Malpractice Books

A comprehensive review of this book appears in the July-August 2006 issue of "Biomedical Instrumentation and Technology", Vol. 40, No. 4, p. 290. This is a reference that should be on the bookshelf of every department head and policy maker which is involved in the delivery of healthcare or its oversight.

This book came out long before the Institute of Medicine Report, "To Err is Human", and in some ways it is better. It provides a great deal of background information essential to understanding this important but long-neglected problem. As a physician, it has completely changed my understanding of how errors occur in the profession of medicine. Although some chapters are difficult to read, I believe every physician and physician in training should read the forward, Chapter 13, "Operating at the Sharp End", and chapter 14,"Fatigue, Performance and Medical Error". When our hospital board asked me about the newspaper reports of error in medicine, I used the information in this book to explain the problem to them.

Not since Erin Brokovich have I seen such determination, tenacity and spunk in a heroine. And even while she's breaking your heart and enraging you about the treatment she receives from her California HMO, somehow she still manages to make you smile and even laugh out loud along the way. I find myself somewhat bored with most memoirs; this however, is a real page turner that I would heartily recommend to anyone looking for a deeply meaningful read.

This book by Elaine Christine O' Malley takes you on a journey with a woman who is bullied by a daunting giant: a California HMO. A single mother is injured in a car accident, then over the course of a harrowing two years is subect to abuse by an HMO who refuses to treat her because she is a "complex" patient, or in plain English, just too expensive to treat. What you will read in this book about the doctors in California will surprise and infuriate you. What you will read about the other "ordinary" people who helped along the way will give you faith in the connections you have with your friends, neighbors and family. This book is cathartic to read, as it is as human as it is mythical (David and Goliath, anyone?).

this is an excellent book for those of you who are interested in the ups and downs of the securities industry. it reminds me of "den of theives" with murder added for excitement.

I worked at Drexel in the 80's in the Mpls office. I know these people. However, I didn't know Michael that well. He was an overwhelming personality. This book really brings back memories of the business in the 80's. This is a great personality study. Michael disreguared basic ethics, not only of the business, but of human decency. I would recommend this to anyone who works in the business or who is interested in true crime.

How wonderful to find a textbook that is not only factually detailed but so clearly written that ---believe it or not---I could hardly put it down. I do wish there were new supplements---it's a treasure. I teach at Pratt Institute's Interior Design Dept., and have assigned it as optional reading and am considering it as assigned reading. The line drawings and illustrations are useful and the sample documents and forms exhaustive.

This is a fabulous book and a must for any professional interior designer to have on their book shelf. The information it contains provides the designer with the basic information needed to evaluate the different types of building and furniture finishes. It covers all of the available types of finishes including floors, walls, and ceilings. The only concern that I have regarding this book is that it is from 1989 and a lot of changes have happened to the industry since that time. Hopefully, the author is in the process of revising it.

As a local from Redding, I can tell you that some of the "heros" in the book put quite a spin on their involvement. Specifically, when objections were raised about the CV program prior to the FBI raid, those objecting were told that the cardiologist and surgeons were saviors and, furthermore, "they really refer a lot of patients to me" ('so please be quiet about your concerns'). These sentiments were issued by some of the directors of departments in the hospital. Imagine my surprise to find one of these individuals lionized in the book rather than indicted himself! Oh well, this made the reading extra riveting for me!

Appalling would have been a more appropriate name for this book; appalling that these actions occurred in this current era of medicine and regulatory compliance. Every new twist in this well-chronicled story can be described as appalling.

The reader is drawn to the charm of Redding, California, but then the evident ethical disconnects of the townsfolk become apparent. As the story implies, the fact that something was not quite right at Redding Medical Center was well known in the community, yet it was spoken of only in whispers and never with any conviction. Because Dr. Moon and Dr. Realyvasquez were revered in the community, one can only wonder whether the townsfolk were devoid of ethics and chose to ignore the whispers or whether their loyalty to their neighbors blinded them to the truth. Or, perhaps, as one Redding resident wrote in a review of this book, "We felt pretty powerless to stop a huge corporation and its power-hungry minions."

Even more inexcusable than the act of fraud by Moon and RV is Tenet's apparent disregard for the practice, all in the name of profit. What principles did corporate executives lack that they allowed these things to happen and to continue without any intervention. This question becomes more significant when we consider that, in addition to settling this lawsuit for $54M, Tenet settled claims in January and July 2006 worth $215M and $900M, respectively.

