[Unknown Member]

He’s just posting the truth about the rad tech reads and that tiktok wasnt even specific to an individual case.
 
They published that now redacted JACR article about it.

[khodadadi_babak89]

where did they publish it?

[khodadadi_babak89]

Oh, I think you are saying that the paper that was retracted had the information in it. I thought you meant they managed to get it published. 
 

[erasmopa]

I am so demoralized that you would make a malpractice attorney out to be a whistleblowing hero and a radiology department out to be the bad actor. Perhaps this is a case where Penn should pay up and I do not intend to pass judgment on that, but the malpractice environment in a place like Philadelphia is repulsive.

Perhaps the underlying issue of adequate staffing is more complex than an institution being too cheap to pay. Massive overuse of imaging, defensive medicine due to our litigious culture, decreasing reimbursements and a shortage of radiologists are factors worth considering.

Your post just seems a bit too gleeful for my taste.

[erasmopa]

The article implies that the dissecting aneurysm was missed on an X-ray. Whether that is what exactly happened or not I dont know. I would expect the general public to immediately conclude it was an unforgivable miss and I would expect a lawyer to portray it that way, but I might expect a radiologist to be a bit more understanding regarding sensitivity and specificity of X-rays. And I would question whether there has ever been a case involving radiology where the attorney didnt point at greed, lack of time spent on interpretation, and inadequate staffing as factors whether or not they were in fact relevant to the case.

[r.stolze_447]

This attorney won a 19.7 million dollar award last year against Penn for failure to diagnose. Does not seem the type to take on a frivolous lawsuit.  Time will tell.

[erasmopa]

I guess I was accused of posting inaccurate garbage. I read the same article and I saw the quotes about how many images the radiologists review. Whether that is relevant is a separate question. One huge difference between what I read and what checkpoint inhibitor posted is that the article states there was a 5 hour delay in obtaining the X-ray. Maybe there was also a 5 hour delay in interpreting it. I dont know that. But how a 5 hour delay in obtaining the x ray has anything to do with a shortage of radiologists or them reading too many images is beyond me. Hopefully those on this forum understand the distinction ffs

My point is everything the lawyer said about understaffing can be true and still be irrelevant to the case.

[eyoab2011_711]

No, no, no
 
I was responding to the original post which took a cheap shot at UPenn without fact checkingall too common when we find stuff on the internet that superficially confirms ones bias
 
 

Quote from fumoney

I guess I was accused of posting inaccurate garbage. I read the same article and I saw the quotes about how many images the radiologists review. Whether that is relevant is a separate question. One huge difference between what I read and what checkpoint inhibitor posted is that the article states there was a 5 hour delay in obtaining the X-ray. Maybe there was also a 5 hour delay in interpreting it. I dont know that. But how a 5 hour delay in obtaining the x ray has anything to do with a shortage of radiologists or them reading too many images is beyond me. Hopefully those on this forum understand the distinction ffs

My point is everything the lawyer said about understaffing can be true and still be irrelevant to the case.

[erasmopa]

Checkpoint Inhibitor. Cool, I am glad were on the same page.

[Robbro524_990]

Forget the legal case for a second – to cool everyone’s heads.

The question remains: what exactly is going on at UPenn (fraud-wise)? Can it be proven? Or, is it just rumor?

[Unknown Member]

The OP post is much more about Penn being willing to subvert reasonable and necessary radiology standards, including but not limited to using techs to interpret CXRs, for financial gain, than it is about an individual tragic malpractice case. If he sounds satisfied that those egregious facts are coming to light, I think thats entirely fair.

[khodadadi_babak89]

Quote from uncleduke

The OP post is much more about Penn being willing to subvert reasonable and necessary radiology standards, including but not limited to using techs to interpret CXRs, for financial gain, than it is about an individual tragic malpractice case. If he sounds satisfied that those egregious facts are coming to light, I think thats entirely fair.

 
PRECISELY THIS. 
It is only by such misbehavior being publicized that these institutions may be slowed in their rush to take radiologist’s fees to maximize profits for the business

[khodadadi_babak89]

Quote from DOCDAWG

Forget the legal case for a second – to cool everyone’s heads.

