System seems to be working well for the Insurance Industry, but not so good for

 By Dr.Stojadin B. Naumovski, FMG MD, President AAMIS,Inc.

Association of American Medical Information Systems, Co-Founder

Inventor Developer and Implementer of Medical Information System EMRD

August 24, 2009 

Sterling Heights, Michigan/USA

  Here is my take on the proposed Health Care Reform

The statement: “System seems to be working well for the Insurance industry, but not so good for all the patients (and Americans)” is indeed not far from the truth.

If we were to listen to Mr. Dick Morris in order to reform the Health Care in USA we will need to”…cut either payment to doctors or for care of the elderly…”

In the first case, to paraphrase, he said that you get fewer doctors while in the second you get poor care. And, after all that is about the same in both cases.  On July 26^th on the Fox News, Mr. Morris was in fact advertising his book “The Catastrophe”.

I really think that he did just that: Advertise his book, and that’s it! There was no substance in his statements. He may have been contributor to the Clintonites, but I feel so was I with my suggestions about this very issue: Health Care. Their party preference was irrelevant for me then, and the same goes for the proponents of the Health care reform. So now I use my right to express my own opinion on this subject and rebuttal to Mr. Morris’s statements.  But my text should be more than just a response to political analyst’s well calculated statements expressed on the national television.

 "And so my fellow Americans, ask not what your country can do for you - ask what you can do for your country"… was the statement in the Inaugural address of John F. Kennedy.  But talking about arms he also said: "For only when our arms are sufficient beyond doubt can we be certain beyond doubt that they will never be employed."  The same goes for the Health Care and its use. Being the only science that is fighting the cause of its own existence, the future of Medicine and Health Care in USA can learn from President Kennedy’s statement about arms.

These are the words that are still ringing in my ears as I have been listening to the same in many occasions ever since I was I child back in my native Macedonia.  It is worth mentioning that In my family for the past cc. 100-150 years,   many of my ancestors have been traveling back and forth between USA and Macedonia (at first being enslaved by the Ottomans rule and lather by Greece, Bulgaria, Serbia, Albania...).

They were coming to USA healthy, passed strict health exams to be admitted in to the country, then (while health permitting) spent their adult and working lives in America.  When their health deteriorated and without access to a proper and usually expensive Health Care, by some unwritten rule they returned back to the native countryside to only spend the last years of their lives in peace, where they had local Health Care for free (or with just nominal co-pays) and to “end their lives with dignity” in their birth home, and to be berried in the same cemetery with their own ancestors, sometimes even in the same grave. By the strange game of the destiny, I was one of those who usually stayed last at the cemetery to fix up the grave.

They have all remained proud Macedonian American, the real ambassadors of the core Democratic Values we believe in and the love and respect for both the United State as the last hope of so many and for their motherland Macedonia as the final resting place, that love has never diminished trough many generations. For every new generation there was the reminder: First go to America than return to Macedonia. Nothing seems to have changed to the present days.

Except maybe in recent years

Here is illustration of what happens when immigrants come and stay.

Are we not aware of the multiple regional war conflicts, terrorism etc. that have created enormous influx of refugees and immigrants. For Macedonia the surge of refugees started with the NATO bombing of Yugoslavia and the demographic wave from Kosovo and Albania in to Macedonia.  I have promptly warned this will happen, I wrote warning letter to Senator Levin (I hope he remembers) but I guess it was irrelevant as in any other war that we started. It’s called “collateral damage”.

Scaled in to demographic invasion (350-450,000 mostly ethnic Albanian refugees from Kosovo have poured in to a country of at the time little more than 2 Million [not counting the ever-growing numerous Diaspora that was “not home”]. Outside of the fact that this influx of refugees created complete ethnic misbalance and in some areas complete reversal of the ethnic makeup rendering the indigenous Macedonians becoming real minority in some parts of the Country (even to present times) followed by violent demands for constitutional reform in Macedonia, it also created the situation where the government paid Health Care system in Macedonia could no longer carry on without reform of its own.

Significant changes were introduced in to the Health Care System; ranging from gradual privatization, decentralization etc…to closing of facilities, regional hospitals, divergence in the quality of care from one extreme to the other, co-pay not affordable for many, lack of medications, resources…In some institutions patients had to bring in their own forks, spoons, gowns…and even medications to the Hospital (if admitted), to total deterioration of Health Care System previously trusted and cherished. The reform is still on the way,[as is now days in most parts of the world, including even USA and even  China…] with plethora of foreign advisers paid for  by the government and by International Community with strings attached funds.

This new situation has created a challenge for the elderly Macedonian American: to go back with the tradition, or to stay in USA? At the same time, they qualify for Medicare and/or Medicaid offering them acceptable coverage for the Health Care costs. It appears no longer feasible to even travel overseas, the cost of airline ticket is too high, and on top of everything it is not safe to stay in the practically lawlessness area infested by terrorists, drugs running gangs etc. who are continuing the new style of unpunished ethnic cleansing and genocide of Macedonians (that appears to even have outside support system as well). Not to worry, Macedonian American who are recipients of Medicare/Medicaid System are only small minority. One may ask, what is the big picture in all this?

The number of those from other ethnic groups and regions who live in US and who fall in to this same category is many more times greater and  will need to be determined for the purpose of more precise planning the Health Care reform. The numbers may very significantly from area to area, as it is their distribution in United States, but the areas where they come from will range from the Balkans to Middle East, Africa...and of course next door Mexico, Another words - from everywhere where the misfortune has created hell.  Since the US Census does not address this very important data (it is not included in 2010 as well), the only option we are left with (and the quickest I guess) is to just make a cross section analysis of Medicaid (and maybe Medicare as well) recipients for their ethnic origin and native languages spoken and the big picture will become quite clear. I think the Medicaid data would give us better picture.

