The Hippocratic Oath And Health Care Reform

With all the issues of critical importance facing President Obama, be it the financial crisis, our energy dependence, the flashpoints of North Korea, Iran, the Middle East, of no less importance is the commitment to health care reform. Therefore I feel it incumbent that if one comes across a deeply personal experience that goes to the nexus of an issue with forceful and lucid insight one needs share it with all who care. I am taking the liberty of quoting verbatim from a recent letter to the editor of the Lakeville Journal, a weekly paper serving Litchfield County, Connecticut, and surrounding area.

To the Editor: Health Care System Just Isn't Fair

This is a letter about fairness, the Hippocratic oath and a 60-year-old promise.

Mr. P., a self-employed man in his 40s, came to me a few days after being seen in the emergency room of an area hospital for a severe fracture of a knuckle of his dominant hand. He had tried to get an appointment with the orthopedic surgeon who had been on-call for the ER the night he went there, only to be told he needed to bring a certain amount of cash upfront since he had no insurance.

He told me he had no way of getting his hand on the requested amount of money. I gave him some pain pills and gave him the phone number of a worker for the county social services agency so he could apply for Medicaid.

I also told him it was my understanding that the orthopedics group would accept his Medicaid since that is part of their obligation to a hospital when they are "on-call to the ER." A month later he called on me to request more medicine for pain since his Medicaid was still pending. In the meantime, his hand was clearly developing tendon and ligament tightening from lack of use. He was beside himself because he had lost his way to making a living and had been forced to ask for food stamps.

The next time I saw him, his Medicaid had come through but the local orthopedist's receptionist informed him they were not obligated to see him since there were other orthopedic surgeons in the area who did accept Medicaid. While this may be strictly true, the way Medicaid patients from Dutchess County get to see an orthopedic specialist is by signing up for one of the monthly Medicaid clinics at the Poughkeepsie hospitals, where they take their chances on being seen by the kind of specialist they need.

Six weeks after his injury, my patient finally got in to see a hip specialist who took an X-ray and told him there was nothing more to be done since the bones had healed. The fact that they had healed in a deformed mass of callous with contractures that prevented him opening the hand or moving it in any useful way was apparently not remarked upon. As of this writing, it has been six months since Mr. P. was last able to do the work by which he earns his living and the chance of returning his hand to useful function is very slim.

The fairness issue comes in when you consider the difference between the quality of treatment that is available to people with health insurance through the Medicaid program versus other types of health insurance. The Hippocratic oath comes into the picture when you consider the obligation of the orthopedic surgeon to "do no harm."

The broken promise is a reflection of the fact that the U.S. government signed onto the Universal Declaration of Human Rights on Dec. 10, 1948. Our own Eleanor Roosevelt chaired the International Commission that formulated the statement, which was ultimately approved by the United Nations. Article 25 declared the right to medical care.

The fact that medical care is a human right was settled long ago. It's about time that our government lived up to its obligations to protect that right.

Anna M. Timell, MD
Cornwall and Dover Plains, N.Y.

The letter speaks eloquently to an issue critical to the administration and the conduct of our society. Dr. Timell should be commended.