Medical Rebels : When Caring for Patients Means Breaking the Rules

By Finkelstein, Katherine Eban | The Nation, February 21, 2000 | Go to article overview
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Medical Rebels : When Caring for Patients Means Breaking the Rules

Finkelstein, Katherine Eban, The Nation

Four years ago, California's healthcare workers declared open season on the law.

When Governor Pete Wilson issued emergency regulations prohibiting state employees from providing pregnancy-related care to undocumented immigrants, the reaction was swift and unequivocal. Public health professionals from San Francisco to Orange County declared they would defy the Governor and continue to provide care.

The defiance took two contrasting routes: legal and illegal. The San Francisco Public Health Department sued the Governor, arguing that his executive order was unfairly issued because there was no emergency. But a groundswell of revulsion against the regulations led clinicians to a far more extreme measure: Twenty thousand of them in the Bay Area signed pledge cards stating that they would disobey any law that required them to deny services.

Dr. Sandra Hernandez, then San Francisco's public health director, recalled that her staff circulated through beauty salons in the Mission district to reassure immigrant women that they could still get care. "We intended to openly break the law," said Nora Roman, a nurse at San Francisco General Hospital. "We expected whole facilities to break the law."

As it turned out, they didn't have to. Within the month, a San Francisco judge issued an injunction against the state order, so the clinicians stood down. But their threat was an early blueprint for medical insurrection, which has grown steadily beneath the surface of managed care.

It's been almost six years since the Clinton Administration's healthcare reform plan went down in flames, and public discontent with corporate medicine continues to grow. Doctors have tried to regain control of care by joining labor unions in record numbers; patients, and even some doctors, have sued HMOs. But healthcare professionals have also been crossing the line into subtly and overtly illegal acts-from manipulation of the system and defiance of laws they deem unjust to fraud and threats of violence-in defense of their patients.

At Cambridge Hospital in Boston, a group of doctors formally pledged to ignore provisions of the new welfare legislation and to make the hospital a "sanctuary" for all patients, including undocumented immigrants. In Toledo, Ohio, a distressed mother convinced the billing department of a major hospital to charge the care for her uninsured, dying son to an expired Medicaid card-and let the government try to catch up with them. In North Carolina, doctors overwhelmed by paperwork requirements write "The Body Is Clean" and other absurdist phrases on patients' medical charts. Dr. Deb Richter, while working as a physician in Buffalo, told a managed- care representative who was trying to enter one of her examining rooms, "Get out, you're not touching my patients," and forced him from her office. Other healthcare professionals talk of organizing wide-scale civil disobedience to attract attention to the system's injustices.

This type of resistance is particularly noteworthy in the hierarchical and tradition-bound medical profession, where radical forms of protest have been rare. When activism has emerged, it has usually been around relatively narrow issues, such as the need for better care or more research dollars for AIDS, breast cancer or spinal-cord injuries. But anger at HMOs for interfering with efforts to treat patients has cut through a broad cross section of healthcare professionals, from RNs in city emergency rooms and liberal family doctors to archconservative surgeons.

In 1997 a poll released by Louis Harris and Associates reported that more than half of America's doctors believed the US health system is getting worse. Doctors in states dominated by HMOs were more likely to cite serious problems in caring for patients. Since then, as enraged doctors have drafted recruits, a new generation of medical practitioners has learned that the best way to treat patients may be to ignore the rules.

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