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ADVICE FROM THE PAST HOPE FOR THE FUTURE
Inaugural Address of the President 2003 Annual Meeting of the AMA House of Delegates Hyatt Regency Chicago Chicago, Illinois Wednesday, June 18, 2003
Donald J. Palmisano, MD, JD President American Medical Association
To be the 158th president of our American Medical Association is a great honor. I thank you.
No one stands on this stage, on this night, without the support of family, friends, and colleagues. I’d like to thank all of you -- and give special mention to a few.
[INTRODUCTION of FAMILY and GUESTS]
These are people who have played an important role in my life and made much of what I do possible. Now let me tell you a story about a beloved person who is not here tonight.
One hot August day many years ago, a troubled man took hostages at gunpoint in a house in New Orleans. The police arrived. As the gunman looked on, the ranking officer on the scene approached the house and laid his service revolver on the ground. He then walked through the door.
At that moment the troubled man who held the hostages pointed his gun in the policeman’s face and said “Now I am going to kill you.”
This policeman raised his right hand – not to ward off a weapon, or to strike a blow -- but to feel the gunman’s forehead. Calmly, the policeman said: “You have a fever. Let me take you to Charity Hospital.”
After a dramatic pause, the gunman gave up his gun, and the policeman, true to his promise, took the troubled man to the hospital. The hostages were unharmed and their lives were saved.
That policeman was my Dad, Dominic Palmisano. I only wish that he was alive and here to see this day. But I feel his spirit here with me – with us -- tonight.
The side of life he experienced was often far different from the New Orleans of popular myth as the City that Care Forgot.
Yet for all these pressures – he remained a rock of integrity and a constant source of wisdom. People respected him, and counted on him. I know I did.
In my first year of medical school, I questioned whether it was within me to succeed as a doctor. But my Dad had confidence in me.
He told me – “Do your homework – have courage – and don’t give up.”
Simple words. But powerful instructions for a life worth living. Tonight, I commend this advice to you – as we, as an organization, confront the threats to our profession – and the patients we swear an oath to serve.
And I, too, take those words to heart tonight as I accept your charge as president of the AMA.
“Do your homework – have courage – and don’t give up.”
I heeded those words. I stayed in school – and in 1963, I graduated. The rubella vaccine was still six years away. The first commercial CAT scanner - eight years away. And the discovery of moving genes from one organism to another -- recombinant DNA -- 10 years away.
For physicians, “doing our homework” has meant using -- or pursuing -- new innovations, procedures and treatments. Keeping current with scientific literature. Listening to our patients. And doing what is in their best interests.
And because of that ethic, in 40 years as a physician, I have witnessed the miracles of organ transplants … vaccines … chemotherapy … long-term intravenous nutrition - TPN … and more. The eloquent Dr. Phil Berry, in the audience tonight, is living proof of one such miracle, himself a recipient of a liver transplant 17 years ago. Yesterday’s science fiction is today’s reality. And tomorrow will be even brighter for our young physicians.
Provided our profession is still there for them.
Because we must ask: will the next 40 years bring such life-enhancing innovation to our world -- or will ominous forces subvert progress and cast us into a new Dark Age -- a Dark Age of Medicine?
With all the marvels of medical science at our fingertips, one could conclude there has never been a better time to be a physician.
Yet many physicians would disagree. As would those who once dreamed of a career in Medicine – and whose dreams have turned elsewhere.
Why would this be so?
Consider the unfunded mandates – and the tangle of regulations – that crush practices beneath an avalanche of paperwork – and strangle physicians in red tape. …
The relentless march toward centralized government control of Medicine and the price fixing, rationing and unreasoning – and unreasonable -- power of much of managed care. …
Medicare payments locked into a flawed formula – that drives physicians from the program and ends access for vulnerable seniors. …
The threat to patient privacy and trust despite our best efforts to block marketeers. …
Millions struggling without health insurance – even though most have jobs and draw a paycheck. …
The challenge to rebuild and enhance our public health system -- because the world is now a very dangerous place. …
And a medical liability system that is fueling skyrocketing insurance premiums and system costs through lottery-style legal judgments.
Colleagues: We have to do our homework, have courage, and not give up.
And our “homework” assignment now – is to assess the threats to our profession – to educate ourselves about solutions – and to prepare to fix an ailing system. And in this case, our patient is American Medicine itself.
By using the scientific method as a framework for analysis, we can make observations, gather evidence, test hypotheses, validate the findings, and prepare our argument.
This same approach can help solve the problems in law that beset the practice of Medicine. It is a powerful tool to help debunk our opponents’ unfounded and ever-changing arguments.
