"The Perfect Storm"

small logo (A Bad Omen for Healthcare)

In the July 1, 2002 issue of U.S. News and World Report, writer Mary Brophy Marcus wrote an article about the critical shortages of physicians in the United States due to the malpractice crisis, which piece she entitled Healthcare's "Perfect Storm." The title is, indeed, most appropriate, one that portends an ominous future for the Americans. The same crisis could wreak havoc to our own healthcare in the Philippines, and cause us and our family immeasurable pain and suffering, if we, the people, allow it happen by our indifference and inaction. I only pray that the Filipinos would be united and vigilant enough to fight (even our legislators) to preserve our inalienable right to help design our own destiny, protect our family and children, and prevent this storm from coming our way.

In this revealing and alarming essay, the author related how a Las Vegas OB-GYN specialist with a thriving practice, seeing 40 patients a day and delivering 20 babies a week, had to fold his obstetrics practice after 12 years because of skyrocketing malpractice premium in the United States. Although he had never been sued before, his malpractice rate jumped from $33,000 (more than 1.7 million pesos at an exchange rate of 52) to a more ridiculous $108,000 (about 5.6 million pesos) a year! At an income tax (bracket) rate of almost 50%, this physician had to earn 11.2 million pesos a year just to be able to pay Uncle Sam the annual income tax equivalent to 5.6 million pesos, with nothing left in his pocket for his family or office staff and other overhead expenses.

The example the writer illustrated above is typical and widespread across North America, where there is currently a healthcare crisis, almost to a catastrophic proportion. The run-away malpractice insurance premium rate is forcing countless physicians, especially those specialists regularly performing high-risk procedures (heart surgeons, obstetricians, neurosurgeons, orthopedic surgeons, emergency room physicians, etc.) to curtail their practices or retire prematurely, or change career, to avoid debts or bankruptcy. Many disenchanted physicians have reluctantly ceased the practice of medicine altogether, and even the patients who are the suffering victims of this healthcare crisis do understand and empathize with the physicians.

"People are dying," stated Loren Johnson, president of the American College of Emergency Physicians' California chapter. The reason is because states are running low on vital medical specialists and services as a result of this malpractice crisis.

The Washington County Hospital in Hagerstown, Maryland, like many other hospitals, has shut down their trauma center (emergency room) because of lack of physicians and the very costly malpractice premium. Many training hospitals are concerned that the high cost of malpractice premium they have to buy for their residents might cause them to close their programs. And this will further reduce the number of practicing physicians in the country, making healthcare even lesser accessible for the people.

When both hands of the physicians are tied as a consequence of a prohibitive malpractice insurance premium, a coverage required by all hospitals in order for a physician to join the medical staff, they are essentially deprived of their individual constitutional right to practice their profession and art. And the ultimate victims who will suffer the brunt of all this are the people, the patients, especially the sickness-prone seniors and the children. Continuously forcing physicians to stop practicing medicine by creating a monster of an impediment before them, one that is virtually impossible for them to scale, will eventually brew into a healthcare "perfect storm" where, not only medical care, but all of us, patients and family members, will eventually be sucked under and drown.

The malpractice crisis has been going on for years, where mind-boggling sky- high damage awards paid as compensation for the plaintiff patient averaged about $3.5 million (about 182 million pesos) in 1999, because there was no cap in the malpractice awards in almost all parts of the United States. In some cases, the suit involved an ugly scar following surgery or a patient's unmet expectation of a perfect result. The potential profitability of filing a suit against a physician becomes a strong incentive for many patients to sue their physician at a drop of a hat. Indeed, the United States, most unfortunately, has become a very litigious society. And the victims are nobody else but the people, the patients and their family.

The crisis came to a head when St. Paul Companies, the largest malpractice insurers, dropped tens of thousands of physicians, leaving them naked, without any coverage at all, and scampering for other insurers. And this would come at a prohibitive price because other insurers took advantage of this situation and raised their premiums. The reason for all this was the increase of medical lawsuits and the high-priced damage awards.

