Bubba, Elizabeth, and John (Edwards) . . . Not Exactly Abraham, Martin and John

Bubba is my hero. He hangs in arguments and "debates" on the GSO blogs (particularly Ed Cone's) with a tenacity and ferocity that I very much admire. He doesn't suffer fools or foolish positions/arguments/questions. He knows how to cut through a lot of the fence-sitting BS (and the name-calling) to the heart of a matter (as he has done in the GSO PD/RMA report boondoggle). He has some SMALL experience in military matters (as does my blogfather, Mr. P), and is obviously well and widely read on those issues as evidenced by many of the links he cites in his blog-battles.

On occasion, he has had my back when the ususal suspects gang-up . . . and I have taken his. Alas I cannot do it as often as I would like. My skin is not so thick these days.

Bubba's blog, "Noteworthy" was recently developed to counter some of the drivel spilling out of so many of the "lefty" blogs that have dominated the GSO landscape. He was challenged to do it (as was I), by people who apparently thought we'd just "go away". We didn't. And I'd say our blogs have helped us define/refine our voices & positions when we venture out to other people's yards to play.

Anyway, this post on John Edwards caught my eye a few days ago. The links Bubba cited here and here and here and here and here warmed my wounded heart. I was beginning to despair that the whole world was being taken in by John Edwards' carefully cultivated political machinations . . . where (in the absence of actually serving in public office) both his "phony" postion at a publicly-supported university (created by the state's educational & political elite just for him) and his wife's new book tour are being strategically used to get/keep his name and pretty-boy visage "out there" as a prelude to another Presidential run.

The state's big news outlets, of course, eat it all up.

Elizabeth Edwards has been particularly visible of late. She's been at Converge South (I've wondered, does Elizabeth Edwards have a copy of the RMA report?) and on UNC-TV . . . making the predictable rounds to pump up sales of her book, "Saving Graces". The book is also featured on Edwards' website, now entitled "One America Committee". It's an "extension" of the Two Americas theme that got hammered TO DEATH on the 2004 campaign trail . . . and has since morphed and become a rallying cry for everything from disaster reponse to race relations to gay rights to illegal immigration. (I actually hate citing all the Edwards links. I just think it's part of the story.)

The politics of division did not work for Edwards in 2004. So in 2008, he's decided that we'll "unite" (behind him). In the meantime he's got a website worthy of a rock star.

Whatever works to pull in the disenchanted, gullible masses, right?

Long ago, before I discovered the blogosphere, I dedicated an entire page of the Asheboro Pediatrics website to John Edwards. After the election, I deleted the page thinking (hoping, actually) he would be gone from the political landscape and that would be that. Ironically, given Edwards' renewed and obvious posturing, it's still relevant. So I'm re-publishing it here. The excerpt is long and will be highlighted in purple for anyone who doesn't have the attention span and wants to skip down:

Special Dedication (Not) to Senator & Vice Presidential Candidate, John Edwards

Given the performance of his staff in addressing her entreaties for help with the NHSC, Dr. Johnson has long wondered about the specifics of John Edwards’ championship of “ordinary people”. She questioned the Senator’s populist assertions that he had spent his law career going after “big HMO’s and big insurance companies”. She was under the impression that John Edwards is now “set for life” because of the twenty-plus verdicts & settlements he won against doctors during his heyday as a trial lawyer.

For one who now talks about being “optimistic” and taking “the high road”, the truth is John Edwards spent YEARS turning the lives of doctors and nurses upside down . . . many of them good, productive people who went to work in the morning only intending to help others. For at one point in his life, Edwards certainly did believe in “tearing people apart”. He thrived on it. He’s PROUD of it.

Dr. Johnson need wonder no more about the Senator’s track record and the effect it has already had on all of our lives. Senator Edwards’ legal career was chronicled in a front-page story of the Raleigh News & Observer on September 9, 2003. The New York Times followed suit on January 31, 2004.