Our homework gives us a basis for a new health system in which everyone has insurance and everyone has choice. With defined contributions, individual ownership, and tax incentives – applicable to private or public programs – we can get coverage for all and true competition.
This allows choice among plans and selection of physicians. This puts patients – not bureaucrats – in control. Our analysis shows it can work – and it is gaining support.
On the Medicare mistake – we did our homework – and won a victory.
The AMA and specialty, state, county and parish medical societies gave proof positive of the power of speaking with one voice!
This fight isn’t over. Physicians are penalized if Medicare services grow faster than the gross domestic product.
Medicare’s payment formula is fatally flawed – and must be replaced.
And as Lagniappe – that’s what we call “a little something extra” down in New Orleans -- maybe we can regain the right to privately contract with patients! After all, this is the United States of America where the right of private contract is the hallmark of the Free Enterprise System.
We’ve done our homework on the issue of patient safety. We see the need to stop the shame and blame mentality and focus instead on system analysis. To use the scientific method. To employ a system in which experts review errors, give feedback on how to prevent a recurrence and disseminate the lessons learned nationwide.
Our efforts helped lead to legislation approved by the House of Representatives earlier this year, which would create a voluntary, confidential error reporting system that would, without question, curb medical mistakes.
Opportunistic lawsuits and damning headlines do nothing to prevent those errors. And all of society is paying for the broken liability system.
Remember, all of our miraculous medical advances and insuring the uninsured are ultimately meaningless -- if you can’t find a physician! And that is why medical liability reform is AMA’s number one legislative priority!
Our medical liability system has a fatal illness. It benefits a few at the expense of the many. It costs our patients access to care – and sometimes costs them their lives.
A crisis rages in 18 states – home to 140 million people – half our nation’s population – our patients.
What is a crisis?
A pregnant woman in labor and distress and no obstetrician available. Or a 9 year old boy with head trauma and no neurosurgeon left in town. Or the only trauma center closing.
Aldous Huxley said, “Facts don’t cease to exist because they’re ignored.” We’re doing our homework – and we won’t allow our opponents to ignore the facts! Their junk math and empty, out-of-context anecdotes won’t fool any of us – any of the time. And we won’t allow them to fool our patients – any of them. Science – the facts – the truth – are on our side.
Some say this assault of litigation makes medical care safer by punishing physicians when errors occur or allegations abound. But there is no evidence of that. None!
To really enhance safety, the AMA helped launch the National Patient Safety Foundation in 1996 and has supported it with over one million dollars a year.
The Association of Trial Lawyers of America expends a lot of rhetoric on patient safety. But, to date -- despite our repeated challenges to match our donations – they have not given one dime.
Some say that there is no shortage of specialists – go to Wheeling, West Virginia … with no neurosurgeons available for trauma.
Some say that doctors are not limiting their practices, or moving to other states … go to Pennsylvania, where an exodus is taking place that one doctor compared to fleeing a burning building.
Some say doctors can afford the premiums … Try telling that to neurosurgeons in Chicago who are paying more than $200,000 or obstetricians in Miami whose premiums are $249,000.
Some say there are no frivolous lawsuits … go to South Florida, where every neurosurgeon has been sued – five times, on average. We’ve done our homework – we know the facts.
Last fall, I took part in a physician rally in Fort Lauderdale, Florida, joining more than 500 physicians and patients gathered to demand action on the liability crisis.
Among them was a young obstetrician, Dr. Khadra Osmon.
She stood hand-in-hand with her pregnant patient and said to the crowd – “Helping a woman deliver her baby is the most extraordinary experience a doctor can have -- and I won’t be doing that anymore.”
Her liability premiums tripled and she had no choice but to give up the part of her practice she treasured most. A loss beyond calculation -- both for her and her patients.
To what do we owe this crisis?
Our opponents say higher rates are the fault of the insurance companies losing money in the stock market – but medical liability insurers have had five years of stable and positive returns on investment.
The sad fact is more money is paid for claims than is received in premiums. Because an out-of-control medical liability system has turned our civil courts into casinos. Awards do not correlate with negligence and non-economic damages can’t be objectively predicted. This creates an unstable environment akin to a chain reaction. Plus, there is no accountability for filing frivolous suits that some attorneys use as a ticket to the lottery.
I won’t repeat the alarming statistics of rapidly escalating median and average awards in the millions and the outrageous costs of defending the frivolous suits. You can read all about it on the AMA web site.
But let me emphasize that this medical liability system adds $70 billion to $126 billion to health care costs each year.
Imagine a world in which these resources were used to insure the uninsured. Or improve access to medical care in rural areas. Or spur innovation in medical technologies, especially those that lead to safer medical practices.
