2004marchapril by Advocates for Better Health

March/April 2004

CELEBRATING the PROFESSION March 30, 2004

In This Issue • Tort Reform • 2003 Medicare Legislation • Legislating Informed Consent

Schwarz Williams Companies

Announces a New Partnership with Ramsey Medical Society For Group Employee Benefits Schwarz Williams Companies, Inc., a human resource (HR) services firm, announces an exclusive marketing agreement with the Ramsey Medical Society (RMS) to provide individual and group benefits to its 1,350 members. The firm has worked with the Minnesota Medical Association and Hennepin Medical Society since 2001. The new agreement gives Schwarz Williams exclusive rights to market and service group benefits to RMS member clinics, as well as individual life, health and long-term disability products to physicians and their employees. Schwarz Williams’ broad range of insurance and financial planning products and services include: • Group Employee Benefits (medical, dental, life, disability) • Human Resource Support Services • Executive Benefits • Retirement Programs • COBRA/HIPAA/ERISA compliance; and • Benefit Administration Insurance products are available from a wide variety of carriers.

“This new relationship offers a three-fold opportunity to our members,” said Roger Johnson, CEO of Ramsey Medical Society. “Schwarz Williams will help our clinics to address the rising cost of health care benefits, which was the top concern identified in a recent membership survey. In addition, physicians and their staffs will have access to all employee benefits beyond health care, and clinics will have an experienced resource for all their HR needs.” Schwarz Williams offers a full menu of services that can be either integrated into a complete HR program or sold separately. Fee-based services that can save time and money, especially for small clinics without HR departments, include HR consulting and financial planning services, COBRA, flex administration, consolidated billing, and payroll support.

For more information on how Schwarz Williams can benefit your practice contact Jim Fries: Schwarz Williams Companies, Inc. (763) 591-5822 8401 Golden Valley Road, Suite 300 Golden Valley, MN 55427

Visit www.schwarzwilliams.com

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4HESE REFORMS WORK !CCORDING TO THE !MERICAN !CADEMY OF !CTUARIES STATES WITH NONECONOMIC CAPS HAVE FEWER CLAIMS LOWER AWARDS AND LOWER MALPRACTICE PREMIUMS THAN STATES WITHOUT CAPS #APPING THE NON ECONOMIC AWARDS IN MEDICAL MALPRACTICE CASES WILL LEAD TO MORE PREDICTABILITY AND STABILITY IN MEDICAL MALPRACTICE COVERAGE AND REDUCE ONE OF THE COSTS OF PROVIDING CARE 4HIS LEGISLATION WILL ATTRACT A LARGE AMOUNT OF OPPOSITION FROM TRIAL LAWYERS AND OTHER GROUPS INTENT ON PRESERVING THE STATUS QUO )T IS CRITICAL THAT YOUR LEGISLATORS HEAR FROM YOU ON THE IM PORTANCE OF PASSING MEDICAL LIABILITY TORT REFORM ,EGISLATORS TRUST AND RESPECT THEIR PHYSICIANS SO YOUR VOICE IS CRITICAL )T WILL BE AN UPHILL BATTLE IN THE -INNESOTA 3ENATE BUT IT IS IMPORTANT THAT WE BEGIN THE DISCUSSION %LIMINATING THE PROVIDER TAX IS ANOTHER EASY STEP THE LEGISLATURE CAN TAKE TO REDUCE HEALTH CARE COSTS 4HE PERCENT PROVIDER TAX WILL ADD ALMOST BILLION TO THE COST OF HEALTH CARE OVER THE NEXT FOUR YEARS ) WILL CONTINUE TO RAISE THIS ISSUE AS THE DISCUSSION ON HEALTH CARE COSTS MOVES FORWARD 4ACKLING THE ISSUE OF HEALTH CARE COSTS WILL BE CHALLENGING FOR THE ,EGISLATURE -AJOR REFORMS SEEM TO COME ABOUT ONCE EVERY YEARS 7E CAN ONLY DO THIS WITH INPUT AND SUPPORT FROM YOU THE EXPERTS & 3ENATOR 'EOFFREY -ICHEL REPRESENTING $ISTRICT %DINA AND 7EST "LOOMINGTON SERVES ON THE %DUCATION 0OLICY #OMMITTEE + &INANCE #OMMITTEE AND 3TATE 'OV ERNMENT &INANCE #OMMITTEE )N ADDITION HE SERVES AS COUNSEL FOR -INNESOTA ,IFE )NSURANCE AND IS A MEMBER OF THE "OARD OF $IRECTORS OF THE -INNESOTA #HAMBER OF #OMMERCE AND THE 3AINT 0AUL 9-#!

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9OU HAVE BEEN WITH THE /LMSTED -EDICAL #ENTER FOR ALMOST YEARS 7HAT HAVE BEEN THE MOST IMPORTANT CHANGES IN THE PRACTICE OF MEDICINE DURING YOUR CAREER &ROM A PERSONAL PRACTICE STANDPOINT THE MOST STRIKING CHANGE DURING MY CAREER HAS BEEN THE DEVELOPMENT OF VIDEOENDOSCOPY AND LAPAROSCOPIC SURGERY ) NOW SPEND TWO THIRDS OF MY WORK TIME PLAYING VIDEOGAMES &ROM THE MACROSCOPIC POINT OF VIEW -EDICARE AND -EDICAID -EDICARE CAME INTO BEING MY SENIOR YEAR IN MEDICAL SCHOOL AND -EDICAID FOLLOWED A COUPLE OF YEARS LATER 4HESE PROGRAMS HAVE PUMPED HUGE AMOUNTS OF MONEY INTO HEALTH CARE TO THE GREAT BENElT OF PHYSICIANS AND PATIENTS ALIKE 4HE COSTS WERE AS THE !-! ACCURATELY PREDICTED SEVERAL TIMES WHAT #ONGRESS EXPECTED AND SO THE NEVER ENDING SERIES OF CONTROLS HAVE FOLLOWED ALSO AS PREDICTED BY THE !-! &EW PEOPLE WHO REMEMBER THE hGOOD OLD DAYSv WOULD WANT TO RETURN TO THEM THEY WEREN T ALL THAT GOOD 4HE ECONOMIC CONSTRAINTS ON MEDICAL PRACTICE WERE MUCH WORSE THAN OUR REGULATORY ONES

7HAT HAS DRAWN YOU TO BECOME ACTIVE IN ORGANIZED MEDICINE 4O ME PARTICIPATION IN MEDICAL ORGANIZATIONS IS AN INTEGRAL PART OF BEING A PHYSICIAN AN OBLIGATION AND A PRIVILEGE 4HE PROFESSION AS A WHOLE HAS CERTAIN RESPONSIBILITIES TO SOCIETY WHICH CAN ONLY BE MET BY ORGANIZATIONS 4HE CURRENT WEAKNESS OF OUR PROFESSION IS A DIRECT RESULT OF THE LACK OF PARTICIPATION BY THE MAJORITY OF PHYSICIANS )F PHYSICIANS FAIL TO ACTIVELY MEET OUR RESPONSIBILITIES MEDICINE WILL CEASE TO BE A PROFESSION AND WILL BECOME JUST AN OCCUPATION

7HAT ARE THE TWO BIGGEST LEGISLATIVE PRIORITIES REGARDING HEALTH CARE AND MEDICINE IN -INNESOTA AND OR NATIONALLY .ATIONALLY THE TWO BIGGEST LEGISLATIVE PRIORITIES ARE TORT REFORM AND -EDICARE REIMBURSEMENT )N -INNESOTA THERE ARE FOUR MAJOR ISSUES %LIMINATING THE SICK TAX IS STILL A CRITICAL ISSUE OF GOVERNMENTAL FAIRNESS AND INTEGRITY )NCREASING THE TOBACCO TAX IS AN IMPORTANT MEANS OF REDUCING UNDERAGE SMOKING 4HERE ARE A NUMBER OF ISSUES AROUND PROFESSIONAL LIABILITY #ONTAINING HEALTH CARE COSTS IS A RE EMERGING ISSUE CONCERNING WHICH THE --! IS CURRENTLY TRYING TO DElNE ITS ROLE AND POSITIONS

)S THE hSICK CARE TAXv NECESSARY 4HE SICK TAX IS NOT A NECESSARY EVIL IT IS JUST EVIL )T IS OUR STATE S MOST REGRESSIVE TAX )T TAXES THE SICK TO PAY THE EXPENSES OF OTHERS WHO ARE SICK LEAVING THE HEALTHY ALONE -INNESOTA#ARE IS A GOOD PROGRAM FOR REDUCING THE NUMBER OF UNINSURED BUT AS A SOCIETAL OBLIGATION IT SHOULD BE FUNDED BY ALL OF SOCIETY NOT JUST THOSE ALREADY UNFORTUNATE TO BE SICK THEMSELVES 4O FURTHER INSULT OUR INTELLIGENCE IT WAS DISHONESTLY DISGUISED AS A TAX ON PROVIDERS

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2ICHARD 4HOMAS A PARTNER WITH "URKE AND 4HOMAS PRACTICES IN THE lELDS OF NEGLIGENCE INSURANCE DISPUTES AND PERSONAL INJURY MATTERS ! PAST PRESIDENT OF THE -INNESOTA $EFENSE ,AWYERS !SSOCIATION HE CONTINUES TO SERVE AS CO CHAIR OF ITS ,AW )MPROVEMENT #OMMITTEE

TION 3HOULD WE RELY UPON THE GOOD JUDGMENT OF JURORS AS WE HAVE FOR HUNDREDS OF YEARS TO DETERMINE LIABILITY AND DAMAGES UNFETTERED BY THE CONSTRAINTS OF STATUTORY RESTRICTIONS THAT KNOW NOTHING OF THE SPECIlC CIRCUMSTANCES OF A GIVEN CASE ) CAN AN SWER THAT QUESTION "UT THEN THERE IS THIS QUESTION 3HOULD WE CONTINUE A SYSTEM THAT LARGELY COMPENSATES ONLY A FEW TO OFTEN EXTRAORDINARY DEGREES FOR UNQUANTIlABLE AND ULTIMATELY UNKNOWABLE DAMAGES WHEN TO DO SO THREATENS ACCESS TO MEDICAL CARE FOR THE MANY WHICH IN TURN CAN CAUSE EVEN GREATER SUFFERING THAN WE HAVE JUST COMPENSATED ) CAN ANSWER THAT QUESTION TOO 7E NEED AFFORDABLE AND ACCESSIBLE MEDICAL CARE 7E NEED TO REASONABLY COMPEN SATE THOSE WHO ARE INJURED DUE TO NEGLIGENCE &INDING THE RIGHT BALANCE BETWEEN THESE COMPETING AND LAUDABLE VALUES IS THE CHALLENGE OF TORT REFORM 4HAT CHALLENGE IS NOT MET HOWEVER WHEN THE PLAINTIFFS BAR TURNS A BLIND EYE TO THE REALITIES OF OUR CURRENT SYSTEM 4HAT CHALLENGE CAN ONLY BE MET WHEN ALL OF THE PLAYERS I E THE PLAINTIFFS BAR THE DEFENSE BAR THE MEDICAL PRACTITIONERS AND THE ULTIMATE CONSUMERS WORK TO DEVELOP A SYSTEM THAT ACCOMMODATES THE NEEDS OF ALL 4HAT WILL NEVER OCCUR SO LONG AS THE AR GUMENT PERSISTS THAT THERE IS NO CRISIS AT ALL OR WORSE THE hCRISISv IS A FRAUD DIRECTED AT INCREASING THE PROlTS OF ONE GROUP AT THE EXPENSE OF THE OTHER 4HE CRISIS IS REAL 4O THE GREAT ASTONISHMENT OF THOSE WHO FOLLOW THIS SUBJECT IT IS OFTEN ARGUED BY THE PLAINTIFFS BAR THAT INSURANCE PREMIUMS ARE UNRELATED TO LOSS 4HEY ARGUE THAT THE COST OF PAYING AWARDS IS NOT THE ENGINE DRIVING RATES )NDEED THEIR ARGUMENT PERSISTS AS IF THE LOSSES INSURERS PAY HAVE NO CONNECTION TO PREMIUMS CHARGED BECAUSE THE CONNEC TION BETWEEN THE TWO IS MYSTICAL AT BEST OVERWHELMED BY THE CARRIER S CAPACITY TO MAKE THE REAL MONEY ON INVESTMENTS )T IS THE MARKET NOT THE COST OF THE TORT SYSTEM THAT IS BEHIND ALL OF THIS 7HEN "RIAN 3HORT MEDIATED A CASE ONE AFTERNOON ) HEARD HIM SAY WHAT ) AM SURE MANY HAVE HEARD ON OTHER OCCASIONS h.O INSURANCE COMPANY HAS EVER PAID A CLAIM .OT ONE 4HEIR POLICYHOLDERS PAY THEM ALL v 4HE ELEGANCE OF THAT STATEMENT RIDES WITH THE FACT THAT IT IS NOT ONLY TRUE BUT ALSO INESCAPABLY TRUE (ERE IS THE BOTTOM LINE THE INESCAPABLE FACT THAT CANNOT BE IGNORED OR WISHED AWAY IN IN THIS COUNTRY WAS PAID IN CLAIMS FOR EVERY DOLLAR COLLECTED IN PREMIUMS 4HIS MEANS THAT THE TORT #ONTINUED ON PAGE

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TWISTED 4HUS A TORT IS TWISTED OR WRONGFUL CONDUCT CAUSING HARM 4HE PROFESSOR GOES ON TO EXPLAIN THAT THE PRIMARY PURPOSE OF TORT LAW IS TO ALLOCATE THE LOSSES ARISING OUT OF HUMAN ACTIVITY FROM THE VICTIMS OF WRONGFUL CONDUCT TO THE WRONGFUL ACTORS )T IS IRONIC THAT AT ITS CORE TORT LAW IS CAPITALISTIC 4HE COST OF THE LOSSES INHERENT IN NEGLIGENT HUMAN ACTIVITY IS TO BE BORNE BY THE NEGLIGENT ACTOR )N MY YEARS AS A PERSONAL INJURY LAWYER ) HAVE OBSERVED THAT ACTIONS IN TORT HAVE REPEATEDLY AND REGULARLY ACHIEVED THE GOAL OF PROVIDING FAIR AND JUST COMPENSATION #HILDREN OF PARENTS KILLED BY MALPRACTICE HAVE GONE TO COLLEGE 0ERSONS WITH SPINAL CORD INJURIES HAVE PURCHASED ACCESSIBLE HOMES (UNDREDS OF INJURED PERSONS HAVE RECEIVED NEEDED THERAPY AND CARE !LTHOUGH MONEY DOES NOT MAKE PEOPLE WHOLE IT CAN HAVE A REHABILITATIVE AND HEALING IMPACT !DMITTEDLY MY EXPERIENCE IS ANECDOTAL (OWEVER ) HAVE ALSO WITNESSED INSURANCE ADJUSTERS AND DEFENSE LAWYERS TELL MY CLIENTS AFTER A MEDIATION HOW GLAD THEY ARE THAT THE SETTLEMENT MONEY WILL BE AVAILABLE TO RELIEVE MY CLIENT S MENTAL AND PHYSICAL SUFFERING 4HOSE ADJUSTERS AND DEFENSE LAWYERS HAVE LEARNED WHAT ) HAVE LEARNED THE CIVIL JUSTICE SYSTEM OFTEN WORKS AND WORKS WELL

