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... is for good men to do nothing. Edmund Burke
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From: Charles Phillips, M.D. To: Assemblymember
Mary Hayashi Sent: 7/22/2011 6:07:09 P.M. Pacific
Daylight Time To: The Honorable Mary Hayshi Chair California State Assembly Committee on Business,
Professions and Consumer Protection: Subject: OPPOSITION TO AB 655 - A Viewpoint from a Federal Whistleblower MD My name is Charles Roy Phillips, MD
a senior who is also a full time, practicing physician in the San
Joaquin Valley. I see myself now as a federal whistle blower in
health care. I have done this for free for
twenty-five years and now do so half time for free and half time
for the federal and/or state reward. I was most recently (this
Spring) published in Drug Topics out of Ohio maybe
going out to 15,000 pharmacists on the topic of pill splitting (not pill
halving but pill wrecking) in which the California Pharmacy Board is the
problem; the European FDA will soon be the solution. This splitting
into uneven fragments is a long term cost to California as illnesses are not
treated and fall later to government entitlements. Pill splitting is
also a good biopsy of the physician "group ethic" (no ethic at all
but an MD retirement scheme) that wrestles daily with the Hippocratic
Oath. For potential reward (federal and
multi-state), I wander through the target rich environment of
such evils as co-branding health plan/MDs to confuse the public about profit
(like "Kaiser Permanente"), religious health care disowned by the
central health mission (as CEO salaries too high like in Adventist Health
"Care"), upcoding of bills around the
country, the Supreme Court's warning that HMOs are the "creature of
Congress," medical record tampering after bad outcome (rampant in almost
every hospital in "Risk I"), and sham peer review for economic
gain. The list goes on never a dull moment. I even see as a consumer of health
care at times that each hospital lies on its mandatory sign
in paper by saying that the hospital is simply a charity of
hallways, beds, and nurses completely independent from the
physicians. Internal contracts (secret business documents) show that
is not true. And a "non-profit" hospital need only be 51%
non-profit. Also, the mandatory patient "rights"
poster on the hospital wall gets weaker every year as the patient "responsibilities"
get longer (the latter not within the Oath). Kaiser physicians
before leaving Kansas were part of the "Mid-West Bioethics
Committee" that helped wreck this standard paper with the Joint Commission
giving up on its ethics own book. I am unpopular within the flow of
money toward those milking the medical system. For
example, when the article on hospital chart tampering came out as a front page
issue in the USA TODAY in 2008 naming me as the [unpaid]
consultant, two hospitals briefly tried to find reasons to get me off staff
the same day. After a brief conversation that I had with them
that the (then) largest circulation newspaper in the US (going out to sixty
countries) might want to talk about retaliation on physicians making the system
transparent both hospitals retreated. The newspaper did pull the
second story on East Coast tampering (already written), and the reporter left
the paper. Such is the influence of hospitals on ethics whether or not
that hospital is dripping in religious symbols. Generally, I look for federal intervention
in this state of "Kaiser-fornia" (my
word), because our state has so hopelessly sold out the patient at every
turn and from the top. The average California patient would, for example,
assure you that Anthem Blue Cross is non-profit organization.
But that was the purpose of the billion dollar (?) buyout of the
non-profit name "Blue Cross" during the conversion years ago to
for-profit Anthem. Now, about$1 billion a year being sent to Indiana
in profit to help fund the WellPoint, Inc. CEO (? Lear jet).
The average California patient would
also assure you that Permanente physicians are just salaried, like to eat
broccoli, and share their treatment strategies online. Such patients
miss that these physicians really split the Health Plan profit ($3
billion in 2007) and are set up for immense, salary-equivalent
vesting retirements for life. They are to get this money
required to always support (even to you) the Health Plan's
"expansion." They are direct creditors to the Health Plan and
must also be patients for life. That is why they also have a shadow
control of the Plan. Similarly, the average Blue Shield
patient hears "non-profit" and has no idea that the physician groups
giant Independent Practice Associations (not independent at all) join
in the Blue Shield risk of MD cost, testing cost, and medication cost. In
this way, the MDs share the "risk" profit generally the Kaiser
formula (50% of every dollar saved). And when the legislature does step
in the Department of Insurance splitting off the Department Managed Health
Care (DMHC) the latter is given a bipolar assignment of patient protection
and physician group solvency. Only the protection of MD solvency
can lead to a future career as the DMHC leaders leave.
Meanwhile, government like your committee is mocked by the HMOs as the one
eyed giant throwing rocks at Ulysses the modern IPA fleet (Click
here: http://businesspractices.kaiserpapers.org/pdfs/permmap.pdf). So in the middle of all of this
failing healthcare, I spend most of my time interacting with federal sources,
thus leaving Sacramento to shoot itself in each toe in the name of patient
care. In fact, I am sure that should all of the anti-patient yokes
be cast off, there would suddenly be less MD retirement money in the
Bahamas and more medical care (read as more jobs in California).
