DJP Update 3-19-2010 Anesthesiologists (ASA) say NO on health bill; AMA HoD conference call today at Noon; LAGNIAPPE: Thoughts from the past as you fight for patients and physicians
TIME SENSITIVE ESPECIALLY ITEM TWO
ITEM ONE: Anesthesiologists (ASA) say NO on health
Here is the tweet at: http://twitter.com/djpNEWS
DJPNEWS
More doctor organiz oppose current health bill #hcr #ASA Anes.http://tinyurl.com/yk6nvec & #TexMed http://tinyurl.com/ydssh6e
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ITEM TWO: AMA HOUSE OF DELEGATES CONFERENCE CALL TODAY AT NOON – call 800.794.6070 and enter the pass code 8278297#
From: AMA Delegates <ama.delegates@enews.ama-assn.org>
Sent: Fri, Mar 19, 2010 8:33 am
Subject: Health System Reform Legislation – Conference Call for the House of Delegates
To: Delegates and Alternate Delegates
From: Jeremy A. Lazarus, MD, Speaker, and Andrew W. Gurman, MD, Vice
Speaker
Our email of March 10 noted our intent to convene a conference call
after the final legislative language on health system reform was
reviewed and analyzed.
We will hold a call at 12 noon, Central time (1:00 pm Eastern, 11:00 am
Mountain, 10:00 am Pacific) TODAY (Friday, March 19). Your Speakers will
be on the call along with other members of the Board of Trustees to
discuss developments with health system reform legislation.
To participate, call 800.794.6070 and enter the pass code 8278297# (you
must include the # sign).
This call is meant for delegates and alternate delegates. We realize
this is short notice and will be setting up an additional call for the
Federation later today, which you may participate in as well. That
call-in information will be forthcoming as soon as it is available.
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CAUTION:
Be sure to read the health bill as it passed the Senate PLUS read the amendments that also will be voted by the House. Thus the complete and complex legislation that may become law will include both of those. They are available online. Read the readmissions policy. Read the payment control and price-fixing. Note the complexity. It would be very interesting to have a quiz given to those supporting this bill to see how many answers they get correct. That would include Congress as well as any doctors supporting it.
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ITEM THREE: LAGNIAPPE – Thoughts from the past as you fight for patients and physicians
Year 1978:
The Regulators
Guest Editorial
The Regulators:
The Danger of Blind Obedience
DONALD J. PALMISANO, MD New Orleans
In my opinion, we will receive more demands from regulatory bodies and voluntary accrediting agencies. We must be ever vigilant lest our freedoms be compromised or our patients harmed. We must protect the trusted doctor-patient relationship. I submit we have a covenant with our patients. We have a responsibility to them higher than the morals of the marketplace because of our position of trust; it is a fiduciary relationship. People in their moments of illness tell us their innermost secrets as they fight for their lives. The confidentiality of the patient must not be violated.
The person who advocates blind obedience to regulations is in reality no different than the cowards of Nazi Germany who herded innocents into gas chambers because the regulations told them a specific number had to die each day.
BEWARE OF A HOLOCAUST OF FREEDOMS AND INDIVIDUAL RIGHTS LIT BY PERFUMED POPINJAYS SPEWING REGULATIONS THAT WOULD CHAIN YOUR REASON AND CONSCIENCE.
Have you not heard the voices of those (administrators, doctors or others) who sell their intellectual birthrights of freedom and independence?
The payment varies; some get money: some get certainty: and some compromise regulatory lawsuits to avoid controversy and possible attention to their jobs. Because of their ever-changing chameleon-like characters and bankrupt philosophies with resulting low self-esteems, they fear that. the spotlight will cause loss of their jobs. Not a few even opt for power to control you. Their rationalization is the same: “Oh, you don’t understand. This is the law (or regulation); we have no choice. If we don’t do it or join, it will be done to us without our participation. At least by obeying or joining, we have some ‘input’. Our funds will be cut off.”
THREAT – COERCION – FEAR OF LOSS – SUBMISSION – THE PATTERN IS MONOTONOUS. What these cowardly individuals fail to understand is that victory falls to the regulators when you sanction their actions.
Do not forget that “The power to tax involves the power to destroy”(Chief Justice Marshall, United States Supreme Court: McCulloch vs. Maryland 17 U.s. (4 Wheat) 316 (1819).) The power to regulate is the power to enslave. Absolute power corrupts.
Let us briefly look to a specific US Supreme Court case and note the judge’s advice and see if you experience a deja vu:
In United States vs. Butler 297 US I (1936), a Congressional Act sought to raise farm prices by reducing surplus production. Farmers who agreed to contract with the Department of Agriculture were paid money extracted from all farms taxed on a particular commodity. A cotton processor challenged the tax stating the Act was beyond congressional constitutional authority. The US Supreme Court agreed with the farmer and ruled the scheme unconstitutional.