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*UST AS ) HAVE OBSERVED THE BENElCIAL CONSEQUENCES OF PERSONAL INJURY LAWSUITS ) HAVE ALSO NOTED THE REPEATED AND REGULAR CALLS FOR TORT REFORM )T IS PREDICTABLE THAT WHENEVER THE lNANCIAL MARKETS TUMBLE CAUSING INSURERS LOSSES IN THEIR lNANCIAL INVESTMENTS AND OR LARGE NATURAL DISASTERS SUCH AS mOODS OR EARTHQUAKES OCCUR CAUSING LARGE CLAIMS AGAINST RE INSURERS PREMIUMS INCREASE AND INSURERS DEmECT ATTENTION BY CLAMORING FOR TORT REFORM )N THE MID S A COMBINATION OF SAGGING lNANCIAL MARKETS AND NATURAL DISASTERS LED TO INCREASED PREMIUMS !S A RESULT THERE WAS A hTORT CRISISv AND LEGISLATURES ACROSS !MERICA ENACTED LAWS LIMITING TORT RECOVERIES AND ACCESS TO JUSTICE .OW HISTORY IS REPEATING ITSELF &ROM $ECEMBER THROUGH $ECEMBER THE lNANCIAL MARKETS FELL PERCENT .ATURAL DISASTERS EXACERBATED BY CLAIMS FOLLOWING THE TERRORIST ATTACKS OF HAVE ACCORDING TO *ACK +LEVEN AT -IDWEST -EDICAL )NSURANCE #OMPANY CAUSED LARGE INCREASES IN RE INSURANCE RATES 4HESE EVENTS TOTALLY UNRELATED TO MALPRACTICE CLAIM FREQUENCY OR SEVERITY HAVE IMPACTED PREMIUMS AND HAVE RESULTED IN NEW CALLS FOR TORT REFORM

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SYSTEM BASED UPON PREMIUMS COLLECTED IS COSTING ONE THIRD MORE THAN EVEN THE CURRENT RATES CAN SUPPORT )F NOTHING IS CHANGED AND CLAIMS DO NOT INCREASE PREMIUMS MUST GO UP 7HILE OPPONENTS TO TORT REFORM CAN ARGUE THAT INSURER IN VESTMENT CAN REDUCE THE BURDEN AND IT CAN IT DOES NOT CHANGE THE FACT THAT THE BURDEN REMAINS /UR TORT SYSTEM COSTS AN ENORMOUS AMOUNT 7HAT DOES THIS MEAN TO OUR ACCESS TO HEALTH CARE 3OME EXAMPLES ILLUSTRATE THE CON CERN s )N *OLIET )LLINOIS THE TOWN S ONLY NEU ROSURGEON LEFT WHEN HIS MALPRACTICE PREMIUM WENT FROM PER YEAR TO s /N .OV THREE OBSTETRI CIAN GYNECOLOGISTS IN &AYETTE #OUNTY 0ENNSYLVANIA STOPPED DOING CHILD

BIRTH DELIVERIES /NCE THE PRACTICE WAS SO RESTRICTED THEIR COST OF PREMIUMS DROPPED FROM IN EXCESS OF TO UNDER s !LINGTON 0! -EMORIAL (OSPITAL CLOSED ITS TRAUMA CENTER IN -ONTGOMERY #OUNTY AT THE END OF BECAUSE ITS PREMIUM HAD INCREASED FROM MILLION TO MILLION SINCE s )N 4ACOMA 7ASHINGTON SOME RATES HAVE TRIPLED RESULTING IN A PERCENT LOSS IN PHYSICIANS SINCE ACCORD ING TO THE 7ASHINGTON 3TATE -EDICAL !SSOCIATION s 3IMILAR STORIES ARE FOUND IN THE STATES OF 6ERMONT .EVADA .ORTH #ARO LINA /HIO 7EST 6IRGINIA -ISSISSIPPI &LORIDA 'EORGIA .EW *ERSEY !RIZONA 7YOMING AND !RKANSAS 0RACTITIONERS ARE LEAVING STATES AND CURTAILING THEIR PRACTICES (OSPITALS ARE ELIMINATING HIGH RISK AREAS OF PRACTICE

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4HIS IS HAPPENING )T IS REAL 2ECENTLY MORE THAN SURGEONS IN THE COUNTY AROUND THE *ACKSONVILLE &LORIDA AREA STOPPED DOING ELECTIVE SURGERY 4HE COUNTY TREATED THIS LIKE A NATURAL DISASTER AND ACTIVATED AN EMERGENCY RESPONSE SYSTEM TYPICALLY RESERVED FOR HURRICANES 4HIS EXPLOSION OF PREMIUMS HAS ALSO HAD A DIRECT EFFECT ON THE CHOICES MEDI CAL STUDENTS ARE MAKING WITH RESPECT TO THEIR RESIDENCY TRAINING !CCORDING TO THE !MERICAN -EDICAL 3TUDENT !SSOCIA TION 7EB SITE PERCENT OF THE MEDICAL STUDENTS SURVEYED HAVE SWITCHED SPECIAL TIES DUE TO PERCEIVED RISK PERCENT MORE ARE CONSIDERING IT ,AST YEAR PERCENT OF THE OBSTETRICIAN GYNECOLOGY RESIDENCY SLOTS AND PERCENT OF EMERGENCY PHYSI CIAN POSITIONS WENT UNlLLED AT THE TIME OF THE lRST CHOICES MADE BY THE MEDICAL STUDENTS 4HUS THE SOBERING STATISTIC THAT CLAIMS COST FOR EACH DOLLAR OF PREMIUM TELLS US THAT THE CRISIS IS REAL 4HIS DATA IS SUPPORTED BY REPORTS FROM THE .ATIONAL 0RACTITIONER $ATA "ANK INDICATING THAT BETWEEN AND CLAIMS AGAINST PHYSICIANS INCREASED PERCENT 4HE MEDIAN PAYMENTS FOR THESE CLAIMS MORE THAN DOUBLED DURING THAT TIME 6ERDICTS AND SETTLEMENTS OF MORE THAN ONE MILLION DOLLARS CLIMBED FROM PER YEAR TO )N ADDITION hMEGA AWARDSv ARE STAGGERING 4HE 3TATE OF .EW 9ORK HAD THREE JURY VERDICTS IN EXCESS OF IN -ISSIS SIPPI HAD A JURY AWARD OF IN 0ENNSYLVANIA HAD ONE VERDICT OF IN ,ET US NOT FORGET THAT IT CAN HAPPEN HERE IN 3COTT #OUNTY IN (ENNEPIN #OUNTY 4HE PRINCIPAL RESPONSE TO THIS CRISIS IS THE CONCEPT OF A TORT CAP ON NON ECONOMIC DAMAGES 4HE PRINCIPAL OBJECTION TO THIS RESPONSE PREDICTABLY BY THE PLAINTIFFS BAR IS THAT CAPS DO NOT WORK AND FOR THIS

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THEY TURN TO THE EXPERIENCE OF #ALIFORNIA WHOSE CAP OF HAS BEEN IN PLACE FOR YEARS DURING WHICH THAT STATE HAS HAD INSURANCE PREMIUM INCREASES OF PERCENT 7HAT IS NOT SAID HOWEVER AND WHICH BEARS SOME MENTION IS THE FACT THAT INSURANCE PREMIUMS OVER THIS SAME PERIOD OF TIME FOR STATES WITHOUT CAPS INCREASED AN AVERAGE OF PERCENT )T IS OF INTEREST THAT IN #ALIFORNIA HAD THE HIGHEST INSURANCE RATES AMONG ALL STATES WHILE IT NOW RANKS IN THE LOWER ONE HALF 4HIS IS TRUE DESPITE THE FACT THAT #ALIFORNIANS ARE NOT SHY ABOUT LITIGATION AND THE STATE EXPERIENCES A PERCENT HIGHER RATE OF CLAIMS THAN THE NATIONAL AVERAGE 4HE OVERALL HEALTH CARE COST SAVINGS FOR #ALI FORNIA RESIDENTS DUE TO THE CAP ALONE IS PERCENT TO PERCENT 4HE EFFECTIVENESS OF SUCH A CAP IS NOT SURPRISING GIVEN THE STUDIES INDICATING THAT IN TORT RECOVER IES NON ECONOMIC DAMAGES RANGE FROM PERCENT 4EXAS STUDY TO PERCENT &LORIDA STUDY OF THE AWARD #APS DO REDUCE PREMIUMS AND THE OVERALL COST OF HEALTH CARE FOR THOSE JURIS DICTIONS THAT USE THEM 4HE QUESTION RE MAINS AS TO WHETHER THE COST SAVINGS IS FAIR !GAIN WE RETURN TO THE QUESTIONS POSED )S THE CURRENT SYSTEM LIMITING HEALTH CARE AND REDUCING THE QUALITY OF CARE AVAILABLE SO THAT THE FEW WHO SEEK RECOVERY CAN HAVE UNRESTRICTED RECOVERY FOR LOSSES THAT ARE AT BEST PERCEIVED BUT UNQUANTIlABLE IN ANY MEANINGFUL WAY !LL EXPERIENCED TRIAL LAWYERS KNOW THAT JUROR RESPONSE TO THE SAME INJURY IN TERMS OF PAIN AND SUFFERING VARIES TREMEN DOUSLY 'IVEN THE VERY REAL IMPACT THAT OUR CURRENT SYSTEM HAS ON THE CONTINUED COST AND AVAILABILITY OF HEALTH CARE A TRUE IRONY EMERGES WHEN WE JEOPARDIZE THE HEALTH OF MANY SO THAT WE CAN COMPENSATE ONLY A FEW WHICH IN TURN RESULTS IN AN INCREASE OF THOSE INJURED )T IS TIME TO REFORM THIS SYSTEM NOT ABANDON IT SO THAT HEALTH CARE CAN BE

AVAILABLE TO THE GREATEST NUMBER AT THE HIGHEST QUALITY TO PREVENT THE VERY INJU RIES THE PLAINTIFFS BAR SEEKS TO COMPENSATE AFTER THE FACT 7HETHER SUCH REFORMS WILL OCCUR IS IMPOSSIBLE TO JUDGE AT THIS POINT 4HE (OUSE HAS PASSED A CAP ON NON ECONOMIC DAMAGES BUT THE BILL HAS YET TO RECEIVE THE NECESSARY 3ENATE SUPPORT TO lND ITS WAY TO THE 0RESIDENT )T IS ARGUED THAT THE hVICTIMSv OF MALPRACTICE LACK THE VOICE OF THE MEDICAL COMMUNITY OR ITS POLITICAL INmUENCE "UT CONSIDER THIS )N THE !MERICAN -EDICAL !SSOCIATION SPENT MILLION ON CONGRESSIONAL ELEC TIONS IN THE !MERICAN 4RIAL ,AWYERS !SSOCIATION SPENT MILLION ! FINAL NOTE ON THE CHANGE IN -INNESOTA S JOINT AND SEVERAL LIABILITY LAW (ERE TOO THE WISDOM OF THE CHANGE DEPENDS ENTIRELY UPON WHOM ONE ASKS AND THE ROLE HE OR SHE IS PLAYING AT THE TIME 7E START HOWEVER WITH THE LONG STAND ING VIEW THAT -INNESOTA AS DID MOST STATES HAD UNRESTRICTED JOINT AND SEVERAL LIABILITY FOR ALL DEFENDANTS FOR YEARS /NE PERCENT FAULT COULD RESULT IN A DEFENDANT PAYING AN ENTIRE AWARD 4HIS WAS DEEMED JUSTIlED BECAUSE OF THE PRESENCE OF SOME CAUSAL FAULT 7HAT IS FORGOTTEN HOWEVER IS THAT AT THAT TIME PERCENT FAULT ON THE PLAINTIFF BARRED ALL RECOVERY .O ONE IS CURRENTLY ARGUING A RETURN TO THAT ASPECT OF THE SYSTEM 4HE SYSTEM WAS CHANGED OF COURSE SO THAT THE PLAINTIFF S FAULT ONLY REDUCED RE COVERY UNTIL THE POINT WHERE THE PLAINTIFF S FAULT MORE THAN THE ACTIONS OF OTHERS WAS THE CAUSE OF THE INJURY 2ECOVERY WAS THEN BARRED )F WE APPLY THESE SAME PRINCIPLES TO DEFENDANTS THE RESULT IS THE LAW IN ITS CURRENT STATUS 4HE DEFENDANT PAYS FOR HIS OR HER FAULT ONLY JUST AS THE PLAINTIFF S RE COVERY IS REDUCED ONLY BY HIS OR HER FAULT 7HEN THE DEFENDANT S FAULT BECOMES THE PRIMARY CAUSE OF THE INJURY THAT IS

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GREATER THAN PERCENT THE DEFENDANT IS NOW LIABLE FOR THE ENTIRE AWARD JUST AS THE PLAINTIFF WHO IS MORE THAN PERCENT AT FAULT LOSES THE ENTIRE AWARD .O SYSTEM OF FAULT ALLOCATION IS PERFECT BECAUSE WE ARE ALWAYS DEALING WITH THE QUESTION OF HAVING SOMEONE PAY FOR THE INJURIES THEY DID NOT CAUSE #URRENT LAW HOWEVER DOES HAVE THE BEAUTY OF SYMMETRY AND WITH SYMMETRY FAIRNESS 0URE COMPARATIVE FAULT OF COURSE IS THE LEAST FAIR OF ALL SINCE IT ALLOWS THE PLAINTIFF TO WIN EVERY CASE ALTHOUGH AT REDUCED AMOUNTS $O WE REALLY WANT TO AWARD SOMEONE WHO IS PERCENT AT FAULT FOR PERCENT OF HIS OR HER DAMAGES )T CAN THUS BE SEEN THAT TORT REFORM IS NEITHER THE DEMON OF THE DEFENSE BAR NOR THE PRODUCT OF INSURER GREED 2ATHER IT IS AN EFFORT TO BALANCE THE NEEDS OF THE INJURED AGAINST THE NEEDS OF SOCIETY TO PROVIDE SERVICES AND HEALTH CARE 7HEN THE BALANCE SWINGS TO ELIMINATE ESSENTIAL SERVICES THAT ARE REQUIRED TO PREVENT THE VERY INJURIES BEING SOUGHT BY THE TORT PLAINTIFF CHANGE IS NECESSARY & Ì ÌiÃÊ £Ê/ iÊ >}>â i]Ê Õ iÊ ]ÊÓääÎ]Ê>ÌÊxä° ÓÊ `°]Ê>ÌÊxx° ÎÊ* >`i « >Ê µÕ ÀiÀ]Ê Õ}ÕÃÌÊÎä]ÊÓääÓ° {Ê ,i«°Ê i Ê >À`]Ê -* É -Ê Õ V>Ì ]Ê iV°Ê £Î]Ê ÓääÓ° xÊº/ iÊ «>VÌÊ vÊ i` V> Ê > «À>VÌ ViÊ ÃÕÀ> ViÊ> `Ê/ ÀÌÊ ,iv À Ê Ê7>Ã }Ì ½ÃÊ i> Ì Ê >ÀiÊ i ÛiÀÞÊ-ÞÃÌi ]»Ê 7>Ã }Ì Ê -Ì>ÌiÊ i` V> `ÕV>Ì Ê > `Ê ,iÃi>ÀV Ê Õ `>Ì ]Ê-i«Ìi LiÀÊÓääÓ° ÈÊ ``ÀiÃÃ }ÊÌ iÊ iÜÊ i> Ì Ê >ÀiÊ À Ã Ã\Ê,iv À }ÊÌ iÊ i` V> Ê Ì }>Ì Ê -ÞÃÌi Ê Ì Ê «À ÛiÊ Ì iÊ +Õ> ÌÞÊ vÊ i> Ì Ê >Ài]Ê >ÀV ÊÎ]ÊÓääÎ]Ê>ÌÊ{ È° ÇÊ/ i]ÊÃÕ«À>Ê ÌiÊ£]Ê>ÌÊxä° nÊ `°]Ê>ÌÊxn° Ê º/ iÊ «>VÌÊ vÊ i` V> Ê > «À>VÌ ViÊ ÃÕÀ> ViÊ > `Ê / ÀÌÊ ,iv À Ê Ê 7>Ã }Ì ½ÃÊ i> Ì Ê >ÀiÊ i ÛiÀÞÊ -ÞÃÌi ]»Ê>ÌÊ£Ó° £äÊ `°]Ê>ÌÊ£Î°Ê ££Ê/ i]ÊÃÕ«À>Ê ÌiÊ£]Ê>ÌÊxä°Ê £ÓÊ `° £ÎÊ `° £{Ê °Ê iÃÃ iÀÊ > `Ê °Ê V i > ]Ê º Ê VÌ ÀÃÊ *À>VÌ ViÊ