Health Care and Immigration

As in our previous example in the Republic of Macedonia, here in United States we have similar immigration challenge of our own. And the burden on the American Health Care for the H.C. services to illegal immigrants is even greater. Isn’t the previous example good reminder of what is at stake here and now in the Health Care Reform Bill? Since we will end up paying for it any way, don’t you think we should amend the US Census 2010 forms with few more questions such as one’s ethnicity (After  it is publicly redefined to reflect the meaning of the word ethnicity it  self, and not as a racial denominator?  I believe it will help the Health Care Planning and Patient care over all, but in other areas of our society as well where the diversity will be recognized as a core value and an asset, instead of being treated as liability. The data will be also useful for planning of this segment of the health care and for introduction of Public Health Clinics with broadened spectrum of services in addition to the free preventive vaccination etc. already available.

The beginnings of the Health Care reform (e.g. HIPAA etc.)

I wrote nice letter to the first lady Hillary Clinton almost ten years ago expressing my concerns and included were some suggestions of what I felt was needed in order to set the tone for positive change and improvements in the Health Care field altogether.

To guarantee the right of the patients to access their own medical records so they can then make an informed decision in making the choice of their own doctors, the ultimate right of every patient in the World and certainly in USA as well, was only to start with. 

How will the patients know who did what for them in the past without having access to their own Medical Records? How will the patient give Informed Consent and agree for treatment without access to the Medical Records and other relevant information? This was in part accomplished by the legislation that I believe my letter was part of the trigger for- HIPAA (Heath Information Portability and Accessibility Act that was ultimately signed in to Law by President Clinton in December 2000; no less does  Sen. Hillary Clinton, then The First Lady, deserve my gratitude for her part in preparation of that legislation.)

Well, the access to medical records and free choice of one’s doctor was the first thing I suggested in my letter. Mrs. Hillary Clinton, I felt had sincere interest in the issue of Health Care Reform and improvement in this very important segment for the society. So, in 2000, HIPAA have us the access to the Medical Records only and also gave us confidentiality protection. What happened with the free choice of one’s Doctor, Hospital…? This time more remains to be done.

Free Choice of your Doctor and Hospital

The same way again I am writing this with proposal to uphold and include in the reform the very basic principles and ultimate rights of the patients worldwide, including in America.

Free choice of one’s Doctors is the ultimate right of every individual [and patient]. It should include not only unrestricted choice of the Doctor but not restricted choice of the Hospital (the institution) as well. Of course on the same note we may mention special situations where that may not be the case only in certain medical conditions when taking the patient to the nearest hospital would have saved his life. But even then it should be with patients previous designation of choice (or if incapacitated by the choice of his designee) and the fulfilled usual “informed consent”.

The Free Market Economy and the Health Care

Looking at the Health Care in the society that is declared to stand for the principles of Free Market Economy opens the question of “leveling the playing field”,  antitrust laws and regulations etc.

But there is another very important issue at stake: how will the patient make informed choice without knowing who did and what for him so far? The HIPAA is guarantying patient’s access of the personal Medical Records and also protects one’s privacy, but there is no organized (or visibly so) system or institutions willing to provide that access, or third party services and providers of the Electronic Medical Records access for the patients, that will do that for nominal fee. Attorneys for example are usually paying (and charging it to the client, who is or was a patient) large sums of money to obtain rendered and assembled copy of clients Medical Records for litigation purposes. Often these moneys are from The  Disability Administration or from the Insurance Company that instead in to the patients pocket end up being collateral cost of doing business for a “drone” company dealing with(or associated with) the Attorney’s office. The cost for copy of EMRD records should be nominal, and if you want paid by the HMO (in light of the savings it can generate on readmission, savings in ordering repeat tests etc., or provided at no cost by the provider of the health care services, especially since if properly organized and implemented its cost would be only a fraction of the operating cost, and let’s not forget the benefit of time saving when the same patient returns for service.

From my own experience (as VP and COO of AAMIS) having  personally  developed and implemented  the pilot  programs in cooperation with two major Hospitals and Health Care providers in Detroit Metropolitan Area and my associates (Dr. Ali Kafi and Dr. Reza Dabir, both prominent Cardiovascular Surgeons) who’s support in cutting the “red tape” was also instrumental  for success of the programs), I can only applaud the latest announcement for the 1.2 Billion for Health Care Records Technology ; but I am asking will this include the needed support for my program for EMRD that included  the kind of  Personal   Medical Folder of Queued Medical Files (very easy to access, brows trough  and understand by the patients) that so far I personally  delivered  to many delighted  patients? Needless to say, these patients by the way were even willing to pay the nominal cost of the disk/disc themselves?

In addition, I must add,  no patient (to my knowledge so far) who received one of these “disk/disc” [or other media of delivery, including one’s  PC, Digital Phone (several models of Sprint PC Phones successfully tested] had ever complained about the care received.

 Instead of complaining, they were rather bragging about the care received by their Doctors and Hospitals.  It is interesting to note that the Hospitals (St.John Hospital and Medical Center- Detroit and Oakwood Hospital and Medical Centers –Dearborn [both in Michigan] that were  involved in this pilot program were also in the top 100 US Hospitals for Cardiac Surgery Care for the life of the program. One of the Hospitals was visited by then First Lady Hillary Clinton. At that time the Hospital had functioning special H&P Admit Program run by the Residents and FMG MD’s who were building the first cornerstone file of the new database  immediately available to the consulting physicians, lather to be accessed and interfaced by the EMRD program. 