This is a well-researched and well-narrated book that exposes the reader to the realities of healthcare. Those of us who work in healthcare and believe in its merits cannot deny that fraud and abuse occur. We, as healthcare workers, have a duty to our patients, employers, and community to recognize and report these practices.

Stephen Klaidman does a wonderful job of exposing just how awry medicine can be in Coronary: A True story of Medicine gone Awry. This book gives a detailed account of two cardiologists making a living off of performing unnecessary heart surgeries. It was one brave soul, John Corapi, who with help from others, eventually took these physicians down. The practice of the two surgeons, Drs. Moon and Realyvasquez, were completely unethical.

I believe that the author attempted to show just how prevalent situations like this occur and how easy it is to get away with it. I think that he also attempted to show how difficult it can be to prove that situations like this are in existence. It took years to take down Drs. Moon and Realyvasquez. Many complaints were voiced in regard to Dr. Moon's callous treatment to patients and concerns on his medical diagnosis were presented, but none were taken seriously or acted upon. And why would they be? Dr. Moon was performing so many bypass operations and generating so much revenue that who dare question him?

I feel that this book did a good job capture the case of Drs. Moon and Realyvasquez and Redding Medical Center. I am sure that there is a lot of information that we do not know either because the author did not know or because it was never discovered. Some believe that some of the accounts referenced in the book may not be true. I feel that the author did show some bias in writing the book as it is my opinion that he sided with the patients or "victims" if you will and did not give an objective view 100% of the time. It is clear that he would not have written this book exposing the doctors and the healthcare organization if he did not have a certain amount of bias in the matter. If you feel passionate about a particular topic then it is not easy to write about it objectively.

I would definitely recommend this book to other readers, especially readers who work in the healthcare field. It is a book that prompts much thought around ethics in healthcare. After reading this book, I started doing more research ethical issues surrounding surgical procedures. I found an article on doctors removing defibrillators from dead people, reusing them and pocketing the money. It is amazing how much information you will find in these ethical issues in healthcare, and this is only the stuff we know. It will really get you thinking!

Ronnie H.

The title says it all. Coronary is a true story of two physicians working in the Tenet Healthcare system who treat patients for questionable or unconfirmed conditions by doing cardiac surgery -for the monetary reward of how much revenue they could bring in to the healthcare corporation. Klaidman provides a detailed (sometimes too detailed) account of the patients and their families, the healthcare workers as well as the surgeons who performed the surgeries.

The book begins with background information and good hooks to keep you reading. It flattens out in the latter parts but it grabs you enough to keep reading to the end- which is appalling to say the least. This book challenges our basic ethical nature and makes you think twice about physician diagnosis and the need for a second opinion. It makes you consider the cost of care and the insurance and hospital corporation motives for advertising costly and technical procedures.

As a healthcare worker, I am amazed at how the book detailed some of the Tenet Healthcare systems employee reactions and actions. The fear and sometimes non-chalant response makes me realize that this is probably not the only healthcare organization that suffers from this.

The story is about the tragic unraveling of the current state of healthcare and the injustice of the justice system. As leading physicians, Dr. Moon and Dr. Realyvasquez, in the northern California community of Redding are revered not only by the medical community and the town's people for their efforts in bringing Redding Medical Center (RMC) to the forefront as a, if not the, leading cardiac center in California. Both of these physicians have placed RMC on the map for the progressive work and impressive volumes of interventions they have managed to establish in both the arenas of cardiac catheterizations and open-heart surgery in California and the nation. Together, they have single-handedly generated the majority of the clientele and revenue for the medical center, which is owned by Tenet Healthcare. The full disclosure of the events by the author, spanning from the early 1990s to 2002 reveals that approximately one third of the patients received angiograms not actually indicated and a portion also required unnecessary open heart surgery, is heartrending and disturbing in an industry established to provide care and to do no harm. These physicians' activities led to no less than fraudulent claims to Medicare at state and federal levels, implicating Tenet Healthcare and to truly life altering results and even death to patients they treated. The exposure of the power and the influence these men have on their patients, the hospital and staff within the system, not to mention the community at large is remarkable.
The author takes the reader through a factual journey that includes the events and perspective of multiple patients with positive and negative outcomes, hospital staff that worked directly with these physicians and were long time members of the community, peers of each physician, FBI agents and lawyers. While there is a great deal of information to absorb it is apparent the author felt compelled to present as much information as possible so the reader could draw informed decisions on this extremely unfortunate state of events that effected many lives including the community of Redding and the medical community at large. One nurse is quoted in the book as saying that the raid by the FBI on RMC had been devastating to the hospital and community and had engendered an "environment of immense suspicion. Nobody trusts anybody."
Is justice served when after years of investigations and hundreds of interviews revealing malpractice and negligence the physicians walk with a financial settlement to reimburse Medicare yet continue to carry a medical license and practice medicine? What about those patients whose lives were altered and/or destroyed by these men's arrogance and need for power and money? These are questions for the individual reader to decide.
It would serve healthcare workers, particularly those in positions of administrative responsibility, well to read this book for the insight it brings to mind regarding the power and control frequently given to physicians for no other reason than the title they bear rather than the privilege and responsibility that goes with such designations. Patients could glean the importance of taking time to step back and ask questions. The physician is not always right; a second or even third opinion could possibly save their life. The decision is theirs to make.

