Arrogance, Abuse, Fraud, and Medical Malpractice:

Arrogance, Abuse, Fraud, and Medical Malpractice:

How Some Physicians Beg for Law Suits

- MC Kean

 

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Our health care system is much sicker than even Michael Moore understands. Greedy physicians addicted to money are literally abusing and battering patients for the sake of profit.

 

Physicians and mass media often depict patients and their lawyers who file lawsuits against Doctors as greedy, money-grubbing opportunist. 1

It turns out this is more projection than reality. A 1990 study by Harvard researchers of 31,000 medical records subjected to evaluation by practicing doctors and nurses, “found that doctors were injuring one out of every 25 patients (latter studies put that figure closer to one out of every seven patients), and that only 4 percent of these injured patients sued.” 2

Another Harvard study of 1,452 malpractice lawsuits found that more than 90 percent of the claims evidence supported medical injury and 25 percent of the time the patient died, 60% of these injuries resulted from physician wrongdoing. The study also found when “baseless” malpractice suits were brought they were “efficiently thrown out.” Only 145 of 515 patients suffering injury, but where physician fault was unclear received compensation. On the other hand, 236 cases were thrown out of court despite evidence of injury and physician error. 3.

While there is no evidence that malpractice claims are being driven by greedy patients and lawyers, there is an abundance of evidence that greed is driving the malpractice suits. Not the greed of the patients, but the greed of the medical practitioners themselves. In other words, physicians are the greedy, money-grubbing opportunists, and the patients and their lawyers are just fighting back against an arrogant disregard for patient’s rights, dignity, and health, against incompetence and even fraud. In a real way, a vast body of Doctors have waged war on patients, arrogantly imposing their will and their interest against the patients’ will and best interest. Laws, Medical Licensing Boards, even lawsuits have largely failed to discourage profitable, but reckless and abusive practices. Below are a several examples of how Physicians abuse patients for personal profit, a brief analysis of patient protections, followed by some suggestions for fighting back.

1. Kickback driven medicine: An overwhelming number of physicians get kickbacks and other economic incentives from pharmaceutical companies, not only for being willing to prescribe a drug, or implant a devise, but also for research. Often, physicians also get kickbacks from other Physicians, hospitals, and imaging facilities to which they refer patients. Physicians even get kickbacks for implant devises. Influenced by a greed for these kickbacks, many physicians prescribe medications and procedures they know are NOT the most effective response to a problem, or may even be for a problem you do not have. 4. In one study one third of the Doctors interviewed, “admitted they would order unnecessary MRI scans and 25% referred patients to an imaging center where they had a financial interest.” 20.

 

2. Promoting unnecessary surgeries: Physicians often fail to tell a patient of less radical alternatives, fail to disclose and even mislead patients about risks, and encourage a patient to elect surgeries that are not good for their health. “While it is difficult to distinguish "necessary" from "unnecessary" surgeries, some estimates put the latter at 2.5 million a year, resulting in 11,600 deaths a year as well as severe pain and disability for many of the survivors.” 5.  Breast implants are just one example. Implants are never permanent. Most will require another surgery within five years, virtually 100% fail within 10 years. 6.  Reconstruction after a mastectomy requires multiple surgeries (including one on the healthy breast), and thus provides a whole string of opportunities for surgeons to make big bucks. For women with cancer this is particularly cruel even murderous as evidence indicates that physical trauma the like of multiple surgeries can encourage the spread of cancer. 7.  Surgeons virtually never reveal this trauma induced cancer growth risk. Even women’s magazines have described new “perky” breasts, and perhaps even a tummy tuck, as a couple among ten reasons to “be glad you have breast cancer.” 8.

While plastic surgeons claim options for such reconstruction are, “essential to women’s self-esteem“, there are less dangerous roads to dealing with self-esteem issues, patients are not well informed of risks, and surgeons literally peddle reconstruction. The only unsolicited call I ever remember receiving from my breast cancer surgeon was to inquire as to why I would turn down reconstruction. (Wonder if she was to get a kickback from the plastic surgeon, who acted as if he got kickbacks for implants.)

3. Bait and switch: You do a little research, meet and agree to a surgery by a certain physician, chosen for various reasons, experience, sex, bedside manor, temperament; then, once under anesthesia, your surgeon pulls a bait and switch. The person actually performing the surgery is much less experienced, or this may even be their first surgery, or first surgery of this type. Sometimes the surgeon you thought was performing is in attendance supervising. Your life threatening surgery is being used as training and you are an unwitting breathing cadaver. 9

Other times the person you thought was performing the surgery has moved on to a high paying client and left you with a resident under no supervision. The surgeon you thought was performing is paid for miraculously doing two surgeries at once in two different locations. 10 The resident is on salary.

Once limited to teaching hospitals this sort of medical fraud is now infiltrating private practices. While you are never told, while misleading language is used, while students are hidden, and even while out right lies are employed to cover this bait and switch, physicians argue that any reasonable person should know that in teaching facilities students are participating in their care, including the performance of major life threatening surgeries. Patients may or may not know a hospital is a teaching hospital; and the average patient does not know their physician will lie; we are not told the relationship is an adversarial one, rather than fiduciary (one where the physician’s primary concern is our health).

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4. Unnecessary procedures and exams for the sake of training: Extending anesthesia and resulting in physical trauma, excessive bruising, bleeding, and increased infections of patients, physicians often take the opportunity provided by anesthesia to parade in a line of students to perform exams. Although research indicates that 87% of patients would allow training if asked, making this sort of medical fraud unnecessary, it would take time to explain to the patient and the patient might set terms or limitations, such as on the number of trainees to be performing a procedure. 10.

Informed patients while often willing to accept one or two trainees, are less likely, for example, to consent to their pelvic or anus being penetrated multiple times by multiple people. This gang bang approach to teaching is very abusive. While many argue it does not rise to the level of rape as there is no sexual intent, this argument is again invalid. 11

One could argue with such logic that the physical touching and penetration of a prisoner might be torture, but not rape as the intent was not sexual but rather investigative. Statistics indicate that such practices are risking patient health. While Teaching facilities want you to think that you will get superior up to date care at such facilities, this is just not the case. Oregon Health Sciences University is one example. OHSU patient safety ratings reveal a below average raiying for:

1. prevention of death in procedures where mortality is usually very low,

2. absence of foreign body left in during procedure,

3. avoidance of excessive bruising or bleeding as a consequence of a procedure or surgery.

These stats indicate many physicians are prioritizing teaching over patient health and safety. Simply put you are more likely to die from a relatively simple and safe procedure, and will likely suffer greater trauma and pain from procedures performed at OHSU, than non-teaching facilities. The surprise is not that, OHSU is sued on average of 23 times a year, but that this figure is not much higher. One reason may be OHSU has access to the PDX VA. While the V.A. would like vets to think the big teaching facilities are better than the smaller VA facilities; the history of the V.A. also reveals unacceptable abuse and risk of patients for the sake of training. 12.

Again, while cancer patients provide a host of opportunity in this regard the trauma from such practices can feed cancer. Furthermore, physicians do not seem to give any special consideration to a subject already in pain from recent surgeries, and show no qualms about subjecting such patients to more trauma from multiple penetrations by inexperienced students/trainees. No more than teaching hospitals they take pity on the crying children, as a line of students enter their rooms to practice arterial blood gasses, as was described to me by an asthmatic patient who spent their childhood in hospitals.

5. Physicians will lie. Telling your Doctor what you do and do not want to happen to you or your body while under anesthesia is no protection. Physicians often do as they please and simply lie before and after the fact no matter what preferences, you might have expressed. After all, they know even better than the date rapist how effective these drugs are at ensuring their violations of your rights, your body, your health, and their oath remain unknown to you. If you complain, a physician may flag your chart, “don’t ask”. This does not mean they will not seize the opportunity anesthesia provides to violate you, just that they will employ a “don’t ask; don’t tell” policy in relationship to your care. 13.

Doctors are often arrogant and indifferent to the very concept of informed consent. Physicians patronizingly claim to know what is best for patients, while they fail to listen or respond to expressed needs, violate patients expressed will, and even do things to patients they would not allow be done to themselves. 14.

Surely not all the staff is going to go along with this? I have listened to countless stories of this sort of abuse over the last two months, not only from patients, but also from nurses and other physicians I have interviewed. Most indicated that while they did not agree with what was done they did not report violations of consent, or even sexual assault, (such as an anesthesiologist who awakens women from anesthesia by pinching their nipples.) Mind you, I know some of these confessors well, the only reason I can see for their silence is a culture of such silence. 15.

 

6. Physicians target the poor: Physicians target the poor, mentally disabled, and seriously ill patients who are heavily dependent upon the medical access they receive, as they are less likely to file lawsuits. Veterans have historically been part of this pool of the abused poor as many large V.A. Medical facilities are linked to Medical Schools and economic incentives for lawyers to represent victims are minimal. In many cases the awards will not cover the costs of litigation. This is about to get much worse. As physicians look for more ways to avoid State legislation regarding teaching, as physicians look for ever more disempowered patients, as the government looks for ways to cut the costs of caring for veterans, ALL V.A. facilities are about to become teaching facilities. A physician can come from anywhere in the country (or world) to be trained on any vet in any state disregarding the state laws and often Federal Laws as well. The V.A. even employees unlicensed practitioners, and has a history of failing to check credentials. 16.

