Obamacare will kill patients (Not kidding....if you can't see the doctor when you are sick...how can you recover?)

OK…Let me get this right…Longer wait for patients to see the doctor…Doctors will be paid less…Those of us who pay for their Health Insurance will pay higher premiums…Those on Medicaid will have to search for a physician that will accept Medicaid….So now all Floridians will be miserable…and The Government will try to tell us we’ll all be better for it! Thanks for nothing OBAMA!

Florida doesn't have enough doctors for Medicaid expansion, lobby group says

February 22, 2013|By Kathleen Haughney, Tallahassee Bureau

TALLAHASSEE Brace yourself for longer lines at the doctor's office.

Whether you're employed and insured, elderly and on Medicare, or poor and covered by Medicaid, the Florida Medical Association says there's a growing shortage of doctors — especially specialists — available to provide you with medical care.

And if the Florida Legislature goes along with Gov. Rick Scott's recommendation to offer Medicaid coverage to an additional 1 million Floridians — part of the Affordable Care Act that takes effect next January — the FMA says that shortage will only get worse

"Florida needs more doctors and it needs more nurses, and it needs them working together in teams," said Rebecca O'Hara, a lobbyist for the FMA.

About 15 million Floridians have health insurance today, and Obamacare, which requires most adults to have coverage by January, could add as many as 2.5 million more. One million would come through a potential expansion of the federal-state Medicaid program that Scott announced this week he was backing. The others would be the result of new mandates requiring employers and individuals to have insurance or be fined.

Currently, the state has 44,804 doctors, but about 5,600 of them are expected to retire in the next five years. And even though Florida has opened three new medical schools in the past dozen years, the state isn't producing as many doctors as it needs. Scott's budget this year has $80 million to fund programs to train 700 new residents a year, in hopes they'll remain in the state.

Of all patients, people covered by Medicaid may have the hardest time finding a doctor; only 59 percent of the state's physicians are taking new Medicaid patients, according to a Kaiser Health News study.

Committees in both the House and Senate have been meeting for the past two months to discuss implementation of the Affordable Care Act. On March 4, they expect to see two major studies by the Office of Economic and Demographic Research, one that looks at the overall economic impact of the health-care overhaul and another that simply examines Medicaid expansion.

Scott, however, has already made clear how he feels about that.

On Wednesday, he unexpectedly announced that he had reversed his earlier, adamant opposition and now wants a three-year expansion that would cover single adults and families earning up to 138 percent of the poverty line; the costs would be fully covered by the federal government. If the expansion is re-approved after three years, the federal government is committed to paying no less than 90 percent of the cost.

House and Senate leaders will begin their budget deliberations in the coming weeks, which will include the decision over new residency slots, along with the debate over whether to expand Medicaid. Many lawmakers have expressed opposition.

Sen. Joe Negron, R-Stuart, who chairs the Senate committee studying the AFA, said lawmakers have heard concerns about a potential physician shortage, but he said he did not believe that would be a "determining factor" in the committee's decision over whether to expand Medicaid.

One reason, he said, is the responsibility for coverage may soon be falling to private health insurance companies or physician groups.

The federal government this week gave Florida preliminary approval of a plan that would put most of Florida's current 3.3 million Medicaid recipients — and any added via expansion — in some form of managed care, either HMOs or doctor-run networks, by 2014. In order for HMOs or the provider service networks to get state-approved contracts, they must prove they can provide "adequate" care, which means patients must be able to see a doctor in a reasonable time.

"It's their responsibility to have network adequacy," Negron said of the private providers. "So, they'll be responsible for making sure people can get care with network physicians."

Negron also noted that the amount doctors will be paid for seeing Medicaid patients is rising, which may prompt more physicians to take them. As part of the health care law, primary-care doctors will be paid as much for a Medicaid patient as they are under Medicare, a 73 percent increase.

Health care advocates who back the expansion say they aren't worried either.