It’s a fascinating story. John Edwards made millions of dollars for plaintiffs (and himself) by suing physicians. He specialized in “bad baby cases”. The New & Observer’s article states that after some of those massive jury verdicts, “(stunned) hospitals scrambled to change their review procedures”. Some physicians, particularly OB-GYNS (who are the primary target of these lawsuits), argue that trial lawyers like Edwards are the major reason malpractice insurance premiums are rising so rapidly . . . the reason that physicians are leaving the practice of medicine in droves (particularly in rural/underserved areas) . . . and the reason for rising medical bills (since the costs of these verdicts, as well as the “defensive medicine” they generate, are only being passed to the consumer). C-Section rates, in particular, have skyrocketed - based on what commentators in the Times’ article called the “questionable science” behind fetal monitoring (monitoring that Edwards touted during his lawsuits). However studies show that despite all of this elaborate monitoring . . . and the resultant double-digit increase in C-Section rates . . . the incidence of cerebral palsy has not lowered. This would indicate that, in most cases, the disorder is NOT caused by “negligence”. Riding on a different car of the same legal train, EMTALA laws have been warped and misconstrued beyond all common sense or reason. The concept of triage means nothing anymore. People can call ambulances for the most trivial complaints . . . and then sue already over-burdened Emergency Departments (alleging discrimination or something equally ridiculous) if someone at the Emergency Room door dares to tell them, “This is simply not an appropriate use of our limited resources”. . . and tries to direct them back to their primary care provider. And we WONDER where our healthcare dollars are going? One doctor in the News & Observer article was quoted as saying, “everybody pays . . . for John Edwards’ fifty million.” That doctor is right.

Edwards, who now tells us that he wants to reform the healthcare nightmare he helped create, says “the problems of the medical profession are largely caused by insurance companies squeezing doctors”. But that is a gross oversimplification which deflects Edwards’ own culpability – and that of his ambulance-chasing peers. According to the News & Observer, Edwards supports tax credits and screening frivolous lawsuits, but opposes capping damages in malpractice cases. Tax credits and screening are very good ideas. But Edwards won’t take the extra steps that would hinder the kinds of legal maneuvers that put so much money in his own pocket. There’s a reason the trial-lawyers stood up and cheered when his selection as John Kerry’s running mate was announced.

Mr. Edwards, savvy fellow that he is, likely knows what many doctors are still unwilling to admit. Selling caps on malpractice damages to the general public is problematic if doctors do not first clean up the process by which they police their own. In what is medicine’s dirtiest little secret, medical peer review, as legislated by the Health Care Quality Improvement Act of 1986 (HCQIA), is simply not working. Peer review is not “speedy” nor does it provide doctors the full protections of constitutional due process. It is not fair for those who might be unjustly accused. It does not protect those who blow the whistle (either on bad medical or corporate behavior), nor does it effectively “police” truly bad apples. It does not hold hospitals and their administrators (or their lawyers) to the same ethical cannons as doctors. HCQIA does not define or penalize bad faith – and the blanket immunity it grants peer review can easily be misused to cover up adverse outcomes (rather than correct them) under the smokescreen of “quality assurance”. It also makes the incredibly naïve assumption that the process is always initiated and overseen by people who only have the best interests of patients at heart. It does not provide safeguards that forbid conflict of interest. THE TRUTH IS that despite the unparalleled legal protections afforded peer review, medical errors are soaring. However, most of those errors are not intentional malpractice (i.e. a doctor knowingly imposing a treatment that causes harm). They are instead system failures (as in the tragic, still hard to believe, case of Jessica Santillan’s heart transplant gone horribly wrong at Duke) or errors of omission (somebody didn’t DO something that someone else thinks they should have done).

Moreover, it is just a fact of life that, in delivery rooms and OR’s and Emergency Departments, bad things happen because bad things happen – they are not anyone’s “fault”. And bad things happen quickly. But malpractice lawyers are afforded the luxury of months or even years of 20/20 hindsight – handpicking experts to critique decisions that doctors make in just “split seconds” or minutes or hours. ON TOP OF ALL THAT, as early as 1993, the AMA’s then-President, John Clowe, was forced to acknowledge that HCQIA had created a monster . . . that medical peer review was frequently not initiated by hospitals to protect patients, but instead manipulated for economic reasons – used to cast out potential competitors or discredit doctors that administrators deemed “disruptive” because they dared to question business tactics or raise quality of care issues. This kind of thing has been going on for so long it even has a name . . . it’s called “sham” peer review. In 1993 Dr. Clowe promised to push the envelope on the issue. It’s 2004. And still, the AMA leadership continues to back blanket immunity – in the process selling out an entire generation of physicians – because the AMA is absolutely terrified of lawyers like John Edwards. They should be ashamed.