The impact of “the disk/disc” was very positive as I suggested in the beginning of the program originally started exclusively (with few exceptions) in the Cardiovascular Surgery field where patients usually were making the choice of the doctor and institution they trusted for the complex and risky upcoming surgery. At the same time the EMRD become a useful teaching tool in pre-operative preparation and post-operative management of the cardiovascular patients.

The names of Cardiac Surgeons who’s patients received this kind of Electronic Medical Folders (along with Cardiac Catheterization videos, admit notes, lab results, consults etc.) are from the very top in this extremely competitive ( and costly) medical field, and I will fill free to add most of them as the endorsement of this EMRD approach.

The interest for EMRD was not limited to US. I have met with Prof.Dr. Kenneth Taylor, who is the leading authority from the British Royal College of Cardiovascular Surgery. He visited Detroit for his research presentation at St.John Hospital about new discoveries in Cardiovascular Surgery field. He was most impressed with the ideas and usefulness of the EMRD program. Soon after that Great Britain introduced nationwide medical records computer system (announced on BBC World News 24 on December 16, 2006).

As a Macedonian American, I cannot but point out that even relatively small countries such as The Republic of Macedonia had Doctors like  Academic Dr. Zhan Mitrev, whom I know personally  since he was a Medical Student; who  after having circled the World, returned to Macedonia and more or less single handedly pioneered the innovative Medicine in his country. He had developed Cardiovascular Surgery Center equipped with the latest technology that is EMRD friendly. He was named Academic by the World University “Plato” Academy.  It was recognition of   the real core values in the Macedonian Doctor, Who is Director of the Hospital “Philip II” (the name of Alexander of Macedon’s father). This was perfect example that the real values cannot be denied and indeed belong to all of humanity.  While introducing noninvasive 3D –Angiography and other state of the art procedures, Dr.Mitrev’s private Medical Center is sharing all the available data with its patients. Just a reminder Macedonia does not have HIPAA yet and is going trough debate on reform of the Health Care of their own in several segments of the HC field. All this is done with involvement from outside help in part paid for by the government of Macedonia, and with support by funds from the International Community and Macedonian Diaspora, as well as several initiatives by the World Medical Relief, Inc. All this has enlightened   the Macedonia Doctors and medical professionals and encouraged them to follow the professional track of American Medicine and to use the available innovations in the field.

I was asking myself: Why not US? If British can do it, Macedonians are struggling to do it, why not us, why not here in USA?  The answer was simple but also complex. Because we needed reform of the Health Care System that is bigger and more complex than any other in the world, with more control by the HMO’s  and with many states and as many State Laws, rules, regulations…So I was waiting for the real reform momentum.

Now that everyone is talking about the reform I would like to give my sincere and modest impute, hoping this time it will really be heard (and read) by those interested in real improvement of the Health Care, especially by our Representatives in the US Congress, our US Senators, President Obama an Vice President Joe Biden and their advisory team. No less I hope that this text   will see the daylight for my fellows American.

 The First Hurtle is behind

Going back to HIPPA, the legislation protected patient’s privacy and guaranteed the patients right to access their own medical records. Even if it did not spell out the format and mode of delivery, the patients had the right and opportunity to see for the first time own medical records (excluding the Federal Privacy Act of 1974 (5 USC sec. 552a, http://www.usdoj.gov/opcl/privacyact1974.htm about accessing one’s Medical Records in possession by the Federal Government  and excluding Medical Information Bureau – (MIB)- central database of medical information shared by insurance companies usually not accessible by the individual himself… Ups! Don’t forget that MIB is not subject to HIPAA!?). So what is really happening and who can see what, who controls what about one’s Health and Health Care?  So Banks have “Credit reports and scores”, Insurances and HMO’s have Medical Information Bureau and codes (scores to). Only Doctors, Hospitals and other Health Providers, and patients  do not have centralized and organized system(or visibly so) to access not only information that will help improve and advance the field of Medicine while saving  money for the Health Care, but often life saving information. Where does it end?

So this was the first hurtle [ very big one I will add] that has been overcome, a very big step in the Health Care Reform that was  all of a sudden perceived as real revolution of the system. There was even open opposition and resistance (by some) to the very idea that patients will receive digital folder with Queued Medical Files including Operative Reports, Consults, H&P’s, Radiology Reports,  X-Ray Reports and  even films, Cardiac Catheterization videos and reports, MRI video files, Discharge Summaries, Medications, Allergies… EMRD at a glance, queued and sorted out, easy to access and understand, to browse trough as if you have just visited your own Health Web Site.

Patients were delighted. Doctors had only one choice, to make sure they do it right and to correctly dictate the findings, to describe every step in the surgery etc. I believe this has already resulted in improved patients care, to a degree of mutual confidence and trust between the patient and the care provider; something that was needed so bad in the field. But now this will need to be seen all over the Health Care field.

Patients were able to understand and to comprehend the procedures and to appreciate the new mutual relationship that was indeed definitely reshaping the Health Care they were receiving. With this first step the process was only started and will only improve in the future. It was great pleasure to be part of the positive change, to be able to participate in shaping of the future of Health Care. This filling should be the right of all and not the privilege of the few, therefore the reform should be broadened as much as it is possible, and to definitely include the patients, Electronic Medical Records Disc, Digital Medical File, Queued Medical Files.

 The Medical Records Browser that I have advocated for many years and in today’s day and age should be just another Internet Browser.  The Queued Medical Files, Electronic/Digital Medical Records patients had received trough AAMIS, (as I initially promised) were indeed accessible by every browser, even by pc phone’s explorer!

Opening the HMO’s “iron curtain”

HMO lines and boundaries, the lists of providers, these are but the equivalent of the “iron curtain” for the patients in the Health Care field.  If USA could crack and open “the iron curtain” between Western and Eastern Europe, why not open the HMO “iron curtain” that separates Doctors from patients? 

