Are You Really Surprised?

This morning, I happened to read an article where a Senator was grandstanding about the supposed opiate abuse epidemic.  He was blaming the epidemic on everyone.  Doctors, the “evil” pharmaceutical industry, and even the DEA for not “doing something.”  Because whenever something is in the news, politicians want to “do something!”

I don’t deny that we have an epidemic of opiate abuse.  But at the most fundamental level, there is someone to blame — namely, politicians.  Our politicians have created government involvement in healthcare. (Whether that’s a good thing or a bad thing is another debate for another time.)  With government involvement comes the need to “measure” how effective the government interventions are.  And as we’ve all found when the government studies medicine, they like things that are easy to measure and sound good.   In EMS, that’s usually cardiac arrest survival — because dead or not dead is easy to measure and by golly, we don’t want dead people.

So, the government decided that “pain” was something worth measuring and studying for Medicare and Medicaid.  And then, the various accrediting bodies jumped on board because the government had already decided that pain management was a “good thing” and therefore measuring it for accreditation purposes was also a “good thing.” So, along came the messages.  Pain scale charts everywhere.  Providers being judged for pain management.  Providers being told that the goal is to get the pain to a zero on a zero to ten schedule.

But the reality kicks in.  In most acute settings (including EMS), we have limited pain management tools — mostly opiates.  And for the average person, pain is an emergency.  And I’ve already mentioned how hard it can be to get in to see a primary care provider and the inevitable referrals to specialists, labs, and imaging for all but the most minor complaints.  In short, if you’re in pain, you have two choices — be in pain until your doctor can see you and then get an opinion as to what’s wrong or seek immediate care and get opiates.

So, here we are.  People are rational and usually want relief now.  So, the tool of choice for acute pain management remains opiates. And people are now expecting their pain to be managed and they’ve almost come to expect that the relief will come in the form of an opiate. We’re now at the point where patients feel they have right to opiates for pain management.  Is it any wonder that we’ve created addicts?

And at the same time that CMS and the healthcare accreditation world demand that we “DO SOMETHING” about pain, the DEA and many state medical boards have differing opinions.  The current opiate “crisis” has led to a concern about overprescribing, which, in many cases, is rightfully justified. Especially in Texas, we’ve had a crisis with “pill mills” writing narcotic prescriptions way too easily for virtually no medical reason.  Those providers can and should be sanctioned.  But the DEA and the various state medical boards have also created a climate of fear where physicians feel as if their professional prerogative to treat patients is questioned, thus causing most chronic pain patients to be referred to pain management clinics, where again, there’s a wait to be seen, thus sending patients back to the acute care world and/or street drugs.

And as for the DEA, let’s not forget their unusual interpretations of the various controlled substances laws. Because most laws (including controlled substances laws) aren’t written to consider EMS, we’ve had some bizarre implementations of the laws by DEA in particular.  There are several DEA regional offices that have determined that EMS has no authority to administer any controlled substances (pain management and sedation).  Others have held that each ambulance and station (or posting location in system status management) has to be licensed as a facility by the DEA.  These competing interpretations have reached the point there’s legislation pending before Congress to clarify EMS providers’ authority to administer controlled substances.

And in the EMS setting, let’s not even discuss that the only pain management option we have in most systems is an opiate.  Opiates aren’t great for chronic pain or mild pain, but if the only tool you have is a hammer, everything starts to look like a nail.

I’ve been a lawyer in government practice for over twelve years now.  I don’t expect that you can get various government agencies to all get along or even use the same playbook.  But what I have come to expect is that if you get government involved in healthcare, you’re going to have some unintended consequences. The only thing you can consistently expect from government interfering in the physician (or nurse or medic) relationship with a patient is that there will be consequences.  And said consequences will be unexpected.  More often than not, they may even be worse than the problem they were addressing.

Google Let Me Down.

The following is an email that I sent to Google in response to them choosing artist/activist Yuri Kochiyama for today’s Google Doodle on the main Google page.