On the other hand, the AMA has good reason to be terrified. John Edwards is not the only Senator or Congressman in Washington who got his or her start as a lawyer.

Greta Van Susteren made some excellent points about “tort reform” in her book, “My Turn at the Bully Pulpit”. She argues that “one price does not fit all” and that punitive damages do change bad behavior in cases of corporate negligence. She’s right. Greta, God bless her, also takes the extra step of identifying “the bad guys” as the “hourly-rate” lawyers who provide civil defense for insurance companies and hospitals and corporations . . . then there are the plaintiffs’ lawyers who do not accept contingency (i.e. no win – no money for the lawyer). These lawyers have no incentive to settle a case fully fairly and quickly, but every reason to blow up and drag on the case forever . . . to stack up hours whether they win or lose. Who pays? We all do.

This is exactly what happened in Dr. Johnson’s situation. She was fired within three weeks of successfully intervening in a “bad baby case” (defying an administrator’s specific “warning” in order to do so), and later reporting what happened to peer review. Instead of running away with her tail tucked between her legs, she decided to stand and fight. The law is supposed to be on her side. For it is a fact that if Randolph Hospital administrators and lawyers had acted ethically in the first place . . . if her National Health Service Corps (NHSC) contract had been fully honored by RMA and/or enforced by the government, there would have been no legal claim(s) to pursue. She could have transitioned her practice, Dr. Anderson could have joined her and they could have gotten on with their lives. That was too simple for Randolph Hospital administrators – so eager to control the medical landscape. The lawyers got creative.

If, once the contractual breeches were identified, the hospital’s lawyers had moved to fairly and fully compensate her early in the “game”, Dr. Johnson’s claims could have been settled quickly, quietly and for considerably less than what it cost the hospital to defend/prosecute two lawsuits and eventually settle with her anyway. Again, Dr. Johnson would be in practice in Asheboro today with Dr. Anderson at her side. But the lawyers had no incentive to settle. Moreover, no one on the hospital’s “honorable” Board of Directors was really looking at the numbers . . . or the real cost to the community of what their administrators had done. And (of course) the concepts of due process and fair trade practice had been thrown out the backs of the wagons that the Board circled around their “tough but fair” administrators – administrators who have yet to answer for their actions – who have instead been richly rewarded with stratospheric salary increases financed on the public’s dime – and who all blithely plan to retire (or be promoted) from their positions. That speaks to the notion of personal responsibility. In this day & age of “no-fault” settlements, indemnification of corporate officers, and sealed agreements nobody is ever responsible for what they do . . . even when they outright lie under Oath.

Dr. Johnson wonders what Asheboro’s medical landscape would be like if someone other than Robert Morrison had been in the top chair at Randolph Hospital . . . if the focus had been on human service rather than economic development. She also wonders what practicing medicine would be like, if every time she walked into a delivery room and was placed in a “rescue” situation, she did not have to look over her shoulder for the next John Edwards.

The reader is referred back to the beginning of our dedication, and the News & Observer quote: “(stunned) hospitals scrambled to change their review processes”. Well, they did not change them enough. Dr. Johnson’s case demonstrates that those review processes only work in the context of who has the most money, power and influence. Good doctors – the kind that John Edwards says he supports – can find themselves squashed like bugs.

Dr. Johnson is exactly the kind of doctor that John Edwards wanted on the floor the night Jennifer Campbell was born (brain damaged after a delivery gone wrong – Edwards won a 6.5 million dollar jury verdict for the family). Dr. Johnson found herself in that exact situation – advocating for a child identified by the nursing staff as being at critical risk and in harm’s way. Instead of deferring to the medico-political hierarchy (as is what happened, at least according to Edwards, in Jennifer’s case), when the nurses expressed their concerns, Dr. Johnson chose to listen and to act . . . and was fired for her trouble. If the child had died, she might have been sued by a lawyer just like John Edwards. For five years Dr. Johnson has sought an administrative remedy from the government she served. She sought “justice: in the civil courts and was denied because hospital administrators repeatedly lied – treating the process with arrogant contempt. She uncovered and reported “wasteful spending” – in the form of breached & ignored federal agreements and bloated “not-for-profit” salaries. She has asked for the criminal courts to enforce the laws that we do have that govern these matters – but to date, the Randolph County District Attorney has turned a deaf ear.

