Doctors Insurance Agency

2014 is here now

In 2014, approximately 200,000 Sacramento residents will become eligible for health insurance as a result of the Patient Protection and Affordable Care Act. They will be able to see a doctor for check-ups and preventative care. This influx of new patients could potentially overwhelm local health providers. This fact led former California Health and Human Services Agency Director Kim Belshe to declare that, for those running health-care organizations, 2014 is now.

Planning must begin immediately if the health organizations are going to be ready for the changes created by the Affordable Care Act, she said.

On June 7, the Sierra Health Foundation, along with Rep. Doris Matsui, the Public Health Institute and the Teichert Foundation, sponsored a seven-hour symposium on “Mobilizing Care Delivery Improvement in the Sacramento Region in the Era of Health Reform.” Showing up was a who’s who of local and state health leaders, including the former and current California Health and Human Services Agency Directors Kim Belshe and Diana Dooley; the head honchos of UC Davis Health System, Sutter Health, Mercy, Kaiser Permanente, and The Effort; Rep. Doris Matsui, who worked on the legislation; Sierra Health Foundation CEO Chet Hewitt; and Harvard’s John McDonough, who helped write the Massachusetts health bill and worked with the late Sen. Ted Kennedy on health issues.

It was quite a gathering of health wonks. And for seven hours, I was lucky enough to be a fly on the wall while they brainstormed the best ways to prepare Sacramento for the new health-care landscape.

What did I learn? First of all, there is a lot of figuring out still to do.

While there is considerable agreement that President Barack Obama’s Affordable Care Act will go down in history as the most significant advance in health-care policy since the passage of Medicare and Medicaid in 1965, there is much less agreement about how it will be carried out. The health wonks think that the Affordable Care Act provides a great opportunity to improve health care, but they also know it could be a disaster, if health-care organizations do not make smart decisions about how to prepare their groups for the 200,000 people headed their way.

A nationally recognized health expert, McDonough provided an overview of the key elements of the ambitious 800-page health bill. It starts out slow in its first year, with reforms such as banning insurance companies from denying health-care coverage to children with pre-existing conditions; creating a high-risk pool to help people with pre-existing conditions receive health-care coverage; and a favorite at my house, allowing children up to the age of 26 to stay on their parent’s plan. But these provisions are only the warm-up; the act does not really start overhauling the health-care system until 2014.

Obesity and Medical Malpractice | Medical Malpractice

A recent 2008 update on overweight and obesity statistics from the American Heart Association indicate that:

142 million adult Americans are overweight 67.3 million of them are considered to be obese

Simultaneously, this has become a growing market for purveyors of weight loss programs, diet pills and medical treatments such as gastric bypass. Experts estimate that 140,000 patients underwent gastric bypass surgery in 2004 with that number increasing each year. Even so, there has also been a growth in the number of adolescents undergoing such surgery.

On the surface, one would naturally expect medical malpractice claims to increase proportionately to the number of patients seeking help with their weight. In spite of this, that’s only the surface. A study conducted by FLDIC (Florida Doctors Insurance Company), using nationwide medical malpractice insurance data, noted that an increasing number of malpractice cases cite failures by physicians to monitor, treat, or educate patients regarding the risks of their obesity. The study found that such allegations were primarily targeted against the following specialties: Gynecology, Obstetrics, Gastroenterology, Family & General Medicine, Internal/Geriatric Medicine, and Pathology.

Likewise The Doctors Company (which our agency represents) has also seen an alarming increase in lawsuits that involve obese patients. Loss analysis on claims from 1992-2002 identified 287 patients, ranging in age from four to 82, with eigthy-four deaths. A significant factor is that 90% of these obese patients had diabetes.

Just as the weight loss industry has seen dollar signs in this growing market, lawyers are quickly jumping on this particular medical malpractice bandwagon. A quick Google of “medical malpractice, obesity” will prove that point. One website was advertising a recent case that resulted in an award of 1.5 million. Another offered a free case review based on an online survey. Their focus may be justified, as Surgery for Obesity and Related Diseases (Volume 3, Issue 1) published a review of one hundred bariatric lawsuits by a consortium of surgeons and a med-mal attorney with evidence of negligence found in twenty-eight of the cases.

Of course, as indicated in the Florida study, the risk is just a real for physicians in other specialties. In an overview of 5 obesity-related claims published by The Doctors Company, only one was directly related to gastric bypass surgery. The others included failure to diagnose a myocardial infarction and pneumonia, nerve damage caused by positioning on a treatment table, post-op complications and paralysis from spinal surgery, and complications from manipulation while under IV sedation.

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