Greg Mellowe, policy director for health advocacy group Florida Chain, said the state needed to carefully watch the situation as it develops, but added, "We don't believe that there is a crisis brewing."

Mellowe noted that many uninsured already receive care — often in emergency rooms, which is more expensive — that hospitals aren't paid for. If many of these patients have insurance coverage, he said, hospitals may see an opportunity to shift resources to primary care settings.

Lawmakers are slated to return to Tallahassee the week of March 4 for the beginning of the 2013 legislative session. The studies from the state economists are also due at that time.

Negron said until the state can look at that information, it was impossible to say what direction the Legislature would take.

"It will be a judgment call to make on the right way to proceed for Florida's families and businesses," he said. "I just think it's too early to tell where either the House or Senate will come down on this."

khaughney@tribune.com or 850-224-6214

Doctor shortage

Number of doctors in Florida: 44,804

Number of people with health insurance coverage: 15 million

Number expected in 2014, including a Medicaid expansion: 17 million to 17.5 million

Percentage of physicians expected to retire in the next five years: 5,600

Concierge Medicine works for Physicians and Patients! Obamacare does Not!

Concierge medicine for the people! American patients seek concierge services from their physician at only $50 a month! Sounds Good!

Bruce Japsen, Contributor

Forbes

Pharma & Healthcare 1/30/2013 @ 9:30AM

1 In 10 Doctor Practices Flee Medicare To Concierge Medicine

As Medicare whacks away at what doctors are paid and health insurers move away from paying fees for service to bundled payments, more physicians who own their own practices will start direct pay or concierge medicine in the next one to three years.

New data from a national survey of nearly 14,000 physicians conducted by physician staffing firm Merritt Hawkins for The Physicians Foundation, analyzing 2012 practice patterns, found that 9.6 percent of “practice owners” were planning to convert to concierge practices in the next one to three years.

The movement is across all medical disciplines with 6.8 percent of all physicians planning to stop taking insurance in favor of concierge-style medicine or so-called “direct primary care.”

“Physicians have been running for cover for several years now,” said Mark Smith, president of Merritt Hawkins. “There is a lot of uncertainty in health care now and the only certainty is there is a lot of talk about cutting physicians fees. One way to get out of it is to go off the grid.”

The data release comes less than a month after Congress waited until the 11^th hour to avoid the fiscal cliff as well as the so-called “doc fix” on Medicare payments. Even though a cut of nearly 27 percent in Medicare payments to doctors was avoided, doctors remain upset at the lack of a permanent solution for dramatic cuts to doctor payments from the Medicare health insurance program for the elderly under the sustainable growth rate formula also known as “SGR.”

Already, one in five physicians is restricting the number of Medicare patients in their practice and one in three primary care doctors – the providers on the front lines of keeping the cost of seniors’ care low – are restricting Medicare patients, according to a 2010 AMA survey of more than 9,000 physicians who care for Medicare patients.

Under direct primary care, doctors contract directly with patients to provide all of their primary care needs free of insurance interference at a price generally between $50 and $60 a month per patient. It’s what the New York Times last spring called “concierge for the masses” because it was much cheaper than the historically high cost of concierge medicine some Congressional investigators found to be $5,000 to $15,000 a year or more.

“It’s not just for the rich and famous anymore,” Merritt Hawkins’ Smith said of concierge medicine and direct primary care practices. “If you can afford a gym membership, you can afford this kind of care.”

 

The direct primary care approach provides unlimited visits to a physician’s office plus 24-hour access to doctors through e-mail consultations. The primary care model has drawn insurance industry opposition in part because the health insurer middleman is cut out of the equation as doctors are no longer paid by the likes of Aetna (AET), Humana (HUM) or a UnitedHealth Group (UNH).

Under a proposal under consideration by Congress and Medicare officials, a pilot program  would provide “monthly fee-based payments for direct primary care medical homes” for certain Medicare beneficiaries, according to the legislation introduced by Rep.  Bill Cassidy, a Louisiana Republican and physician.