Now, one will say, the vet can get medical care elsewhere; but illness breeds poverty, and war breeds illness, and you are often not told, mislead, even blatantly lied to as to who provided what care, who did what including what unnecessary penetrations to your body.

Women are particularly vulnerable. Women are relatively few in number within the V.A. system and thus scarce relative to the demand for training specific to women’s health. Female Vets are subject to a sort of intensified trauma resulting from both more frequent and intense abuses by physicians, and for many patients this in conjunction with a history of military sexual trauma. “The problems with sexual harassment, assault and rape are systemic in the military beginning with recruiters, military academies, carrying on through service and at the Veterans Administrations.” 17.

Refusing to respect these women’s requests for female practitioners, pulling the old bait and switch tactic, and using women as vending machines for training multiple students results in not only physical harm, but also serious psychological harm. These practices also increase women’s risk of sexual assault.

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Creating Opportunities for Rape: A woman has a fundamental right to protect herself from sexual assault or rape as she sees fit. The physician undermines this right when the patient is not allowed to exclude, limit, and/or negotiate the terms of male participation from certain types of care and while under anesthesia. Failing to acquire informed consent and refusing full disclosure in a Federal facility is a violation of a patient’s civil rights and should be prosecuted accordingly. While physicians would like you to think, they as a class are above such crimes as sexual assault this is simply not the case.

A Times investigation found 55 licensed practitioners in the state of Washington alone who had rap sheets for sex crimes.” 18. Sexual misconduct is a common problem and protection against offenders practicing in the medical field is insufficient to non-existent.

0nce you are put under anesthesia you have no way of knowing what is being done to you by whom. Medical staff seems to think nothing of leaving women alone under sedation with a man, a stranger to these patients; not something a reasonable woman would ever tolerate if told the truth. Physician’s response to reasonable requests by reasonable women is to simply lie. I know this from personal experience.

Complaining to the V.A. about violations of my requests for, and promises made of, female only staff during procedures like colonoscopies, oophorectomies, and a mastectomy, complaining about being left in the care of men while under anesthesia, and requests for explanations for symptoms synonymous with sexual assault for which the physician claimed to have no medical explanation, has gotten me nothing more than a “don’t ask; don’t tell” flag in my chart by that same Doctor.

It seems many physicians are unwilling to give up even a small fraction of their income, many hospitals unwilling to spend a fraction more, to ensure the safety of women under anesthesia, or even respect women‘s own attempts to protect themselves. It took a movement to get women into the medical profession, and the rest of us were promised the comfort and security of female care only to be betrayed by petty greedy women the likes of those who have betrayed this reporter/patient.

If physicians are willing to lie to patients, to put patients at an unreasonable risk, to seek all sorts of ways to avoid any sort of meaningful informed consent, to even engage in outright medical fraud, how is a patient to have confidence in a diagnosis? How can a patent feel confident that the diagnosis is not motivated more by the need to teach this or that procedure than a thorough analysis of medical history and data? How can a patient know that a prescription or surgical suggestion from their physician is motivated by concern for their well being rather than personal profit? You cannot!

In June 2002, for example, a Chicago cardiologist was sentenced to 12-1/2 years in federal prison and was ordered to pay $16.5 million in fines and restitution after pleading guilty to performing 750 medically unnecessary heart catheterizations, along with unnecessary angioplasties and other tests as part of a 10-year fraud scheme. 19 My own significant other suffered an unnecessary heart catheterization.

 

What protection does a patient have?

Medical Licensing Boards are little help. Sanctions are rarely proportionate to the offense. Physicians are often given no more than a few months of limitations on practice or short suspensions. Even in the most repetitive and/or grievous abuses such as sexual assaults while a patient is under anesthesia or performing high risk unnecessary surgeries, physicians are often given little more than limitations on patient demographics and mandatory counseling. At worse they may receive two to five years suspensions with mandatory counseling followed by reinstatement with temporary supervision.

These disciplinary actions are too lenient and too few to make a difference. “A D.C.-based advocacy group found only 33% of doctors who made 10 or more malpractice payments were disciplined by their state medical board; some—with as many as 31 payments—have never been disciplined.” 20.

Laws are not effective. When laws are changed to help protect patients, the old, “do not ask, does not tell” tactic is employed. This was the case with California consent laws relating to informed consent and using patients under anesthesia as teaching tools for pelvic exams. 21. Illinois followed. 22

At first, many hospitals voluntarily conformed, then after a few big teaching hospitals and their Physician’s thumb their nose at the law, reminded legislatures that the patients are under anesthesia and therefore make lousy witnesses, interest in conforming to the law seemed to fade and continued abuse has to date gone unchallenged. 23

Lawsuits do not work. Rather than clean up their act to reduce risks of suits, many physicians have retaliated against malpractice lawyers and their family members refusing them care or firing their nursing spouses. Patients who sue one physician are refused care by others. Even some Physicians who have testified as expert witnesses on behalf of plaintiffs have suffered retaliation from employing hospitals and State Medical boards.

In Florida, Tampa General Hospital revised its employee "code of conduct" to prohibit staff from testifying on behalf of plaintiffs. (They may testify as witnesses for hospitals and doctors.) “In Jersey City, the medical staff at Christ Hospital voted to remove George Ciechanowski as chief of staff, according to news accounts, because he backed malpractice legislation that many of his colleagues opposed.”, 24.

Regardless of awards and even if insurance companies refuse to insure repeat offenders, this does not seem to slow down the abuse. Awards are not proportional to the injury, nor large enough relative to income achieved through such abuses to discourage the practices. In spite of lawsuits, sanctions, and payouts, patient abuse remains profitable. 25

Research and empirical evidence has done little to change attitudes. Research indicates that listening to and respecting patient wishes in conjunction with honesty and early confession and apology for error reduces litigation. A few hospitals that have revamped policies and practices in response to this research have reduced malpractice payouts by 85% 26 Unfortunately, such evidence fails to persuade physician attitudes, who claim they have, “No time to listen and talk to patients.” 27.

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What is to be done?

When patients’ health and well-being are no longer the top priority of physicians the system is no longer trust worthy and should be radically reconstructed to once again serve the interests of equal protection and security of ALL patients. Piecemeal socialization or V.A. type medical care within an overarching for profit system only tends to subject the poor who do manage to access medical care to the sort of abuses described above.

I heard a wise person suggest that if all the Physicians and other medical staff who worked at the V.A. had to use the V.A. themselves for medical care, things would change. Likewise, only in a one-payer system that treats ALL citizens who seek medical care the same, will some of us not be subjected to such abuse in the interest of others. Only in a one-payer system will physicians and other medical staff find their interests in common with the patient’s interest.

What can we as patients needing care do in the meantime?

1. Demand a single payer system,

2. While seeking the bulk of your health care on the margins outside of the mainstream of large corporate medicine. There are many ailments that can be effectively treated by Chinese Physicians and naturopathic doctors.

3. Demand family member presence while under anesthesia.

4. Read all consent documents, and do not be afraid to alter those documents or bring your own for the physician to sign.

5. Ask if trainees will be involved in your care at the time you make an appointment. Record the conversation.

6. Be ready to refuse care or be turned away and find care elsewhere.

7. Lobby your state and federal representatives for greater protective legislation. Add a clause to consent forms in facilities such as the V.A. regarding adherence to state regulations they are not otherwise obligated to follow.

8. Be suspicious of Physicians who make multiple referrals, use coercive tactics to convince you to do things, respond to every concern you may express with another scan, MRI, or other test, seem to have more patients than can be properly cared for without many residents and trainees helping out, lie to you even once.

9. Educate yourself and become wise about how you access medical care before you discover you have been abused. Remember, no medical care, or delayed medical care can, in many cases, be better than bad medical care.

10. Be a skeptic. Expect your Doctor to lie to you. Remember their Hippocratic Oath has more to do with P.R. propaganda than having any real meaning to many physicians.

11. When you find a Doctor has abused you; let the rest of us know. Post flyers, post adds, get the word out about that Doctor. Start an Abusive Doctor boycott list web site in your area. As we boycott those physicians and seek care with more ethical practitioners incentives may shift a bit.

- MC Kean

1. The following two articles represent a very small fraction of the propaganda concerning lawsuits and medical malpractice.

A Confederacy of Boobs, by Michael Fumento Reason, October 1995

Medical Malpractice Suits Are Dividing the Nation!, by Marcel Votlucka , The Stony Brook Press, December 8, 2005

2. Study Casts Doubt on Claims That the Medical Malpractice System Is Plagued By Frivolous Lawsuits, Harvard School of Public Health, May 10, 2006

3. Too Many Malpractice Suits, Or Not Enough?, By Solange De Santis, ConsumerAffairs.Com, October 18, 2004

Also see,

Medical Malpractice in TX: is one of many articles, facts, and research published by, Public Citizen, regarding lawsuit propaganda.

The Medical Malpractice Myth: Forget tort reform. The Democrats have a better diagnosis, by Ezra Klein, Slate, Tuesday, July 11, 2006

4. Prescription Drug Scams, by Dean Baker, Thruthout, June 29, 2006

Drug Trials Hide Conflicts for Doctors , by KURT EICHENWALD and GINA KOLATA, May 16, 1999

Insurers Pay Doctors to Switch to Generics, by Joe Mantone, The Wall Street Journal Health Blog, Jan 24, 2008.