It is interesting to note the judge’s answer to the claim of the government that the plan was constitutional because it was voluntary:
The regulation is not in fact voluntary. The farmer of course may refuse to comply, but the price of such refusal is the loss of benefits. The amount suffered is intended to be sufficient to force pressure on him to agree to the proposed regulation. The power to confer or withhold unlimited benefits is the power to coerce or destroy.
If the cotton grower elects not to accept the benefits, he will receive less for his crops: those who receive payments will be able to undersell him. The result may well be financial ruin. The coercive purpose and intent of the statute are not obscured..
Before you accept the premise of a plan, keep in mind that the “power to tax lightly is the power to tax severely”. (New York vs. United States 326 US 572 (1946).) (You could equally well substitute the word regulate for tax.)
I advocate knowledge and rational lawful activism. Read the law or regulation. Use reason to analyze it. Is it just and in the best interest of those who have entrusted themselves to your care: or is it arbitrary, unreasonable or capricious. Does it preserve the right of confidentiality? Question the regulations.
Do not be intimidated and accept answers cloned from Humpty Dumpty:
In Through the Looking Glass by Lewis Carroll. Alice asks Humpty Dumpty “Why do you sit out here all alone?’
“Why because there’s nobody with me!,” cried Humpty Dumpty.
“Don’t you think I know the answer to that! Ask another?’
Ask the regulator to put his answer in writing and sign it. Ask him who will be responsible if irreparable harm is done to your patient as a result of his regulation.
Circulate copies of your question and his response to the appropriate authorities, legislators and the press.
The bright light of inquiry and careful documentation may cause the incompetent or unreasonable regulator to flee like the amoeba under the microscope when the viewing light is turned on.
Remember, if men of integrity and courage had not challenged regulations and taxes, there would have been no Declaration of Independence. Let us not forget our heritage and let us not by default desecrate the acts of Americans who died fighting throughout the world for the freedoms we enjoy today.
From the Outgoing Chief of Staff Methodist Hospital, New Orleans, l.a. The speech was given on October 9, 1978.
Copyright 1978 Donald J. Palmisano.
JANUARY. 1979- VOL 131, No. 1-The Journal of the Louisiana State Medical Society
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1985
From another article and speech in 1985: The Sine Qua Non of Quality Medical Care
BY DJP
EXCERPTS:
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1. The first inquiry, the sine qua non of the doctor-patient relationship in quality medicine, is simply stated:
Is this in the patient’s best interest? The patient’s welfare must be paramount.
2. Understand that the essence of the acronyms – PPOs, etc. – is contract medicine. An essential part of the contract is payment by third parties to you for services rendered. The responsibility for evaluation of the charge and the responsibility for payment is removed from the patient. Also cost containment, a prominent feature of these contracts, is a concept that may be bureaucratic in conception and flawed in execution. In fact, this may he the Achilles heel of the currently proposed forms of contract medicine because of the potential chameleon-like change into rationing of necessary medical care. Only a patient has the right to ration his or her individual medical care.
5. Never fail to use the concept of “Lateral Thinking” proposed by deBono in his book New Think. Define the problem, challenge assumptions and consider alternative solutions. As physicians, we are trained to use the scientific method and thus have the background to do a proper investigation.
6. Anticipate that a battle of philosophical principles is imminent. If you grant an erroneous premise, all the meetings and attention to detail will not make the conclusion correct. When one concludes that enslavement is wrong it serves no worthwhile purpose to go to meetings that will decide who will be the guards. Challenge assumptions! Remember that those who lust to control your destiny draw their power from your sanction.
7. Have the courage to come to a conclusion and act on your convictions. Do not let intimidation or fear or panic control your destiny. Let reason reign. Remember that one person in the right tips the scales of justice more than the majority in the wrong. In the quest for right, go for truth and not for the votes or market shares. Let Galileo be your hero and not the Opportunists in the Vestibule of Hell vividly portrayed in Dante’s Inferno. Imagine in your mind’s eye Galileo brought before the authorities. They ask him to recant. He looks them in the eye and says, “Though it may be heresy, the fact remains that the earth revolves around the sun” Cherish independence. Read for inspiration the life of Thomas Paine, author of Common Sense, and an intellectual father of the American struggle for independence. He too lived in times that tried men’s souls .“
Search out the Brian Hooker translation of Edmond Rostand’s Cyrano de Bergerac. Relax and delight in Cyrano’s bravery and wit, Listen for a moment as Cyrano answers his friend Le Bret.
