Lawyers v. Doctors

Just in case anyone was still wondering if I was a nerd or not, I'll just mention that last week I was watching a panel regarding medical malpractice on CSPAN. Mind you, I'm not a medical professional, involved in the insurance industry, or a lawyer. Just a nerd.

Anyway, the speakers on this panel were mostly law professors, and some of those asking questions were doctors. Once it again it struck me how similar those two professions are, and just how much distrust exists between them. (The best part of this conference was when one of the participants pointed out this series of articles in the journal Medical Economics.) Both doctors and lawyers:

1. Require advanced training in a rather technical field. This training serves as a gatekeeper to the profession.
2. Use jargon that defines who is "one of us" and who is "one of them."
3. Often serve people who are incredibly vulnerable. This is what motivates most people to get involved in their profession in the first place, the chance to "help those in need." Temptations also come from having the power over the vulnerable; arrogance being one of the most prominent.
4. Earn good money (According to the Bureau of Labor Statistics in 2003, the median salary for family and general practitioners was $137,670 and for lawyers it was $92,730) and have the potential to be very lucrative.
5. Each like to judge the other based on the worst examples. (Doctors who say lawyers are all ambulance chasers looking for a huge payout and lawyers who say doctors just want to avoid responsibility for malpractice)
6. Like most professions, they seem reluctant to discipline thier own. Lawyers suggestions for dealing with the malpractice crisis often involves doctors

Senator Cornyn recants

Looks like Cornyn realized the implications of his earlier statements.

Mr. President, the purpose for my rising is to follow up on some remarks that I made yesterday, Monday, on the floor of the Senate. A full transcript of those remarks, which has to do with judges and recent decisions of the United States Supreme Court, are available, of course in the Congressional Record, but are also available on my official website for anyone who would care to read them.

As a former judge myself for 13 years, who has a number of close personal friends who still serve on the bench today, I am outraged by recent acts of courthouse violence. I certainly hope that no one will construe my remarks on Monday otherwise. Considered in context, I don’t think a reasonable listener or reader could.

As I said on Monday, there's no possible justification for courthouse violence. Indeed, I met with a federal judge, a friend of mine, in Texas just this past week, to make sure that we’re doing everything we can to protect our judges and courthouse personnel against further acts of violence. And like my colleague from Illinois, I personally know judges and their families who have been victims of violence and have grieved with those families.

But I want to make one thing clear: I'm not aware of any evidence whatsoever linking recent acts of courthouse violence to the various controversial rulings that have captured the nation’s attention in recent years.

My point was, and is, simply this: We should all be concerned that the judiciary is losing the respect that it needs to serve the American people well. We should all want judges to interpret the law fairly – not impose their own personal views on the nation. We should all want to fix our broken judicial confirmation process. And we should all be disturbed by overheated rhetoric about the judiciary, from both sides of the aisle. I regret it that my remarks have been taken out of context to create a wrong impression about my position, and possibly be construed to contribute to the problem rather than to a solution.

Our judiciary must not be politicized. Rhetoric about the judiciary and about judicial nominees must be toned down. And our broken judicial confirmation process must be fixed, once and for all.

How to Create a Culture of Life

1. Fight Stalinists.

Stalin's last successor made an admission: "Everything that happened in Eastern Europe in these last few years," Mikhail Gorbachev said, "would have been impossible without this pope."

2. Speak for those who are ignored.

He spoke against capitalism and communism, spoke up for the poor, spoke up for life as he defined it from very beginning to very end. "I am the voice of the voiceless," he said in 1979 on his first overseas trip as pope.

3. Don't be captive to partisan politics.

Viewed through the lens of American politics, the pope was an enigma — "to the left of liberal Democrats on social issues and to the right of conservative Republicans on moral values," in the words of Thomas Reese, a Jesuit priest and church observer.

4. Work for debt relief for poor countries. (So far, 23 countries have been able to get out from under crushing debt)

The Pope said canceling the debt was essential to fight poverty: “I appeal to all persons involved, and in particular to the most powerful nations, to prevent the Millennium jubilee passing by without decisive steps toward a definitive solution to the debt problem.”