The next step in the reform, in addition of the access to one’s medical records, should be another guaranteed right; that is to choose the Doctor across the HMO lines, to choose the Hospital across the HMO boundaries.

Once licensed, the M.D.’s, D.O.’s and alike, as well as other Health Care Providers should be granted access to the patients trough guaranteed right of the Patient to chose their own Doctor. The same goes for the Hospital or other Health Care provider. And that is not all; it should also be open on a national level. That is free market economy with even playing field for all. Let the quality of care decide, let the patients choice decide who will run the future of the Health Care in America, what direction we move in.

Not to mix Credit Check companies in to this, but one will a priori recognize the discrepancy.  Mortgage industry and Banks, creditors… they have free choice of Bank and Mortgage broker/banker …they have “Free credit report.com”. It is the HIB of the Bankers world. This is part of the problem wile acting as if it was part of the solution. They also got the federal dollars to even continue to do the same. Instead of using the appraisals and the equity as factors in calculating one’s risk and mortgage (loan) interest , the credit report’s score approach was the factor that started the vicious cycle that got us so deep in that neck of the woods. Look at all their commercials on TV. They must do good business if they could afford such exposure.  Health Care Field and the patients do not have “Free Medical Records.com”, they do not have control of the choice, no ability of scrutinizing the same for the risks they are facing, no tool to begin with. The HMO’s have it all instead. For long and lasting success of the reform, reshaping and restructuring of these relationships in the society has to be part of the goal of the Health Care Reform. Hospitals and Doctors never collect more than 65% of the dollar they worked for. The rest of it goes to discounting account receivables to banks in order to receive some of the own payroll deduction money back via the Bank and its associates pictured as collectors, credit reporters etc. Let’s not forget where the Bank got the chunk of the money from [it happened recently].

Are the Doctors and Hospitals to become “licensed collectors”? Is that what the Health Care in America should continue to be like?

Patients who chose their own Doctor, and who know what the Doctor and Hospital did for them do not doge the payments, they often gift even entire inheritance to the Hospital [of their choice]. Examples are many and the illustration for it is the growing number of donations by individual patients for Hospitals, the waiting lists for volunteering etc. That is only possible in communities where Hospitals and Doctors, (as well as other staff) have created the mutual relationship with patients, one that is of appreciation and mutual understanding and sacrifice; respect for one another based on known facts and documented heroism by the Medical Professionals and the Hospitals they are all part of.  I will welcome anyone who wants to challenge this statement.

Federal M.D. License and the Primary Care in the Medical Field

Restructuring the medical practice all together, with introduction of House Officers with Primary Care Physicians in the forefront, admission services etc, with minimum licensing requirements (e.g. Florida, California -one year Residency v.s. current 3-5 years of residency in various specialty fields nationwide, rendering the residents equal to minimally paid and exploited “sweat shop” employees, and all in order to cover the financial gaps described above in the text. Entire research studies have been conducted covering the stress of the Residents [Doctors]. There were even documented stress related suicides of Residents. Let’s not forget the medical community has to be part of this reform as well. The debate has to include this portion of the reform and to include primary and preventive care, national licensing, opening HMO lines, simplifying hospital credentialing etc. We must find proper “use” for the tens of thousands of Foreign Medical Graduates (foreign doctors waiting for licensing in US) who are presently holding odd jobs outside of the medical field  and are struggling to get “match” in the notorious  Residency Matching Program. This is happening while the rural America does not have primary health care available. The same goes for the US Medical Graduates who are loaded with student loans and debts and whose salary as a Residents Physician does not cover even their basic needs. Are we talking about the divine profession of Medicine here? Are we talking of the pressure brought about by the Hippocratic Oath?

Finding solutions for the Incomplete Chart Room

Guaranteed  cash flow payments in piece mill fission and eliminating of the “Incomplete chart room account receivables” based on missing “face sheet”, “Discharge Summary”…where HMO’s are not paying any  of the charges for months (if not for years). This is hurting the Hospital finances and its ability to remain in normal operation. Many local and community Hospitals were closed.

Payments should be made for services rendered “as it goes” and not after waiting for months for completion of entire   paper charts. Time is money is it not? Electronic/Digital Medical Records are verifiable form of records that should be compensated without delay. The current systems varies from one to the other extreme, may be based on outcomes, HMO’s impose limitations of hospital stays …so the patient care is not the paramount interest of the HMO. The Hospitals and the Doctors are faced with sacrifice of the financial compensation in order to secure the patients well being or sometimes maybe (?) vice versa. Medical professionals in most cases (if not in all) are on the patient’s side, while the hospital administrators are faced with their own hurtle how to keep the Hospital (or Doctors practice) financially viable.

Primary care federal M.D. license will give a chance not only to the young Doctors who will be our Health Care in the near future; it will also improve their standard of living while being in Residency Programs. Those Programs   can also be modified to allow the practicing primary care Doctors to continue their education and specialize in the field of their choice same way as   the” no worker left behind” program did for the blue collar workers. 

This should definitely bring improvement. The change in the reform has to address this issue while having the patients on its side as determining factor of who gets what from the Federal health Care Stimulus Package in the reform (at list this time, if the home owners could not influence the flow of the federal funds to the Mortgage industry last time, and most still did not have modified the interest rates and home loans; unfortunately some have even lost their homes!).

The patients should be able to decide by their own choice across the field who will receive compensation for their Health Care, the same way as they will determine the car dealers who will get the money for the “junk cars” in the “cash for crunch” program.

