Dr.J's HouseCalls: A Very Healthy "Non-profit" Profit Margin

Friday, March 06, 2009

A Very Healthy "Non-profit" Profit Margin

A reader sent me this link. Blue Cross/Blue Shield's exceptionally healthy "non-profit" profit margin is irking some North Carolina lawmakers.

My Blue Cross premiums go up every year. On the other hand, I have worked the policy over the last year or so. If I keep it up, pretty soon there shouldn't be anything left to take out or fix.

I still wonder what happened to "ProCare" . . . the little grass-roots-movement that apparently couldn't move Blue Cross . . . which burst upon the scene and flamed out/abruptly disappeared a few years back. If anyone has the dirt, please drop me a comment or e-mail.

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HELLO. I am a Board-Certified Pediatrician, born, bred and educated in the once-great state of North Carolina (I decided to be a doctor in the 6th grade). Alas, I made the mistake of putting my trust in Randolph Hospital (as well as the Federal & state governments), returning home to practice in Asheboro & Randolph County. And let me tell you, people. THERE IS NO PLACE LIKE THIS HOME.

There's a lot to sort through on this blog. So, to keep things simple, here on the Housecalls' sidebar is what Asheboro's Courier Tribune might call a third-person "short-take" (click the underlined links for details) of Dr. Johnson's tale-of-hometown-woe . . . IF the Courier Tribune's publisher (Hi Diane!), editor (Hi Ray!), and "reporters" (Hi Annette!) didn not live in Randolph Hospital's back pocket.

It's the Reader's Digest Version. Here goes: Against odds, local girl makes good . . . jumps through all the hoops/pays all the dues, and becomes an MD.

Despite being surgically-mauled and permanently scarred at Randolph Hospital as a child, the newly-minted Pediatrician comes back home to practice at Randolph Medical Associates (RMA). Her medical-school loans were repaid by the Feds/State in return for service.

In classic, mill-town, good-ole boy fashion, the young/idealistic/outspoken Pediatrician gets used, abused and stomped on by the leaders of her hometown . . . and is ultimately fired after blowing-the-whistle on BAD CARE in a newborn case being botched by a "Moses Cone Hospital-owned" MD (previously falsely-advertised by the hospital as having skills he did NOT possess).

By ALL accounts, the doctor saves the baby's life.

Defying the prior threats of executives (she was basically told to "shut up" about serious problems at the hospital, "or else") the Pediatrician does her duty and reports incident to peer review . . . and later on, the North Carolina Medical Board, JCAHO, and the Department of Health & Human Services.

As a physician in North Carolina, you are ethically-bound to report bad care (and can be disciplined or sued if you don't). But Dr. Johnson would learn the very hard way that medical whistle-blowers in this state have ZERO real protection. All of the oversight agencies are essentially useless when doctors or nurses come under fire for doing the right thing. They don't care. They're not there.

It is not enough for Bob Morrison and Steven Eblin to simply fire Dr. Johnson and let her smoothly transition to private practice (as the hospital's recruitment agreement with the government specifically mandates) . . . or just move on to another job with another practice in the area.

This story is ALL about the abuse of power and retaliation. These hospital executives want to teach the young doctor a lesson - and to send a very clear message to other physicians in the community who might be foolish enough to stand in their way. Meanwhile, their in-name-only Board of Directors rubber-stamps everything these two corporate bullies do . . . at times even lying to the doctor's angry patients/parents in order to cover their executives' tracks.

And/so Randolph Hospital puts the Pediatrician in a contractual vice-grip . . . while it methodically absorbs her practice, - with executives hiding behind confidentiality and privacy laws as they go - allowing rumor & innuendo to destroy the doctor's local reputation while they sit back and play innocent. Many of her patients are given the impression she just abandoned them. She is black-balled for miles for fighting/talking back.

The Pediatrician sues the practice (after the government she served honorably and in good faith takes a wholesale dive on enforcing the full terms of her public service agreement).

Attempting to humiliate the doctor and fiscally intimidate her into dropping the her lawsuit (i.e. "just going away" and shutting up), Randolph Hospital unsuccessfully SLAPP-sues the Pediatrician for "libel" because she told the TRUTH to the state & Federal governments she served.

Meanwhile, as the doctor goes on the road to make ends meet . . . and struggles to pay her bills & attorney's fees (at one point her Mother - a teacher in Asheboro for over thirty years - has to pay her mortgage), the greedy executives who screwed her over, and the doctors who "inherited" her practice (she's not in the way to compete), do very well for themsleves in the name of "charity". The hospital-owned Pediatricians at RMA almost immediately get production bonuses & raises based on incentives - in part fueled by the influx of Dr. Johnson's patients to their own rolls. But we'll get to that.

The cases are settled in 2001 in the Pediatrician's favor - she is "awarded" less than one year's salary after a three-year legal battle and losing everything she had built in the three years before that (i.e. a practice that wound up being quick bonus money for other hospital-owned doctors). The hospital's lying lawyers plead "near bankruptcy" during negotiations . . . they insist they cannot afford to pay the damages that justice demands.

But the lawyers know that the hospital's tax returns say otherwise.

Randolph Hospital also tells the battle-weary, criminally corporately traumatized, almost bankrupt Pediatrician that if she settles, it will cooperate fully in helping her get another practice off the ground. But afterwards, as she hits roadblock after obfuscation tactic, it quickly becomes clear to the doctor that this was a lie designed to divert the ugly mess away from the Courtroon and all sweep it all under the rug on the cheap.

Frustrated, the Pediatrician starts digging through her legal files and discovers that hospital administrators REPEATEDLY LIED UNDER OATH about the "confidentiality" of their "non-profit" books & salaries (in violation of both IRS Code and N.C. General Statute) . . . negotiating a deal on the lies . . . and significantly cheating her at settlement.

