Articles by JCS
Hospital Fraud and Discrimination
JC Smith, MA, DC
Recently three executive officers of the Columbia/HCA Healthcare Corp. have been served with federal indictments for possible Medicaid and Medicare fraud, and now our local hospital is also being incriminated. And it hasn't been just these corporations alone that were accused of cheating Medicare. Of the 5,000 hospitals in the Medicare audit, 4,600 were found to be involved in defrauding patients with over-billing for services. Apparently fraud has become an ingrained element of the American for-profit hospital system, costing taxpayers an extra, whopping $26 billion for Medicare alone.
This is just another example of fraud and greed in the medical system that has lead to a shameless situation where the medical/hospital professionals seem more interested in their wealth than in helping patients regain their health. Sickness care in the U.S. in 1994 totaled more than one trillion dollars or 14% of the gross domestic spending. All the while, Americans lead the world in every category of chronic degenerative disease, indicating something is terribly amiss with this expensive, but ineffective, medical system. Indeed, the answer to any health care reform does not rest with more drugs and more surgeries, as the medical profession would have it!
An October 15, 1997 article in USA Today, "Study finds medical care influenced by geography," reported that "Your doctor's choice of treatment for a range of diseases and even for care at the end of your life is influenced just as much by where you live as it is by any scientific criteria of what's best." While we chiropractors may smugly say, "So what's new?", the unassuming public is once again being mislead by unscrupulous M.D.s. For example, this report, based on data in The Dartmouth Atlas of Health Care, indicated that "residents of Fort Collins, Colo., Fort Myers, Fla., and Bend, Ore., were 23 to 4 times more likely to have risky surgery for chronic back pain than residents of Miami, Fla., Chicago and Lexington, Ky."
Combined with reports by some medical writers that 78% to 90% of all surgeries are unnecessary and 80% of all medications will be off the market within five years due to ineffectiveness or serious side-effects, the medical system is not only greedy and arbitrary, but moreover, it is highly ineffective. More striking is the fact that the United States ranks 22nd in life-expectancy in the western world. Apparently, we Americans aren't getting the bang for our health-care bucks! All the while, the medical professionals are laughing all the way to the bank, leaving a wake of disability and despair behind them.
An August 12, 1997 editorial in The Macon Telegraph newspaper, "For-profit hospital chain putting on a new face," mentioned that "Columbia's new management promises to apply the brakes to new acquisitions until it can initiate changes that do not create incentives for fraud and malpractice in the overzealous pursuit of efficiency." While this editorial spin sounds nice, I seriously question whether this hospital chain is seeking clinical efficiency or excessive profit in their operation. Perhaps the editors should have written, "overzealous pursuit of money" instead. Columbia remains the proverbial wolf in sheep's clothing, no matter what kindly spin the Macon editors may put on this tragic situation.
When even the New England Journal of Medicine coined a descript motto, "Squeeze care to expand profits," to depict the feelings of the growing HMO industry, something is terribly wrong in our health-care system. After decades of strangling the golden goose of health insurance by the medical professionals themselves, their dissent over the hospital and insurance administrators who now appear in competition for the health care dollars is nothing less than the proverbial pot calling the kettle black. Whether it's insurance companies or hospitals squeezing care to expand their profits, or medical doctors rendering unnecessary, ineffective and arbitrary care, the obvious conclusion by any objective bystander is simple: The medical system is very sick and costly.
While Columbia hospital executives give short TV sound-bytes proclaiming their sincere efforts to contain these rising health-care costs as they did on their August 11, 1997 "60 Minutes" segment with Mike Wallace, many people have trouble swallowing their PR pill. When it takes an act of Congress, forced by public outcry, to pass a bill to allow birthing women to stay one extra day overnight in hospital, something is terribly askew in the minds of these insurance administrators. When insurance companies gladly pay for ineffective back surgeries while excluding chiropractic care which has been proven to be quicker, safer and more effective, something is amiss in their supposed intention to bring the best of care to their patients. Their hypocrisy is obvious to any learned investigator of this apparent medical mess.
This is especially true for those elder chiropractors who have silently watched this medical mess develop into the catastrophic condition it is now. We have been tight-lipped, containing our suspicions as the medical monopoly marched on with their drugs and scalpels in hand, leaving a wake of disability and huge costs behind. While many ignored the pleas for President Clinton's Health Care Reform and call a change in the direction of our health care delivery system as it accelerated down this road of excessive pills and surgeries, the worst case scenario has now become reality--an over-medicated society, greedy, uncaring hospitals and patients subjected to mostly unnecessary, ineffective surgeries, all at an outrageous expense!
Compounding this medical mess is the unassuming public who are being railroaded into unnecessary medical procedures by ridicule and voodoo threats by unscrupulous doctors about the supposed dangers of "alternative" care. Moreover, blind faith among patients who fail to seek a second opinion or to question whatever treatment their MD prescribes only adds to these unnecessary services. At best, second opinions are rare and then are simply more "medical" opinions, not a true opinion from another school of "alternative" thought. God forbid that patients might be told about options to drugs and surgery that rest outside the medical world!