Searchable Electronic/Digital Medical Records

The additional benefit of having the searchable format of Queued Files of Electronic Medical Records that is easy to access and interface via Information Superhighway and the Internet Servers gives the ability for scientific advancements in Medicine, for research and strategic statistical analysis, as well as planning of the Health Care in general, e.g. risk groups, vaccines, medications, staffing, preventive health care programs, prophylaxis etc.  Just think of the recent H1N1 virus outbreak and pandemic. Patients can see at any time who did what for them, Rx Medications, Allergies, Results etc. as well as subsequently to make the choice of the Doctor, institution, HMO plan etc.

The Health Care Joint Commission from Lansing inspecting the Medical Records system and files at St. John Hospital was impressed of the quality and organization of the same. It will also be fair to state that St. John Hospital was among the first to test touch screen tablets for RN notes input at patient room level more than 15 years ago and it should not be surprising that the management of the Hospital and the Doctors supported the EMRD (developed by me for AAMIS) that was promoted simultaneous with the HIPAA legislation back in year 2000, same day articles about both appeared in Detroit News and Free Press in December 2000.(Web Link)

The simplicity of the browsing through EMRD was proven one more time at the presentation for high executive of Blue Cross/Blue Shield who claimed he is ignorant in computers, but had no difficulty browsing the files stored on a Floppy Disk. His excitement was short since he soon realized what this kind of records will mean for the HMO’s -no more withholding payments for incomplete chart room cases, even though the estimated savings of 8-10 hours on readmission would have accounted in to several hundreds of dollars for each admission. Should we call those files “toxic assets” for the HMO’s or should we call them “hidden assets” for the Hospitals? It will depend which side one is on.

The excitement for the program was also expressed by [then] Director of Residency Programs Dr. Steven Minnick. He was also well informed of the upcoming Bluetooth technology and the new portable PC’s, such as today’s PC phones and PDR’s.

Again about Mr. Morris, because the substance counts

Mr. Morris whom I mentioned at the very beginning is not talking (and not only Mr. Morris) of the Insurance and HMO schemes. Even the so called “critics” of the proposed new Health Care Bill by President Obama is abstaining from opening the debate on the core substance of the HMO’s operations and Health insurance options that are being jiggled with. Why is that so?

Well, I think it has a lot to do with the reform being “Insurance based” and not principle based. If the reform introduces “private counseling about end of life with dignity” with one’s doctor, then an open question is: Who is the Doctor and who is making the choice? Is that the Doctor on the list of providers contracted by the Insurance or HMO’s (or Government Pool respectively), or is that a Doctor the patient chooses out of the pool of all physicians in USA who are licensed with “National License” for all states? So far the answer is NO for both. 

This breaches the first principle of choosing one’s own Doctor and must not pass as is! At this time I will not even get involved in discussions or speculations as to the content of that “counseling”.

The experience of Dr. Burzinsky from Texas is still fresh. Dr. Burzynski is one of the pioneers in alternative cancer research, known worldwide for discovering Antineoplastons. Antineoplaston Therapy targets cancer cells without destroying normal cells. If I recall correctly, he was Doctor Oncologist who was accused of practicing in Texas on patients from Michigan. I remember then of signing the Petition along with many others nationwide, to release the Doctor from all these claims and accusations.

The memory is still fresh of the patient that I had the privilege to do and H&P for (as a part of the H&P Service at Detroit’s St. John Hospital Oncology floor). It was H&P of patient who returned to Michigan 5-6 years after initially being diagnosed with malignant tumor of the Brain, staged for tumor and given 6 months to live. From my recollection the information that was provided by the husband and a friend who happened to be a nurse, she went down to Texas on her own to see and be treated by Dr. Burzinsky. She was returning after so long with some CNS deficiencies but communicative and still in over all good shape.  There are more cases to quote, sufficient to write a bestseller book on this issue.

Here is another one, this time nothing to do with Dr.Burzinsky: Nurse with fourth stage Cancer of the Breast. She was given 6 months to live. After contacting Seattle’s Fred Hutchinson Cancer Research Center for possible Bonne Morrow transplant (they have Nobel Prize Winners for Medicine for Bone Morrow transplant) and informed that procedure cost was estimated at $350,000 dollars [not covered by the HMO], solution was found easy: Doctor from Seattle came to Detroit and the procedure of bone morrow transplantation was done at Henry Ford Hospital (after at first bone marrow was obtained,  and then surgical, Radiation and Chemo Therapy completed). The Hospital cost to my knowledge was not more than $ 50,000 and was covered by the Health Plan. I do not think the Doctors even charged for the services.

Here is another one: Patient with diffuse (100%) blockages of the Coronary arteries was pronounced inoperable and was in desperation counting his days in one Hospital (maybe perfect candidate for “end of life consultation with his doctor” that he did not have- from the currently proposed health reform), but after second opinion in another Hospital, after repeating the catheterization to view the coronaries (because previous Hospital denied  the Catheterization  films, EMRD was still not available at that time), after subsequent  surgery with extensive endarterectomy  using the Mills technique  by  very prominent Cardiovascular Surgeon, patient was doing fine and has sent me a thank you note month or so later. 

But alas, after the happy end and the “miracle from the 7^th street”, In subsequent admission to the Hospital , while limited previous  information was available for this patient who then had symptoms  that  warranted procedure he was taken to Cardiac Catheterization Lab. for the procedure that would have maybe even been contraindicated  under the circumstances. So this new procedure ultimately had “killed” the patient. Here we have buried the unintentional mistake of one along with the heroism of the previous doctor. It was an ethnic patient with recognizable last name. To my knowledge no one has contested, complained or sued!

