Friday, March 29, 2024 Mar 29, 2024
60° F Dallas, TX
Advertisement
Health & Medicine

The Texas Paradox: What Really Goes On In McAllen

By |

A FrontBurnervian sends us a fascinating case from McAllen which highlights almost everything wrong with our healthcare system.  In fact, the problems are so obvious the solutions present themselves. I really, really think it’s worth reading:

In a past life, I was a healthcare consultant for a boutique firm based in Ft. Worth, and practice administrator. I found the New Yorker piece interesting, and the follow-up response you posted even more so.

It’s a catch-22. The same industry (insurance) that pays providers also protects them. The providers lose on both accounts.

One of my most challenging clients came from McAllen. Allow me to tell his tale.

This particular physician was triple boarded in Emergency Medicine, Cardiology, and Family Practice, I’ll call him Dr. A. Lots and lots of docs are double boarded, but very few have three areas of expertise. Even fewer strive for the types of fellowships Dr. A had under his belt. After a stint in the Peace Corps, he attended medical school with the goal “to help people.” After graduation, he sought out a path where his efforts would render the most benefit to mankind. Yes, he was that naive.

He went to McAllen, a decision that would eventually destroy his life and career. What the New Yorker failed to accurately capture is this: a Hollywood producer couldn’t script a more exciting place in terms of healthcare, and I’m serious. The emergency rooms county wide are ripe with horrific farm accidents, mysterious border diseases, and the “usual.” The hospitals actively recruit and “guarantee” new docs. There’s nothing typical about a healthcare day in a McAllen, and in that sense it is like our own Parkland Hospital. But, unlike Parkland, there’s no time/room for the “teaching” hospital model. Basically, what I’m saying is this: the population of McAllen skews to be very sick. Be it cultural or financial, these folks don’t seek out routine care. The ER is the first and often first and only line of defense in the war on illness and death.

I loved working down there. One night, in 1992, while covering the ER, a family brought their 82-year-old grandmother in. She resided on the other side of the border, was not a US resident, and did not have insurance. Of course, Dr. A didn’t know or care about this at the time. She was clearly having a heart attack. The family tearfully begged him to save her. The patient was: morbidly obese (350+ lbs), diabetic, and subsequent test showed multiple striations of scar tissue on the heart wall (which indicate one or more previous heart attack(s)). Dr. A informed the family of the patient’s prognosis: not good, less than a 10% survival chance.

So, Dr. A treats her and moves her upstairs, but not before placing a subclavian CVP line for vascular access. Normally, this would be done by a med/surg team in the ER, but Dr. A, with his cardiology board certification was well qualified to do so. The patient’s condition was so fragile that the line could not wait for the on call med/surg unit on call. The patient had such poor circulation, there was no other way to obtain vascular access for treatment. The patient went to the ICU/CCU (cardiac care unit), and died within 24 hours. A massive clot, leading to a stroke, and it was another “outcome statistic.” But wait, within weeks, the family wanted to sue the hospital and ALL doctors who participated in the patient’s care. (Although Dr. A placed the line that would eventually contribute to the stroke, there were other physicians charged with the clotting meds and management of the line. There are some seriously nice golf courses down there, and at least once in the 24-hour period, the patient was delayed in getting clotting meds/rounds.) Never mind that the patient was at death’s door when she presented. And, that was her responsibility…

It was at this point, the hospital engaged the services of my consulting firm. Because they were on the line for a six-figure sum in relation to Dr. A’s career, they wanted a full audit of him… We provided comprehensive reports on his stats: outcomes, cost/benefit analysis, and projections. Dr. A was the only one in the pool of involved docs with a guarantee from the hospital. The litigation soured Dr. A, and we helped him initiate a practice in Euless as the litigation raged on. Within 2 years, he was the “best” PCP in the mid-cities. The other docs settled out of court. As we inched our way to a settlement with Dr. A’s attorney, and malpractice carrier, we were hopeful.

Then, one afternoon, Dr. A got a certified letter. His malpractice carrier was bankrupt. There was no money to pay claims. He was on the line personally for this suit. We mobilized a team of finance guys and started throwing assets into universal whole life insurance policies, the only asset in Texas immune from legal judgements. By this time, Dr. A was responsible for the care of over 100,000 people on capitated and managed care plans. Then, one day, the receptionist transferred a call to my little desk in Dr. A’s office. “Hello, this is so-and-so with Dateline NBC. We’re doing a story on this poor Mexican lady Dr. A killed. Can he sit for an interview?” Hell, to the no. Within 2 more years, Dr. A unraveled. Depression and addiction are rampant in the lives of doctors. Too much pressure. Dr. A was forced to surrender his license. Last I heard, he was back in school to get his MBA.

To sum it up, a patient who, in spite of her significant health issues, outlived the average life expectancy of that time by 8 years got very sick, and crossed the border from Mexico to seek medical treatment. That care was provided to her for free. She died. Her family sued. The doctor gave up.

So, yes, there are lessons to be learned from McAllen, Texas. Our firm did a study on comparative “socialized” medical systems in other countries. (This, was contracted after “Hilarycare,” which was bigger than the phone book, but not as interesting.) Of the systems we studied, Germany holds the most promise. (No one ever talks about Germany.) Physicians there are reimbursed by the government for the premiums paid to carriers and are indemnified against claims similar to those that took down Dr. A. The market response is that malpractice premiums are relatively low (80% less than in the US). Germany host cutting edge treatments (disc replacement in neurosurgery) and cancer care that we should envy. (Thanks, FDA!)

Another thought I had on the New Yorker article post and subsequent response was this: I’ve never ONCE seen a doctor try to “make up” revenue from the reduced fee schedule allowed by Medicare/Medicaid. I did see a marked increase of ordered tests and procedures, but this was a response to the recommendations of the medical directors at the malpractice carriers. I have seen doctors increase volume. For example, PCP’s in 1990 would average 35 patients a day, now do up to 200 +/day with NP and PA adjuncts.

With the cry for “healthcare reform,” this article is indeed timely. From my perspective, we don’t need a nationalized system. What we need is some kind of system to overcome the catch-22, but allows the market to self-adjust.

Related Articles

Image
Arts & Entertainment

Here’s Who Is Coming to Dallas This Weekend: March 28-31

It's going to be a gorgeous weekend. Pencil in some live music in between those egg hunts and brunches.
Image
Arts & Entertainment

Arlington Museum of Art Debuts Two Must-See Nature-Inspired Additions

The chill of the Arctic Circle and a futuristic digital archive mark the grand opening of the Arlington Museum of Art’s new location.
By Brett Grega
Image
Arts & Entertainment

An Award-Winning SXSW Short Gave a Dallas Filmmaker an Outlet for Her Grief

Sara Nimeh balances humor and poignancy in a coming-of-age drama inspired by her childhood memories.
By Todd Jorgenson
Advertisement