In This Issue:
 President’s Message
The Battle for Tort Reform: Is it the wrong battle?
Find a Neurosurgeon directory
Highlights from the 2010 Scientific Meeting
President’s Message
Eric M. Altschuler, MD
As one of my duties as President of the Pennsylvania Neurosurgical Society, I recently attended the Pennsylvania Medical Society’s annual business meeting held in late October 2010. The main focus of the meeting was to encourage all physicians to engage in this era of change in the health care delivery system.
We were told that physicians who provide measurable quality and value in patient care will be best able to meet new challenges and succeed in this new environment. In a breakout session, I asked a room of physician leaders exactly what this new environment will look like – in other words, can anyone help me understand what is in the new health care reform act.
I was met with blank stares and mostly silence and was told that no one really understood what would happen with this law and which parts would actually be funded. However, I was encouraged by these physicians to get involved to help shape this new nebulous system. I left that meeting wondering how I could influence such a voracious system that consumes close to 20 percent of our entire gross national product and is fast contributing to the bankruptcy of our country.
Sure, I could contact my national, state and local politicians to put my proverbial two cents into the discussion. I could argue my personal belief that anyone accessing the health care system should forfeit their right to sue unless criminal intent could be proven much the same way I believe that same person should forfeit those same rights while accessing the public roads, airways, retail markets, playing fields, etc. But sadly, I’m afraid I would be looked upon as a nutcase and certainly un-American.
I could also propose phased-in yearly public cap limits on medical reimbursements per individual (exclusive of privately purchased additional insurance) or phased-in age limits on expensive therapies or ICU care. But again that would fly into the face of the “everything for everyone no matter the cost” philosophy for all those well-intentioned Americans who don’t mind letting our grandchildren pay an un-payable debt burden.
Instead of proposing preposterous ideas, I felt after leaving that meeting that the best way to shape the new environment would be by attempting to create my own microcosm of quality and value in medicine as it relates to the only thing I can really influence and that is how I manage my own patients.
I will try to shape this new system by resorting to some old fashioned techniques. I will do my best to spend more time explaining to my patients that the results of a test have to change my current management in order to justify the cost to all of us who will be paying for that test. Is an imaging study really needed on every patient who comes to our office? Is a second, third or fourth study needed because a patient is complaining of pain?
Will a second, third or fourth surgery really make a difference? Does that patient with back pain really display signs/symptoms of instability? Is expensive hardware indicated? Am I thinking of RVU’s when I make my decisions? Is that octogenarian with multiple medical problems who suffered a serious head injury or hemorrhagic stroke presenting with coma going to enjoy life after the craniotomy?
These are just a few of the questions that we each must answer and accept the extra effort and responsibility that accompanies our chosen profession if we are to really make a collective difference in shaping this new system. Big changes will really only occur from many collective small changes. This is how I am going to get involved, by trying to be a better doctor, aware that my decisions will help shape the new environment.
From the Editor
The Battle for Tort Reform: Is it the wrong battle?
By Bruce Wilder, MD, MPH, JD
We have witnessed over the last several years a battle for tort reform that has mainly gone on in the committee rooms and Legislature floors, and consumed untold amounts of money from PACs and individual contributions to legislators. Where strides have been made, it has often been at the expense of raising hurdles for all potential plaintiffs, even those with valid claims. In addition, the plaintiff bar knows that even arguably valid cases that are only worth an award of, say, $100,000, are not worth (to them) pursuing. Neither of these situations endears the injured plaintiff to the medical profession, or to the legal profession.
We have seen in Pennsylvania a drop in the number of claims filed, and the amount paid out in claims. This is most likely, in part, due to Pennsylvania Supreme Court rule changes see PNS Newsletter, July 1, 2010) .
In addition, there are two trends that might explain present and anticipated future decreases in the number of filings against physicians. First is the growing practice of early notification to patients to whom medical errors have occurred, along with an offer to negotiate a settlement. Second is the "sorry" movement and related legislation.
A few hospitals are beginning to recognize that when errors occur, there are numerous benefits to notifying the patient as soon as possible after it is clear that there has been an error. These benefits include the avoidance of costly and protracted litigation that, among other things, tends to generate bad feelings (and much angst) on the part of everyone involved (See Disclosing Medical Errors Does Not Mean Greater Liability Costs, New Study Finds, JAMA 2010;304:1656, October 20, 2010).
The physicians involved are much less likely to be sued (or even identified as having paid a claim), and the effectiveness of error prevention programs is enhanced. Moreover, money that would ordinarily be siphoned off to cover litigation costs could go directly to the patient.
As to the second issue, a number of states have enacted so-called "sorry" legislation. That is, legislation that renders inadmissible certain statements (expressions of compassion of sympathy, with or without an admission of fault, depending upon how the legislation is crafted) made by a physician or other health care provider, following an adverse event, but before a claim has been made. Such statements are considered hearsay, but are generally admissible under the “excited utterance,” or “statement against interest” exceptions.
So-called "sorry" laws would in effect nullify the hearsay exception. Not unexpectedly, plaintiff lawyers do not like legislation that makes admissions of fault inadmissible (interestingly, some plaintiff lawyers want to keep expressions of empathy and compassion inadmissible because admission of such statements may generate some sympathy for the doctor in the minds of the jury).
The argument for making statements admitting fault inadmissible goes like this: When there has been an adverse event, patients, their families and the physician may say things that, upon further reflection, may not be the most accurate. Different people remember things differently, and there may be a genuine dispute about what was actually said, and testimony in a trial may come down to a “he said, she said” moment, which is the reason for the hearsay rule in the first place.