5. Speak truth to power concerning war.

In a meeting at the Vatican at the start of a three-day presidential trip to Italy and France, the pontiff, 84, praised Bush for his leadership against abortion in the United States and AIDS in Africa. But the pope, who was too weak to stand and barely audible as he read a statement, also had stern words for Bush, deploring the prisoner-abuse scandal in Iraq and violence in the region.

"Mr. President, your visit to Rome takes place at a moment of great concern for the continuing situation of grave unrest in the Middle East, both in Iraq and in the Holy Land," said John Paul, an ardent critic of the war in Iraq. "You are very familiar with the unequivocal position of the Holy See in this regard, expressed in numerous documents, through direct and indirect contacts, and in the many diplomatic efforts which have been made."

...Yet the pope did not shy away from criticizing U.S. policy. In a reference to the Abu Ghraib prison scandal, the pope said: "In the past few weeks, other deplorable events have come to light which have troubled the civic and religious conscience of all, and made more difficult a serene and resolute commitment to shared human values. In the absence of such a commitment, neither war nor terrorism will ever be overcome."

6. Promote just relationships between employers and employees.

The pontiff’s most powerful statement on workers came in 1981 in the encyclical Laborem Exercens—“On Human Work”—in which John Paul called for “ever new movements of solidarity of the workers and with the workers. This solidarity must be present whenever it is called for by the social degrading of the subject of work, by exploitation of the workers and by the growing areas of poverty and even hunger.”

The encyclical goes on to reaffirm the support of the Roman Catholic Church for a just wage, available and affordable health care, the right to a retirement pension and workers’ compensation for work-based injuries or illnesses.

7. Forgive those who persecute you.

Dec. 27, 1983
Turkish terrorist Mehmet Ali Agca, the pope's would-be assassin, kisses the pontiff's hand
He makes a visit to the Rebibbia prison, meeting with Alì Agca, the Turk who made an assassination attempt on him on May 13, 1981.

How NOT to Create a Culture of Life

1. Vaguely threaten judges.

SUGAR LAND, Texas, March 31 /U.S. Newswire/ -- House Majority Leader Tom DeLay (R-Texas) today released the following statement mourning the passing of Terri Schiavo:

"Mrs. Schiavo's death is a moral poverty and a legal tragedy. This loss happened because our legal system did not protect the people who need protection most, and that will change. The time will come for the men responsible for this to answer for their behavior, but not today. Today we grieve, we pray, and we hope to God this fate never befalls another. Our thoughts and prayers are with the Schindlers and with Terri Schiavo's friends in this time of deep sorrow."

Surely Delay did not really mean violence, right? I'm sure that future comments will clarify his meaning.

Sen. Edward M. Kennedy (D-Mass.) said Thursday that "at a time when emotions are running high, Mr. DeLay needs to make clear that he is not advocating violence against anyone."

Dan Allen, DeLay's communications director, said that DeLay was "once again expressing his disappointment in how the courts clearly ignored the intent of the legislation that was passed."

Way to make it clear that you are not advocating violence. But isn't Kennedy jumping to conclusions? Why should Delay think that anyone might interpret "The time will some for the men responsible for this to answer for their behavior" as a call for violence? Well, there is this.

A Buncombe County man was arrested for allegedly putting out a bounty on Michael Schiavo and on a judge who denied a request to reinsert Schiavo’s feeding tube.

Richard Alan Meywes of Fairview is accused of sending an e-mail putting a $250,000 bounty “on the head of Michael Schiavo” and another $50,000 to eliminate Pinellas County Circuit Court Judge George Greer.

“It is my understanding that whoever eliminates Michael Schiavo from the planet while inflicting as much pain and suffering that he can bear stands to be paid this reward in cash,” the e-mail said, according to a text of the message contained in an affidavit prepared by Tampa FBI agent A.J. Gilman.

And this.