I realize that Google Doodles are sometimes meant to cause us to think.  That’s a good thing.   But today’s Google Doodle honoring Yuri Kochiyama was way too much.  I “Googled” her and found this in Wikipedia:

In response to the United States’ actions following the September 11 attacks in 2001, Kochiyama stated that “it’s important we all understand that the main terrorist and the main enemy of the world’s people is the U.S. government” and that “the goal of the war [on terrorism] is more than just getting oil and fuel. The United States is intent on taking over the world.”

While the United States has certainly made mistakes and there are certainly different views about our role in the world, I consider honoring this “activist” to be a grave dishonor and a slap in the face to those who died on 9/11, first responders, and those who serve in our United States armed forces.

Over the last two weeks, there has been extensive media coverage about an anti-conservative bias in the tech world. While I had been somewhat skeptical of this, your decision to “honor” this far-left, anti-American activist is certainly evidence of at least a cognitive disconnect with many Americans, especially those who hold conservative or libertarian values.

To me, Google is a source of information.  I expect an information source to be an honest broker of such information or, at the very least, to disclose its biases.  Today, Google let me down.  And that’s something that’s let me down.

Very truly yours,

Wes Ogilvie

I could go on and on here, but suffice it to say that I think it’s bad business to take an unnecessary political stand that pokes many of your customers right in the eye. Rather than an attempt to be hip, edgy, or thought-provoking, this decision shows the disdain that many in the cultural left have for anyone in “flyover country.” These tech hipsters share their progressive views where the tech industry gets government subsidies while wearing a Che Guevara t-shirt and “Feeling the Bern.” It always strikes me that many of the people who are the loudest about the wrongs in America are among those who benefit the most from what makes America great — namely free enterprise supported by the values enshrined in our United States Constitution.

In summation, you’d never have a Google, Apple, Facebook, Dell, the New York Times, or even the movie industry in anyplace but America.  And as the late great Merle Haggard sang, “If you don’t love it, leave it.  Let this song I’m singing be your warning.”

