On September 1, 1995, Presbyterian hospital called me to their imposing corporate Board Room in Charlotte, NC and dropped a bomb on me.  They said they were summarily suspending my hospital privileges at 4 pm that day!

Suspension from a hospital is a kiss of death for any physician!  I knew that I would never be able to deliver any more babies nor take care of women who needed gynecologic surgery.  The future of my family went bleak in front of my eyes. 

I knew that they had been reviewing my charts for several months now.  But I had no idea that they would not even give me a chance to present my side of the story with regard to any of those charts before taking such Draconian action.  This was truly a stab in the back. 

“We do not have to tell you what the charts are.”  Said then CEO of Presbyterian hospital and chief of ob-gyn.  They simply stated that I had 24 “problematic” charts, as determined by the peer review committee. 

I had received my M.D. from New Jersey Medical School in 1985 and finished my ob-gyn residency from Temple University hospital in 1989.  I had come to Charlotte in 1990 and become a member of Presbyterian hospital medical staff as an ob-gyn physician.

On December 1994, I had a surgical mishap.  Inadvertently, I punctured the external iliac artery in a patient during laparoscopy.  This was unfortunate but a known complication of such a procedure.  I immediately proceeded to laparotomy.  I summoned a general surgeon and a cardiovascular surgeon to assist me with the repair.  The patient went home after a few days stay in the hospital.  My malpractice insurance company as well as several independent reviewers determined that I met the standard of care in this case.  However, citing business reasons, the insurance company later decided to settle the lawsuit for 300K.

Following the incident, Presbyterian hospital went on a fishing expedition of my charts from over a two year period.  Most of these charts had been filed in the hospital archives as having had no problems with them.  Anyway, a departmental “peer review” committee headed by Dr. X somehow managed to label 24 of them “problematic” out of my 102 charts reviewed.

Did Dr. X have more experience than I as an ob-gyn?  No, we both finished medical school and residency in same years.  The difference is that he is a good old Southern boy trained at Chapel Hill while I am India born, with my residency from Philadelphia.  He was later promoted to the position of the chief of the ob-gyn department. 

Although I repeatedly asked the hospital for an independent external review of my charts, the hospital did not grant that simple request.  The Medical Board of North Carolina asked an experienced ob-gyn physician from Charlotte, Dr. Y to review my cases.  He as well as several other reviewers found my charts to be within the standard of care. 

According to a letter circulated by Dr. Z in October 1998 among the hospital’s medical staff, I was the first physician to be suspended in 20 years at Presbyterian hospital!  Was it just a coincidence that I was the first ob-gyn physician of Indian origin at Presbyterian hospital?  I decided to do a little research starting with the local courts.  I found out the following facts, which are true to the best of my knowledge.

Dr. A injured a patient’s bladder while performing laparoscopy.  The jury found him negligent and awarded the Plaintiff $100,000. (92-CVS-16674)

Dr. B performed a laparoscopic surgery in October 1993 at Union Memorial Hospital.  An injury to the intestine was not recognized at this time.  Patient presented later with abdominal abscess and died.  (Union County 95 CVS 01325) Dr. B performed another laparoscopy in November 1994 at which time a bowel perforation was not recognized.  She died of sepsis.  (Union County, 96 CVS 00992)  Presbyterian hospital had no problem subsequently giving Dr. B privileges in ob-gyn department.

Dr. C performed a laser laparoscopy on a patient in 1995 (99- CVS-5141).  The patient complained of abdominal pain on December 2 and 3, the physician prescribed stool softener.  On December 4, she fell down and the husband had to carry her.  An exploratory laparotomy and hemicolectomy was done.  Suit also named Nalle clinic.  Dr. C kept a patient on ovulation induction for one year, after which an xray revealed her tubes to be blocked.  (99-CVS-1540)

Dr. D performed a laser laparoscopy in September 1991 on a patient and perforated her small bowel.  She underwent multiple subsequent surgeries and became unable to eat and drink.  She was placed on TPN (intravenous nutrition).  The suit also named Bradford Clinic and PHAC.  (94-CVS-11679)

Dr. E performed a laparoscopy on a patient who died from overwhelming sepsis six days later.  (97-CVS-1707)  Dr. E also failed to respond to nurse’s pages for another patient in labor in August 1989.  The infant suffered severe physical and neurological injuries.  (92-CVS-11209)

Dr. F failed to manage fetal distress during labor in 1992, the parties named (Dr. F and Mintview ob-gyn) settled for $5M in May 1995.

Drs. G and H were performing a hysterectomy at Presbyterian hospital, while managing a labor patient at Carolinas Medical Center in September 1995.  They failed to respond to fetal distress in time.  The baby was born with zero apgars and died 16 hours after birth.(96-CVS-9576)

Dr. J failed to assess fetal distress in February 1987.  The result was severe physical and neurological injuries.  (96-CVS-7927).

