SOURCE: New York Times
TITLE : E-Mail Illuminates Doctors' Protest
DATE : March 10, 2003
AUTHOR: By ANDREW JACOBS
Wear 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 Consumer Rights, 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
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
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
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