This is a collaborative post by Too Old To Work, Too Young To Retire (TOTWTYTR) and me. It started from an email exchange and then we decided write a post that will appear on both blogs. I’m not sure exactly how this will work out, but it’s worth a try.
TOTWTYTR: I will say that I’m not sure how much Presidential election blogging I will do this time around. Neither of the “presumptive” candidates are ideal by any definition of the word. One is a brash entrepreneur and reality TV show host with no political experience. The other is the epitome of the political insider. Who also happens to have little in the way of achievement that isn’t tied to her former President husband. Trump is (or was) hated by the GOP establishment, while Clinton is the darling of the Donkey set.
Those are my preliminary thoughts outside of the collaborative portion of the post. The parts in regular fonts are from the original email from The Ambulance Chaser. My comments are in red interspersed.
ME: So, since we’re among friends and for the most part, relatively like-minded
ones at that, I figure I’ll share my insights as to how we’ve ended up with
Donald Trump as the presumptive Republican nominee.
Let me first say that, in the words of Marc Antony, I come to bury Trump,
not praise him.  I cast my vote for Cruz not out of support
of him, but at least knowing who he is and what he stands for.   Like some
of us here, I too share the disgust at the Republican Party’s current
fascination with bedroom and bathroom habits.  It’s unseemly,
narrow-minded, and especially hypocritical coming from a party that
supposedly is the champion of limited government.
TOTWTYTR: Which is the common perception, but the Democrats seem far more interested of
late in peoples’ sex lives and bathroom habits. After all, it’s they that are proposing “affirmative consent” laws
on campuses and trying to change the public bathroom habits of the American public.
Trump has for the most part totally ignored those issues and the pressure to discuss them. Wise move.
My major complaint with the Republican Party, which I share with you, is that they aren’t acting like conservatives.
This despite the fact that most Americans are politically center-right, not left.
ME: So, how’d we get to Trump?  Well, for one thing, I do think that social
conservatism has a limited appeal.  There’s only so many voters out there
for whom homosexuality, abortion, and school prayer are their core,
fundamental issues.  Bluntly, if it was me, I wouldn’t even make an effort
to appeal to them.  And by and large, Trump really hasn’t.
TOTWTYTR: See? We agree.
ME: What has Trump done?  He’s appealed to blue collar Reagan Democrats.  The
comments about foreign trade and “making America great again” appeal to
blue collar, Rust Belt voters.  For all of the talk about the Republicans
being “politically incorrect,” the Republicans really aren’t all that
willing to offend or speak painful truths.  Trump has said what many people
are afraid to say in “polite company” about immigration and Islamic
terrorism. And in that “everyman” appeal, he scores more points with
voters.  While I don’t have the statistical analysis, I’d hazard a guess
that Trump is doing especially well with independent and previously
unengaged voters.
TOTWTYTR: This is one point on which we disagree.
Trump is drawing support from broad segments of the population. For the
most part it’s people who are fed up with the establishments of both
parties. That was part of the appeal of Ted Cruz and is a large part of
the appeal of Bernie Sanders.
My sister, who is at least on the surface a liberal Democrat, is a self
described “Bernie Girl”. I’m not sure what his appeal to her is, because
chances are she’ll be negatively impacted by his communist financial
policies.
My son has a MBA and is a Trump supporter. Trump is hugely popular in
the southern state in which he lives. My daughter in law says that if it comes
down to Trump vs Hillary, she’ll stay home. Which is okay, because
that’s in effect a vote for Trump. She is pretty conservative. No
college, but she’s a sharp young women.
Mrs. EMS Artifact didn’t like Cruz, but likes Trump. If anything, she is far more
conservative than people think I am. She can’t stand Hillary or Bernie, especially Hillary.
My friend Peg, a former Canadian and former left leaning Democrat, hates
Obama, Hillary, and Bernie. She likes Trump, but not Cruz.
Women not liking Cruz seems to be a trend, at least in my not very scientific polling.
I have several friends who are life long Republicans who like Trump.
They’re tired of the GOP establishment bending over for the Democrats.
They want conservative fiscal policies, don’t care about social issues either way, do care about immigration.
I could go on and on in this vein, but I think the point is clear.
ME: In all fairness, Trump is remarkably naive on foreign and defense affairs.
His comments about making NATO, South Korea, and Japan pay for more of
their defense are short-sighted and, if enacted, could well lead to the USA
losing leverage there and those nations asserting a more independent
foreign policy that might not align with US interests.  As for his domestic
policies, he makes vague promises that make for great soundbites.  For
those that mock and dismiss him, I’ll note that Obama got elected on vague
promises of “hope and change.” That worked for enough voters.  It might
just well for Trump.
TOTWTYTR: I don’t know if Trump is a conservative or not. I think he’s more of a
populist than anything else. If he wins, I hop he’ll make good choices
for his cabinet, national security adviser, head of the CIA, etc… The
big question with Trump is federal judges, especially SCOTUS.
This is my biggest question mark about Trump. What will he do if he wins? Will he govern from the center,
the right, or the left? Or a mix?
Of course he won’t be the first candidate that was elected with the electorate not knowing where he
stands on some crucial issues.
Of course, I could be wrong about that. He might pick judges that are more liberal than would Hillary.
I doubt it, though.
Obama has proposed that our allies pick up more
of the funding for NATO and their own defense. Which is one reason we
don’t have nearly as many allies as we did a few years ago.
Japan has increased defense spending, as have other of our allies. They have
zero faith in Obama fulfilling any of the US obligations to defend them if it
comes to that. T: aiwan and South Korea share that, as do allied countries in Europe.
Our so called allies in the Middle East are also very concerned about this election.
I’m not suggesting that we pay for all of our allies defense forces, but there is value
in having a strong military of our own. Helping other nations is part of that, but they are going
to have to increase their commitment to defending themselves. Especially Europe, which I expect
is once again going to be defending the gates of Vienna from the Islamic hoards. Or maybe London,
Paris and Berlin.
ME: Both parties are to blame for the Trump phenomenon. The Republicans talk a tough game,
especially on immigration, and routinely fail to deliver — primarily because many of
their large business supporters depend on immigration. All the Republicans have delivered
during the Obama administration, with congressional majorities for six of eight years, are
press releases, showboating, grandstanding, and pandering to a small fringe of evangelical
voters who wouldn’t vote for the Democrats anyway. The Democrats have delivered more government
entitlements, more wealth transfer, a near Communist fascination with class envy, and a naked,
brazen attempt to appeal to every identity group out there.
TOTWTYTR: Trump is expressing the disgust of people in both parties with the
status quo. You’ll notice that no one has asked Obama to go out and
campaign with or for them. For good reason, President Jug Ears is not
particularly popular.
ME: The media?  Well, they have some fault too. They bemoan the lack of
substance in politics, yet they engage in “gotcha” journalism designed to
dig up past mistakes and foibles, thus eliminating anyone except those
bland candidates who, since fifth grade, have strove to avoid anything
controversial or embarrassing.  They’ve turned politics into a horserace
and a reality show.  In fact, “Who Wants To Be President” might well turn
out a better candidate than the primary process has this year.
The media is in the bag for the Democrats. Very few people in the media
identify as Republicans and even a casual perusal of the news will show
that the main stream media does all it can to cover for Obama and
Hillary. I expect that the attacks on Trump in the MSM will intensify
now that he’s the presumptive nominee.
The modern left and the modern right are both incredibly out of touch with
most Americans.  Both parties engage in “crony capitalism” where free
enterprise is a myth.  Rather, big business plays both parties for
subsidies.  The Republicans fund “economic development” and grant subsidies
to corporate agriculture.  Meanwhile the Democrats will fund “green energy”
and want to address economic justice by giving money to people with bad
credit and build nice things in areas where people are rioting.
So, when modern liberalism helps us “feel the Bern” in our “safe spaces”
and modern conservatism is worried about the bathroom at Target, yet fails
to seriously address terrorism or an economy that works for what the modern
left and the Wall Street crowd calls “flyover country,” we can look in the
mirror and realize that the sad state of American politics and the American
media have given us Donald Trump.  We’ve ended up with a self-funded
billionaire who, by his sheer wealth, is perceived to not have to pander to
any donors and says the first thing on his mind.  America, meet your
reality show presidential candidate.
TOTWTYTR: Thus, we have the rise of a neo populist candidate that has been remarkably non specific
about what he actually plans to do to “Make America Great Again”.
Obama gave rise to Trump’s model of campaigning. He too ran as a neo populist who was remarkably
non specific about what he would actually do. We’ve had eight years of fundamental transformation and
it appears that much of the voting public is tired of that.
I’m not sure if the public knows that they want in the next President, but they have made it very clear what they
DON’T want.