Med-tech perks for doctors questioned, by JANET MOORE, Star Tribune, Feb 28, 2008

Is Something Rotten in the State of Radiology?, by Leonard Berlin, MD, FACR, Imaging Economics, March 2007

5. Profit-Seekers, by Payne Hertz, Wednesday, August 29, 2007

Also see,

Needless Surgery, Reprinted from Consumer Reports on Health (March 1998)
© 1998 Consumers Union*

To Go Under the Knife--or Not?, by Kate Murphy, Business Week, July 7 2003

 

Health Department Fines Parkway Hospital $32,000 for Performing Unnecessary Surgeries on Patients from Leben Home, state of New York Department of Health, 7/16/01

Blue Cross and Blue Shield Plans File $30 Million Lawsuit Alleging "Rent a Patient" Fraud in Southern California, Summary by Blue Cross Blue Shield Association, BMC Cancer. 2005; 5: 94. Published online 2005 August 4. doi: 10.1186/1471-2407-5-94.

Laparoscopic Cholecystectomy Atrocity, Elizabeth Eugenia James-LaBozetta

Central Ohio Patient's-rights Service (C.O.P.S.) and Citizens for Medical Safety

 

6. High Rate of Failure Estimated for Silicone Breast Implants, by GARDINER HARRIS, New York Times, Published: April 7, 2005

7. Breast surgery accelerates recurrences in some women., Heatlh Facts, Nov 5, 200

Trauma-associated growth of suspected dormant micrometastasis

, Nagi S El Saghir,1 Ihab I Elhajj,1 Fady B Geara,2 and Mukbil H Hourani3 BMC Cancer. 2005; 5: 94. Published online 2005 August 4. doi: 10.1186/1471-2407-5-94.

 

STRESS HORMONES MAY PLAY NEW ROLE IN SPEEDING UP CANCER GROWTH, Cancer Research, Nov. 1, 2006 republished OHSU Research News

 

Tumor dormancy: not so sleepy after all, by Cliff Murray, Nature Medicine, 1, 117 - 118 (1995)

 

Does surgery unfavorably perturb the “natural history” of early breast cancer by accelerating the appearance of distant metastases?,European Journal of Cancer, Volume 41, Issue 4, Pages 508-515 M. Baum, R. Demicheli, W. Hrushesky, M. Retsky

Wounding from Biopsy and Breast cancer progression, Ritsky etal, The Lancet, Vol 357, March 31, 2001

HOW SCIENTIFIC ARE ORTHODOX CANCER TREATMENTS?

, by Walter Last

 

8. Top 10 Reasons to Be Glad You Have Breast Cancer, by PJ Hamel
Monday, May 7, 2007

Breast Cancer Sells, by Lucinda Marshall, AlterNet. Posted October 24, 2007.

9. Are Med Students Practicing on You?, By: Suz Redfearn, Mens Heatlh

 

10.VA uses unsupervised residents and other practices that would not be accepted elsewhereBy JOAN MAZZOLINI, THE PLAIN DEALER Cleveland, Ohio Sunday, January 28, 2001

11. Not Rape, but Still Not Right: Hospitals Should Get Clearer
Consent Before Med Students Probe Anesthetized Women,
Evan Schulz, LEGAL TIMES, Mar. 17, 2003, 54;

Also see,

Using tort law to secure patient dignity, by
JOHN DUNCAN
Independent
ROBIN FRETWELL WILSON
Washington and Lee University - School of Law
DAN LUGINBILL
Ness, Jett & Tanner, LLC
MATTHEW RICHARDSON
Wyche, Burgess, Freeman & Parham, PA

U of Maryland Legal Studies Paper No. 2004-24

Training Intrusive and Needs Patient Consent, Activists Say, WASH. POST, May 10,
2003, at A1; Darin L. Passer, Medical Students Respect Their Patients, THE STATE,
July 19, 2003

Having obstetric/gynecological surgery anytime soon at one of the hundreds of teaching hospitals around the country?, by Melissa Waters, Concurring Opinions, July 24, 2007

12. V.A. Malpractice info website.

13. Don't Ask, Don't Tell: A Change in Medical Student Attitudes After Obstetrics/Gynecology Clerkships Toward Seeking Consent for Pelvic Examinations on an Anesthetized Patient, Peter Ubel 188 AM. J. OBSTETRICS & GYNECOLOGY 575 (2003).

14.Informed consent in public hospitals, by SP Kalantri, Indian Journal of Medical Ethics, Oct - Dec 2000

 

15. “Nearly half of doctors in a recent survey admit to witnessing a serious medical error but not reporting it.” How Professional Is Your Doctor?, Tara Parker Pope, The New York Times, December 3, 2007,

16. V.A. Malpractice info website.

17. Rape Nation, By Kari Lydersen, for AlterNet, July 2, 2004.

18. Gregoire pledges to reform health-care licensing, by Michael J. Berens, Seattle Times staff reporter April 30, 2006

19. The Problem of Health Care Fraud, National Health Care Anti Fraud Association

20. Phoenix Doctor's Picture Taking Latest Sad Tale of Medical Malpractice, |by Parker Waichman Alonso LLP

Also see,

Public Citizen Releases Database With Names of 1,112 "Questionable Doctors" in Pennsylvania, Oct. 29, 2003

Also see,

The story of Dr. John York and the Calif. Board of Medical Quality Assurance, by Al Schallau

Bad doctors get slapped on the wrist

, by Janet Kornblum, USA Today, Aug, 30, 2006

21. NON-CONSENSUAL PELVIC EXAMINATIONS, By: John Kasprak, Senior Attorney, ORL Research Report, June 22, 2004

22. First State Law in Nation Protecting Women From Unauthorized Pelvic Exams Takes Effect January 1st, Office of Assemblywoman Sally J. Lieber, Dec 19, 2003

23. Pelvic exams on unconscious women? More hospitals say no

, A.P. March 11, 2003

Using tort law to secure patient dignity: often used as teaching tools for medical students, unauthorized pelvic exams erode patient rights. Litigation can reinstate them., Duncan, John ; Luginbill, Dan ; Richardson, Matthew ; Wilson, Robin Fretwell , Trial, OCT 1, 2004

24. Medical-malpractice battle gets personal, By Laura Parker, USA TODAY, June 13, 2004

Also see,

How Malpractice Suits Keep My Profession Honest, by Bernard Sussman, Washington Post, April 24, 2005; Page B02

Doctors Take the Offensive. More-Aggressive Tack Used to Cut Frivolous Malpractice Claims, By RACHEL EMMA SILVERMAN Staff Reporter of THE WALL STREET JOURNAL March 23, 2004

The Medical Malpractice Myth, by Tom Baker, University Of Chicago Press, December 1, 2005

 

2.0.CO;2-D">Law and the Life Sciences: Doctors Sue Lawyers: Malpractice inside out, George J. Annas The Hastings Center Report, Vol. 7, No. 5 (Oct., 1977), pp. 15-16
doi:10.2307/3560717

25. Lax oversight favors doctors over patients: Doctors keep licenses despite lawsuits, sexual assaults, even patient deaths, , By GINA BARTON, JOURNAL SENTINEL WATCHDOG REPORT, : Jan. 26, 2008

 

26. Listening and talking to patients. A remedy for malpractice suits?, G W Lester and S G Smith University of Saint Thomas, Houston, Texas. 1993 and,

Apology a tool to avoid malpractice suits, By Lindsey Tanner, A.P., The Boston Globe, Nov. 12, 2004

27. “No time to listen and talk to patients.” by A W Wirtzer (al. Lester 268, or Western Journal of Medicine, June, 1993 pg 639)

 

   

 

Images - http://www.albany.com/wellness-blog/Medical-Malpractice-Lawsuits.jpg

 

 

Student Doc tells of Medical Rape - "Anesthetized women look so vulnerable.

"Anesthetized women look so vulnerable."[119]

I am all gloved up, fifth in line. At Tufts, medical students - particularly male students - practice pelvic exams on anesthetized women without their consent and without their knowledge. Women come in for surgery and, once they're asleep, we all gather around; line forms to the left.

In the medical ethics literature this practice has been called, "an outrageous assault upon the dignity and autonomy of the patient...."[120] "The practice shows a lack of respect for these patients as persons, revealing a moral insensitivity and a misuse of power."[121] "It is just another example of the way in which physicians abuse their power and have shown themselves unwilling to police themselves in matters of ethics, especially with regard to female patients."[122]

We learn more than examination skills. Taking advantage of the woman's vulnerability - as she lay naked on a table unconscious - we learn that patients are tools to exploit for our education.

It all started on the first day when the clerkship director described that we were to gain valuable experience doing pelvic exams on women in the operating room. I asked him if the women knew what we were doing. Are the women asked permission? "No," he said. And not only no, he described that he was, "ethically comfortable with that." I did some reading.

Massachusetts state law reads: "Every patient... has the right... to refuse to be examined... by students... and to refuse any care or examination when the primary purpose is educational or informational rather than therapeutic."[123] Yes, the right to refuse, but what if the patient doesn't even know? Was the director's attitude what-she-doesn't-know-can't-hurt-her? The confrontation continued.

