Happy Holidays

Health Reform

January 23, 2010

Rep. Mike Rogers

Michigan 8th Congressional District

Dear Rep. Rogers

I am writing you this letter in regards to the Republican party's role in health care reform, and the promise of revising or repealing the present healthcare reform initiative. As you know from my many previous communications, I have long been a limited government advocate. It has been, and continues to be, a personal  belief that individual liberty is paramount, and in the recent past we have lost our way. 

But today I write from  different perspectives. I am by training and practice an emergency physician since 1991, and most recently I have moved into an administrative role as the vice president and chief medical officer of a hospital in southeastern Michigan. I would like to share some perspectives from the front line as an emergency physician, as a hospital administrator concerned with budgets, and finally as a US citizen.

First, I would like to introduce a fictional, though very typical, patient in any emergency department across the country. Mike, a middle-aged unemployed man without health insurance arrives to the emergency department via an ambulance after dialing 911 with crushing chest pain. It becomes clear to the staff in the emergency department that Mike is suffering an acute myocardial infarction, otherwise known to nonmedical layperson, as a heart attack.

As you are assuredly aware, because most hospitals participate in federally funded insurance programs, such as Medicare and Medicaid, we operate under a myriad of federal regulations. These regulations are so numerous and detailed that we have in effect become a privatized extension of the federal government. One of these regulations, the Emergency Medical Treatment and Active Labor Act (EMTALA) directs us to treat and stabilize any patient presenting to the hospital requesting emergency medical treatment regardless of their ability to pay. This regulation grew out of the practice, that most would agree is ethically empty, of some hospitals refusing to offer timely medical care to patients without insurance, and redirecting them to public hospitals.

As a patient advocate and a physician treating Mike my path is the clearest;  though I may not be paid for the care that I direct, I am morally comfortable treating Mike like any other patient.

 As a hospital administrator, Mike's treatment is consistent with our not-for-profit mission but  I need to figure out how to pay for the inevitably expensive, technologically burdened, and potentially life-saving treatment that Mike will need, which I do by charging those with insurance enough to cover both the insured and the uninsured patients. This overcharging, or cost shifting, results in the often quoted inefficient and expensive costs of providing care in our nation's emergency departments.

As a citizen of the United States and a believer in small government I have another problem. Is providing treatment to Mike part of the original mission of our country? Our declaration of independence states that "We hold these truths to be self evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness." Is Mike's medical treatment, which very well may preserve his life, consistent with these unalienable rights? Specifically, the unalienable right to life? How does this integrate with my belief in small government?

Furthermore, is the' right to life' as purported by many across the political spectrum, and most often applied to abortion, applicable in this instance? Mike's immediate treatment may in fact save his life. 

These questions vex me, and lead me into moral, ethical, political, and philosophical conundrums that my education has not prepared me for. But I can assure you, from both an administrative and clinical perspective:  it 'feels right' to treat Mike like anyone else.

As you can see, I am conflicted between my personal  ethical belief in small government, and my moralistic compass as an emergency physician, hospital administrator, and US citizen. How to best weave these conflicting strands together?

So as you participate in the Republican Party's agenda to repeal the Obama health care reform initiative, I ask that you keep Mike and his heart attack in mind, and I look to your leadership on these issues. How should healthcare providers be reimbursed for care to those who cannot afford it? Is access to healthcare for all of our citizens part of the natural unalienable rights our founding fathers referred to? What does the' right to life' mean outside the abortion debate? Who is going to pay for Mike's medical care under the current Federal regulations? Do you want me to turn Mike away?

As always, I appreciate the ability to communicate my concerns to you as my elected representative. May God be with you as you weigh the alternatives.

Respectfully,

David P. Walters, DO, MHSA, FACEP

Associate Clinical Professor

Michigan State University College of Osteopathic Medicine

Vice President and Chief Medical Officer

Botsford Hospital

Farmington Hills, MI       

Executive Committee Meeting

I just came from our Executive Committee Meeting tonight, and I have to say that as a member of the committee for over 12 years, that the present group has embraced their job in a very positve manner. This had changed the committee from a ver angry and argumentative committee to a responsible and fun committee. A formerly staid committee has become engaged and involved. My thanks goes out to all of the members of the committee for a job well done!

Happy New Year

I hope all of you had a safe and a fun Holiday and New Year. Personally, though it was busy, it was one of my best crowned by ringing in the new year at home with Lori and our two children, Louis (17) and Claire (15). Lori and I will not have many more opportunities to so selfishly enjoy our childeren by ourselves.

I am looking forward to re-invigorating this blog, so stay tuned to regular posts here relevant to Botsford Hospital and our Medical Staff.