http://theambulancechaser.com/2016/05/489/

You Get What You Pay For

In Texas, we have a strong tradition of limited government.  In particular, we limit the role of county government.  In most counties, county government provides law enforcement, jails, courts, and roads.  Because of the limits placed on county government by the Texas Constitution as well as the limited source of funds available to county government (primarily property tax revenues), the majority of county governments in Texas do not directly provide fire or EMS services.  In response to the need to fund fire and EMS services for smaller communities and/or unincorporated areas of the county, the Texas Legislature authorizes the creation of Emergency Services Districts (ESDs).   ESDs have the authority to levy a property tax to provide fire and/or EMS protection within their boundaries. That tax is up to ten cents per one hundred dollars of property value.

North Hays County ESD #1 is the Emergency Services District that serves Dripping Springs and much of the rest of northwestern Hays County.  They currently tax their property at a rate of 2.52 cents per one hundred dollars of property value.  They are holding an election on May 7 to raise the tax rate to a maximum of seven cents per hundred dollars of property value to continue funding EMS in their district.  Currently, San Marcos/Hays County EMS is their contracted EMS provider and, like many EMS systems, faces increasing call volume as well as increasing costs of providing EMS in the district.  (Disclosure: I formerly worked as a part-time medic for San Marcos/Hays County EMS. I have also responded with San Marcos/Hays County EMS on mutual aid with another EMS service in the area.)