This was before the EMRD was really available to the patient and the disk/disc that patient would have brought in ER, or the staff simply would have accessed on the Intranet Web Server… had it been available the EMRD would have not only saved this patients life but would have also documented the state of the art procedure by the surgeon.

Should I continue with the case where the best friend of the patient (Doctor from another Hospital) was physically removed from the room of his best friend because “he did not have privileges in this hospital”, transfer to another hospital was denied by the attending neurosurgeon, even when the other Hospital’s Neurosurgeon was willing to arrange the transfer of the patient. The organ harvesting organization was matriculate in obtaining authorization by the wife to obtain the organs wile convincing the wife not to go along with the transfer to the other Hospital ; no other doctor by the Hospital  No 1. was there at this time, just the nursing staff and “the organ harvesting  canvasser”.  To make the long story short, the patient ended up dying. At the time of communication for transfer to Hospital #2 the hospital chart of the patient was empty, the only note was written on a napkin. Again, it was an ethnic patient with recognizable last name. The wife did not have the chance to have counseling by her Doctor about the “end of life with dignity”, this was rather done by organ harvesting team. Ultimately year and a half later not being able to cope with the new reality she also committed suicide and left three children orphans. Earlier while the patient was still alive, the State Attorney General’s office was contacted and criminal investigation of the Hospital was requested by the friend Doctor via Attorney General’s office should the patient end up dying. “No criminal wrong doing” was found. This was a perfect example of the Organ for transplant harvesting/canvassing system that was way more effective (federally funded I suppose?) then the Health Care system that suppose to save one’s life.

I have another case for you. This time it was organ recipient in a Liver transplant case. After being brought to the very end from bleeding after multiple teeth extractions by Oral Surgeon patient with already known case of chronic Hepatitis, a known heavy bleeder was treated in office and released home (we could easily assume because of the cost). After the procedure the Oral Surgeon went on vacation. Subsequently, patient lost too much blood. He called a relative (who happened to be Doctor) , he was urgently taken to local Hospital and was saved in the last minute with blood transfusion that literally was started at the ER door of the Hospital. However month or so lather he needed Liver transplant because the damage to his liver from the blood loss was so grave that he would have died without the organ transplant. His surgery was performed in top of the line institution, by top of the line Surgeon. After all that was done he was not given HBIG preoperatively, intra operatively and postoperatively to prevent Hepatitis of the graft. [High titer hepatitis B immunoglobulin (HBIG) has significantly reduced the recurrence of hepatitis B virus (HBV) infection after liver transplantation]. It was not available. Patient ended up dying some six weeks later in the Hospital where he had the transplant done, after initially had uneventful surgery and postoperative recovery and was happy again, at list for a while... All the support was there for the family including the “end of life counseling”. It was not until they were told the truth about the HBIG that they made the decision. The family said goodbye to the loved one who was conscious but was “sedated” for “Comfort care” as directed by the family, at which point he closed his eyes for the last time.

Organ was there, the best surgeons and the best hospital… but there was no HBIG! Was it the dollars issue? What was the procedure and hospitalization cost after all? One can guess. It was all covered by Health Insurance, Medicaid…?

There is another case whose son was a doctor. The son arranged the liver transplant more than ten years ago. The father is still alive and doing fine. But the son is dead. He was killed in his own house, while the family was away. It appears that his partners were killed to! The investigation is still on; I suppose it was not even mentioned in the evening news!?

He was prominent MRI center owner. His MRI center favor (at no cost MRI to a man without HMO approval) intercepted a major medical mistake. The patient was suppose to have surgery for supposedly Cancer of the Pancreas followed by chemotherapy, Radiation and what not…No open diagnostic or invasive procedures were performed, no biopsy. The Surgeon, needless to say was not chosen by the patient, it was from the HMO list of providers.

This patient came to his friend Doctor for free advice, and to share the grave prognosis he received. But his friend Doctor did not agree with the surgeon’s action plan. He has also learned that there was no “counseling on end of life with dignity “options either. Patient did not speak English either! “No informed consent”.  It was friend to a friend talk, the Doctor did not think there was anything wrong with the patient, and he was right!  Medical records were obtained and compiled, all led in to that same direction. The ultimate test was the 3D-MRI at the MRI center. Radiologists from famous national medical center read the results (for FREE) and cleared the fog, no cancer or other abnormality!

The patient walked away with clear bill of health (and is still doing fine). He later apologized to the surgeon for not showing up for the surgery!
Another case: It is the case of nonsmoking otherwise previously healthy 50+ old soccer player from Eastern Europe who won a Green Card on a INS lottery.  He was only working in a “new capacity” about a year or so as a welder. He experienced sudden onset of symptoms that ultimately in few days was diagnosed as very aggressive Non-Small Cell Cancer of the Lung.  He was referred to the HMO’s Oncologist in a “second class” community Hospital. He did not have a choice of Doctor or Hospital! The Doctor was an “anonymous” Oncologist who was on the HMO’s providers list.  What happened? Well, patient received his first chemo therapy and three days lather when he felt sick reported to his oncologist and was referred for admission to the hospital. At the hospital, despite all the symptoms he had, patient was left unattended, fell from the bed and bleed internally to death.  His wife was the only relative he had in US. The only son, high school kid, was back in the old country. This patient and Eastern Orthodox, was going to be buried with the help of some ad hock gathered compatriots and by Adventist priest, without a cross and without the word from the Bible. It is worth to note that only few days before his chemo (and ultimately before he died) he was asked, [along with the wife and friend Doctor], to live local franchise restaurant “because the Manager needed the table” while six other tables were unattended. It was obvious that the party of three did not speak English among themselves! Complaint was filed with the State Attorney General’s office Civil Rights Commission that lead to apology by the franchise’s attorneys and assurance that ethnic tolerance training program will be implemented for the franchise employees. No monetary damages were requested by the complaint filer.

