The doc then goes into hiding. The patient, Ms. Cregan was from Ireland leading the Irish Medical Council to express concern about the
regulations governing the establishment and operation of cosmetic
surgery clinics in Ireland.
So we wander over to New York's Physician Profiling System and we look up Dr. Michael Evan Sachs, license number 131958 (issued in 1977).
And we find one judgement from 2001 and 32 settlements from 1995 to 2003. All of the payments are "average" or "below average."
And in particular we look for any restrictions on this practice. Here's what we find, updated a mere five days before the surgery on Ms. Cregan:
Dr. Sachs shall be precluded from performing complex nasal
procedures except when assisting, or assisted by, a surgeon who is
either Board-Certified by the American Board of Plastic Surgery, Inc.
or Board-Certified by the American Board of Otolaryngology and who has
completed a fellowship in facial-plastic surgery, and who has at least
ten years of experience and expertise in performing such complex
procedures. For purposes of this limitation, the term "complex nasal
procedures" shall mean those requiring multiple operations (more than
two planned procedures) and serial reconstructive procedures, include
those involving congenital malformations.
This limitation shall not preclude him from performing, without such
assistance, routine nasal-septal procedures, including but not limited
to routine nasoplasties, open rhinoplasties, and cartilage or synthetic
grafts for structural and functional purposes.
We find the same text at the State's Office of Professional Conduct and we find that he did not contest the charge of negligence in a prior case nor challenge three years of probation. We also find the legal Consent Agreement(PDF) stipulating the restrictions on his practice and indicating negligence on multiple treatments of a single patient. It's legalese and not revealing. You try to imagine what's between the lines.
Neither regulatory oversight, nor professional colleagues, nor the threat of lawsuits and high liability premiums (which probably were considered just a part of doing business), prevented this loss. Yes, there might have been a prior condition (though, if so, it would have been nice to know wouldn't it). But even if that's the case, doesn't it seem like there might be a pattern here?
Though the number of physician housecalls is growing, it's still tough to make it work financially. A local group, Homedical sees about 500 patients with four MDs and one NP. All of its patients are homebound.
But Homedical is having a tough time financially. Last week, they sent out an e-mail asking for donations and they followed it up with this story in the Albany Times-Union. They're looking for $300,000 ($600 per average patient) which I suspect is going to be tough unless they find an angel.
One of Homedical's physicians, Dr. Roberta Miller, ran what I'm told was a quite innovative home care program through the Albany VA hospital. But she left the VA after an internal struggle that I still don't completely understand.
We've been interviewing Paul DiGiovanni, MD about his dual roles, physician and county legislator.
In our last post, we discussed Medicaid. (The first part is here.) In this one, we explore public health and some operational issues.
We've been interviewing Paul DiGiovanni about his dual roles, physician and county legislator. The latter role is particularly important in New York's healthcare system because counties generally pay about 25 percent of the bill for the nation's most expensive Medicaid program. In this posting we get into Medicaid issues.
I met Paul DiGiovanni by e-mail
just about a year ago and was intrigued with his story. Paul's a physician
(whose specialty is Pathology) who had just won election as a Republican to the Cortland County Legislature. (For more on Cortland County, click here.) Paul had run for the office two years previously, his first run for public
office, narrowly losing to a 28-year incumbent. This time around, he was part
of a sea change in the County Legislature,
which flipped from 13-6 Democratic to 14-5 Republican.
When we met, Paul was tearing
his hair out trying to get his hands on some Medicaid data. Ahhh, another member of the Coalition of the Data Deprived.
Paul's now completing
his first year as a County Legislator
and that, combined with his background as a physician and as a fellow data maven, give
him an unusual perspective that's worth sharing. So we're going to do an online interview here.
We’ll do this is several parts, first getting some background. Then we'll get into Medicaid, followed by other discussions at the intersection of medicine and public policy. We'll probably wind up debating and readers are free to join in by commenting. My questions are italicized. And of course, I can comment too.
The picture of Paul and his family was taken Christmas 2002. From left to right is son Domenic, wife Angela holding their baby Gabriele, Paul, son Gianluca, daughter Emilia Rose.