Bacon's Rebellion

Democracy Thrives in Sunlight

Make It Easier for Physicians to Donate Medical Care

—

by

James A. Bacon
in

extremes

August “Augie” Wallmeyer, a long-time lobbyist and member of Virginia’s political class, decided in his semi-retirement years to tour the state, with special attention to rural regions that are largely unknown to those who dwell in Virginia major metropolitan areas. In compiling material for his soon-to-be-published book, “The Extremes of Virginia,” he says, he’d “met dozens of people, heard their stories, listened to their dreams, their fears, their hopes, their gripes.”

In a four-part series in the Richmond Times-Dispatch editorial page, Wallmeyer has done a fine job describing the hardships and challenges of Southwest Virginia, Southside and the Eastern Shore. Like a good public policy wonk, he offers a number of suggestions on how the General Assembly can help. For the most part, specific proposals are small-bore, suggesting that he sees no sweeping remedies, no magic bullets.

But one idea struck me as immensely practical: Physicians and lawyers need to figure out how to change the malpractice laws to make it easier for health care professionals to donate their care. Writes Wallmeyer:

Physicians who treat poor and indigent people without charge fear getting sued by their patients, which is one reason very many doctors simply don’t treat the poor. They fear not only lawsuits related to their medical practice, but also being accused of crimes by their patients, some of whom have mental health problems. …

Virginia’s legislature should forcefully insist that the medical and legal communities mutually resolve this problem and then adopt a statute that actually protects doctors from lawsuits when treating poor people, while appropriately preserving the legitimate legal rights of the poor.

Bacon’s bottom line:

On this blog, I have highlighted several proposals to improve affordability and access to the health care system for Virginia’s poor that don’t expose taxpayers to the enormous risk of expanding Medicaid. Add Wallmeyer’s idea to the list.

— JAB

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42 responses to “Make It Easier for Physicians to Donate Medical Care”

  1. LarrytheG Avatar
    LarrytheG

    § 54.1-106

    Health care professionals rendering services to patients of certain clinics exempt from liability

    https://vacode.org/2016/54.1/I/1/54.1-106/

  2. V N Avatar
    V N

    Here is the problem: you will get less competant docs who will take advantage of those laws, screw up something, and get away with murder.

    1. DonR Avatar
      DonR

      I doubt it. If you are a lousy doctor I imagine you are struggling to make a living. Why would you give away your time for free? Are the doctors in Doctors without borders lousy doctors because they donate their time?

  3. Acbar Avatar
    Acbar

    It’s worth noting, there is a provision in the State Bar regs expressly allowing retired lawyers to practice law, even though the lawyer is not current on Continuing Legal Education or current on liability insurance, for pro bono (unpaid) legal work such as for legal aid.

  4. LarrytheG Avatar
    LarrytheG

    Doctors alone are not the sole providers either. People will need blood work, x-ray techs, someone to read the x-rays, nurses, etc.

    the premise continues to be that Medicaid expansion will cost more than if we continue to not provide care to the uninsured.

    and the problem is – the folks that oppose the expansion don’t have realistic solutions but rather a series of what amounts to lame and inadequate “ideas” … i.e. “look at all the things we are doing to help”!

    finally, yes – V N nails it… once again the “free market” solution is one in which the poor are put at more risk but removing safeguards that most of the rest of us would not agree to.

    There are a series of “free” clinics in Va that essentially operate as managed care practices that already encourage volunteer staffing – while maintaining the standard of care but these clinics need heat, air, electricity, water,sewer, supplies, equipment, etc. to operate and volunteer hours alone will not do it.

    how about a free market solution for that?

  5. Peter Galuszka Avatar
    Peter Galuszka

    Ya got love it!

    Wallmayer and Bacon want to improve access to physicians by poor, rural people.

    The solution? Cut regulation, of course, for doctors and lawyers willing to work in lower income areas. Forget about malpractice!

    The result: poor people get screwed again. Because they are poor, they would not get the needed legal protections they otherwise would if they were rich enough to live in wealthier areas. So, if your doctor takes out your heart by mistake instead of a gall stone, you don’t get to sue. Ditto if your lawyer mistakenly assigns your possessions to your cat instead of your children when he prepares a will.

    You want to help the rural poor? Here’s a novel idea — expand Medicaid to 400,000 Virginians who are too rich for the standard program but don’t make enough for private insurance.

    A few other ideas:

    (1) Pass laws making certain that bankrupt coal companies cannot end retiree health and insurance benefits while paying top executives lush bonuses.

    (2) Ditto to textile companies that take a powder overseas.