NOTE: The author informs me that his book has been re-written and re-edited, and that the version of the book currently available is thus slightly longer than and otherwise changed from the version that I review here.
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TerrO.R. is a brief, self-published novel by Joseph Neuschatz, a doctor, whose medical expertise is apparent on every page of the book. The book's protagonist is Dr. Philip Newman, an anesthesiologist at Soundedge Hospital, whose troubles begin when a 19-year-old patient, otherwise in good health, inexplicably dies during routine surgery. The case is strange at the outset: despite his age, the patient is being forced by his dominating father to have his tattoos removed. And when the operation goes awry, the father is unusually quick to sue. Neuschatz takes us through the operation and other day-to-day experiences in the life of a busy anesthesiologist. And he turns Newman into an armchair amateur sleuth insofar as Newman figures out--from a pattern of such cases--the complicated story behind the tragic tattoo operation.

TerrO.R. is a sort of didactic novel, a lightly fictionalized vehicle for delivering information about medical care as well as Neuschatz's opinions about the health care industry. Neuschatz talks readers through procedures in passages that are authoritative but rather dull for the layman:

"The side about to be operated on received an intravenous cannula (attached to a syringe extension) and a deflated tourniquet. After most of the venous blood was ejected by the rolling of a tight elastic bandage (on the vertically elevated arm) from the finger tips down, the tourniquet was inflated and the bandage removed. The veins of the now pale and anemic looking arm were ready to be filled with a diluted Lidocaine solution."

There are a great many such descriptions in the book. In the non-medical parts of the book--the narrative holding the medical sections together--the writing is bland and the dialogue very stiff:

"'You never stop making me laugh, Arthur! I always know I can count on your good advice.'

"Any time, Dr. Newman! Give my love to Mrs. Newman.'

"'Only if you give my love to Mrs. Ross.'

"With pleasure! But I will be able to do that only if she decides to talk to me tonight. By tomorrow, I will probably forget!'

"'Tell her that I insist she be nice to you. You are my hero!'

"'I will tell her what you just said, for sure! Have a nice Sunday!'

"'You too...'"

There is also a loose end I would have liked tied up. (Or was that car accident really just a car accident?)

All that said, the mystery behind the failed operation is an interesting one, and its solution perhaps not so far-fetched. I can imagine the book's plot being translated successfully into an episode of a medical show such as House.

-- Debra Hamel

Dr. Neuschatz has written a very intriguing novel about the the life of an anethesiologist Dr. Phillip Newman and his wife Kyra who is a pediatric nurse. Due to a serious unexpected death in the Operating Room, the story takes some unusual twists and turns which no reader can anticipate. There is a major surprise ending that will satisfy any reader of medical mystery thrillers. Dr. Robin Cook may be the more experienced novelist and best selling author but Dr. Neuschatz provides an equally thrilling reading experience. His book contains a highly contemporary theme which will leave a huge impact on the reader at the end. Furthermore, while the book explores a serious subject, there is much humor in the book, making it quite fun to read.

Unfortunately and unexpectedly, one of Dr. Phillip Newman's patients codes during surgery while he is being administered anesthesia and subsequently dies. It is a young man who is 19 years old who elects to have surgery to remove some tattoos. He had no allergies, no significant medical history and of note, no previous surgeries (therefore never had general anesthesia either). Suddenly, Dr. Newman is faced with a huge lawsuit for malpractice ... The hospital wants him to settle out of court. Although, Dr. Newman is reassured by his colleagues that this is how it is in modern medicine, it bothers him and he begins to research possibly causes for this most unfortunate death. Despite being reassured, that any physician can expect this in a highly litigious society (such as ours), he does not accept this explanation. Dr. Newman starts asking probing questions, what could have gone wrong? What special factors were over-looked? He arrives at some startling conclusions after he takes on the role of scientist and epidemiolgist. He realizes, some of the dyes used in the tattoo *could* have caused a reaction with the anesthesia. He does an internet search and asks some questions on an anesthesiolgist specialty site, looking for similar cases.