Physicians who can anticipate such a scenario, may become overly guarded and their conversations with patients and their families may become stilted and defensive, further raising suspicions and generating distrust – not a good thing when patients need frank discussions about what happened and why it happened. And so it goes. If a physician has said something that is misinterpreted as an admission of fault, even if inadmissible at trial, it informs the patient or his/her family “where the bodies are buried,” so that further investigation could uncover better evidence of negligence, if indeed there was negligence. Thus, the inadmissibility of alleged admissions of fault before a claim has been made, it seems to me, is a reasonable trade-off for enabling a frank conversation during a time of distress for all involved.
Of course, the patient safety movement we have seen in the last few years will most likely have a positive effect on the number of claims being asserted, because it will actually decrease the incidence of medical professional negligence. For patient safety measures to be effective, physicians need to not only buy into those efforts, but should also take an active role in developing institutional error-prevention programs.
While efforts to improve the litigation process are salutary, it seems to me that we should direct more effort toward promoting the alternative measures I have discussed above.
Members can join our Find a Neurosurgeon directory
The public can find PNS member physicians in their area through our website. As a PNS member, you receive one complimentary listing in the database, which is called Find a Neurosurgeon. But your practice information will not be listed unless you give us permission to use your contact information in this directory.
To request a permission form, please e-mail our administrative office at pns@pamedsoc.org or call (717) 558-7750, ext. 1587.
Highlights from the 2010 Scientific Meeting
PNS held its scientific meeting July 9-10 at The Hotel Hershey. Along with legislative udpates on issues affecting neurosurgeons, the meeting covered a variety of clinical topics from some of the field's most respected neurosurgeons. Topics included Electrophysiological Monitoring in
Spinal Surgery, Hypothermia, Endovascular Therapy, Non-Operative Treatment for Spinal Pain, and Novel Treatments for Malignant Brain Tumors.
Learn about the 2011 scientific meeting, which is July 8-9, 2011, at The Hotel Hershey.
| Pictured from left to right: Paul J. Marcotte, MD; Robert G. Whitmore, MD; Daniel R. Kramer, MD; Akshal S. Patel, MD; Eric L. Zager, MD. Drs. Whitmore, Kramer and Patel were the top finishers in the PNS Research Presentation Competition, which is open to all neurosurgical physicians, residents, fellows, medical students and physician assistants.
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| Incoming PNS President Eric M. Altschuler, MD, left, listens as outgoing PNS President Eric L. Zager, MD, right, speaks during the 2010 Annual Scientific Meeting.
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| Michele Gaiski, center, poses with Eric L. Zager, MD, left, Paul J. Marcotte, MD, second from right, Eric M. Altschuler, MD, right. Michele was honored for her years as the Society's Executive Director.
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President
Eric M. Altschuler, MD
Pittsburgh Neurosurgery Assoc.
Suite 224
1501 Locust Street
Pittsburgh, PA 15219-5128
(412) 471-4772
President-Elect
Kevin M. Cockroft, MD, FACS
Milton S. Hershey Medical Center
PO Box 850
Hershey, PA 17033-0850
(717) 531-8807
Secretary-Treasurer
William C. Welch, MD
University of Pennsylvania
The Neurological Institute
330 S. 9th Street, 4th Floor
Philadelphia, PA 19107
(215) 829-6700
Immediate Past President
Eric L. Zager, MD, FACS
Hospital of the University of Pennsylvania
3400 Spruce Street
Philadelphia, PA 19104-4206
(215) 662-3497
Historian
Raymond C. Truex, Jr., MD, FACS
Councilors
Arnold G. Salotto, MD
Paul J. Marcotte, MD
Ashvin T. Ragoowansi, MD
Robert E. Harbaugh, MD, FACS, FAHA
Perry J. Argires, MD
Christopher D. Kager, MD
James S. Harrop, MD
J. Brad Bellotte, MD
Mark R. Iantosca, MD
Newsletter Editor
Bruce L. Wilder, MD, MPH, JD
Suite 1050
436 Seventh Avenue
Pittsburgh, PA 15219-1826
(412) 683-6015
bwild@interprofessional.com
Executive Director
Susie Wilson
777 East Park Drive
PO Box 8820
Harrisburg, PA 17105-8820
(717) 558-7750 ext. 1515
Fax (717) 558-7841
swilson@pamedsoc.org
Opinions expressed in this newsletter do not
necessarily reflect the Society’s point of view.
We hope you've had a chance to visit our website at www.paneurosurgicalsociety.org. If not, please take a few minutes to do so. If you have additional thoughts or suggestions regarding the site, let us know!
This e-newsletter is for members of the Pennsylvania Neurosurgical Society only. If you would like to be removed from this list, please send an e-mail to that effect, with your full name and addressed to pns@pamedsoc.org or call (717) 558-7750, ext. 1515.
PNS News is the official publication of the Pennsylvania Neurosurgical Society. It is published electronically twice yearly.
PNS News contains announcements of the Society and other news items about members, or that may be of special interest to members. It also contains reports from officers and liaisons to other organizations that pertain to neurosurgery in Pennsylvania.
Society members are encouraged to submit scientific articles and opinion pieces of interest to Pennsylvania neurosurgeons. Members are also invited to solicit similar articles from colleagues who are not members. Final decisions on publication are made by the Editor, in consultation with members of the Council of the Pennsylvania Neurosurgical Society.
Send submissions to pns@pamedsoc.org.
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