Supporters of the direct primary care approach see the pilots as a way to show Congress and an Obama administration eager to reign in Medicare spending that the concept can provide quality medical care and lower costs.

 

 

Obamacare...Patients wait for care....Just ask the Brits and the Canadians! Oh yeah...there goes our research and manufactoring industry...it was nice knowin' ya!

Here comes Obamacare....wait for it....wait for it....wait....wait.....wait...(that's what we will do when we need to see the doctor)

 

The take-away is that women (in Canada) face nearly double the mortality risk from breast cancer that American women face; British men face six times the mortality risk from prostate cancer than that faced by American men.

 

 

May/June 2009

Obamacare: Medical Malpractice

By

Edward H. Crane

Edward H. Crane is the founder and president of the Cato Institute.

The columnist Robert J. Samuelson had a perceptive piece in the Washington Post recently in which he stood back from the policy trees to look at the Barack Obama forest. What he saw was disturbing. He suggests that Obama is advancing a “post-material economy” designed to “achieve broad social goals” that will end up spending more to get less. The president proposes to radically restructure America’s energy industry through massive tax increases (“cap and trade”) in the name of fighting the problematic notion that mankind’s miniscule addition to greenhouse gases will create crippling global warming. But as the world-renowned scientist Freeman Dyson points out, “Most of the evolution of life occurred on a planet substantially warmer than it is now and substantially richer in carbon dioxide.”

Obama also proposes to make the failed public school model available to even younger children and make liberal arts college more accessible to hundreds of thousands of students who, as American Enterprise Institute scholar Charles Murray points out, would be much better off going to vocational schools or junior colleges. Obama would escalate George W. Bush’s efforts to essentially federalize education in America. Never mind that the word “education” in not to be found in the federal Constitution.

But perhaps most threatening to most Americans is Obama’s determination to nationalize health care in America. It’s a truly bad idea. But that is what the president has made clear he wants. Obama has publicly declared his preference for a single-payer system “managed like Canada.” His initial proposal, part of an ill-defined $634 billion “down payment” on health care reform, would create heavily subsidized federal insurance that would put private insurance at an unhealthy disadvantage. Some estimates suggest that private insurance would be reduced by more than 60 percent, leading ultimately to its collapse. Speaking of the Canadian system, Obama says of his approach that “it may be we end up transitioning to such a system.” Ya think?

That, of course, would be a tremendous mistake, a fundamental mistake. America is a land of free individuals. Socialized medicine is not what we as a nation are about—and with good reason, both philosophical and practical. Consider:

• Eight out of ten of the most recent major medical innovations, ranging from MRIs to hip replacement, have come from the United States.
• Americans have access, on a per capita basis, to three times as many CT scans as Canadians and four times as many as Britons. Had the actress Natasha Richardson had her skiing accident in upstate New York rather than in Canada, she might have had a chance of survival.
• According to Vancouver’s Fraser Institute, the average wait for treatment by a specialist in Canada is 18 weeks. As the Canadian Supreme Court ruled when eliminating the national health care monopoly in 2005: “The evidence shows that in the case of certain surgical procedures, the delays that are the necessary result of waiting lists increase the patient’s risk of mortality… The evidence also shows that many patients on non-urgent waiting lists are in pain and cannot fully enjoy any real quality of life.”
• According to a Cato study British women face nearly double the mortality risk from breast cancer that American women face; British men face six times the mortality risk from prostate cancer than that faced by American men.

Really, does it make any sense whatsoever to change our health care system to a nationalized system? None of which should suggest that we can’t improve on our employer-based, third-party payer approach. And we seem to be moving away from that. Cato published the first book on Health Savings Accounts, which bring about a major improvement by individualizing and making portable health insurance. The next great innovation is from University of Chicago finance professor and newly minted Cato adjunct scholar John Cochrane. His Cato Policy Analysis (no.633), “Health-Status Insurance: How Markets Can Provide Health Security,” is a brilliant solution to high insurance costs and issues such as preexisting conditions.