The question remains: what exactly is going on at UPenn (fraud-wise)? Can it be proven? Or, is it just rumor?

It is proven. They admit it in print. (Although the word “admit” is mine. They might use the word “celebrate”)
they attempted to publish their experience using techs to read cases. It was thwarted by one of my colleagues in PPP who contacted the provost of Penn, who had them retract the paper for violations of human subjects review. The subjects of the paper (residents) did not give informed consent, and actually, it is arguable that being in a position where the chair (a co-author) controlled their subsequent employment, they could not give informed consent. 

They have defended publicly at the RSNA their use of non-physicians to read cases, saying it helps prevent burn out.
If you want to read the paper, it is here:
[link=https://www.dropbox.com/s/yky0enck5awd24c/Penn%20paper.%20radiology%20extenders.pdf?dl=0]https://www.dropbox.com/s…y%20extenders.pdf?dl=0[/link]
 
note that the combination of Tech reading – tech dictating – staff reviewing – staff signing was 50% faster than the process of staff reading-dictating-and signing.
Think about that. Two people working on the case was 50% faster than one person working on it. Clearly the over-read process was VERY cursory – perhaps approaching blind signing.  

[erasmopa]

Phil,

Much of what you write is fair and I commend you for your efforts in shining a light on the risks of midlevels and such practicing without appropriate oversight.

My major concern is that it seems you have gotten quite chummy with this malpractice attorney. Do you think his motivation in putting these videos on TikTok is to bring about positive change in patient care? If so youre far less cynical than me. My belief is he is doing so as a free form of advertising so all individuals thinking of suing Penn call him first. And whether Penn provides excellent or terrible care they will get sued the same amount since lawyers have to eat.

Secondly, I am unclear how this lawsuit relates to techs interpreting studies if at all. I know that is your major gripe with Penn and your concern on that issue is valid. Without understanding the exact details of the case, my guess would be the same thing could have happened pretty much anywhere, and if it was a delay in obtaining an X-ray and a failure to diagnose dissection on radiograph then of the holes in the Swiss cheese I think the interpretation wasnt a major one, even though of course thats what the lawyer is going to argue.

I agree healthcare is going down the drain. And Id love to see that fixed, but I dont want to see radiologists choosing med mal attorneys as their bed fellow in trying to fix things. Their interest is not in fixing anything.

[khodadadi_babak89]

This is turning into an in depth discussion, which I like. I don’t deal well with 145 character posts.  (tomorrow, I will go dark, though, 11 hour drive coming up)
 

Quote from fumoney

Phil,

Much of what you write is fair and I commend you for your efforts in shining a light on the risks of midlevels and such practicing without appropriate oversight.

My major concern is that it seems you have gotten quite chummy with this malpractice attorney. Do you think his motivation in putting these videos on TikTok is to bring about positive change in patient care? If so youre far less cynical than me. My belief is he is doing so as a free form of advertising so all individuals thinking of suing Penn call him first. And whether Penn provides excellent or terrible care they will get sued the same amount since lawyers have to eat.
 

Let me say this. I do not take a binary view of these things, i.e. all malpractice suits are bad. In cases where there was bad luck, or just a bad outcome which is statistically inevitable, and the doc gets sued, I am not a fan. I have testified for the defense in these. (I have never testified for a plaintiff). This is different. Much different. You have a large business – Penn – which has made policy decisions based on profit considerations that can result in patient harm. Make that “That WILL result in patient harm. This is evil. This is not a one-off bad luck, or bad decision. 
This is similar to the Alexis Ochoa case in which the hospital made a policy decision to put an NP – an incapable NP – in charge of an ER with no one else there. Alexis died as a direct result of this, and she had a very curable problem. I am a fan of suing the hospital for this. It is the only think that will get their attention and result in changes.
Motivation: I have only talked to him once, I don’t know him well enough to make judgements about this yet. It is possible to 1) be concerned about making a living and 2) do something that helps people at the same time. After all, that is what we do. We have all seen Physicians who abuse patients in the pursuit of dollars. I have seen this first hand more than once. There are attorneys who push the money side too hard as well. Too hard. 

