Earlier this week, two doctors and an administrative assistant filed a lawsuit against Santa Clara Valley Medical Center alleging substandard care at a government hospital. I worked at government hospitals at the beginning of my career and knew how inefficient they could be, so my first impression from the newspaper article was that patients had probably been injured because of ordinary bureaucratic ineptitude. When I tracked down the actual lawsuit and slogged through all 73 pages of it, however, I realized that this particular hospital, although perhaps a bit worse, isn’t all that different from what passes for the private sector these days. Medicine isn’t practiced well out of a bureaucratic structure and I suppose the practice of medicine is going to get worse before it gets better.
Santa Clara Valley Medical Center is a public hospital owned and operated by the county. It is a large teaching hospital with many of its own residents as well as others rotating through from Stanford. From what I can tell, the bulk of the medical staff are county employees.
The lawsuit describes turmoil within the cardiology department, but the sort of chaos you thought was confined to kindergarten or lunatic asylums. The assistant made some waves about what she saw as poor care, so her superiors, including doctors, flyspecked her work for technical violations of the rules so they could punish her. Turns out she looked at her sister’s medical records–with her sister’s permission–because she had been billed for a procedure that she didn’t have. Never mind, that’s a firing offense. Then the assistant files a Workers’ Compensation claim for “work-related stress” and then later one of her doctor bosses sends out a nasty email about her to everybody. The lawsuit goes on like that for 73 pages of dysfunction and describes boorish and puerile behavior by doctors and administrators alike. The whole thing would be comical but patients were jeopardized and careers were ruined.
I’ve seen much too much political backbiting in hospitals in recent years. There was a time when hospitals competed with one another and the administrators competed to get the finest physicians to practice at their hospitals.
Actually, I’ve only read about those times–things were already going bad when I started practicing in 1981. But things have gone from bad to worse during my career. A hospital doesn’t have to compete very hard because state and federal laws allow a hospital to block competitors from moving into its catchment area. Hospital administrators don’t much care for their doctors anymore, either. The federal government long ago distorted the number of specialists so that every large hospital usually has a surfeit in all of the common specialties. Why compete when three doctors apply whenever a doctor at a large hospital quits the staff?
I suspect the future will see most hospitals owned by one government or another. And, more absurdities like the lawsuit at Santa Clara.