He knows the response of his team to the code was textbook perfect based on the current guidelines for ACLS (advanced cardiac life support) as taught by the American Heart Association. A 19 year old male died ... when it was an *elective* surgery to remove some tattoos. It should *not* have become life-threatening. It turns out news about the Code Blue which was unsuccessful in the OR passed through the hospital grapevine ... and the news spread even to a some other physician colleagues. Through some odd circumstances, Dr. Newman learned that his 19 year old patient *had* indeed had surgery at the age of 17 for a type of testicular cancer. Oddly enough, Dr. Newman also discovered, a life insurance policy had been taken out for this 19 year old exactly 3 months prior to this surgery. Strange, it seems as if it was known something would happen. In the meantime, Dr. Phillip Newman also discovered other cases similar to his, where tattoos were removed and the patients had sudden death while under anesthesia. The reader will be left hanging at this point to wonder what could have been the similarities in all these cases and it is NOT what you think. Dr. Neuschatz provides a real cliff-hanger to this question and then with a very sharp curve - the answer arrives and is much more sinister and threatening than anyone could imagine. This is a most highly recommended book. It baffles me why this book was not accepted by a publishing company and why the author had to 'self-publish' it. It has an outstanding plot and brilliant ending. It has highly accurate medical and surgical descriptions used within proper context. What more can any reader desire? Erika Borsos [pepper flower]

terrO.R. This is a brilliant book by an obvously brilliant author. Apparently I am not the only one who thinks this because it did win an award. I am not a stranger to medical personnel and medical establishments; I found the characters and the settings realistic. It should be both intersting and reassuring for the reader to learn what happens on the other side of the surgical drape. While this is a genuinely scary book as indicated by the title, it also does a great job of allowing us to get inside an anesthesiologist's head (Dr. Newman and Dr. Neushatz). This is a timely book that will leave a lasting impression. Yes,it is short, but then you also will not be able to put it down once you start it, so its brevity is not a negative. Actually I was sorry when the book was over and plan to re-read it to see how the clues fall in place.

This book has been reviewed a number of times; some of the reviews have criticized writing style or pointed to editing mistakes. Granted this book is not Shakespearean, but for most it will be a lot more entertaining and we are sure of the author.

Lastly, I think this would make a great scary movie and wonder if the author has considered this. Given the popularity of crime and medical series on TV, there should be a big audience for this book in print, on the big screen or the TV screen.

"TerrO.R", by Joseph J. Neuschatz, Booklocker.com, Inc., 2006. ISBN -10 1-60145-015-X. SC 128/151 pages. Intro., 42 Chapters & Epilogue 4 pgs., 8 1/2" x 5 1/2".

A unique, intriguing medical mystery: too short for a novel, too long for a short short, but comfortable as a mildly loquacious but highly readable novella containing a good mix of twist and turns to pique and maintain interest.

The story line with its finely revealed details could have only been written by a medical specialist, in this case an anesthesiologist, who exposes and explores the innermost mindset of specialists entrusted with safe passage of patients while under the knife. Thusly, we learn of the mission, day-to-day responsibilities and of dire consequences and unforseeable events which occur if things don't go as planned, akin to PTSS or post-traumatic stress syndrome -- where lives are virtually turned upside-down.

Neuschatz provides a lucid exposition of the medico-legal jungle awaiting therapeutic misadventure, one perhaps even inciting adverse outcomes as witnessed by protagonist Dr. Newman and colleagues. The plot's resolution is believable but one is wont to pray and hope it isn't so...as it'd make us too vulnerable. Is it fiction?...you decide. The author is to be congratulated on compiling a nice literary piece that is highly readable, not overly technical but thought-provoking to maintain interest - the ending contains a smidgen of antipathy on current day societal moral principles, a conclusion or fustian, although valid, better left for the reader.

Joseph J. Neuschatz's self-published first novel is a short medical mystery thriller. Our protagonist is anesthesiologist Philip Neuman, a friendly, hard-working professional who begins to connect the dots in a smattering of seemingly unrelated accidental anesthesiology deaths around the country. No governing body or organization has an interest in gathering data about a pattern of deaths. Individual hospitals would rather quietly settle with families and avoid potentially disastrous, costly litigation.

Neuschatz is well-versed in the climate of the modern American medical industry. In his novel, he raises concerns about malpractice insurance and the overwhelming pressure for doctors to quietly settle and avoid rate increases that could cut short their career. He rails against the tax deductions encouraging the upper class to purchase gas-guzzling Hummers. Neuschatz also employs Do No Resuscitate orders as a well-placed plot device, and the protagonist discusses the moral dilemmas of doctors performing non-emergency surgery on DNR patients (many doctors simply refuse to do so, according to Neuschatz).