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0RESIDENT 'EORGE 7 "USH IN HIS 3TATE OF THE 5NION !DDRESS SOUNDED THE TRUMPET CALL OF A WAR AGAINST TORT VIC TIMS BY STATING "ECAUSE OF EXCESS LITIGATION EVERY BODY PAYS MORE FOR HEALTH CARE AND MANY PARTS OF !MERICA ARE LOSING lNE DOCTORS .O ONE HAS EVER BEEN HEALED BY A FRIVOLOUS LAWSUIT ) URGE #ONGRESS TO PASS MEDICAL LIABILITY TORT REFORM 0RESIDENT "USH S CALL FOR TORT REFORM IS ALSO A REPEAT OF HISTORY )N -R "USH MADE TORT REFORM A CENTERPIECE OF HIS CAMPAIGN FOR GOVERNOR OF 4EXAS )NDEED IT WAS AND IS A PERFECT CAMPAIGN ISSUE FOR A 2EPUBLICAN CANDIDATE )T ATTACKS A CON STITUENCY OF OUR COUNTRY THAT IS ESSENTIALLY VOICELESS 4ORT VICTIMS LACK BOTH THE ORGA NIZATION AND lNANCIAL STRENGTH TO RESPOND TO CHALLENGES TO THEIR LEGAL RIGHTS 7HEN hTRIAL LAWYERSv RESPOND WE ARE PERCEIVED AS BEING GREEDY AND PROTECTING OUR SELF INTERESTS !T THE SAME TIME CALLS FOR TORT REFORM APPEAL TO WEALTHY CONSTITUENCIES AND PROFESSIONALS WHO ARE PRIME TARGETS FOR GENEROUS CAMPAIGN CONTRIBUTIONS 0RESIDENT "USH HAS ASKED #ONGRESS TO PASS A LAW CAPPING PAIN AND SUFFERING DAMAGES ON MEDICAL MALPRACTICE CLAIMS AT 4HE LEGISLATION IS NOW PENDING IN #ONGRESS

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4HE SUGGESTION THAT CAPS ON PAIN AND SUFFERING DAMAGES WILL LIMIT FRIVOLOUS LAWSUITS IS CLEARLY ERRONEOUS 3TUDIES OF INSURANCE PREMIUMS IN STATES WITH CAPS AS COMPARED TO STATES WITHOUT CAPS HAVE ESTABLISHED THAT PREMIUM RATES DO NOT DECLINE WHEN CAPS ARE IMPOSED )NSTEAD CAPS ON DAMAGES SIMPLY LIMIT THE RECOV ERIES OF THE MOST EGREGIOUSLY DAMAGED PERSONS -ANY PHYSICIANS UNDERSTAND THAT FOR MANY INJURIES INCLUD ING SEVERE SCARRING OR THE DEATH OF A CHILD

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IS INADEQUATE )N A COMMENTARY ON THE RECENT DEATH OF A YEAR OLD GIRL AT $UKE 5NIVERSITY -EDICAL #ENTER AFTER RECEIVING A MISMATCHED HEART LUNG TRANSPLANT $R %DWARD #AMPION COMMENTED IN THE PRES TIGIOUS .EW %NGLAND *OURNAL OF -EDICINE THAT h(ER STORY DOES NOT SUPPORT THE CASE FOR STRICT LIMITS ON THE DAMAGES A JURY CAN AWARD )NSTEAD IT INCREASES THE PRESSURE FOR MORE REGULATION OF COMPLEX SYSTEMS SUCH AS TRANSPLANTS v 4HOSE WHO ARE CONCERNED ABOUT FRIVOLOUS LAWSUITS WOULD DO WELL TO STUDY THE IMPACT OF -INN 3TAT e ON MEDICAL MALPRACTICE LITIGATION IN -INNESOTA $URING THE hMAL PRACTICE CRISIS v REPRESENTATIVES OF THE -INNESOTA -EDICAL !SSOCIATION AND -IDWEST -EDICAL )NSURANCE #OMPANY --)# APPROACHED A GROUP OF PLAIN TIFFS LAWYERS AND EXPRESSED CONCERN THAT MANY LAWSUITS WERE COMMENCED WITHOUT EXPERT SUPPORT AND THAT THERE WAS NO MECHANISM FOR OBTAINING DISMISSAL OF SUCH UNSUPPORTED CASES SHORT OF A TRIAL 4HE PLAINTIFFS LAWYERS RESPONDED WITH A PROPOSED STATUTE THAT REQUIRED AN AFlDA VIT BY THE PLAINTIFF S LAWYER AT THE TIME A LAWSUIT WAS COMMENCED STATING THAT THE FACTS OF THE CASE HAD BEEN REVIEWED WITH A QUALIlED EXPERT WHO FELT THAT THE CASE HAD PROBABLE MERIT )N ADDITION THE PROPOSED STATUTE REQUIRED A SECOND AFlDAVIT WITHIN SIX MONTHS OF THE COMMENCEMENT OF AN ACTION SETTING FORTH THE IDENTITY OF A QUALI lED EXPERT AND A SUMMARY OF THE EXPERT S OPINIONS 4HE PROPOSAL WAS JOINTLY SUP PORTED BY THE PLAINTIFFS BAR AND BY THE DEFENSE BAR AND -INN 3TAT e WAS ENACTED 3INCE DOZENS IF NOT HUNDREDS OF MALPRACTICE ACTIONS LACKING CREDIBLE EXPERT SUPPORT HAVE BEEN DISMISSED IN EARLY STAGES OF LITIGATION !S A RESULT DEFENSE COSTS HAVE BEEN REDUCED AND THE NUMBER OF MALPRACTICE ACTIONS HAS STABI LIZED AND EVEN DECLINED IN -INNESOTA &OR

EXAMPLE IN AND THERE WERE RESPECTIVELY AND NEW CASES lLED 4HIS IS A SUBSTANTIAL REDUCTION FROM OVER CASES PER YEAR IN EARLIER YEARS )T IS PROBABLE THAT -INN 3TAT e HAS EVEN HAD A SIGNIlCANT ROLE IN MODERATING MALPRACTICE INSURANCE RATES IN -INNESOTA --)# HAS BOASTED THAT ITS RATES ARE SOME OF THE BEST IN THE COUNTRY &OR EXAMPLE IN THE BASE RATE FOR A -INNESOTA IN TERNAL MEDICINE SPECIALIST WAS PER YEAR AS COMPARED WITH &LORIDA -ICHIGAN )LLINOIS AND .EW 9ORK )N ADDITION IN --)# REBATED IN PREMIUMS TO ITS INSUREDS -INNESOTA HAS HAD SOME MULTI MIL LION DOLLAR MEDICAL MALPRACTICE VERDICTS .EVERTHELESS RATES REMAIN MODERATE 4HE EVIDENCE IS CLEAR THAT CAPS ON PAIN AND SUF FERING ARE NOT THE ANSWER TO THE PERCEIVED MALPRACTICE CRISIS AND IF #ONGRESS TRULY WANTS TO LIMIT FRIVOLOUS CASES IT SHOULD CONSIDER -INN 3TAT e AS A MODEL FOR FEDERAL LEGISLATION / ÀÌÊ,iv À Ê iÃÊ ÌÊ *ÀiÛi ÌÊ > «À>VÌ Vi

4HE PRIMARY CAUSE OF MALPRACTICE LAWSUITS ISxMALPRACTICE 7HENEVER PREMIUMS RISE DOCTORS AND INSURERS ARGUE THAT THE SOLU TION IS TORT REFORM (OWEVER EVEN IF LAWS WERE PASSED TO PREVENT MALPRACTICE LAW SUITS THE PROBLEM OF MALPRACTICE WOULD NOT DISAPPEAR ! RECENT REPORT BY THE )NSTI TUTE OF -EDICINE ESTIMATED THAT BETWEEN AND PEOPLE ARE KILLED EACH YEAR BY PREVENTABLE MEDICAL ERRORS -ORE PEOPLE DIE FROM MALPRACTICE THAN FROM BREAST CANCER OR AUTOMOBILE ACCIDENTS ! RECENT STUDY PUBLISHED IN THE .EW %NGLAND *OURNAL OF -EDICINE REPORTED THAT ONE THIRD OF ALL DOCTORS OR THEIR FAMILIES HAVE EXPERIENCED MEDICAL ERRORS IN THE COURSE OF RECEIVING MEDICAL TREATMENT AND PERCENT HAVE WITNESSED MEDICAL ERRORS CAUSING SERIOUS HARM IN THE PAST YEAR -OST OF THESE PHYSICIANS EXPECT TO

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SEE SIMILAR ERRORS IN THE NEXT YEAR ! RECENT ARTICLE IN THE !RCHIVES OF )NTERNAL -EDICINE COMMENTED ON THE INCIDENCE OF MEDICATION ERRORS KNOWN AS ADVERSE DRUG EVENTS 4HE STUDY CONCLUDED THAT PERCENT OF ADVERSE DRUG EVENTS WERE PREVENTABLE AND THAT THE CONSEQUENCES OF ADVERSE DRUG EVENTS WERE OFTEN SEVERE )NTERESTINGLY ALTHOUGH MOST PHYSI CIANS FEEL SURGEONS WHO MAKE ERRORS WITH SERIOUS CONSEQUENCES SHOULD BE SUBJECT TO LAWSUITS WHEN ASKED HOW TO ADDRESS MALPRACTICE MANY SUGGEST THAT MAKING IT MORE DIFlCULT TO lLE MALPRACTICE LAW SUITS AND IMPOSING CAPS ON DAMAGES IS A hGOOD PLACE TO START v !CCORDINGLY THERE IS A TENDENCY BY PHYSICIANS TO BLAME TRIAL LAWYERS AND LAWSUITS AS THE CAUSE OF THE MALPRACTICE CRISIS AND TO OFFER TORT REFORM AS THE CURE 4HIS APPROACH IS SIMILAR TO PRESCRIBING AN ANTIBIOTIC FOR A VIRAL INFEC TION 4HE hTREATMENTv IS INEFFECTIVE AND #ONTINUED ON PAGE

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OFTEN CAUSES MORE HARM THAN GOOD ,IM ITING OUR CITIZENS ACCESS TO JUSTICE FAIR COMPENSATION WILL DO NOTHING TO STEM THE PREVALENCE OF MEDICAL ERRORS AND WILL LIKELY DAMAGE THE PUBLIC S CONlDENCE IN OUR LEGAL SYSTEM AND RESULT IN UNDER COM PENSATED TORT VICTIMS %QUALLY DISTRESSING A MEDICAL PRO FESSION OR GOVERNMENT THAT ATTEMPTS TO SHIFT THE BLAME FOR MEDICAL ERRORS TO TRIAL LAWYERS FOR INHERENT DElCIENCIES OR FAILINGS IN THE PROVISION OF MEDICAL CARE WILL LOSE THE OPPORTUNITY FOR SELF EXAMINATION AND IMPROVEMENT &ORMER !LABAMA #OACH h"EARv "RYANT WHEN COMMENTING ON MISTAKES IS CREDITED WITH SAYING THAT ONE SHOULD h!DMIT THEM LEARN FROM THEM AND NOT REPEAT THEM v 3URGEON AND AUTHOR !TUL 'AWANDE IN HIS RECENT BOOK #OMPLICATIONS HIGH LIGHTED THE PRODUCTIVE APPROACH THAT ANESTHESIOLOGISTS TOOK IN WHEN A CLOSED CLAIMS STUDY REVEALED THAT MANY ANESTHESIOLOGY DEATHS WERE PREVENTABLE 2ATHER THAN CLAMORING FOR TORT REFORM $R %LLISON 0IERCE WHO WAS THEN VICE PRESIDENT OF THE !MERICAN 3OCIETY OF !NESTHESIOLOGISTS ADVOCATED CHANGES IN PRACTICE TO PREVENT ANESTHESIA ERRORS $R 0IERCE CALLED FOR STANDARDIZATION OF THE DI ALS USED TO TURN UP THE GAS OR OXYGEN USED DURING THE ADMINISTRATION OF ANESTHESIA AND ADVOCATED THE MEASUREMENT OF CARBON DIOXIDE AFTER INTUBATION OF PATIENTS !S A RESULT OF THESE CHANGES THERE WAS A PERCENT DECREASE IN THE NUMBER OF SURGERY PATIENTS WHO DIED FROM HUMAN ERROR ON THE PART OF THE ANESTHESIOLOGIST 3IMILAR IMPROVEMENTS WERE MADE IN WHEN THE !MERICAN !CADEMY OF /RTHOPEDIC 3URGEONS ADDRESSED THE PROBLEM OF OPER ATING ON THE WRONG ARM OR THE WRONG LEG 4HE ORTHOPEDISTS MADE IT STANDARD PRAC TICE FOR THE PATIENT TO MARK THE CORRECT BODY PART WITH AN INK MARKER BEFORE GOING ÊÊÊÊ >ÀV É «À ÊÓää{Ê

TO THE OPERATING ROOM 7RONG SIDED OP ERATIONS HAVE BEEN DRASTICALLY REDUCED $R 'AWANDE WROTE h)N RETROSPECT EVERYONE WILL ASK @7HY DIDN T ) THINK OF THAT v

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!LTHOUGH THE APPLICATION OF JOINT AND SEVERAL LIABILITY IS NOT OFTEN NECESSARY IN MALPRACTICE ACTIONS THOSE ADVOCATING TORT REFORM OFTEN ARGUE THAT JOINT AND SEVERAL LIABILITY IS UNFAIR TO DEFENDANTS WITH hDEEP POCKETS v $URING THE LEGISLATIVE SES SION THE -INNESOTA ,EGISLATURE ENACTED CHANGES TO -INNESOTA S JOINT AND SEVERAL LIABILITY LAW 0RIOR TO THE RECENT AMEND MENT A DEFENDANT FOUND GREATER THAN PERCENT AT FAULT COULD BE JOINTLY AND SEVERALLY LIABLE FOR A VERDICT IN FAVOR OF THE PLAINTIFF IF A CO DEFENDANT COULD NOT PAY ITS PROPORTIONATE SHARE -INN 3TAT e SUBD !CCORDINGLY IN A DRAM SHOP CASE WHERE AN ILLEGALLY SERVED DRUNK DRIVER KILLED OR INJURED AN INNOCENT FAULTLESS VICTIM THE BAR COULD BE HELD LIABLE FOR MORE THAN ITS PROPOR TIONATE SHARE OF THE DAMAGE AWARD IF THE DRUNK DRIVER AS IS OFTEN THE CASE LACKED ADEQUATE INSURANCE COVERAGE 4HE RECENT AMENDMENT OF -INN 3TAT e SUBD PROVIDES THAT A DEFENDANT IS NOT JOINTLY LIABLE UNLESS HE OR SHE IS GREATER THAN PERCENT AT FAULT -INN 3ESS ,AW #H 3 & 4HUS AFTER THE NEW LAW WENT INTO EFFECT ON !UGUST MANY PERSONS INJURED BY DRUNK DRIVERS WILL BE UNDER COMPEN SATED *URIES USUALLY ASSIGN A MAJORITY OF FAULT TO THE DRUNK DRIVER )F WE ASSUME A VERDICT WITH THE BAR PERCENT AT FAULT AND THE UNINSURED DRUNK DRIVER PERCENT AT FAULT THE FAULTLESS PLAINTIFF WILL COLLECT ONLY OF THE VERDICT )NSURERS AND THE DEFENSE BAR ARGUE THAT IN THIS EXAMPLE THE BAR IS PAYING ONLY ITS hFAIR SHARE v (OWEVER IS IT REALLY hFAIRv THAT THE FAULTLESS INJURED PLAINTIFF

