Tag Archives: malpractice

disasters, healthcare, law, politics, slut shamers

I hope more OB-GYNs leave red states…

A couple of days ago, I read a story in The Guardian about how, as of May 2023, Bonner General Health, a hospital in Sandpoint, Idaho is no longer going to offer labor, delivery and other obstetrical services. Hospital officials cite the state’s new draconian laws against abortion as the main reason why they must stop offering care to pregnant women. New pregnant patients are no longer being referred to Bonner Health for obstetrics care, and existing patients are being offered alternatives to Bonner for their obstetrics needs. According to a statement put out by the hospital:

Highly respected, talented physicians are leaving. Recruiting replacements will be extraordinarily difficult. In addition, the Idaho Legislature continues to introduce and pass bills that criminalize physicians for medical care nationally recognized as the standard of care. Consequences for Idaho Physicians providing the standard of care may include civil litigation and criminal prosecution, leading to jail time or fines.

Idaho does not allow abortions after six weeks gestation except in documented cases of rape, incest, or threat to the mother’s life. It is also one of six states that prosecutes physicians for providing abortions. Consequently, a lot of OB-GYNs are leaving the state, as are many pediatricians. According to the same statement:

Without pediatrician coverage to manage neonatal resuscitations and perinatal care, it is unsafe and unethical to offer routine Labor and Delivery services; despite our best efforts over months of negotiations. Our inpatient pediatric services will no longer be consistent and reliable in May. BGH has reached out to other active and retired providers in the community requesting assistance with pediatric call coverage with no long-term sustainable solutions. Our low patient volume is insufficient to attract candidates for pediatric hospitalists, and we cannot afford to continue having locum tenens physicians.

The statement also indicated that besides the political climate in Idaho, the number of births in the Sandpoint community were steadily dropping. Only 265 babies were born at Bonner General Health in 2022, and fewer than ten pediatric patients were admitted for other reasons. The demographics of the area where the hospital is located are changing, with fewer people giving birth, and more older people living in the community. There is also an updated facility at Kootenai Health, which has staffing 24/7. However… I just did a calculation of the distance between Bonner General Health and Kootenai Health:

This could be a real problem in an emergency situation…

Doctors in Idaho have found themselves having to choose between violating state law or providing competent care to their patients. Last year, a federal lawsuit was filed by twenty states and medical groups against Idaho’s extreme abortion bans. According to AP News:

“[Idaho’s abortion ban laws] will really place physicians in a lose-lose situation,” said Jeff Dubner, the deputy legal director for Democracy Forward, the legal team representing the coalition of medical associations.

Physicians who follow the federal law will be at risk of criminal prosecution and the loss of their medical license, said Dubner, and those who follow state law could damage patients’ health and place themselves and their hospitals at risk of federal fines or loss of funding.

Naturally, there were some really stupid comments from “pro-life types” about this development. I saw a number of ignorant statements from men about how, if OB-GYNs want to provide abortion care, they shouldn’t be in the healthcare business. Some people were trying to dismiss the news as scare tactics, or even as “woke” journalism. Below is one egregiously ignorant comment made by a man named Mark:

They’re not dedicated to their patients. If they cared, it wouldn’t make a difference as the new mothers need care.They want to perform abortions which are more frequent and makes them easy money. Why would you want to be under the care of an MD that only cares about how much money he makes.

I decided to respond to Mark’s comment. This was what I wrote:

Sometimes abortions are medically necessary. OB-GYNs already pay huge malpractice insurance premiums. Banning abortion is DANGEROUS to women! Threatening the doctors with arrest or losing their license if they need to provide abortion care is too much of a liability for them.

Women will die because of these laws!

I hope more doctors move to states where they are allowed to practice their professions without interference from ignorant politicians and their equally ignorant constituents. Maybe when some red state’s legislator’s wife is in dire need of immediate competent care from a qualified OB-GYN, and they can’t find one, they will rethink their extreme policies regarding abortion.

More than a few simply stated that this is just a “business decision”. I agree, Bonner General Health’s decision is a “business decision”, however, the decision isn’t just being made by hospital administrators. It’s also being made by highly trained, very talented and capable physicians, who have spent many years and many thousands of dollars to become experts in their fields. And they want to be able to practice their professions without being hamstrung by ignorant MALE legislators and their equally ignorant constituents. OB-GYNs already pay huge malpractice insurance premiums.