I did talk to the attorney in the Alexis Ochoa case, and he was on a crusade to get this hospital to stop its abuses. He was furious about Alexis’ death. He had a very caring, personal interest in this case. 
We have a PPP member who is a practicing physician and also a malpractice attorney. He is, in my estimation, fighting the good fight. Does he get paid for it. Of course.  
so, again, there are layers of nuance here that need to be considered.  
 

Secondly, I am unclear how this lawsuit relates to techs interpreting studies if at all. I know that is your major gripe with Penn and your concern on that issue is valid.

let me say this – My major concern in all of these things is that business interests in medicine are perverting medical care in the US and are taking physicians along for the ride. We know about PE – they take 30-40% of physician collections and at the same time increase the work required to the point that you can’t do a quality job. Penn is doing the same thing. They are perhaps worse, because at least PE companies don’t pretend to be in it for anything other than profit. Penn, and others like them, on the other hand, represent themselves as the pinnacle of quality medical care, while they are destroying the quality with precisely the same tactics as PE companies. 
Now – what is the link – The link is this – The tech interpreting x-ray situation was born of shortage of physicians and over work of the physicians. This case, according to a physician who has been deposed, was a result of the same over work. Did a tech interpret his case? I don’t know just yet. 
 

Without understanding the exact details of the case, my guess would be the same thing could have happened pretty much anywhere, and if it was a delay in obtaining an X-ray and a failure to diagnose dissection on radiograph then of the holes in the Swiss cheese I think the interpretation wasnt a major one, even though of course thats what the lawyer is going to argue.

Of course I would like to see the actual films, to make a more precise judgement.

I agree healthcare is going down the drain. And Id love to see that fixed, but I dont want to see radiologists choosing med mal attorneys as their bed fellow in trying to fix things. Their interest is not in fixing anything.

I do not see hospitals fixing it. 
I do not see PE companies fixing it
I do not see employed physicians fixing this.
I do not see legislators fixing this.
Who is left?
All ideas are welcome here, if you have an idea about how to fix this, tell us.  

I will also say that if NPs and PAs had to pay malpractice premiums commensurate with the risk they represent to patients, they and their employers would be more circumspect about their practices. As it stands, in most states they are nearly immune from suits. Their malpractice for $1m/$3m costs them $1600. That is a measure of how difficult it is to sue them, compared to suing you.

So you see situations as illustrated by the screen capture I am posting here.
My Goal is to prevent Mellissa Bryson from caring for me — or you – or anyone. 
Melissa has been trained to care for colds, give vaccinations, and the like, and she is so arrogant that she has conflated this into thinking she is an ICU doc who cares for children and pregnant women. She is dangerous. WORSE – she is being hired by hospitals. They are as irresponsible. This is reckless disregard for patient safety. 

And with that, I sign off for the night
 

[toumeray]

I want to see the suits making these hiring and staffing decisions face a malpractice court jury. Why shouldnt they be held liable for these decisions? How you decide to staff a department has implications for the care that is delivered. If you do it trying to cut every corner, leave it run by a skeleton crew, and an inevitable mistake happens, it should be you the administrator that is on trial. I believe there should be more malpractice lawsuits against INDIVIDUAL admins not just against the hospital. Make them scared to make these decisions and forced to take malpractice insurance. Thats one way to mitigate the problem.

[ipadfawazipad_778]

Wow. I had no clue NPs were so versitile and capable. You keep on slaying girl, Melissa Bryson! I mean what you cover requires at least three highly specialized physicians. The most scary are those who dont even know what they dont know.

[khodadadi_babak89]

Quote from AKOMAN

Wow. I had no clue NPs were so versitile and capable. You keep on slaying girl, Melissa Bryson! I mean what you cover requires at least three highly specialized physicians. The most scary are those who dont even know what they dont know.