Dr. K delayed performing a c/section after unsuccessful vacuum extraction of a baby with much fundal pressure.  The baby was born with birth asphyxia and skull fracture.  The jury awarded Plaintiff 23.2 million.  The hospital settled separately for $6M.  (95-CVS-13212)

These cases are only the tip of the iceberg of adverse events involving Presbyterian physicians.  I know of no disciplinary action whatsoever, let alone suspension, against these physicians by the hospital.  They kept practicing at Presbyterian hospital.  In fact, some of them sat in my judgment. 

I have spent eleven long years in the courts and a million dollars in legal fees.  I have been living one hell of a life.  Any semblance of normalcy has disappeared.  I think it is quite a simple question and would like YOU to answer it.  DID THE HOSPITAL DISCRIMINATE AGAINST ME?  Feel free to drop me a note at 

RON A. VIRMANI, M.D.
Board Certified Obstetrician and Gynecologist
4626 Charlestown Manor Drive
Charlotte NC 28211 

704-362-2240 (Phone) - 704-362-5702 (Fax) - RVBABY1@YAHOO.COM

For thousands of years, medicine was variously practiced as black magic, witchcraft and a form of art.  Starting with the renaissance, it became more of a science over a period of many centuries.  Here I am referring to Western medicine, specifically the U.S. brand of medicine. A completely new phenomenon took place in this country in the 1960’s and 70’s.  Medicine became big business.  Fueled by unparalleled  technological advances and human greed both at the same time, the scope and cost of medical system shot through the roof. 

Nobody paid any attention to this phenomenon at that time.  The concepts of resource limitations and fiscal discipline did not exist.  Medical insurance companies wrote generous checks, always with a smile.  Doctors, drug companies, hospitals and anybody associated with medical system made oodles of money; some would call it obscene.  Human organs were taken out of people’s bodies by the millions and lab tests were ordered all as a lucrative business.  The lawyers got on the gravy train by suing physicians.  There was some awakening when medical insurance costs started soaring and malpractice insurance became high.  Government and managed care industry stepped in to check this runaway process in the 1980’s.

But the system is still spiraling out of control today.  Forty five million Americans lack basic health insurance.  Physicians in many states are quitting medical practice because they can not afford the malpractice insurance costs.  Some are paying more than $200,000 this year in malpractice premiums.  Let me quote from a poignant letter from one Dr. Herman Solomon, of Wichita, Kansas, who decided to retire recently, in the American Medical News, published by AMA:  “Even in my dreams, I did not think that I would not be working now, but the nightmares of Medicare and managed care awoke me.  Now that I am almost 65, my biggest concerns are about personal care for me, my family and the general future population.  Our system is broken.  Managed care hasn’t solved our problems, and I don’t expect the federal government to fix them either”.

Contrast that despondent tone with the happy faces of 24-year old graduates of pharmacy schools, who are getting job-offers for $90,000 this year, plus all benefits and signing bonuses too!  Also by comparison, a pediatrician (MD), who is about 30 years old after 4 years of sleepless medical school and 3 years of grueling residency, may get a $60,000 salary. 

How did we get into this mess?  A main reason for the state of medicine today is an empty think tank of the past.  This essay is intended to provide some fuel for this tank. 

One - Medicine fights nature

The medical system goes to great lengths to fight nature.  In 1983, I was a medical student.  A 78-year old semi-conscious lady with chronic lymphocytic leukemia was admitted to the hospital with pseudomonas sepsis.  The nature in its own wisdom is trying to end the life of the poor lady in a painless way.  The time has come; the old must give way to the young.  The limited and precious resources of the universe must cycle from one generation to the next.  This is the plain law of nature.  However, enter the wonderful medicine of modern world.  It declares that death is unnatural.  It must be fought against with every available resource.  So the poor lady gets an IV in the arm and is placed on antibiotic coverage.  She gets stuck many times a day for blood tests.  She spends a couple of weeks in an obtunded state of mind.  After a couple of weeks, she develops bacterial peritonitis and is transferred to the intensive care unit.  Her blood pressure is unstable, so a Swan-Ganz catheter is put in to manage fluids.  She is taken for an operation that reveals an abdominal abscess that is removed.  However, a few days later, her condition does not improve and her heart begins to fail.  She is “coded” several times at great expense but ultimately succumbs.

To me, this whole process is a senseless exercise.  The lady spent 30 days in misery, thanks to our advanced medical technology.  Her relatives also spent the 30 days in equal misery.  Somebody paid 30,000 dollars for her so-called “medical care”.  Ultimately we all share that cost.  Some thousand pounds of garbage was generated in these 30 days.  This legacy will be left on this planet for future generations to clean up and suffer the consequences of polluted water and air supply.

 Two -  Medicine does not deliver what people really need

In 1985, I had just finished my acting internship in an inner city university hospital.  A young black man – an IV drug user comes to the hospital and is diagnosed with staphylococcus endocarditis.  He is treated at public expense for six weeks in the hospital – at a cost of say $20,000.  He goes home and returns in two weeks with the same problem.  This happens again and again.  The nature in its own wisdom is trying to deal with an abnormal and unhealthy way of living.  But the medical system decides to intervene.  The cardiologists get busy doing echoes of his heart and writing esoteric papers about vegetations on the valves.  The infectious disease people cite profound references on how to best treat his infections.  The students and resident physicians are merely using him as a medium to learn.  All these people have no real interest in this person.  If they meet him on the street, they will avoid him in all ways possible.  However, the system dictates that they show genuine interest in him while he is in the hospital.  So they end up providing “medical care” for him even though they do not really “care” for him.  Interesting concept.  Isn’t it?