Occasionally, however, there is a state issue in California which I
choose to address with a certain urgency. In
2011 it appears that I need to revisit Sham Peer Review. My first experience with Sham
Peer Review was in 1980 when I officially noted that one physician was giving
out too much vicodin. As the director of the
Methadone Clinic (and many other programs), I could not sit by and watch
it. The review of this economically useful MD was a sham (in letting him
off), and I was told that I was no longer the first choice to be the next Medical
Director of this huge system. The post of County Health Officer was
still open should I like my weekends off. Having just completed a
textbook for paramedics, I did not want to become a health officer. I
became board certified in family medicine and emergency medicine about then -
doing some of each since. The lesson was that physicians are viewed by
hospitals as cost centers rather than ethic centers. Good cost centers
stay; and sometimes the best MDs are asked to leave. This year I will be involved in the
topic of Sham Peer Review both through this email-letter to you (in
Sacramento) [I am available free to your committee if needed] and as an expert
witness in a federal court (a volunteer role in a maturing case). In the
latter case a rural hospital's "Medical Advisory Committee" (read as
group of MD friends) tossed out the Medical Staff Bylaws for ten years,
reformulated the MD voting list (changes never approved by the Board), held
lunch meetings that deputized non-hospital practicing friend MDs to vote in
Peer Review, and otherwise wrecked a new hospital budget (tax initiative) as
well. The grand jury has come to watch - invited in by
me. When it is over, this federal case court battle will be a textbook
case of how not to do Peer Review (physician targeting).
The hospital according to a meeting this week may have to sell itself to
the Adventists for permitting such shady dealings. [Most
likely the Adventists hospital leaders were loaning them money for lawyers to
conduct this attack.] The trouble is that Sham Peer Review
is about the only "peer review" that I see going on. It is particularly troubling in Kaiser where a
physician wishing to leave the partnership can expect sudden false
charges. The little secret is that each Permanente physician looks
forward to a retirement - funded by the Health Plan - worth about $2
million. Should the partnership be able to knock out a partner with a
complaint or make the work schedule impossible (like a two hour commute each
way), then the Permanente partnership gets to split the money already pledged
by the Health Plan to that physician. Secondly, the leaving partner might
well become the perfect legal expert messenger reflecting all of the
anti-patient policies within, like not testing for diabetes in heavy
patients. And the partners have no contract with Permanente - only
the "contract" of applying to Permanante as
a small box on the hospital application in the beginning. Thus a war
often occurs - in which I am sometimes called upon to be the expert
(subject to a secrecy contract of its own) - as the "partner" wants
to get outside this group (like The Firm). AB 655 appears to endorse hospitals
communicating with one another about such sham processes without the doctor so previously
targeted knowing what is sent and why. The wording - as suggested
by Senior Counsel Jeffrey White of Washington, D.C. - The responding peer review
body Since most IPA's copy Permanente,
these "responsible" physicians also have reasons to try to ease
partners out of retirement equity. The original Kaiser competitor
physicians - Foundations for Medical Care - have, for example, found the
most money in being the utilization review partners of Anthem and other plans
with FMCs having highly secret MD boards. FMCs would love to knock
out "outlier" physicians who do not sign contracts that turn PPOs
into HMOs. I am an "outlier" physician and proud of
it. Such utilization review (UR) in the business world would be
like having Wendys decide what shape all burgers
should be. It is simply monopoly empowerment - each city in California
being divided up like a pie. When I came to Fresno, everyone asked
what "camp" I was joining. Having survived SCUD missiles, I was
not looking for a "camp" to hide within. This is allanti-physician - the classical
physician on TV. A similar hospital power (this time
I will name one that is directly anti-patient) is accorded within
the DMHC whereby a patient complaining of hospital care has no idea what the
hospital might send to the "HMO Help" system. Given the medical
chart tampering I have seen (done in Risk Management across the hall or
nearby) the patient would rarely have a full pictured shared. I am
not surprised that the for profit "Help"
contractor rules against the patient about 60% of the time. The
DMHC should be merged back with the Department of Insurance (DOI) as a single
state experiment (the California department split) that did not work. I
am not a big fan of the DOI - as they just told me that "self
insurance" (half of the industry) is not really "insurance" at all - but at least companies like Anthem
cannot hide in the canyon between the two governmental alter-egos.
I would hope that your committee
might make real progress in Peer Review and first (before AB 655)
examine the money trails. You might even learn about a lawyer who
flies in from Colorado just to facilitate sham peer review (I'll
guess six a year - thus full time) and then flies home to help her husband
run a worldwide maritime physician credentialing company. The problem is
that the same physician she attacks in California is listed as being approved
on her family's worldwide list. Hmmmmmm. She
thinks that she is now qualified to rewrite ("re-engineer") medical
staff bylaws - making it all "simple" and in the hands of the Medical
Staff President. In You will find
that land transactions often follow sham peer review - the tough President of
the Medical Staff having either a great house sale (Hanford) or a brand new MRI
in a small town (Corcoran). Hmmmmmm. Certainly, your committee can do a
lot of good. As I do not count on that, I will invite federal remedies
just as fast. In fact, the more you solve on your own, the less reward I
get. And I will be a fan of the CMA when it follows the highest road - as
it did, for example, in 2000 winning the right of any physician to do physical
therapy - a key appeals case in Fresno. On the other hand, the
CMA's own financing should be an open book, e.g. whether the Permanente
physicians represent a far greater portion of physicians than their numbers
might suggest. Certainly dues are a small part of the AMA budget -
so state chapters should be transparent (for patients to understand). Perhaps the CMA might decide if
medical practice guidelines coming out of Oakland should influence care in
Washington, DC, where the frontline physician cannot print out the
pressures applied from within the "work station" computer.
And, I would welcome the CMA to join in with me on topics like pill splitting,
medical record tampering, co-branding so profit merges with non-profit,
etc. which are all patient-centric issues. But, then, I recall my first TV show
may have been the black and white screen version of the Lone
Ranger. And I liked Last Samurai Standing. Thanks in advance for your time. Chuck Phillips, MD |