Imagine a world in which our medical liability system supported healing, education and innovation, instead of breeding fear, suffering and mistrust.
Now consider the cruel reality of a system that doesn’t accurately identify negligence, that decreases quality and access to care, and increases the cost of medical care.
This is because a cadre of trial lawyers is choking the health care system. They operate without any decent restraint, and are unaccountable for filing even the most worthless complaint.
On any given day, more than 125,000 cases against physicians clog our nation’s courts. Think about that! Yet 70 percent of those filed are closed with no payment -- and physicians win 80 percent of the cases that do go to trial.
If 70 percent of the appendices I removed were normal, I would not be allowed to operate. I believe we can all agree that the time is right for some peer review for the attorneys filing these claims!
Don’t misunderstand me. This is not a blanket indictment against the legal profession. As an attorney myself – and proud husband and father to other members of the Louisiana bar – I have great respect for the many fine lawyers who protect our freedoms and the lawyers like Tom Casey, John Hainkel, and others in the Louisiana legislature in 1975 – and one of whom is here tonight, Ron Faucheux, who helped us achieve landmark medical liability reform in a dramatic win. And let’s not forget Philip Howard, another attorney also here tonight, whose book clearly identifies the current system as one destroying Medicine.
But unfortunately, we know there are those who act like predators, exploiting patients and physicians to enrich themselves. Let’s have zero tolerance for these individuals! Our medical profession must fight them as aggressively as we fight cancer and other maladies.
To combat this pernicious threat – we must do our homework, have courage and not give up.
In his State of the Union address, President Bush said “No one has ever been healed by a frivolous lawsuit.” But I know many physicians whose spirit and reputation have been harmed by one.
And that’s true for our patients, as well. Because this crisis discourages innovation and use of new, life-saving medical techniques.
In 1972, Dr. Jim Brown – who’s here in the audience tonight -- helped me save a pregnant woman’s life. We defied the conventional wisdom that treatment was hopeless and performed a dramatic operation, then pioneered outpatient hyperalimentation – TPN -- in Louisiana, and documented for the first time in history that copper is an essential nutrient for adult health.
But in the toxic liability environment that threatens Medicine today, would a surgeon dare blaze a clinical trail to save a life and risk being sued … or conclude that innovation was too high a risk for a liability claim? Will doctors continue to retire from emergency care consultation in the ER because the risk of litigation is such a clear and present danger?
Such are the signs of the times. And ignoring facts does not make them disappear.
The last quarter of the 20th century may go down in history as the age of litigation – unchecked litigation – absent any sense of responsibility, or conscience. It’s a poison that threatens Medicine’s viability.
Again, I’m reminded of my Dad’s words – that we do our homework, have courage and not give up. And cleaning up this toxic environment will require all the courage we can summon.
And we are no strangers to courage. Every day, we see it in our patients’ eyes. We need courage as we seek to fathom the mysteries of human life – and when we put our education and training into action to heal another.
Together we will have courage to counter personal attacks – which are often lies, and cloaked in the anonymity of the coward – as some opponents try to deflect attention from a debate they are losing.
It is up to us to put this courage into action – to make the 21st century the age of common sense – with a new system of justice, with true accountability for all -- including attorneys. Let’s put an end to jackpot justice.
In a debate over liberty in another time and place, the Roman Cicero asked: “How long must we tolerate these abuses?” That question echoes down through the ages and resonates with us today.
We must ask: How long can we tolerate a liability system – that threatens medical innovation? That threatens mothers who want babies, that threatens children who are trauma victims, that threatens the sickest and most vulnerable among us? I say -- no longer!
Some would say fixing this broken system is a “mission: impossible.”
But we have the courage to offer a solution. One proven with scientific means. The HEALTH Act, which has passed the House of Representatives and is now before the Senate.
It allows plaintiffs to be compensated for lost wages and for medical costs, without limit. It gives patients a greater share of awards by limiting the amount attorneys receive. And it caps the subjective non-economic awards such as pain and suffering at $250,000 per incident.
The HEALTH act is based on MICRA, reforms that have worked in California for more than a quarter century. We did our homework. We have the proof. We need now the courage to put our convictions into action.
We must master this information – and make sure our legislators know the facts – and insist that they deliver meaningful reform. Yes, words mean something! We are not interested in illusions that solve nothing and please no one -- except those attorneys who benefit from the status quo.
Success with proven reforms is emergency therapy. And we won't stop with that treatment as we strive to bring justice, reliability, and accountability to all who venture into the halls of blind justice.
The choice for legislators is simple: you can continue allowing unlimited, unquantifiable non-economic damages – pain and suffering – and lose doctors and access to care for patients. Or vote for a reasonable balance that keeps doctors in practice and provides access to care for patients in their hour of need.