The Woodside Hospice where she died, the circuit and federal courts that refused to order her feedingtube restored, the city of Pinellas Park and its police were inundated with angry phone calls and e-mails from people who felt they should have done something to stop her death. Police logged several bomb threats and over 900 phone calls.

"The majority of them have been very hostile, expressing their opposition to our involvement," said Pinellas Park Police Capt. Sanfield Forseth. "We still have a threat to the hospice."

In this statement, Vice President Cheney showed you can make Delay's argument about the judiciary while being clear that violence is unacceptable.

Vice President Cheney says he opposes revenge against judges for their refusal to prolong the life of the late Terri Schiavo, although he did not criticize House Majority Leader Tom DeLay (R-Tex.) for declaring that they will "answer for their behavior."

Cheney was asked about the issue on Friday by the editorial board of the New York Post. He said twice that he had not seen DeLay's remarks, but the vice president said he would "have problems" with the idea of retribution against the courts. "I don't think that's appropriate," he said. "I may disagree with decisions made by judges in any one particular case. But I don't think there would be much support for the proposition that because a judge hands down a decision we don't like, that somehow we ought to go out -- there's a reason why judges get lifetime appointments."

2. Imply that opposing your policy goal will lead to murder.

"It causes a lot of people, including me, great distress to see judges use the authority that they have been given to make raw political or ideological decisions," he said. Sometimes, he said, "the Supreme Court has taken on this role as a policymaker rather than an enforcer of political decisions made by elected representatives of the people."

Cornyn continued: "I don't know if there is a cause-and-effect connection, but we have seen some recent episodes of courthouse violence in this country. . . . And I wonder whether there may be some connection between the perception in some quarters, on some occasions, where judges are making political decisions yet are unaccountable to the public, that it builds up and builds up and builds up to the point where some people engage in, engage in violence. Certainly without any justification, but a concern that I have."

Cornyn, who spoke in a nearly empty chamber, did not specify cases of violence against judges. Two fatal episodes made headlines this year, although authorities said the motives appeared to be personal, not political. In Chicago, a man fatally shot the husband and mother of a federal judge who had ruled against him in a medical malpractice suit. And in Atlanta last month, a man broke away from a deputy and fatally shot four people, including the judge presiding over his rape trial.

LarkNews.com

Sometimes you comes across something while browsing online that makes you laugh out loud. I just found LarkNews.com and disturbed my wife's studying several times while reading it. Here's a sample:

Woman upset by theater mix-up

LANCASTER, Pa. — Maria Holsapple thought she was attending performances at the local community theater, but after twelve weeks, she was angered to learn she had been attending Oak Grove Center, a 3,000-member church.
"I would never willingly go into an evangelical church," says Holsapple, a practicing Catholic.
She came after Oak Grove mailed her "tickets" to upcoming "drama presentations." She enjoyed the "mini-concert, the play and the motivational speech they threw in at the end," she says.
"It worked well as performance art," she says. "I was convinced it was a groundbreaking new theater company."
But when neighbors remarked that they had seen her at church, Holsapple called Oak Grove and discovered it was a house of worship.
"The pastor quoted Jesus, but he quoted Socrates, too, and Britney Spears," she says. "How was I to know?" •

Bush's Comments on Terri Schiavo

Here is what President Bush on the morning of Terri Schiavo's death, according to a transcript from the Transcript:>Washington Post.

BUSH: Thank you all. Please be seated.

Today, millions of Americans are saddened by the death of Terri Schiavo.

Laura and I extend our condolences to Terri Schiavo's families.

I appreciate the example of grace and dignity they have displayed at a difficult time. I urge all those who honor Terri Schiavo to continue to work to build a culture of life where all Americans are welcomed and valued and protected, especially those who live at the mercy of others.

The essence of civilization is that the strong have a duty to protect the weak.

In cases where there are serious doubts and questions, the presumption should be in the favor of life.

