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Solutions to
the Rising Cost of Healthcare
A Community in Need
Suffers the Loss of a Vital Medical Resource
SOURCE: Information gathered by the American Policy
Roundtable
Compiled by Professor Charles McGowen, M.D. and Chief
Medical Advisor to the American Policy Roundtable; August
11, 2008.
In the mid 1940s, after
serving his country in WWII, receiving a GI bill that would
pay for his education, graduating from medical school and
completing an internship in a southern university hospital,
a young man returned to his home town in the mountainous
district of North Carolina which is known as Appalachia. The
description of his place of origin (as it appeared in the
journal entitled Medical Economics) puts one in mind of the
town of Mayberry in the Andy Griffith TV series. The doctor,
recently married to his high school sweetheart who had
become a school teacher, set up a general, family practice
and provided a much needed source of medical care to his
boyhood, hometown neighbors, who were for the most part
financially poor by most standards. His young bride
began to teach in a local rural school until their first
child was born.
As time passed the young
couple had two sons and a daughter, the latter ultimately
going off to college to study history and the sons
eventually admitted to medical school following their
completion of undergraduate degrees. The daughter, following
in her mom’s footsteps became a teacher, the sons, after
completing their internships went on to finish residencies;
one in a med-peds program which involved a combined four
year program studying internal medicine and pediatrics. The
other brother spent four years in the mastery of general
surgery. After carrying out their post graduate training the
two brothers, like their father before them, felt a calling
to return to their mountain home and attend to the medical
needs of the country folks in Appalachia with whom they had
been raised. The year was 1975.
The internist/pediatrician
became a consultant for his dad when the problems in those
areas of expertise extended beyond the father’s ability to
diagnose or treat them. The surgeon handled the operative
problems, both emergent and elective, which neither his dad
nor his brother could manage. It was a complete clinic in
every respect and they had two beds for extreme emergencies
until transport to a distant hospital could be arranged. The
only thing lacking in their clinical practice was a local
hospital. The nearest one of those was fifty miles away and
that was too far to safely travel in the midst of either a
medical or surgical emergency. The only solution to that
predicament was to finance and build a small hospital
themselves.
Within a short time, having
pooled their funds and taken out a construction loan, the
three physicians planned and developed a 75 bed hospital,
equally divided between pediatric, medical and surgical
sections. They had a laboratory, X-ray unit, emergency room,
laundry, central supply, hospital pharmacy, a small business
office, a waiting room and operative suite. They did not get
rich, but they were able to pay off their mortgage and
periodically make the necessary improvements in their small
hospital and upgrade to become state of the art as medical
technology became more sophisticated. Managed care had not
yet poked is bureaucratic nose into their everyday practice
and the people of that community were more than pleased with
the service afforded to them. It was 1980.
Before long, in 1990, the
managers of the Joint Commission on Accreditation of
Hospitals (JCAH) who had been working for a decade on
changing the way larger hospitals in metropolitan areas did
business, eventually found their way to this comfortable,
little Appalachian community and decided that they knew best
how to serve the locals as opposed to how they had been
successfully treated by the dedicated dad and ultimately his
well trained sons over the previous 45 years. Year after
year the JCAH nit picked away at the methods by which the
three experienced physicians delivered health care. The
father gradually became so frustrated that he retired and
the sons began to notice that the cost of complying with the
JCAH coordinator’s rules and regulations were eating into
their bottom line and affecting their ability to stay afloat
financially. The proverbial straw that broke the camel’s
back came in 1996. The doors to the operating suite were
found to be non-compliant with the hospital accreditation
manager’s, capricious standards. Those were the same doors
that had been swinging in and out for 26 years as the
surgeon with his immaculately scrubbed and properly gloved
hands held high, his mask and gown appropriately affixed,
pushed through to attend to a patient in need of his
surgical skills. Those doors had been swinging in as the
General Practice father entered to deliver a baby and out
again as he presented the newborn child to the proud father
who’d been anxiously pacing up and down in the waiting room.
The JCAH had summarily declared that those doors were to be
no more than 1/32 of an inch apart when closed, but they
were found instead to possess a 1/16 inch gap. The JCAH team
demanded that the doors be changed, and if the brothers did
not comply, their hospital would be shut down.
Frustrated, nearly bankrupt
and quite angry, the brothers sadly and reluctantly closed
their 75 bed hospital and sold it to a man who converted it
into a nursing home. Now the folks in that small town and
their two excellently trained and dedicated physicians must
travel 50 miles to reach the nearest hospital. Time formerly
spent treating their patients must now be expended driving
the serpentine roads of their Appalachian mountain region, a
journey that takes at least 90 minutes one way (in good
weather) to visit their patients and make daily hospital
rounds. 90 minutes in the face of a medical or surgical
emergency, is a very long time. It can make the difference
between the continued life and the untimely death of an
extremely ill patient.
This sort bureaucratic
nonsense and more is what we are in for if we continue to
allow the business managers in HMOs, the JCAH and government
bureaucrats to control the practice of medicine. That will
be especially true under a national socialized, healthcare
system as proposed by Senator Barack Hussein Obama. There is
a workable, time proven, alternative system of delivering
health care and next week we shall look at that. Finally,
having diagnosed the problem and having identified the
disease causing agents, we are ready to implement a cure for
our ailing system of providing health care to the citizens
of America.
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