When Otis Bowen, M.D., became governor of Indiana, he was instrumental in passing a law that set the cap on malpractice award to a reasonable and realistic level. A handful of other states have followed suit or are trying to enact the same law, but majority of the states still have no such legal cap. As a result, twelve states are now in a healthcare crisis mode and 30 others are on the brink of this same catastrophe.

"The U.S. liability system has created a liability lottery, where select patients receive astronomical awards, and others suffer because of it," states Donald Palmino, a New Orleans surgeon, lawyer and malpractice expert, who is President of the American Medical Association.

In Las Vegas, for instance, like in many other metropolis, one sees a billboard almost every mile, advertising personal injury lawyers, with a "no-legal-fee-if-we-lose" incentive, practically enticing people to sue their physicians. There are 137 pages of attorneys listed on the yellow pages in Las Vegas alone. Only the lawyers and malpractice insurance companies profit from this crisis.

Can this crisis happen to the Philippines?

Yes, since we, Filipinos, are very fond of copying everything and anything from the United States. As a matter of fact, it appears that Senator Noli de Castro and some fellow legislators, importing the idea from the USA, have authored a bill (SB No. 2295) mandating malpractice insurance coverage for every physician in the Philippines. Obviously, he and his cohorts, do not care enough for our people and our healthcare to the point of wanting to "import" even a bad piece of legislation from the U.S. They seem to think that as long as it is "made in", and imported from, the U.S.A., it is good for us. Are Senator de Castro and his associates in congress shamefully misinformed, miserably blind, simply dumb, or cleverly planning to invest in, or put up, malpractice insurance companies in the Philippines? If the reason is none of the above, then why in heaven's name would these legislators, who have sworn to serve and protect the interest and welfare of the Filipinos, even think of a stupid and harmful piece of legislation like the mandatory malpractice for physicians in our country when the same experiment has despondently failed in the United States and has been causing a healthcare havoc, pain and suffering among the Americans? Why do we have to import mistakes, miseries and heartaches from abroad when we have the expertise right in the Philippines. It has long been apparent that our leaders, like Erap, Noli de Castro, and the likes of them, to mention only a few, are experts in inventing those miseries for our people.

I challenge every Filipino to aggressively let Senator de Castro know (by text, email or letter) that we do not want his mandatory malpractice insurance Senate Bill 2295 because it will severely hurt all of us, including his own family in the Philippines.

Let us copy and import from the United States only what will be good for our people and not a bad piece of legislation that has already been proven deleterious by the Americans themselves, and who are now trying very hard to undo and correct their errors of the past.

If we must, I suggest we immediately import the following "goodies" from the United States, or from elsewhere, to be delivered ASAP to the Philippines by Federal Express or DHL: (1) For our President, senators and congressmen, provincial, city, barangay officials, our military and law enforcement agencies: Discipline, a sense of moral responsibility, good and honest leadership and governance, bereft of corruption; (2) For all Filipinos: (a) Personal discipline, positive assertiveness, and an enthusiastic, unapologetic individual public display of love and pride of our country; (b) respect for, and eagerness to fly, the Philippine flag, with sincere patriotism in every one of us; and (c) generosity and compassion for our less fortunate fellow Filipinos; and, (3) For all our leaders and judges: true and timely justice for every Filipino and our national guests and visitors.

Yes, if we have to copy or import something from the West, or from elsewhere, let us not choose one that will hurt the Filipinos, like Noli de Castro's SB 2295, or limit our choice to hamburger and French fries, or to changing the color of our hair to blonde and our complexion to white, or to mouthing four-letter English cuss words and other obscene languages, or to practicing disrespect for the elders, or to playing rap music and doing the moon walk. Instead, let us imitate and import whatever we, Filipinos, need to make our beloved Philippines a great and prosperous country, like Singapore, or even the United States (if we must copy it). After all, we, Filipinos, already possess all the necessary God-given potential qualities, cultural and personal attributes, and natural resources, to be a great nation. Let us not waste all this by being stupid.

©2003Raoul R. Diez, M.A.O.D.