat Medical Technologies on several counts, has had a history, in this case, so far, of bad behavior you can read about in my earlier articles - including the sending of thugs to my home in a clear attempt to dissuade me from writing about them.

The Cavitat v. Aetna case is a "Donnybrook" - a battle for supremacy. It is the first outright challenge, by the public, of "the decision process" Aetna insurance, and its affiliates, uses to determine exactly what health care offerings they will pay, or not pay, for. Cavitat, in essence, has accused Aetna, of using questionable standards, and dubious individuals (the "quackbusters"), to evaluate health care offerings - and is being very specific in those accusations. The case, if successful, will force Aetna to use standards more in line with the reality of health care - and Aetna is pulling out all of the stops to try and stop this attempt.

But Cavitat, last week, played a new card Aetna didn't expect. They brought in well known California Litigator Carlos F. Negrete to take over as lead trial attorney - and Aetna started to seriously "whimper"... First they tried to block Negrete's entry into the case - and that's when the Judge yanked down their pants... In essence, after the Judge whacked Aetna's butt, she made them take their pile of "Motions," and and dump them in the trash bin themselves. Her words, eyeball-to-eyeball, so-to-speak, with Aetna's counsel, while they stood there, so-to-speak, with their pants down, were:

If anyone has an expectation that this case is going to be won or lost on motion practice or that the battles with regard to motion practice are going to be somehow determinative, I urge you to put aside that notion. The goal here is to have a full and fair opportunity for both parties to present evidence as to disputed facts and apply the law. I know that these two parties don't like each other. It's apparent. I also know that there are several ways to handle a lawsuit. Some people play hardball, some people play softball; but I will tell you right now that the goal here is to have a fair process. And I have very little tolerance for hyperbole, attacks between counsel, or unnecessary motion practice. So I urge you to get focused on what it is you need to try and let's get on with it. Any need for clarification or further explanation?

Aetna, as you may have read in my earlier articles, made a counter-accusation earlier in the case, which, in essence, the Judge tossed out for lack of substance last month. It appears, from this hearing, and Aetna's attorney's behavior, that Aetna can't seem to find a "defense" against Cavitat's onslaught. - and needs to rely on tricks... Aetna's Motions for this hearing, were, basically, a rehash of the counter-accusation they already had tossed out. The trial starts in June, and the Judge said about that:

We invite jurors to give comments after every single trial; and you might well find those comments interesting, particularly the comments that have arisen from civil litigation. They will be apparent to you. They are comments like: "No more exhibits. Do the attorneys think we are dumb? Why do the attorneys put on repetitive evidence? Why couldn't the parties settle this case?" These are the kinds of comments that jurors make. And I urge you to consider that as you start fine-tuning your presentation for trial. We are asking jurors to resolve this civil dispute; and jurors do not like, in my experience, to have their time wasted or their intelligence insulted, and they particularly are resistant to situations where they are asked to make a determination between parties where they believe that the parties could have resolved the case themselves.

I can't wait to see how Aetna insurance is going to put "'s" Stephen Barrett on the stand, and explain how, and why, this old fart, who works out of his basement in Allentown, Pennsylvania, hasn't had a license to practice medicine since 1993, couldn't pass the exams to be certified as a Psychiatrist, has, at best, only had part time employment throughout his career, and was formally declared by the US Court system as "biased, and unworthy of credibility," has become Aetna's NUMBER ONE expert on health care practices.

Even more, I can't wait to hear how Aetna explains how, and why, they use formally discredited Robert S. Baratz, "Bobbie Bogus," as their expert on Dentistry, etc...

You can trust your regulators to protect you

When they get around to it, maybe

NSW health authorities waited almost 18 months before investigating an overseas-trained doctor banned elsewhere in the state for misdiagnosing 208 patients. The doctor, who is still registered to work in NSW as a general practitioner unsupervised and as a pathologist under strict supervision, is believed to have moved to Queensland where he can work without restriction as a GP.

The Illawarra Area Health Service banned Farid Zaer in April 2004 and began to review 6300 patient records after it suspected the doctor had failed to correctly analyse tests for many diseases, including cancer. Three months later it notified the Hunter New England Area Health Service, where the doctor had worked between 1999 and 2001, that it was investigating him. The Hunter service did not begin to review the records of 7300 patients diagnosed by Dr Zaer until last month. In March last year the Illawarra service found Dr Zaer had underdiagnosed 92 patients, overdiagnosed 106 and failed to correctly diagnose a further 10.

