Friday, September 14, 2007

A Blacklist by Any Other Name Would Stink as Bad

Whitecoat Rants has just posted a timely article on the use of patient blacklists in the ER on his blog under the title "The List."

If you’ve worked in an ED, you have a list. It may be written or it may be kept in the back of your head somewhere, but you have a list.
You always give the benefit of the doubt to patients in pain, but there are a few that keep coming back that make you say “hmmmmmm” to yourself.

Why does he call it “The List?” Why doesn't he call it what it is, a “blacklist?” Because it is both illegal and unethical to have one? While I don’t doubt most ER docs get some real drug-seekers from time to time, I’m willing to bet most people on that list have been falsely accused, Whitecoat's assertion of giving patients the “benefit of the doubt” notwithstanding. You don’t give someone the “benefit of the doubt” by putting them on a blacklist, what you do is you appoint yourself judge, jury and executioner and pronounce a lifetime sentence of denial of treatment, at least at that hospital. Being blacklisted can and does result in the denial of care and injury or even death to a patient who has been so stigmatized. After all, that is its purpose.

It’s notable how many doctors are proponents of tort “reform” and the idea that if they injure or kill someone through error or negligence they should not have to pay for that. Certainly, they shouldn’t have to pay for life. But what happens to a guy who really is a drug seeker, really did screw up this one time in his life, and learns his lesson and cleans up his act afterwards? Apparently, he deserves to be punished for the rest of his life, even if the next time he shows up in the ER it is for a legitimate problem. Let’s not even ask what happens to someone who’s been falsely accused, and maybe has to stick a gun in his mouth to get pain relief because he isn’t going to get it from a doctor. Funny how doctors don’t seem to think the victims of blacklisting should maybe get a second chance if they ever show up in real pain after that, but think doctors should be absolved of responsibility for their own screw-ups. Apparently, altering a piece of paper is a more heinous crime than altering someone’s existence. Once he’s on that blacklist, a patient is branded for life with the Scarlet Letter “A” for “addict.”

Blacklisting is a time-honored tool of repression by totalitarian governments and featured prominently in the struggle for workers rights here in the US. Dissidents in the Soviet Union were branded with psychiatric illnesses, most often schizophrenia, and barred from employment in government agencies and universities. In US labor history, blacklists were used as a weapon against union members and their leaders and would be shared across companies in a given industry to deny jobs to those with union sympathies. In any context, blacklists are almost always a tool of oppression designed to deny someone access to something they need or desire.

Although Whitecoat's blacklist seems aimed at drug-seekers, in reality, patients can be and often are blacklisted for other reasons as well, particularly for filing complaints against doctors. Trudy Newman, in her article "DEADLY MEDICAL PRACTICES," discusses some of the ways in which patients may find themselves blacklisted and the implications for their medical care:

Patients who dare to question or challenge their doctor’s authority, or the medical treatment that they receive, may find that they become BLACKLISTED (i.e. denied specialist care). Physicians demonstrate a stronger allegiance to their colleagues, than they do towards their innocent and trusting patients. Patients with iatrogenic illnesses often become victims of the blacklist. The problems usually start when medical mistakes are made (either intentionally or unintentionally) and denied. Then the lies and cover-up begin. Documents are often modified, falsified, mysteriously disappear, or important information is excluded from the record. Doctors will go to great lengths to avoid being held accountable, and are generally protected by their professional associations. Once the patient is blacklisted he can then expect to be subjected to character assassination from the medical profession. The patient can anticipate being attacked, discredited and demonized. How dare a patient challenge a doctor's authority? To avoid taking any responsibility for their errors, actions or behavior, doctors--and their governing bodies--will often employ the same tactics that communist countries use to quash political dissent. The patient will be labeled "difficult" or "psychiatric." Such pejorative labels are given to divert attention away from the negligent, incompetent or malpracticing doctor. Patients should not take such labels personally, because these labels say more about the physicians than they do about the patients. Blacklisting is not an error. Blacklisting is an intentional act.

Given the serious and deadly consequences of being blacklisted, doctors who engage in this practice should face criminal charges, but seldom if ever do. At most, I would imagine you would have a case for a libel suit if you could in fact prove you were blacklisted, but many times the blacklist is not a physical list at all, but just a bunch of doctors talking amongst themselves. In either case, the damage is all too real. If you know or suspect that you have been blacklisted, don't let the matter sit and fester, contact a lawyer and demand that your name be removed from the list. Your life may depend on it.

Whitecoat finishes his "rant":

The good thing about The List is that once people know they are on the list, they don’t visit the ED nearly as much.
The sad part about the list is that we have to have a List at all.

The sad part is that doctors are allowed to get away with it.

1 comment:

Joel said...

Another sad part is the rationalizations that enable them to believe they are behaving in the interests of patients and not blacklisting when they are blacklisting.

See: http://patient-safety.com/white_wall_of_silence.htm