At the outset of President Obama's summit on health care Thursday, Sen. Lamar Alexander (R., Tenn.) told the president to "put an end to junk lawsuits against doctors." No one could protest that sentiment. But any effort at malpractice reform needs to ensure that the medical profession does a better job of policing itself. Three recent stories shine a floodlight on the need for improvement.
First is the case of Kermit B. Gosnell of West Philadelphia and his unlicensed assistants, who, as reported by The Inquirer, were suspected by federal investigators of illegally distributing prescription drugs. But what officers found during a search of Gosnell's office was "blood on the floor, and parts of aborted fetuses were displayed in jars."
(I didn't recognize Gosnell's name at first, but someone in the media uncovered court records showing that I had sued him on behalf of a former patient in 1991. I don't remember the case and the file has long been disposed of, but those two degrees of separation have caused me to take note of this now-national story.)
The subsequent order suspending Gosnell's medical license alleges that a patient recently under his care died after ingesting painkillers and undergoing a botched abortion. One report in the Philadelphia Daily News described Gosnell "cradling" a bottle containing the fetus he'd just removed from a 13-year-old. The same story detailed how a woman had to be rushed to the hospital hours after an operation that left part of the fetus in her. Gosnell has reportedly been named as a defendant in at least 46 civil cases.
The allegations have national significance, but not just for their gruesome nature and abortion implications. The case also says something relevant in the debate over health-care reform. The vivid allegations regarding Gosnell are only the latest example of the medical community's need to rid itself of extreme malpractice.
"Dr. Gosnell is the poster boy for the failure of the medical profession and Pennsylvania authorities to discipline repeat malpractice offenders until they stumble on something so shocking that it can't be ignored," Tom Kline, one of Philadelphia's top malpractice lawyers, told me. "The larger lesson here is that the medical profession and state authorities must do a better job disciplining the 5 percent of physicians on whose behalf 50 percent of the malpractice-insurance claims are paid."
In Delaware, pediatrician Earl Bradley is accused of 471 counts of molesting 103 children. The allegations are brutal: Bradley winning his young patients' trust with candy and ice cream; children screaming as he held them upside down and molested them; young patients trying to get free as the doctor chased them in his Disney-themed office. Many of the alleged encounters were caught on video. In announcing the indictment last week, Delaware Attorney General Beau Biden said the number could increase as more alleged victims are identified.
Worse, as Cris Barrish of the News Journal in Wilmington reported earlier this month, Bradley's sister Lynda Barnes told police in 2005 about parents' complaints that Bradley had improperly touched their children. A police report recently made public noted that Barnes had sent a letter regarding her brother's alleged behavior to the Medical Society of Delaware around the same time, though the exact allegations in that letter remain unclear.
What is clear, however, is that the same medical society had for weeks denied receiving any letter about Bradley and tried to avoid turning over the potentially relevant minutes from a December 2004 meeting of its Physicians Health Committee.
All these reports come a few months after the tragic shooting at Fort Hood in which 13 were killed and dozens more were wounded. That case is notorious for the red flags of an obvious terrorist that were missed. Well, what about the red flags that Maj. Malik Nadal Hasan was also a psychiatrist whose professional life raised as many concerns as his radical political views did? As Arthur Caplan, the nation's foremost bioethicist, told me, Hasan had "a track record of bad reports, lousy evaluations, people saying he couldn't do the job." And yet, he continued to earn promotions.
"What is he doing practicing psychiatry at all? Who cares what his politics are? Why wasn't this guy pulled because he just wasn't fit to serve as a physician, certainly not fit to serve as a military psychiatrist," Caplan said at the time. "And I don't think they were profiling him. I think it's the old boys club continuing to protect bad-apple physicians."
On the eve of the president's health-care summit, the American Medical Association was trumpeting reforms that it said would drop the "federal budget deficits by about $54 billion during the 2010–2019 period." Such cost-saving measures sound great in the abstract. But lost in the demonization of trial lawyers for political points is the medical community's inability to cut costs by cutting loose the malpractitioners among them. In that sense, the red flags are, unfortunately, being overlooked all over again.