Enter the local state representative in the area — a man named Jason Isaac. Mr. Isaac has come out publicly against the tax increase and is pandering to a reactionary anti-tax element of a conservative electorate.  Heck, I’m pretty conservative.  Those that know me have described me as a fiscal conservative, socially libertarian, and a neo-conservative hawk on foreign policy.  I’m no Bernie Sanders here.

If Mr. Isaac is truly concerned about the actions of the ESD, he would know that the Texas Department of Agriculture has information about the formation and operation of ESDs.  But it’s easier to put out posts on social media addressing an issue where the accountability lies with local government.  I thought that Texas conservatives favored local control and local solutions for local problems?

But there are some very legitimate roles for government to play, particularly local government. One expectation that all of us have, save for a few anarchists, is for our 911 calls to be answered and for help to come.  Better yet, we expect competent providers to deliver compassionate and clinically appropriate emergency medical care.  San Marcos/Hays County EMS has delivered that care to Hays County for years, including the residents of North Hays County ESD #1.  I’m standing for quality EMS, not sound-bites designed to appeal to fears about property taxes.

Clickbait for you. Frustration for me.

Right now, the EMS social media is abuzz with a piece of so-called religious rights legislation that’s passed the Michigan House of Representatives.  In short, the legislation allows for a person to claim a religious exemption from other laws that infringe upon their religious rights.  Currently, legislation such as this is most commonly championed by Christian social conservatives as an attempt to nullify local and state gay rights provisions.  Our “friends” at EMS1 are headlining this as “Will Michigan allow EMS providers to withhold care based on the patient’s sexuality?”

Here’s my take as an EMS provider, attorney, and someone who’s analyzed state legislation for over a dozen years.  Oh, and also as someone who completely supports the rights of gays and lesbians, including the right to marry.  This bill doesn’t impact EMS one bit.  Not one iota at all.  Doesn’t even mention EMS. I am not YOUR lawyer (although, for the right retainer and hourly rate, that COULD change…), but I can’t see how this proposed piece of legislation changes the duty to respond and the duty to act for EMS (or the fire department or police either).

Also, the bill has only passed through the Michigan House of Representatives and still has to make it past the Michigan Senate and get the signature of the Governor.  As I’ve said before, the legislative process is designed to kill legislation, not pass it.  The chances of a bill getting becoming law are slightly better than my getting a lucrative basketball contract, but probably not as good as your next EMS shift not getting to transport a non-acute patient.

I blame two parties for this kerfuffle and misinformation.  One, somewhere out there, there’s probably a well-meaning and sincere gay rights activist who took the conclusions of this legislation well past the logical extreme.  Second, the lemmings of EMS social media AND the EMS websites blindly posted this without any research, whether out of a lack of legal understanding, believing in a specific agenda, or just trying to drive up clicks.

I’m going to do something I only do occasionally and only when I’m really peeved. I’m calling a publication out by name.  EMS1 — You guys should know better.

As the great American President Abraham Lincoln once said, “Don’t believe everything you read on the internet.”

I am not a hero

In my “real” job, I’m sure as heck not a hero.  Reviewing contracts just doesn’t save a lot of lives.

When I’m at my “fun” job on the ambulance, it’s not heroism either.  It’s doing something I’m passionate about.  It’s the pride, honor, integrity, and dare I say, the compassion of providing medical care to people in the worst moments.  (Let’s face it, even if we consider it “BS,” it’s still the worst thing in our patient’s day.)  I walk into houses, businesses, and the street and see humanity at its worst.

I’m hanging out at the Texas EMS Conference this week, learning new things, renewing friendships, and making new friends.  Watching a British paramedic experiencing Texas for the first time is rather funny at times.  Driving through the Fort Worth Stockyards listening to George Strait while you explain the history of our country, our state, and the “Old West” is a perfect way to remind yourself of how special these moments are.  EMS, fire, law enforcement, and emergency medicine creates a special bond and kinship between all of us.

