I opened my internal medicine practice nearly four decades ago to serve a growing urban community. I gravitated toward the underserved geriatric population because they were vulnerable patients, and eventually moved into the bygone field of house calls for homebound seniors.
This improved my learning curve, as house calls are not taught in medical school or residency, yet bridge the continuity gap between hospitalization and patients returning home after illness acute. I spent many hours at our local hospital admitting elderly patients and managing their care once they returned home.
From this perspective, I witnessed an increasing takeover of medical decisions by physicians, which were then relinquished to hospital administrators.
As an outspoken member of the medical staff, I was invited to participate in the Physicians' Medical Executive Committee. My peers elected me for five years and I served as chair of the department of medicine for three years. I have also chaired numerous hospital committees.
I clung to the hope of working within the hospital system to improve care. This does not happen. Many of my physician colleagues were continually under siege by the hospital administration for speaking out against aberrant care. Immediately after my election, I became the target of false allegations of “remedial action” and code of conduct violations.
Questionable policies and procedures developed by the hospital administration have raised concerns. I have repeatedly reported them to monitoring agencies, resulting in financial and operational sanctions.
As a result, I was forced to overcome many obstacles to remain a staff member. For example, most doctors know that you have to reapply for staff privileges, usually every two years. The hospital administration made me reapply every four months.
The hospital had financial control over many physician groups, with contract-dangling administrative tactics enticing them to vote to enrich profits by increasing administrative salaries, bonuses and pension plans.
Along the same lines, hospital board members received construction work, bank deposits, real estate leases in hospital buildings, and medical offices for doctors appointed to the board. In return, the hospital administration also got their vote.
The quality of health care was just a public relations illusion and was compromised at the hospital.
Operating under duress made it difficult to work within the system, not only with aggressive and derisive tactics against doctors, but also with legal problems.
A great example of this came when I was chair of the ethics committee.
The hospital administration informed me that the committee would be meeting for an emergency meeting regarding a critically ill patient in intensive care.
This 50-year-old gentleman arrived unconscious, without advance care directive and was intubated.
His family, including his wife and three adult children, were present, as were two lawyers, one from the hospital and the other from the patient's fund. Three doctors and two community members whom I had nominated were also on the committee. One was a member of the planning commission and the other was a local attorney.
Since the patient did not have an advance directive and could not verbally express his wishes, the lawyers argued that under the law the HMO and the hospital administration could assume responsibility for making medical decisions .
The family fiercely objected, demanding that care continue, as they were told the hospital intended to “pull the plug” after a two-week stay because medical care was “unnecessary.”
The local attorney quickly looked up California law and found that the hospital and HMO attorney were correct. We informed the family that the hospital and HMO could make medical decisions. Their frustrated declaration: “There should be a law!” tears flowed.
Other members of the ethics committee were also discouraged, but before leaving my role as chair, I warned the hospital's legal team that if the community somehow found out about this scandalous takeover of medical decision-making, this could have negative consequences for the hospital's health care.
Even more appalling, the hospital and HMO discovered a loophole in state law and wanted to use it against their patients and the community.
My wife and I have been high-profile advocates for decades and even organized a picket at the hospital when they decided to close the transitional care unit, which served as a springboard for elderly care active towards home.
Subsequently, we were elected to a government group known as the California Senior Legislature, which helped us submit a proposal to the Legislature.
In our research, 46 out of 50 states had hierarchical laws allowing family members to be moved to the top of the list if a patient was admitted to a hospital without an advance directive and could not consciously make medical decisions. California was one of those states that had a loophole.
We worked with Los Angeles State Assemblyman Mike Gibson and his team, presenting live testimony online and in Sacramento to the Legislature and Senate committees in support of our proposal, AB 2338 2022.
It passed unanimously and was signed into law by the Governor of California.
It's common to hear about the grief family members experience at the hands of hospital administrators, insurance companies, and other obstacles they face when it comes to health care. Taking medical decision-making power away from doctors and placing it in the hands of profiteering hospital administrators is detrimental to our nation's health care.
One hopeful reward doctors can receive for serving the public is a monumental effort to wrest medical decision-making power back from hospital administrators. Additionally, doctors can sometimes better advocate for their patients and even pass legislation to close a legal loophole.
Yet the biggest reward came when the hospital decided to heed the warning and not “pull the plug” on the unconscious 50-year-old patient in intensive care.
Eventually, he was released from the hospital and returned home to his family.
Gene Uzawa Dorio is an internal medicine physician who blogs at SCV doctor's report.