I, too, hope that we can build a culture of life where everyone (not just Americans) is welcomed, valued, and protected. I agree that the strong have a duty to protect the weak, and that we should err on the side of life. I think that these principles should apply to all sorts of policy questions, including abortion, immigration, health care, tort reform, the environment, foreign policy, capital punishment, bankruptcy, Social Security, Medicare, etc.

People of good faith can differ on exactly which policy proposals do the best job of promoting a culture of life. But I do think that it is reasonable to expect our politicans, particularly those who claim to be evangelical Christians, to explain how all their policy proposals fare when it comes to protecting the weak and valuing the vulnerable.

I think it goes without saying that I believe that most of President Bush's policies do exactly the opposite of encouraging the strong to fulfill their duty to protect the weak, in fact, most of them make it easier for the strong to exploit the weak. (If you want to make a prediction about his position on just about any domestic (or even many foreign) policies issues, ask yourself what would help big business. More often than not, that is Bush's position.)

Johann Christoph Arnold

Johann Christoph Arnold, a pastor who is part of the Bruderhof Community, has some good thoughts on the moral and theological issues brought up by the Terri Schiavo situation. This was written before her death, and with compassion for everyone involved.

That there is widespread public debate on a topic close to the hearts of everyone can never be a bad thing. It shows that democracy is alive and well, and that life is worth living. But where there are differences of opinion, and differences in religious belief and faith, there must also be respect for one another. And so we should use this opportunity not to push forward our own ideas and agendas, but to seek what is truly God's will. In the end the human race will only survive if we humble ourselves, and submit ourselves to God, who longs for each of us to find a true destiny, a fulfillment of life through service to others.

I wish that more of that respect and setting aside political agendas was evident. Arnold focuses on our culture's difficulty in dealing with death and pain. One of the attorney's involved asked a great question yesterday. How much of the focus on creating a culture of life has more to do with a fear of death? (Don't get me wrong, I think that there is much work to be done in our country to create a culture of life) Arnold also poses a question for those who think that Schiavo should have been left alive to leave space for a miracle.

This case goes far beyond Terri's physical condition, her medical outlook (whatever it is) and whether or not her feeding tube should be removed. It is really a case that should give pause and lead us to serious soul-searching. It should make us think about what God might do if we would for once give him a chance. In the end it is he alone who, as creator of life, should be the one to take life away when he feels it is the right moment for a person. Therefore re-inserting a feeding tube, or fighting to keep one in, is no less a form of human interference.

I believe that there are times today when God works "miracles" (that's a problematic term for me, but in general what I mean is a supernatural intervention) but that in the days between the removal of the feeding tube and her death yesterday, God had plenty of space to intervene.

I also don't know exactly what a natural death means anymore. Wouldn't a natural death would have occurred 15 years ago if there had not been any human intervention after oxygen was deprived from Schiavo's brain? Does a natural death just mean one that our medical technology is not able to prevent yet, like Christopher Reeve's death? I say that as one who believes our medical knowledge and abilities comes directly from God and that what we consider to be everyday medical care is a direct manifestation of God's work. These issues are much murkier than those who are talking about the "murder" of Terri Schiavo acknowledge.

A good overview of some of the legal issue can be found here.

Terri Schiavo

I think that there is a law somewhere stating that all bloggers must comment on Terri Schiavo, so here I go.

On the moral issue, I don't think we have enough accurate information. Can she respond? Did she talk to her brother? Is she in a PVS? A MCS? The answers to those questions comes down to her parent's word vs. her husband's. I do think that there can be times when allowing someone to die is the most obedient decision. Newsweek has an interview with a Jesuit bioethicist who states this case. Here is money quote:

Here's the question I ask of these right-to-lifers, including Vatican bishops: as we enter into Holy Week and we proclaim that death is not triumphant and that with the power of resurrection and the glory of Easter we have the triumph of Christ over death, what are they talking about by presenting death as an unmitigated evil? It doesn't fit Christian context...
But is anyone arguing that for Schiavo to die would be an "unmitigated evil"? They just don't want her death to happen unnecessarily.
It's not happening unnecessarily. It's happening because her heart attack has rendered her utterly incapable of any future human relationships.