He countered, "These women sign off that right to refuse on their surgical consent form." Having long learned a healthy skepticism about the pronouncements of authority, I got a copy of the form. The only mention of students reads as follows: "I am aware that occasionally there may be visiting surgeons/ healthcare professionals/ students observing techniques." Observing? We were going to be doing a lot more than observing. I went back to talk to him.

"Women are smart," he told me. "They know that when it says a student observes, that the student will be participating in the procedures." My eyes widened. And anyway, I was told, "Most women wouldn't mind." My jaw dropped. And, "Why are you so sensitive?"

I was just stunned, a stranger in a strange land. I was reminded of the summer I spent in Louisiana, where I had a debate with an orthopedic surgeon over whether or not the abolishment of slavery was really a good thing. "Now just think about it," I was admonished. What do you even say? How do you even respond?

So if the patients already secretly know and wouldn't mind regardless, then surely the course director wouldn't mind me wasting my breath to ask the women permission. (For that matter, he shouldn't mind a quick letter to the Boston Globe either.) No, I was told initially, I am not to ask women permission to use them - their bodies - for our education. I shouldn't let them know. Why? "We would just confuse the patients," he said. "You don't ask permission for male genital exams, do you?" I was asked. "We don't get them to sign permission for every little detail?"

John M. Smith, in Women and Doctors writes, "Many doctors regularly abuse women as a result of underlying prejudice and self-deception."[124] The whole situation reminds me of a famous James Thurber cartoon. A male doctor is leering over the headboard of a hospital bed at a female patient. Caption: "You're not my patient, you're my meat."[125]

"It is grossly unjust to exploit the vulnerable."[126]

Maybe the women wouldn't mind not being asked. After all, he is a doctor. I went back to the library. Sixty-nine women were asked in a British survey whether they thought permission should be specifically sought for students doing pelvic exams in the operating room. One hundred percent said yes; they all thought that specific permission should be sought.[127] A Swedish study found that 90% of gynecologic patients "would feel aggrieved if they discovered that they had participated in [any kind of] clinical training without first having been informed or given the opportunity of declining."[128] And of course, "Express consent does not mean a signature on a piece of paper... [it means] the patient must understand the general nature of the procedure - that is, that she is being used for teaching."[129]

I brought this to the director's attention. I gave him a copy of the British study. He dismissed it; how could I possibly extrapolate data from a British low income clinic to our population? Again, speechless. Even if the data were two orders of magnitude off and only one out of a hundred would mind not being asked, shouldn't that be enough?

The practice may even put the school and hospital in legal jeopardy - battery, professional misconduct, perhaps even aggravated sexual assault. Maybe I should just walk out of the OR and call the police. As written in a British Sunday Times article, "There is nothing to stop a woman bringing a legal action of assault. The only reason no one has done it is because they don't know what's going on."[130] The attending assured me they had thought of that too. "It's been past the risk analysis committee," he told me as he patted my shoulder, "there's nothing to worry about." At that point I gave up.

Appendix 49 offers some perspective on this outrageous practice.

Yes, It's True: Med Students Perform Pelvic Exams on Anesthetized Women

Yes, It's True: Med Students Perform Pelvic Exams on Anesthetized Women

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From the now defunct Non-Con web site

Posted by Jill—Unnecesarean

Public health reporter André Picard published an editorial yesterday in the Canadian newspaper, The Globe and Mail, imploring the medical community to end the practice of performing vaginal exams on anesthetized women without their consent. The article about physician Sara Wainberg’s research and personal accounts of the practice has ignited comment storms, debate and outrage.

Pelvic examinations performed routinely in teaching hospitals on uninformed, anesthetized women prepped for unrelated surgeries is not breaking news. The topic bubbles up to the surface every few years, incites a media frenzy, then simmers back down into what Picard calls “one of those dirty little secrets of medicine” and again drops from the public eye.

The story is that the practice of digitally raping anesthetized female and male patients without their consent continues.

One of many articles on the ethics of performing pelvic exams on anesthetized women was written by Robin Fretwell Wilson, a professor of law at the University of South Carolina School of Law, who testified before the Federal Trade Commission and Department of Justice Hearing on June 10, 2003. In her article, Unauthorized Practice: Teaching Pelvic Examination on Women Under Anesthesia that appeared in the Journal of the American Medical Women’s Association in 2003, Wilson cites study after study showing that the practice is routine.

In February, Ubel et al reported that 90% of medical students at four Philadelphia-area medical schools performed pelvic examinations on anesthetized patients for educational purposes during their obstetrics/gynecology rotation. Although trumpeted as proof that physicians are lax in securing permission, the study was not clear on the matter of consent. Caldicott et al reported in January that 53% of students at a single English medical school performed pelvic or rectal examinations on anesthetized patients. Students acted without any written or oral consent in 24% of the exams.

Research in the United States, Canada, and Great Britain has shown that the unauthorized use of women is not confined to 1 or 2 medical schools. Using anesthetized patients before surgery to teach abnormal anatomy “has long been practiced.” Women are also used to teach normal anatomy. As late as 1992, Beckmann found that 37.3% of US and Canadian medical schools reported using anesthetized patients to teach pelvic exams.

Other data in Wilson’s article:

[In 2002], nearly half of Canadian medical students (47%) at the University of Toronto reported “pressure to act unethically” and named as the leading culprit the collision between medical education and patient care. Many were asked to perform pelvic examinations without consent.

Ninety-four percent of Oxford Medical School graduates learned to perform digital rectal examinations using male and female patients, many of whom were anesthetized.

Only 37.5% of teaching hospitals “inform patients that students would be involved in their care.”

Forty-two percent of US students are not forthright about their status when doing pelvic exams on conscious women.

Five percent of obstetrics/gynecology department chairs tell students to introduce themselves as doctors and just proceed.

 

Some states in the U.S. ban the practice of digitally violating anesthetized female patients. California Governor Gray Davis signed AB 663 into law during the first half of the 2003-04 legislative session which makes the performance of pelvic examinations on anesthetized or unconscious women without consent by doctors and medical students a misdemeanor and ground for the loss of their medical license.

The glaring limitation in the bill is, as Wilson wrote, ”[no] woman can enforce her own interests in being asked if she never knows an exam has taken place” and therefore the bill “suffers from the same limitations as existing causes of action for battery and the failure to secure informed consent.” While AB 663 increases the sanctions for unauthorized exams, Wilson argues that it does nothing to remedy the underlying pressures that have fostered the use of patients as teaching tools without permission.

Ironically, under the subheading “Exaggerated Fear of Refusal,” Wilson cites multiples showing that women will consent to pelvic examinations for educational purposes, even while anesthetized or during birth.

Dr. Ari Silver-Isenstadt, co-author of the aforementioned study about Philadelphia-area medical schools appeared on ABC’s Good Morning America show on June 10, 2004 to discuss the study. He told ABC that the study was based on his own experiences in medical school when “[he] was asked to participate in some of these educational experiences and [he] felt very uncomfortable…”

Naturally, many patients take issue with the idea that their anesthetized bodies will be probed without their expressed consent and knowledge.

One such patient was Zahara Heckscher, who was interviewed by the Washington Post in May 2003. According to the article, Heckscher was preparing to have an ovarian cyst removed at George Washington University Hospital and asked her surgeon if medical students would be practicing pelvic exams on her while she was unconscious.

Shocked when she received a “yes” answer, Heckscher “wrote a note on her consent form forbidding anyone other than her attending physician to perform a pelvic exam on her while she was under anesthesia.”

Not all doctors agree that patients at a teaching hospital should complain about the practice.

Former ACOG president, Dr. Thomas Purdon, expressed concern “that an important quality evaluation that’s been a mainstay of evaluation in the operating room for more than 50 years is getting sensationalized,” according to OB/GYN News.

“It’s a crucial teaching point to see how a procedure is done, what the pathology is, and to tie that to the pelvic exam,” said Dr. Purdon of the Arizona Health Sciences Center in Tucson.

Purdon also argued that this type of treatment is implicit.

In Dr. Purdon’s view, patients who get treated at a teaching hospital “should already know that it’s not just one single doctor who’s taking care of them.”

Purdon expressed frustration that people who go to university centers for care are “pick[ing] apart” something so important.

Although the practice of performing pelvic exams on paid volunteers has gained popularity in some institutions over the last 15 years, physicians are never going to get enough paid volunteers to adequately teach students, he said.

As an educator, “it’s frustrating for me that people who want to go to university centers for the latest treatments and technology pick apart something that’s an area of importance,” he said.

It’s common in a teaching situation for a medical student, one or two residents, and a faculty person to compose a surgical team. It’s not as if 12 medical students are in the operating room examining the anesthetized patient, he said.

Activist Michael Greger, MD, told the Washington Post that the voluntary guideline of having one or two students perform the exam is widely ignored. Said Greger, “If they have five medical students on an OB-GYN rotation, they aren’t going to let one do it and not the other four.”

Bioethicist and medical historian, Jacob Appel, analyzed the recent court-ordered hospitalization of then pregnant woman Samantha Burton for the Huffington Post in his article, “Medical Kidnapping: Rogue Obstetricians vs. Pregnant Women,” in which he stated:

Preventing a competent pregnant woman from leaving the hospital under these circumstances is no less egregious than compelling her to have an abortion. Forcing additional intrusive care upon her, such as unwanted vaginal exams or cervical assessments, is legally-sanctioned digital rape.