Yep – she is,  by her claim to brilliance, inadvertently advertising her ignorance. 
I have MANY similar posts from other.  MANY MANY MANY. 

[khodadadi_babak89]

Incidentally,  Penn has a history of cheating on billing:

[link=https://www.falseclaimsact.com/case/united-states-government-gets-12-million-settlement-from-the-hospital-of-the-university-of-pennsylvania-over-allegations-of-medicare-billing-fraud/]https://www.falseclaimsact.com/case/united-states-government-gets-12-million-settlement-from-the-hospital-of-the-university-of-pennsylvania-over-allegations-of-medicare-billing-fraud/[/link]

Saunders lawyers, Gaetan J. Alfano and Marc S. Raspanti, said Saunders learned of the fraud in 1995. Saunders became concerned when he learned that Penn administrators were recruiting elderly nursing home patients for psychiatric treatment. Counselors like Saunders were told they would lose their jobs if enrollment didnt increase.
Mr. Alfano and Mr. Raspanti said elderly nursing home residents who were beyond help were signed up even though they couldnt participate in nor benefit from psychiatric counseling.
To increase revenues, administrators directed counselors to bill Medicare for therapy sessions when their patients were watching television, attending birthday parties, and napping, Raspanti said. Staff members were told to bill Medicare for feeding the patients lunch, according to Raspanti and Alfano.

That was $12 Million, 
This one was $30 million, for billing for resident services:

[link=https://www.nytimes.com/1995/12/13/us/university-agrees-to-pay-in-settlement-on-medicare.html]https://www.nytimes.com/1995/12/13/us/university-agrees-to-pay-in-settlement-on-medicare.html[/link]
 
This one was  for only $845K, for doing unnecessary cardiac stent procedures:
[link=https://www.beckershospitalreview.com/legal-regulatory-issues/penn-health-system-settles-improper-billing-allegations-for-845k.html]https://www.beckershospitalreview.com/legal-regulatory-issues/penn-health-system-settles-improper-billing-allegations-for-845k.html[/link]
 
 

[erasmopa]

Totally agree that there are perverse business incentives in medicine that hurt both physicians and patients. I would love to see those who make such decisions held liable. I would love to see them named individually in lawsuits rather than doctors. What should really happen is that unless a doctor does something unethical their name should be removed from any lawsuit and replaced by the entity they work for.

I still dont believe med mal attorneys care about their clients or quality of care. Being a good actor is part of the job.

[Unknown Member]

Penn community medicine doctors do ok financially and prob make more than the younger clinical associates that are on the clinical educator track.

[khodadadi_babak89]

Quote from fumoney

I still dont believe med mal attorneys care about their clients or quality of care. Being a good actor is part of the job.

It’s hard to know what to do with this statement. It’s like saying that NPs are great because they care about patients and physicians do not. 

But one point – does it matter what the internal thoughts of the attorney are, if something good comes out of it?  When big tobacco finally had to answer for its deception and abuse of people, and was forced to pay up, do we care what the attorneys were thinking?  

[erasmopa]

Time will tell. If lawsuits bring about improvements in care that is a positive. I think its more likely the word will get out that any lawsuit filed against Penn no matter how frivolous is an easy payout given the negative publicity.

And of course in each case one or a few doctors will have their name bashed. The hospital will lose money, the lawyers will lose interest in their moral crusade once their pockets are lined, and no positive will come of it. Thats just my prediction.

But I am happy to be proven wrong. I do think non doctors providing care beyond their abilities should have to carry real insurance and hospitals administrators should be sued by name, but I am pretty sure doctors will remain the sacrificial lamb in all cases.

[eyoab2011_711]

Interesting that on another thread we were warned of the dangers of over generalizationsand here we string together anecdote and self righteous indignation to over generalize the care provided in medicine.
 
 The fact of the matter is one could teach a good radiology technologist to interpret portable ICU radiographs and I suspect that many who chose that path would interpret with far more care and diligence than many radiologists.  Is there a slippery slopesurebut it is also a large leap.
 