Any comment?  Is comment needed at all?

The availability of the records can save one’s life.  It sounds not believable?  It is all true, and I can assure you there is more where this came from.

So how do people feel about the reform? Good and not so good at the same time.

Basic principles of accessing own medical records (legislation is already available-HIPAA) choosing one’s doctor, institution, options, making sure the doctor of choice gets paid…open HMO lines, federal licensing… all this should precede any other discussions about the Health Care reform. In my opinion, then and only then will the general public listen carefully?

Otherwise, the reform is turning in to “giving the perpetual control over the Health Care and the Health Care dollars”, that are being turned over to the HMO’s (who’s partner becomes the Government). It appears the same as in the Mortgage and Banking industry, same as with recent bail out of the automotive industry. Now, after so many years we finally see President’s plans such as federal dollars for old cars (“CASH FOR CLUNKERS”), something that Germany for instance had for years, Germans were buying new car every other year and got tax incentives for it. After all it is never late for good things to happen, right?

While we made countries in Eastern Europe privatize their  resources for half a penny on the dollar, rendering them bankrupt, forced to sell out to neocolonial business ventures and even plain schemes by  interest groups, here in USA we have partially nationalized the Banking, Mortgage, Automotive industry…where is the end?  I am not totally against it, don’t get me wrong, but we could not continue with the same rhetoric and expect the respect of our friends in that region.

I understand it is foreign policy issue, but we need to improve on that front to. We can afford College books copyrighted 2008 and published by US publishers to have content contradicting the official US policy, or openly state lies instead of facts. We cannot afford a map in such a book having written Albania over the territory of Republic of Macedonia and therefore making it neighbor with Bulgaria. If it is just error, it should be corrected, but when the book content about the related region is in sync with the previous mistakes in the same book it becomes pattern.

The volatile Balkan can’t take those mistakes. It will resonate dissonantly with our friends and allies. Our diplomats were thought by the same authors, that are a shame, and yes we look ridiculous. Yes I know it has nothing to do with the Health Care reform, but is also a “mental health issue”. Either is this a case of Pseudologia Fantastica –Munchausen’s Syndrome (the liar believes his own lies), or it is maybe something else, lobbying and changing History for interest groups, but in any case it is not normal, not healthy and need to be cured [so it becomes Health Care problem]. Having the PhD next to one’s name does not guarantee the right to abuse the confidence by the society. Does the author have regular annual physical, or maybe HMO does not approve of one that often? We do remember very violent actions by some, are we not? In the past we also know of individual scientist being mentally ill but regardless they were receiving Nobel prizes for science, but certainly it was not for books like one I described above. This is only a symptom that something is wrong there. Do you see my point? We do require D.O.T. Physical exam, drug testing for Truck Drivers, and D.O.T. even proposed special license/certificate for M.D.’s and alike to be qualified for performing those exams. How about the rest of the society, who will “intercept” and diagnose the abnormalities in those without Health Insurance?

About the Pharmaceutical Industry and Medications

The facts about pharmaceuticals are widely available, about medications to. Just visit the Internet. So why are we keeping our selves in the dark?

We did not touch the issue of medications and the Pharmaceutical industry that is inseparable part of the Health Care.  Questions such as why we do not have access to list of medications that are already in use worldwide and would have resulted in saving lives and cost of care as well is long. Registration of medications trough FDA is long process controlled by the big fish.  That segment of the Health Care needs reform as well. We need legislation for the right of the patients to use medicine that thy choose even if it’s coming from abroad, same way as we allow other countries to use our medications [in many cases our pharmaceutical industry imposes the conditions and dictates who does what in the Medical field not just here, but in other countries as well].

Many good medications are available (and some are even made in relatively small countries like Macedonia) but the same medications are not available in USA. Why? It is business, that’s why. Well the reform needs to address this issue as well. How to get the best and list expensive drugs for our patients?

Here are some interesting examples. Prior to the war on (and the bombing of) Yugoslavia, the Galenika Pharmaceutical Company from Belgrade was the supplier for the large portion of the US needs for Compazine (Prochlorperazine) at low cost. [it was antiemetic medicine, largely used in oncology for the control of side effects in patients treated with chemotherapy]. The war in Yugoslavia has changed that. Then, overnight much more expensive Zofran become the drug of choice and still is. I did not calculate the over all increase in the cost of care for these group of patients alone, but there were lots of discussions in the debate on the Health Care Reform and the cost of care for the terminally ill. There was even proposal for “…end of life with dignity counseling…” as a cost saving measure?!

Or another miracle drug, Renascin (Tocopherol Nicotinate) that is combination of Vitamin E and Nicothinic Acid, made in Germany since 1961, license was sold to Yugoslavia (Farmakos – Prizren/Kosovo and Metohija).  Among the first to be bombed by NATO in Yugoslavia was Farmakos in Prizren!?  Why? Does General Clark have an explanation how did this happen?  This medicine alone could have made huge difference in everyone’s life. Its action on the vascular (and micro vascular level are indeed miraculous).  Just think of the impact on the CAD(Coronary Artery Disease), PVD (Peripheral Vascular Disease), or about many conditions related to the poor vascular circulation in the brain, etc.

Are we not allowed to talk about science and medicine unless is US Made and approved first? Some have asked why not importing medications from Canada? There are medications listed in the Martindale’s Pharmacopoeia that are not listed in the PDR, same goes for Merck Index and other facultative Pharmaceutical literature. How are we going to explain to the American patients who controls (and intends to continue to do so) their health and Health Care system as well (among other things in their mortal lives)?