As a mystery, TerrO.R. has the standard number of red herrings and plot twists. The end, in which the amateur-gumshoe anesthesiologist gets to interrogate a terrorist suspect himself, is entirely implausible but ties up the story efficiently,. The writing is somewhat uneven and smattered with Excessive Random Capitalization and URLs printed right in the narrative, but for a self-published title, perhaps this can perhaps be forgiven. The culprits in the medical malpractice mystery are a surprise group, providing a satisfying end to this novel.

When you're in the hospital if you think docs are going to do every thing they can to save your life, you're may be dead wrong.

The majority of docs and hospital workers resist every new quality program that can improve outcomes. Look how low the adoption of six sigma is in healthcare. Most of the major quality control programs created in industry are absent in hospitals. Often the programs they have run at such a low level they don't provide much benefit.

Do some research and find out how many errors are made that kill people in hospitals. Estimates range between 100,000 and 250,000 deaths per year, and that doesn't include those that are injured or crippled up.

If somebody makes a mistake in Iraq and 3 soldiers are killed, it's national news and every politician is calling for somebody's head. Kill a 100,000 people in the hospital every year with mistakes, who cares.

Yes, there are a few people who are trying to fix the problems, but not enough are trying. Half the time hospitals don't even know how to measure outcomes, errors and problems. A lot of hospitals use bogus quality programs to tout how they comply with xyz blah, blah, blah, but the truth is these programs have little or no impact on errors, mortality or morbidity.

This book is a good place to start if you're interested in the subject.

60,000 people killed in auto accidents every year, more than 100,000 killed annually in hospital accidents, why aren't the politicians screaming and hollering about those dead bodies? Well, it doesn't get them any votes!

This is a top notch book required for all our first year medical students. It will change the way you think about medical mistakes. Guarenteed to save lives . . .Not only that, but it reads like a thriller novel, so you get all the benifit while it feels like you're goofing off!
Dr. Imber Coppinger, 15 years in medicine

Excellent book for both the medical field and lay people alike.
Great ideas for improving health care in the USA.

Why their way is the best way. I suggest you read What your doctor Won't Tell You. This is a gutsy non self-serving and tell all book that will help you get through our terrible health system

"Internal Bleeding" is a good primer on medical culture. The authors focus on the issues related to medical errors. The book is largely well written, but occasionally the authors resort to hyperbole to make points; terms like "crisis" and "epidemic" are occasionally warranted, but their overuse tends to occlude important nuances within the issues discussed.

I was particularly interested in the analogies the authors made to the aerospace field, and found the cultural comparisons insightful. The discussion of the space shuttle accidents (pp. 49-51) are a proper indictment of NASA management, and makes the argument that in medicine and aerospace as well, taking routinely good outcomes as positive reinforcement of perceived infallibility is asking for disaster. ("NASA had forgotten how to be afraid.") On pp. 88-89 the authors discuss the differences between "slips" and "mistakes" and include a valuable commentary on trapping errors, much like the latest iteration of aviation training attempts to trap errors with "Threat and Error Management".

The authors provide excellent commentary on the makings of master diagnosticians, hypothesis testing, and the applicability of Bayes' theorem to medical reasoning on pp. 110-112 and p.117. This section provides an excellent view into the minds of doctors as they make challenging evaluations in complex cases: although not specifically stated at this point, similar thought processes are used in other highly skilled, tightly-coupled professions, such as aviation. The authors also explain why overreliance on automation and underreliance on physician wisdom is certain to result in bad medicine, despite the utility of computer systems in medicine. ("Any doctor who could be replaced by a computer should be.")

The authors return to their aviation subtext on p.147 in their discussion of pilot selection versus medical school selection; the conclusion reached is that the real-world evaluations given to pilot candidates would be a much better template for medical school applicants than what is currently used. On pp.156-157 the authors discuss doctors as being psychological perfectionists, and provide examples from other professions which tend to validate their hypothesis. The crux of the discussion is the intolerance for mistakes within the profession and within the psyche of individual surgeons, a trait common to pilots. Furthering the discussion of error-intolerance is a discussion (p. 176; p. 366) of one of the most common types of errors in both aviation and medicine: communications and the handoff error, a theme that is common throughout the remainder of the book. The authors make clear that while pilots are lauded for soliciting input from others (it wasn't always so), surgeons are known for being exceedingly inflexible (p. 191; p.222) to the detriment of the patient. When coupled with communication issues and power-distance problems, inflexibility is not a desirable trait in a surgeon. On pp. 222-224 there is an informative discussion of the roles of communications in both medical and aviation errors, concluding with a recounting of the worst aviation accident in history at Tenerife, which was caused largely by communication problems.

