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HEALTHCARE POLICY ISSUE
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Healthcare Policy Issue
Policies in healthcare involve decisions and actions taken by players in the healthcare system to enhance the efficiency of achieving specified goals. The actions may include a government executing a set of rules and regulations to improve the overall healthcare system or end malpractices in the sector. At this juncture, the government implements different types of policies and procedures to ensure the standardization of healthcare services. For instance, in the wake of medical malpractice scenarios such as Dr. Duntsch’s case, the state can implement quality improvement legislation to ensure that physicians offer the best possible healthcare services. In this regard, a critical evaluation of the Health Care Quality Improvement Act (HCQIA) of 1986, in line with Dr. Duntsch’s case, is essential in understanding the role of policies in streamlining the healthcare system.
History of the Issue
Christopher Duntsch was a Texas-based neurosurgeon who earned the nickname “Dr. Death” after his medical malpractices went viral on mainstream media. The horrific name is attributed to the killings of patients who had trusted him with their lives. Instead of getting the much-needed medical care, most of his subjects ended up dead or maimed, and the issue was further worsened by the failure of the Texas Medical Board to immediately stop him from operating on more patients (Elbein, 2013). Nonetheless, when he was eventually fired, nothing could stop him from starting his clinic, as his medical language remained unrevoked. Therefore, it is evident that the case involved many issues that warrant formulating policies to guarantee patients’ quality medical care.
The infamous acts of Dr. Duntsch’s two years as a neurosurgeon involved performing operations on 38 patients. According to Hyman (2018), of all his patients, 31 either sustained serious injuries or were left paralyzed, while two patients lost their lives due to surgery-related complications. Following the procedure, most of Dr. Duntsch could be diagnosed with incomplete paralysis. Some of the incidents include Duntsch’s first victim, lady Kellie Martin, who was experiencing back pains after falling in her kitchen. Her treatment required a simple procedure that should have lasted less than two hours; however, the basic surgical operation Duntsch took about five hours to complete. According to Goodman (2016), the patient woke up in shock as she could not move or feel her feet. Later, it turned out that the procedure led to her nerve root being cut off. The other patient who fell victim to Duntsch’s unprofessionalism was Floell Brown. It is reported that Mrs. Brown experienced an acute stroke a few hours following her operation, as Duntsch had cut the vertebral artery during the procedure (Goodman, 2016). Further, according to the Anatomy of a Tragedy (2018), Duntsch also mishandled Mary Efurd, a 71- year patient who was supposed to undergo an operation to infuse her vertebrae; however, after the procedure, she could not stand and was in severe pain. A follow-up CT scan indicated that the procedure led to her nerve root being amputated, and the root nerve also had several screw holes. This botched surgery led to the demise of Mrs. Efurd and the conviction of Dr. Duntsch, who is currently serving a life sentence in prison. Overall, the account of Duntsch’s malpractice cases, coupled with similar unreported incidents, necessitated the formulation of policies to curb the vice.
Specific Recommendations Addressing the Issue
In 1986, Ron Wyden, a congressman for Oregon, formulated the HCQIA and brought it to the attention of Congress. The ensuing debate that led to the Act’s passing in 1986 was attributed to the high number of lawsuits on medical malpractice over the preceding two decades and the need to ensure patient safety. The emergence of a case challenging a surgeon’s peer review called for the need to shield peer reviewers from antitrust suits, ensuring that the quality of healthcare remains in check. Existing statutes safeguarded peer reviewers in some states, such as Oregon. However, the legislation had not been adopted at the federal level, meaning medical malpractice in some states could easily translate into other regions that did not have the legislation because physicians could go and start practicing where the law was not being enforced. For instance, in Dr. Duntsch’s case, the situation worsened when professional peer reviewers failed in their obligation of reporting physician incompetencies, allowing Duntsch to continue operating in different hospitals despite many cases of medical malpractice (Keegan et al., 2021). The consumers and lobby groups pushed for enacting the Act to protect patients from medical malpractice by doctors at the federal level, a move that saw most states across the country, including California adopting the policy. According to Snavely (2018), consumers took the mantle of pushing for the Act to be passed because the hospitals and physicians were reluctant to report their peers. According to Au et al. (2020), the reluctance of peer reviewers was attributed to a conflict of interest and the possibility of damaging the reputation of the physicians and the hospital, making it challenging to report system errors. However, with the increased lobbying and adoption of the HQIA policy, more physicians started adhering to the AMA code of conduct, reporting medical malpractice by their peers, and protecting patients against “bad” physicians like Duntsch. Generally, forces beyond the healthcare system had a significant role in adopting the policy meant to address medical malpractice and ensure high-quality healthcare.
The establishment of HQCIA gave the healthcare peer-reviewing process immunity and capacity, empowering it to pinpoint failures in the healthcare sector and find solutions to them. Nevertheless, the American Medical Association rejected the move to create a National Practitioner Databank that is not regulated by the medical boards because of the possibility of an increase in the number of misleading suits (Furrow, 2018). However, the Act was later amended, allowing non-physician lobby groups an opportunity to review doctors. Even though the concerned group was limited to reviewing economic and monetary situations, there were more explicit instructions on clinical conditions and healthcare quality. Overall, the Act was essential in determining medical professionals’ history and indiscipline tendencies. It allowed clinics and hospitals to ascertain the quality of a doctor, and those charged with malpractice cases could no longer practice in the other as the law is now applicable at the federal level. Therefore, the Act was significant in addressing the issue and ensuring that healthcare quality is enhanced throughout the U.S.
