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April 2016
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  • An Unfortunate Scenario in a World without ISMS
    ISMS President
    Scott A. Cooper, MD

    As individual physicians, we know that we, and the work we do, would be sorely missed if we weren’t here. But collectively, do we understand what the world – or at least, Illinois – would be like if the Illinois State Medical Society didn’t exist?

    Let me paint a picture for you.

    A woman gave birth to a baby girl. She was delivered at home by a lay midwife with a high school education. (ISMS has repeatedly stopped lay midwives from obtaining licensure, but ISMS doesn’t exist, remember?)

    The mother went to the hospital, bleeding. Dr. Malta, an obstetrician, was called, and it was found that the patient had a twin pregnancy that hadn’t been discovered previously. A stillbirth was delivered in the emergency department with the help of the obstetrician.

    The mother sued the obstetrician, the emergency physician and the hospital. Of course, with no ISMS, there was no requirement that a certificate of merit be filed in that lawsuit, let alone that it be signed by a physician in the relevant specialty.

    Dr. Malta, already stressed out from the lawsuit, started having back pain a couple months later. She ended up seeing “Doctor Bruce,” who turned out to be a nurse practitioner with a PhD. Without ISMS, there was no collaborative agreement between him and a physician.

    He thought Dr. Malta was drug seeking, and brushed off her request for a CT scan. Without ISMS, there was no Prescription Monitoring Program he could have checked to find out whether his suspicions had any merit, so she was back at square one.

    After months of pain and frustration, Dr. Malta began to feel depressed and went to a clinical psychologist. He was able to prescribe an antidepressant he believed might help. Of course, it really was just a guess, since in the world I am describing he wasn’t required to obtain additional pharmacologic training; it wasn’t included in the new psychologist prescribing law, which passed easily without ISMS to oppose it.

    Still unable to bear the pain, our OB/GYN went to the emergency department and demanded a CT scan. It was done, and it found that her SI joint and bone tissue were eaten away. A biopsy with cultures was ordered, and she was put under by a Certified Registered Nurse Anesthetist (CRNA). There were no anesthesiologists anymore.

    Neither the CRNA nor the psychologist who prescribed Dr. Malta antidepressants were aware that the mix of medications she was taking affected the QT interval in her heart's electrical cycle, and she had a ventricular fibrillation arrest. When all was said and done, she wound up in a persistent vegetative state with tube feedings.

    Some members of her family wanted the tube feedings stopped, but Dr. Malta had not done advance care planning. Without ISMS, there was no Practitioner Orders for Life Sustaining Treatment (POLST) form in Illinois, which would have allowed her to check a box to indicate whether she wanted tube feedings; either the forms that did exist were too difficult to use or she wasn’t aware of her options.

    In the absence of ISMS advocacy, family members were not able to make care decisions for their loved ones under clear health care surrogacy laws. A protracted legal battle ensued.

    Dr. Malta passed away before the issue was resolved, but not before her family was torn apart. A sad end to an unfortunate story.

    Well, it’s not really the end. Someone finally reviewed Dr. Malta’s biopsy and culture test results. It turns out the mother at the beginning of this story regularly consumed raw milk and had contracted Brucellosis. The mother had unknowingly passed it along to Dr. Malta. This undiagnosed (and rare) disease had been passed along to her physician, and turned out to be the root of Dr. Malta’s illness.

    Stringing all these incidents together into one hypothetical story may be a bit extreme, but any one piece of this puzzle could have catastrophic results for patients, families and health care professionals involved.

    Fortunately, this nightmare scenario is not real.

    ISMS does exist, and works hard every day to protect our patients and our profession from bad policy. But if we don’t work hard in turn to protect and strengthen ISMS, it may not be as effective tomorrow as it is today.

    As physicians, we often look at issues with a fragmented view. I’m an emergency doctor, so I have my specialty bias. I’m from Lake County, so I often support the views of my local colleagues. But doctors must support ISMS not only for what we can do for you individually, but also for our ability to work on advocacy issues that affect us all. Believe me, there is no other organization doing what ISMS does for doctors and patients in the legislative arena in Illinois. If you aren’t on board, it is time to purchase your ticket. We can’t do it without you.

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