SHOULD BEAR THE LOSS WHEN AN hAT FAULTv BAR OWNER IN THE BUSINESS OF SELLING INTOXICAT ING BEVERAGES COMMITS AN ILLEGAL SALE )F INSURERS WERE REALLY INTERESTED IN FAIRNESS THEY WOULD FAVOR A PURE COMPARA TIVE FAULT STATUTE THAT WOULD ALSO PRESERVE JOINT AND SEVERAL LIABILITY WHENEVER THE PLAINTIFF WAS LESS AT FAULT THAN THE AGGRE GATE FAULT OF THE DEFENDANTS 4HE DILUTION OF -INNESOTA S JOINT AND SEVERAL LIABILITY LAW ENACTED BY THE ,EGISLATURE IS A TRIUMPH OF SPECIAL INTERESTS OVER BASIC PRINCIPLES OF FAIRNESS AND JUSTICE

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#LINICAL DECISION SUPPORT IS AN IMPORTANT PART OF A BROADER STRATEGY FOR ACHIEVING CONSIS TENTLY HIGHER LEVELS OF PATIENT SAFETY AND QUAL ITY OF CARE !LERTS AND TRIGGERS TO PHYSICIANS NURSES PHARMACISTS AND OTHER PERSONNEL ADD A VITAL hSAFETY NETv TO ENSURE THAT OUR BEST INTEN TIONS ARE REALIZED IN CARE DELIVERY 0OPULATIONS WILL RECEIVE BETTER CARE BY ENSURING THAT HIGH QUALITY CARE IS DELIVERED ON A CONSISTENT BASIS $ATA FROM ALERTS AND OTHER INTERNAL TRIGGERS CAN BE USED TO MEASURE CLINICAL QUALITY AND THE DEGREE OF IMPROVEMENT IN CARE 4HEY CAN ALSO BE USED TO IDENTIFY AREAS OF CLINICAL CONCERN AND #ONTINUED ON PAGE

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AND CURTAILING THE COST OF DRUGS )N THIS AREA THE 5NITED 3TATES IS ISOLATED INTERNATIONALLY 7E STAND ALONE AS THE ONLY INDUSTRIALIZED COUNTRY REFUSING TO PUT THE NEEDS OF THE !MERICAN PEOPLE AHEAD OF THE PROlTEERING OF THE PHAR MACEUTICAL COMPANIES !S A RESULT !MERICANS BOTH INSURED AND UNINSURED YOUNG AND OLD PAY PRICES AS MUCH AS TWICE AS HIGH AS THE REST OF THE INDUSTRIALIZED WORLD 4O KEEP IT SIMPLE THERE ARE BUT TWO WAYS TO LOWER PRESCRIPTION DRUG PRICES IN THIS COUNTRY /NE IS FOR HONEST NEGOTIATIONS AND REGU LATION THAT ALLOWS DRUG COMPANIES TO HAVE A GOOD BUT NOT EXCESSIVE PROlT AND ALLOWING FOR NEEDED RESEARCH AND DEVELOPMENT &OR EXAMPLE THE PRICES OF DRUGS FOR "RITAIN ARE ONE HALF THE COST OF DRUGS IN THE 5 3 WHILE STILL ALLOWING PHARMACEUTICAL COMPANIES TO MAKE A PERCENT NET PROlT AND SPENDING AN EQUAL AMOUNT ON 2 $ 02)-% )NSTITUTE 5NIVERSITY OF -INNESOTA 7HILE MANY MAY FAVOR THIS IT IS UNLIKELY TO BE ADOPTED IN THIS COUNTRY ES PECIALLY AS THE -EDICARE PRESCRIPTION DRUG BILL SPECIlCALLY PROHIBITS PRICE NEGOTIATION BY THE 5 3 GOVERNMENT 4HE SECOND AND ONLY VIABLE OPTION IS TO ALLOW THE POWER OF INTERNATIONAL FREE MARKETS TO

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#ONGRESSIONAL LEADERSHIP AND AT THE STATE LEVEL BY 'OVERNOR 0AWLENTY AND OTHER GOVERNORS WILL NOT GO AWAY 4HE 3ENATE VERSION OF THE 0HARMACEUTICAL -ARKETING !CT 3 IS VERY VERY MUCH ALIVE 3PONSORED BY 3ENATOR "YRON $ORGAN $ .$ WITH SIGNIlCANT CO SPONSORSHIP FROM 3ENATORS $AYTON $ -. &EINGOLD $ 7) AND -C#AIN 2 !: HEAR INGS ON THE LEGISLATION ARE EXPECTED THIS SPRING 7E ASK -INNESOTA PHYSICIANS TO JOIN THE 3ENIOR &EDERATION TO PUT THE NEEDS OF THE !MERICAN PEOPLE AHEAD OF THE GREED OF THE PHARMACEUTI CAL INDUSTRY 7ITH THE ACTIVE SUPPORT OF THE -EDICARE *USTICE #OALITION CONSUMERS PROVIDERS AND PAYERS WILL BE INCREASING THE CALL FOR AFFORDABLE MEDICATIONS FOR ALL !MERICANS IN THE MONTHS AHEAD 4HE 3ENIOR &EDERATION IS CONDUCTING A MAJOR COMMUNITY EDUCATION CAMPAIGN ON THE MANY ISSUES RAISED BY THE LEGISLATION -ULTI ME DIA PRESENTATIONS ARE AVAILABLE FOR PROFESSIONAL CIVIC AND RELIGIOUS AS WELL SENIOR ORGANIZA TIONS )F YOU WOULD LIKE MORE INFORMATION OR TO BECOME INVOLVED IN THE CAMPAIGN PLEASE CONTACT THE -INNESOTA 3ENIOR &EDERATION AT & 0ETER 4 7YCKOFF IS EXECUTIVE DIRECTOR OF THE -INNE SOTA 3ENIOR &EDERATION -ETROPOLITAN 2EGION

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s )N &9 !3# UPDATE WILL BE #0) 5 MINUS PERCENTAGE POINTS IN &9 PLUS THE LAST QUARTER OF AND EACH OF CALENDAR YEARS THROUGH THE UPDATE WILL BE FROZEN AT PERCENT s 2EPEALS YEAR PAYMENT SURVEY REQUIREMENT UPON IMPLEMENTATION OF NEW !3# PAYMENT SYSTEM REQUIRES '!/ STUDY THAT COMPARES RELATIVE COSTS OF PROCEDURES IN !3#S TO THOSE IN HOSPITAL OUTPATIENT DEPARTMENTS WITH REPORT DUE *AN AND RECOMMENDATIONS MUST FOCUS ON I APPROPRIATENESS OF USING GROUPS AND RELATIVE WEIGHTS ESTABLISHED FOR THE HOSPITAL 003 AS A BASIS FOR THE NEW !3# PAYMENT SYSTEM II IF THESE WEIGHTS ARE APPROPRIATE WHETHER !3# PAYMENTS SHOULD BE BASED ON A UNIFORM PERCENTAGE OF SUCH WEIGHTS WHETHER THE PERCENTAGES SHOULD VARY OR WHETHER THE WEIGHTS SHOULD BE REVISED FOR CERTAIN PROCEDURES OR TYPES OF SERVICES III THE APPROPRIATENESS OF A GEOGRAPHIC ADJUSTMENT IN THE !3# PAYMENT SYSTEM AND IF APPROPRIATE THE LABOR AND NON LABOR SHARES OF SUCH PAYMENT s 2EQUIRES SUBJECT TO THESE RECOMMENDATIONS A NEW PAYMENT SYSTEM FOR !3#S ON OR AFTER *AN AND BEFORE *AN SYSTEM TO BE BUDGET NEUTRAL AGGREGATE SPENDING UNDER THE NEW SYSTEM MUST BE THE SAME AS WOULD HAVE BEEN UNDER THE OLD SYSTEM 3EC i` V>ÀiÊ i> Ì Ê >ÀiÊ+Õ> ÌÞÊ i Ã

s 2EQUIRES YEAR DEMO TO EXAMINE FACTORS THAT IMPROVE QUALITY OF CARE INCLUDING I INCENTIVES TO IMPROVE PATIENT SAFETY QUALITY AND EFl CIENCY II USE OF BEST PRACTICE GUIDELINES III REDUCTION OF SCIENTIlC UNCERTAINTY THROUGH OUTCOMES MEASUREMENT IV SHARED PROVIDER PATIENT DECISION MAKING V USE OF CULTURALLY SENSITIVE CARE AND VI lNANCIAL EFFECTS OF THESE CHANGES 3EC ,i}Õ >Ì ÀÞÊ,i iv

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s 0HYSICIANS ARE PERMITTED TO SUBMIT ADDITIONAL INFORMATION PRIOR TO THE CONSENT SETTLEMENT BUT IF THEY LATER AGREE TO A CONSENT SETTLEMENT THEY WAIVE THEIR APPEAL RIGHTS 3EC O #ONTRACTORS ARE NOT ABLE TO RECOUP AN OVERPAYMENT UNTIL THE 1UALI lED )NDEPENDENT #ONTRACTOR HAS RENDERED A DECISION O 0HYSICIANS WHOSE ENROLLMENT APPLICATIONS ARE DENIED OR REVOKED ARE PERMITTED TO APPEAL UNDER e H OF THE 3OCIAL 3ECURITY !CT 3EC A Û> Õ>Ì ÊEÊ > >}i i ÌÊ E ®Ê

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GENERALLY BE PERCENT OF THE MANUFACTURER S AVERAGE SALES PRICE IN %STABLISHES COMPETITIVE BIDDING AS A PHYSICIAN CHOICE IN 6ACCINES WILL CONTINUE TO BE PAID AT PERCENT OF !70 3EC s )NCREASES PRACTICE EXPENSE PAYMENTS FOR DRUG ADMINISTRATION REVIEWS EXISTING CODES AND EXEMPTS ANY REVISIONS FROM BUDGET NEUTRALITY ALLOWS SUPPLEMENTAL SURVEYS ON PRACTICE EXPENSES FOR DRUG ADMINISTRATION REQUIRES -ED0!# REVIEW OF PAYMENT CHANGES AS THEY IMPACT PAYMENT AND ACCESS BY FOR ONCOLOGISTS AND BY FOR OTHER AFFECTED SPECIALTIES 3EC ,i « ÀÌ>Ì

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s 2EQUIRES PAYMENT OF 0ART " PREMIUM TO VARY ACCORDING TO INCOME LEVEL THOSE WITH INCOMES AT O FOR INDIVIDUAL AND FOR MARRIED COUPLES CONTINUE TO PAY PERCENT O TO TO FOR COUPLES PAY PERCENT O TO TO FOR COUPLES PAY PERCENT O TO TO FOR COUPLES PAY PERCENT AND O !BOVE FOR COUPLES PAY PERCENT s !UTHORIZES )23 TO DISCLOSE CERTAIN BENElCIARY INFO TO THE 3OCIAL 3ECURITY !DMINISTRATION REGARDING INCOME RELATED MATTERS 3EC

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!3 ) 2%&,%#4 /. 4()3 WEEK S -EDICARE LEGISLATION ) AM REMINDED OF THE GREAT DE BATE OVER HEALTH CARE REFORM WHEN A BIPARTISAN GROUP OF hMAINSTREAMv 3ENATORS TRIED TO lND A POLICY MIDDLE GROUND BETWEEN THE #LINTONS AND THE hDO NOTHINGv 2EPUBLICANS /N A DAY WHEN WE WERE PARTICULARLY DISCOURAGED 3ENA 9Ê 6 Ê 1, , ,

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ENOUGHv SO BOTH THE RIGHT AND THE LEFT FOUND A COMPROMISE SO THEY COULD hDO SOMETHING v !FTER ) SORT THROUGH ALL THE hWINNERSv AND hLOSERSv IN THIS LEGISLATION MEASURED IN MONEY MADE OR LOST OVER TIME ) COME TO THE CONCLUSION THAT !MERICANS ARE ABOUT TO PAY AN AWFULLY HIGH PRICE FOR A COMPARATIVELY SMALL BENElT A DIRECTION MUCH OF MEDICINE IS TAKING TODAY 4HE BOTTOM LINE IS THAT THERE IS AN EVER WIDENING GAP BETWEEN PROVIDERS AND BENElCIARIES THE HEALTHCARE PROVIDERS INSURANCE INDUSTRIES AND SOME EMPLOYERS GAIN OR SAVE MONEY WHILE CONSUMERS LOSE IN BOTH COVERAGE AND COST 4HIS LEGISLATION IS NOT SO MUCH AN EXPANSION OF BENElTS AS IT IS AN EXPANSION OF -EDICARE RESOURCES TO SUPPORT THIRD PARTY PAYERS MEDICAL PROVIDERS AND INTERMEDIARIES LIKE THE PHARMACY BENElTS MANAGERS )T DOES NOTHING TO SIMPLIFY THE PROGRAM TO REDUCE THE RELIANCE ON SUPPLE MENTAL -EDIGAP AND RETIREE WRAPAROUNDS AND IT GUARANTEES THAT -EDICARE WILL BE THE BUSIEST PHONE LINE IN !MERICA ) LL MAKE JUST TWO OBSERVATIONS HERE AND ) WILL EXPAND ON THEM IN COMING WEEKS &IRST 'OVERNOR 'EORGE 7 "USH IN HIS ELECTION CAMPAIGN HAD A REASONABLE AND AFFORDABLE PROPOSITION FOR THE NEEDIEST AMONG US )MMEDIATE (ELPING (AND WAS DESIGNED TO INCREASE THE lNANCING OF THE EXISTING -EDICAID PROGRAM FOR FOUR YEARS TO HELP THE STATES HELP THE MOST NEEDY SENIORS WITH THEIR DRUG COSTS A SIMPLE SOLUTION BUILT ON AN EXISTING PROGRAM AND INFRASTRUCTURE /NCE HE WAS ELECTED THE MEMBERS OF THE 3ENATE AND THE (OUSE REJECTED HIS PROPOSAL AND INSISTED THAT -EDICARE REFORM HAD TO GO HAND IN HAND WITH EXPANDING A PRE SCRIPTION DRUG BENElT 4HREE YEARS LATER 7E HAVE DOUBLED THE COST OF GETTING DRUGS TO SENIORS AND PEOPLE WITH DISABILITIES WHO NEED THEM AND CAN T AFFORD THEM

