Transatlantic Chancers

by Kieran Healy on April 23, 2005

A sad story in the Times today about a woman from Limerick who died following a facelift at the hands of a self-promoting New York surgeon:

Mrs. Cregan had left her home in rural Ireland two days before, telling her husband, a farmer and part-time plumber, that she would be attending a business course in Dublin. In fact she had flown to the United States to have a face-lift performed by Dr. Michael E. Sachs in his offices on Central Park South. Hours after surgery she went into cardiac arrest and was rushed to the hospital. … Examining Mrs. Cregan’s knapsack after her death, her family found a folded copy of an article from The Sunday Independent of Ireland. It was a glowing account of a face-lift performed by Dr. Sachs, “a leading cosmetic and facial reconstruction surgeon” in the United States, the article said, with a “highly confidential client list.”

Sachs appears to have drummed up interest in Ireland via a story in the Sunday Indo Magazine about a facelift he performed on an Irish woman for free, in exchange for the publicity. Sachs seems like a dodgy character:

Dr. Sachs is among the most sued doctors in New York State, having settled 33 malpractice suits since 1995 … last year the State Health Department took the extraordinary step of banning Dr. Sachs – an ear, nose and throat specialist – from performing complex nasal surgeries without the supervision of another surgeon; … the operating room in his office is not accredited … [and] while he states on his Web site that he has been affiliated with the New York Eye and Ear Infirmary “for the last 23 years,” he is not affiliated with that hospital or any other.

A sidelight to the story is that Brendan O’Connor, the editor of the Magazine, is quoted defending the Indo’s decision to run the original story:

“If this guy is fit to practice medicine in the United States, who are we to say he’s not fit to practice?” said Brendan O’Connor, the editor of The Sunday Independent magazine. But Mr. O’Connor said last week he was unaware of the 33 lawsuits or the restrictions placed on Dr. Sachs by New York State health authorities.

I knew Brendan in college. We were on the committee of the Philosoph (the University debating society) at the same time. He was a viciously funny guy. After college he became a journalist and TV personality. Any time I’ve come across him since then, his success in those areas seems to have gone hand in hand with an increasing tendency towards media hackery. This is a pity, as when I knew him he had a finely-calibrated bullshit detector and a talent for brutally exposing it in others.

Meanwhile, Sachs continues to see himself as something of a hero:

“He was full of praise for himself,” Mrs. Kelly said of Dr. Sachs. “He said, ‘I operate on presidents’ wives’ and talked about where he is in life, how popular he is.” That evening Mrs. Cregan was declared brain-dead. The family had her respirator disconnected the next morning, and she died almost immediately.

“Without a doubt it’s a tragedy,” Dr. Sachs said last week. “We did everything we could to treat her with as much care, respect and love as we could.” He said he has resumed his normal surgery schedule and has the support of friends and former patients. “They’re patting me on the back, and saying, ‘Listen, Dr. Sachs, you’re a really fine surgeon, and I trust you to do my surgery.’ My patients were consoling me. It made me feel great.”

{ 17 comments }

1

SamChevre 04.24.05 at 4:10 am

The number of times he’s been sued may not be relevant–you’d have to know more facts to say. Elective plastic surgery in one of the three specialties with the highest risk of malpractice suits (along with OB and radiology). The misrepresentations of his credentials and the disciplinary action are much more of a concern.

2

ry 04.24.05 at 4:32 am

THe idiocy of elective comestice surgery. Do people really understand the risks they take when undergoing surgery?
Poor woman.

3

lakelobos 04.24.05 at 6:07 am

“The idiocy of elective comestice surgery,” is too harsh, how about “the puzzle?”

4

Maria 04.24.05 at 7:40 am

Agreed, Kieran. I didn’t know BOC in college, though I saw him debate a few times and he was as sharp as he was funny. It’s a bit revolting to see him washing his and the Sindo’s hands of any responsibility in the matter.

Even by the standards of that newspaper, I’m amazed they didn’t do any background research on the doctor before collaborating in back-scratching puff pieces that play on people’s ignorance and insecurities. Looks like BOC’s gone native.

5

Ray 04.24.05 at 7:58 am

Research? In the Sindo?
They got out of the habit, after all those opinion columns about how awful and antiAmerican the left is, and how Ireland is a nation of begrudgers who don’t appreciate the shining talents that walk among us (like, to pick an example out of the air, Dr Sir Anthony J F O’Reilly), and oh, sorry, have to end it there, there are some very important pictures of models to squeeze in…

6

tad brennan 04.24.05 at 11:17 am

I’m looking for a larger issue in here, i.e. beyond the particular tragedy of one patient, one butcher run amok, and one friend of KH’s gone media hack.

