3 ms·

Triple booking surgeons? Do they think patients in need of surgeries are just going to up and cancel, and hospitals are behaving like airlines?

toomuchtodo 2y ago
Lack of accountability leads to outcomes. As a patient, you don't know your trust is being violated (in this specific scenario). https://www.seattletimes.com/nation-world/texas-heart-surgeons-accused-of-double-booking-surgeries-delegating-dangerous-procedures/ https://www.seattletimes.com/nation-world/texas-heart-surgeo... https://www.justice.gov/usao-sdtx/pr/texas-medical-center-institutions-agree-pay-15m-record-settlement-involving-concurrent https://www.justice.gov/usao-sdtx/pr/texas-medical-center-in...
- malfist 2y ago
  Texas also has "tort reform", limiting you to a maximum of $250k in damages. Good luck suing a big hospital for malpractice, you gotta pay the lawyer too out of that $250k.
  - mandmandam 2y ago
    > you gotta pay the lawyer too out of that $250k On average, a medical malpractice case might require anywhere from 500 to 1,000 hours of legal work, with more complex cases potentially requiring over 2,000 hours. Average lawyer cost in 2022 was $313/hr. So we're basically looking at, generously, 750 hrs x $300, or $225k to the lawyer. And that's just one side - the hospital presumably pays near the same. ... Huh. Once again, I am stunned at the American legal system being so obviously and cartoonishly evil.
    - arcticbull 2y ago
      The Texas legal system to be specific.
      - ToValueFunfetti 2y ago
        Texas is probably limiting malpractice suit damages because they are a significant contributor to our insane healthcare costs. The math above where a hospital is out a minimum of $200k for any suit that isn't thrown out is not restricted to Texas; this is a national issue with some Texas duck tape slapped on.
        vkou 2y ago
        They are more likely limiting malpractice suit damages because hospitals and clinics donate to political campaigns, but people hurt by medical malpractice don't. The end result is that doctors are essentially lawsuit-proof (as the minimum cost of a suit exceeds the maximum possible recovery) in Texas, and you have no recourse if yours was at fault. It's a beautiful system.
        blackeyeblitzar 2y ago
        That’s a good argument for it that I didn’t think of. But I can’t help but think this was likely just some business friendly thing that was lobbied for under the misleading label of “reform”
        vkou 2y ago
        It's an argument that hasn't borne out in practice. Texas medical costs are lock-step with the lest of the country. Texas malpractice rates are leading the country.
  - 0xcde4c3db 2y ago
    I hope that limit only applies to punitive damages. For medical malpractice in the US, actual damages could easily exceed $250k.
    - phonon 2y ago
      https://crosleylaw.com/blog/texas-personal-injury-law-changes-texas-tort-reform/#:~:text=Tort%20Reform%20in%20Texas&text=Examples%20include%20pain%20and%20suffering,cap%20was%20set%20at%20%24250%2C000 https://crosleylaw.com/blog/texas-personal-injury-law-change....
    - voxic11 2y ago
      The cap applies to actual damages, specifically non-economic actual damages such as pain and suffering, mental anguish, and loss of companionship. It does not apply to economic actual damages such as lost wages and medical costs. Before tort reform punitive damages were already capped in Texas at a value twice the amount of economic damages plus the amount of non-economic damages, so tort reform does also have a effect of sometimes reducing punitive damages.
blackeyeblitzar 2y ago
https://www.usatoday.com/story/news/health/2024/06/25/baylor-college-of-medicine-settlement/74208300007/ https://www.usatoday.com/story/news/health/2024/06/25/baylor... In Texas, three hospitals (Baylor St. Luke’s Medical Center (BSLMC), Baylor College of Medicine (BCM) and Surgical Associates of Texas P.A. (SAT)) agreed to pay $15m as part of a settlement with the DOJ. These doctors/surgeons were booked for multiple simultaneous procedures that they could not have possibly conducted, even though they recorded things to make it look like they conducted all the surgeries. In reality many procedures were performed by unqualified residents and other caretakers and not who the patient was told would be performing the procedure. > To make it seem as if the teaching physicians were present during the "entire" operation, they would lie on medical records, the court filings say. The medical staff also would not tell patients that the surgeon planned on leaving the room to perform another operation, the documents continued. This only came out because of a whistleblower, and because the DOJ pursued it. It is nearly impossible for a patient to know if they are wronged or harmed this way because they are put under for these procedures, and because friends/family are typically not allowed to observe or record anything (likely to prevent accountability). And then there’s the cost of lawsuits, the stress, and limitations under law (like tort reform in Texas) - it’s just lucky that this was pursued by a government agency (DOJ). > Under the False Claims Act, the private whistleblower who reported the allegations will receive over $3 million from the settlement, the Justice Department said. We need more incentives like this, but we also need greater penalties and jail time for the practitioners and literally everyone who knew. They should be investigating who was in the room, what was recorded in logs, and who accessed records, and go after all of them. Right now, this settlement achieves nothing. Some articles claimed that these hospitals made more than $150 million off these procedures for which they are settling the lawsuit for just $15 million.
SkyPuncher 2y ago
More common than you think. A lot of hospital care is done by residents with surgeons overseeing and stepping in for the most difficult parts. Our healthcare system would literally collapse without residents doing the heavy lifting. It won’t change until we stop artificially limiting the supply of doctors or give mid level practitioners more power.
- CatWChainsaw 2y ago
  Or both, both would be nice. Until then I guess we all just have to make sure we never need to use the healthcare system we all pay so much for.
- blackeyeblitzar 2y ago
  Yep professional medical organizations and universities are causing this artificial supply limit to benefit those who are already practicing and part of this ecosystem.
  - ben_w 2y ago
    Without claiming the two systems have the same limiting factors, the UK health system is also struggling, and there the staff shortage is the government's limits on (1) how many spots universities have, (2) immigration. This is despite health in general, and the HNS in particular, being a major source of interest for the electorate.
    - OJFord 2y ago
      Alternatively (or also) pay scales and emigration. There are doctors leaving for Australia (which advertised golden handshakes & Australian lifestyle in the UK to UK doctors) and nurses for better pay/conditions in private care facilities; it's not (just) a supply of trained people at source issue. Salaries are also much more compressed than in North America - UK junior doctors generally earn more than NA residents, but then not that much more (maybe 4-5x from lowest to highest, not >10x to reach hundreds of thousands) as consultants (attendings). Locum pay & additional private work can make up for some of that, but probably not all, and I assume similar could be done in NA if you wanted to earn more (or open their own practice, pharma sponsorship, etc.) It's probably true in general (relatively compressed salary ranges) actually, not just in medicine.
pyuser583 2y ago
It’s absolutely insane how many people don’t show up for doctors appointments, including surgery.