For example, in 1994 the Agency for Health Care Policy and Research (AHCPR), an agency of the US Public Health Service, issued a new guideline for acute low back pain in adults.1 This comprehensive, two-year study by 23 medical experts reviewing more than 4,000 articles from the Library of Congress concluded that proven methods for back pain included spinal manipulation and warned that "It should only be done by a professional with experience in manipulation." In fact, this expert panel also mentioned that "Surgery has been found to be helpful in only one in 100 cases of back pain."
Yet more back surgeries were performed last year than ever before! Apparently, the surgeons and hospitals have chosen to ignore this new guideline even though studies have shown that chiropractic spinal manipulative therapy is safer, cheaper, quicker and longer-lasting than anything the medical world has to offer. Again, profit seems to supersede giving patients a freedom of choice to solve their back pain problems with more cost and clinically-effective means.
Not only has fraud by hospitals and unnecessary treatments by physicians become commonplace in the American health care delivery system, the same groups can also be accused of blatant discrimination and segregation. In 1989, a Chicago federal court in an antitrust case (Wilk et al. v. AMA et al.) filed by a group of chiropractors in 1976 against the medical and hospital associations ruled in favor of the chiropractors. Basically, this federal court concluded that public hospitals cannot discriminate against chiropractors just because they are chiropractors. In fact, the court noted in its summation that while the medical professionals were criticizing chiropractic care, some of their own researchers had shown that spinal manipulation was more effective than the medical methods of drugs and surgery!
Despite this landmark ruling, not one chiropractor is on staff in any hospital in middle Georgia. When I applied to the local hospital in Warner Robins, I was rudely dismissed by the Hospital Board with their explanation which said, "A hospital is a place to practice medicine, and chiropractic is not medicine." (Just where did they get that definition?) The same research and expert testimony that convinced a federal court couldn't convince this kangaroo court. In effect, the Board violated the exact ruling by the federal court--that you can't discriminate against a chiropractor just because he is a chiropractor! But, as I was told off the record, "No yankee judge is going to tell us Southerners what to do!" Apparently "Jim Crow, MD," is still very much alive and working in middle Georgia!
Is the medical prejudice toward chiropractors any different than racism, sexism or any other form of bigotry? It seems that the medical professionals have lied to the public so much about chiropractors that they have now believe it themselves! Despite the AHCPR recommendations and a similar Canadian recommendation from the Ontario Ministry of Health (Manga Report 2 ) which endorses chiropractors as gatekeepers for all back problems, the medical boycott continues, fueled not by facts or research, but only by a bigoted attitude and a desire to monopolize the health-care marketplace.
For example, in a July 17, 1996 article in The Macon Telegraph, "No bones to pick," Macon internist Dr. William May typified this medical bias when he mentioned that "Their training is based on theories not taught to or believed by most physicians." How can anyone be for or against something that he admittedly knows nothing? If this doesn't characterize the closed-minded attitude of "Jim Crow, MD", what does? "Don't confuse me with the facts" seems to be the medical position about chiropractic.
Only in the sham marketplace of American health-care can this occur. Imagine if Delta Airlines took over Hartsfield Airport, kicked out all other airlines, raised ticket costs, defrauded the passengers and freight customers, and told untrue scare stories about their competitors! Of course, that could never happen in an open marketplace, but it happens daily in the sacrosanct world of medicine. In fact, the AMA appears to be the fourth branch of government but, in this case, they are unelected, self-serving and accountable to no other branch. Indeed, the AMA appears to be a monopoly, charges like a monopoly, and has the control of a monopoly. And we wonder why we have a Health Care Crisis without the market forces of free-enterprise at work? Go figure!
As a chiropractic practitioner, I am insulted by this medical bigotry in more ways than one. First of all, as a licensed health-care professional, I am insulted when an MD slanders my profession knowing full well the research doesn't support his "Jim Crow" attitude. As a consumer, I am insulted knowing that we are not given the freedom of choice that is vital in our free enterprise economy. As a patient, I am insulted when my medical insurance will gladly pay for an unnecessary back surgery, but discriminates against my profession because MDs control the insurance boards. And as a health-care provider, I am incensed when hospitals and surgeons railroad patients into expensive surgeries by excluding my professional service. As an American, I am infuriated when the medical monopolists control people with untrue voodoo scare stories intended to exploit naive, frightened patients into back surgeries that are effective in one in 100 cases according to the US Public Health Service report.