As André Picard wrote, “the problem is the result of a failure to communicate. It is also a striking example of a lingering bit of paternalism that is still all-too-present in medical culture – this notion that “we do the surgery and the details are none of your business.”

With sufficient evidence that the majority of women would consent to a pelvic exam if asked, the practice of medical students manually raping anesthetized women in the name of education is a pitiful relic of medical culture. Were it not for the many brave medical and nursing students over the years who spoke out against the practice of culturally-sanctioned digital rape in the operating room and in labor and delivery under the guise of frequent unnecessary cervical checks, this would remain a dirty little secret.

If a Tree Falls: If a Patient is Assaulted Under Anesthesia - MCKean

If a Tree Falls:

If a Patient is Assaulted Under Anesthesia

Few patients realize American medicine has a long history and extensive current practice of violating anesthetized patients rights. This is done in a multitude of ways. Oneis Ghost surgeries, where a patient is told one person will be performing the procedure, but the operation is literally subcontracted out (with kickback and all) to another surgeon and the surgeon you thought was operating has moved on to a higher paying patient/procedure. Other times your surgery is handed over to interns and residents to whom you have never been introduced. The physician the patient was told would be performing the procedure may be merely supervising, or may have moved on to the next case and only be available by phone in the case of an emergency. Once under anesthesia for surgery or colonoscopies physicians often take the opportunity to do things to patients to which they did not consent, such as teams of interns, residents, and students lining up to perform pelvic, breast, and rectal exams on sedated patients, for the sake of education. 1. 

Students and interns, are hidden; the patient is manipulated and deceived. The patient is blatantly lied to before and after about who actually performed the procedure. Vague language in the consent form may allow for such substitutions and intimate practice exams for the sake of education rather than patient health. Other times patients are given “conscious sedation” (date rape drugs) to obtain drug facilitated signatures on consent forms allowing the switch, when the patient is in no condition to read the form they are being asked to sign, will not likely remember the incident, and are in a drug induced mind altered (including unnaturally conciliatory) state of mind. “Gurney consenting” is a method often used on patients who staff has reason to think will not consent to substitutions, video tapping, many spectators, or multiple pelvic exams by teams of students lined up 8 and even 12 deep…, adolescent girls, rape victims, religious patients, or simply a patient who wants to know and approve the experience level of the performing physician. Errors are covered up, injuries denied; even molestation (medical and sexual) of sedated patients is covered up and allowed to continue. This is not the medical culture which we are lead to believe exists, where patients health, rights, and dignity are health professionals primary concern.

As patients, we are lead to believe that patients have rights, and physicians respect our rights as a matter of practice and oath. We are further lead to believe that there are laws protecting these rights, and physicians found in violation are punished and/or restricted from practice . This is a perspective the public holds because it is an image that is aggressively projected and protected by medical “professionals”. The World Medical Association Declaration of Helsinki 2000 declared that, “The well-being of the human subject be given the highest priority and accorded precedence over the interests of science and society.“ This is not medical education and research as it is practice, more propaganda than reflective of practice. Many common practices among practitioners, hospitals, drug companies, imaging companies, and labs prove this declaration hollow.
In addition to these Ghost surgeries, and gang bang intimate student exams, kickback driven medicine, unnecessary surgeries and other harmful procedures, are all common practices that prove the WMA declaration to be no more than propaganda. An overwhelming number of physicians get kickbacks and other economic incentives from pharmaceutical companies, not only for being willing to prescribe a drug, or implant a devise, but also for research. Often, physicians also get kickbacks from other Physicians, hospitals, and imaging facilities to which they refer patients. Physicians even get kickbacks for implant devises. Influenced by a greed for these kickbacks, many physicians prescribe medications and procedures they know are NOT the most effective response to your medical condition or may not even be indicated in your case, but you have become part of a side effects study. 2. In one study one third of the Doctors interviewed, “admitted they would order unnecessary MRI scans and 25% referred patients to an imaging center where they had a financial interest.” 3.

Physicians promote unnecessary surgeries and other risky procedures, often failing to tell a patient of less radical alternatives, to disclose and even mislead patients about risks, and encourage a patient to elect procedures that are not good for their health. “While it is difficult to distinguish "necessary" from "unnecessary" surgeries, some estimates put the latter at 2.5 million a year, resulting in 11,600 deaths a year as well as severe pain and disability for many of the survivors.” 4. Breast implants are just one example. Implants are never permanent. Most will require another surgery within five years, virtually 100% fail within 10 years. 5. Reconstruction after a mastectomy requires multiple surgeries (including one on the healthy breast), and thus provides a whole string of opportunities for surgeons to make big bucks. For women with cancer this is particularly cruel even murderous as evidence indicates that physical trauma the like of multiple surgeries can encourage the spread of cancer. 6. Surgeons virtually never reveal this trauma induced cancer growth risk. Even women’s magazines have described new “perky” breasts, and perhaps even a tummy tuck, as a couple among ten reasons to “be glad you have breast cancer.” 7. While plastic surgeons claim options for such reconstruction are, “essential to women’s self-esteem“, there are less dangerous roads to dealing with self-esteem issues, patients are not well informed of risks, and surgeons literally peddle reconstruction.
 
This is not the medical culture which we are lead to believe exists, where patients health, rights, and dignity are health professionals primary concern. One would think we would hear from our better, more ethical physicians, if such violations were common, that medical boards would act to remedy the situation. It is harder to understand the silence of more ethical less greedy physicians, or nurses for that matter. There is, however, one violation practiced by physicians historically and today that provides us with an insight, a perspective, from which to think of these violations by many physicians, and silence by others, that leads us to a deeper understanding of how medical culture is literally constructed one generation after another to an end conductive of such patient abuse. Unnecessary exams and tests are harmful to patient health, medical radiation cumulative and a proven source of cancer, medications often dangerous. Currently, however, I want to address a practice that physicians claim carries NO risk of harm to patients, serves only to benefit ALL members of society, and are willing to VIOLENTLY defend the practice over all claims to patient autonomy, all reasonable notions of informed consent. I chose this practice because I think it ultimately is very informative and insightful perspective to take a look at in terms of medical staff attitudes towards patients and patient’s rights. This is the practice of “medical rape”.
Manifest in various forms, medical rape is essentially a non-consensual, non-emergency, intimate exam (pelvic, breast, or rectal) or procedure. Students are inducted into the culture of disrespect for patient autonomy, dignity, privacy, and yes, even health, through medical rape in the form of lines of students, interns and residents, six, eight, or more (many reports have been in the double digits), performing practice pelvic, rectal, and breast exams on manipulated young clinic patients or uninformed sedated patients waiting for surgery. Many intersexuals are traumatized by medical staff forcing apart their legs for gangs of students to inspect their genitals.
Now medical culture resists “medical procedures” being referred to as “rape”, regardless of lack of consent, use of chemical force and restraint, lies and manipulation, and the employment of methods they are very well aware patients would not tolerate were they informed. My goal herein is to think about how we got to the point where in spite of what we are told about patient/physician relations, women are subjected non-consensual non-emergency, non-medically indicated pelvic exams, and more. If we are to understand this medical culture of patient violation, it is insightful to approach the subject from the direction of historical practice, in conjunction with the rationalizations of apologists that refer to themselves as medial ethicists. This is a sort of “People’s History” of Allopathic Medicine. With no intent to go into the detail Howard Zenn has in his books, I want to take a critical look at medical practices as they relate to violations of patient’s autonomy, of the fiduciary relationship between patient and physician, how such violations are rationalized, the philosophical and pragmatic weaknesses of such rationalizations, and what needs to be done to ensure patient autonomy, dignity, and rights are respected.

The History:

We tend to be vaguely aware of a distant historical past of exploitive medical experiments performed upon the bodies of slaves, mental heath patients, criminals, prisoners of war, veterans, poor women and minorities. We seem to rarely know the details however, Newborns injected with radioactive substances, military personnel exposed to chemical weapons, mentally challenged children infected with hepatitis, seventy-three disabled children fed oatmeal laced with radioactive isotopes, pregnant women injected with radioactive iron,…; from it’s inception allopathic or “western” medical “advancements” to a significant extent, originated from research and education methods that violate any sense of human or civil rights, autonomy or dignity. 8

At first patients wealthy and poor alike feared and avoided violent and invasive allopathic care. It was a well-grounded fear, and avoidance of the allopath was a wise decision. When medicine was diverse in theory and practice, patients had a choice of homeopathic, naturopathic, Chinese medicine, herbalists, Indian medicine, “allopathic medicine” (which became what we now know as “western medicine”), and midwives. Diet, dietary supplements, herbs, tonics, and topical, were the tools of the most scientific (empirical) medical care. Environmental exposures, bleeding, mercury poisoning, and other very unscientific methods were employed by the allopath. What became known as regular medicine was not based upon science but philosophy, theology, and myth, while traditional Chinese Medicine, homeopathic, and herbal based medical care were grounded in centuries of empirical data collection and analysis. The relative lack of success in treatment, in conjunction with the violence and death that plagued patients who dared suffer the allopath, and given that patients had a choice, most chose NOT to seek the care of the allopath. The poor reputation of allopathic medicine in conjunction with much competition from other practitioners ensured the relative poverty of the allopathic physician. Left with few paying patients relative to other physicians, allopathic medicine was not thriving.

