Today's News

Friday, March 12, 2004

Members raise questions, get answers at Town Hall Meeting

By Carolyn Rogers

An orthopaedic surgeon's impassioned statement decrying "false and misleading" expert witness testimony being given by AAOS members in Florida courts drew a standing ovation from the several hundred members in attendance at Thursday's lively Town Hall Meeting.

Brian S. Ziegler, MD, of Merritt Island, Fla., delivered the comment on expert witness testimony, which was one of several topics addressed at the one-hour-plus interactive discussion. The meeting was so successful, in fact, that nearly a dozen members were still lined up at the microphones-questions in hand-when the session had to conclude to make room for an upcoming symposium.

AAOS President James H. Herndon, MD, First Vice President Robert W. Bucholz, MD, and Second Vice President Stuart L. Weinstein fielded the members' questions and comments, which ranged from medical liability reform and binding arbitration agreements to Medicare payment changes and maintenance of competence. One member even proposed that the Academy organize a medical liability reform rally in Washington during next year's Annual Meeting.

The meeting had no set agenda. "Those who come to the microphone will set the agenda," said moderator William J. Tipton Jr., MD, medical director of the AAOS, at the onset of the meeting.

Expert witness testimony
Dr. Ziegler spent his time at the mike pleading with the Academy to institute an expert witness review board with a disciplinary component, similar to one in place at the American Association of Neurological Surgeons.

According to Dr. Ziegler, out-of-state orthopaedists who deliver "false and misleading testimony" are a problem. Because these surgeons are not from Florida, the state has no authority to discipline them.

The members in question seem "to be willing to testify to just about anything if the price is right," Dr. Ziegler said. "And they are relying on their membership in this organization to lend credence to their words."

The AAOS is in the process of creating a new Orthopaedic Surgeons Expert Witness Program to ensure that orthopaedists who serve as expert witnesses are fully qualified and are following certain ethical principles. The program involves education and advocacy and, in the future, may have a disciplinary component.

"The time to implement that program is now," Dr. Ziegler concluded.

The audience response to his plea sent a "loud and clear" message to those on stage. Dr. Bucholz pledged "To move ahead with due speed to establish a program that will be effective."

Medical Liability Reform
In response to a question about medical liability reform, Dr. Herndon pointed out that, "Just 7 percent of our members have donated $1,000, or less, to our medical liability reform campaign. That's really pathetic. We've raised a little over $1 million, and the trial lawyers have raised more than $17 million, and they are prepared to raise $1 million in every state, if necessary."

Paul Collins, MD, chair of the Orthopaedic PAC, responded to a speaker who asked if the medical community should form one national PAC, rather than developing individual state or specialty PACs. The member asked if the funding problem may be due, in part, to trial lawyers putting all their money into one central PAC.

"Actually, the trial lawyers have effectively split their funds among several different PACs as well," Dr. Collins said. "Because the medical professions is so under-funded, however, we do need to work together on this issue. That's why the DMLR [Doctors for Medical Liability Re-form] was developed. The DMLR is setting the stage for us as a profession."

Medicare payment changes
Another orthopaedist spoke up about a recent change in Medicare payment practices that he said is having a direct impact on both patient care and physician reimbursement. When Medicare split the technical and service components under the skilled nursing payment system, it created a major problem.

Because X-rays are considered under the technical component, which goes to nursing homes, orthopaedists will no longer receive reimbursement for any required follow-up radiographs.

Unfortunately, the X-rays taken at nursing homes are often of such poor quality that the orthopaedist is left with little choice but to take a new X-ray "gratis," the speaker said.

Daniel Sung, JD, a policy analyst in the AAOS department of socioeconomic and state affairs, said that the Academy is aware of the problem with the new regulation and is working on a response.

"We are certainly happy that so many members showed up today," Dr. Tipton said at the conclusion of the session. "This was a active group who really participated and brought some excellent questions to the table."

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Last modified 12/March/2004