While left-wing coalitions like Health Care for America Now gear up to do battle, and more traditional opponents of socialized medicine like the business community and the American Medical Association prepare to essentially capitulate, all parties should pay attention to a recent front page story in the New York Times, headlined “Doctor Shortage Proves Obstacle to Obama Goals.” You don’t suppose that shortage has anything to do with the prospect of nationalized health care, do you?

 

Nurse Practitioners and Physician Assistants are in the cross-hairs of the Malpractice Lawyers industry! America...Here comes the PAIN!!!

As more Nurse Practitioners and Physician Assistants are used to fill the void in the Physician shortage Malpractice Lawyers will begin a campaign to sue the Mid-Levels. It is just beginning, but an aggressive field of Malpractice lawyers will begin the process of setting high award cases. Trail lawyers will be happy, patients looking to hit the “Jackpot” (and you all know who you are) will be happy, and the America will again seeing rising costs of its Health Care take place. Everyone loses except the trail lawyers!

 On the Defensive

More patients are naming nurses in malpractice suits

From Nurseweek.com

By Todd Stein
May 15, 2000
Illustration: Margie Paschke/
William Jacoby/Photodisc

 Not so long ago, the distinction between nurses and physicians was pretty clear: Physicians took care of the medicine, nurses took care of the patient. Today, as nurses take on more of the physician’s medical duties, they are increasingly exposed to a physician’s greatest fear – the malpractice lawsuit.

"Clearly, there has been a marked increase" in malpractice suits naming nurses as defendants, said William McDonough, senior vice president for health care at Boston-based Marsh Inc., the world’s biggest insurance brokerage firm. McDonough estimates that the number of malpractice lawsuits naming nurses as defendants has risen 10 percent nationally since 1995.

That number may be low, especially where highly skilled nurses are concerned. A study of nurse-malpractice lawsuits in Harvard University medical institutions found that claims against nurse practitioners jumped 16 percent between 1984 and 1992.

Insurance experts mostly blame the increase on overzealous lawyers lured by substantial jury awards. Lawyers blame managed care for axing hospital staffs and increasing patient loads – leading to more mistakes. But all sides agree the primary reason more nurses are getting sued is, ironically, that they are more skilled than ever before.

"Patients expect more of nurses, so when something goes wrong there’s less hesitation to blame them," said Marc Mandell, a Norwich, Conn., lawyer who specializes in nursing risk management.

More vulnerable

As their professional roles expand, nurses are naturally becoming more vulnerable to the types of lawsuits that have plagued physicians for years. Malpractice is the legal term for negligence by any licensed professional. Case law began recognizing nurses as professionals in the mid-1970s, and has lately come to see registered nurses as "assertive, decisive healthcare providers," according to a 1985 New York appellate court opinion.

"Unlike a generation ago, jurors are more likely to agree that if something goes wrong, the nurse should have picked it up just like a doctor," Mandell said.

The financial cost of malpractice is covered by most employers’ insurance policies, and few experts suggest nurses need their own malpractice insurance. But if malpractice is claimed, the cost to a nurse’s career can be staggering. Even if the nurse is a so-called "tag-along" defendant and not the primary focus of the lawsuit, once money is exchanged through an out-of-court settlement or jury award, the nurse’s name is automatically reported to the state Board of Nurse Examiners, to insurers and to the federal government’s National Practitioners Databank.

State nursing boards are increasingly likely to suspend or discipline nurses who are found guilty in malpractice suits. Even if the board is lenient, employers may not be. Nurses are required to report their involvement in a malpractice suit to each of their employers for the rest of their professional careers.

"The patient isn’t the only victim in a malpractice case," said Tom Packer, a San Francisco lawyer who specializes in defending nurses in liability cases. "The emotional and professional effect on nurses can be devastating because it’s forever on their record that one of their patients was paid money after they alleged malpractice, even if they only got one dollar."