toomuchtodo 2y ago

Lack of accountability leads to outcomes. As a patient, you don't know your trust is being violated (in this specific scenario). https://www.seattletimes.com/nation-world/texas-heart-surgeons-accused-of-double-booking-surgeries-delegating-dangerous-procedures/ https://www.seattletimes.com/nation-world/texas-heart-surgeo... https://www.justice.gov/usao-sdtx/pr/texas-medical-center-institutions-agree-pay-15m-record-settlement-involving-concurrent https://www.justice.gov/usao-sdtx/pr/texas-medical-center-in...

malfist 2y ago
Texas also has "tort reform", limiting you to a maximum of $250k in damages. Good luck suing a big hospital for malpractice, you gotta pay the lawyer too out of that $250k.
- mandmandam 2y ago
  > you gotta pay the lawyer too out of that $250k On average, a medical malpractice case might require anywhere from 500 to 1,000 hours of legal work, with more complex cases potentially requiring over 2,000 hours. Average lawyer cost in 2022 was $313/hr. So we're basically looking at, generously, 750 hrs x $300, or $225k to the lawyer. And that's just one side - the hospital presumably pays near the same. ... Huh. Once again, I am stunned at the American legal system being so obviously and cartoonishly evil.
  - arcticbull 2y ago
    The Texas legal system to be specific.
    - ToValueFunfetti 2y ago
      Texas is probably limiting malpractice suit damages because they are a significant contributor to our insane healthcare costs. The math above where a hospital is out a minimum of $200k for any suit that isn't thrown out is not restricted to Texas; this is a national issue with some Texas duck tape slapped on.
      - vkou 2y ago
        They are more likely limiting malpractice suit damages because hospitals and clinics donate to political campaigns, but people hurt by medical malpractice don't. The end result is that doctors are essentially lawsuit-proof (as the minimum cost of a suit exceeds the maximum possible recovery) in Texas, and you have no recourse if yours was at fault. It's a beautiful system.
      - blackeyeblitzar 2y ago
        That’s a good argument for it that I didn’t think of. But I can’t help but think this was likely just some business friendly thing that was lobbied for under the misleading label of “reform”
        vkou 2y ago
        It's an argument that hasn't borne out in practice. Texas medical costs are lock-step with the lest of the country. Texas malpractice rates are leading the country.
- 0xcde4c3db 2y ago
  I hope that limit only applies to punitive damages. For medical malpractice in the US, actual damages could easily exceed $250k.
  - phonon 2y ago
    https://crosleylaw.com/blog/texas-personal-injury-law-changes-texas-tort-reform/#:~:text=Tort%20Reform%20in%20Texas&text=Examples%20include%20pain%20and%20suffering,cap%20was%20set%20at%20%24250%2C000 https://crosleylaw.com/blog/texas-personal-injury-law-change....
  - voxic11 2y ago
    The cap applies to actual damages, specifically non-economic actual damages such as pain and suffering, mental anguish, and loss of companionship. It does not apply to economic actual damages such as lost wages and medical costs. Before tort reform punitive damages were already capped in Texas at a value twice the amount of economic damages plus the amount of non-economic damages, so tort reform does also have a effect of sometimes reducing punitive damages.