All this is practicing medicine from the ivory tower.  Nobody will step outside the hospital and see where the man lives.  What he eats.  What he does with his life.  That is where the problem lies.  This man never had a healthy environment to grow up in.  The fact that now the society decides to spend fifty thousand dollars to treat him does not change his prognosis.  Who really benefits from this mindless process?  We know that the money actually goes to various components of the medical system.

Let this man go.  Take all that money and change the face of the slum.  Give these neglected men and women homes to live in.  Give them jobs.  Give them a life to be proud of and you will have provided them with real health care.  They do not need the ultra-modern medicine of the university hospital – the respirators, the cardiac monitors, the dialysis units, and the codes – that is a complete waste of money. 

Medicine of today is essentially “One size fits all”.  No matter who you are, what your resources are, what your life-style is, the medical answer is the same.  This does not happen in other walks and necessities of life.  If you are hungry and have five dollars, you buy a hot dog from the street vendor.  You do not eat an elaborate meal in a trendy restaurant.  But if you have a heart attack, you get the same million-dollar treatment as if you were a king.  Of course, you can not pay, so the general public foots the bill.  Although I believe that all citizens should have access to basic health care, it is not economically feasible for everybody to be considered candidates for heart bypass and other tertiary medical care of today. 

Three - Modern diseases are mostly social in origin

In 1988, I was a senior resident in the department of obstetrics and gynecology at Temple University Hospital in Philadelphia.  After I finished my duties one afternoon in the hospital, I started driving towards my apartment.  Just a couple of blocks down, a lady flagged me down and I decided to give her a ride.  She looked disheveled and pitiful.  Once into the car, she asked me if she could give me oral sex for ten dollars.  I said that I was not interested.  Then she asked me how about for five dollars.  I told her no.  She did not want to ride any further and I dropped her off.

As I drove off, I realized that she was probably a drug addict.  Still, my heart was filled with extreme sadness.  I felt very sorry for her.  It was an irony to me that in the U.S., one individual such as Oprah was worth a billion dollars and another had to offer herself as a sex object for a mere 5 dollars!   This was a vivid example of polarization of resources in our society. 

One of the manifestations of social inequities or polarization of resources is poverty. Out of poverty, emanate a multitude of problems (and medical diseases) ranging from violence, drugs, rapes, school shootings, sexually transmitted diseases, obesity, cancer, infectious diseases, psychiatric disorders etc.

On the other hand, many other diseases are symptoms of excess resources.  Thirty percent people in this country are obese, that figure goes up by 1% every year.  Obesity generates a gamut of diseases like high blood pressure, heart disease, diabetes, osteoarthritis, certain cancers etc.

As the process of polarization of resources grows unchecked in our society, the social ills will grow and so will the medical woes.  Indeed, polarization of resources is a worldwide phenomenon and we shall talk about that below.

Four - Medicine is incompatible with survival of this planet 

It would be intuitive to most of us that the medicine practiced on this planet should be compatible with the long-term survival of this planet.  Is that indeed the case? 

It is my belief that this planet is facing three problems of immense magnitude as we embark on the 21^st century:

1.      Polarization of resources:  As has already been mentioned, the disparity between the haves and have-nots in the world is huge, inhuman and unconscionable.  This is not only true of one nation versus the other but also inside a given nation.  This keeps on getting worse by leaps and bounds.  The economy has become “global”, which is great for those who import one dollar of consumer goods, sell it for fifty and pocket the profit.  But most people on this planet see themselves as sliding off the level of subsistence.  Life has become utterly frustrating and desperate for many people in this world.  Timothy McVeigh’s actions, although not excusable, were meant to convey that message.  Not only are the real jobs shrinking, but also the jobs left are essentially meaningless, such as typing medical manuscripts or collecting toll.  One can hardly imagine that one can somehow fulfill life by typing a doctor’s dictation for the rest of life.  It is easy to see that medicine practiced as today contributes to the problem of polarization.  The CEO of a managed care company makes several million dollars a year and an office medical assistant makes $8 an hour.  A preemie baby is kept in the neonatal intensive care nursery at the cost of $2000 a day, that money ends up going to the super-specialist physicians and manufacturers of medical equipment and drug companies.

2.      Pollution and depletion of resources:  The Western civilization is depleting nature at a rapid rate.  In the U.S., six trees are cut down for each person every year.  Deforestation, urban sprawl, loss of habitat of all natural forms of life has reached alarming proportions.  Hundreds of species have become extinct.  Still, the West shows no real understanding of the issues but is driven by insatiable greed.  What moral right does 5% population living in the U.S. have to 30% resources of the world?  What moral right does the medicine have to cage thousands of animals in its labs and conduct experiments on them everyday?  Do we have any moral superiority over other species?  The message of the Western civilization that it is ok to kill other animals so a human life can be saved or prolonged by a few minutes is going to backfire on the humans.  Every week I receive so many medical journals and magazines, I can hardly read any.  They all end up in the trash.  If I did manage to read some of them, I would lose my health because I would not have any time to engage in sports activities.  I cringe every time the nurse draws up half the medicine from a $50 vial and discards the rest.  The medical trash includes polyvinyl chloride plastic, paper, batteries, discarded equipment etc.  Its incineration leads to emissions of dioxins and mercury as well as furans, arsenic, lead, cadmium and generation of ash which needs to be treated as hazardous waste.

