Exaggeration, Unethical, or Just Plain Despicable?

Today’s Courier-Journal reported on a legislative hearing in Frankfort concerning the struggling implementation of our new Medicaid Managed Care companies in Kentucky. The focus was on slow payments to providers and difficulties arising from having to interact with the systems of three different providers, although there were apparently also problems in obtaining timely authorizations for treatment or prescriptions. None of this should have been completely unexpected given the relative speed at which rather drastic changes were made to the Medicaid program of Kentucky. Most of the state just went from unbridled fee-for-service care to the more closely supervised system we call managed care. I am certainly not surprised! What is more important is how this vital healthcare system reacts and repairs itself. Time will tell.

What did surprise and more-than-disappoint me was the report of the behavior of an unnamed psychiatrist in Kentucky who is said to have refused to continue to treat two of his current patients who are children because “he has not been paid since Nov 1.” Why is this not abandonment and a cause for disciplinary action by the Medical Licensure Board, or if there are any damages, in a civil court? My friends in the Medical Licensure Board, what does it take for you to investigate this accusation? You may consider this a complaint. The safety of two children is in jeopardy, or the good image of physicians has been sacrificed to make a better story for our legislators. Either alternative begs for clarification and resolution. Reports like this, when true, make me ashamed on behalf of my profession.

Of course it is unreasonable to expect a single physician or hospital to shoulder the cost of caring for the disadvantaged alone and indefinitely. If Medicare and Medicaid do not pay providers enough to cover a reasonable overhead, the whole system will fail. However this is almost most certainly not a case of a physician going hungry while the state gets its act together. The doctor is going to get paid eventually unless he was padding his bill. Who is at the greater risk here, the doctor, or two children in foster care?  If this physician is using his patients as pawns to score political points, despicable is too mild a word.

 From the American College of Physicians Ethics Manual, 2012:
The patient–physician relationship entails special obligations for the physician to serve the patient’s interest because of the specialized knowledge that physicians possess, the confidential nature of the relationship, and the imbalance of power between patient and physician. Physicians publicly profess that they will use their skills for the benefit of patients, not their own benefit. Physicians must uphold this declaration, as should their professional associations as communities of physicians that put patient welfare first.

The physician’s primary commitment must always be to the patient’s welfare and best interests, whether in preventing or treating illness or helping patients to cope with illness, disability, and death. The physician must respect the dignity of all persons and respect their uniqueness. The interests of the patient should always be promoted regardless of financial arrangements; the health care setting; or patient characteristics, such as decision-making capacity, behavior, or social status. Although the physician should be fairly compensated for services rendered, a sense of duty to the patient should take precedence over concern about compensation.

Peter Hasselbacher, MD
Feb 2, 2012