As someone who has a master’s degree in public health-health administration, this story is kind of in my wheelhouse. I just don’t think most rank and file Americans even consider how much doctors have to pay for malpractice insurance. The actual costs vary by state and speciality, but OB-GYNs typically pay among the very highest annual premiums for this protection, because the stakes are simply that high. Guess what. The costs are not going down, especially in the wake of these new abortion bans. While doctors in some specialties pay a few thousand dollars a year for malpractice insurance, according to Physicians Thrive:

Average annual malpractice insurance premiums range from $4k to $12k, though surgeons in some states pay as high as $50k and OB/GYNS may pay in excess of $200,000.

According to Cunningham Group, a medical malpractice insurer:

Obstetrician/Gynecologists (OB/Gyns) pay among the highest premiums for medical professional liability insurance coverage in all of medicine. An OB/Gyn who practices in a major metropolitan area can expect to pay an annual premium in the neighborhood of $100,000 to $200,000, and this burdensome cost of doing business—coupled with an omnipresent fear of lawsuits—has influenced many to see fewer high-risk obstetric patients, reduce the number of gynecological surgeries they perform, exit private practice in favor of hospital employment or move their practice to an area with a more favorable liability climate. Our historic med-mal rates shows the cost that an OB/Gyn pays for their insurance in every state.

Granted, the same article states that claims are going down, and tort reform is making lawsuits less of a risk for providers. But my guess is that the new abortion ban laws are going to lead to some catastrophic OB-GYN cases. Not enough have happened yet to raise widespread awareness, but they inevitably will. And then, the risks will either increase again, or more people will opt out of having children. That may seem like a good thing, until you realize that if people stop reproducing, the population will age more, and there will be more need for other medical services, and fewer human beings to provide them. You may one day find yourself having your medication dispensed in a hospital by a robot nurse, instead of a live human being.

An article in The Washington Post from August 2022 discussed the dilemma doctors in Texas are facing. Olgert Bardhi, a primary care physician in training, will probably be a full fledged doctor with highly sought after skills as of 2025. But Dr. Bardhi, who is currently getting his highly valuable training in Dallas, said that the new laws regarding abortion really bother him. According to the article:

Although [Bardhi] doesn’t provide abortion care right now, laws limiting the procedure have created confusion and uncertainty over what treatments are legal for miscarriage and keep him from even advising pregnant patients on the option of abortion, he said. Aiding and abetting an abortion in Texas also exposes doctors to civil lawsuits and criminal prosecution.

The article continued:

“It definitely does bother me,” Bardhi said. “If a patient comes in, and you can’t provide them the care that you are supposed to for their well-being, maybe I shouldn’t practice here. The thought has crossed my mind.”

There is now a “chilling effect” for OB-GYNs trying to provide care to their patients in states where abortion is suddenly practically banned. The end result is that doctors are scared, and it’s causing them to go to places where they can relax and do their jobs without so much fear. After all of the money, time, and effort expended for their training, can you blame them?

Don’t think this scenario is realistic? Consider this. Back in 2019, I wrote a blog post titled “Whatever you think is best, doctor.” It was inspired by a piece written by Dr. Jen Gunter, a rather famous OB-GYN who has written some pretty awesome books about women’s healthcare. Here’s a lengthy passage from my 2019 post about Dr. Gunter and a case she encountered back in 1998:

[Dr. Gunter] was called in to perform an abortion on a woman who was very sick and in her first trimester of pregnancy. The woman’s condition was rapidly deteriorating and the pregnancy was making her situation worse. Although her life was not in immediate danger, her caregivers feared that if she continued her pregnancy, her condition would quickly decompensate and she would need dialysis due to kidney failure.

