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Date: Wed, 12 May 1999 16:19:42 EDT
>From Dr. K. Mattox writing to the Critical Care Medicine List (CCM-L) and
the Trauma Care Discussion List (Trauma-L). Dr. Mattox is a founding
father, prolific author, and innovative researcher in the principles and
practice of Trauma medicine.
May 10, 1999, issue of American Medical News
"N.J. doctors fight rules for crash victims."
This article cites the N.J. Automobile Insurance Cost Reduction
Act, designed to cut premiums by 15% which will pay only for services to
critical trauma patients which are approved in the "care paths" developed by
consultants of Pricewaterhouse Coopers, or if deemed medically necessary by
an independent reviewer. The care paths require that to be considered for
payment, physicians and other providers submit treatment plans for approval
before care can continue. These "care paths" were NOT developed by any group
with specific expertise in trauma care, trauma systems development, or
quality review, such as the American College of Surgeons Committee on Trauma,
the American Association for the Surgery of Trauma, Society of Critical Care
Medicine, or others. The care paths were developed by insurance companies to
reduce money available for patients with complex injuries. Such denial of
treatment is the very reason that the State of Texas developed a patient
protection act and the AMA has addressed a similar bill at the national
level. Whereas all professionals agree that we must fight fraud from
unscrupulous practitioners, the Trauma Center Verification process of the
American College of Surgeons was established to assure quality and to allow
the practicing surgeon to exercise judgement, not follow a cook book approach
to patient care, especially one created without input from appropriate
medical specialists. From past experience, we all know that guidelines such
as these rapidly become law, and become impossible to change. It is bad
enough for a hospital committee to develop a mandated "clinical pathway,"
"practice guideline," or "critical pathway." For an insurance company,
automobile agency, or a managed care organization to create a mandatory set
of rules to be followed prior to paying for an already provided emergency
service is the height of the illegal practice of medicine without a license.
In my opinion, all patients, potential patients, surgeons, intensivists,
emergency physicians, trauma nurses, trauma centers, medical professional
organizations, EMS organizations etc. should oppose such intrusion into the
professions at the local, state, and national level. If insurance
companies, including managed care organizations, wish to practice medicine, I
suggest they go to medical school, obtain a viable state license to practice,
purchase professional liability insurance and prepare to be held liable for
the care they render and/or critical services which they deny. I would urge
the New Jersey Medical Association and ALL state medical associations to
oppose this limitation of practice for emergency and critical patient care.
With the simplest application of Orwellian extrapolation, one can quickly
envision how government, managed care organizations, business, employers, and
others will limit patient care that does not match their non-medical
(economically driven) committee derived preconceived "care paths."
Please put on your individual web sites and contact your local medical
society, state medical society, legislature, and all of the professional
organizations you belong to. If unchecked, this trend will distroy the
practice of medicine as we have known it.
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