    (3) Make sure the Tobacco Fund does what it is supposed to do, other than bankroll the Kilgore family, let director use money for personal purposes and help non-profit, religious institutions like Liberty University with expensive infrastructure.

    I’d love to write by own book on all of this, but I doubt the Richmond Times-Dispatch would give it a four-Sunday right in excerpts. That, dear readers, is reserved for the conservative, lobbyist in-crowd many of whom are likely to have worked for Dominion.

  6. TooManyTaxes Avatar
    TooManyTaxes

    Shouldn’t the state think about expanding its no-fault plan for neurological injuries suffered by babies during birth (Birth-Related Neurological Injury Compensation Act (NICA))? This step could occur with or without changes to the Medicaid system?

  7. LarrytheG Avatar
    LarrytheG

    I think managed care clinics might be a cost effective way to provide care to the poor and uninsured.

    If Virginia does not want to take the Medicaid expansion – fine – then find another way to fund them – perhaps as Peter suggests by using the Tobacco fund

    but refusing to take the Medicaid AND not doing anything else is not leadership.

    Now if some folks think not doing anything is less cost – then perhaps they can actually make that case… and hospitals that make a profit – will be required to fund all the charity care in their area.

    in other words – man up – own the problem and stop blaming the Feds … for what Virginia refuses to do itself.

    1. TooManyTaxes Avatar
      TooManyTaxes

      There is a very interesting article on Medicaid reform by Manhattan Institute Senior Fellow Oren Cass in the 9/12/16 National Review. It would sail over the WaPo editorial board’s collective head as it goes beyond spending more money.

  8. Acbar Avatar
    Acbar

    Gee, I thought JB had a serious proposal; then I read LG’s and PG’s snarky, slash-and-burn comments attacking market forces. To me this is not ideological but deeply practical: The talent of retired professionals is often wasted, and these are people who have the time as well as skill to give, but they can’t afford to risk becoming penniless from malpractice suits while on fixed incomes and at the brink of declining health. OF COURSE there’s a risk that a medical travesty will occur, but which path results in the far-greater good: encouraging all these potential volunteers to practice community health, or effectively barring them by denying liability protection?

    Why do we EVER have limitations on liability? Why do we protect “good Samaritans” and keep our obstetricians from fleeing Virginia to practice elsewhere and protect businesses from wrongful death sympathy suits? Because enforcement of common sense through the cumulative actions of trial lawyers is a hell-of-an-inefficient way to dictate public policy. Because allowing plaintiffs to proceed with lawsuits when they haven’t a dime at risk fosters tons of unnecessary, speculative litigation. Because settling unjust lawsuits to get rid of them rather than fight them is the bane of many businesses. There would be a lot more limitations on lawsuits if our legislature, our GA, weren’t dominated by lawyers.

    Yet, once again, Peter and Larry can only carp at the evils that MIGHT be done by those doddering fools who would mistake the heart for a gallstone and yank it out still pulsating before the crowd at the base of the temple steps, a human sacrifice to the gods that kept Medicaid expansion at bay!

    Well, here’s my take on it: we need both a dramatic expansion of community health and better use of retirees’ time. And while the GA in its infinite wisdom refuses to act on the former, we need the latter all the more as a policy stopgap, as well as, to stop wasting all that talent. And that will require liability protection. Wallmeyer and Bacon are right about this.

  9. LarrytheG Avatar
    LarrytheG

    I basically pointed out that Virginia already protects volunteers if they do so in community clinics – which is how you want to leverage volunteer care….

    and I also pointed out that standard of care should be equitable and to not treat the poor any differently in terms of the same protection afforded others…

    Wallmeyer and Bacon are NOT right about this in my view unless they first acknowledge that they already knew that volunteers ARE protected in community health clinics and WHY this is a problem for those who don’t want to volunteer through those clinics.

    where would you have those doctors volunteering if not at community clinics? – which is where you’d find things like nurses, record keeping… etc.. managed care… with other doctors and specialists…. ALL protected by current law which is decades old.

    My bigger point was that we already have a system for helping the poor – Community Clinics – and the problem is that we still don’t have enough money to adequately fund them – BEYOND the volunteer doctors already providing their services

    What I suggest is that folks read up on this… before they propose “ideas” that some of which are already in place -work – but need “more” in order to serve the need.

    1. Acbar Avatar
      Acbar

      Says LG: “I basically pointed out that Virginia already protects volunteers if they do so in community clinics – which is how you want to leverage volunteer care….” Really? That would be a significant answer to Wallmeyer etc. if true; and yes that’s exactly what I’d like to see — but that point isn’t made in ANY earlier comments and, more importantly, that’s not my understanding of the situation for doctors, although it is to an extent for lawyers (as I pointed out). Got any citations?