3.      The Population Explosion:  Anybody can see that this planet can not house the present 6 billion inhabitants with any sense of human decency.  It is projected that there will be 2 billion more people on this planet in the next 25 years.  Reducing (or at least containing) population is the crying need of the hour in this world.  The nature and its resources can not take abuse at a breakneck pace as it is going on now, thanks in good part to modern medicine.  By prolonging life to an absurd extent, the medicine has completely upset the natural balance.  Much more emphasis is placed on ‘saving’ a life than ‘ending’ it in a dignified way as if one is so much morally superior to the other.  The fact is that life and death are both equally important aspects of the cycle of nature.  When a physician, Dr. Jack Kevorkian, came along to mitigate the human suffering and end lives of diseased patients in their terminal stages, they prosecuted him and put him in jail for life.  While the state of Oregon has a law allowing people to end their lives in a dignified manner, the U.S. State Attorney General Mr. Aschcroft is going to challenge that in the Supreme Court.  Abortion has become a dirty word.  Many state governments do not pay a few hundred dollars for abortion but have no qualms paying a hundred times as much for an (unwanted) pregnancy carried to full term and delivered.  Many such pregnant women are abused because of the unwanted pregnancy.  Many develop complications of pregnancy.  Many infants born of these pregnancies end up in NICU (Neonatal Intensive Care Unit) costing up to half a million dollars.  Further, many of these unwanted children are subject to abuse.  Many may actually wind up in prisons and cause further drain on the public exchequer. 

As one can see from the above discussion, the medical system is not helping, rather it is exacerbating the problems existing on this planet. 

Five - Cost of medicine is exorbitant

The national price tag for medical care was about 300 billion dollars in 1985.  Now it stands at 1.4 trillion dollars.  For 280 million inhabitants of this country, this breaks down to about $5000 a year per person.  The Gross National Product (GNP) of this country is $8.4 trillion.  The medical expenditure thus now stands at a horrifying 17% of GNP.  It is still growing in absolute terms as well as a proportion to GNP and there is no end in sight.  Both the managed care and the government have tinkered with it but have been unable to contain the problem.

The cost of medicine should be more compatible with the life-style of people.  Otherwise people are consuming more then they are producing.   This is precisely what has been happening for the last forty years and getting worse every day.  The present generation is living on borrowed money from the next generation.  Not only that, a country like U.S. has the power to draw up resources from the third-world countries.  Which really means that we are consuming worldwide resources at a very high rate to practice our extremely wasteful way of medicine.  This situation is bound to implode.

Who really deserves medical care?  How much medical care does one deserve?  These are the questions that must be answered because after all, for somebody to receive medical care, somebody has to work for providing it.  This list of providers include doctors, nurses, health professionals in general and also the society at large.  The major health care provider is really the environment – the nature, the plant and animal kingdom that are being brutally exploited by the medical technology.  The environment, the water and the air supply are being polluted by industries manufacturing medical equipment, drug companies producing drugs and chemical companies producing other items like oxygen, paper, x-ray films, nuclear material and what have you.  All this leaves a heavy scar on the only and wonderful mother we have, the nature.

Six - Social cost of medicine 

The person who receives the fruits of this medical system should be able to understand and comprehend various costs and other aspects of medicine.  Secondly, he or she should be able to repay to the system by undoing all the damages when he or she gets well.  True that there are going to be some chronically debilitated persons whose medical costs are going to have to be borne by the society.  But we can’t afford to have the whole society turn into a chronically bedridden society.  This is happening right now with the increasing geriatric population and a medicine that has the power to prolong a perfectly useless and functionless life.  The job of nursing in a nursing home can not be much fun.

Even in the hospital these days, people don’t come to the hospital, get better, say thank you and leave.  But they come in to stay for a long time; they survive with the least amount of functions remaining and die a slow prolonged death unable to repay anything to the society that works around the clock. How many people in this country today are simply surviving in a vegetative state in the neurological intensive care units and other similar places?  The resident physicians, nurses and many other medical personnel lose their sleep, children don’t see their parents for days.  How can young mothers breastfeed their children if they are working 100 hours a week training as a resident physician?  Young men and women working the night shift in the hospital forego normal living and healthy sex because they are caught up in the insane process of keeping bodies alive with no function or further utility.  All in the name of medicine! 