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7E HAVE A LIMITED DRUG BENElT IN THE -EDI CARE PROGRAM WITH A PREDICTABLE PARTICIPA TION RATE OF AT BEST PERCENT GIVEN THE VALUE OF THESE BENElTS AS CONSTRUCTED AND 4HE COSTS TO REALLY LOW INCOME !MERICANS PRIMARILY ELIGIBLE FOR -EDICAID WILL GO UP NOT DOWN 3ECOND IF YOU LOOK CLOSELY ENOUGH AT THIS BILL YOU CAN ACTUALLY SEE THE FUTURE OF THE 2EPUBLICAN 0ARTY S HEALTH POLICY AGENDA !ND ITS MOST VISIBLE VIABLE SPOKESMAN IS NONE OTHER THAN FORMER (OUSE 3PEAKER .EWT 'INGRICH 7E ARE HEADED FOR THE DECLINE OF -EDICARE AND -EDICAID AS WE KNOW IT WE ARE MOVING TOWARDS A VISION OF THE FUTURE THAT -R 'IN GRICH RECENTLY EXPRESSED AS hA SHIFTING AWAY FROM THE FAILED BUREAUCRATIC THIRD PARTY PAYER MODEL AND BACK TO A MARKET MEDIATED BINARY PAYER MODEL WHERE THE CUSTOMER CONTROLS HIS OWN lRST HEALTH DOLLARS v 4HOSE WHO DOMINATE THE MAJORITY PARTY SEE LARGE NATIONAL MANAGED CARE ORGANIZATIONS HEALTH INSURERS AS A MEANS TO AN END WRESTLING CONTROL OF MEDICAL hMARKETSv FROM GOVERNMENT PAYERS WHILE BUILDING CONSUMER PURCHASING CA PACITY THROUGH HEALTH SAVINGS ACCOUNTS TIERED BENElTS AND CATASTROPHIC INSURANCE 4HEY SEE (EALTH 3AVINGS !CCOUNTS AND THE &EDERAL %MPLOYEE (EALTH "ENElT 0LAN &% ("0 AS A MODEL FOR MOVING EMPLOYERS AWAY FROM THE "UYERS (EALTH #ARE !CTION 'ROUP AND ,EAPFROG hPAY FOR PERFORMANCEv OR hCOMMAND AND CONTROLv EFFORTS WHILE hCONSUMER DRIVEN HEALTH CAREv MAKES THE EMPLOYER ROLE IN PLAN OR PROVIDER PERFORMANCE OR EMPLOYEE HEALTH BENElTS INCREASINGLY IRRELEVANT 3UCH MECHA NISMS ARE DESIGNED TO ENCOURAGE EMPLOYERS TO h7ALMARTIZEv THEIR HEALTH BENElTS LEAVING PERCENT OF EMPLOYEES TO CHOOSE THEIR OWN SERVICES ALA $ElNITY OR PROVIDERS ALA 6IVIUS AND THE OTHER PERCENT OF EMPLOYEES WITH HIGHEST COST MEDICAL CONDITIONS REPRESENTING PERCENT OF ALL HEALTH CARE EXPENDITURES TO THE PRIVATE INSURANCE INDUSTRY 7E WILL PAY A PRICE FOR A LONG TIME FOR THE POLICY DECISIONS EMBODIED IN THIS BILL .ATIONAL MANAGED CARE ORGANIZATIONS AND INSURANCE COMPANIES WILL BE GUARANTEED PAYMENT FOR A SERVICE WHOSE COSTS ALREADY RISE TWO TIMES FASTER THAN THE ECONOMY AND WILL ALWAYS EXCEED THE COSTS OF THOSE SERVICES -EDICARE ALREADY PAYS PRIVATE -EDICARE #HOICE PLANS PERCENT OF

FEE FOR SERVICE -EDICARE AFTER YOU FACTOR IN mOORS LIABILITY ADJUSTMENTS ETC .OW THEY LL GET AN EXTRA BILLION %MPLOYERS WILL GET A BOOST IN THE FORM OF A BILLION PAYMENT DESIGNED TO ENCOURAGE THEM TO MAINTAIN CURRENT DRUG BENElTS FOR THEIR RETIRED EMPLOYEES 3TATES LIKE -INNESOTA THAT HAVE BEEN lNANC ING THE DRUG COSTS OF THE DUAL ELIGIBLES LOW INCOME AND DISABLED ELDERLY WHO RECEIVE BOTH -EDICAID AND -EDICARE BENElTS WILL NOW BE SUBJECT TO A hCLAWBACK v 4HAT IS -INNESOTA WILL HAVE TO PAY A FEE TO THE FEDERAL GOVERNMENT IN EXCHANGE FOR THE -EDICARE PROGRAM ASSUMING RESPONSIBILITY FOR DRUG COSTS OF THE DUAL ELIGIBLES 7HAT WE PAY OUT WILL LIKELY BE MORE THAN WHAT WE GET BACK .EW PRESCRIPTION DRUG PLANS WILL BE ABLE TO COMPETE FOR SENIORS BUSINESS AND WILL BEAR SOME RISK FROM PERCENT TO PERCENT 0HARMACY BENElTS MANAGERS AND OTHER IN SURANCE PLANS THAT JUMP INTO THE BIDDING PROCESS ARE GUARANTEED A PRICE AND WILL BEAR LIMITED RISK 4HE GOVERNMENT WILL PAY THE DIFFERENCE ON THEIR LOSSES $RUG COMPANIES GET THE BEST DEAL BECAUSE THERE WILL BE FEDERAL DOLLARS mOWING INTO DRUG PURCHASING "UT -EDICARE UNLIKE THE 6ETERANS !DMINISTRATION AND -EDICAID CAN NOT BARGAIN TO GET LOWER PRICES AS THEY DO IN #ANADA AND EVERY OTHER COUNTRY IN THE WORLD !ND THERE WILL BE NO RE IMPORTATION OR IMPORTATION FROM COUNTRIES WHERE THE GOVERNMENT IS ALLOWED TO NEGOTIATE VOLUME PRICES )N CONTRAST TO WHAT THIS BILL HAS TO OF FER WHAT -EDICARE NEEDS MOST ARE SIMPLICITY CHOICE AND ACCOUNTABILITY )N THE COMING WEEKS ) WILL EXPAND ON HOW THIS NEW LEGISLATION WILL IMPACT ACCESS AND QUALITY FOR -EDICARE BENElCIARIES PARTICULARLY IN -INNESOTA ) WELCOME YOUR COMMENTS AND REmECTIONS AS WELL & $AVID $URENBERGER SERVED AS 3ENIOR 5NITED 3TATES 3ENATOR FOR -INNESOTA FROM TO (E SERVES NOW AS #HAIRMAN OF THE .ATIONAL )NSTITUTE OF (EALTH 0OLICY .)(0 A PROGRAM OF THE 5NI VERSITY OF 3T 4HOMAS .)(0 MEMBERS ARE HEALTH CARE HEALTH PLANS AND BUSINESS ORGANIZATIONS FROM SIX STATES IN THE 5PPER -IDWEST WHOSE GOAL IS TO CHANGE THE HEALTH CARE SYSTEM FROM THE INSIDE OUT AND THEREBY TO INmUENCE NATIONAL HEALTH POLICY CHANGE

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ABOUT THE DEMOCRATIC CAUCUSES COMING TO )OWA ) DECIDED IT WAS TIME TO TAKE A ROAD TRIP !FTER A YEAR AND A HALF OF STUDYING MEDICAL SCIENCE AND CLINICAL PRACTICE ) WAS BEGINNING TO UNDERSTAND THIS THING WE CALL MEDICINE !LONG THE WAY ONE THING WAS BECOMING VERY CLEAR &OR ME PRACTIC ING MEDICINE WAS GOING TO INVOLVE MORE THAN TREATING PATIENTS IN A CLINIC )T WAS GOING TO INVOLVE IMPROVING THE SOCIOECONOMIC CLIMATE IN WHICH THEY LIVED THEIR LIVES $OCTORS DO NOT WORK IN A VACUUM 3INCE THEY WERE IN THE NEIGHBORHOOD ) WANTED TO SEE lRST HAND WHAT THE DEMOCRATIC CANDIDATES WERE SELLING THE PUBLIC AS FAR AS HEALTH CARE WAS CONCERNED ) ALSO WANTED TO SEE WHAT THE PEOPLE OF )OWA THOUGHT OF IT $EMOCRATS HAVE BEEN TALKING ABOUT UNIVERSAL HEALTH CARE SINCE (ARRY 4RUMAN AND SINCE 4RUMAN THEY HAVEN T BEEN ABLE TO DELIVER ) WANTED TO SEE IF ONE PERSON WITH A CAR AND A SLEEPING BAG AT THE RIGHT MOMENT IN THE RIGHT PLACE COULD DO ANYTHING ABOUT IT ) WAS GOING TO GRILL THE CANDIDATES ON THEIR HEALTH CARE PLANS ) WAS GOING TO lND OUT WHAT THE )OWANS THOUGHT ABOUT HEALTH CARE ) WAS GOING TO PROMOTE THE CAUSE OF HEALTH CARE TO THE NATIONAL MEDIA ) WAS GOING TO )OWA !ND ) REALLY WASN T SURE IF ) WOULD ACTUALLY ACCOMPLISH ANYTHING ) WOKE UP ON 3ATURDAY AT A M BEFORE MY ALARM CLOCK SHOWERED SHAVED PACKED UP THREW MY THINGS IN THE CAR AND ATE BREAKFAST ON THE mY &OR THE NEXT THREE DAYS ) WAS ON THE CAMPAIGN TRAIL RACING FROM TOWN TO TOWN TALKING TO EVERY CANDIDATE VOTER PRESS PERSON AND VOLUNTEER ) COULD lND

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/ iÊ > ` `>ÌiÃÊ (OWARD $EAN WAS mIPPING PANCAKES AT A VERY FOLKSY BREAKFAST EVENT IN -ASON #ITY )OWA !S HE mIPPED HIS lRST PANCAKE WAY UP INTO THE AIR AND ONTO A VOTER S PLATE ) SHOUTED h(EY $R $EAN CAN YOU DO THAT WITH OUR FOREIGN POLICY v h) BETTER v HE REPLIED (E mIPPED ANOTHER PAN CAKE HIGHER INTO THE AIR h(OW ABOUT THE HEALTH CARE SYSTEM v h4HE HEALTH CARE SYSTEM TOO v ! FEW PANCAKES LATER HE LANDED ONE ON THE mOOR ! WOMAN IN HIS ENTOURAGE WHO WAS STANDING NEXT TO ME GRABBED HER COWORKER EXCITEDLY h/H MY GOD ) VE GOT TO CALL MY MOM (E DROPPED ONE v !FTER $EAN GOT DONE WITH PANCAKES HE TOOK OFF HIS APRON AND HUNG IT ON A CHAIR A FEW FEET FROM ME 7HILE )OWA 3ENATOR 4OM (ARKIN WAS WARMING UP THE CROWD ) LEANED OVER A PRESS BARRIER INTRODUCED MYSELF TO $R $EAN AND ASKED HIM WHY HIS UNIVERSAL HEALTH CARE PLAN WOULD WORK WHEN THE #LINTON PLAN HADN T (E REPLIED THAT HIS PLAN HAD WORKED IN 6ERMONT ALREADY AND THAT HE KNEW HE COULD GET IT BY #ONGRESS ) THEN ASKED IF THIS PLAN WAS HIS ULTIMATE VISION FOR HEALTH CARE IN THE 5NITED 3TATES OR JUST A STEP TOWARD SINGLE PAYER HEALTH CARE (E REPLIED THAT SINGLE PAYER WAS A NICE IDEA BUT IT WOULDN T GET PAST #ONGRESS (E WAS ABOUT TO CONTINUE BUT HE WAS CALLED TO THE STAGE BY (ARKIN AND THE CHEERS OF THE )OWANS IN ATTENDANCE ) MET *OHN %DWARDS AND $ENNIS +UCINICH AT $UBUQUE S 'RAND 2IVER #ENTER *OHN +ERRY WAS SCHEDULED TO BE THERE AS WELL BUT HAD CAN CELED %DWARD S SHOWMANSHIP WAS IMPRESSIVE ! ROCK AND ROLL GUITAR SOLO BEGAN TO BLAST FROM THE 0! THE LOADING DOCK DOOR OPENED SLOWLY lRST REVEALING A HUGE *OHN %DWARDS BANNER HANGING ON IT AND THEN *OHN %DWARDS HIMSELF (E STRODE INTO THE ARENA AND ONTO THE STAGE THROUGH A TUNNEL OF HIS CHEERING SUPPORTERS (E WAS AN EXCELLENT ORATOR WHO SOUNDED A

LOT LESS MODERATE THAN THE STATEMENTS ON HIS 7EB SITE !T THE END OF HIS SPEECH HE EXITED THE ARENA INTO THE LOBBY AND ) APPROACHED HIM THROUGH THE CROWD OF REPORTERS h#OULD ) GET YOU TO WEIGH IN ON GLOBAL !)$3 3ENATOR %DWARDS v h/H YEAH HUGE ISSUE "UT CAN WE DO IT OUTSIDE ) JUST DON T WANT TO KEEP PEOPLE WAITING v ) TRUSTINGLY FOLLOWED HIS INSTRUCTIONS EXITING THE LOBBY AREA TO THE DOORS WHERE HIS BUS WAS PARKED ) WAITED PATIENTLY FOR %DWARDS BUT WHEN HE AND HIS PEOPLE REACHED THE DOORS THEY RAN ACROSS THE SIDEWALK STRAIGHT PAST ME AND JUMPED INTO THE BUS TRAILED BY THRONGS OF FANS 4HE FANS SCREAMED %DWARDS WAVED (IS ROCK AND ROLL SOUNDTRACK BLARED 4HE BUS DROVE AWAY ) KNOW THESES GUYS HAVE TIGHT SCHEDULES BUT THE FACT REMAINS (E DITCHED ME +UCINICH WAS AN EXCELLENT DYNAMIC SPEAKER WHO SPOKE IN PARAGRAPHS AND RETURNED PERIODICALLY TO UNDERLYING THEMES SUCH AS hTHE TRUTH SHALL SET YOU FREE v ) QUERIED HIM BEFORE HE TOOK THE STAGE AND HE SAID HE D TALK TO ME AFTER HIS SPEECH ) MET HIM AFTER HIS SPEECH AS HE WAS WORKING HIS WAY OUT OF THE ARENA THROUGH A CROWD OF LOCAL PRESS AND ASKED IF HIS PLAN FOR NATIONALIZED SINGLE PAYER HEALTH CARE WAS REALLY A VIABLE OPTION FOR THE MIL LION !MERICANS WITHOUT HEALTH INSURANCE (E SAID HE D TALK TO ME IN THE LOBBY .OW WARY OF BEING BLOWN OFF ) STUCK CLOSE TO HIM AND WHEN WE REACHED THE LOBBY ) WAS NEXT IN LINE TO TALK WITH HIM RIGHT AFTER A PATIENT )OWA VOTER WHO WANTED HIS AUTOGRAPH WHEN +UCINICH GOT MOBBED BY THE %UROPEAN AND 3OUTH !MERICAN PRESS WITH WHOM APPARENTLY HE IS VERY POPULAR ) TRIED TO HOLD MY GROUND AND GET MY QUESTION IN BUT A &RENCH REPORTER SHOVED HER MICROPHONE RIGHT IN MY FACE AND PUSHED PAST ME TO GET TO +UCINICH ALMOST KNOCKING OVER THE NICE )OWAN WHO WAS WAIT ING PATIENTLY FOR AN AUTOGRAPH ) STUMBLED