Wydase (highly purified Hyaluronidaze) approved in US for front chamber Glaucoma prevention after Eye surgery (Cataract etc.) In England they have made Widase for treatment of MI. It would not be strange if you compare the statistics with Streptokinase, Urokinaze, and the more expensive TPA, but to do the job the either of the three need to be used within two(2) hours of the MI. Interestingly  Wydase will do the same even within twelve (12) hours. That is very significant. The implications are apparent. Many will recognize this as “why sell Corona if Miller Light is selling well”. Not to joke with the “beer summit”, but maybe we ought to have “medications summits” and discuss the issues. J

Another medicine Lasonil (note: not the same with Lasonil N) is Heparinoid plus Hyauluronidaze as ointment for local application in contusions, injuries, peripheral vascular problems. It is with effects hardly matched by anything else.  Not available in US, and lately even hard to get even in Europe. I do not remind you of the Betaseron lottery era for treatment of M.S. France then refused to use this medication and to “put its citizen on lottery as it did USA”.  But I plead with you; we should do everything in our power for this not to happen again.

Jack Drewfuss Fondation even dedicated and published two books on the Phenitoin and its multiple applications vs. the FDA approval for its use.

The list goes on ad nauseum.

As a reminder, Mr.Morris will have to get the HMO’s and the Pharmaceutical industry included in his future rhetoric when he comes back on Fox News, and certainly be happy when HMO’s instead of the word “Catastrophe” (the title of his new book) are included in Washington Post’s vocabulary.

How to fix this mess?

Well I could suggest few things that can get the real reform started and well on the way without spending even one dollar of federal money. My approach will result in instant savings of significant portion of what is currently being spent for Health Care cost.

First of all I suggest is that all Hospitals and Doctors allow   “Free access to EMRD/ Medical Records for all patients”. Let’s start with all V.A. patients.  Let’s reverse the old belief that VA provides bad services for its patients. From what I know, V.A. has the best EMR so far. It only remains to be interfaced and distributed in the same (or similar) format that I have developed as EMRD for AAMIS in the two Hospitals. Let’s make the same available for Medicare, Medicaid, SS Disability cases…

The benefits are so obvious.  We will level   the playing field for all who receive Government payment for Health Care services, we will also have control over the spending, payments will be peace mill and not in “chunks” so cash flow output will actually decrease while becoming more regular for those who are regular providers of services and are obviously “chosen” by the patients.  SS Disability cases will be easily accessible; can be judged on the merit and not on the litigation capability by attorneys who virtually live of the “settlements” for their clients and de-facto by federal dollars, or by dollars intended to compensate one’s losses.

We should not allow the collectors and their associates from “Free credit report.com” along with the HMO’s hold the Health Care hostage and make the same sink, the way they killed the mortgage industry that was “so easy to fix under Greenspan’s watch” and pulled down our entire society.

In the Mortgage industry the equity in the real estate is the factor that should determine the risk and ultimately the interest rate for the loan, not the score by the credit report.  The one’s health and life style should determine the risk and the cost of one’s Health Care plan, but no one should be deprived of guaranteed choice of one’s Doctor. It would be like “Medicare for all” in terms of the choice and payments for services, but without the “co pay”. Reasonable charges should be tested for all providers, and paid promptly to those who are chosen by the patients. Many Doctors will gladly accept the 80% rather then 60-65% after many months (sometimes years or never) and after the head ache and discounting accounts receivables to the Banks in order to receive in fact their own payroll deduction money. Tax breaks and incentives should be offered for those who are directly chosen by the patients may be another way to stimulate compliance with the new rules once we have leveled the playing field of Health Care. I am sure that no Doctor wants to be “licensed debt collector” and all of them (or at list the absolute majority) wants to practice the divine profession of Medicine without regular daily financial headache.

By some statistics, the most risky professions in America for acute MI are the Doctors, Truck Drivers and waiters. This must be related to the daily stress of waiting for patients, loads, customers and patrons. The stress of the unknown future (and present) earnings, and yes the lock of good quality Health care on a regular basis- they are all busy, stressed and frustrated.

My professor in Medical School who was from Macedonia was educated in Glasgow (Scotland). He was teaching us with Cronin’s “Citadel” as a reminder. He was teaching us to know what we know, to be brave and to use our expertise when certain and without delay. But he was also teaching us to know what we do not know, to be afraid and not to make stupid mistakes, to know who knows the things we don’t, to ask and not to be ashamed or afraid to ask for the help and participation in the care of the patients by one who knows better, and above all to know who knows what and to respect each other’s knowledge and skills without prejudice.

When helping the patient he was teaching us to expect the reward/compensation to be according to the service we did for the patient, but also according to patients real possibilities and means available to the patient. That was the prescription for happiness in the Health Care practice. More or less every Doctor who accepted the divine Hippocratic Oath had in fact accepted these principles as well. In today’s Health Care one can find two versions of this divine Oath: the original Hippocratic Oath and the modified “market economy “version of the same. It is the time to level them up and to bring the Divine Health Care field to par.

We must introduce reform that will provide a healthy environment for the happy practicing medical professionals who are carrying for happy and healthy patients, healthy environment for the truck drivers and waiters/waitress who will not get sick worrying about “what if’s” but rather enjoying their jobs in the service industry so important for our society and everyone else in every other profession around us in our prosperous country that we are so proud of.

“Mens sana in corpora sano”, can be only achieved in a healthy society that cares for its citizen to be physically and mentally healthy. It is less expensive to have and to maintain public community golf course where people play free golf all year long, than to have ten by-passes for one year in the same community. To be prepared is everyone’s humanitarian need. Are you prepared? Are we prepared [for the future] is my motto today.

 Let’s make our country to be healthy and happy society again.