The medical system forces the most up-to-date technology on everybody irrespective of his or her ethical and religious beliefs or ability to pay.  Let us say that I have a child born with a severe case of osteogenesis imperfecta.  The medical system of today is going to put this baby in the neonatal intensive care unit and try to prolong its life as much as possible.  Then they are going to bill me $100,000 for the 3 months till the baby dies.  I would not have the power to say that I do not want all this heroic medicine, the baby is going to die anyway; and I would rather send my $100,000 for the children in Ethiopia.  Such thinking on my part would be so politically incorrect as to earn me the title of “child-abuser” if not “child-killer”.  The system, both medical and legal, will let loose its wrath on me because of it. 

The medicine practiced today is TV medicine.  It has to be spectacular.  Never mind the 40 million people, who do not have health insurance in this country, never mind the 30% unemployment of black youth in the inner cities, the priority of the system is to go ahead with million dollar artificial heart transplants.  There have been many people who have tried to get their message across against the drawbacks of high technology.  Unabomber was one of them.  Although his methods were questionable, he had a valid message.

Seven - Questionable medical research

Research is the buzzword of modern medicine.  Millions of people are directly and indirectly involved in cardiovascular, genetic, drug research etc.  One may imagine that all these people who are assiduously trying to find a key to better health for others must themselves be healthy people living a healthy life.  Has it occurred to anybody that a 9 to 5 sedentary job of working with test tubes and writing papers is far from an active and healthy way of living? The task of most research is inherently boring, unrewarding and mundane that it turns many researchers into smokers, alcoholics and drug users – thereby destroying their health.  To suggest that any of this research will actually benefit human body and mind is far-fetched. 

Instead of paying one person $50,000 a year to conduct research on alcoholism in the inner city, we could pay the same amount of money to 5 individuals for gainful employment and the problem of alcoholism would not arise in the first place.  After all, why do people drink or use drugs?  Because after years of unemployment, social security checks and finding nothing worthwhile in life to do, one is most likely to turn to drugs, sex and alcohol as a way of having some minimal enjoyment of life.  When these people come to the hospital with liver disease, the medical system preaches to them not to abuse substances and sends them back home without any opportunity of making anything out of life.  Then the system sets up an alcohol research lab with a million-dollar investment to study their liver disease.  Instead the same money could be utilized much more wisely to improve the living conditions of the people who turn to drugs and alcohol as an escape from their miserable life.

I question the drug research going on in this country and the West because its only objective is to make money for the drug companies.  It lacks the breadth of vision necessary for a better planet.  There was a time when medical research pushed the idea of feeding children formula milk as one superior to breast milk.  Now it is well known that breast milk transmits many immunoglobulins to the child protecting them against asthma and allergies.  There was another time, medical researchers with tobacco companies stated that smoking did not cause cancer.

Now we have research going on with gene therapy, cloning and such.  I have apprehensions about this sort of research because instinctively this is too much interference with nature.  Secondly, if everybody wanted a designer baby, who is going to pay the huge bill?

Eight - Trap of inactivity

The Western society is hopelessly caught in the trap of inactivity.  This is the key of many modern diseases including the leading cause of death in the U.S. – the cardiovascular disease.  There was the wonderful invention of TV, which made people sit on their couches.  Then came video games, which made the children physically less active.  Then came Internet, both adults and children now spend more time sitting on their posteriors.  The same is true of the workplace.  The agrarian and industrial society became white collar and people now sit in their cubes in front of tubes. 

The clothing people wear in the office environment are more restrictive of body movements.  They wear neckties that restrict blood flow to the brain.  Women wear high heels that adversely affect the health of their feet. 

The Center for Disease Control (CDC) recommends that adults accumulate 30 minutes or more of moderately intense physical activity on most – preferably all – days of the week.  A recent study found that only 32% of the adults meet this recommended guideline.  I suspect that these are senior citizens.  Most of us modern day slaves are not able to find the time or opportunity for such activity. 

The corporations that run our lives on this planet have imposed this sedentary lifestyle on us.  The corporations dictate that our clothes will be made in China and will be transported to U.S. because it is “cheaper” that way.  The corporations dictate that factories will prepare our food and we shall consume that in fast food places.  All this, so we can sit on our desk and do perfectly unnecessary things in life, such as sue a physician, market new drugs, run hospitals, merge two corporations etc.  Instead, if all of us got up and started jogging under the blue skies, I can assure you that we shall be in far better health.

The nature did not design us to sit in windowless offices in tight panty hoses and type away.  We were meant to get up in the morning to the chirping of the birds, feed our cattle, till our land and interact with the elements.  We were designed to run and jump and catch and lift heavy loads.  We were meant to have sound bodies so we could have sound minds.  How sound can a body be if it needs to be hauled everyday for two hours by a two ton SUV that runs on oil imported from thousands of miles away?

We live in our suburban homes and grill twenty-ounce steak to consume at one sitting after our sedentary day at work.  We ride our comfortable lawnmower to cut our grass.  When our waistline expands and cholesterol rises, we ask our physician to put us on cholesterol-lowering medication.  We demand that the insurance (meaning other people) pay for that.  Still when we have a heart attack at the age of fifty, we run to the hospital to get a quadruple bypass.  And if by chance, something goes wrong with that, we find the best lawyer to sue the pants off everybody in town.  Are we a little spoiled?  I would say that this is the height of arrogance.

