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Local physicians' woes are our problems, too

September 29, 2004|by BOB MAGINNIS

When a large group of Washington County physicians recently announced that they would protest steep increases in their malpractice insurance rates by ceasing to do anything but emergency procedures starting Nov. 15, I was a little bit concerned and puzzled at the same time.

Just what is nonemergency surgery, anyway? Is it what most of us would consider cosmetic procedures - tummy tucks, liposuction and the like? Or is it exploratory surgery that isn't a life-or-death matter if not done immediately, such as colonoscopies and breast biopsies?

Washington County Hospital officials are waiting to find out, too, according to CEO James Hamill.

On Monday, Hamill said the hospital's board has discussed the issue and members have agreed on two things - that they support physicians' efforts to get relief and reform and that the hospital has an obligation to meet the health-care needs of the region.

"I think we have to put this thing in context. One of the things we don't know is the extent of it and what the definition of 'elective' is going to be," he said.

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Asked if this is going to be a financial problem for the institution, Hamill said that since surgery is about 25 percent of what the hospital does, it could have an effect on revenues.

"Our first hope is that it will get folks' attention," he said, then added that at the same time, the hospital is going to have to provide coverage.

"I think this is new ground for everyone involved," he said.

Asked if the doctors scheduled their work slowdown for Nov. 15 to get procedures completed on patients already in the pipeline, Hamill said he felt that was probably part of it.

"You really would have to ask them. They're trying to make a serious statement and get a reasonable response," he said.

Asked what he felt patients should do at this point, Hamill said the hospital is advising patient to talk with their doctors about what's best for whatever condition they might have.

Figuratively speaking, Hamill and the hospital board probably feel like Florida residents waiting for the next hurricane. First, it was the trauma center closing and the frantic rush to craft a solution.

Then came the Certificate of Need battle with the Hagerstown city government, which may or may not be over. Now comes the doctors' proposed slowdown, which could be averted if the Maryland General Assembly holds a special session to address some of the doctors' complaints.

This situation is like the trauma shutdown, in that local doctors are not asking for special treatment. In both cases, doctors identified a serious problem with the system and made gutsy moves to shake it up.

Nobody has to tell them that there are risks involved. In a system in which doctors say they often perform more tests than they feel are necessary, what would be the consequences of not performing a nonemergency procedure - and then finding out that a life-threatening condition had gone undetected and untreated?

At the core of the issue, this is what's unfair: Doctors are expected to always be there - and to always produce good outcomes. But sometimes a patient's health is such that a good outcome would be a miracle.

It would also be a miracle, in my view, if the legislature crafted a solution quickly. What's more likely is that legislative leaders will come up with some cash to temporarily subsidize malpractice premiums while a more comprehensive solution is found.

There's a Maryland law that prevents hospitals such as Washington County from turning away any patient in need of care. Many assumed that meant there would always be a doctor there, waiting to treat us. Maybe we assumed wrong.

The other possibility to be concerned about is if one of the neighboring states solves this issue and there's a mass migration of doctors. At a time when we were looking for more medical services to be available locally, we might have to get used to long trips for routine care.




If you believe in the arts and in downtown Hagerstown, you can support both by attending the 2004 Progressive Dinner on Thursday, Oct. 7, starting at 5:30 p.m.

The event, which will benefit the Classical Youth Ballet Company and the Washington County Arts Council, features a variety of menu choices at a number of downtown restaurants.

For more information on the event, please call 301-739-8577, ext. 183.

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