The law considers a doctor to be a fiduciary, which means that he and his patient are in a relationship of trust and confidence. The doctor must act for the benefit of his patient. He owes a duty of loyalty to his patient and he may never put his own interest above that of the patient. The same applies to a lawyer and his client. A physician fiduciary who takes advantage of his position to benefit himself at the expense of his patient is self dealing and the law should treat him harshly.
Such is the accusation against Dr. Yasser Awaad, a pediatric neurologist formerly at Oakwood Hospital in Dearborn, Michigan and now practicing in Saudi Arabia. Dr. Awaad is being sued for falsely diagnosing epilepsy in hundreds of children in the Detroit area merely to increase his income. According to the newspaper, Dr. Awaad earned $600,692 in 2005, more than anyone else at the Oakwood Hospital. His base salary was $250,000 and the rest of his pay was for bringing business to the hospital. If true, Dr. Awaad is a scoundrel and Oakwood Hospital is even worse.
There is plenty of blame to go around. The Michigan Department of Community health has been investigating charges of wrongdoing by Dr. Awaad since 2006, and isn’t done yet. By 2007, Dr. Awaad closed shop and left the country. Last September, Michigan Medicaid settled a fraud case against the hospital for more than $300,000 that evolved from Dr. Awaad’s care of indigent patients. Dr. Awaad would order numerous tests at the hospital and, even if the tests were negative, start the patient on antiepileptic drugs, which would require regular follow up. Dr. Awaad would also send the patient back to the hospital for expensive follow up testing and monitoring. Dr. Awaad repeated the process hundreds of times between 1994 and 2007. Some frustrated parents took their children to see different doctors who found completely normal diagnostic tests even though Dr. Awaad had diagnosed epilepsy. Despite several physician complaints, no one in authority did anything until the investigation that started in 2006. A court hearing last week prompted the newspaper report.
Dr. Awaad’s story, though contemptible, is not rare. Why did he get away with it for so long? Other doctors reported him and yet he continued his schemes. Some would argue that government must do more to put a stop to these kinds of practices. I would argue that government obviously failed here and is likely incapable of solving this kind of problem. Increasing government oversight will typically impair honest doctors, reduce care to the people who need it and the deceivers will still find new ways to trick the oversight mechanisms. As long as a big pot of money is available from a third party, some crook will come along to take it.