Analysis of the Financial Implications
The implementation of the healthcare quality improvement policy was bound to conflicts between interested groups, notably the medical stakeholders and the concerned groups, which would eventually turn out to be costly. Interestingly, the conflict would result in losses for both parties; for instance, when the medical stakeholders abused the Act, the interest group felt the loss. On the other hand, incidents of unjustified reporting and profiling of medical practitioners on NPDB destroyed their reputations, costing them their professional careers. In the report by Segal (2019), the implementation of HCQIA contributed to an increase in sham peer reviews that resulted in multimillion-dollar suits. Additionally, suits on medical professionals have led to some stop operating due to fear; this move deprives them of their livelihood and negatively impacts the country’s economy. Therefore, enacting the quality improvement act in healthcare brought about several economic implications that needed alternative measures to resolve them.
The misuse of HCQIA meant that improving the existing legislation was critical in avoiding conflicts between interest groups and stakeholders in the medical industry. I believe one of the best ways to ensure that the Act is effective is by treating both parties fairly. The most significant aspect is inclusivity in decision-making regarding changes and amendments to the policy. Some are of the view that amending the bill will water it down, as scaling down on reporting incidents of medical malpractice until the issue is thoroughly investigated will reduce the severity of dealing with the cases. However, I believe that the formulation of a special committee can overcome this trade-off to fasten investigations into medical malpractices as they may arise. Additionally, considering existing research on the issue and considering the views of several scholars on amending the law will be critical in overcoming these shortcomings. The amendment of the Act must consider the concerns of each party to avoid issues of conflict of interest. An inclusive amendment will objectively reduce the Act’s vulnerability to abuse and fake peer reviews. Therefore, all interest groups and stakeholders in the health sector must be encouraged to present their issues for consideration during policy reviews.
The departments overseeing this case included medical boards, hospitals, physicians, consumers, patients, and the courts. However, the Act has an impact on patients and medical practitioners: the Act protects patients from medical malpractices by compelling medical professionals to meet specific standards of care. The consumers, on the other hand, are the primary influencers that lobbied for the enactment of the bill to safeguard their medical interests. Overall, the involvement of different departments in overseeing this issue necessitated peer reviews of doctors leading to the setting out of malpractices that could be investigated, and appropriate corrective measures are undertaken to enhance the quality of healthcare.
Conclusion
Undoubtedly, issues of medical malpractice are rampant in the United States healthcare system, and most incidents go undetected or unreported. In this regard, the enactment of HCQIA and NPDB was crucial in protecting patients from quack medical practitioners such as Dr. Duntsch. Reporting physicians involved in medical malpractices is essential in sensitizing the consumer to avoid seeking medical attention from such practitioners. Even though the implementation of this Act has had some adverse impacts that have proved costly to the healthcare system by generating unfair completion, a few amendments to the Act are enough to enhance its effectiveness. There is a need to revise the operational structure of the Act to guarantee fairness to all parties during investigations and only post cases of medical malpractice on NPDB once the case has been thoroughly investigated and determined. Overall, the issue of medical malpractice has dire consequences for patients and physicians. Therefore, appropriate policies must be in place to ensure that medical professionals operate within set standards for patients to receive the best quality care to improve their health outcomes.
References
Au, H. D., Kim, D. I., Garrison, R. C., Yu, M., Thompson, G., Fargo, R., Nathaniel, B., Chitsazan, M., Puvvula, L. K., Motabar, A., & Loo, L. K. (2020, June 5). Code S: Redesigning hospital-wide peer review processes to identify system errors. Cureus. doi: 10.7759/cureus.8466
Elbein, S. (2013). Anatomy of a tragedy: The story behind ‘sociopath surgeon’ Christopher Duntsch. Texas Observer. Retrieved from https://www.texasobserver.org/anatomy-tragedy/
Furrow, B. R. (2018). Searching for adverse events: Big data and beyond. Annals Health L., 27, 149. Retrieved from https://lawecommons.luc.edu/cgi/viewcontent.cgi?article=1461&context=annals
Goodman, M. (2016). Dr. Death: The shocking story of Christopher Duntsch, a madman with a scalpel. D Magazine. Retrieved from www.dmagazine.com/publications/dmagazine/2016/november/christopher-duntsch-dr-death/.
Hyman, D. A. (2018). Are we driven by data: The problem of bad doctors. Denv. L. Rev., pp. 96, 761. Retrieved from https://static1.squarespace.com/static/5cb79f7efd6793296c0eb738/t/5d5f4f732bb45500019e9fd0/1566527348036/Vol96_Issue4_Hyman_FINAL.pdf
Keegan, W., Tessier, W., & Story, J. (2021). Where does it begin and how to stop it: Opportunities to prevent “bad” physicians. Missouri Medicine, 118(3), 206–210. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8210989/pdf/ms118_p0206.pdf
Segal, D. (2019). State medical boards: Are the regulators regulated? J. Corp. L., 45, 285. . Retrieved from https://www.researchgate.net/profile/David-Segal/publication/349278645_State_Medical_Boards_Are_the_Regulators_Regulated/links/602779d045851589399efc8a/State-Medical-Boards-Are-the-Regulators-Regulated.pdf?_sg0=started_experiment_milestone&origin=journalDetail
Snavely, J. (2018). Federal health policy hall of shame and AAPS advocacy hall of fame. J Am Phys Surg, pp. 23, 72–80. Retrieved from https://www.jpands.org/vol23no3/snavely.pdf