"I wish to begin by making a public confession: .... as a physician, I caused the death of a man."

[marmar]

Dr. Linda Peeno's testimony on managed care to the U.S. House of Representatives, 5-30-96:



Mr. Chairman and Members of the Committee:

My name is Linda Peeno. I am a physician with training in Internal Medicine and Infectious Diseases. Currently, I work in the field of medical and health care ethics. As part of this effort, I chair a hospital ethics committee (University of Louisville Hospital), for which I do consultation, education and policy development. I am the executive director of an international academic society (International Society for the Systems Sciences), and as chair of its Medicine and Healthcare group, I work on ethical issues in international health care systems. I serve on the national board of Citizen Action, a non-partisan consumer organization, through which I work toward equitable health reform. I am the founder of the CARE Foundation, a nonprofit group organized to promote consumer education, public accountability, and ethical responsibility in managed care. I am here to represent the largest interest group in our health care system: those affected by its design and operations, those who validate its consequences within their lives.

II. SUMMARY

As a former medical director, I have done the dirty work of managed care. This prompted me to leave and work aggressively for health care ethics. Because I know how the "system" works, I am best able to identify its ethical transgressions and suggest corrections.

Health care is a special category of business in that every decision, whether clinical or economic, has an ethical component. The ethical issues for "managed care" fall into four major categories of concern: professional, medical, business, and social. Some of the more important areas for attention include: the lack of professional code of ethics for physician executives; interference with the principles of informed consent and patient autonomy; violation of consumer rights; and social maleficence in obstruction to access and delivery.

I contend that "managed care," as we currently know it, is inherently unethical in its organization and operation. Furthermore, I maintain that we have an industry which can exist only through flagrant ethical violations against individuals and the public. Based on my experience, a health plan's resistance to ethical correctives will be proportionate to its reliance on ethical transgressions for its "success." We must not sanction their unethical practices at the expense of individual rights and public good will.

Although the "managed care" industry is quick to defend its actions with high-sounding justifications, their claims break down under examination. For example, can they really support the argument that the effects of "managed care" are necessary for the "good of society." What does this mean? Who should decide this? Can this be appropriately determined by the entity who stands to benefit the most from an economic definition of this "good"?

The systemic ethical problems in managed care require urgent correction in several areas: the monitoring of denials of care; the elimination of certain contracting arrangements with physicians; the requirement for full disclosures of financial arrangements, cost-cutting strategies, and consumer information; the development of open and reported grievance procedures; and the mandate of ethical guides and processes. How could the industry object? After all, this is just a way for "managed care" to apply its own processes of "quality management" and "outcome analysis" to itself?

Nothing less than the life and well-being of our society depends upon this. We have gone too far under our current system called "managed care." How much more harm and death must occur before we have the courage to do something about it?

III. ETHICS FROM THE FRONTLINES

I wish to begin by making a public confession: In the spring of 1987, as a physician, I caused the death of a man.

Although this was known to many people, I have not been taken before any court of law or called to account for this in any professional or public forum. In fact, just the opposite occurred: I was "rewarded" for this. It bought me an improved reputation in my job, and contributed to my advancement afterwards. Not only did I demonstrate I could indeed do what was expected of me, I exemplified the "good" company doctor: I saved a half million dollars! ...........(more)

The complete piece is at: http://www.thenationalcoalition.org/DrPeenotestimony.html

[Yavapai]

1. managed care = death panels

[Frustratedlady]

2. Amen! Pretty sad, isn't it? And, people pay for the privilege. eom

[yellerpup]

3. Dr. Peeno speaks eloquently.

She seems like a good person to lead in this area. Thanks. :kick:

[Catherina]

4. K&R n/t

[Time for change]

5. Wow! Awesome testimony

[rasputin1952]

6. The true "Death Panels" are the faceless people in insurance companies...

that make life and death decisions based on how much money they can save the company. That's it, bottom line. Some "bureaucrat" is not making these decisions, some fool, w/o much training in the medical field, a "Deskocrat", makes a decision not based on medical need for the patient, but on how much in bonuses he or she might drag in for saving a company money it will spend on furniture, invest in funds to make more money and ensure that the officers of the corporation get tens of millions in in pay and stock options...usually leaving said company in dire straights, yet pocketing $20,000,000 or more in the process.

It should not be amazing to people that there are more accountants than adjuster in insurance. It is easy, when necessary, to find a physician that will take a few thousand dollars, (or perhaps less), to come up with a diagnosis/prognosis that will ensure the patient does not receive the treatment they need or deserve. The flaws in the current system are many. Until we have the guts to face the facts, that you or I may die simply because we don't have the means to pay for necessary care out of pocket, we will hear of these stories and hopefully empathize with the victims enough to make sure we demand changes. People should not be forced to die because of economic rewasons.

I spent many years in the medical field, both in the Army and in civilian life...I have seen firsthand what this doctor has described, I am appalled that we allow this to continue and will continue to fight to ensure everyone receives the care they deserve. In our own coveted Declaration of Independence,, "Life, Liberty and the Pursuit of Happiness" is so often quoted by those who would deny all three to people because they are ill, it is sickening to see what our nation has become in the arena of health care.

[tpsbmam]

7. K&R -- thanks for posting this. n/t

[herbm]

8. Her whole statement is an indictment with a reasonable solution. Thank you for this post.

[area51]

9. Kick.

Each day, 273 people die due to lack of health care in the U.S.; that's 100,000 deaths per year.

We need single-payer health care, not a welfare bailout for the serial-killer insurance agencies.

We don't need the GingrichCare of mandated, unregulated, for-profit insurance that is still too expensive, only pays parts of medical bills, denies claims, bankrupts and kills people.

Republinazi '93 plan:

"Subtitle F: Universal Coverage - Requires each citizen or lawful permanent resident to be covered under a qualified health plan or equivalent health care program by January 1, 2005."

"We will never have real reform until people's health stops being treated as a financial opportunity for corporations."

"Any proposal that sticks with our current dependence on for-profit private insurers ... will not be sustainable. And the new law will not get us to universal coverage ...." -- T.R. Reid, The Healing of America