blackeyeblitzar 2y ago

https://www.usatoday.com/story/news/health/2024/06/25/baylor-college-of-medicine-settlement/74208300007/ https://www.usatoday.com/story/news/health/2024/06/25/baylor... In Texas, three hospitals (Baylor St. Luke’s Medical Center (BSLMC), Baylor College of Medicine (BCM) and Surgical Associates of Texas P.A. (SAT)) agreed to pay $15m as part of a settlement with the DOJ. These doctors/surgeons were booked for multiple simultaneous procedures that they could not have possibly conducted, even though they recorded things to make it look like they conducted all the surgeries. In reality many procedures were performed by unqualified residents and other caretakers and not who the patient was told would be performing the procedure. > To make it seem as if the teaching physicians were present during the "entire" operation, they would lie on medical records, the court filings say. The medical staff also would not tell patients that the surgeon planned on leaving the room to perform another operation, the documents continued. This only came out because of a whistleblower, and because the DOJ pursued it. It is nearly impossible for a patient to know if they are wronged or harmed this way because they are put under for these procedures, and because friends/family are typically not allowed to observe or record anything (likely to prevent accountability). And then there’s the cost of lawsuits, the stress, and limitations under law (like tort reform in Texas) - it’s just lucky that this was pursued by a government agency (DOJ). > Under the False Claims Act, the private whistleblower who reported the allegations will receive over $3 million from the settlement, the Justice Department said. We need more incentives like this, but we also need greater penalties and jail time for the practitioners and literally everyone who knew. They should be investigating who was in the room, what was recorded in logs, and who accessed records, and go after all of them. Right now, this settlement achieves nothing. Some articles claimed that these hospitals made more than $150 million off these procedures for which they are settling the lawsuit for just $15 million.

SkyPuncher 2y ago

More common than you think. A lot of hospital care is done by residents with surgeons overseeing and stepping in for the most difficult parts. Our healthcare system would literally collapse without residents doing the heavy lifting. It won’t change until we stop artificially limiting the supply of doctors or give mid level practitioners more power.

CatWChainsaw 2y ago
Or both, both would be nice. Until then I guess we all just have to make sure we never need to use the healthcare system we all pay so much for.
blackeyeblitzar 2y ago
Yep professional medical organizations and universities are causing this artificial supply limit to benefit those who are already practicing and part of this ecosystem.
- ben_w 2y ago
  Without claiming the two systems have the same limiting factors, the UK health system is also struggling, and there the staff shortage is the government's limits on (1) how many spots universities have, (2) immigration. This is despite health in general, and the HNS in particular, being a major source of interest for the electorate.
  - OJFord 2y ago
    Alternatively (or also) pay scales and emigration. There are doctors leaving for Australia (which advertised golden handshakes & Australian lifestyle in the UK to UK doctors) and nurses for better pay/conditions in private care facilities; it's not (just) a supply of trained people at source issue. Salaries are also much more compressed than in North America - UK junior doctors generally earn more than NA residents, but then not that much more (maybe 4-5x from lowest to highest, not >10x to reach hundreds of thousands) as consultants (attendings). Locum pay & additional private work can make up for some of that, but probably not all, and I assume similar could be done in NA if you wanted to earn more (or open their own practice, pharma sponsorship, etc.) It's probably true in general (relatively compressed salary ranges) actually, not just in medicine.

pyuser583 2y ago

It’s absolutely insane how many people don’t show up for doctors appointments, including surgery.