Cyrano Very well, then I exaggerate!
Le Bret (Triumphantly) Oh, you do!
Cyrano: Yes; On principle. There are things in this world a man does well to carry to extremes.
Le Bret: Stop trying to be Three Musketeers in one! Fortune and glory-
Cyrano:
What would you have me do?
Seek for the patronage of some great man
Make my knees callous, and cultivate a supple spine, – Wear out my belly groveling in the dust?
No thank you! Scratch the back of any swine
That roots up gold for me? Tickle the horns
Of Mammon with my left hand, while my right
Too proud to know his partner’s business,
Takes in the fee? No thank you!
Calculate, scheme, be afraid,
Love more to make a visit than a poem,
Seek introductions, favors, influences? – No thank you! No, I thank you! And again
I thank you! – But, . . . To sing, to laugh, to dream, To walk in my own way and be alone, Free, with an eye to see things as they are, A voice that meal’s manhood – to cock my hat
Where I choose – At a word, A Yes, a No,
To fight – or write. To travel any road
Under the sun, under the stars, nor doubt
If fame or fortune lie beyond the bourne-
Never to make a line I have not heard
In my own heart; yet, with all modesty
To say; “My soul, be satisfied with flowers,
With fruit, with weeds even; but gather them
In the one garden you may call your own.”
So, when I win some triumph, by some chance,
Render no share to Caesar — in a word,
I am too proud to be a parasite,
And if my nature wants the germ that grows
Towering to heaven like the mountain pine,
Or like the oak, sheltering multitudes, – I stand, not high it ‘nay be – but alone!
From Cyrano de Bergerac by Edmond Ilostand – Brian Hooker translation, copyright 1923 by Holt, Rinehart, Winston; copyright 1951 by Doris C. Hooker -reprinted by permission of Hott, Rinehart. Winston, Publisher.
In contrast to the above brave souls, our actions should not he in the model of the social metaphysicians – those who derive their self-esteem from what others think of them. Remember our heritage. America is a land of immigrants born not of privilege but of opportunity. This is a land of giants – not in physical stature but in freedom of the soul. The soul of this nation is a heroic commitment to freedom, liberty and individual responsibility. Inherent in the definition of liberty is the absence of coercion. If you meet critics who state these values are storybook patriotism not consistent with the realities of the present world, have them tell that to the widows and children of Americans who died on battlefields around the world defending these ideals.
Also tell it to those who now stand ready to make the ultimate sacrifice try this nation. To challenge schemes that threaten quality medical care and encourage rationing not in the patient’s best interest should not be a difficult decision to make. The only time it creates anxiety is when the physician fears economic loss for failure to cooperate with what the promoters claim is the wave of the future. Is this a rational fear? Even if the non-joiner went bankrupt, is this a greater burden than the loss of life suffered by those who died for principles? One does not go to a debtor’s prison for bankruptcy. One can start anew and learn how to compete more efficiently the second time around and still not compromise principle. The likelihood of disaster because of failure to join present schemes is remote in my opinion. Also, a currently popular soothsayer, John Naisbitt, concludes that we are now in an information society and human resources are the competitive edge. Quality will be paramount. I believe in Competition, the Free Enterprise System and Freedom of Contract.
These are hallmarks of America. However, as physicians, we must balance competition and efficiency with our fiduciary responsibility to our patients. Compete as a professional and not as a hustler. The competent professional attracts patients with skills of healing, not with thinly disguised kickbacks or coercion.
……
In closing, I would remind you of the beautiful poem by Kipling entitled “If.”
It contains many “If” passages; ie,
If you can bear to hear the truth you’ve spoken twisted by knaves to make a trap for fools,
Then he speaks of risk and my modification follows:
If you can risk it all standing up for truth And the patient’s best interest
Yours is the Earth and everything that’s in it,
And – which is more – you will be a Doctor in the true sense of the word, my son
And lastly, to modify Henley’s Invictus:
My goal is to be the master of my fate:
My goal is to be the captain of my soul.
You have been patient while I exercised by First Amendment rights. Thank you for allowing me to serve you this year as President. As my physician friends in Hawaii say:
Aloha, Mahalo!
Reprinted from pages 15-17 of the May 1985,
Journal of the Louisiana State Medical Society
Copyright by the Journal of the Louisiana State Medical Society, Inc.
This speech was delivered to the Louisiana State Medical Society House of Delegates on March 8, 1985 by outgoing president Donald J. Palmisano, MD, JD.
©1985 Donald J. Palmisano, MD, JD
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Stay well.
Donald
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Donald J. Palmisano, MD, JD
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