I don't know if she is, in fact, incapable of any future human relationship, and I think there are reasons to question the way that both the husband and the parents answer this question.

There are certainly political questions raised here, and nobody should be surprised that I find the actions of the congressional Republicans to be unethical and hypocritical. As in Bush v Gore, the conservative are intervening in a situation strictly for political reasons AND they want to claim that their intervention should not set a precedent for future cases. If the intervention was the right thing to do, then why not set a precedent?

The hypocrisy abounds. You have Republicans judge shopping, looking for the federal government to overturn the decision that the state courts have consistently made, trying to intervene in the sanctity of marriage.

When I hear Republicans in Congress expressing their concern for creating a culture of life, I am amazed. These are the politicians who are advocating tort reform that protects insurance companies from the victims of medical malpractice, just last week pushed a budget resolution through the House that would cut funding for Medicaid by between $15 - $20 billion, and passed the bankruptcy bill authored by the credit card industry.

In the Republican version of a culture of life, the next Terri Schiavo would not have her malpractice award, leaving her more dependent on Medicaid for her care (at least what's left of Medicaid). If this future Terri Schiavo lived in Texas, the hospital will be legally permitted to withhold life-sustaining care over the family's objections thanks to a bill signed by Gov. Bush. Oh yeah, her family will also have a more difficult time getting back on their feet financially thanks to the bankruptcy bill.

That's a culture of life?

Narnia on Tour

Narnia on Tour sounds like a great way to get ready for movie version of The Lion, The Witch, and The Wardrobe, which is now scheduled to open Dec. 9. Here is a blurb from the site:

Welcome to Narnia on Tour. It is a tour that combines the literary prowess of artists and authors with the engaging insights of audiences around the world...

The primary goal of the tour is to foster informed conversation about Lewis, his faith, imagination, and writing.

As this site builds within the next months, it will become a resource not only in terms of the tour dates for next fall, but by offering new articles about Lewis, who was influenced by Lewis, and authors who write in a similar vein as he wrote.

The dates of the tour are between September 30 and November 19. I was excited to see this:

Portland, OR
Reason, Imagination, and Holiness: C.S. Lewis's Creative Vision of Faith
TERRY GLASPEY
Author of The Spiritual Legacy of C.S. Lewis

Looks like I'm going to be able to catch this! Look and see if there is an event near you!

Two movie previews

In case you haven't seen it yet, here is the trailer for Star Wars: Revenge of the Sith.

There is also a new video "featurette" called Behind the Magic of Narnia Chapter II: The Director.

Legal Affairs Debate Club - The Doctor's Court?

Legal Affairs bills itself as "The Magazine At The Intersection of Law And Life." Their website has a weekly debate on legal issues, giving two individuals the chance to make one comment a day on the topic. The topic this past week?

George W. Bush is pushing an aggressive agenda for reforming medical malpractice law, with a focus on capping the amount of damages patients can be awarded if their doctors harm them. But some advocates suggest a completely different reform: "health courts." These jury-less courts would deal only with medical claims and be administered by trained healthcare professionals. This, supporters argue, might improve healthcare by providing quicker resolution to malpractice suits and limiting frivolous claims.

Are health courts a good idea?

I think that they have the potential to be a good idea, and that it would be wonderful to try out some pilot projects. A good friend of mine, who is a Phd/MD and one of the smartest people I know, had this to say about the problems our current system faces.

Patients (and juries) cannot distinguish between a "bad outcome" which can occur even when everyone does everything right, an accidental mistake (which anyone can make), and willful disregard of the standard of care (malpractice). Furthermore, many mistakes which occur are a result of both a flawed systemic process and an individual mistake.
Most catastrophic events are rarely the result of a single flaw or mistake, but rather the chance multiplicity of several smaller mistakes, themselves non-fatal, which together cause a disaster.