But allow me to digress here into the really serious current events of the day.  Ferguson, Missouri.  I’ve had a few friends who aren’t in public safety or medicine post some pretty snarky comments on Facebook about the grand jury decision, Officer Darren Wilson, and/or law enforcement in general. I won’t hector or lecture you.  All I ask is that you try to be as compassionate to your public servants as you are to the thug culture, the “oppressed” who aren’t really oppressed, the criminal underclass, and the looters.  Take it from someone who sees more than Instagram shots of the Mike Browns and Leslie Cochrans of the world — crime, homelessness, and the drug culture aren’t hip, cool, or funny.  They’re a one-way ticket to self-destruction.

You have a right to those opinions.  The “uncool” people that you mock protect your rights to be hip, liberal, and oh so cool. Me?  I have the right to unfriend you.

Thanks for listening.  I’ll try to be funnier in the next blog.

Dear NAEMT

Hey there, it’s The Ambulance Chaser.

Recently, a friend of mine asked why he should renew his NAEMT membership.  I had to think for a minute.  Then I thought for several more minutes. Finally, I told him I maintain my NAEMT membership because I’m affiliate faculty for one of your continuing education programs and because membership provides me a significant discount on EMS Expo (Every other year in Las Vegas – yes please!).   Another person mentioned the 5.11 clothing discount.

What nobody mentioned was NAEMT’s advocacy for the profession.  Why?  Rightly or wrongly, it’s because a lot of us in the field see NAEMT and its leadership as a self-perpetuating good old boys club advocating for its pet causes.

Some of you who know me away from my blog know that I’ve been in state government for over ten years as an attorney and that I’ve previously been legislative staff here in the Lone Star State and have even worked in political campaigns.   When have I seen or met with a representative from NAEMT or any state affiliate (by the way, Texas no longer has a state organization affiliated with NAEMT)?  NEVER.

What do I see from NAEMT for advocacy?  Ham-handed attempts at influencing Congress.  The EMS Field Bill is a useless attempt at finding another source of money for certain EMS agencies that already excel at writing grant applications.  EMS on the Hill Day is, while well-meaning, just another opportunity for certain EMS leaders to wear full dress uniforms that look like a cross between the Knights of Columbus, Captain Crunch, and a Turkish admiral.

Right now, there’s a discussion on the Texas EMS email list about a Texas Board of Nursing administrative rule that’s been interpreted and applied so as to prevent EMS providers from functioning at their certification level in the emergency room.  How does this happen?  Quite simply.  The nursing profession is organized and knows how to get things done politically.  Our supposed “voice for our profession” is way too quiet in the Texas state capitol.  I’m willing to bet you that the other 49 state capitols aren’t being visited by NAEMT either.

So, NAEMT, here’s the deal.  I’m going to keep my membership up.  I want to go to Vegas cheaper (who doesn’t?). I want my continuing education classes, although it’s a damned shame that we have to rely on so much continuing education to make up for the gaps in our initial education.  And yes, I occasionally want some discounted clothing.

But since I’m a member, I’m going to continue to speak out.  And I’m going to keep asking when you’re going to step up for our profession in a meaningful way.  Self congratulatory photos and press releases mentioning the same old names just aren’t going to cut it forever.

Being a Sheepdog

A good friend of mine who’s a non-practicing paramedic and currently serves as a law enforcement officer out in the Texas Hill Country had a good post on Facebook about the current divide in this country and how it’s also manifesting itself in the divide between law enforcement and the public they serve.

I’d say the gap exists, not just between law enforcement and the community, but between public servants (police, fire, military, and EMS) and the community.  There’s a lot of reasons, I’m sure, but allow me to throw some thoughts out there.

For better or worse, and certainly without ill intentions, we have created a lot of those barriers.  We’ve hidden behind artificially created barriers between “us” and the public we serve.  We cite “homeland security,” “officer safety,” and “HIPAA” as reasons why we no longer engage with the public or create barriers to such engagement.

