Doctors Orders

Health Care Sound-Off: Tester Holds Meetings With Missoula Doctors

By Travis Koch, 8-25-09

	From left, at Community Medical Center: Dr. Lawrence Gerstle, Sen. Jon Tester and CMC President & CEO Steve Carlson. Photo by Travis Koch.

Montana Sen. Jon Tester sat down at two Missoula hospitals this morning to get a second—and third, and fourth ... and 25th—opinion on the state of the nation’s health care system and what to do about fixing it.

He got an earful.

“We’re doing more tests and procedures than necessary to prove that a problem we know doesn’t exist isn’t there,” said Chriss Mack, a neurosurgeon at Saint Patrick Hospital and one of 25 health care professionals who attended two roundtable discussions organized by Tester.

“What are we really trying to accomplish?” asked Jeff Fee, president and CEO of Saint Patrick. “Are we trying to provide health care for everyone, or are we trying to rein in costs? I would encourage Congress to be clear about what they’re trying to accomplish.”

Tester listened to those views and dozens of others at the two meetings today, one at Saint Patrick and another at Community Medical Center. His goal: to hear medical professionals express their concerns and frustrations with proposed (and unproposed) reforms to America’s health care system, one of the hottest topics in the nation today.

“I’m here to get the perspectives of the folks who are in the trenches,” Tester said.

Topics ranged from the alarming decline in the number of primary care physicians to the challenges of providing coverage to the uninsured. But by far the most common refrain was the need for liability reform or changes in the way tort laws and malpractice insurance affect health care providers.

Nearly everyone at both meetings agreed that malpractice insurance is not only excessively costly, but also places pressure on doctors to perform unnecessary tests and procedures simply to cover themselves in the event of a lawsuit. Several doctors described this common practice as “defensive medicine,” and claimed that it accounts for a substantial part of the cost of health care in America. Greg Kazemi, medical director of the Saint Patrick emergency department and chest pain center, estimated that as much as 50 percent of the costs for emergency care is for defensive practices.

Fee said there was widespread frustration among health care practitioners that tort reform was not being considered as part of the solution.

“Tort is eating us alive,” as Chriss Mack put it. “How is this not abundantly obvious to Congress?”

“This issue has come up at every meeting at hospitals around the state,” said Tester, who recommended that doctors and lawyers get together to have a conversation about the problem of frivolous lawsuits.

But Matt Maxwell, director of cardiovascular surgery at Saint Patrick, said frivolous lawsuits aren’t the problem. The real issue, according to Maxwell, is how to appropriately compensate patients for accidental deaths or illness that aren’t a result of negligence. Doctors today can be sued for anything that might go wrong with a patient, physicians noted.

“Right now, we have one system that deals with both bad outcomes and malpractice,” said Maxwell. He proposed that a second compensation system be inserted in any health care reform bill -– one that would deal with no-fault cases differently than malpractice cases. That would cut down on frivolous lawsuits, frivolous medicine and increasing overhead costs, he said.

Some of the physicians were skeptical that their concerns would find a home in a health care reform bill.

“If Congressional leaders don’t listen to these recurring themes, that would be a big mistake,” said Jonathan Weisul, chief medical officer at Community Medical Center.

“It’s one thing to listen,” added Maxwell. “It’s another thing to make a transition.”

Frank Reed, a primary care physician and president of Community Physician Group in Missoula, said that health care is “a moral and ethical issue before it’s a policy issue. I’m fundamentally concerned that until we make the switch from health care being a commodity to a right, no change will come.”

Tester hasn’t proposed any health care legislation for Congress to consider—that role has been filled by Sen. Max Baucus, a fellow Montana Democrat. But Tester will be a part of the Senate debate, and he said he wants to visit with health care practitioners in major hospitals across the state to hear where they think the debate should go.

In spite of his admission that the current health care system is in dire need of an overhaul, Tester himself raised questions about how extensively Congress plans to reform health care. When pressed about specifics, Tester said, “I don’t think you’re going to see a bill that moves health care in a totally new direction. I think the end-system is going to be something you’re already familiar with.” Tester said he didn’t think a total makeover of the health care system was politically possible at this time.

After the meeting at Saint Patrick, Tester said most of the comments he heard from the health care providers were familiar.

“I think it was a great and lively discussion,” he said. “They have their concerns as everybody does. It emphasizes the fact that we need a bill.”

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