John Edwards spoke about the dreams of ordinary Americans in his speech at the Democratic convention. Dr. Johnson’s dream, to practice medicine in her hometown, was destroyed. She has repeatedly petitioned her representatives for the opportunity to legislatively correct the problems her case identified . . . so that other young doctors do not have to suffer the destruction of their dreams. It’s not an unreasonable request and it should not be hard. Yet the doors in Washington . . . including those of John Edward (the self-described “champion of ordinary people”) . . . have been slammed in her face.

John Kerry and John Edwards would have the public believe that the government can solve all of our healthcare problems. But if the lawyers are so good at fixing things, why do we have the mess we have? As it is now, a good portion of our population has NO fiscal responsibility whatsoever for their healthcare choices – everything is “free” – it is a vicious circle of one generation with these expectations generating another. Meanwhile, those who do not “qualify” for government benefits . . . the working poor and the middle-class . . . pay dearly for their healthcare (or go without it). Finally those blessed with higher incomes are penalized for their success by paying their healthcare tabs - then picking up the slack on everyone else’s in the form of higher taxes. President Ronald Reagan once wisely admonished us that, “Government is not the solution to our problems, government IS the problem.” Of course, President Reagan never had cause to ponder the meaning of the word, “is”.

John Kerry recently proposed a program (originally put forth by Senator Edwards in his presidential campaign) that rewards a four-year college education to any young person who would provide “two years service to the United States”. It is a noble idea – but it is not a new one – the military, as well as various public health agencies have been selling this supposedly sweet deal for years. But Dr. Johnson’s experience as an NHSC physician in Asheboro – and those of many physicians in the military – is proof positive that there is much to clean up in the federal & state programs that already make these kinds of guarantees . . . before we throw more good money after bad. Again, the truth IS that when Senator John Edwards had the chance, he did not lift a finger to help Dr. Johnson.

Senator John Edwards was raised in Robbins. Dr. Johnson is from Asheboro. Senator Edwards is “the son of a mill worker”. Dr. Johnson is the daughter of a teacher. Both left home to better themselves and both dedicated themselves to service in their respective fields. Both feel passionately about what they do. John Edwards went to the big city to practice law. Dr. Johnson came home to practice medicine. John Edwards was richly rewarded for his passion and his drive. We know how Dr. Johnson’s passion and dedication were rewarded. She wonders how parents in Asheboro can tell their children to study hard and work harder and value ethics . . . knowing what happened to her when she did all these things and came home . . . when she went above and beyond her “end of the bargain” . . . only to be thrown out with the garbage.

This page is dedicated to the lawyers – in particular, Senator John Edwards – who have turned a noble profession into a lottery practiced in a climate of fear. John Edwards may be very bright and very gifted and very pretty and from North Carolina. But he should not preach to Dr. Johnson or her family or her patients & parents about how much he “cares” about justice or “ordinary” citizens until he does something in this case to PROVE IT. He certainly has no reason to expect the votes of these people he left behind in the dust of a North Carolina mill town . . . people he professes to represent. Dr. Johnson, her family and her patients know all about “the two Americas” – one for people who work hard and play by the rules – and the other for those with money who abuse their influence and power. “Hope is on the way???” Please. Dr. Johnson’s dream to serve her hometown died during the administration of another smooth-talking “star” in Senator Edwards’ party . . . a man . . . a lawyer actually . . . from Hope."

Beaten "Black and Blue" by public service in North Carolina's medical arena, I blogged my thoughts on John Edwards very early on. Here's an excerpt from that post: "When he was Senator, I wrote John Edwards several letters about my situation – and go no help. By that time he was already running for President, and I joined a number of other constituents whose representation fell by the wayside . . . sacrificed to the “greater” goal of putting our own Kennedy wannabe in the West Wing. Later it made my blood boil when, during his campaign, the former malpractice lawyer proposed more loan-repayment-for-public service programs – when he had done ABSOLUTELY NOTHING to help a constituent burned by one of those programs."