The Medical Board of Queensland was notified on September 29 last year that conditions had been imposed on Dr Zaer's practice as a pathologist in NSW. "Even though he is not registered to practise as a pathologist in Queensland, the board still wrote to Dr Zaer and advised him that it was considering imposing similar conditions on his general registration," the board's executive officer Jim O'Dempsey told The Weekend Australian. The board will consider the matter at a meeting this month.

The case comes only a month after Queensland police recommended the Indian-trained surgeon Jayant Patel face at least 28criminal charges relating to 13patient deaths and more than 30 cases of patient harm at Bundaberg Base Hospital. Dr Patel was director of surgery at the Bundaberg hospital for two years before he returned to the US last April.

Dr Zaer, who trained at the University of Bombay in India, can work as a junior pathologist in NSW under supervision by an area health service director of pathology or by a staff specialist. He can work in NSW as a GP without supervision. Debra Graves, chief executive of the Royal College of Pathologists of Australia, said the case was worrying. "I have no idea why the area health services weren't talking to each other."

Rosemary Aldrich, acting director of clinical governance for the Hunter New England Service, defended the delay of the investigation until last month. "While concerns might have been raised in the Illawarra, if there were no concerns raised ... in the New England area, we had no way of knowing whether there was a risk or not," she said. "Until we had some more robust evidence that there might have been a risk, which we received once we were made aware of the Illawarra's definitive review, then we were able to make a judgment and respond."

Dr Zaer worked at the Wollongong Medical Centre, south of Sydney, as a GP until two weeks ago. "We never had any problems with his work as a GP," said centre manager Theo Aroney. "General practice is very different to the work involved as a pathologist. My understanding is that there was controversy regarding some of his diagnostic results while looking under a microscope, which is very different to what we do in general practice." Dr Zaer did not return phone calls from The Weekend Australian.


Philippines nurse shortage

For years, the Philippines has provided nurses to the hospitals of the world's rich nations, but a recent escalation in the exodus of medical workers has left the local health-care system on the verge of collapse. Lured by higher salaries abroad and fed up with political instability at home, over 100,000 nurses -- including former doctors -- have left the Philippines in the last decade and are now working overseas, studies show. Experts say the "brain drain" is also a result of the government's policy of encouraging Filipinos to work abroad so they can send back billions of dollars a year, which fuel local consumption, the main engine of the country's economic growth.

"In two to three years, the health-care system would collapse," said Jossel Ebesate, secretary general of the Alliance of Health Workers (AHW), a group of medical workers. He added that of the roughly 1,600 private hospitals in the country, only 700 were now operational due to the shortage of nurses and doctors. Former health secretary Jaime Galvez Tan says the nurses who remain in the Philippines are overwhelmed by the number of patients they must take care of. At some hospitals on the southern island of Mindanao, there is one nurse for 55 patients, said Tan, now a professor at the University of the Philippines. The ideal ratio is one nurse to four patients, he said. Even at the government-run Philippine General Hospital in Manila, the country's largest medical institution, the nurse-to-patient ratio is 1-to-26, a study by Tan shows.

What is even more worrying, Tan said, is the recent trend of doctors leaving the Philippines after enrolling in nursing schools so they can work as nurses overseas. "I expect more negative impact because 80 percent of doctors have taken up nursing," he said. While many developed countries impose high barriers for allowing foreign doctors to continue to practice, they are willing to accept nurses with open arms due to the shortage at home, which is expected to continue due to aging populations. Tan says that in the United States alone, there is a shortfall of 150,000 nursing jobs in 2005, adding that the number is predicted to hit 800,000 in 2010.

Doctors from the Philippines can expect higher wages abroad, even if they work as nurses. Pepi Ocampo, a student at Manila's De La Salle University, says he's decided to enroll in a nursing school rather than a medical school after graduating from college. "At first, I wanted to become a doctor, but I realized that it was not practical," he said. "I decided to go into nursing as I want to earn lots of money ... My parents suggested that I become a nurse. They were interested more in the pay." The basic monthly salary for nurses working in public hospitals in the Philippines is around 9,900 pesos ($190) and 7,000 pesos for those in private institutions. In the United States or Britain, they would earn between 100,000 to 120,000 pesos, AHW's Ebesate said. The entry level salary for doctors at public hospitals in the Philippines is about 12,500 pesos, while doctors at private clinics earn about 17,000 a month.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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