All of chapter 20 is laudable as it really distills the culture of safety concept down to the essentials. Notably, pp. 348-349 discusses the potential usefulness of Failure Mode and Effects Analysis, a longstanding aviation tool, in medicine, while p. 351 serves to recap the aviation safety from a historical vantage point.

Finally, the authors detail one of the most potentially beneficial changes that could be made in American healthcare (pp. 342-343) where they discuss the advantages of a no fault system of compensation for victims of bad healthcare.

This book is really a study of safety systems in a hospital environment, with relevant discussions of other germane industries (especially aviation) throughout. It is not a dry, academic tome; it is quite accessible to anyone who is interested in healthcare in the US. I recommend the book for safety professionals in any field, to physicians and medical professionals, and to anyone else with an interest in curbing errors in medicine. No book is perfect, but "Internal Bleeding" does cover the most salient points in the dialogue that is taking place (or should be taking place) in hospitals across the country.

From my standpoint as a physician, I found the objective data very provocative. However, I consider Tom Baker's conclusions and interpretations based on the data misguided and inflated. I consider that the book is useful to read, as it contains accurate data based on research. However, his interpretation and representation of the data to support his views that there should be more litigation and access to litigation than there is today against medical professionals only serves to promote his bias against medical professionals working in good faith in an imperfect world.

I had a corneal transplant back when I was just a kid. The doctor never told me how to recognize rejection because supposedly "only five percent of the world's population has immune systems that would recognize something so small."

Unfortunately, I fall into that five percent. The day the surgeon pulled stitches from the eye, I thought the starting haziness was the aftermath of stitch removal.

In a few expensive hours, I was told the graft was lost due to rejection and the "greasy film" was an inflamed, thickened cornea.

The eye was flooded with ophthalmic steroids to halt septicity.

The steroid flooding destroyed my lens, which led to a second surgery to remove the lens and insert a replacement. Then, I formed thick scar tissue and the doctor used a laser to try to get that scar tissue down.

I waited over twenty years for another transplant in that eye. The eye was beat up and no doctor wanted to touch such a banged-up mess.

Several years ago a gifted and heaven-touched ophthalmologist did an exemplary new transplant.

Yet my wait was for naught! You see, the original surgeon - all those years back - missed the scar tissue and hit my PUPIL with his laser.

I can't use ambient lighting. I surround myself with pricey ultra-maneuverable lighting to get the light just right.

I wear special shades when I go outside to block out as much sunlight as possible. Oncoming car lights at night make me a scared and blinded Bambi.

I was totally blind for a while.

Light will never fall properly in this eye. No one knows, yet, how to sew "tissue paper" pupils very well.

Lawyers, so far, won't even hear me out - outright cutting me off - once I get past the year of the initial surgery and the year of my discovery. STATUTE OF LIMITATIONS!

As I write, the front of my blouse is wet because I just can't stop the tears. They never stop when this subject comes up.

I do my math and I agree with this author. You, surgeons and others, that think he is so off the mark, take my place for a day!

If my "good" eye, for what ever reason, runs into any problem, I will again find need to touch all the food on my plate to orient myself before eating.

I won't visit Amazon so much because I've been raped of something so very, very precious and irreplaceable...

I can do no better than the detailed criticisms of this book already posted. Having practiced surgery for over 30 years and an author myself, I'll tell you Baker's attitude is an example of what's driving health care in this country toward mediocracy and away from the high quality our nation could achieve if physicians were just left alone to do their job. The book itself is a symptom of ITBED (Ivory Tower Blind Eye Disease,) ignoring the real problems plaguing our health care system. They are two-fold -- the lack of appropriate reimbursement and lack of tort reform. (If you don't believe the latter, check out the state of Texas.)

Everyone quotes Baker's facts. Well, look at the medicals schools -- you don't have to have an "A" average to get into one. Look at the residency programs in our country --they're having trouble filling them! Why don't smart kids want to be doctors?

You really want to know what's happening? Don't read this book, ask your doctor! And ask him or her now, because there may soon be a time when you'll be in the need of emergency care and someone will just hand you a mouse and tell you to surf the net for your treatment. You see, if your doctor explains all the options to you, it might confuse you so much, you won't be able to make a decision and you might wind up suing the doctor. This actually happened and the jury found in favor of the patient. The doctor explained too much! Do you get it? We can't win!