      1. Acbar Avatar
        Acbar

        All right, I have to eat crow here, I failed to see that yesterday in the very first comment posted all by itself you cited 54.1-106 — which is directly relevant to this discussion. I’ve been re-reading all the other things you said without finding any mention of liability protection. But in light of that law, already on the books, why did Wallmeyer make the plea he did? Of course any retiree volunteering his medical expertise should do so in a clinic format — how else will he have access to the facilities, the assisting staff, or the policing of his own fading skills?

  10. Peter Galuszka Avatar
    Peter Galuszka

    What about Medicaid acbar? As usual commenters here dodge the crucial questions. As Larry says, aren’t volunteer docs and lawyers held harmless?

    1. Acbar Avatar
      Acbar

      Medicaid is not what this posting was about. And I maintain Medicaid would not make this problem go away in the parts of Virginia Wallmeyer focuses on. Besides which I sympathize with the issue of retiree talents rendered useless by our superlitigous society and overrestrictive licensing bureaucracies. Besides which, as you undoubtedly know, I’ve got a history here on BR of urging that Virginia suck on the federal teat (aka take the federal money and run) — https://www.baconsrebellion.com/2015/12/agreed-we-cant-risk-expanding-medicaid-but-whats-the-alternative.html — despite the philosophical objection often voiced here to any expansion of any federal entitlement anyhow anywho on grounds that these entitlements are budget-unsustainable — despite which I blame philosophical concerns on both ends of the spectrum for too damn much Congressional lockjaw not to mention unhelpful snark — despite which we seem destined to be preaching and electing more of the same this November. As for Larry on the subject of liability, it’s not helpful to criticize people for not having read what nobody has posted. Sure, there are free clinics in Virginia but what does that say about liability coverage for volunteers? I’m waiting to learn the answer. Why can’t you and Larry address Jim’s posts rather than flying off on the same, repetitive tangents every time?

  11. LarrytheG Avatar
    LarrytheG

    Here’s the 59 free clinics that ARE already exist in Va and whose volunteer staffs are protected from liability.

    Why do we portray this liability thing as an obstacle to helping the poor – when it is clearly not?

    http://www.vafreeclinics.org/find-clinic/

    We already have a significant backbone and there are significant advantages to delivering volunteer care through these clinics as they provide all the administrative support services – including universal medical records – as well as the panoply of different kinds of physician services from primary care to specialists to include things like dental care, etc..

    It’s much more cost-effective than individuals giving voluntarily care – and a simple example… the patient needs to go and get an xray and see a specialist. At the clinic – this is coordinated and integrated…. an individual physician would have to be making phone calls and finding who would do the needed services, etc…

    Charity care needs to be centralized and managed care… with one medical record that all providers access …

    Why do we NOT have blog posts in BR that talk about these already successful operations rather than continuing to point out how the “system” is “hurting” attempts to help?

    It’s like Bacon can’t highlight things that work – he can only point to the “failures”… and why we can’t provide additional charity care.

    the real story is that we already do – and we don’t need to be re-inventing tort law or treating the poor with a different standard to do it.

    1. Acbar Avatar
      Acbar

      You say — “whose volunteer staffs are protected from liability” — but I see no evidence of that, on the link you supplied or elsewhere.

      You say — “Why do we NOT have blog posts in BR that talk about these already successful operations rather than continuing to point out how the “system” is “hurting” attempts to help?” Damn, I thought that was exactly what BR was attempting to do, and also to point out an obstacle that, if true, needs to be addressed; but if not true, it would sure help us all (including author Wallmeyer) to know it — with citations, not surmise!

  12. DonR Avatar
    DonR

    Liberals love Europe and European healthcare. Has anybody ever wondered how medical malpractice works in Europe?

    1. No jury trials – decisions made by a judge.
    2. No contingent fees.
    3. Loser pays winner’s court costs.
    4. Strict caps on “pain and suffering” awards.
    5. In most countries – economic harm is calculated through a set of tables rather than opinion.

    Of course, the Trial Lawyers Association might stop contributing to the Clinton Foundation if she suggested something like that.

    1. LarrytheG Avatar
      LarrytheG

      Don – Europe has Universal Coverage… right?

      I suspect most folks who want to see Universal Coverage would be fine with the steps you advocate…

      do you consider Europe more or less “infested” with those nasty liberals since they do have Universal Coverage?

      you guys kill me Don… your idea of “liberal” just ricochets and boomerangs off the walls depending on your narrative.