"As an aside, during the 2004 election, my Daddy gave me a great bumper sticker. It says, "I live in North Carolina and I'm not voting for John Edwards". Pops mailed it to me when I was living in Memphis - and told me to put it on the car before I drove home. It was great! I got lots of honks and thumbs-up and high-fives on I-40. Not a single one-fingered salute. The sticker is still on the car . . . for alas, if the News & Observer has its way, I expect I will need it again."

*Editorial note: When I traded in the car earlier this year, the bumper sticker went with it.

Where Elizabeth is concerned, on the surface she seems likeable enough, and it's very hard for a woman to be the least bit critical of another woman who has lost a child, dealt with fertility issues, and battled breast cancer. Besides, anyone who does so in Elizabeth's case risks evisceration by the fawning political groupies that seem to follow this power-couple everywhere. Camp Edwards knows that. Revelling a little too obviously in her "untouchable" status, Ms. Edwards recently took on Hillary Clinton, telling Ladies Home Journal that she thought her decisions had made here "happier" and "more joyful" than the Former First Lady and Junior US Senator representing (please notice I did not say, "from") New York.

It was a comparison that fell completely flat with me. Given that I have no love for Senator Clinton, that's no small accomplishment.

As professional woman who is now suddenly/unexpectedly wrestling with decisions pertaining to her own desire for a family (particularly a daughter) . . . decisions pertaining to fertility and her future medical risks/long-term health . . . decisions that were first postponed in deference to establishing a career/practice (not to mention covering the pregnancy leaves of other women), and then to a legal battle that never should have been necessary over a future that was stolen/irreperably altered . . . decisions put off in the naive and obviously misguided hope that one day the law & government would actually do what it was supposed to do . . . I thought Ms. Edwards' comments demonstrated an incredible self-righteousness and insensitivity.

Many women make career vs. family choices. Many woman suffer the loss of a child. Many women face fertility issues. Many woman face their own mortality from one evil, despicable disease or another. But most of those women suffer and face this adversity without the many of the advantages & resources Elizabeth has enjoyed. And many women make different choices . . . based on their own sense of personal/social responsibilty and moral compasses.

I expect, primarily for religious and very practical/professional considerations, my own medical decisions will be different from hers. That does not make mine wrong . . . or "less joyful". I prefer to see the possibilites for great joy in the options that remain for me.

I did not attend Converge South in large part because I believed Elizabeth Edwards' appearance there was a self-serving political and book-selling stunt. I still do. The mass-leaking and publication of the RMA report immediately after "the convergence" (where what to do with the leakage was fairly openly discussed) . . . an illegal act, as far as I am concerned . . . was icing on the cake of that correct decision.

I wonder if (given the controversy surrounding the conference this time around) Elizabeth will be so eager to come next year. If she remains healthy (and I hope she does), by then her husband will likely be in the Presidential race. I expect they would want to steer clear of any controversy . . . especially one that tweaks the criminal and got just a little too close.

As it stands now, I have nothing good to say about John Edwards' representation of our state in the past . . . I am very skeptical about his "work" at Chapel Hill . . . and I certainly do not believe he is qualified for the Presidency. In lieu of a chance superficial meeting at a blogging conference (where once again, I would be the lowly "ordinary" soul "reaching out" for help), I would suggest that if Elizabeth or her husband would like to change the mind of this former constituent about their motives or their politics, the first thing they should do (particulary given my experience as a phyisican burned serving the poor they say they want to help), is answer some correspondence and consider meeting with me to discuss the pitfalls of the programs and ideas they propose.

I'm not wasting any more time on writing either one of them. I gave at the office.

You cannot fix the future unless/until you examine and address the failures of the past. And you can't do that if all you want to hear is "yes" men/women. It's a theme Edwards would no doubt like to manipulate on a larger scale (i.e. Bush and the war on terror). Perhaps he should first look at his own actions (or lack thereof) a little closer to home.

One of the "Locker Room" links Bubba cited in his post was entitled, "Videri quam esse". For those who missed those classes in grade school, the Latin is a play on North Carolina's state motto, "Esse quam videri", translated, "To be rather than to seem". Where Edwards is concerned, the "Locker Room" rather drolly reversed the vebiage of the motto . . . changing its meaning to something that better suited the former Senator from North Carolina. Latin/Classical Civilization was one of my (three) undergraduate majors at UNC-G (although these days I need Wheelock to help translate anything but the simplest phrase). I loved it:

"To seem rather than to be."