Maybe the AMA’s continuing refusal to discipline any of their own? Maybe the need to resist so-called “tort reform” efforts to deprive citizens of their access to remedies against such doctors?

Absent some larger point, I suppose I can simply join you in saying it is a sad story.

7

P O'Neill 04.24.05 at 12:06 pm

I do wonder where her family will stand if Bush gets his “tort reform” legislation through. Presumably the centerpiece of this reform will be to limit punitive damages. So under that regime, this quack will have been better off for her having died, because the damages will be limited to her remaining earnings, some pain and suffering damages for the family — but no long-term care expenses, and some cap on total punitive damages. Just a cost of doing business until he can find some other overseas hacks to do another puff-piece for him.

8

nolo 04.24.05 at 1:04 pm

I notice that the “33” figure doesn’t refer to the number of times this guy was sued — it refers to the number of times his insurer settled claims brought against him in the past 10 years. Trust me– if that guy settled 33 malpractice suits in the last 10 years, it was because he was f***ing up bigtime. Three f***ups per year that were worth suing over is appalling. Three f***ups per year that were worth settling is atrocious.

9

nolo 04.24.05 at 1:12 pm

p o’neill, the tort reformers don’t just want to cap punitive damages, they want to cap noneconomic damages (i.e., “pain and suffering”) as well. Personally, I almost don’t care that much about caps on punitive damages, since punitive damages are rara avis. Putting caps on noneconomic damages, though, makes it really cheap to hurt people who are not big wage earners, such as (a) the poor, (b) the elderly, (c) homemakers, and (d) those who were already disabled. My former law school professor and mentor, Stephan Landsman (now at DePaul University), made me proud a few weeks ago on C-Span when he correctly pointed out in a panel discussion on tort reform that these sorts of caps present a serious moral issue.

10

anciano 04.24.05 at 4:34 pm

As an American academic physician of some age, not a surgeon, I know people who’ve been sued 2 or 3 times who seem to be careful and decent. Settling even a dozen suits is just too many- and this guy Sachs settled only those sutis where he was at a disadvantage- probably there were many more than 33 suits filed. The AMA is unfortunately not much interested in reform. The message for lay people is don’t trust doctors and hospitals that advertise, stay away from breast implants and cosmetic surgery. There are a few good places that advertise- Johns Hopkins Medical Center comes to mind-but they are siphoning off money needed for patient care and putting too much emphasis on making money.

Missouri has decided to end Medicaid, a government program begun under LBJ, to provide care for poor and uninsured people. That will be phased out over 3 years. The AMA is silent. And yet, most Americans believe that they have the world’s best healthcare. That’s seriously wrong. In reality, you shouldn’t believe any politician who claims that your country has the best healthcare. Nobody has figured out how to control costs and focus on the essentials, partly because politicians don’t like to say, “you have to pay and you don’t get everything that you want”. Medicaid accounts for 30% of the budget of some states- it’s expensive and the bureaucrats’ idea to cope with costs by simply tripling copayments is wrong- choices must be made, and lawsuits will not solve this problem.

11

vik 04.24.05 at 4:47 pm

ok you guys are idiots if you honestly believe that the malpractice lawsuit system in any way encourages discipline of doctors, lower errors (countries with or without the ability to sue doctors have the same rates of error), fair settlements (most settlements are to ppl who are not malpractice victims (ie cerebral palsy babies’ families), most victims of malpractice do not sue (ppl are much more influenced by whether they like their dr. or not), and most of the money goes in administrative expenses or lawyers’ fees in any case) or good for society as a whole. On the last pt, I think the real moral issue is whether we want poor areas deprived of elementary medical service (try getting a baby delivered by a medical professional in the Rio Grande valley or even getting a real Ob/Gyn to deliver your baby anywhere in America if its an uncomplicated case) or the elderly exposed to way more dangers than they need to be. On an anecdotal level, my friend’s grandfather had a stroke in s. florida and thanks to the malpractice premiums, no neurosurgeons were close enough to his area for him to get an interventional procedure that would save his life.

