Monday, August 27, 2012

California Vs. Freedom of Contract

ER physician-blogger "White Coat" discusses the latest controversy over medical billing and freedom of contract in California, in his post: "Fair Payment?"

He cites a recent 8/17/2012 Los Angeles Times story, "State suing doctor over billing tactics".

Short summary of the basic facts:
A patient comes into the ER with an injured finger, requiring stitches.

The ER doctor is prepared to treat him, but the patient instead requests a plastic surgeon, because he wants "a professional" to do it.

The plastic surgeon (Dr. Martello) explains to the patient that her fee is more than the usual amount covered by his managed care plan for an ER repair.  The patient signs a form agreeing to pay the difference.

The surgeon performs the requested procedure. 
The state of California then sues the doctor, overriding her agreement with the patient and forcing her to accept what the state deems is an appropriate (and much lower) fee.  The state also attempts to revoke her medical license.
The LA Times notes that there is no dispute about the quality of the doctor's work.  Instead, the issue is about whether the doctor should be able to collect the agreed-upon fee:
Selesnick [Dr. Martello's lawyer] said the patients didn't want an emergency room doctor to stitch them up, so they waited for a plastic surgeon. "They wanted a professional," he said. He added, "No one is complaining that Dr. Martello did a bad job."

Selesnick argued that the state's case against his client underscores a larger problem: no one wants to pay for medical services. "Dr. Martello is definitely passionate about being a physician," he said. "She is equally as passionate about getting paid for the work that she did."
As Dr. "White Coat" notes:
The patients refused to have the emergency physician repair their wounds and demanded that they be treated by a “professional”. Now they’re accepting the “professional’s” services without planning on paying her the price that she asked?

Wonder why there are so many specialists who aren’t providing care to emergency department patients?...

I wonder if this whole “we’ll pay you what WE think is fair” line of reasoning would work when the doctor went to pay her California state taxes…
(Read the full text of his blog post, "Fair Payment?")

I'm especially encouraged by Dr. Martello's moral clarity.  She explicitly recognizes that she has the right to treat patients on her terms (mutually agreed to with the patient), and that the state has no right to dispose of her skill, training, and medical services by arbitrary decree.

The California courts may or may not agree with the doctor.  But I'm glad there are doctors like Dr. Martello fighting for her individual rights and for her freedom to contract.

(Link via Dr. Art Fougner.)