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BACKWARD STUNNED BY THIS AND IMMEDIATELY LOST MY PLACE IN THE %UROPEAN PRESS SWARM ) WAITED DEJECTED AT THE BACK OF THE PRESS CROWD HOPING FOR ANOTHER CHANCE BUT +UCINICH S CAM PAIGN MANAGER TOLD HIM THEY HAD TO LEAVE (E APOLOGIZED FOR LEAVING AND LEFT 7ATCHING THE NICE )OWAN GLARE AT THE &RENCH JOURNALIST WHO HAD STOLEN HIS AUTOGRAPH OPPORTUNITY MADE ME REALIZE THAT ) WAS NOT RUDE ENOUGH TO COMPETE WITH THE CAMPAIGN REPORTERS *OHN +ERRY WAS SCHEDULED TO APPEAR AT P M IN #EDAR 2APIDS AT AN INTIMATE THEATER IN THE ROUND STYLE VENUE 4HE CANDI DATE WAS GOING TO HOLD A QUESTION AND ANSWER SESSION FOR UNDECIDED VOTERS )T WAS PAST P M 4HE LOCAL COMEDIAN AND ONE OF THE *OHN +ERRY BIOGRAPHERS WHO WERE WARMING UP THE CROWD WERE OUT OF MATERIAL ALREADY *OHN +ERRY WAS LATE )N ORDER TO lLL IN THE TIME +ERRY S DAUGHTERS 6ANESSA AND !LEXANDRA TOOK THE STAGE AND SAID A FEW WORDS IN SUPPORT OF THEIR FATHER 4HEY SEEMED TO BE RUNNING OUT OF THINGS TO SAY AND WONDERING WHAT TO DO NEXT WHEN ) DECIDED TO INTERVENE ) STEPPED TO THE EDGE OF THE STAGE h(I ) WAS WONDERING IF YOU WOULD TAKE QUESTIONS v 4HE COMEDIAN JUMPED UP TO TRY AND RESCUE THEM BUT THEY BOTH SAID SURE THEY WOULD ) CONTINUED h9OU WERE TALKING ABOUT GROWING UP WITH *OHN +ERRY AND MOST OF US GROWING UP KIND OF THOUGHT OUR PARENTS WERE A LITTLE WEIRD v 4HE CROWD BEGAN TO LAUGH h) M PRETTY MUCH GROWN UP AND ) STILL THINK MY PARENTS ARE WEIRD v -ORE LAUGHING AND THE COMEDIAN BEGAN TO GET NERVOUS h)S YOUR DAD WEIRD v 4HE SISTERS SMILED SIMULTANEOUSLY AND TOLD A STORY ABOUT HOW ONE TIME HE WORE A BATH ING SUIT ON THE OUTSIDE OF A FULL WET SUIT AND HOW HE USED TO MAKE PANCAKES IN ANIMAL AND ALPHABET SHAPES 4HIS PROVOKED MORE AUDIENCE QUESTIONS AND lNALLY ENDED WITH AN AUDIENCE MEMBER SUGGESTING THAT THEY DEBATE THE "USH DAUGHTERS ,ATER ) APOLOGIZED TO THE POSSIBLE lRST FAMILY MEMBERS FOR PUTTING THEM ON THE SPOT BUT THEY SAID THAT IT WAS FUN +ERRY lNALLY GOT THERE ) WAITED MY TURN AND ASKED HIM IF HE REALLY HAD A PLAN TO ADDRESS THE !)$3 EPIDEMIC OR IF HE WAS JUST BLINDLY PLEDGING MONEY AND MAKING DECLARATIONS LIKE EVERYONE ELSE SEEMED TO BE DOING +ERRY IS VERY PROUD OF HIS HISTORY OF SUPPORTING AND AUTHORING !)$3 BILLS SO MY QUESTION PROVOKED A LENGTHY RESPONSE THAT TURNED INTO A RALLYING CALL TO THE PEOPLE OF !MERICA (E CONTINUED TO

ANSWER QUESTIONS UNTIL WELL PAST P M WHEN HIS CAMPAIGN MANAGERS PRETTY MUCH DRAGGED HIM AWAY TO CATCH A PLANE TO A NATIONAL 46 INTERVIEW IN $ES -OINES )N A UNION HALL IN THE SMALL TOWN OF .EWTON )OWA $ICK 'EPHARDT mANKED BY *IMMY (OFFA AND THREE OTHER NATIONAL UNION LEADERS SPOKE TO AN ENTHUSIASTIC CROWD 'E PHARDT WAS BEING ENDORSED BY EVERY UNION YOU CAN THINK OF AND GAVE A SPEECH BLASTING .!&4! AND CALLING FOR NEW JOBS (IS EYES WELLED WITH TEARS WHEN HE TALKED ABOUT HIS SON WHO ALMOST DIED OF CANCER AS A CHILD !FTER HIS SPEECH HE VERY CARINGLY SHOOK HANDS WITH AND TALKED TO EVERYONE WHO CAME UP TO HIM AND ALMOST IGNORED THE JOURNALISTS IN FAVOR OF THE FRIENDLY )OWAN UNIONISTS 4HE JOURNALISTS THEMSELVES WERE UNCOMMONLY COURTEOUS KNOWING THAT SHOVING ASIDE A UNION MEMBER IN THEIR OWN UNION HALL WOULD HAVE VERY NEGATIVE REPERCUS SIONS 'EPHARDT STOPPED FOR A BRIEF INTERVIEW VIA SATELLITE BUT HIS CAMPAIGN ORGANIZERS WERE EAGER TO DRAG HIM OFF TO THE NEXT EVENT (E MADE HIS WAY TOWARD THE DOOR PAUSED FOR ONE LAST PHOTO WITH THE LOCAL UNION BOSS S FAMILY AND THEN BID FAREWELL TO THE CROWD ) FOLLOWED 'EPHARDT OUT THE DOOR GOT HIS ATTENTION AND BEGAN ASKING HIM h7HY EMPLOYER BASED HEALTH CARE v (E WAS ABOUT TO RESPOND WHEN A 3CAN DINAVIAN LOOKING REPORTER IN A FUZZY TURTLENECK AND HIS CAMERAMAN JUMPED BETWEEN 'EPHARDT AND ME AND ASKED HIM HIS POLICY TOWARD %U ROPE ) GAVE UP AND WALKED AWAY !S HE lNISHED WITH THEIR QUESTION 'EPHARDT GLANCED ACROSS THE PARKING LOT AND GAVE ME A PUZZLED LOOK AS HE JUMPED INTO HIS BIG 356 AND WAS SPED AWAY (E PROBABLY THOUGHT ) WAS A REPORTER AND HE D PROBABLY NEVER SEEN ONE GIVE UP AND WALK AWAY / iÊ*ÀiÃÃ ) ALSO HAD PLENTY OF OPPORTUNITIES TO SPEAK WITH THE PROVERBIAL FOURTH BRANCH OF THE !MERICAN GOVERNMENT THE MEDIA AND GIVE INTERVIEWS 4HEY REGARDED ME AS A CURIOUS PHENOMENON A NOMADIC ONE MAN HEALTH CARE LOBBY /NE JOURNALIST FROM -ASSACHUSETTS WAS EVEN PUTTING TOGETHER A PIECE ABOUT PEOPLE S EXPECTATIONS ABOUT THE HEALTH CARE DEBATE

WERE FRUSTRATED WITH THE LARGE YEARLY INCREASES IN INSURANCE PREMIUMS THE SHRINKING SERVICES THE GROWING CO PAYS AND THE GREATER THAN PER CENT PROlTS THAT THE PHARMACEUTICAL COMPANIES WERE MAKING 4HERE WAS ALSO A PROFOUND FEAR IN MANY OF THE PEOPLE OF ANOTHER FOUR YEARS OF THIS WITHOUT DRASTIC CHANGE ) REALIZED THAT THE CAN DIDATES WHO WERE REALLY CLICKING WITH )OWANS AND PULLING AHEAD IN THE POLLS WERE HEAVILY EMPHASIZING THEIR hELECTABILITY v 4HE )OWANS DIDN T SEEM TO FOCUS ON THE lNER DISTINCTIONS BETWEEN THE POLICIES OF THE CANDIDATES BUT MORE ON THE IDEA OF GETTING A DEMOCRAT ANY DEMOCRAT INTO OFFICE )T WASN T SO MUCH ABOUT WHAT THEY WERE GOING TO DO IN OFlCE AS MUCH AS THAT THEY COULD GET THERE / iÊ ÃÃÕi )N THREE DAYS AT THE CAUCUSES ) TALKED TO THE TOP lVE CANDIDATES COUNTLESS )OWANS JOURNALISTS AND CAMPAIGN WORKERS 7HAT ) LEARNED FROM EVERYONE WAS THAT HEALTH CARE IS A HUGE ISSUE %VERYONE ) SPOKE WITH LISTED HEALTH CARE IF NOT AS THE NUMBER ONE ISSUE FOR THE ELECTION THEN AT LEAST IN THE TOP THREE 4HE CANDIDATES THEM SELVES AGREED .OTABLY $ICK 'EPHARDT CALLED HEALTH CARE THE ISSUE OF THE ELECTION AND *OHN +ERRY WARNED OF THE IMPENDING IMPLOSION OF THE HEALTH CARE SYSTEM / iÊ ` /N MY LAST DAY IN )OWA ) WAS TALKING TO A LOCAL VOLUNTEER AND HE ASKED ME IF ) WAS A MEDICAL STUDENT SHOULDN T ) BE STUDYING RIGHT NOW ! GOOD POINT (E COULD BE RIGHT ) IMAGINED "UT THEN AGAIN MAYBE ) WAS STUDYING RIGHT NOW h4HIS IS MEDICAL SCHOOL v ) TOLD HIM (E SMILED AND WE BOTH WATCHED AS THE PRESS POOL OF ANOTHER CANDIDATE POURED FROM THEIR BUS INTO THE BUILDING LIKE STORM TROOPERS FRANTICALLY lGHTING FOR A GOOD VANTAGE POINT IN ANTICIPATION OF ANOTHER DRAMATIC ENTRANCE AT ANOTHER STOP ON THE LONG HAUL TOWARDS THE 5 3 PRESIDENCY & 7ILL .ICHOLSON IS A SECOND YEAR MEDICAL STUDENT AT THE 5NIVERSITY OF -INNESOTA

/ iÊ*i « i 4HE )OWANS ) MET WERE MOSTLY FROM SMALL TOWNS MOSTLY DEMOCRATS AND MOST OF THEM

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!3 ! 0(93)#)!. 7(!4 7/5,$ 9/5 4().+ IF WHEN FACED WITH A PARTICULAR CLINICAL SITUATION YOU WERE REQUIRED BY LAW TO SAY SOMETHING TO YOUR PATIENT THAT IN YOUR PROFESSIONAL OPINION WAS MEDICALLY INAPPROPRIATE OR IN SOME CASES DOWNRIGHT CRUEL (OW WOULD THAT MAKE YOU FEEL 4HIS IS WHAT HAPPENED ON *ULY TO OBSTETRICIAN GYNECOLOGISTS AND OTHERS WHO COUNSEL WOMEN REGARDING OPTIONS WHEN FACED WITH AN UNPLANNED OR ABNORMAL PREGNANCY WITH THE PASSAGE OF THE SO CALLED h7OMAN S 2IGHT TO +NOW !CT 724+ v 4HE 724+ LAW LEGISLATES THAT PARTICULAR INFORMATION BE PROVIDED TO WOMEN CONSIDERING A PREGNANCY TERMINATION )T SPECIlES HOW AND BY WHOM THIS INFORMATION CAN BE GIVEN REQUIRES THAT IT BE GIVEN AT LEAST HOURS BEFORE THE PROCEDURE IS PERFORMED UNLESS THERE IS A hSERIOUS RISK OF SUBSTANTIAL AND IRREVERSIBLE IMPAIRMENT OF A MAJOR BODILY FUNCTIONv AND DElNES REPORTING REQUIREMENTS TO THE #OMMIS SIONER OF (EALTH .O ONE OPPOSES INFORMED CONSENT BEFORE MEDICAL OR SURGICAL TREATMENT )N FACT INFORMED CONSENT IS ALREADY REQUIRED BY LAW -INN 3TATUTES SUBDIVISION ITEM AND FAILURE TO DO SO IS A FELONY )T WAS ON THIS BASIS AS WELL AS CONCERN THAT THE LAW INTERFERES WITH THE PHYSICIAN PATIENT RELATIONSHIP THAT THE -INNESOTA -EDICAL !SSOCIATION OPPOSED THIS LAW -N!#/' OPPOSED THE LAW AS WELL WITH TESTIMONY REGARDING CONCERNS ABOUT MEDICAL ACCURACY AND THE INABILITY TO INDIVIDUALIZE COUNSELING TO THE WOMAN S PARTICULAR CIRCUMSTANCE .ONETHELESS THE LAW PASSED 3O WHAT HAS HAPPENED TO THE WOMAN S EXPERIENCE WHEN FACED WITH AN UNPLANNED OR ABNORMAL PREGNANCY SINCE *ULY !BORTION CLINICS HAVE MADE THE NECESSARY ADMINISTRATIVE ADJUST MENTS IN THEIR DAY TO DAY ACTIVITIES TO COMPLY WITH THE LAW "UT WHAT OF THE /B 'YN IN GENERAL PRACTICE WHO MAY FACE THIS ISSUE ONLY A FEW TIMES A YEAR AND GENERALLY IN THE SETTING OF A DESIRED PREGNANCY THAT IS ABNORMAL OR A SERIOUSLY ILL MOTHER 4HE FOLLOWING SCENARIO ILLUSTRATES THE INHUMANE NATURE OF THIS LAW )N OUTSTATE -INNESOTA A PHYSICIAN DISCUSSES THE OPTIONS WITH HIS PATIENT AND HER HUSBAND REGARDING THEIR NEWLY DIAGNOSED WEEK ANENCEPHALIC FETUS !FTER REVIEWING THE RISKS AND BENElTS OF CARRYING THE PREGNANCY TO TERM VS TERMINATION THEY CHOOSE THE LATTER AS BEST FOR THEIR FAMILY 0ERINATAL HOSPICE AN OPTION ACCEPTABLE TO SOME WAS NOT RIGHT FOR THEM .OW THE PHYSICIAN MUST DISCUSS AND DOCUMENT THE STATE MANDATED INFORMED CONSENT (E TELLS THEM hMEDICAL ASSISTANCE