Now you can believe a majority (yes, that high) of America’s OB/Gyns and Neurosurgeons and Orthopedic surgeons are incompetent thanks to having multiple lawsuits filed against them but I think you will change your views if you ever ask real doctors about who they perceive as the best at what they do or bother to acquire real medical knowledge or god forbid, have need of their services. In many cases, the ones most likely to be sued are those willing to take on the worst cases and also oddly enough, the ones most likely to be training foreign doctors (before all the europeans here gloat, go and look at the CV’s of the most highly respected physicians in your countries and notice how many of them went to be trained in America by American surgeons in procedures developed and paid for by the system).

The present system benefits no one except the trial lawyers–not patients, not doctors, and not future medical practice. It is a huge distortion and unlike say, our screwed up private health insurance system, one thats easily fixed. If any of you actually cared about the injured patients, I would refer you to Slate’s discussion of Sweden’s malpractice system which is both fairer and better for everyone.

12

tad brennan 04.24.05 at 10:02 pm

Vik–

Let’s take my idiocy as read. That settled, I think you misunderstand my opposition to “tort reform”.

I agree that the current system has problems. For instance, I agree that bad doctors sometimes avoid suits and good doctors sometimes attract them for irrelevant reasons. I agree that not enough of the award go to the victims (though I believe you are wrong to say that “most” goes to the lawyer–a more typical split would be 1/3 to the firm and 2/3 to the victim). I agree that a more administratively-based system could have advantages over the adversarial system currently employed, perhaps with the sort of no-fault structure outlined in the Slate article you mention.

On the other hand, I do hope you are aware of the ample evidence that insurance premiums have continued rising throughout a recent past when both awards and suits have been holding constant. Yes, premiums are going up–because the insurers want a certain profit stream, and have failed to gain it through their investment strategies. The premiums have *not* gone up as a result of any “malpractice crisis”. One of these days the M.D.s are going to realize that they are being exploited by the insurers, and are being asked to misrepresent the source of the rise in premiums, and then I hope the M.D.’s will turn on the insurers. (But I’m not waiting).

So–I will agree with you that the current system has flaws, and that better systems are conceivable, and even operating in other countries.

Now I think it behooves *you* to agree with me and the other “idiots” above that the legislative program called “tort reform” would do absolutely *nothing* to bring us closer to the sort of rationalized system we’d both prefer.

“Tort reform”, as that phrase is used in contemporary politics, is as much of a misnomer as “Clear Skies”–it would not reform the system at all, it would simply keep all of its worst elements, and tilt the field strongly towards the defense side and away from plaintiffs. The insurers and the big defense bar basically wants to deprive plaintiffs of any effective access to redress–*without* making any movement towards replacing litigation with some other system. If you think the “tort reform” advocates are going to swoon over Sweden, you haven’t been living through the last four years of Republican greed gone mad.

So: when I oppose “tort reform”, it is not because I think the current system is ideal, or even working very well. It’s because our current system, as bad as it is, is still better than it would be under “tort reform”. And until there is a plausible and politically effective groundswell in favor of *real* tort reform (note the lack of quotation marks), i.e. reforming the whole thing, probably in the context of a nationalized insurance system–until that happens, I’ll keep on defending the current system from the pseudo-reformers who would make the whole thing worse.

13

Angie 04.25.05 at 9:16 am

I never could understand the need of some to undergo cosmetic surgery. Poor woman tho. :(

14

Brendan 04.25.05 at 10:02 am

I can’t bring myself to buy the Sindo, tho’ occasionally see it. When I want to read paranoid ravings about meeja conspiracies (Fintan O’Fisk) I’ll do it somewhere else than in a mainstream Sunday newspaper.

15

vik 04.25.05 at 10:45 am

Tad,

I agree with you that a substantial portion of the rise in premiums is due to insurance industry but that ignores the fact that the GAO has concluded that as much as 70 percent of the cost rises have been due to the system itself (ie the increasing costs involved in defending the cases rather than any increase in the awards or the number of cases especially). In addition, the idea that we should wait for a perfect alternative before removing a horribly counterproductive system is a fantasy (though by the way I apologize for the idiocy comment earlier).

Indeed, I think there is more to why physicians side with the insurance companies rather than cutting a deal with the trial lawyers to help cap insurance premiums (ie like how California does and which in fact would have a substantial probability of reducing rates even more effectively) than just cutting costs. The fact is that higher premiums regrettable as they are do not distort the health care system anywhere near as much relying on an adversarial legal system in re malpractice. The number of useless tests, the distrust between pts and physicians, the life threatening reluctance to admit mistakes or be willing to learn from them, the distortion induced in avoiding fields like neurosurgery or Ob/Gyn, etc.–these are all not going to be solved by capping malpractice rates or fighting the insurance companies rather than a damaging litigation-based system.