I heard a plantiff lawyer lecture recently and he said two things were necessary before proceeding with a malpractice suit -- a deep pocket and an injury. John Edwards is running for President of our nation and that's how he made his fortune. Hillary's health plan was worse than socialized medicine. The other guy won't salute our flag. God bless us everyone.
- Constance Uribe, M.D., F.A.C.S.

Baker begins by putting malpractice insurance expenditures into perspective. In 2003, doctors, hospitals, and other health professionals paid only about $11 billion in medical malpractice premiums - out of $1.5 trillion spent on health care, and in comparison to $116 billion Americans paid for personal auto liability and no-fault insurance.

Part of the "problem" is its unpredictable and cyclical nature. Medical malpractice payouts are significantly influenced by a few cases drawn out over several years - thus, when they occur insurers can find themselves needing to temporarily raise rates to recoup losses. Another problem is that doctors bear most of the costs of medical liability, despite receiving only about 15% of health care revenues. And finally, the issue focuses primarily on a few specialities - eg. OB-GYNs.

As for the costs of defensive medicine, early 1990s research by a congressional group found doctors reporting defensive they would take extra defensive medicine costs less than 0.01% of the time in response to various situations posed to them, though at a much greater rate in some situations (eg. when heart disease or brain surgery was involved). These results have been inappropriately generalized, and subsequently largely contradicted by the original authors since concluding that managed care eliminated the impact without increasing malpractice awards. The number of doctors supposedly leaving the profession to avoid malpractice costs has also been overstated (eg. they simply moved to another area), but malpractice rates have led to a decline in part-time practitioners in high-risk areas - a good thing given that malpractice rates are inversely related to practice volume.

Baker believes that malpractice suits are beneficial, citing anesthesiologists' working identify major sources of malpractice awards and thereby significantly reducing errors and holding insurance rates constant over a number of years. He believes that the real medical malpractice problem is that there are too few claims - most instances where patients are harmed due to medical errors do not result in lawsuits, thus not creating incentive and feedback to improve. Therefore, Baker offers several suggestions for improving the rate of lawsuits.

Baker does not go on to look at wastes in other areas of health care. Dr. Relman, however, does. He estimates ("A Second Opinion" that 40-45% of health care expenditures are waste - excess administration, profit, and care that is either not needed or of doubtful value. Others estimate that the new Medicare drug benefit alone adds about $70 billion/year in wasted costs through extra overheads and lack of competitive bidding.

This book is a must read for anyone who thinks that tort reform is a good idea. We've tried it in California. The effect has been to effectively immunize health care providers from liability by closing the courthouse door to claims of medical negligence. There is no incentive to improve the health care system or to address the systemic problems that cause most injuries and deaths.

Medical negligence is a fact. Our government estimates that as many as 98,000 people per year die from preventable medical errors. The cost of these errors is enormous and, when our civil justice system is crippled by tort reform, those costs are often shouldered by the public through increased taxes and fees.

Tort law is designed to do two things: to provide just and reasonable compensation to people injured by the negligence or carelessness of another and to discourage behavior likely to result in injury. When we "dis-incentivize" good medical practices by immunizing health care providers, we make it more, not less, likely that people will be injured as a result of medical errors.

There is no evidence of which I am aware that these reforms have benefitted anyone other than big insurance companies. In California, it is increasingly difficult or impossible for patients who are injured by medical errors to receive "just and reasonable" compensation for the harm caused. The cost of litigating such cases is prohibitive in light of the 32-year-old MICRA cap which limits damages to $250,000 in most cases - even those involving gross negligence or the death of a child.

The best thing about the Maggody series by Joan Hess is the sarcasm (in thoughts and deeds) of Police Chief Arly Hanks, and her relations with the "regulars". She and the Mayor are always at odds, the Reverend is always dipping into the sacramental wine, and Mrs. Bob is attempting to live above her station.

This particular one has the "Old Peoples' Home" being razed, and a secluded ultra-private rehab taking its place. Some of Maggody's residents are turned loose on the unsuspecting population, and everyone is trying to get into the rehab facility to snoop.

When a murder does get committed (as it must, in Maggody), Arly is finally beginning to strike back, at the County Sheriff for his lazy ineptitude, and the mayor, and her own mother. Suspicions are raised, fingers pointed nearly everywhere, and as usual, it is an interval before the reader can begin to spot what is really happening.