The problem was, this was happening in Kansas, where a new restrictive abortion law was enacted that forbade abortions from being done on state government property, unless the mother’s life was in danger. The medical center where Dr. Gunter worked was on state property. While it’s very possible to manage kidney failure on dialysis, it’s not the ideal course of action. It’s better to prevent kidney damage, which would then prevent a host of other serious medical problems that would put the patient’s life in danger. The patient was not about to die, but her condition might eventually cause death if the doctor didn’t act. On the other hand, thanks to the law, if Dr. Gunter made the “wrong” decision, she could be fired or wind up in legal trouble. She could even be arrested, which would be a real problem, since malpractice insurance does not cover criminal prosecution.

The law was vague regarding what Dr. Gunter should do. She spoke to the hospital’s attorneys, who advised her to call the legislator who had written the law. So, instead of prepping her patient for surgery and taking care of her patient’s private medical issues, Dr. Gunter was forced to call up a legislator who had absolutely no clue about this wrinkle in the law because he wasn’t a medical professional. Moreover, Dr. Gunter was about to talk about this lady’s private medical situation with a man who was completely uninvolved, except for the fact that he’d written the law that was holding up Gunter’s ability to take action. To add insult to injury, he didn’t even seem to care! As Gunter launched into a description of the woman’s medical issues necessitating an abortion, the legislator interrupted her and said, “Whatever you think is best, doctor.”

The woman got her abortion and her medical condition improved. But Dr. Gunter was left fuming, since she’d had to waste precious time calling up a legislator who obviously didn’t actually care that much about this law. He hadn’t even listened to her speak for more than a minute before he basically said “whatever”. Meanwhile, this lady’s health– her very life– was in danger. What would have happened if Dr. Gunter had not taken the time to cover her ass by calling the lawmaker? What if she’d simply done the abortion and gotten arrested for breaking the law, even though she’d made the correct medical decision? What if she’d not done the abortion and her patient died? Then she might be on the hook for medical malpractice. She’d also have to deal with the guilt of knowing that she has the training to help women in these dire medical situations, but can’t act due to restrictive, misguided legislation like the “heartbeat” bills being considered and passed in places like Georgia, Ohio, and Alabama.

Of course, in 2023, the “heartbeat bills” have now become laws in a number of states, and doctors are now encountering the same problems Dr. Gunter ran into in Kansas back in 1998. Ironically, Kansas voters made it very clear last year that they want to maintain access to legal abortion services. Today, Dr. Gunter probably wouldn’t have that problem in Kansas. But she would definitely encounter it in Idaho or Texas, or many places in the Deep South.

I hate the thought of women and babies having to pay for the ignorant and misguided policies mostly being made by Republican men in conservative states. I especially hate the fact that the people who will likely suffer the most will be the poorest citizens. However, I think what’s going to have to happen in abortion banning areas is that a lot of women will have to die or get very sick. Some of the folks in power are going to have to be personally confronted by a lack of competent healthcare providers available to take care of them, or their loved ones, before they will understand why it’s so important to let OB-GYNs do their jobs without their interference.

Too many people assume that abortions are always due to a woman being irresponsible or wanting convenience. They never stop to realize that putting that spin on it endangers the lives of everyone… including men. Because I’ll bet some of the OB-GYNs who are deciding to relocate are married to doctors in other specialties, who will choose to move with them. Think about it.

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complaints, condescending twatbags, healthcare, rants

Where is Richard Simmons when we need him?

Yesterday, I read an article in The New York Times entitled “Breaking Down the ‘Wellness-Industrial Complex,’ an Episode at a Time“. It was a surprisingly interesting and disheartening read. I wasn’t attracted to it because of the title, though. I decided to read it because of a quote that was used to draw attention to the article.

A man named Scott Cave, who lives in the Appalachian Mountains region of Virginia and has a doctorate in history, is a regular listener of the podcast, “Maintenance Phase”. The popular podcast, which has existed for about a year, is named after the concept of maintaining weight loss after a successful diet. The hosts, Aubrey Gordon, and Michael Hobbes, “spend each episode exploring what they call the “wellness-industrial complex,” debunking health fads and nutritional advice.” Gordon got started because she collects vintage diet books, and realized that a lot of them were full of ridiculous ideas that ultimately don’t work in keeping people slim and fit.