Guides for protection

Not all the news is bad, though. Thankfully, there are clear guidelines for protecting yourself from a malpractice suit.

Nursing malpractice occurs only under two conditions: You make a mistake that can be proved to have harmed a patient, and the mistake is one that a reasonably careful nurse wouldn’t have made in a similar situation. The law doesn’t require you to provide the best or safest care humanly possible – only to meet a reasonable standard.

In court, that standard is your state’s Nurse Practice Act. So it follows that the primary way to prevent a malpractice lawsuit from being filed is to know the law.

"A nurse absolutely has to be familiar with the Nurse Practice Act, so if she’s asked to do something out of bounds, she knows to refuse it," said Elizabeth Higginbotham, RN, an Austin plaintiff’s lawyer and president of The American Association of Nurse Attorneys (TAANA), Texas chapter, who leads workshops on avoiding malpractice suits for both nurses and hospital administrators.

Many times, Higginbotham said, employers will put nurses in a catch-22 situation where they must choose between compromising their license and keeping their job. A long-term care facility, for instance, may have a policy that requires RNs to let unlicensed personnel hang IVs, even if the state’s Nurse Practice Act requires an RN to do the job. If something goes wrong and a lawsuit is filed, it’s the nurse who will be held responsible.

Similarly, a nurse who notifies a physician that a patient is in trouble is legally responsible for that patient even if the physician makes no response.

"You can’t just drop the ball," Higginbotham said. "You’ve got to go over (the physician’s) head and find somebody who’s going to give you orders to take care of that patient. Otherwise, you might find yourself in my office."

Many state nursing boards make available guidelines that outline a step-by-step process for determining which duties are outside a nurse’s scope of practice. Most can be printed from the Internet free of charge.

Documentation is key

Another way to prevent malpractice suits is to scrupulously document everything from disagreements with the physician to a patient’s noncompliance with medications. "Nobody’s going to protect you but yourself," attorney Mandell said. "And the best way to protect yourself is to document everything and to do it contemporaneously, not after the fact."

Adding to the medical record after a lawsuit has been threatened is one of the most common and costly mistakes a nurse can make, added Monica Mooney, RN, a San Francisco defense lawyer and president of TAANA’s California chapter. "As a defense attorney, that is one of the last things you want to see. Any time you alter the medical record after the fact your liability is huge because it ruins your credibility and the jury’s not likely to believe anything else you say."

Ideally, chart entries should be made at the time of an assessment or intervention and no later than shortly afterward. If you make a mistake in the record, draw a line through it, write "mistaken entry," include the correct information, and initial the changes. Never erase or obscure the record. Document forensics experts are commonly employed by attorneys to uncover such glaring indicators of error.

While other prevention tactics are advisable, perhaps the best technique to prevent a malpractice suit from being filed is the one that comes most natural to nurses. Being kind.

"Politeness is the best cure against malpractice," Mandell said. "If the patient likes you and you’ve been kind to that patient you decrease your odds of being sued immensely."

Politicians and their Lawyer backers are seeking to raise Medical Malpractice premiums! Forget the 30% recover fees, politicians and lawyers want much more!

….And you thought lawmakers were elected to represent the people! Well...you got it wrong! Lawmakers (generally and more often these lawmakers are lawyers seeing they can’t find a real job, so they get elected to something) are legislating for themselves and their current and former law firms. The story below shows how these lawmakers are seeking to make more money off the backs of Doctors and Patients!

Lawyer pol bids for higher malpractice fees

• By CARL CAMPANILE
• NY Post
• Last Updated: 12:37 AM, March 21, 2011
• Posted: 12:37 AM, March 21, 2011

A powerful state senator who is a medical-malpractice attorney has sparked a furor by pushing a bill to boost trial lawyers' pay by eliminating 2-decade-old limits on legal fees in such cases.