Nine - Litigation, regulations, insurance

Litigation is another area which is spiraling out of control.  I am aware of bad baby cases where the jury has awarded 23 and 100 million dollars.  While each case may have some merit, the total effect of the litigious climate is a demoralization of medical providers and eventual demise of medicine.  The median jury award doubled from $500,000 in 1996 to $1 million in year 2000.  In March 2002, a Florida jury awarded $78.5 million in a brain-damage case.  One wonders if that person was worth that much money without the brain-damage?  St. Paul has already pulled out of the malpractice insurance market, leaving 40,000 physicians hanging.  PHICO Insurance company is in liquidation.  Malpractice awards are likely to keep getting bigger until the medical system slowly collapses around us.

The medical insurance companies spoiled the American public in the 60’s and 70’s.  The workplace provided insurance and the medical care was thus virtually free to the public.  Everybody started feeling that they were entitled to all available medicine and somebody should pay for it.  Medicaid, Medicare and managed care perpetuated the same entitlement feeling.  Now the public simply thinks that somebody should go to medical school at his or her expense for 10 years and then treat them for free.  They do not think that way about lawyers or plumbers or buying a hamburger.  But when they go to a physician, they want to pay nothing.  And should anything go less than perfect, the public is ready to sue. 

Frankly, I have trouble understanding the concept of medical insurance.  Assume for example, person A is a healthy young individual.  He works diligently from 9 to 5, goes home, exercises, takes in fresh air, plays with his children, keeps his heart and lungs in good shape.  But person B, a coworker, frequently works a couple of extra hours.  He then hangs out with the boss and other workers in a bar after work where they smoke and bond and what have you.  Naturally, the boss thinks that B is better worker than A.  Soon B is on the fast-track, gets many raises.  After a few years, B has a heart attack because of his life-style.  So the insurance pays for his hospitalization.  Not only is B ahead in the office rat-race, but also he receives huge benefit from the health plan.  The insurance has essentially taken from the healthy person and given to the sick one.  It has handsomely rewarded an unhealthy life-style.

Doctors can hardly spend any time practicing medicine today because of the mind-boggling number of regulations of government, managed care companies and other agencies.  Each time a physician gets sued, which is a standard fare these days, a huge chunk of life is taken away from the physician’s life and his family.  I have spent more time in the last year on legal matters than reading medical books. 

Should a managed care company deny a certain expensive procedure, a lawsuit is ready.  But after all, we all have to pay for this extremely expensive way of medical care.  Our attitude is one of arrogance and needs tough love.

Ten - Modern medicine has no moral basis

As mentioned above, our whole existence and life-style are simply not rational.  They do not derive from the nature of who we are and who we are supposed to be.  We have evolved into this ultra-greedy predatory creature that is hogging up every available piece of resource on this planet with a vicious frenzy.  Upon this frenzy is built the entire Western culture, a part of which is the system of U.S. medicine.

We have no right to spend $5000 a year per person for medicine alone.  There are one billion people living on this planet who do not make one single dollar a day.  Do we have any shame?

What moral right do we have to cage, torture and traumatize thousands of animals for our medical experiments?  The other species have an innate right to exist on this planet without having to justify their existence by sacrificing for us humans. 

A ninety two-year-old woman in the U.S. nursing home has a heart flutter and she gets a pacemaker to live for another couple of years.  This places unnecessary stress on the nursing home workers as well as the children and grandchildren of the woman.  The medicine is essentially taking from the healthy and giving to the sick.  When is enough enough?

Our children are inheriting from us a huge national debt of $5 trillion.  That means every child in this country has a debt of $20,000 at birth.  The children are also inheriting a world that is scarred from our acts of greed.  The relentless drought in many parts of U.S. is indicative of global warming as well as deforestation and urban sprawl. 

How much fun are our children going to have to clean up our stockpiles of weapons, medical and other waste?  When they work, they will find that half their paycheck disappears in taking care of old people on Medicare.  They will find countless nursing homes with those old people in debilitated hopeless states.  They will also inherit countless preemie babies requiring thousands of dollars worth of care every day.  I certainly do not envy our future generations.

SUMMARY

The medical system in the U.S. was not founded on altruism, humanitarian concerns or sound principles of economics.  While some students might have gone into medical school for idealistic purposes, by and large the medical system has pursued money and glamour.  How do we know that?  Have you noticed that one still has a hard time finding red-blooded white American doctors to practice in the inner cities and rural areas?  The white doctors who control the medical establishment with their bureaucrat white male friends practice and live in the suburbs.  Rural health leaders recently sent a letter to USDA to keep the foreign medical graduate program alive so there will be somebody to work in the rural areas!

The basis of U.S. medical system has been greed and callous disregard for the nature.  Like other systems in the U.S., medicine has grown to what it has been able to get away with.  In its own self-interest and aided by religious right, medicine has chosen to preach that all human life must be prolonged at whatever cost to the society and the planet.  If each human inhabitant of this planet started spending $5000 per year on medical care, the total bill would be 6.5 billion X 5000  = 32.5 trillion dollars.  This is essentially the same as the entire GWP (Gross World Product), which is 38 trillion dollars.  Clearly the situation is unsustainable.  Further, it is absurd to think that there can be any human life on earth without a healthy flourishing of other species.  Medicine needs to dole out tough love in order to mitigate the suffering of humans and the animal kingdom.