      So let me guess… we want Europe’s approach to torts but the US approach to health care? 😉

    2. Acbar Avatar
      Acbar

      Thank you, Don — some sense, finally.

  13. DonR Avatar
    DonR

    ” … rural regions that are largely unknown to those who dwell in Virginia major metropolitan areas …”

    Where do you come up with this stuff?

    Are the dwellers of rural areas largely unaware of Virginia’s cities and suburbs too?

    1. James A. Bacon Avatar
      James A. Bacon

      How many names of Virginia counties could you identify on a map?

      I’ve lived in six different cities/towns, and I’ve reported on the state my entire adult life, and I’d probably miss 10%. I’d bet most Northern Virginia residents could identify more than 20%.

      1. LarrytheG Avatar
        LarrytheG

        there are about 100 counties and 33 cities and towns and I’m willing to bet very few could identify 90% of them -much less rank them according to median income, number of uninsured or number on welfare and food stamps.

        when you get right down to it a LOT of us – are downright ignorant about the facts … but that don’t keep us from forming opinions, eh?

      2. Acbar Avatar
        Acbar

        I was required to memorize all 100 counties in the 5th grade. Shows you how much good it has done me; I can still find Elizabeth City!

        1. LarrytheG Avatar
          LarrytheG

          Good LORD Acbar! I would maintain it’s contributed to your geographic awareness in ways you may not be aware…sorta like knowing what the river basins and tribs in Va are!

      3. DonR Avatar
        DonR

        Me? I spend hours and hours on Virginia demographics. I try hard to bring you and your arguments to a more quantitative view of Virginia. I wouldn’t be able to identify all the counties but I’d get 70% – 80% right. Does that make rural Virginia “largely unknown” to me? As for residents of Northern Virginia being able to identify no more than 20%, you might be right. But here’s a shocker – rural Virginians wouldn’t do any better. Regardless of your “geography bee” approach I think it was a gratuitous comment to claim that Virginia’s rural regions are largely unknown to residents of Virginia’s metropolitan areas.

  14. DonR Avatar
    DonR

    “In a four-part series in the Richmond Times-Dispatch editorial page, Wallmeyer has done a fine job describing the hardships and challenges of Southwest Virginia, Southside and the Eastern Shore. ”

    The Eastern Shore is a very interesting place. When I drive through the Eastern Shore on my way to Norfolk (via the bridge tunnel complex) I am always amazed by the difference between the Maryland counties of the eastern shore and the Virginia counties. You can almost feel the poverty and despair shoot up as you cross the line from Maryland into Virginia. If you ever want to see clear evidence of the difference between a well run state like Maryland and a crony capitalist sham of a state – go to the Eastern Shore.

    1. LarrytheG Avatar
      LarrytheG

      geeze Don – Maryland has been run by the Dems for like…forever..

      1. DonR Avatar
        DonR

        Why do you think I am anti-Dem? Who did I publicly and repeatedly support on this blog in the last Governor’s election? I am anti-corruption and the more corrupt party in Virginia is clearly the Republican Party although the Democrats have their moments. However, the small number of Virginia politicians who I do see consistently agitating for more fairness and transparency are all Democrats.

    2. James A. Bacon Avatar
      James A. Bacon

      Do you think that proximity to the immense and wealthy Washington-Baltimore metropolitan area has anything to do with the success of rural Maryland localities on the Eastern Shore?

      1. LarrytheG Avatar
        LarrytheG

        ” Do you think that proximity to the immense and wealthy Washington-Baltimore metropolitan area has anything to do with the success of rural VIRGINIA localities on the Eastern Shore?

        geeze Bacon…

        1. James A. Bacon Avatar
          James A. Bacon

          Not as much. An extra drive time of a half hour to an hour makes a big difference when it comes to appealing to the second-home market.

          1. LarrytheG Avatar
            LarrytheG

            probably not the drive – but terrain. If the Virginia Eastern Shore were the topography of Nags Head or Myrtle Beach -it would be a different story..

          2. James A. Bacon Avatar
            James A. Bacon

            There’s also the fact that the Nature Conservancy owns just about the whole Atlantic coastline — prime developable territory.

          3. Acbar Avatar
            Acbar

            They are just keeping the coastline clear so no one will be there to object to the offshore windmills.

            As for the Delmarva economy: your driving time point is well taken, but the bulk of the Maryland Eastern Shore is hardly prosperous. I’d say even the Washington second home crowd begins to thin beyond Easton to the south or Chestertown to the north, about 1 1/2 hours from DC. As for the Virginia Eastern Shore, why go there when the places available as second homes on the west side of the Bay are still plentiful and a lot closer?