Sen. John DeFrancisco (R-Syracuse), chairman of the Finance Committee, is "of counsel" to the Syracuse medical-malpractice law firm DeFrancisco & Falgiatano.

And watchdog groups say his advocacy for an end to limits on contingency fees is a blatant conflict of interest, while health-care-industry officials claim giving more money to attorneys could dramatically increase malpractice-insurance premiums for medical providers and reduce payouts to patients.

"It's a conflict of interest for a lawyer to champion a bill that benefits his profession and his law firm," said Citizens Union President Dick Dadey.

The bill also undercuts Gov. Cuomo's bid to slash malpractice costs.

In response to medical-industry complaints about high malpractice premiums, Cuomo proposed a $250,000 cap on non-economic "pain and suffering" awards, to slash $700 million in costs.

In exchange, health-care providers and unions backed Cuomo's plan to trim Medicaid.

Current law caps fees for attorneys who earn a percentage of what their clients win. They're now paid on a sliding scale.

For example, lawyers can collect up to 30 percent on judgments of less than $250,000 but no more than 10 percent of awards of more than 1.25 million. DeFrancisco's bill would abolish those limits.

"This bill would drastically worsen hospitals' already oppressive medical-malpractice costs and threaten access to care. To enact it would be shameless," said Brian Conway, spokesman for the Greater New York Hospital Association.

DeFrancisco declined comment.

 

Physicians doing the right thing!!! Tell malpractice lawyers to go get treatment somewhere else!

I would enjoy reading about medical malpractice attorneys being forced to open their own hospitals because physicians and health systems refused to treat them (on a non-emergent basis). That way...these pencil-necked sub-humans can sue themselves. Dang...that would be fun to watch!

I know this story is from 2004, but it is just such a feel good read! Physicians refusing to treat malpractice lawyer, and their families (on a non-emergent basis)…love it!!!!

