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The New York Times
Mar 10, 2003
by ANDREW JACOBS
Anatomy of a Strike: Doctors' E-Mail Shows Depth of AngerWear white lab coats at public appearances. Punish uncooperative colleagues. Above all, make sure patients experience colossal inconveniences.
A month after thousands of New Jersey doctors staged a work stoppage to protest rising malpractice insurance rates, a series of e-mail messages between doctors and protest organizers making those and other recommendations offers an intriguing glimpse into the strategies and sentiments that drove the five-day job action.
Most of New Jersey's 20,000 physicians canceled routine checkups and rescheduled elective surgery during the week of Feb. 4 in one of the nation's largest walkouts ever by doctors. Emergency rooms were inundated with patients, and a mass rally in Trenton drew 4,000 doctors and extensive media coverage. Another walkout is planned in Connecticut later this month, and on March 11, busloads of New York doctors are expected to demonstrate in Albany.
The e-mail messages, distributed by the Foundation for Taxpayer and ConsumerRights, a consumer group opposed to the doctors' demands, reveal the intense frustration and anger felt by physicians in New Jersey, many of whom blame trial lawyers, Democratic legislators and greedy patients for their skyrocketing insurance premiums. In the messages, lawyers are referred to as "prostitutes" and "blood suckers," and doctors who refuse to participate are called "scabs" and "parasites."
Representatives of the Consumer Rights group declined to say how they obtained the e-mail messages, which were in an Internet forum used by doctors.
In the weeks leading up to the protests, physicians were advised that wavering colleagues should be threatened with a loss of referrals, the financial mainstay of many private practices. "You are either with us or against us, there is no in between," the vice president of the Hudson County Medical Society, Steven P. Shikiar, warned in a message that went to 1,500 physicians.
The main goal of the campaign, he and others said, was to make patients feel the effects of the work stoppage through increased bureaucracy and postponed treatment. "Cause confusion and inconvenience," Dr. Shikiar wrote. "Let them know that this is the health care system of the future if it is not fixed now."
Another doctor whose name did not appear on the e-mail message proposed an even more radical step: to cease writing prescriptions for inexpensive generic medications and write prescriptions only for limited quantities so patients are forced to make multiple return visits. "Don't call in Rx's. Make the patients pick up written script," said the doctor, using the medical shorthand for prescriptions. "The patient can pick up the script from a box outside my office door where they can read a prominent sign explaining what we are doing."
Dr. Shikiar, an Englewood surgeon who organized the e-mail forum, said that many suggestions were made during a heightened emotional climate, and most were quickly disavowed. "I tried to leave the discussion open," he said in a telephone interview. "I don't think it's fair and reasonable to look at one line out of one e-mail and draw any conclusions."
Some ideas, like denying health care to lawyers, legislators and their families, were immediately rejected, he said. Others, like a call to boycott National Public Radio for what one writer called "a slant against doctors" was simply ignored.
But some protest strategies -- and the flinty language used by a handful of doctors -- has provoked a furor among those who oppose the physicians' main objective, a $250,000 cap on "pain and suffering" awards to victims of medical malpractice. Doctors were not seeking any change in the other award category, which compensates malpractice victims for lost wages and medical expenses.
Some critics cited a protest placard that compared legislators to Osama bin Laden and a letter, distributed on the Internet by a North Brunswick urologist, that likened a ranking state senator to Saddam Hussein. Assemblyman Neil M. Cohen, chairman of the commerce and banking committee, whose office was picketed by 80 doctors, said the vitriol was excessive, and in the end, counterproductive. "The doctors got carried away with themselves," he said.
Mr. Cohen, a Democrat who is helping to draft malpractice reform legislation, said he thought that many physicians had been fed inaccurate or incomplete information about the recent spike in malpractice premiums. The rallying cry over jackpot awards, he said, ignored statistics that showed a drop in medical malpractice lawsuits last year. Of 205 cases that went to a jury in New Jersey in 2002, physicians won 151; only 18 of the verdicts yielded judgments of more than $1 million, far fewer than the "dozens" cited during the protests. Those awards included damages for lost wages and medical expenses, as well as for pain and suffering.
Mr. Cohen and others cite a study by the Medical Society of New Jersey, the group that helped orchestrate the job action, that showed that the $250,000 cap would lead to only a 6 percent drop in insurance rates. He added that most doctors were not told about other factors behind the increases in premiums, including investment losses and other problems in the insurance industry. "I think they decided to go with the $250,000 cap mantra because it fit nicely on a hat," Mr. Cohen said.
A compromise on the malpractice awards issue appears to be in the works. The current Senate bill includes a $300,000 limit on the amount insurers would pay for pain and suffering, but also would create a $25 million fund each year to augment cases that juries deem catastrophic. Even then, the award could be no more than $1 million. The so-called excess award fund would be financed through a $3 payroll surcharge on employees who work in the medical, legal and accounting professions.
Dr. Robert S. Rigolosi, president of the medical society, said he was heartened by negotiations in the Legislature, adding that rumors of another job slowdown were just that. "I think we're arriving at some reasonable compromises," he said. "We can work through the differences we have." Groups representing trial lawyers and consumer watchdog organizations, however, remain opposed to any cap on awards.
In the continuing Internet forum discussion, many doctors are still unhappy. In e-mail messages, some called the proposed compromise a sellout and a few clamored for a second walkout. Overall, however, there was widespread satisfaction that a profession known for its political quiescence was able to draw so much attention to the malpractice awards issue. Several doctors, feeling empowered by last month's experience, vowed to unseat unsympathetic lawmakers during next year's elections.
Dr. John M. Taylor, a plastic surgeon from Long Branch who made an unsuccessful bid for the Assembly two years ago as a Libertarian Party candidate, said running for political office alone had its benefits.
"There is nothing like a direct threat to a professional politician's job by a well-funded challenger to set their pants on fire, even if you don't win the election," he wrote.
He added that gathering petition signatures for the ballot would be a "piece of cake." "Our waiting rooms alone," he wrote, "would provide enough signatures within a week or two."
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