Several years ago, while on vacation in an unnamed large city known for legalized gambling, buffets, and neon signs, I stopped by their central fire station to get some photos and maybe meet some firefighters and/or medics.   The garage bay doors were closed and there wasn’t even a doorbell to ring.  I walked around to another door and there was a phone to pick up.  When I explained that I was a visiting medic from Texas, I was promptly told that their station wasn’t open to visitors or the public.

Combine that with some communities encrypting all public safety communications (granted, I have ZERO problem with encrypting sensitive channels like SWAT, narcotics, surveillance, etc.) and eliminating ride-alongs, and you’ve created an environment where a communications barrier exists — and where rumor and conspiracy theories can flourish.

Yes, those of us who are public servants are the sheepdogs who protect the sheep.  If anything, that means even MORE of an obligation to be amongst the sheep.

My advice: be approachable.  Let’s be the ones who remind the public that we’re here for them.  Otherwise, as we’ve seen this week near St. Louis, those who reflexively dislike us will have ample opportunity to spread their message.  For better or worse, we live in a constitutional republic and we are servants of the public.  It behooves us to gain and maintain the public’s trust.  One can practice “officer safety,” “scene safety,” or “situational awareness” without coming across as a member of an occupying army.  Take off the wrap-around shades, interact with the public, and show a kid (or even, gasp, an adult) your vehicle.  It’ll keep you safer in the long run.

Ok, rant over, y’all.

On Liability

As an attorney and a paramedic, I’ve definitely got opinions on medical malpractice and liability.  As some of my devoted minions (well, all two of you outside of family), I’ve experienced my own issues with healthcare liability, not all of which I’ve blogged about.

First, my legal profession deserves a huge chunk of blame for this.  We’ve convinced the public, either deliberately or by omission, that a bad outcome automatically equates to malpractice.  This just isn’t true.  No one in the medical world is able to work miracles or reverse irreversible processes.  We will all die of something eventually and sometimes, even in the best settings, there is nothing that can be done for that.

However, the medical world bears some fault as well.  The medical world regularly fails to understand how the legal system works and as such, probably makes things worse.   The things I see most often are administrators and risk managers who try to mitigate risk down to zero.  As such, good medicines, good interventions, and good clinical judgment get banished in the name of “patient protection.”  The acceptable/tolerable risk to the healthcare liability watchdogs, accrediting bodies, and risk managers becomes ZERO.  As but a simple example of that, look how Phenergan (promethazine) has greatly been displaced as an anti-emetic in the emergency and prehospital settings by Zofran (ondasterone) because of the concerns about vascular damage.   Yes, the danger exists, but there are steps to mitigate the risk.  However, for the people whose livelihood is made by “protecting” clinicians from the lawsuit bogeyman, zero risk is tolerable.  So, when you have a patient who’s vomiting up their Zofran orally-dissolving tablets, thank risk management.  <GRIN>

Additionally, the risk management types like to hide transparency or accountability behind the fear of litigation.  As such, we end up with “peer reviews” where medical misadventures are hid behind laws that shield the providers from accountability.  These inspire a belief amongst laypersons that the professional community shields its own.  Even if the provider receives discipline or remediation after a peer review, it’s considered confidential by law (at least in Texas). In my opinion, this limits transparency and accountability and enhances the “coverup” feeling that patients and/or their families sometimes feel.

Many people who’ve experienced a bad outcome come to lawyers in the hopes that the bad outcome can be explained.  Granted, some come for the litigation jackpot, but there’s also a great number of people who seek legal counsel because of an honest desire to find out what happened.

My solutions are simple.  It’s getting them into place that would be the hard part.

Step 1: Accountability and transparency.  First, any explanations or apologies provided by healthcare providers should be excluded, as a matter of law, from serving as evidence of liability.  Second, peer review confidentiality should be waived to the extent in the event that a provider does receive remediation or a loss of privileges that the complaining party is informed.  However, this waiver still should not be admissible for purposes of establishing liability.