Also the motives of the Rep. party are pretty obviously cynical but I dont think that necessarily means that one must object to their policy prescriptions. After all, even liars tell the truth sometimes, even by mistake…

16

tad brennan 04.25.05 at 12:13 pm

Vik–

“the idea that we should wait for a perfect alternative before removing a horribly counterproductive system”

We can agree to reject this idea, and even find clever French phrases to express our rejection (“le meilleur etc.”).

But that was not my proposal. My point was that we should not remove a horribly counterproductive system in order to make way for an even *more* horribly counterproductive system.

That’s all that is on offer right now: the “tort reform” agenda contains no positive fixes for any of the problems that bedevil health care. It just reduces the plaintiff’s access to the courts.

It leaves all of the problems in place. It just makes it harder for patients to sue, in particular poor patients whose only access comes from firms willing to take a percentage.

(You know, of course, that the entire “tort reform” boondoggle will have no effect on the actors that in fact file the vast majority of civil suits, namely corporations who have their own in-house staff of litigators. So the number of suits filed will not fall that much, but the number of suits filed by people who do not have their own in-house staff of litigators will fall a lot. I.e., the non-wealthy will lose access to the courts.)

If “tort reform” contained provisions to remedy the sorts of problems you point to, it would be a very different beast than it is.

You mention, for instance,” the life threatening reluctance to admit mistakes,” and I agree there is a real issue here. If the caps on damages were combined with a legal provision for doctors to gain immunity by immediately admitting mistakes and offering to make the injured patient whole through administrative remedies, then we would be moving incrementally towards a better system.

Another possible improvement: it strikes me as absurd, from the systemic standpoint, that operating rooms do not have ten or twelve video-cameras in them recording from every angle. Jet pilots work with their recorders on; doctors could learn to, as well. And for every case of malpractice or mere human error it recorded, it might also record some piece of exculpatory evidence that would clear a falsely-accused MD’s name. The shroud of secrecy that surrounds the OR is a relic of a bygone age, like the sleep-deprivation hazing rituals inflicted on residents, and it too must go.

So: proposals to reform the medical malpractice system that also increased the documentation of surgical procedures, that provided amnesty for timely admission of error on the MD’s part, that had any of the other beneficial features we have been agreeing on–these might be worth discussing.

But instead, we get a give-away for the insurance companies and the AMA, with nothing for patients. “Tort reform” keeps its scare-quotes.

17

rvman 04.26.05 at 1:33 pm

Let’s slow down before we pull the long knives on the insurers. Modern insurance works like this: The insurer sells insurance, and collects premiums. At this point, the insurer has an asset – cash, and a liability – potential future claims. He takes the cash and invests it – in a mix of reinsurance (essentially, insurance outsourcing to mitigate risk), stocks, bonds, and other investments. His revenue streams are premiums and investment returns. His costs are, primarily, payouts on claims.

In the ’80s and early ’90s these investments were making money hand over fist, so the (competitive) insurance companies lowered prices to gain more business. The investment money machine started breaking down in the late ’90s, as interest rates stabilized at a very low rate (making bonds very low yield and stable in price), and stocks started to teeter over the edge.

In recent years, returns on investment in liquid assets simply hasn’t been the way it used to be. Thus, with claims stable or rising, and half of his revenue stream collapsing and out of his control, the insurer seeks revenues where he can – by raising premiums.

Insurers, contrary to many beliefs, are not massively profitable – they have razor thin margins and little room for error. Don’t feel sorry for them – they are businesses, and on the whole successful ones – but don’t assume they are exploiting everyone around them either. Most who try end up with single digit or worse market shares – and a massive profit per customer on no customers is still zero.

Premiums are increasing – across the board – due to reduced returns on invested premiums, not increasing claims, and not “greed”. Tort reform, as it has been proposed, neither will solve the problem, nor is it a “giveaway” to insurers or doctors, nor will it be an apocalypse for patients.

(Though it is probably, on net, damaging to slightly patients whose doctor is a quack, it will help, very slightly, those whose doctor has left because of difficult insurance premiums. If you want to shoot the quacks, get the AMA out of the way – the solution in a licenced profession is to go after the licences.)

Mostly it is a rather well-targeted partisan hand grenade tossed by the Republicans into the plaintiff’s bar – a major funding source for the Democrats.

Comments on this entry are closed.