Arly's private life enters into this book, first as a brief glance into her vacation, and then some significant occurences, including how her current guy is actually dependable. I hope this doesn't destroy Arly's acerbic wit, sarcasm and charm, as that was always the most diverting part of the Maggody books.

This book is not the best of the series, but nowhere near the bottom either. If you live in a small town, not just a small town in northern Arkansas, you will enjoy the read.

I had quite a few laughs with this one.The people who are forced to be together at the rehab center start acting up and it is hilarious.When it comes to showing the childish behavior of spoiled celebrities,Joan really nailed it here.The best dialogue in the book occurs when the 'inmates' start griping.Get your hands on the book.If your down and need a few laughs,this will get it done for you.

This read like a transition to a more serious Arly, which I very much hope doesn't actually happen. I found it disappointing that, like every other fictional female sleuth, she suddenly needs a man to solve her problems; the strong and caustic loner is going all domestic. If it's true to the trite formula that applies to Hess's other series, Jack will start complaining about Arly sticking her pretty inept nose where it doesn't belong in the next installment, especially given the ending (which just make me groan -- and why the heck do Ruby and Estelle KNOW this in the first place? That's just gross). And all the discussion about her New York Socialite past was scary -- does the character really need to go there? I could see this going in an interesting direction if Jack is suddenly out of the picture and Arly is allowed to return to character, given the not-too-surprising ending, but otherwise this might be the death of the series.

I was so glad to see another Maggody book! And, I liked it - but...think it dragged in parts - I almost felt as if this was the "wrap it all up" book - because it seemed every single citizen of Maggody had to be mentioned - no matter how obsurely. I liked the book - just not as much as I've liked the others. The humor was not as sharp.

Interesting new twists for our heroine in this one. A must read for fans of Maggody. All the usual from that most amusing place.

This book really drives home the issues associated with the "dark side" of healthcare. Whether you term the issue medical negligence or malpractice, it's real and this book does a good job of discussing the subject. The use of real-life examples is excellent. Dr. Williams' practical, no-nonsense approach would seem to go a long way in solving medical malpractice. This book was quite interesting and a quick read.

I was debating whether or not to buy and read this book until I saw Dr. Van Pelt's comments and then I was sure that I wanted to read it. Talk about the pot calling the kettle black. I will let you know what I thought of the book after I read it.

In the modern-day America, twice as many people are killed by medical error as die in traffic accidents. Dr. Ira E. Williams, a medical professional and oral surgeon of 40 years' experience, warns of the many failings of today's system of medical practice regulation in First, Do No Harm: The Cure For Medical Malpractice. Addressing the skyrocketing cost of malpractice lawsuits, the questionable validity of relying upon the courts and the legal profession to set standards for medicine, the limitations of peer review, and stressing that medical negligence is not just the work of a few "bad apples" but a pathology that can affect any doctor, as all medical practitioners are themselves fallible human beings, First, Do No Harm is a rivet-ing revelation of a severe social problem. First, Do No Harm goes beyond pointing out the injury, however; it offers viable strategies for improving national health care, including drawing from the positive examples in veteran's hospitals and promoting increased self-regulation. An absolute "must-read" for anyone involved in the medical industry today, whether as a practitioner or a patient.

Dr. Williams presents a practical solution to the medical malpractice "crisis" that seems so real. This book has changed my assumptions about the medical community.

I was very disappointed by this book as it really has nothing new. Identifed on the cover as "Dr. Ira E. Williams," the author is a DDS oral/maxillofacial surgeon who has obviously had "turf wars" with MD head and neck surgeons, and seems to have a lot of sour grapes. It is clear to Dr. Williams that he is the superior surgeon, and if he had been consulted could have solved most of the MDs' mistakes. He complained to the local Peer Review Organization about some of his colleagues, and they gave the opinion there was "no substandard care." He concludes that peer organizations have no teeth, and are run by good old boys more concerned with protecting their buddies than in good patient care. In fact, peer review organizations I have been involved in operate almost exactly like the IRPR he ends up recommending in his last chapter, and are staffed by diligent, caring people who honestly want the best for patients, though usually are less arrogant about being sure their approach is the only right one. Meanwhile, he ignores or belittles new approaches (like the aviation model) that actually stand likely to reduce the frightening statistics on medical errors. He gives his prejudice away on page 138 when he states "...the only solution is to identify, control, and discipline negligent practitioners," ignoring the fact that most errors are committed by competent, careful, and up-to-date doctors who are not perfect. Chastising people again and again to never make a mistake and punishing them when they do can never create faultless people, but has created the defensive-medicine mess we're in today.
This book promised a new idea, but really doesn't offer any advice except to try harder and stop whining.