Let me ask: Why aren't chiropractors on the staff of every hospital? Knowing that 80-90% of all adults will suffer from a bout of acute low back pain which is the second-leading reason for visits to doctors and the third-leading reason for hospital admissions, why is the safest and cheapest form of care being excluded? Knowing that many auto accidents, sport injuries, bicycle falls, horse falls, etc., happen daily, why is this proven method for treating back pain not included or available in our hospitals? Could it be excluded for the very reasons chiropractic was praised by the researchers--that is, because it is cheaper, safer, quicker and longer-lasting? Indeed, the average back surgery case costs approximately $14,000 according to MetLife statistics, while some fusions and laminectomies are double or triple that amount. On the other hand, research has shown that for the same acute low back pain case, chiropractic care cost only $800.3 Obviously, the for-profit hospitals are less interested in offering inexpensive solutions when they can railroad patients into costly surgery instead.
This segregation of chiropractic from hospitals is nothing less than another form of fraud. Apparently to the medical monopolists, there are right ways and wrong ways to get well. To "Jim Crow, MD", the right ways are drugs and surgery, and the wrong ways are everything else--whether it's chiropractic, vitamin/mineral therapy, massage therapy, acupuncture, homeopathy, herbalism, or any of the "ounces of prevention." Apparently, our hospitals and medical professionals are only concerned about selling their "pound of cure" to the exclusion of all other forms of health-care, even though some other ways have been shown to work better.
Despite the continued medical boycott, the public is becoming more aware of "alternative" care. In 1993, David Eisenberg, MD, from Harvard Medical School, conducted an exhaustive poll 4 to determine which types of health-care providers Americans were using. To the surprise of everyone, his research discovered that Americans made more visits to non-MDs (425 million) than to MDs (388 million). Over one-third of Americans, mostly college-educated Baby Boomers, used non-MDs and paid as much money ($13 billion) for these services as were paid for all hospitalization costs during that same year.
This trend to "alternative" care providers has scared the medical profession to the extent that the AMA's House of Delegates passed a resolution this summer to warn the public about the so-called "hazards" of alternative care. Of course, this is just another attempt to scare the public with more voodoo stories. Ironically, in the case of spinal manipulative therapy, the rate of morbidity is 1-2 per million, while the medical equivalent of back surgery was 15,600 per million. Of course, I doubt that the AMA will warn the public about their own methods, which now are considered to be the third-leading cause of death in the country. Drugs and surgeries are renown for their side-effects, and for the AMA to wage a propaganda war on alternative health care is ludicrous, although it happens regularly. According to an article5 in USA Today by D. Levy, "Helping hospitals learn from tragic mistakes," the "annual toll of medical harm" is 1.3 million injuries, 180,000 deaths, $50 million total costs, and $14 billion in uncompensated costs. Just who is hurting whom? Obviously the AMA attack on alternative care is another smokescreen to conceal their own iatrogenic problems.
The double standard of the AMA is also well illustrated with their attack on chiropractic's safety record. Recently, for example, the Red Cross assured Americans that our blood supply was "extremely safe" from HIV infection, saying that the chance of contracting this virus was only 1-2 cases per million. But, when spinal manipulation is attributed with 1-2 cases of accidents per million, some MDs want to say chiropractic is dangerous! Meanwhile, over 3,000 people die every week from medical malpractice! This double standard exemplifies their bias toward any and all non-MD services. Again, there's right ways and wrong ways to get well--it depends upon who profits, or so it seems.
When Americans can finally see through the smokescreen of bigoted reasons the medical chauvinists have used for decades to dissuade patients from chiropractic care, then progress will be made. When patients demand a freedom to chose their own spinal care rather than blindly accepting the voodoo diagnosis of the back surgeon, then progress will come. When insurance companies realize the vast savings to be made by using chiropractic care instead of surgery, then progress will begin. When hospitals do the right thing rather than the most profitable, then real progress will happen.
Until then, "consumer beware" should be the motto of any patient entering the hospital with back or any health problems. Until then, "Jim Crow, MD" will continue to misinform, misdiagnose and mistreat the millions of back pain sufferers who could be helped with safe and effective chiropractic care. Until then, patients will be denied their freedom of choice in hospitals about their most important asset--their own bodies. Until then, medical fraud and discrimination will continue, costs will rise and more people will be denied proper health-care using the best technology available, even if it's chiropractic care.
1 Bigos, S et al. Acute Low Back Pain in Adults, Clinical Practice Guidelines No. 14. Public Health Service, U.S. Department of Health and Human Services, AHCPR Pub. No. 95-0642, Rockville, Md.: Dec. 1994.
2 Manga, P et al. "The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain." Ontario Ministry of Health, 1993.
3 Carey, TS et al., "The Outcomes and Costs of Care for Acute Low Back Pain among Patients seen by Primary Care Practitioners, Chiropractors, and Orthopedic Surgeons," NEJM, 333 (4).
4 Eisenberg, DM et al. "Unconventional Medicine in the United States, NEJM, 328 (4) (28 Jan. 1993): 246-252
5 Levy, D. Helping hospitals learn from tragic mistakes. USA Today, Nov. 5, 1996.