Stephanie Mencimer, who writes for The Washington Monthly and argues against the health court, would say that it is elitist to claim that non-medical juries are incapable of making distinctions between bad outcomes, accidental mistakes, and malpractice. Even if it is elitist, it very likely is true. I think that I am a pretty smart guy, but I'm sure that there are many cases in which I would not have the ability to make those distinctions. Besides, in a health court, the defenant would actually be tried by a jury of his or her peers, unlike in our current system. She makes a few other ridiculous claims, like suspecting that defensive medicine is a myth and that unnecessary tests are usually ordered to make doctors lots of money. Many health care providers that I have talked to make decisions every day on the basis of lawsuit avoidance.

Mencimer does bring up a few valid concerns relating to tort reform, however none of them are reasons to oppose the creation of a health court. She says that lawsuits "are a symptom of secrecy" and "distrust within the health care system." I think she is wrong about the reasons for that secrecy (she says the"direct financial incentive to keep their errors under wraps...far exceeds the penalties they might suffer through lawsuits"), but agree that secrecy is a problem.

I have heard "experts" say that most lawsuits are filed in order to get good information about their outcome. (I don't know if there is any empirical evidence for this, but it makes intuitive sense and there is plenty of anecdotal evidence) If there is a bad outcome, "risk management" encourages doctors to tell their patients nothing because anything they say can come back to haunt them in a lawsuit. Then patients, who do not know if the bad outcome is a result of malpractice or not, feels forced to file a lawsuit in order to get that information. A health court might reduce some of the fears on the part of doctors and hospitals that giving information to patients could harm them in a lawsuit, encouraging them to be more transparent in the event of a bad outcome, and reducing the number of lawsuits filed.

The other valid point she makes is critiquing the inclusion of plans to cap attorney's fees and cap non-economic damages. If health courts do a good job of discriminating between bad outcomes, accidental mistakes, and malpractice, then there is no need for these proposals. As Mencimer argues, capping fees, "rather than sav[ing] clients money, ...prevent[s] people from getting representation at all." Since taking on a malpractice suit involves the attorney spending their own cash to prepare the case, capping their contingency fees would increase the risk that the attorney would lose money on the case. And in an effective health court, a cap on non-economic damages would only protect doctors (and their insurance companies) who commit malpractice.

On balance, I believe that the argument for trying out a health court out is a good one.

In a future post I will talk about my perspective that this debate over tort reform, as it is played out in the media, is as much about doctors' distrust for lawyers (and lawyers' distrust for doctors) as anything else. It is interesting that the two professions have so much in common, both when they are at their best and when they are at the worst.

Bitter Pill Awards

I just finished reading "The Truth About the Drug Companies: How They Deceive Us and What to Do About It," by Marcia Angell, former editor of the New England Journal of Medicine. It is an interesting look at one of the most profitable industries in the world, an industry that profits not by excelling in the free market, but rather by manipulating the government's involvement in the market.

On Wednesday, the pharmaceutical "Direct to Consumer Advertising" industry hosted its annual awards dinner honoring drug companies for clever advertising campaigns of prescription drugs on TV, in print and online. Community Catalyst, a national nonprofit advocacy organization focused on ensuring quality, affordable health care for all, gave out its own drug marketing awards.

The categories are:

* Performance Anxiety Award: For Exploitation of Male Fears of Inadequacy
* Speak No Evil Award: For Concealing Drug Risks and Exaggerating Benefits in the Name of Profits
* Least Extreme Makeover Award: For Dressing Up an Old Drug with a New Name and a New Price Tag
* Smells like Teen Exploitation Award: For Shameless Marketing of Prescription Drugs to Kids
* Cure for the Human Condition Award: For Hawking Pills to Treat the Trials of Everyday Life
* Asleep at the Wheel Award: For Failure to Police Drug Advertising
* Real Deal Award: For Providing Unbiased and Independent Information about Prescription Drugs

Jeffrey Overstreet

The Seattle Times has a profile of my favorite movie reviewer, Jeffrey Overstreet.

U2

This interesting column in catapult magazine talks about the "bawdiness" of U2's lead singer, Bono. It's great stuff!

Narnia art!

Here is some of the production art from the upcoming movie. It looks great!