Opportunistic philosophers (linked to eugenics) and emerging pharmaceutical companies offered the allopath the American Medical Association (A.M.A.), an organization that would seek the elimination of competition and control over medical education and the market, ensuring the high income of the allopathic doctor. The objective of the AMA, was to eliminate patient choice, “to secure a government-enforced medical monopoly and high incomes for mainstream doctors.” 9. The A.M.A. lumped ALL sorts of medical care, including midwifery, in with snake oil salesmen, and lobbied for legislation eliminating their competition. Alternatives were all but eliminated from for- profit medical care. The poor, however, sustained medical care in the form of the old women and men passing on home remedies and basic medical knowledge.

One might assume the poor simply could not afford the allopath, or lived more remote lives, and both are true, but the situation was not so simple. While profit driven medical care was reserved for the privileged, patients with money and social status have not only the ability to pay the bill, but also the means to retaliate should the physician deviate from a professional standard of care and the patient suffer. This made the physicians paying customers risky research subjects. Physicians learned early on to treat privileged white males (those who can afford to pay for their medical care and lawyer fees) with more respect.

In the late 1700s a Mr. Slater sued a Dr. Stapleton and Dr. Baker for re-breaking a poorly healed bone. The court found in favor of Mr. Slater because the defendants acted, “contrary to known standard of care and did so without the informed consent of the subject.” Although, the treatment turned out to set a new standard of care in the end, the courts decision did not turn on the success of the experiment, but on the lack of informed consent, that the patient, "...may take courage and put himself in such a situation as to enable him to undergo the operation". 10. (Slater v Baker and Stapleton (1797) 95 English Reports 860.)

Physicians not eager to give up their God like position to treat people as less that full subjects; but, also wanting to make money without being sued, learned to treat the more privileged according to the standard of care, and experiment on those less likely to sue. While being offered little in terms of medical care (medicine administered in their interest), these subjugated groups served as a resource for human lab rats upon which to test this or that drug, treatment, or procedure. Financial and other coercive means were employed in some cases, others downright deception. Informed consent, in any meaningful sense of the word, was rarely sought. Thus, the poor had more than simple economic inability to pay keeping them from seeking medical care from “outsiders”, and in particular from the allopath. 11.

With the advent of surgery; however, physicians needed more than lab rats, they needed living cadavers. While drafted soldiers may “volunteer” to be lab rats in order to avoid being sent to kill others, and many patients can unknowingly be injected with this or that, surgical experimentation presents the problem of being impossible to hide from the patient. Given the extreme nature of surgery and the very high infection rate at the time, (rendering surgery a very risky proposition), it was virtually impossible to acquire “consent“.

The allopath turned to non-free peoples as a resource for breathing cadavers. Subjects with absolutely no freedom to object, slaves, poor mental health patients, and prisoners of war became prime targets for some of the most vial forms of human exploitation. Dr J Marion Sims,(1813-1884) the “father of modern Gynecology”, and the first physician to have a statue erected in his honor in the United States, provides a particularly atrocious, if not unique, example. Doctor Sims avoided the problem of a scarcity in “voluntary” subjects by using African American slave women. The problem of patient autonomy and the need for consent was avoided, and not thinking of the women as human subjects, Dr. Sims operated on his slave and Irish female subjects without anesthesia, something he dare not do to women of privilege. The condition for which Sims sought a cure, …, was largely caused within the slave population by malnourishment and/or pregnancies at a young age, such that the pelvic was underdeveloped leading to prolonged obstructed labors. Dr. Sims not only did not do anything to help the condition of these women, he used them, and their unborn. Most of the women used in his experiments died, many after suffering for weeks. When slave owners refused him further access to their property, he purchased slaves, the first a seventeen year old slave girl he called Anarcha for $500 upon which he performed over 30 operations within a few months in spite of the fact that his own records indicate she was cured after the 13th surgery. There is no reason to assume the slaves he purchased (particularly given the price) were always afflicted prior to Sims’ experiments. Anarcha’s condition (several vaginal tears) was the result of a three-day labor, and then a rough forceps (another of Sims’ inventions) assisted delivery by Dr. Sims, an experimental procedure in which he had no previous experience, using an experimental tool still controversial to this day. While you can read modern apologists who insinuate that these procedures may have been voluntary, these women were slaves, anesthesia was not used (until post surgery so Sims would not have to listen to their moans), and the number of surgeries performed on single subjects were in the double digits. People were asked to hold the women down, most of who after a couple of times could no longer stomach the task, nor Dr. Sims. 12. There is every reason to assume the bulk of these women did not “volunteer” and the girl(s) he purchased most certainly did not.

Apologists also argue that without this sort of violence and abuse the achievements of Sims would never have been enjoyed by millions of women today. This is an obvious logical fallacy as there is no reason to assume that similar (perhaps less violent) procedures would not have been developed by other physicians. More than logical fallacy, historical evidence refutes the claim. In fact, Sims was not the first to repair vesicovaginal fistulas successfully. Twenty-five years before Sims' experiments (from 1845 to 1849) , Montague Gosset in England had used silver wire in a fistula repair, and the use of lead shot to hold wire sutures in place was also known. In 1836, John Peter Mettauer in Virginia and, in 1839, George Hayward in Massachusetts succeeded in closing fistulas. 13. Thus, there is no reason to assume that only Sims could have copied and published these achievements. There is no reason to assume such advancements require such violations of human autonomy. Many contemporaries made medical advances without the use of captive patients. Ephraim McDowell of Kentucky, who in 1809 performed the first successful abdominal operation, and Crawford Long of Georgia, who in 1842 used ether as an anesthetic for the first time, to name just two, both used informed, free, white patients.

Many medical anti-ethicists, as they can only descriptively be called, argue that Sims must be judge by the standards of his time, not ours. However, many speculate Sims left the South due to significant criticism. His colleagues at a Woman’s Hospital Sims help found were so critical of Sims’ unethical experimentation that they voted to ban his cancer surgeries and limit the number of spectators in attendance at surgeries. Eventually, his colleagues so feared for the lives of patients at the hospital they invited Dr. Sims to leave the Hospital. His brother-in-law, also a physician, pleaded with Sims to give up his surgeries. James Simpson of Edinburgh, pointedly remarked in critic of Sr. Sims, "I took occasion to make an extensive series of experiments ... [on] a number of unfortunate pigs, which were always, of course, first indulged with a good dose of chloroform." 14. Nor was Sims a Calvinistic practitioner who did not believe in anesthesia, as he did give his victims chloroform post surgery, if only so he did not have to listen to their moans from the pain.

Given Sims experiments (as he brutally carried them out) would not have been possible had his subjects not been slaves, given such abuse was not necessary for the “advancement of women’s medicine”, given the criticism of his own contemporaries, and given both slavery and non-consensual experimental procedures have come under mass social critic and legal restraint one might find it hard to understand why contemporary medical ethicists might defend Sims’ experiments. Still, many physicians are irrationally emphatic about in their defense of Dr. Sims, arguing the end justified his means. I am convinced, and evidence suggest, they do so not because their argument is well supported by reason or evidence, but because they feel they have a vested interest in opposition to patient autonomy and the ethic against violating informed consent; they have a vested interest in treating the rich and subjecting the poor to violent abuses against patient autonomy, dignity, and health. Contemporary acts of medical violence are rationalized in the same manor Sims’ experiments employing medical rape of the slave women has been rationalized and re-rationalized by some physicians and medical (anti) ethicists. The fact that in spite of criticism in his own day, today Physicians’ rewrite history not only in overwhelming defense, but worship of Dr. Sims is very telling. In fact, to this day people are often reduced to captive patients, not as much through slavery as through force, physical and chemical.
MCKean

To be Continued: To be Continued: In the next chapter I will talk about current practice. We will also address physician justifications for violations of Kant's moral imperative, their fiduciary duties, and Hippocratic oath. Finally we will propose legislation to address these violations and an opportunity for you to act.

1... Not Rape, but Still Not Right: Hospitals Should Get Clearer
Consent Before Med Students Probe Anesthetized Women,
Evan Schulz, LEGAL TIMES, Mar. 17, 2003, 54;

Also see,

 

..Using tort law to secure patient dignity, by
JOHN DUNCAN
Independent
ROBIN FRETWELL WILSON
Washington and Lee University - School of Law
DAN LUGINBILL
Ness, Jett & Tanner, LLC
MATTHEW RICHARDSON
Wyche, Burgess, Freeman & Parham, PA

 

U of Maryland Legal Studies Paper No. 2004-24

 

Training Intrusive and Needs Patient Consent, Activists Say, WASH. POST, May 10,
2003, at A1; Darin L. Passer, Medical Students Respect Their Patients, THE STATE,
July 19, 2003

 

Having obstetric/gynecological surgery anytime soon at one of the hundreds of teaching hospitals around the country?, by Melissa Waters, Concurring Opinions, July 24, 2007

2.

Prescription Drug Scams, by Dean Baker, Thruthout, June 29, 2006

 

Drug Trials Hide Conflicts for Doctors , by KURT EICHENWALD and GINA KOLATA, May 16, 1999

 

Insurers Pay Doctors to Switch to Generics, by Joe Mantone, The Wall Street Journal Health Blog, Jan 24, 2008.

 

Med-tech perks for doctors questioned, by JANET MOORE, Star Tribune, Feb 28, 2008

 

Is Something Rotten in the State of Radiology?, by Leonard Berlin, MD, FACR, Imaging Economics, March 2007

3.

