Joan R. Rose
Good Samaritan Laws: Should doctors responding to a hospital emergency
New Jersey doctors who assist in hospital emergencies cannot use Good
Samaritan laws as protection against malpractice suits, the state's high
court has ruled. The law isn't intended to protect physicians who care
for patients in fully equipped and staffed hospitals, the court said.
In the case before the court, complications arose during a delivery,
and the attending physician called for assistance. The doctor who responded
specialized in maternal-fetal medicine but had no prior relationship with
the patient, whose child was born severely brain damaged and died before
age 3. His parents sued both doctors, the medical center, and others.
All but the specialist settled before the trial. The responding doctor
unsuccessfully contended in the ensuing malpractice suit that she was
immune under the Good Samaritan Act because she acted in the absence of
duty to do so and that the location of the emergency was irrelevant.
New Jersey is among 29 states whose Good Sam laws don't explicitly address
whether in-hospital care can be shielded from liability. For more on the
subject, see "Do
Good Samaritan laws protect you in the hospital?," May 10, 2002.
Managed Care: Patients may cheat themselves out of better health care
By the end of last year, most states and the District of Columbia had
enacted external review laws that allow patients to appeal denials by
health plans. But some HMO enrollees may still not be getting the coverage
they're entitled to.
A Consumers Union review of appeals filed with the Texas Department
of Insurance found that Independent Review Organizations (IROs) fully
or partially overturned more than half the treatment denials they considered.
Moreover, HMOs consistently denyand are overturnedon treatment
decisions involving mental illness, gastric bypass for obesity, and substance
abuse. In fact, the study found that 70 percent of treatment denials for
mental illness are overturned on appeal.
Despite the strong likelihood that denials will be overturned, Consumers
Union says, Texas' five-year-old independent appeals process was used
to settle only 587 disputes last year. CU analysts believe that the number
of appeals is low given the thousands of coverage decisions Texas HMOs
make each week. They speculate that patients may not be aware that they
have the right to appeal to an outside party or that their experience
with the HMO's internal appeal process is so frustrating they simply give
Still, Texas appears to be doing a better than average job. A recent
Kaiser Family Foundation study of 41 states and the District of Columbia
with independent review laws found that only about 4,000 patients nationwide
appeal HMO treatment decisions each year.
Medical Practice: Locum tenens: They're not just retirees anymore
America is becoming increasingly dependent upon itinerant providers,
says Staff Care, a locum tenens physician recruiting firm. Once considered
a way for older doctors to ease into retirement, locum tenens is now drawing
younger physicianseven those right out of residency.
While doctors with 11 or more years of practice experience still make
up the largest proportion of temporary physicians, new doctors made up
11 percent of all locum tenens practitioners last year (up from 1 percent
in 1997). There have been other changes in the industry as well: For instance,
the demand for FPs and other primary care physicians is abating. Overall,
FPs, GPs, and internists were the targets of just 21 percent of all searches
last year, down from 65 percent in 1997.