I have known many PAs and NPs who are far more caring and thorough than MDs.  Many are far more knowledgeable about the patients they follow.  Are some bad, terrible, incompetent?  Sure but so are some doctors.
 
Is Penn unethicalperhapsbut they are by no means an outlier in medicine or business in general.
 
But Penn tried something outside the box to offload physician workload and it is not that much different than how ultrasound runs in the vast majority of PP.  Is the problem that Penn stood to gain financially (not sure what the gain would be for DRG based studies), or that they might be right, that some tasks in radiology are perfectly suited for non-MDs

[eyoab2011_711]

During a [link=https://drive.google.com/file/d/1WFTZ_iA8GDoz10Lj27GqCeHmRYqFpgl3/view?usp=sharing]May 2022 deposition[/link], one of the radiologists said that the radiology department was understaffed and that its a chronic problem that has gone on for many years. The same radiologist said that he has often been required on his own to view around a quarter of a million radiologic images per day.
 
if you click on this in the link Phil included it will take to a court ruling that discusses this allegation and names the radiologist.  Worth reading.  
 
And understaffed is a matter of opinion depending on expectations.  TBF Schall admits they have fewer radiologist than they would like by 0-15%, but I doubt you will find an academic program in this country that doesnt believe they are in the same situation.  Be interesting to see the RVU productivity of the typical Penn radiologist

[khodadadi_babak89]

Quote from Checkpoint Inhibitor

No, no, no

I was responding to the original post which took a cheap shot at UPenn without fact checkingall too common when we find stuff on the internet that superficially confirms ones bias

Quote from fumoney

I guess I was accused of posting inaccurate garbage. I read the same article and I saw the quotes about how many images the radiologists review. Whether that is relevant is a separate question. One huge difference between what I read and what checkpoint inhibitor posted is that the article states there was a 5 hour delay in obtaining the X-ray. Maybe there was also a 5 hour delay in interpreting it. I dont know that. But how a 5 hour delay in obtaining the x ray has anything to do with a shortage of radiologists or them reading too many images is beyond me. Hopefully those on this forum understand the distinction ffs

My point is everything the lawyer said about understaffing can be true and still be irrelevant to the case.

 
OK here I am – what is the cheap shot??? Where is the absence of fact checking? I know I didn’t put into the post everything I know… 

Penn is way understaffed. I have known this from other sources. This is another source. This, by the way was said in a sworn deposition. Fact checked. 

Penn is cutting corners unethically to keep income up while pushing through cases and charging patients full charge. They themselves have said this in print and at the RSNA. Faculty members have online said how great it was that the administration was looking for way to lighten their load by using non-physicians to care for patients.  Fact checked. 
That is not a cheap shot.

Now – I can’t verify some of the things Bosworth said, and some of what is written in the article (WHICH I DID NOT WRITE) is very very imprecise. Such as – does x-ray include CT?”  That is not my contention. 

I do understand the angst about malpractice attorneys. I have had some experience with them myself. HOWEVER  –  This is a situation in which a major institution is degrading medical care in order to make coin. Patients will be hurt, patients are being hurt. That may eventually mean you or (like me) a family member. Where is the control of this? Not the institution, which doesn’t care. Not the physicians, who are employed and will be fired if they speak up. 
The only source of control is if these institutions have to pay for the damage they do. 

In this case, there was a real screw up. I talked to bosworth, and, while I didn’t get all the particulars, the patient had apparently had a very typical dissection complaint (tearing chest pain) for hours before he was properly cared for. Just these words should get you a ticket to the CT with OR on standby, wouldn’t you agree. 

IN another case, that is well known, the case of Alexis Ochoa, she was seen with typical presentation for PE. Chest pain, syncope, O2 sats in the 80s, and on BCPs. The ER she went to had only an NP. Who didn’t know this was how PE looked. She treated her with beta blockers for an elevated heart rate and killed her. The attorney went after 1) the institution which put her in the ER alone to save money 2) the physician who was supposed to be supervising her, but was not available, and had only met her once. The hospitla and physical lost a 6.2 million award. I think that is the only way to get their attention. 