Phoenix Doctor's Picture Taking Latest Sad Tale of Medical Malpractice, |by Parker Waichman Alonso LLP

4.

Profit-Seekers, by Payne Hertz, Wednesday, August 29, 2007

Also see,

 

Needless Surgery, Reprinted from Consumer Reports on Health (March 1998)
© 1998 Consumers Union*

 

To Go Under the Knife--or Not?, by Kate Murphy, Business Week, July 7 2003

 

 

Health Department Fines Parkway Hospital $32,000 for Performing Unnecessary Surgeries on Patients from Leben Home, state of New York Department of Health, 7/16/01

 

Blue Cross and Blue Shield Plans File $30 Million Lawsuit Alleging "Rent a Patient" Fraud in Southern California, Summary by Blue Cross Blue Shield Association, BMC Cancer. 2005; 5: 94. Published online 2005 August 4. doi: 10.1186/1471-2407-5-94.

 

Laparoscopic Cholecystectomy Atrocity, Elizabeth Eugenia James-LaBozetta

Central Ohio Patient's-rights Service (C.O.P.S.) and

Citizens for Medical Safety

 

5.

High Rate of Failure Estimated for Silicone Breast Implants, by GARDINER HARRIS, New York Times, Published: April 7, 2005

6.

Breast surgery accelerates recurrences in some women., Heatlh Facts, Nov 5, 200

 

Trauma-associated growth of suspected dormant micrometastasis, Nagi S El Saghir,1 Ihab I Elhajj,1 Fady B Geara,2 and Mukbil H Hourani3 BMC Cancer. 2005; 5: 94. Published online 2005 August 4. doi: 10.1186/1471-2407-5-94.

 

 

 

STRESS HORMONES MAY PLAY NEW ROLE IN SPEEDING UP CANCER GROWTH, Cancer Research, Nov. 1, 2006 republished OHSU Research News

 

 

Tumor dormancy: not so sleepy after all, by Cliff Murray, Nature Medicine, 1, 117 - 118 (1995)

 

 

Does surgery unfavorably perturb the “natural history” of early breast cancer by accelerating the appearance of distant metastases?,European Journal of Cancer, Volume 41, Issue 4, Pages 508-515 M. Baum, R. Demicheli, W. Hrushesky, M. Retsky

Wounding from Biopsy and Breast cancer progression,

Ritsky etal, The Lancet, Vol 357, March 31, 2001

 

HOW SCIENTIFIC ARE ORTHODOX CANCER TREATMENTS?, by Walter Last

 

7.

Top 10 Reasons to Be Glad You Have Breast Cancer, by  PJ Hamel
Monday, May 7, 2007

8.

Vaccines and Medical Experiments on Children, Minorities, Woman and Inmates (1845 - 2007), Friday, December 14, 2007 by: Mike Adams, Natural News Editor
BITTER PILL : Disseminating Truth And Fighting Tyranny

 

http://www.homersbitterpill.com/2008/12/human-medical-experimentation-in-united.html

 

Race, Health Care and the Law Speaking Truth to Power! Basis of Distrust

 

http://academic.udayton.edu/health/05bioethics/slavery02.htm

 

Human medical experimentation in the United States: The shocking true history of modern medicine and psychiatry (1833-1965)

 

Toxins in the Bodies of Newborns Lead to a Contaminated Generation

9/9/2008 - (NaturalNews)

 

Hepatitis B Vaccine: Good for 'Newborn' Prostitutes and Drug Users, but Who Else? 7/11/2008 - (NaturalNews)

9.

AMA’s stated purpose

10.

(Slater v Baker and Stapleton (1797) 95 English Reports 860.)

11.

http://jme.bmj.com/cgi/content/full/34/3/180#B12

 

http://jme.bmj.com/cgi/content/abstract/32/6/346

http://jme.bmj.com/cgi/content/full/34/3/180 .. B19

 

http://shm.oxfordjournals.org/cgi/content/abstract/20/2/223

http://jme.bmj.com/cgi/content/full/34/3/180 .. B18

 

http://www.naturalnews.com/022383.html

12.

(James Marion Sims: some speculations and a new position Caroline M de Costa MJA 2003; 178 (12): 660-663)

McGregor DM. Sexual surgery and the origins of gynecology: J. Marion Sims, his hospital, and his patients. New York, Garland Publishing, 1989:47.)

13.

Kaiser IH. Reappraisals of J. Marion Sims. Am J Obstet Gynecol 1978; 132:878-884.

Simpson JY. Clinical lectures on disease of women. Philadelphia, Blanchard and Lea, 1863:24.

14.

Simpson JY. Clinical lectures on disease of women. Philadelphia, Blanchard and Lea, 1863:24.)  

 

 

If a Tree Falls

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Original Content at http://www.opednews.com/articles/If-a-Tree-Falls--If-a-Pat-by-MC-Kean-091122-423.html


November 23, 2009

If a Tree Falls: If a Patient is Assaulted Under Anesthesia

By MC Kean

Few patients realize American medicine has a long history and extensive current practice of violating anesthetized patients rights. This is done in a multitude of ways. One is Ghost surgeries, where a patient is told one person will be performing the procedure, but the operation is handed over to interns and residents to whom you have never been introduced once you are under anesthesia. The physician the patient was told would be performing the procedure may be merely supervising, or may have moved on to the next case and only be available by phone in the case of an emergency.

Students and interns, are hidden; the patient is manipulated and deceived. The patient is blatantly lied to before and after about who actually performed the procedure. Vague language in the consent form may allow for such substitutions. Other times patients are given “conscious sedation” (date rape drugs) to obtain drug facilitated signatures on consent forms when the patient is in no condition to read the form they are being asked to sign, will not likely remember the incident, and are in a drug induced mind altered (including unnaturally conciliatory) state of mind. This is a method often used on patients who staff has reason to think will not consent to substitutions, video taping, or multiple pelvic exams", adolescent girls, rape victims, religious patients, or simply a patient who wants to know and approve the experience level of the performing physician.

Once under anesthesia for surgery or colonoscopes physicians often take the opportunity to do things to patients to which they did not consent, such as teams of interns, residents, and students lining up to perform pelvic, breast, and rectal exams on sedated patients, for the sake of education. Errors are covered up, injuries denied; even molestation (medical and sexual) of sedated patients is covered up and allowed to continue. This is not the medical culture which we are lead to believe exists, where patients health, rights, and dignity are health professionals primary concern.

We are convinced that in the western world the average medical patient has established rights to dignity, privacy, and self-determination, that physicians are trained to respect and protect these rights, and any physicians found in violation are punished and/or restricted from practice . This is a perspective the public holds because it is an image that is aggressively projected and protected by medical “professionals”. It is an understanding come by via propaganda and is not reflective of reality. So, what is real?

My goal herein is to think about how we got to the point where in spite of what we are told about patient/physician relations, women are subjected to forced rape exams, non-consensual non-emergency, often even non-medically indicated pelvic exams, and more. This is a sort of “People's History” of Allopathic Medicine. With no intent to go into the detail Howard Zinn has in his books, I want to take a critical look at medical practices as they relate to violations of patient's autonomy, of the fiduciary relationship between patient and physician, how such violations are rationalized, and what needs to be done to ensure patient autonomy, dignity, and rights are respected.

I. The History:

We tend to be vaguely aware of a distant historical past of exploitive medical experiments performed upon the bodies of slaves, mental heath patients, criminals, prisoners of war, veterans, poor women and minorities. We seem to rarely know the details however, Newborns injected with radioactive substances, military personnel exposed to chemical weapons, mentally challenged children infected with hepatitis, seventy-three disabled children fed oatmeal laced with radioactive isotopes, pregnant women injected with radioactive iron,"; from it's inception allopathic or “western” medical “advancements” to a significant extent, originated from research and education methods that violate any sense of human or civil rights, autonomy or dignity. 1

At first patients wealthy and poor alike feared and avoided violent and invasive allopathic care. It was a well-grounded fear, and avoidance of the allopath was a wise decision. When medicine was diverse in theory and practice, patients had a choice of homeopathic, naturopathic, Chinese medicine, herbalists, Indian medicine, “allopathic medicine” (which became what we now know as “western medicine”), and midwives. Diet, dietary supplements, herbs, tonics, and topical, were the tools of the most scientific (empirical) medical care. Environmental exposures, bleeding, mercury poisoning, and other very unscientific methods were employed by the allopath. What became known as regular medicine was not based upon science but philosophy, theology, and myth, while traditional Chinese Medicine, homeopathic, and herbal based medical care were grounded in centuries of empirical data collection and analysis. The relative lack of success in treatment, in conjunction with the violence and death that plagued any patient who dared suffer the allopath, and given that patients had a choice, most chose NOT to seek the care of the allopath. The poor reputation of allopathic medicine in conjunction with much competition from other practitioners ensured the relative poverty of the allopathic physician. Left with few paying patients relative to other physicians, allopathic medicine was not thriving.