          4. DonR Avatar
            DonR

            And developing part of the seashore like Maryland did in Ocean City makes a big difference to the tourism market. Allowing a reasonable number of casinos at the horse racing tracks kept the horse racing industry alive. Allowing counties to collect an income tax and use that tax on local initiatives makes a big difference. Prohibiting the wholesale destruction of the menhaden market so that game fishing thrives makes a big difference. It’s a whole lot more than the second home market, although proximity to urban areas definitely makes a difference. As usual, Virginia never developed anything approximating a city on its eastern shore. Salisbury has 125,00 people in the metro area, a commercial airport and a 4 year university. Salisbury is in Wicomico County and is a long way from the Washington / Baltimore area. Meanwhile, Wicomico County has median houehold income of $52,301 compared to Accomack – $39,389 and Northampton – $34,656.

            I’d be surprised if there was any material second home economy in Wicomico.

  15. Peter Galuszka Avatar
    Peter Galuszka

    I did think Wallmeyer did a good job on rural
    Drug addiction. It is what I found when I researched my book.

    Don the Ripper us right on the Eastern Shore. The Virginia side is like driving into the 1850s

  16. LarrytheG Avatar
    LarrytheG

    Nature Conservancy owns it because it looks like this:

    http://www.virginiaplaces.org/geology/graphics/barrier2.jpg

    instead of this

    https://www.findrentals.com/images/v2/vacations/destination-guide-main/topsail-island-rentals.jpg

    1. James A. Bacon Avatar
      James A. Bacon

      Right, I think most of us would prefer the Nature Conservancy approach. But back to Don’s point: When you take the highest-value land off the table from development, you’re not doing much to create jobs and promote prosperity.

  17. LarrytheG Avatar
    LarrytheG

    when you look at the Virginia barrier islands -you realize there is no bridge network like you see with other states barrier islands.

    So without access – the development potential is not even a “potential’!

    next – a LOT of the land is marsh fresh, brackish and salt -ideal for wildlife … and some of the worst bugs I’ve ever encountered and that includes black flies and mosquitos in Canada…

    finally – such land would be IDEAL for wind turbines as the “viewshed” impacts are minimal because of a lack of development and ditto for solar if there was a 500kv line – a lot of fallow land could be used to help the Eastern Shore generate income and become a major energy supplier – but it would take an investment of grid infrastructure to do it.

    we’ve gone far afield here from the blog subject!

  18. LarrytheG Avatar
    LarrytheG

    The current lack of liability protection for individual doctors is not a big impact problem that would do much to help solve issue of medical care for the poor and highlighting it in that way is just overblown.

    Like the “Community” in Community Colleges – Community Health Clinics are the way to go in Virginia for care for those who are uninsured and/or lack enough resources to get regular medical care.

    They integrate and centralize – comprehensive medical services beyond just one kind of individual doctor … they pull together the full range of personnel and services that actually comprise medical care these days.

    A key advantage of such managed care operations is the use of universal medical records that allow all care givers to see all the relevant medical data for the clients – so that, for instance, the endocrinologist treating a patient for diabetes can see what meds the primary care guy has prescribed…and the primary care guy can see if the diabetes is being well managed , etc…

    What is missing from these community clinics is enough resources to serve the need. They just lack everything from staff, to building, to supplies to computer resources, etc….

    you could expand the volunteers by allowing individual physicians to become part of the “network” with computer access so that they could perform at their own offices but access the clients community clinic data via computer – and in doing that – the doctor would be a “volunteer” at the clinic and protected from liability – without having to re-create the wheel.

    In fact, providing a path to liability protection THROUGH the community clinic network would actually be a win-win because it would expand the staffing resources of the clinic – with satellite sites without having to physically expand the clinic itself.

    that is – if you had a well designed and functioning computer network.. which takes money and competent salaried resources – but could also be configured to allow citizens and retired to offer their volunteer computer expertise.

    All along in this continuum – there are two ways to go –

    one way is to see the possibilities to improve – to reform – to grab the opportunities to make things better..

    the other way is to focus on perceived problems and to see to use the identification of those problems as part of a laundry list of what is wrong with government in a never ending blame game.

    In one chooses to focus on the former – he is called a liberal leftist … even if that support makes things better, even saves money by leveraging cost-effective approaches.. it’s still characterized by the ignorati as viewing the issue through “ideological lens”.

    we have way, way too many of the blamers these days and less and less of those who are willing to accept that we have problems and flaws and our duty is to work to fix them… not burn it all down and walk away satisfied as if something has been accomplished.. NOT!

  19. Peter Galuszka Avatar
    Peter Galuszka

    How about adding a government option to Obamaacare?

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