The solution was a FRAUD - not just upon Dr. Johnson, but the taxpayer that paid to bring her home.

The hospital's big-gun lawyers had to have known that the answers they filed on their clients' behalf were false . . . and the Pediatrician's local lawyer was either grossly negligent or criminally-stupid as he advised her.

Unfortunately, in terms of enforcing legal ethics or protecting the victims of white-collar crime the North Carolina State Bar & N.C. Attorney General, Roy Cooper, blow nothing but hot air.

Perjury is a felony - and a crime without a statute of limitations in North Carolina . . . because IT OBSTRUCTS JUSTICE. It shows nothing but CONTEMPT for the people and the state.

The Pediatrician's subsequent multiple inquiries & complaints to local, state and Federal law enforcment are ignored. To date, the case has NOT been INVESTIGATED, much less prosecuted, by local/state/Federal officials.

The North Carolina Medical & Pediatric "establishment" likewise turns a blind eye. They don't want the public to know about medicine's ugly little secrets - i.e. what can really happen to your child in the middle of the night . . . or to your child's doctor for answering a terrified nurse's phone call.

The local press (the Courier Tribune and the Greensboro News & Record) also play deaf, dumb and blind . . . to service their big advertisers (Randolph Hospital and Moses Cone) . . . Asheboro residents might as well be reading Pravda.

To add insult to injury, when the doctor accepts the noble Greensboro N&R's promise of "citizen journalism" at its two-faced value, dives into the blogosphere and begs for help, "Blogsboro's" enlightened, "progressive" pseudo-journalist/blogger-king Edward Cone-of-the-Moses-Cone-Healthcare-System-Cones and his friends give her another beating (online) . . . liberally attacking her sanity and character . . . regularly pontificating about transparency and accountability without so much as looking at the black & white of sworn Court documents - or posing a coherent question to the VIP's and "non-profit" institutions she accused.

FACTS DO NOT MATTER AT ALL to the so-called journalists in this crowd. Their "ethics" do not require them to act. Yet they can't understand why more and more people are giving up their newspaper subscriptions.

The hypocrisy and heavily-drenched-in-partisan-hate indifference of many of these people is not rocket science. Dr. Johnson's experience in Hillary Clinton's "village" belies everything Mr. Cone's heroes in the North Carolina's Democratic Party (Hunt, Sleazely, Cooper, Edwards, Perdue) ever told you about the mighty and benevolent government being on the side of right . . . or rewarding education & hard work . . . or wanting to bridge the gag between "the Two Americas".

Now, thirteen years after the nightmare began, the ex-Governor/former-N.C.-Attorney-General to whom Dr. Johnson once pleaded her case is a convicted felon and former Senator John Edwards is a wife-cheating porn star. Former President Clinton actually embraced perjury as a part of his own legal strategy.

On the other (more local) side of the political aisle, former "Mista Speaka", Harold Brubaker is of no help either. He "has to live in this town", you see. And Congressman Howard Coble's office, initially helpful (in a belated, far-too-little-far-too-late-fashion), moves to radio silence when it becomes clear laws were broken. He cannot step on any of "the right people's" toes.

Alas, even "hope and change" were not for Dr. Johnson. President Obama didn't want to hear about it as his administration "Rahmed" through healthcare "reform" that failed to plug ANY of the holes in oversight Dr. Johnson fell through . . . indeed, where the NHSC is concerned, "Obamacare" simply threw more good money after bad . . . and put the IRS in charge. (It's LUDICROUS, but not really a surprise. After all, the President's wife is a former patient-dumping, cherry-picking, $317,000/year hospital executive.)

In summary, the good doctor was TOTALLY HOSED in public service in the good ole' USA, but she's not supposed to be NAIL-SPITTING MAD about any of it. She's supposed to forgive and forget - and SILENTLY watch her profession implode due to a half-century of failed social policy . . . courtesy of smug politicians who have no clue about who she is or what she is about.

As current Asheboro Mayor, David Smith, tells his not-so-little white lies and side-steps over a home-grown young professional's dead body in order to re-vitalize the town that greed killed, it is Dr. Johnson's position that where Asheboro is concerned, "cheap grace" just does not cut it.

Justice is not ever easy. Dr. Johnson gets that. But it should not be this hard - or this elusive either. This entire nightmare could have been STOPPED cold by a couple of well-placed phone calls by Federal officials thirteen years ago. But NOBODY did their job EXCEPT Dr. Johnson.

AND/SO THIS "DIME-A-DOZEN" PEDIATRICIAN IS NOT GETTING OVER IT. SHE'S NOT MOVING ON . . . NOT UNTIL SOMEONE AT RANDOLPH HOSPITAL (OR IN THE STATE/FEDERAL GOVERNMENT AGENCIES THAT TOTALLY FAILED HER) ANSWERS FOR WHAT WAS DONE TO A GOOD DOCTOR WHO CAME HOME AND DID HER JOB AND PLAYED BY THE RULES THAT EVERYONE ELSE IGNORED.

Thank you for visiting Housecalls. Please tell your friends about the site/blog.

Dr.J's HouseCalls

Friday, March 06, 2009

A Very Healthy "Non-profit" Profit Margin

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An Angry Pediatrician-Done-Wrong Fights Back

NOTE TO READERS:

Why I'm In The Blogosphere

The Injustice At The Core Of This Story

Do You Believe The Doctors Or The Executives?

You're Invited To My Own Tea Party For President Obama

The North Carolina Medical Board And Oversight

On Rabbits And Heroes

Life In Asheboro, North Carolina: To Have One, You Gotta Be "Right People"

Truth To Power

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