Cave says he listens to “Maintenance Phase” because “he appreciates the way the podcast examines and evaluates primary sources in a way that’s fun.” He also relates to some of the topics, since he himself has a weight problem. One time, “Maintenance Phase” did a show about how people who are overweight or obese are more likely to avoid seeing healthcare professionals. Cave identified with that, as once he visited an urgent care practice because he thought he’d broken his finger. He was told, “We don’t think your finger is broken. It might be, but you’re very fat, so you should probably deal with that.”

Mortified by the shaming comment about his weight, Cave ignored signs and symptoms of an autoimmune disease for a long time. He didn’t want to deal with more negative stigma about his size. So he suffered in silence with his swollen finger, and felt ashamed. That negative comment, while based in truth, dealt a terrible blow to Cave’s self-regard and trust in the medical care system.

I can relate to Cave’s reluctance to visit doctors. I haven’t seen one myself in about eleven years. In my case, it’s partly due to not wanting to be lectured about my size or my bad habits. It’s also due to some legitimate trauma I experienced at the hands of an OB-GYN who physically hurt me as she examined me, then fat shamed me.

This doctor’s pelvic exam was so painful that I cried out, and she basically told me to shut up as she stuck me with another, smaller speculum that also hurt. I bit my lip and gutted through the rest of the exam, hoping I wouldn’t pass out. I had to complete the exam so I could join the Peace Corps. Afterwards, the doctor told me I was too fat and would gain weight in Armenia. Then she basically shamed me because she wasn’t able to get a “good look down there”. She claimed I wasn’t “cooperative”. She offered me birth control, even though I was a virgin at the time. I left her office feeling completely violated, humiliated, and frankly, like I had just been assaulted.

It took twelve years for me to have another gynecological exam by a much kinder, more understanding, and professional physician’s assistant. She let me cry, and heard my explanation about why I was so upset and anxious. Then, when she did the exam, it didn’t hurt at all. I remember being so relieved that I wasn’t in pain. Then I was very angry, because the doctor who had done my first exam had hurt me without reason. I hadn’t thought to complain about her. I now wish I had.

I was so upset and stressed out during that second exam that the P.A. thought I had high blood pressure. I ended up having to visit her several more times before she was convinced that I had white coat hypertension. Sadly, we had to move out of the area. The P.A. also changed her practice, and now only works with cardiology patients. So even if we had stayed in the D.C. area, I wouldn’t have been her patient for long.

I last saw a doctor in 2010 at Bill’s insistence, because I thought my gall bladder was giving me issues. It’s probably full of stones. But the ultrasound didn’t show that the gallbladder was so inflamed that it needed to come out just then. And then we moved a bunch of times…

So no, I don’t go to doctors. I know I should, but I don’t. Aside from mycophobia (fear of mushrooms), I also have a touch of iatrophobia (fear of doctors). And I can understand why Cave doesn’t go to doctors, either. The experience is often demoralizing, expensive (for those who don’t have Tricare), and just plain awful.

As you might have guessed, after I read the article, I read some of the comments. Naturally, they were full of people who hadn’t bothered to read the article. Some were very unkind and lacking in empathy. One guy wrote that the article was “stupid” because it was full of people “making excuses”. In his comment he wrote that “all I see” are people justifying being fat. Then he added that he’d lost 100 pounds.

He got some blowback for that comment, including from yours truly. I wrote, “All I see is a guy who is a judgmental jerk. Congratulations on your weight loss. Looks like you also lost your ability to empathize.”

I got many likes for that. The original commenter came back and wrote that he DOES empathize, but Americans are all eating their way into diabetes. And I wrote that while it’s true that obesity leads to a lot of health problems, it’s not helpful to accuse people of “making excuses”, particularly if you’re a total stranger. I didn’t see any “kindness” or actual concern in his comments, only judgment. And then I wrote…

“If you truly do empathize and want to help people, you should be kinder and more empathetic. Instead of insulting and judging, you could be encouraging and enthusiastic. You could learn a lot from Richard Simmons on how to motivate people. Richard Simmons used to be fat, and like you, he lost a lot of weight. But instead of being mean to people, he encourages them. He actually CARES about them.” Of course, I wrote that taking the commenter at his word that he’s really trying to “help”. A lot of people who make comments about “personal responsibility” and concern troll the overweight are really just getting off by acting superior and being jerks.