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BENElTS MAY BE AVAILABLE FOR YOUR PRENATAL CARE CHILDBIRTH AND NEONA TAL CARE v 5NFORTUNATELY THIS BABY IS GOING TO DIE 0ERHAPS INFORMATION ON FUNERAL EXPENSES WOULD BE MORE APPROPRIATE (E THEN STATES hTHE FATHER IS LIABLE TO ASSIST IN THE SUPPORT OF THE CHILD EVEN IF THE FATHER OFFERED TO PAY FOR THE ABORTION v 4HIS FATHER DESPERATELY WISHES HE HAD THE CHOICE OF SUPPORTING THIS CHILD LIKE HE DOES HIS OTHERS .OW THEY ARE INFORMED THAT THEY HAVE THE RIGHT TO REVIEW PRINTED MATERIAL PREPARED BY THE -INNESOTA $EPARTMENT OF (EALTH -$( 4HEY CAN VIEW THIS INFORMATION ON A 7EB SITE IN A BROCHURE FROM THE CLINIC OR IT CAN BE MAILED TO THEM 4HIS INFORMATION CONTAINS COLOR PICTURES OF NORMAL FETUSES AT EVERY TWO WEEKS GESTATION 4HERE IS ADOPTION INFOR MATION AND IT WARNS THEM THAT THEIR FETUS MAY EXPERIENCE PAIN DURING THE ABORTION PROCEDURE (OWEVER NOW THE PHYSICIAN MUST TELL THEM THAT THEIR BABY WILL NEVER LOOK LIKE THOSE PICTURES AND THAT IT SEEMS UNLIKELY THAT THE FETUS WILL EXPERIENCE PAIN SINCE IT HAS NO BRAIN 4HEY DECLINE THEIR RIGHT TO VIEW THE INFORMATION AND THIS IS DOCUMENTED BY THE PHYSICIAN 4HEY ARE THEN INFORMED THAT THEY MUST WAIT HOURS BEFORE PROCEEDING WITH THE PREGNANCY TERMINATION 4HIS IS NOT A PROB LEM 4HEY MUST ARRANGE FOR CHILDCARE ANYWAY )N THIS CLINICAL SCENARIO THE LAW HAS DONE NOTHING TO ENHANCE THIS PATIENT S HEALTH CARE )NDEED IT HAS ADDED TO THEIR PAIN 4HE SAME COULD BE SAID FOR OTHER SITUATIONS SUCH AS SEVERE AND NON FATAL FETAL ANOMALIES PREGNANCY AS A RESULT OF RAPE OR INCEST MATERNAL ILLNESS SUCH AS CANCER AND THE NEED FOR CHEMOTHERAPY OR SITUATIONS WHERE THE PREGNANCY ITSELF THREATENS THE WOMAN S HEALTH !GAIN THE ISSUE HERE IS HUMANE INDIVIDUALIZATION OF INFORMED CONSENT 4HIS LAW OUTLAWS IT 7HEN ALL IS SAID AND DONE THERE ARE FOUR FORMS THAT MUST BE lLLED OUT FOR EVERY PREGNANCY TERMINATION /NE DOCUMENTS THE SCRIPT OF THE hINFORMED CONSENT v INCLUDING WHEN HOW AND BY WHOM IT WAS GIVEN 4HE SECOND IS SIGNED BY THE PATIENT DOCUMENTING THAT SHE RECEIVED THE STATE MANDATED INFORMATION HOURS BEFORE THE ABORTION 4HE THIRD AND FOURTH ARE PROVIDED BY THE STATE )NDEED THEY ARE SENT ANNUALLY TO EVERY PHYSICIAN IN THE STATE REMINDING US OF OUR OBLIGATION TO COMPLY /NE FORM IS TO REPORT THE INFORMED CONSENT PROCESS 4HE OTHER REPORTS THE PROCEDURE INDICATION AND ANY IMMEDIATE COMPLICA TIONS 4HERE IS ALSO A lFTH FORM THAT REQUIRES ANY PHYSICIAN SEEING A DELAYED COMPLICATION OF AN ABORTION TO REPORT THAT TO THE STATE AS WELL

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)N YOUR OPINION WHAT IS THE BIGGEST BARRIER TOWARDS TORT REFORM 4HE GREATEST BARRIER TO TORT REFORM IS THE REFUSAL OF THE PLAINTIFF BAR TO ENGAGE IN HONEST DISCUSSIONS OF THE PROBLEMS AND TO TRY TO REACH REASONABLE SOLUTIONS 4HEY HAVE RESPONDED WITH LIES A SMOKE SCREEN OF DISTORTED AND IRRELEVANT INFORMATION AND OLD FASHIONED POLITICAL PRESSURE AND INmUENCE BUYING 4HIS FORCES US TO RESPOND WITH POLITICS RATHER THAN FACTS AND LOGIC WHICH IS FRUSTRATING TO PHYSICIANS

7ILL --)# SUPPORT CURRENT !-! EFFORTS TO SET ONE NATIONAL LIMIT FOR CLAIMS AGAINST PHYSICIANS --)# AND THE 0)!! 0HYSICIAN )NSURERS !SSOCIATION OF !MERICA ABSO LUTELY SUPPORT THE !-! S EFFORTS --)# S #%/ ALONG WITH !-! AND 0)!! REPRESENTATIVES AND OTHERS IS ONE OF DIRECTORS OF (#,! (EALTH #OALITION ON ,IABILITY AND !CCESS THE LEADING MEDICAL LIABILITY LOBBYING ORGANIZATION )TS SINGLE FOCUS IS ON REFORMS BASED ON #ALIFORNIA S -)#2! INCLUDING A CAP ON NON ECONOMIC DAMAGES

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)T WILL BE INTERESTING TO SEE THE VALUE OF THIS LAW /VER ANNUALLY HAS BEEN ALLOCATED FROM THE GENERAL FUND TO THE -$( FOR ADMINISTERING THIS NEW LAW 4HIS IN A YEAR OF EXTENSIVE CUTS IN SERVICES BY THE STATE ) GUESS THE THEORY IS THAT THERE SHOULD BE AT LEAST AS MANY INFORMED CONSENT FORMS AS THERE ARE ABORTION PROCEDURE FORMS 4HE INFORMED CONSENT FORMS HAVE NO PATIENT IDENTIlERS YET THE -$( WILL RETURN THEM TO THE PHYSICIAN IF THEY ARE INCOMPLETE UNDER PENALTY OF lNES OR WORSE (OW IS THE PHYSICIAN TO KNOW WHICH PATIENT THAT FORM REFERRED TO )F A PATIENT IS JUST ASKING GENERAL QUESTIONS ABOUT OPTIONS BUT CHOOSES TO CONTINUE THE PREGNANCY DOES THE PHYSICIAN NEED TO lLL OUT AND SUBMIT THIS FORM 4HERE IS NO BASELINE WITH WHICH TO COMPARE THIS NEW DATA SO PERSONALLY ) SEE THE NEW REPORTING REQUIREMENTS AS A HUGE WASTE OF HEALTH CARE DOLLARS 7HAT DO YOU THINK 4HIS LAW WAS lNALLY PASSED LAST YEAR BY THE NEW hPRO LIFEv MAJOR ITY IN THE ,EGISLATURE AND ITS 'OVERNOR 4HE TRAGIC LIFE CIRCUMSTANCES THAT LEAD A WOMAN TO EVEN CONSIDER THE OPTION OF ABORTION SHOULD NOT BE EXACERBATED BY A LAW THAT DISRESPECTS THE DOCTOR PATIENT RELATION SHIP THE INDIVIDUALIZATION OF MEDICAL CARE THE CAPABILITY OF WOMEN TO MAKE THEIR OWN HEATH CARE DECISIONS AND THE PROFESSIONALISM OF THE PHYSICIAN 9ET THAT IS EXACTLY WHAT HAS HAPPENED AND ALL ) CAN SAY TO MY PATIENT AT THE END OF THE DISCUSSION IS h) M SO SORRY v &

(OW IS -INNESOTA DOING COMPARED TO THE NATIONAL AVERAGE WITH REGARD TO THE NUMBER OF CASES BROUGHT TO LITIGATION !ND WITH REGARD TO THE AVERAGE PAYMENTS FOR CASES LOST -INNESOTA S RATE OF SIX CLAIMS YEAR PHYSICIANS IS ABOUT HALF THE NATIONAL AVERAGE 4HE AVERAGE INDEMNITY FOR PAID CLAIMS IS JUST UNDER TWO THIRDS THE NATIONAL AVERAGE 9OU CAN SEE THE DIFlCULTY CONVINCING -INNESOTA LEGISLATORS OF THE IMPORTANCE OF THIS ISSUE 4HE PROBLEM IS THAT JUST A FEW BAD CASES AND WE HAVE HAD SOME RECENT BAD JUDICIAL DECISIONS WOULD PRECIPITATE A CRISIS )F TORT REFORM WERE THEN PASSED EXACTLY AS WE WOULD LIKE UNLIKELY IT WOULD TAKE SEVERAL YEARS FOR ITS EFFECTS TO ALLOW PREMIUMS TO RETURN TO REASONABLE LEVELS "AD THINGS CAN HAPPEN QUICKLY WHILE THE GOOD TAKE LONGER

4HERE HAVE BEEN MULTIPLE BILLS INTRODUCED AT THE COM MITTEE LEVEL IN BOTH THE (OUSE AND 3ENATE IN -INNESOTA DEALING WITH UNIVERSAL HEALTH CARE COVERAGE 7HAT DO YOU SEE THE --! S ROLE TO BE IN THIS PROCESS 4HE --! IS ON RECORD AS FAVORING HEALTH INSURANCE FOR ALL 0HYSICIANS LIKE OTHER CITIZENS DON T AGREE ON EXACTLY HOW THIS SHOULD BE ACCOM PLISHED 7E HAVE ADOPTED CERTAIN PRINCIPLES WE AGREE ARE IMPORTANT AND AS OF THIS WRITING ARE CONSIDERING ESTABLISHING A TASK FORCE TO RE EXPLORE HOW WE SHOULD ADDRESS THIS ISSUE ) DON T KNOW WHETHER WE WILL HAVE hA PLAN v 7E WILL DElNITELY SERVE AS A SOURCE OF ACCURATE INFORMATION AND PLAY A ROLE IN EDUCATION OF PHYSICIANS THE PUBLIC AND POLICY MAKERS

7HAT DO YOU THINK ARE THE MOST IMPORTANT STEPS THAT PHYSICIANS CAN TAKE TO IMPROVE SAFETY AND QUALITY IN THE CARE THEY GIVE TO PATIENTS !S ) SIT ON THE --)# CLAIMS COMMITTEE THE COMMON DENOMINATOR IN A GREAT NUMBER OF CASES IS LACK OF COMMUNICATION &IRST EVEN BEFORE NOT HARMING WE HAVE TO LISTEN TO THE PATIENT 7HAT ARE THE SYMPTOMS 7HAT CAN THEY MEAN 7HAT DOES THE PATIENT EXPECT FROM US !S HEALTH CARE HAS BECOME MORE COMPLEX MULTIPLE DOCTORS NURSES AND TECHS CARING FOR A PATIENT HAVE TO COMMUNICATE WITH EACH OTHER CLEARLY ACCURATELY TIMELY AND BE CERTAIN WHAT EACH EXPECTS FROM THE OTHER AND THAT SOMEONE IS IN CHARGE 7E NEED SYSTEMS TO HELP ENSURE THE BALL DOESN T GET DROPPED #LINICAL PATHWAYS AND OTHER PROTOCOLS ARE A BIG HELP 4HE MORE PROCESSES ARE STANDARDIZED THE MORE EVERYONE KNOWS WHAT TO EXPECT ERRORS ARE LESS LIKELY TO OCCUR AND ANYTHING UNEXPECTED IS MORE LIKELY TO BE NOTICED QUICKLY AND DEALT WITH !NYONE WHO IS PAYING ATTENTION SHOULD BE ABLE TO CONSTANTLY NOTICE OPPORTUNITIES TO IMPROVE OUR CARE 4HAT S WHY IT IS CALLED #ONTINUOUS 1UALITY )MPROVEMENT &

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!3 ) "%'). 4(% 0/3)4)/. AS THE TH PRESIDENT OF 2AMSEY -EDICAL 3OCIETY ) AM HUMBLED BY THE EXAMPLE AND WORK THAT ALL THOSE PHYSICIANS PRECEDING ME HAVE GIVEN $R * -ICHAEL 'ONZALEZ #AMPOY SHOWED US THE LEADER SHIP WE NEED IN IMPROVING AND MAINTAINING THE PROFESSIONALISM IN THE PRACTICE OF MEDICINE (IS WORK WITH THE EPIDEMIC OF OBESITY HELPS ALL OF US PHYSICIANS IMPROVE THE CARE OF OUR PATIENTS AND HAS APPROPRIATELY RAISED AWARENESS OF THIS UBIQUITOUS CONDITION -Y THANKS GO OUT TO -I CHAEL AND HIS WIFE 2EBECCA FOR ALL THEIR EFFORTS AND GOODWILL 3INCE THIS IS MY lRST STAB AT THE h0RESIDENT S -ESSAGE v LET ME TELL YOU A BIT ABOUT MYSELF -Y GREATEST ASSET IS MY WIFE ,U,U !LTHOUGH HER REAL NAME IS &LORENCE SHE IS DElNITELY A ,U,U 3HE IS A REGISTERED NURSE A NURTURING MOTHER TO OUR FOUR CHILDREN AND USES HER )TALIAN HERITAGE TO EVERYONE S BENElT WITH HER AWESOME CULINARY SKILLS "UT PERHAPS HER GREATEST STRENGTH IS HER CARING SPIRIT FOR CHILDREN AND THE ILL ) ALWAYS TELL PEOPLE THAT THERE IS NO ONE BETTER AT MINISTERING TO AN ILL CHILD OR ADULT THAN ,U,U (ER PEERS AND FACULTY AT 3T -ARY S #OLLEGE RECOGNIZED THAT TOO WHEN SHE WAS GIVEN THEIR HIGHEST HONOR THE (UMANITARIAN !WARD (ER SUPPORT AND ENERGY HAS GIVEN ME A STRONG FAMILY BASE SO THAT ) CAN WORK IN MY PRACTICE AND PARTICIPATE IN 2AMSEY -EDICAL 3OCIETY ) COULD EXPOUND ON MY FOUR CHILDREN 4ALIA 4RICIA -ICHAEL AND 0ATRICK BUT THEN THIS COL UMN WOULD DEGENERATE INTO A #HRISTMAS LETTER 3UFlCE IT TO SAY ) THINK THEY RE THE BEST !S FOR ME ) AM IN A GROUP ORTHOPEDIC SURGI CAL PRACTICE WITH 3UMMIT /RTHOPEDICS IN 3T 0AUL ) ENJOY THE CAMARADERIE OF MY PARTNERS AND THE HIGH QUALITY OF MEDICINE THEY DELIVER )N CONSIDERING WHAT MESSAGE TO EMPHASIZE DURING MY TENURE AS PRESIDENT THERE ARE SEVERAL WORTHY TOPICS -EDICAL LIABILITY REFORM ELIMINAT ING THE INHERENTLY UNJUST PROVIDER TAX ADVOCATING CREATIVITY AND EFlCIENCY IN PROVIDING ACCESS TO HEALTH CARE FOR ALL CITIZENS MAINTAINING THE PROFES SIONALISM OF MEDICINE RESUSCITATING COLLEGIALITY AMONGST OUR PEERS THESE ARE ALL IMPORTANT ) BE LIEVE THE COMMON DENOMINATOR TO ADDRESS THESE ISSUES IS GRASS ROOTS PARTICIPATION IN THE POLITICAL PROCESS /UR MOST RECENT ISSUE OF -ETRO$OCTORS EMPHASIZED THE IMPORTANCE OF --! (-3 AND