Step 2: Judges should start dismissing frivolous claims.  Period.  This alone would go a great deal toward fixing the frivolous lawsuit issue.  Judges already have the power, but many are afraid to use it because campaign contributions often come from the same lawyers who file the suits.  For the plaintiffs’ lawyers out there, this has got to be preferable to tort reform statutes that limit access to the courts.

Step 3: Here’s my solution to the litigation lottery jackpot.  I’d establish healthcare liability courts in addition to the current court system.  If you want to file your suit in the “regular” courts and try to persuade twelve people who couldn’t get out of jury duty of your righteous anger, then by all means file in “regular” court.  Just understand that damages will be capped at a certain amount and that you won’t get a windfall for “pain and suffering” or other unquantifiable claims.  Healthcare courts would exist without any damage caps.  Here are the two catches.  First, no juries.  Your case will be heard and decided by a judge with expertise in medical liability.  Second, the court can also appoint its own expert to examine the facts of the case and issue a report to the judge. To me, this would lessen the influence of the “hired gun” expert witnesses used by both plaintiffs and defendants.

The pendulum of medical liability constantly swings back and forth between two extremes.  I believe that both extremes fail to satisfy justice.  The legal community needs to understand that bad outcomes aren’t automatically to be associated with wrongdoing. And the medical community owes it to the public it serves to accept responsibility and accountability when something does go wrong.  It goes back to preschool — there’s a great deal of healing power in a simple, sincere apology.  “I’m sorry” goes a long way.

Progressive tension

Most of the time, I try to stay out of politics here, except for EMS politics.  Today, I digress into international politics and religion.  Why?  Because I’m calling out hypocrisy.  If you don’t like my views, that’s ok too.   Google “cute kitten pictures” and come back when I’m blogging on a medical issue again.

Today, I’m calling out the progressive community.  On some issues, I agree with them, especially regarding individual freedoms.   Want to open up a casino that performs gay marriages and has a women’s health clinic that additionally distributes marijuana on site?  Go for it!  Having said that, don’t expect me to subsidize it with my tax money.

But here’s the hypocrisy of the modern left.  By and large, the modern left embraces cultural relativism and multiculturalism.  That’s well and good to be tolerant.  But tolerance is a Western value.  A lot of other cultures don’t embrace tolerance.  Tolerance to them is that you submit to their ideologies and beliefs.

Over the past month, terrorists have kidnapped 200 Nigerian schoolgirls for getting a Western education, a Sudanese woman has been condemned to death for abandoning the faith of her father to become Christian, and several honor killings have been publicized in Pakistan.  George Takei has publicized the plight of the woman in Sudan and no less than the First Lady of the United States, Michelle Obama has tweeted “#BringBackOurGirls” in response to the Nigerian kidnappings.  (Personally, I think a visit from SEAL Team 6 and/or the British Special Air Service would go a long ways toward bringing those girls back.)

For years, mostly conservatives and secular European libertarians have been pointing out that Islam does not always share our Western values, in particular many of the values that the progressive left claims to value such as freedom of religion, secular government, and women’s rights. What did the Left tell those Cassandras who warned us of the intolerance of politicized, radicalized Islam?  Why, Islamophobia of course.

Of course, the minute the Nigerian girls were kidnapped by an Islamic terrorist group whose name literally means “Western education is wrong,” the progressive movement had to say something.  After all, feminism is a core tenet of the modern left.  And at that point, the warning and condemnations came out.  Why, Jay Leno’s wife even came out against sharia (Islamic) law.  Previously, the left described warnings against sharia as Islamophobia from the Tea Party and chuckled a smug, knowing laugh.  (You know, think Bill Maher, Stephen Colbert, or Jon Stewart.)

Tolerance is a virtue (as the old saw goes), but tolerating and granting moral equivalence to a culture and belief system that is diametrically and violently opposed to your own ceases to become tolerance.  Rather, it becomes a suicide pact.   To my liberal friends who wish to appease the barbarians at the gate, don’t think that the wolf won’t eat you.  The wolf may just eat you last.