Opportunistic philosophers (linked to eugenics) and emerging pharmaceutical companies offered the allopath the American Medical Association (A.M.A.), an organization that would seek the elimination of competition and control over medical education and the market, ensuring the high income of the allopathic doctor. The objective of the AMA, was to eliminate patient choice, “to secure a government-enforced medical monopoly and high incomes for mainstream doctors.” 2. The A.M.A. lumped ALL sorts of medical care, including midwifery, in with snake oil salesmen, and lobbied for legislation eliminating their competition. Alternatives were all but eliminated from for-profit medical care. The poor, however, sustained medical care in the form of the old women and men passing on home remedies and basic medical knowledge.

One might assume the poor simply could not afford the allopath, or lived more remote lives, and both are true, but the situation was not so simple. While profit driven medical care was reserved for the privileged, patients with money and social status have not only the ability to pay the bill, but also the means to retaliate should the physician deviate from a professional standard of care and the patient suffer. This made the physicians paying customers risky research subjects. Physicians learned early on to treat privileged white males (those who can afford to pay for their medical care and lawyer fees) with more respect.

In the late 1700s a Mr.Slater sued a Dr. Stapleton and Dr. Baker for re-breaking a poorly healed bone. The court found in favor of Mr. Slater because the defendants acted, “contrary to known standard of care and did so without the informed consent of the subject.” Although, the treatment turned out to set a new standard of care in the end, the courts decision did not turn on the success of the experiment, but on the lack of informed consent, that the patient, "...may take courage and put himself in such a situation as to enable him to undergo the operation". 3. (Slater v Baker and Stapleton (1797) 95 English Reports 860.)

Physicians not eager to give up their Godlike position to treat people as less that full subjects; but, also wanting to make money without being sued, learned to treat the more privileged according to the standard of care, and experiment on those less likely to sue. While being offered little in terms of medical care (medicine administered in their interest), these subjugated groups served as a resource for human lab rats upon which to test this or that drug, treatment, or procedure. Financial and other coercive means were employed in some cases, others downright deception. Informed consent, in any meaningful sense of the word, was rarely sought. Thus, the poor had more than simple economic inability to pay keeping them from seeking medical care from “outsiders”, and in particular from the allopath. 4.

With the advent of surgery; however, physicians needed more than lab rats, they needed living cadavers. While drafted soldiers may “volunteer” to be lab rats in order to avoid being sent to kill others, and many patients can unknowingly be injected with this or that, surgical experimentation presents the problem of being impossible to hide from the patient. Given the extreme nature of surgery and the very high infection rate at the time, (rendering surgery a very risky proposition), it was virtually impossible to acquire “consent“.

The allopath turned to non-free peoples as a resource for breathing cadavers. Subjects with absolutely no freedom to object, slaves, poor mental health patients, and prisoners of war became prime targets for some of the most vial forms of human exploitation. Dr J Marion Sims,(1813-1884) the “father of modern Gynecology”, and the first physician to have a statue erected in his honor in the United States, provides a particularly atrocious, if not unique, example. Doctor Sims avoided the problem of a scarcity in “voluntary” subjects by using African American slave women. The problem of patient autonomy and the need for consent was avoided, and not thinking of the women as human subjects, Dr. Sims operated on his slave and Irish female subjects without anesthesia, something he dare not do to women of privilege. The condition for which Sims sought a cure, " was largely caused within the slave population by malnourishment and/or pregnancies at a young age, such that the pelvic was underdeveloped leading to prolonged obstructed labors. Dr. Sims not only did not do anything to help the condition of these women, he used them, and their unborn. Most of the women used in his experiments died, many after suffering for weeks. When slave owners refused him further access to their property, he purchased slaves, the first a seventeen year old slave girl he called Anarcha for $500 upon which he performed over 30 operations within a few months in spite of the fact that his own records indicate she was cured after the 13th surgery. There is no reason to assume the slaves he purchased (particularly given the price) were always afflicted prior to Sims' experiments. Anarcha's condition (several vaginal tears) was the result of a three-day labor, and then a rough forceps (another of Sims' inventions) assisted delivery by Dr. Sims, an experimental procedure in which he had no previous experience, using an experimental tool still controversial to this day. While you can read modern apologists who insinuate that these procedures may have been voluntary, these women were slaves, anesthesia was not used (until post surgery so Sims would not have to listen to their moans), and the number of surgeries performed on single subjects were in the double digits. People were asked to hold the women down, most of who after a couple of times could no longer stomach the task, nor Dr. Sims. 5 There is every reason to assume the bulk of these women did not “volunteer” and the girl(s) he purchased most certainly did not.

Apologists also argue that without this sort of violence and abuse the achievements of Sims would never have been enjoyed by millions of women today. This is an obvious logical fallacy as there is no reason to assume that similar (perhaps less violent) procedures would not have been developed by other physicians. More than logical fallacy, historical evidence refutes the claim. In fact, Sims was not the first to repair vesicovaginal fistulas successfully. Twenty-five years before Sims' experiments (from 1845 to 1849) Montague Gosset in England had used silver wire in a fistula repair, and the use of lead shot to hold wire sutures in place was also known. In 1836, John Peter Mettauer in Virginia and, in 1839, George Hayward in Massachusetts succeeded in closing fistulas. 6. Thus, there is no reason to assume that only Sims could have copied and published these achievements. There is no reason to assume such advancements require such violations of human autonomy. Many contemporaries made medical advances without the use of captive patients. Ephraim McDowell of Kentucky, who in 1809 performed the first successful abdominal operation, and Crawford Long of Georgia, who in 1842 used ether as an anesthetic for the first time, to name just two, both used informed, free, white patients.

Many medical anti-ethicists, as they can only descriptively be called, argue that Sims must be judge by the standards of his time, not ours. However, many speculate Sims left the South due to significant criticism. His colleagues at a Woman's Hospital Sims help found were so critical of Sims' unethical experimentation that they voted to ban his cancer surgeries and limit the number of spectators in attendance at surgeries. Eventually, his colleagues so feared for the lives of patients at the hospital they invited Dr. Sims to leave the Hospital. His brother-in-law, also a physician, pleaded with Sims to give up his surgeries. James Simpson of Edinburgh, pointedly remarked in critic of Sr. Sims, "I took occasion to make an extensive series of experiments ... [on] a number of unfortunate pigs, which were always, of course, first indulged with a good dose of chloroform." 7. Nor was Sims a Calvinistic practitioner who did not believe in anesthesia, as he did give his victims chloroform post surgery, if only so he did not have to listen to their moans from the pain.

Given Sims experiments (as he brutally carried them out) would not have been possible had his subjects not been slaves, given such abuse was not necessary for the “advancement of women's medicine”, given the criticism of his own contemporaries, and given both slavery and non-consensual experimental procedures have come under mass social critic and legal restraint one might find it hard to understand why contemporary medical ethicists might defend Sims' experiments. Still, many physicians are irrationally emphatic about in their defense of Dr. Sims, arguing the end justified his means. I am convinced, and evidence suggest, they do so not because their argument is well supported by reason or evidence, but because they feel they have a vested interest in opposition to patient autonomy and the ethic against violating informed consent, they have a vested interest in treating the rich and subjecting the poor to violent abuses against patient autonomy, dignity, and health.

To be Continued: In the next chapter I will talk about current practice. We will also address physician justifications for violations of Kant's moral imperative, their fiduciary duties, and Hippocratic oath. Finally we will propose legislation to address these violations and an opportunity for you to act.

1.

Vaccines and Medical Experiments on Children, Minorities, Woman and Inmates (1845 - 2007), Friday, December 14, 2007 by: Mike Adams, Natural News Editor


BITTER PILL : Disseminating Truth And Fighting Tyranny

http://www.homersbitterpill.com/2008/12/human-medical-experimentation-in-united.html

Race, Health Care and the Law Speaking Truth to Power! Basis of Distrust

http://academic.udayton.edu/health/05bioethics/slavery02.htm

Human medical experimentation in the United States: The shocking true history of modern medicine and psychiatry (1833-1965)

Toxins in the Bodies of Newborns Lead to a Contaminated Generation

9/9/2008 - (NaturalNews)

Hepatitis B Vaccine: Good for 'Newborn' Prostitutes and Drug Users, but Who Else? 7/11/2008 - (NaturalNews)

2.

AMA's stated purpose

3.

(Slater v Baker and Stapleton (1797) 95 English Reports 860.)

4.

http://jme.bmj.com/cgi/content/full/34/3/180#B12

http://jme.bmj.com/cgi/content/abstract/32/6/346

http://jme.bmj.com/cgi/content/full/34/3/180 \ B19

http://shm.oxfordjournals.org/cgi/content/abstract/20/2/223

http://jme.bmj.com/cgi/content/full/34/3/180 \ B18

http://www.naturalnews.com/022383.html

5.

(James Marion Sims: some speculations and a new position Caroline M de Costa MJA 2003; 178 (12): 660-663)

McGregor DM. Sexual surgery and the origins of gynecology: J. Marion Sims, his hospital, and his patients. New York, Garland Publishing, 1989:47.)

6.

Kaiser IH. Reappraisals of J. Marion Sims. Am J Obstet Gynecol 1978; 132:878-884.

Simpson JY. Clinical lectures on disease of women. Philadelphia, Blanchard and Lea, 1863:24.

7.

Simpson JY. Clinical lectures on disease of women. Philadelphia, Blanchard and Lea, 1863:24.)

 

 





Author's Bio: Just one citizen struggling to regain American Democracy. I am a bit of a intellectual jack of all trades master of none. I have studied, economics, sociology, philosophy, womens studies, and political science at a graduate level.

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