Our message to U.S. Senators: Don’t choke off debate – and don’t prevent a vote. Our patients’ lives are at stake.
In the past year I’ve traveled this great land of liberty from the Atlantic to the Pacific and met the doctors who treat those patients. I’ve heard the sad stories of the struggle to deliver quality care in an environment made toxic by a liability crisis. I have seen their courage mobilized -- and sent into battle.
I have stood with them, petitioning government in front of courthouses and statehouses in Ohio, Georgia, Illinois, West Virginia, New Jersey, Florida, Oklahoma, and New York. I’ve witnessed their efforts to achieve limited reforms in states such as Nevada and Pennsylvania. In the print press and on the television news – I have delivered the AMA message – and told their stories.
From them, I have drawn strength and inspiration. I also have learned lessons in my own backyard, at the National D-Day Museum in my hometown of New Orleans.
The exhibits include an account of the U.S. Army Rangers at Omaha Beach in Normandy France on June 6, 1944. Under deadly fire, they scaled the cliffs of Pointe du Hoc and destroyed the guns that were raking the beaches below. This after having been told the mission was futile, and to abandon it.
Remember the surrender of Nazi Germany occurred 11 months after Pointe du Hoc -- and I’ve got a whole year. Together we can do it.
Forty years later, Ronald Reagan paid tribute to the Rangers as “the champions who helped free a continent.”
What will be said of us, 40 years hence? Will we draw from our heritage of courage in this fight, against opponents who are well-funded and well-organized – despite their lack of credible arguments?
Again, I hear my Dad’s words – Do your homework. Have courage. And don’t give up.
Tonight I renew the promise I made to you one year ago when you made me -- your President-elect: “I will fill each unforgiving minute with untiring effort.”
Because we cannot expect change – we cannot effect change -- if we do not work for change. And in this work – we can never give up.
If we miss our chance -- if we desert this battle -- if we abandon our responsibility -- we will lose the most experienced of the practitioners among us – and cripple the next generation of physicians. The consequence of inaction in the face of this crisis will be a future too dark to contemplate -- or allow.
I believe that our generation of physicians has a rendezvous with destiny. Yes, a rendezvous with destiny!
Making this appointment requires our understanding of the facts, the unrelenting conviction of the rightness of our cause, the courage to create our own destiny -- and the will never to give up.
They said we’d never achieve liability reforms in Louisiana in 1975 – but we did it. They said reforms were impossible in California and Indiana in 1975 – but the doctors did it. Winning in 1975 meant not giving up!
And we won’t give up now, despite the naysayers who say we are too weak and our opponents too rich and too strong. When will we be stronger? When more neurosurgeons and obstetricians retire? No -- the time is now.
Let us go forth and tell all our colleagues to enter the arena! Tell them membership in organized Medicine is no longer an option; it is a requirement. Tell them to get involved … take up the debate … become activists … make a difference!
Tell them to stop grousing around the coffeepot. Emulate the warrior spirit of Dr. Ed Annis, a beloved past president of AMA. Emulate the creative activism of Donna Rovito of the Pennsylvania Alliance – who has compiled an exhaustive, media-ready list of doctors who have fled the Keystone State.
Help us restore common sense to the medical liability system. Thwart the bullies who prize personal gain over the common good -- and the naysayers who dismiss our efforts as futile.
President George W. Bush is on our side. Secretary Tommy Thompson is on our side. The U.S. House of Representatives is on our side. Senate Majority Leader, Dr. Bill Frist, is on our side. And more importantly, our patients are on our side because our side -- is their side.
Yes, the tide is here and we need to ride it to success! And those who fail to help will lament that they were not in the battle to save Medicine regardless if the future is the best of times or a new Dark Age.
It’s a lesson we can learn from my father -- on that hot, humid day long ago in New Orleans, when he convinced a troubled man to put down his gun -- a man who sensed that my father had his best interests at heart -- that he was on his side.
That day, my Dad saved lives. Imagine the thousands more we will save, or heal, if we simply follow his advice -- “do your homework, have courage and don’t give up.”
So let’s follow that advice from the past and bring hope to the future by putting an end to jackpot justice and the other threats endangering physicians and the patients we care for. And, in so doing, save our noble profession of ethical science-based Medicine.
Save it so that future generations can get caring, curing, and compassion from those who have dedicated their lives to this calling to service.
That is our charge. This is our Pointe du Hoc. And on behalf of our patients, what is asked of us – what is expected of us – what is required of us -- we will accept. And what we have accepted – we will achieve.
God bless America, God bless our AMA, and God bless each and every one of you. Thank you. ###
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