Welcome to Sir Donald Berwick’s World, Pt. 1

By: Opinion Columnist Dr. Bharani Padmanabhan – September, 2013

In “Miss Smilla’s Feeling for Snow”, one of the best books humanity has produced, Peter Høeg writes about an alcoholic Greenlander who lost her husband – “She gazes at me helplessly. People die. You won’t get anywhere by wondering how or why.” I was instantly reminded of this when reading the article in the Boston Sunday Globe (8/25/13), which turns out to be essentially the same as that published a year ago on June 22, 2012 by the NY Times. Both articles are about our seniors being deliberately slammed with thousands of dollars in unexpected hospital bills, causing them to empty retirement accounts to ward off bill collectors.

Our elderly get put into hospitals when they arrive by ambulance with say, a broken hip. They spend 10 days in a regular bed, get nursing and medical care and three meals a day. When it is time to be transferred to a rehab hospital, the patient’s loved ones are told that they will have to pay cash for the rehab as the patient had never been officially admitted to the hospital in the first place – the patient never was deemed to be an “Inpatient”. The patient was deemed to be under “Observation” the entire 10 days. And oh, they have to pay cash for this hospital “Outpatient stay” as well.

This applies specifically to older people on Medicare, the people in our country with the least amount of loose cash for sudden shocks. The Globe’s article is nicely written in the half of the story that it does cover. Here is the rest of the reality and let us name names, shall we?

Hospitals are second-guessed when they submit their bills to Medicare (now “reformed” by Sir Donald Berwick and his good friend Dr. Lucian Leape) whose non-medical adjusters overrule the doctor’s judgment that the patient with a broken hip needed an Inpatient admission. Medicare thus will refuse to pay the hospital for the stay. To avoid this, hospitals proactively class patients as Outpatients and ding the patients directly. Who needs to fight with some illiterate at Medicare when you can get cash from patients?

Thanks to a campaign by Sir Donald Berwick and his friend Dr. Lucian Leape, hospitals that need to re-admit patients who have been recently discharged are defamed as being bad hospitals that deliver poor quality care.

These cruel frauds have deliberately promoted their conscious lie (naturally called a Harvard Study) that American doctors KILL 98,000 people every single year. This lie, 98,000 DEATHS, is repeated endlessly by comrades in the same manner as the Young Communist Pioneers did in Stalin’s time, something Solzhenitsyn described eloquently.

Sir Donald and Dr. Leape have also managed to promote rules at Medicare, where Sir Donald was Chief that punitively dinged hospitals that re-admitted patients. The claim was that had the hospital’s doctors done their job right the first time, the patient would never have to be re-admitted. Hospitals thus are dinged by the “reformed” Medicare for keeping patients in and dinged if the patients are still sick when they return.

It is thus entirely INEVITABLE that hospitals WILL claim that elderly patients with broken hips were Outpatients the entire 10 days and that when they return to the hospital after discharge, technically it is NOT a re-admission. This makes their numbers look good (which is the only thing that matters now), Dr. Lucian Leape’s Leapfrog Group will reward them with a Score of A, the comrade mouthpieces will say nice things about them and the executives will move on to other hospitals before the numbers are revised.

Honest people continue to be stunned by the document on official US Government letterhead issued by Sir Donald Berwick exhorting hospitals to “collaborate” with Dr. Leape’s Leapfrog Group, an entirely private entity that is trying to coerce the nation’s hospitals into purchasing it’s Score. See it here – http://www.leapfroggroup.org/media/file/Berwick_Letter_Leapfrog_Group.pdf

This is what these illustrious frauds from Harvard call “Improving Quality”, “Reducing Costs” and “Systemic Change”. It is ALL about ticking off boxes on Checklists and not about the human beings themselves.

From a world where we were warned to not equate the map with the territory, Sir Donald and Dr. Leape are pushing us into a world where the Checklist is infinitely more important than human beings. The map is infinitely more important than the territory now. In fact, the map is all. When you deliberately set up a system with checklists and rewards and punishments, the primacy of the Checklist is assured. Patients and their savings accounts are just collateral damage.

Once their mindset is yours, it becomes entirely natural to equate medical care with serving customers at the Cheesecake Factory. And to extoll the Cheesecake Factory as THE model for the practice of medicine, as Dr. Atul Gawande, one of Harvard’s comrade mouthpieces for these two did recently.

Sir Donald has had the joy of implementing his mindset already, in England’s National Health Service, which used to be great for patients and thus much loved before Sir Donald pushed it into his world. The NHS used to have hospital wards that were run essentially by the nursing staff who had a tremendous sense of professional pride and ownership towards their patients as well as the physical environs of the wards.

The first step to effect the corrupt take-over of an organization is to get rid of this sense of ownership. You achieve this by beating the loyal over the head repeatedly till they become despondent and think “Hell, I just work here.”

Sir Donald Berwick and friends achieved this by installing non-medical Administrators above the nurses at NHS hospitals who did their very best at crushing the nurses. Sir Donald and friends naturally charged these Administrators with ticking off boxes on Checklists that ensured hefty bonuses for these Administrators to the tune of hundreds of thousands of British Pounds. The Administrators also terrorized the employees into silence.

Thus the money that was “saved” by not treating the patients, nurses or doctors properly, was redistributed to “Executives” who claimed to be superior at the Management of hospitals than doctors and nurses.

This is absolutely the same philosophy that stole money out of defined pensions here in the US where your money was properly cared for by cautious career professionals, and threw all those Billions into the stock market where they promptly vanished into criminal banks like HSBC which Sir Donald’s good friend Obama then protected from the law.

Continued in Part 2