As I wrote that comment, I couldn’t help but remember an old episode of Fame I recently watched. The character, dance teacher Lydia Grant (Debbie Allen), decides to teach an exercise class for some extra money. She thinks it’s going to be a “piece of cake”, since these were just middle aged women trying to get into a new dress. But when she teaches, using her usual demanding style, she finds that the women in the class aren’t successful. One woman in particular, name of Renee, is about to give up because Lydia is just too demanding.

Lydia is too tough on Renee and she’s about to give up… But then Richard intervenes.

But then Richard Simmons interrupts and shows Lydia how it’s done. He asks Renee if he could have this dance. Renee nods and the two proceed to work out. Richard is encouraging, enthusiastic, and kind, and Renee responds in kind. And not only does she complete the workout, but she also leaves with a big smile on her face!

This is how you motivate people. They’re having fun, and Richard treats Renee like she has worth. It’s a lot better than Richard saying, “If you don’t lose weight, you’re going to get diabetes. Quit making excuses.”

Lydia says there’s no way Renee can meet her “impossible” goal of losing twelve pounds in two weeks. So Richard says, “That’s okay. Let her lose six pounds!” I think that makes a lot of sense, don’t you? There’s nothing that says Renee can’t meet part of her goal and take a bit longer to get where she wants to be.

I’m not saying I love Richard Simmons. In fact, I used to cringe when I saw his ads for Deal-A-Meal and “Sweatin’ to the Oldies”. And I laughed when I read about how he slapped some guy who mocked him at the airport. I did like his 80s era talk show, but it was always on when I was at school.

I just think that when it comes to motivating people to lose weight, Richard is onto something that actually works. Fat people are people, too. Just like everyone else, fat people want to be valued and accepted. Nobody enjoys being insulted, shamed, and judged, especially by total strangers! Moreover, nobody wants to PAY for that experience, especially when the doctor dismisses the patient and says all of their health problems are brought on by a lack of discipline and willpower. And while the commenter on the New York Times piece may actually empathize and care about others, he has a really shitty and off-putting way of showing it.

I got another comment from another person who praised the first commenter for promoting “personal responsibility”. I think personal responsibility is all well and good. But you don’t know why someone is fat. You don’t know what their story is, or if they’ve actually done anything to lose weight. What if that overweight stranger you see has actually been losing weight? What if they’re out and about for the first time in weeks because they’ve lost twenty pounds? How do you think they would feel if you lectured them about personal responsibility and admonished them to slim down? Do you think those words would motivate them to keep going? Or is it more likely that they’d get depressed, say “what’s the use?” and go out for a double cheeseburger?

Besides being cruel and rude, fat shaming people is potentially very damaging. And a person’s weight is also none of your business.

The fact that fat people have to work up the gumption to see doctors is a serious issue. I recently read a horrifying story about a 27 year old woman in Los Angeles named Amanda Lee who visited a doctor because she had lost 35 pounds, was having abdominal pain, and couldn’t eat. Instead of getting to the bottom of why Lee was losing weight and experiencing pain, the doctor said that maybe it was a good thing she was in pain and couldn’t eat. He continued the horror by saying that only being able to eat things like pureed apples was a “blessing”. And he added that she didn’t look “malnourished”. I would add that according to the photos and videos I’ve seen, she doesn’t appear to be that overweight, either. But then, it is Los Angeles. In any case, the doctor refused to do any testing on Lee, and she left his office in tears.

@mandapaints

“Maybe that’s not such a bad thing” not a time to joke.

♬ original sound – Amanda Lee

After her appointment, the mortified young woman recorded a TikTok video in her car. She was sobbing hysterically as she recounted what had happened during her appointment. Commenters encouraged her to see another doctor, so she did. That doctor did a colonoscopy on Amanda Lee and discovered a large tumor. She had surgery to remove it, and was diagnosed with stage 3 colon cancer!

As of June, she was receiving chemotherapy. I hope she also looks into suing that first doctor for malpractice! I’m grateful that the commenters on her video were kind, rather than fat shaming. I’m also glad she shared her story, because I think it will help a lot of people on many different levels.

Well… that about does it for today’s fresh content. We didn’t go out yesterday, so I suspect Bill will want to do something this afternoon. Enjoy your Sunday.

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