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2-3 REPRESENTATION AT THE #APITOL "UT THERE IS NO SUBSTITUTE FOR LAWMAKERS TO HEAR FROM INDI VIDUAL CONSTITUENTS !S YOUR PRESIDENT OF 2-3 ) WOULD LIKE TO ESPECIALLY WAVE THIS mAG OF POLITICAL AWARENESS AND INDIVIDUAL INTERACTION WITH OUR LEGISLATORS 4HE --! HAS MADE THIS PARTICULARLY EASY WITH THEIR INITIATIVE OF THE ,EGISLATIVE !CTION .ETWORK !S A MEMBER OF THIS NETWORK ) AM PROVIDED WITH EFlCIENT E MAIL COMMUNICATIONS ABOUT IMPORTANT LEGISLATIVE ALERTS THE --! S PO SITION ON SPECIlC ISSUES AND THE CHANNELS THROUGH WHICH ) CAN MAKE MY POSITION HEARD ) HAVE TO ADMIT THAT ) AM NOT A VETERAN OF POLITICAL ACTIVITY AT THE STATE LEGISLATURE &OR MANY OF US THIS LACK OF EXPERIENCE IS PARALYZING AND CREATES A NEGATIVE INERTIA TO AVOID INVOLVEMENT 7E THEN OFTEN FOL LOW THE lNAL COMMON PATH OF COMPLAINING ABOUT OUR PROFESSIONAL WOES IN AN UNINFORMED INACTIVE PASSIVE AND SURRENDERING FASHION ) BELIEVE THIS PAINTS A VERY UNATTRACTIVE PICTURE TO OUR PUBLIC ) ADMONISH ALL OF US TO AT LEAST START WITH SIGNING UP WITH THE ,EGISLATIVE !CTION .ET WORK #ONTACT THE --! #ENTER FOR 0HYSI CIAN !DVOCACY AT OR E MAIL WODONNELL MNMED ORG 4HEY CAN TELL YOU WHO YOUR SENATOR AND REPRESENTATIVES ARE AND GET YOU STARTED WITH INFORMATIVE COMMUNICATIONS AND IS SUE SUMMARIES )F YOU ARE TOO BUSY TO SIGN UP DELEGATE IT 2IP THIS PAGE OUT AND GIVE IT TO YOUR SECRETARY OFlCE MANAGER OR OFlCE STAFF WORKER AND TELL THEM TO GET YOU SIGNED UP 7E ARE ALL TOO BUSY AND ) REALIZE THIS REPRESENTS ANOTHER TASK "UT IF YOU CAN DELEGATE SOME OF THE ORGANIZATIONAL PART TO AN OFlCE STAFF MEMBER THAT SHOULD FREE YOU UP TO SIMPLY RESPOND TO THE SUBSEQUENT INFORMA TION ) AM EXCITED FOR THIS YEAR OF SERVICE TO 2-3 AND ALL OF MY PHYSICIAN COLLEAGUES ) PARTICULARLY LOOK FORWARD TO A GREATER PARTICIPATION IN THE POLITICAL PROCESS AND TAKING SOME ACTION ON BEHALF OF OUR PATIENTS 7HEN WE ENHANCE OUR PROFESSION WE ENHANCE PATIENT CARE 4HE TWO ARE INTRINSICALLY COUPLED AND IT S OUR CHARGE WITHIN THE (IPPOCRATIC /ATH TO THWART THOSE WHO WOULD TRY TO UNCOUPLE THAT BOND &

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BODY HAS TO BE A PROFESSIONAL LOBBYIST TO GET UP TO SPEED ON THE ISSUES FACING PHYSICIANS AND PATIENTS 9OU CAN GET ALL THE INFORMATION YOU NEED BY LOGGING ON TO WWW MMAONLINE NET /R YOU CAN CALL THE OFlCES OF THE 2AMSEY -EDICAL 3OCIETY OR THE -INNESOTA -EDICAL !SSOCIATION AT OR 9ET PEOPLE SHY AWAY PREFERRING TO LEAVE POLITICS TO THOSE OF US WHO COULD BE CALLED POLITICALLY ACTIVE 4HE 2AMSEY -EDICAL 3OCIETY &OUNDATION NEEDS !LLIANCE SUPPORT )T S IMPERATIVE WE DO OUR PART TO HELP 2-3& RAISE MONEY TO SUPPORT GRASS ROOTS ORGANIZED MEDICINE EFFORTS AND SELlSHLY WE WANT TO BE SURE THEY CAN PROVIDE US WITH SOME GRANTS 4HE PROBLEM IS THE HANDFUL OF US DOING THE MAJORITY OF THE WORK CAN T ACCOMPLISH IT ALL OURSELVES 7E LL STILL HELP OUT BUT WE RE MOVING ON %LEANOR 'OODALL AND HER HUSBAND "ILL ARE INVESTING IN A BANANA PLANTATION IN 'UATE MALA THAT WILL BE RUN BY THEIR SON IN LAW AND DAUGHTER )F YOU WANT TO lND OUT MORE BE SURE TO ATTEND THE NEXT --! !LLIANCE MEET ING -ARCH AT OUR HOME IN 3UNlSH ,AKE #ONTACT ME AT BECKY MNCOME COM FOR DE TAILS )T PROMISES TO BE A WILD RIDE %LEANOR IS GOING TO SHARE HER ADVENTURES OF ROUNDING UP A CADRE OF INVESTORS TREKKING BACK AND FORTH TO 'UATEMALA SOMETIMES IN AN 356 WITH YOUNG GRANDCHILDREN IN TOW -Y HUSBAND -IKE AND ) HAVE LAUNCHED

THE -INNESOTA #ENTER FOR /BESITY -ETABO LISM AND %NDOCRINOLOGY 0! AND -.#/-% &OUNDATION ) M ALSO A NEW MEMBER OF OUR LOCAL SCHOOL BOARD !ND ) WILL TAKE THE HELM OF THE -INNESOTA -EDICAL !SSOCIATION !LLIANCE IN -AY /NE THING WE VE DISCOVERED WITH THE --! !LLIANCE IS HALF OF OUR MEMBERS SPOUSES AREN T INVOLVED WITH THE --! $R "OB -EICHES HAS NOW CHARGED US WITH HELP ING THE --! GET THOSE SPOUSES ON BOARD !T THE SAME TIME ) M SURE THERE ARE MANY --! MEMBERS WHOSE SPOUSES AREN T MEMBERS OF THE --! !LLIANCE ) M WILLING TO BET THE SAME IS TRUE OF 2-3 AND THE 2-3 !LLIANCE 7E RE WORKING CLOSELY WITH 2-3 TO RECRUIT BOTH PHYSICIANS AND RESI DENTS AND THEIR LIFE PARTNERS !T THE SAME TIME WE WILL LOOK AT EACH OTHER S MEMBERSHIP LISTS TO SEE HOW WE CAN ENCOURAGE BOTH PHYSICIANS AND THEIR SPOUSES TO GET INVOLVED WITH ORGANIZED MEDICINE -EANWHILE WE RE GOING TO HAVE TO TAKE A SERIOUS LOOK AT HOW WE DO BUSINESS AND DECIDE WHERE WE GO FROM HERE &

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ARD .IXON WAS DEAD &AR FROM IT HIS SPIRIT LIVES ON IN THE -ANAGED #ARE -OVEMENT WHICH MORPHED FROM THE (-/ MOVEMENT ) M AFRAID IT IS TRYING TO MORPH ITSELF AGAIN INTO THE SINGLE PAYER OPTION 'OVERNMENT (EALTH #ARE 7AY BACK IN ANCIENT TIMES THE BRIGHT IDEA OF (-/S CAME UP 4HE IDEA WAS THAT INSURANCE WOULD SURELY PAY TO KEEP PEOPLE HEALTHY )F THEY WERE HEALTHY AND USED LESS MEDICAL CARE THEN THE PATIENT AND INSUR ANCE COMPANIES WOULD COME OUT AHEAD 7HY WE D EVEN SAVE MONEY BY GUARANTEEING SO MANY PATIENTS TO A PHYSICIAN THAT THEY COULD RECEIVE A DISCOUNT FOR THEIR SERVICES AND STILL MAKE MONEY %VERYBODY KNOWS THERE IS hFATv IN THE SYSTEM !LL GRAND IDEAS "UT AS USUAL THE IDEAS AND THE PRACTICE WERE TWO DIFFERENT THINGS *UST AS 3OCIALISTS THINK THAT THEY ARE SMARTER THAN ANYONE ELSE AND THEY KNOW HOW TO RUN AN ECONOMY WE JUST NEED TO SEE THEIR WISDOM !NY EXAMPLE YOU WANT REFUTES THIS NOTION 'ERMANY UNDER THE .AZIS OR 5332 FOR YEARS THOUGHT ECO NOMIC CONTROL WOULD WORK WITH DISASTROUS CONSEQUENCES 4HESE GRAND IDEAS HAVE FAILED "UT RATHER THAN ADMIT THIS FAILURE WE CHANGE THE NAME AND TRY HARDER THIS TIME %VEN BETTER IF WE SHIFT THE BLAME FOR THE FAILURE ON SOMEONE ELSE 4HE DOCTORS ARE GREEDY 0ATIENTS DON T hUTI

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!-! !LLIANCE S MISSION IS TO PARTNER WITH PHY SICIANS TO PROMOTE THE GOOD HEALTH OF !MERICA AND TO SUPPORT THE FAMILY OF MEDICINE 3UCH A NOBLE MISSION IS NOT WITHOUT ITS CHALLENGES 4HE PAST HAS PROVEN THAT JOINT ENDEAVORS OF THE -EDICAL !SSOCIATION AND THE !LLIANCE STRENGTHEN BOTH ORGANIZATION S PROGRAMS AND GOALS 9OU AS PHYSICIANS CONTRIBUTE TO THE !LLI ANCE WITH YOUR MEDICAL EXPERTISE AND PRESTIGE FURTHERING OUR MUTUAL GOAL OF IMPROVING HEALTH FOR ALL !MERICANS 4HE !LLIANCE IN TURN LENDS ITS EXPERIENCED VOLUNTEERS READY AND ABLE TO CARRY OUT MULTIPLE AGENDAS 7ITH MORE THAN MEMBERS WE ARE AN INCREDIBLE SOURCE OF ENERGY AND PEOPLE POWER 7E WORK IN OUR COMMUNITIES TO PROMOTE BETTER INDIVIDUAL HEALTH TO PROVIDE EDUCATION ON PUBLIC HEALTH ISSUES AND TO CONDUCT 3!6% 3TOP !MERICA S 6IOLENCE %VERYWHERE PROJECTS IN OVER COUNTIES NATIONWIDE 4HE SUCCESS OF THE !LLIANCE AND ITS PRO GRAMS IS BASED LARGELY ON MEMBERS ABILITY TO COMMUNICATE WITH THE LAY COMMUNITY 7E FOSTER AN ESSENTIAL UNDERSTANDING AND A REAL ACCESSIBILITY BETWEEN PHYSICIANS AND THE PUBLIC /UR PROJECTS AND OUR COMMUNITY REPUTATION THUS PROMOTE ON BEHALF OF THE ENTIRE MEDICAL COMMUNITY A POSITIVE PUBLIC IMAGE 7E WORK TOGETHER WITH YOU IN THE LEG ISLATIVE ARENA TO ENSURE THE BEST HEALTH CARE POLICIES POSSIBLE 7E WILL CONTINUE TO RESEARCH LEGISLATION MEET WITH LEGISLATORS WRITE LET TERS MAKE TELEPHONE CALLS SEND E MAILS AND FAXES CIRCULATE PETITIONS DEVELOP MATERIALS

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FORM COMMITTEES ALL BACKED BY A BELIEF IN THE POSSIBILITIES FOR COOPERATIVE ACTION IN THE LEGISLATIVE ARENA 7E RAISE FUNDS THROUGH THE !-! &OUNDA TION TO FURTHER THE MEDICAL EDUCATION OF FUTURE PHYSICIANS AND TO PROVIDE INCREASED OPPORTUNI TIES FOR COMMUNITY SERVICE ) HAVE A SOFT SPOT FOR THE !-! &OUNDATION BECAUSE MY OWN HUSBAND WAS ONE OF THE MORE THAN MEDICAL STUDENTS WHO HAVE MADE IT lNANCIALLY THROUGH SCHOOL WITH ESSENTIAL ASSISTANCE FROM THE !-!& #AN YOU IMAGINE WHAT HEALTH CARE IN !MERICA WOULD BE LIKE WITH FEWER PHYSICIANS &ROM A VERY PERSONAL POINT OF VIEW ) AM VERY GRATEFUL FOR THE !-! &OUNDATION 7E HAVE DONE SO MUCH TOGETHER ,ET S ALSO CONSIDER OUR COOPERATION IN THE CHAL LENGE OF MEMBERSHIP (AVE YOU ASKED YOUR SPOUSE PARTNERS TO CONSIDER MEMBERSHIP IN THE !LLIANCE 4HAT MEMBERSHIP WILL ADD TO THE RE SOURCES AND STRENGTH OF THE !LLIANCE AS A VOICE FOR THE HEALTH OF YOUR COMMUNITY EVEN IF ACTIVE PARTICIPATION IN PROJECTS IS NOT POSSIBLE -Y HUSBAND HAS APPRECIATED THE PERSPECTIVE THAT MY !LLIANCE INVOLVEMENT HAS BROUGHT TO HIS UNDERSTANDING OF THE COMMUNITY HE SERVES AND TO MY UNDERSTANDING OF SOME OF THE LEGISLATIVE AND POLITICAL IMPACT ON HIS PRACTICE OF MEDI CINE $ID YOU KNOW THAT YOU AS A PHYSICIAN COULD ALSO BECOME A MEMBER OF THE !LLIANCE 7ITH THE .EW 9EAR IN ITS INFANCY LET US PLEDGE TOGETHER WITH RENEWED RESOLUTION TO BUILD ON THE INCREDIBLE EFFORTS AND ACCOMPLISHMENTS OF OUR PAST COLLEAGUES AT ALL LEVELS OF THESE TREMEN DOUS ORGANIZATIONS OF !MERICAN MEDICINE & $IANNE &ENYK IS PAST PRESIDENT OF THE (ENNEPIN -EDICAL 3OCIETY !LLIANCE AND THE -INNESOTA -EDICAL !SSOCIATION !LLIANCE 3HE HAS SERVED IN APPOINTED AND ELECTED POSITIONS OF THE !-! !L LIANCE SINCE

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Continuing Medical Education 2004 CONFERENCES

Providing quality physician education for over 65 years P R I M A RY C A R E F O C U S

S U R G E RY F O C U S

Allergy and Clinical Immunology April 23, 2004

Minimally Invasive Approaches in Surgical Oncology April 22-23, 2004

Urology for the Primary Care Provider April 30, 2004 Primary Care Update in Mental Health April 2004

Midwest Arthroplasty Course: The Knee â&#x20AC;&#x201C; Ligament and Arthritis Surgery May 14-16, 2004

Family Medicine Review: Update 2004 May 3-7, 2004

Lymphatic Mapping & Sentinel Lymph Node Biopsy May 20, 2004

Spring Tune Up: Pain Management for the Primary Care Provider May 2004

Annual Surgery Course: Advances in Trauma & Critical Care Surgery June 16-19, 2004

Twin Cities Marathon Sports Medicine Conference October 1-2, 2004

Pelvic Floor Workshop September 7, 2004

Topics and Advances in Pediatrics October 7-8, 2004 Annual Autumn Seminar: Obstetrics, Gynecology and Womenâ&#x20AC;&#x2122;s Health October 11-12, 2004 Internal Medicine Review October 13-15, 2004

CARDIOLOGY FOCUS Cardiac Arrhythmias: An Update for Internal Medicine, Family Practice and Pediatrics April 9, 2004 Lillehei Symposium: Cardiovascular Care for Primary Practitioners April 19-20, 2004 Preventing Cardiovascular Events: Early Detection and Treatment October 2004 For more information contact: Continuing Medical Education 612.626.7600 or 1.800.776.8636 www.cme.umn.edu / cmereg@umn.edu

Endorectal Ultrasonography September 8, 2004 Principles of Colon & Rectal Surgery September 9-11, 2004

ALSO OFFERED Aging Skin 2004 May 7, 2004 WORLD Lysosomal Disease Clinical Research Network May 13-15, 2004 Workshops in Clinical Hypnosis June 3-5, 2004 North Central Neonatology Issues Conference * Wisconsin Dells June 11-13, 2004 Annual Psychiatry Review: Women's Mental Health Across the Lifespan September 27-28, 2004

* unless otherwise noted, courses take place in the Twin Cities Metro Area.