Posted 6/13/2004 9:46 PM Updated 6/14/2004 7:02 AM

Medical-malpractice battle gets personal By Laura Parker, USA TODAY There are 73,084 working lawyers in Texas. Selina Leewright never thought that being married to one would cost her her job. But that's why Leewright, a nurse, was fired last summer by Good Shepherd Medical Center in the East Texas city of Longview. In dismissing her, hospital officials praised her nursing skills as "fantastic." But they told her that because her husband, Marty, worked at a law firm that does medical-malpractice litigation, the hospital could not continue to employ her. "I was dumbfounded," Leewright says. "They just assumed that my husband does medical malpractice, which he doesn't at all." Leewright's firing was a measure of how toxic the battle over medical-malpractice lawsuits has become. Hospital administrators and doctors across the nation, furious over what they see as waves of frivolous lawsuits that have driven up malpractice insurance costs, are striking back against lawyers with hardball tactics that, in some cases, are raising ethical questions. Some doctors are refusing medical treatment to lawyers, their families and their employees except in emergencies, and the doctors are urging the American Medical Association to endorse that view. Professional medical societies are trying to silence their peers by discouraging doctors from testifying as expert witnesses on behalf of plaintiffs. And a New Jersey doctor who supported malpractice legislation that his colleagues opposed was ousted from his hospital post. While sharing their peers' anger over malpractice lawsuits, some doctors see such tactics — particularly the refusal of treatment — as contrary to the Hippocratic oath, in which new doctors acknowledge "special obligations to all my fellow human beings." But Chris Hawk, a surgeon in Charleston, S.C., says the notion of refusing treatment to malpractice lawyers, their family members and associates not only is justified, it's necessary. "This idea may be repulsive," Hawk says. "It's hardball. But it's ethical." Hawk, 57, says that a doctor's ethical obligation to treat patients applies only to emergency care. "Physicians are not bound to treat everybody who walks through their door," he says. Doctors and lawyers long have been at odds over malpractice litigation. But soaring malpractice-insurance premiums, which hit doctors in high-risk specialties such as neurosurgery and obstetrics particularly hard, have fueled the debate. For doctors who blame the increases in their premiums on unwarranted lawsuits and large jury awards, the solution is clear: Overhaul the nation's civil litigation system, starting with limits on what jurors can award in damages. Malpractice lawyers, led by the Association of Trial Lawyers of America, counter that rising premiums have more to do with the insurance industry than jury awards. They say tighter regulation of the industry is needed. The lawyers say that stifling malpractice litigation could deny Americans some of their rights to seek redress in court when doctors make mistakes. The AMA is backing federal legislation, now stalled in the U.S. Senate, that would cap pain-and-suffering awards against obstetricians and emergency room doctors at $250,000. Meanwhile, the battles continue in state legislatures. All but nine states have restricted medical-malpractice lawsuits in recent years. But the AMA contends that only six states have passed "effective" legislation, meaning laws that cap money awards. This month in Mississippi, where lawmakers have been at odds over the issue for years, the legislature limited medical-malpractice awards for pain and suffering — as opposed to actual medical bills — to $500,000. The measure was approved amid acrimony that Percy Watson, a lawyer and legislator from Hattiesburg, says was unlike anything he had seen in his 25 years in the state House. Watson says that at one point he got a letter from an angry doctor he doesn't know, and that the doctor told Watson he would refuse to treat the lawmaker because of his opposition to limiting malpractice awards against doctors. "But it's not only with this doctor, it's prevalent in other areas in the state," Watson says. "Some of my colleagues in Hattiesburg who were not involved in (malpractice issues) have been refused the services of doctors just because they are lawyers." In South Carolina, Hawk says he first urged fellow doctors to refuse non-emergency treatment to lawyers, their families and employees in a speech at the state medical association's convention in March. The state association declined to endorse his proposal. Patricia Westmoreland, a dermatologist and member of the association's board of trustees, says she supports limits on awards and sympathizes with Hawk's frustration. But she disagrees with his approach. "It flies in the face of just basic honesty and goodness," she says. "It's prejudiced. As a physician, I take an oath to see people and take care of people, and to refuse to take care of a sick person is just anathema to me." But Hawk wants the AMA to adopt his view as its policy. That seems unlikely — AMA leaders have been silent on the issue — but Hawk plans to argue his case in Chicago this week during the AMA's annual meeting. Hawk says his tactic is "analogous to hitting the lawyers with a 2-by-4. Now we have their attention. Now maybe we can make some progress." Plaintiffs allegedly blacklisted The bitter divide between doctors and lawyers has been exposed in a range of ways recently. Earlier this spring, a Texas radiologist's Web site, DoctorsKnow.Us, set up a national database of patients and their attorneys who have sued for malpractice. The site's stated purpose was to discourage frivolous lawsuits. But patients and their attorneys suggested the site essentially blacklisted some patients from receiving doctors' services. The site was shut down in March, after