"Wall of Silence"

                                                   a Book Review

          We applaud the "Wall of Silence" written by Rosemary Gibson and Janaradan Prasad Singh. The book is a great public service for it unmasks the culture of doctor errors and tells it like it is. You, or a loved one are in danger in our healthcare system. And there is absolutely nothing in place to protect you. All of the personal horror stories illustrative of a dysfunctional healthcare system should galvanize America to demand the overhaul of healthcare. Indeed, if any other American industry were to function in the same unsafe manner it would be shut down immediately. And yet, a major industry with the power of life and death has been made untouchable, the sacred cow.

          The two authors show in excruciating detail the many ways that "doctor errors" and medical malpractice occurs through personal stories in the book. In surgery, in the wrong medication or overdose, the wrong site surgery, in failing to follow up a lab report. And on and on the list goes. This reviewer didn’t need three hankies to get through the stories, but I did need several wine breaks to get through the book. And that from a victim whose own experience with a high profile doctor in a major hospital was a criminal event. And no, I couldn’t get the doctor. That "Wall of Silence" and the cover-up was well in place. The system has developed great expertise and experience in burying the truth. And the Court aided the crime.

          The system’s failures extend into every aspect of healthcare, from the doctors, nurses, lab technicians, emergency rooms, and even while taking an MRI as one story graphically illustrates with the flying canister that killed a child.

          It is frightening to note that since the Harvard Medical Malpractice study published in the New England Journal of Medicine in 1991 stating up to 100,000 people die per year due to "doctor errors" nothing has changed. If anything, the numbers have gone up. And since the States don’t track and don’t want to track the numbers we just don’t know how many do die.

          The authors have opened the door in stating the failures and even offer some remedies. But, they fall short on going into what is really needed on a grand scale to overhaul our current healthcare system. Our CMS website does go into the changes that must come in order to make our healthcare system safe. Regulation first before the accountability. Odd that the word regulation is never mentioned. And that must come from Washington. It is hard to believe in this day and age we have such an unregulated and uninforced industry. Surely we deserve the same oversight and safety as there is in the packaging of tuna fish. In healthcare when something terrible happens you sue or file a compliant with your state health department. Both procedures take years and are destined to failure. The book mentions the role of health departments in burying the cases. Our website goes into that. Those processes do nothing to change the system. Yes, we do need regulation, accountability, oversight, a chain of command that takes responsibility and also dispenses penalties for any breaches of safety. Each hospital in the country has quality insurance people on staff and yet they seem to be nonfunctional. Some of the big guns in those areas are even mentioned in the book by name. And what have they accomplished? The book furthermore suggests that CEO’s in hospital must implement changes. But how can they when Medicine is big business with a bottom line. That is why we need a national system to remove the greed from healthcare for it corrupts. Then, doctors in hospitals would stop assemblyline medicine to generate profits and would get back to the business of healing. The very thing healthcare spends big dollars lobbying against is regulation. The role of the AMA and its National Patient Safety Foundation aren’t even mentioned in the book since they are a major deterrent to change. The millions they spend to this end is truly shocking.

          The book does go into some aspects of the legal medical malpractice system but not far enough. The high cost of doctor insurance has played a major role in the culture of "doctor errors." It has created liars and cheats who do anything to avoid costly litigations. And so drastic change of the medical malpractice legal system must be a fundamental part of the overhaul of healthcare regulation. We talk about "no fault" insurance in our CMS website. We offer the big solutions for the big problems. Please re-read "Contracts for Silence" and "No Man Can Be a Judge On His Own Case."

          With strong regulation, the State Health Departments would become accountable to protecting the public. With national health insurance including our suggestions the Government would become the insurer for doctors and hospitals. And if something happens, reparation to the victim would take place and it would be mandated from Washington. The word Victim also never appears in the book. Government as the insurer would end out corrupt Court system that protects the doctors and hospitals. Those painful years of litigating would end. For only 1/7 cases ever sees the light of Court. The rest are dismissed or settled – usually with silence.

          Another book lapse is the role of teaching hospitals and their enormous contribution to "doctor errors." Few people seem to know that for each medical student the hospital receives $100,000 to educate and pay salaries. This money comes from the Medicare system. The student receives about $40,000 and the rest to the hospital And in order for the student to become a doctor, he needs a certain amount of patients and a certain amount of hours in his surgical specialty. And that’s when the senior doctor who attracts patients for consultation turns the patient over to a student in surgery. Under cover of the mask the student does the work and the doctor collects the money. Nice Deal. And the patient never knows who performed the surgery. And so "ghost surgeries" are alive and well and flourishing in America. State health departments will tell you they no longer exist. These teaching hospitals have an unlimited supply of training material, for that is what we are. Medicare should act as a strong deterrent behavior to egregious behavior by these hospitals – but it doesn’t. They should impose severe penalties for breeches in safety.

          And the real lapse of the book is the "criminality" that festers and rots our healthcare system. That isn’t even mentioned. CMS has made a strong issue of this. From the experience in Germany, where the Courts (contrary to the situation in the United States) responsibly protect the public from medical malpractice, a minimum of 30% of cases are deemed criminal. The percentage in our country must be much higher. The very word "errors" trivializes the crimes and the lack of a national structure to deal with these acts in every state is our dirty little secret and our national shame. How can doctors maim, cripple, and kill with immunity and impunity, but they do!

          Although we find serious omissions in "The Wall of Silence" nevertheless it will certainly alert the Public to a major national problem. And the personal horror stories are compelling and painful. Perhaps it will help to create that national movement so desperately needed that so many of us do work for. The Public must demand safety in its healthcare. Who knows? Maybe even the AMA  will lobby for opening up the national date bank since they were responsible for Congress shutting it down to the Public in the first place. The Public has the right to know as much as is possible about their doctors. Perhaps even a "Wall of Silence II" is in the works chronicling the omissions we describe.

          And finally, the book does not go into the most important aspect of ‘Wall of Silence’ and that is the lack of "due process and human and civil rights abuses" all issues for our Supreme Court.