It is of great concern to me that the U.S. medicine, which is not even appropriate or affordable for this rich country, is being exported to very poor countries like India.  India is soon going to be the most populous country in the world.  However, most people there lack the basic needs of life.  The infrastructure is poor.  When then U.S. brand of medicine is transplanted there, it is bound to exacerbate the problems of polarization, population, pollution and depletion of already scarce resources; thereby resulting in extreme social disruption.  I guess Thomas Robert Malthus will have to step in and create famine, wars and other catastrophes so as to balance the conditions of overpopulation and utter chaos.

It is my belief that life on this planet is near extinction.  The way the West spends the natural resources on this planet is outrageous and we shall soon join the rank of dinosaurs.  The 21^st century is the final frontier.

The definition of medical care needs to change.  Basic medical care should be made available to all members of the society.  There is no need or justification for the wasteful high-tech medical care.  I do not believe in advanced cardiac resuscitation, organ transplants, saving one pound preemie babies or heroic efforts to save lives.  I do believe in supporting the decisions of those who choose to end their lives for whatever reason.  I believe in providing support for reasonable cases of euthanasia and abortions.  I do not believe that we should experiment on animals whether in medicine or in cosmetics industry.

Medicine should be practiced with eyes open to society, the environment and the nature.  Medicine needs to be in synergy with nature.  When an institution goes against nature, bad things happen.  We have already seen how priests abused children as Catholic Church maintained its anti-nature stand of celibacy.  The nature is inherently benevolent.  Sepsis or kidney failure can be a blessing in disguise.  We must learn to accept nature and live with it.

The medical system needs to be simplified.   The present system of medicine is stressing people out beyond belief.  It is taking a huge toll on human beings as well as nature.  It is indeed creating the very problems that it turns around and treats.  A futile exercise!  Why create the problems in the first place?

Can this medical system be fixed?  This reminds me of the story of the mice who figured out a clever way to survive the attacks of the cat that was decimating their ranks one by one.  They decided to place a bell around the cat’s neck.  But then the question arose who would bell the cat. 

I pray for the fortitude for our country to rise to this giant task with the required wisdom, insight and humility.  Upon this, rests the future of mankind. 

Let us say that you get sick and go to the hospital.  What is there to make sure that you get good care? 

Hospitals will point to their quality control process.  After a patient is discharged, every chart goes through this screening.  Most charts pass this screening, but some charts get flagged according to pre-established criteria such as prolonged hospital stay, death of the patient, excessive bleeding and other adverse events.

These charts then go through a process called “peer review”.  The medical establishment goes to great lengths to make sure that this is a secretive process.  In fact, most states have passed laws to keep this process hidden from the public eye.  In this process, a few physicians selected by the hospital administration pour over the flagged chart and decide if the chart met the accepted standard of care.  If it did, fine.  If it did not, the reviewed physician faces consequences.  The consequence could be some advice, mentoring, being asked to take some additional training, a reprimand, a temporary suspension or complete termination of his privileges. 

In theory, this is an excellent concept.  What better way to police the health of the public but by the “peers” in the same discipline of medicine?  But in practice, the “peer-review” process is where all dirty politics is played out.  Why should a physician criticize the sub-standard care of his buddy?  And what is there to stop him from criticizing the good care of somebody he does not like or care for?  After all, the process is highly subjective and there are no effective checks and balances against abuse of the process.  Once the peer-review committee has spoken, all “fair” administrative hearings are exercises in rubber stamping.

If the good old white boys of the hospital (many hospitals are ruled by such white power elite) want to get rid of a minority physician, it is simply a matter of giving him an unfavorable peer review and throwing him out on the street.  Once labeled a “bad doctor”, this information gets entered in the National Practitioner Data Bank and the career of the reviewed physician suffers an agonizing premature death.  This is exactly what happened in my case.

Born in India , I came to this country in 1976.  I went to New Jersey Medical School from 1981 to 1985.  I finished my ob-gyn residency from Temple University , Philadelphia in 1989.  I heard about the growing city of Charlotte in sunny North Carolina .  It was touted as a world class city.

I brought my family down to join a group practice in Charlotte in 1990, practicing at Presbyterian Hospital .  I was the first ob-gyn of Indian origin to practice in Charlotte .  I delivered hundreds of babies and performed hundreds of surgeries.  All went well.  I was never told I did anything wrong. 

In October 1993, I started a solo practice.  I was not under the “protection” of the group any more.  I began to be treated differently from the other “native” doctors.  Nurses gave me stern looks at times and they would drag their feet carrying out my orders at other times.  They would write notes behind my back, with their prejudiced slant on ordinary events.  These notes were quietly entered into my file, without any chance of defending any implied allegations. 