Do you see another way to stop this sort of corporate misbehavior? Do you think the institutions are righteous enough to control themselves? 
 
Now – what if Penn, seeing this radiologist shortage situation decided to remedy it another way. Let’s say they paid rads 700k for about 18k RVUs per year. (a rate of $38/RVU). They can WELL afford this. My guess is that radiologist pull in this much money anyway, in collections. They may well be able to pay this much without losing money, they wouldn’t make as much, but they wouldn’t lose. We all know that employers are collecting a lot of money from radiologists work, and the game is to pay radiologists as little as possible in order to keep as much as possible for themselves.

They are also sitting on billions of dollars in the bank. My institution has 6.7 billion in cash. More than the GDP of 55 nations in the world.

They could recruit plenty of radiologists to answer that need. They don’t want to. 

Keep in mind that institutions like Penn are paying traveling RNs the equivalent of 300k per year to staff bedside nursing units. 

So Checkpoint inhibitor – how have I cheap-shotted Penn? Did I miss something? I would really like to answer any questions or objections you might have. 

Incidentally – I know that Harold Litt (one of the authors), as well as other Penn faculty members watch these posts. I have received PMs from them before. I would welcome them to the discussion. Or even a PM. 

[eyoab2011_711]

Oh ffs.
 
Lets start with this quoteThe same radiologist said that he has often been required on his own to view around a quarter of a million radiologic images per day.
 
or this quote from the ambulance chaser from the linked deposition in the article
 
 Another said that the HUP chest group meaning those that read chest x-rays has a severe manpower shortage that was said 10 days before my client died and he had a chest x-ray that wasnt read for 5 hours
 
Is it too much to ask that people read the garbage they are posting for accuracy?

[eyoab2011_711]

Funny how the radiologist who claims he is looking at over a quarter million images per day, still works there
 
But nothing like posting misinformation form a bottom feeder ambulance chaser to feed the fever swamps
 
And by all means lets ignore all the times a tech made a finding on a radiograph, and notified the radiologist so that care could be expeditedlets just demean their abilities and knowledge

[alex.nieto_484]

Quote from Checkpoint Inhibitor

Funny how the radiologist who claims he is looking at over a quarter million images per day, still works there

But nothing like posting misinformation form a bottom feeder ambulance chaser to feed the fever swamps

And by all means lets ignore all the times a tech made a finding on a radiograph, and notified the radiologist so that care could be expeditedlets just demean their abilities and knowledge

 
how do you know which radiologist claimed to look at over a quarter millions images per day?

[obebwamivan_25]

Doing the math makes zero sense.
If one reads 100 CT in a day (which I think is a high number), and each CT has 200 images–that’s 20K images.  I know 200 may be high for some (CT head) and low for some (CT full body), but on average…that’s still way short of 250 K images.  I simply don’t know how a person can look at that many images

[Unknown Member]

If youre interested in democracy, justice, and the rule of law, I submit that you dont want a system without med map attorneys any more than you want a system without criminal defense or med map defense attorneys.

[erasmopa]

Ones perspective on the med mal system is going to be shaped by where one lives and works, whether one makes money from it, and what type of med mal suits one has seen.

Democracy and rule of law are nice concepts. In Philly, as it pertains to med mal, the rule of law is written unilaterally by med mal plaintiffs attorneys. I believe they are now trying to make it such that all suits in PA can be tried in Philly.

How does this work out in practice? Bad outcome? Good enough. Whos at fault or is anyone at fault? Who cares? If your name is in the chart pay us out the max that your policy covers.

Democracy is great when its an even playing field. Make plaintiffs attorneys pay a price for frivolous lawsuits and maybe then you have a system that works.

Does the med mal system do any good? There are few if any places that it is more powerful than Philly. Phil has stated over and over how poor the care is at Penn (in no way do I condone that statement btw). That doesnt make sense. If the med mal system is important for policing care then why would care be poor at an institution that is under siege by med mal attorneys? Maybe because the system is in fact broken and bleeds money from the system while giving nothing in return.