news reports detailed difficulties people listed on the site had in getting medical care. In New Hampshire, Tim Coughlin, president of the New Hampshire Trial Lawyers Association, recalls an angry confrontation last fall with RickMiller, a neurosurgeon from Portsmouth, N.H. Miller told Coughlin, 40, that because Coughlin lobbied against limits on malpractice suits, Miller would refuse him treatment. "I don't do medical-malpractice work. I'm just a basic urban lawyer," Coughlin says. "He told me he had made a decision. I told him I thought that was uncalled for. He and I disagree on political matters. "He's known as the best neurosurgeon on the Sea Coast. If I had a brain situation, I would hope he would operate on me regardless of my position" on malpractice suits. "But he's told me he wouldn't." Miller describes his position as "firing a shot across (the) bow" of the trial lawyers group. "If Tim Coughlin came into the emergency room with some life-threatening emergency, I wouldn't hesitate to treat him. But if he came into my office because he had a herniated disk and wanted me to take care of him as an elective patient, I would decline to see him." Miller, who says he has not been sued for malpractice, says he pays $84,151 a year for malpractice insurance. He says that after he paid business costs and taxes last year, his take-home pay was $64,000. "That's less than my malpractice premium," Miller says. "This puts in perspective how desperate the situation is. Attorneys who choose to speak out and try to derail efforts at meaningful tort reform do so at some risk — that they will not be able to come to the best neurosurgeon in New Hampshire. They'll have to go elsewhere, the same way that patients will have to go elsewhere if neurosurgery is no longer available on the Sea Coast." The refusal-to-treat tactic has generated the most controversy in the conflict over medical malpractice. But more disturbing to many lawyers are the efforts to silence doctors from testifying as expert witnesses on behalf of plaintiffs: • In Florida, Tampa General Hospital announced plans in February to revise its employee "code of conduct" by prohibiting staff from testifying on behalf of plaintiffs. (They may testify as witnesses for hospitals and doctors.) • Also in Florida, three doctors who were sued unsuccessfully for malpractice urged the Florida Medical Association to investigate a California doctor's testimony on behalf of the plaintiffs to "prevent the medical profession from being terrorized ... by similar 'experts.' " John Fullerton, a San Francisco internist, has responded by suing the Tampa doctors for libel. He claims that he was defamed by statements the trio made in urging a review of his testimony. His lawsuit also alleges conspiracy, witness intimidation and violation of state racketeering laws. • 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. Lawyers decry the refusal to treat lawyers and the efforts to silence physicians. The lawyers say doctors want it both ways: They want the legal limits on malpractice lawsuits, yet have no qualms about filing suits themselves. When Hawk began his campaign against lawsuits, critics noted that he had filed one after his wife was in a car accident during the mid-1980s. Hawk's insurance company refused to pay the claim because he filed it three days after the legal deadline for doing so had expired, so he sued. A jury awarded his wife $525,000. But an appeals court threw out the case. It said Hawk's suit was moot because he had missed the filing deadline. "I'm not saying somebody shouldn't have the right to sue," Hawk says. "I'm saying we should ... limit the awards, and in some way make the loser pay so that we don't have a lot of frivolous suits. An automobile accident is rarely a frivolous suit." 'I didn't do anything wrong' In Texas, Leewright is considering whether to sue the Longview hospital for wrongful termination. Leewright, 30, was hired on May 29, 2003, and assigned to work in the hospital's nursery. Leewright, whose fluent Spanish helped with Spanish-speaking patients, says she often was called to work extra shifts. "There was a nursing shortage. I wanted them to know I was a team player." Leewright says she thought the job was going well. Then, on July 16, she was called in to meet with her bosses. She says they praised her nursing skills, but then told her that because her husband is a lawyer, she was being terminated. A hospital spokeswoman, Victoria Ashworth, citing confidentiality, says "all personnel matters are private and not discussed with outside parties." Leewright filed a complaint with the Texas Equal Employment Opportunity Commission, which did not make a finding on the merits of her case but issued a notice of her right to sue. Documents filed in that case outline the hospital's practices regarding spouses of lawyers. The hospital, according to one document submitted by its attorney, has an "unwritten practice" not to employ spouses of lawyers who represent plaintiffs in medical malpractice or personal injury lawsuits "because of the perceived likelihood of a conflict of interest." The profitability of Marty Leewright's law firm provides a financial benefit to his wife, the document says. "That gives her an incentive to pass on confidential information that she obtains as a Good Shepherd employee." Leewright says the hospital never mentioned its unwritten practice regarding spouses when it interviewed her for the job. She says she did not violate hospital ethics. "I didn't do anything wrong," she says. "They assume I'm going to be unethical. They assume that I'm kind of sneaky and will try to refer cases. That's absurd." It took her until November to find work at Longview's only other hospital. Marty Leewright says his wife's experience has been difficult. "All the nursing students know about what's happened to her," he says. "It's just like a cloud that follows her around."