As physicians, we all face occasional medical or surgical complications in our practices through no fault of our own.  On December 1, 1994, I was performing laparoscopy on a patient and the trocar inadvertently injured the external iliac artery causing significant bleeding.  I opened up her abdomen, called general and vascular surgeons and repaired her injury.  She went home.  Such incidents, though uncommon, are known complications of the surgery.  Many other doctors have had such incidents and have gone on practicing without a hitch.

However, in my case, the hospital used the incident as a pretext and started doing a wholesale review of my charts from more than a year prior.  These charts had already gone through the quality assurance process and had been filed away without any problems being noted.  Dr. James Hardy, a Chapel Hill graduate, no more experienced than I, conducted this review, shrouded in utter secrecy.  Nobody told me how many charts they were reviewing and what problems, if any, they had ostensibly found. 

On September 1, 1995, the administration summoned me to the imposing large Board Room of the Presbyterian hospital in downtown Charlotte .  Mr. Paul Betzold, the CEO and Dr. Ronald Brown, head of ob-gyn department were present to the results to me.  The ambience was ominous.

They told me that the hospital was summarily suspending me as of 4 PM that day because of a “peer-review” of my 102 patient charts out of which 24 were found to be “problematic”.  I was stunned by this revelation.  I had assumed that the hospital would give me a chance to defend and explain anything that they considered “problematic”.  This is how things are always done in the hospitals.

“No” said Mr. Betzold, “We do not have to tell you what charts are problematic or what the problems are.”

Suspension from the hospital like that is a kiss of death for any physician.  I sought legal help.  Only after two months of wrangling, the hospital would even tell me what “problems” they had with the 24 charts.  Turned out that the problems were everyday things that happen to all ob-gyn’s.  Several independent ob-gyn’s reviewed my charts without any compensation and said the charts met the standard of care.

Over the years, it became clear to me that I was a victim of egregious discrimination based on my national origin.  Doctors, under the control of white power elite of administration, were eager to find faults where there was none.  And of course, they did not have the courage to sit me face to face and simply ask me questions about the cases, because they knew how foolish they would appear.  A senior ob-gyn physician, appointed by the Medical Board of North Carolina, also found my charts to be within the standard of care. 

The best ten years of my life have wasted away right in front of my eyes.  My professional and personal lives have been devastated.  I have vague memory of happy pregnant women coming to my office for their care. I faintly remember the last pink baby I delivered.  The hospital has not budged from its clearly discriminatory and unconscionable position.  They have dragged me from court to court and done everything to ruin my life. 

After an unprecedented victory in the Fourth Circuit Court of Appeals in Richmond , VA , my lawyers obtained records of peer-reviews of other ob-gyn’s from the hospital, to compare with mine.  The double standard is entirely clear from these documents.  I was the first physician to be suspended from the hospital in 20 years!

Unfortunately, the judge handling my case in the district Court succumbed to esophageal cancer in 2004.  Another judge took over the case and simply tossed my case out.  I am in the process of appealing to the 4^th Circuit Court of Appeals, I have no idea if I shall ever get my day in the Court.

I recall the case of Dr. James Jeghers at Duke university some years ago, where a patient died from the wrong heart lung transplant.  I also recall a botched delivery case of Dr. Alice Teague of Charlotte , who had a 23.2 million dollar judgment against her.  None of these physicians have been disciplined by the medical establishment of the state, to the best of my knowledge.  In fact, Presbyterian hospital had no trouble giving privileges to Dr. Kenneth Baker, who had had two patient deaths from laparoscopy.   I am aware of dozens of other cases like that.   

It is clear to me that the medical establishment does not really protect the public but rather cleverly protects its own behind the façade of public good.  Abusing the process of “peer review”, the conniving establishment can target anybody with impunity:  minority doctors, healthy competition, physicians who speak out for patient care – the “whistleblowers” and the ones who are not beholden to them.  If it is not possible to find faults with the charts of a physician, the administration will proceed to label the physician “disruptive” based on self-serving subjective criteria.   From there on, the physician is made to undergo a battery of psychiatric evaluations.   All this is done in the name of public good but is indeed an abuse of public trust and public ultimately suffers.  You will never find a hospital administrator being subjected to psychiatric evaluation. 

It is unfortunate that the legal system, the courts and the judges, do not come to rescue of the hapless victim,  They leave weighty matters of public good in the hands of hospital administrators who have not spent nights and days on call with dedication to patient care like I have.  They are simply trying to shame, intimidate and banish a physician for their ulterior purposes but under the false pretext of quality of care.  Could it be that the courts subscribe to the same club of good old boys? 

The courts need to see through that veil.  The peer review system is broken.  It has degenerated to “buddy review”.  Lawmakers also need to take note.  Unless the medical establishment cleans up its act, the medical errors will not come down and public will suffer.  The widespread nature of bad faith peer review is evident from the websites of Semmelweis society, which is a national organization of the doctors hurt by such sham reviews.  These websites are www.semmelweis.org and www.semmelweissociety.net.   The society is planning its national meeting in Washington D.C. on May 7-9, 2006.

A proud citizen of the U.S. and a well trained Board certified ob-gyn, I do not deliver those pretty babies any more!