Here Today, Gone Tomorrow

Times change. What was here and even normal yesterday can be gone, out of style, and even forbidden tomorrow. So should people be punished retroactively for behavior which was normal or routine when they were doing it 20, 30, or 40 years ago? Many state and federal actions against physicians fall under this umbrella. Actions against physicians need to be put in perspective.

Take masks and gloves. Today we have a fetish with masks and gloves. We know that masks are less than useless for protection against viruses because the viruses are so small that the go right through the mask. So, we should be able to end our magical thinking about masks. It's a bit like turning a light switch on or off several times, as if hitting the switch more than once makes a difference.

We know that turning the light switch on or off more than once has no benefit in reducing COVID risk. We also know wearing a mask does not reduce COVID risk. So, as a nation we should just get over the magical thinking that wearing a mask reduces COVID.

On the other hand, wearing exam gloves is a very different matter. There’s actually a lot of science behind wearing gloves. Back in 1981, I served on an infection control committee and I recommended that we start putting boxes of gloves in the patient rooms. Prior to that time there were no gloves in patient rooms and if the nurses found contamination or some other reason to need gloves, they had to walk back to the nurse’s station and bring the gloves into the patient’s room.

It occurred to me that there would be nurses, doctors, aids and orderlies who would wear gloves more often if the gloves were more conveniently placed in each patient room. My idea was shot down by the majority of the members of the infection control committee saying that keeping gloves in each patient room was impractical, too expensive, and would never work. So, the times, they are a-changin’.

When I was a student and resident 45 years ago, we were taught to do breast exams with our bare hands...no gloves. The times have changed so much that if we were to do that today we would probably be accused of decades of sexual abuse, get a visit from police, and be sanctioned by the state licensing board. What we were taught as normal 45 years ago would be considered no defense.

During that time nobody had chaperones in the room. Having them present in the room didn’t cross anybody’s mind. Although chaperones might be considered protection for the patient, they are really present in the room for the provider to clear up any stories that might occur after the exam.

After all, there are sexually aggressive patients who might take liberties or at the least, make up stories. I personally think chaperones are a violation of patient rights and HIPPA. Either way, patients should be asked for consent for chaperones to be present.

In my residency, one of the older female doctors had been trained at the Mayo clinic. She wore what was called a finger-cot, many of which she kept in her pocket. These are like a very small condom which fits on the index finger and covers the two knuckles at the end of the finger, but leaves the knuckle nearest the hand uncovered. She had probably conducted exams with the finger cot for 40 years and was never called before the medical board because of it. We were also taught to always do a rectal exam at the same time we did a vaginal exam.

I recently read about Dr. Bradford Bomba Sr. a boy’s basketball doctor at Indiana University who had done rectal exams on many high school and college boys. Today this action is considered sexual abuse of young men. Although I would probably have considered this exam to be unnecessary, I can understand that in the current environment it may have been considered to be at least an extreme end of normal.

Like many of these reports of accusations, these allegations are presented as truth while important data which would allow readers to have a better understanding of the situation are omitted. The evidence or lack of it generally points to assumed guilt rather than alleged guilt. Don't get me wrong. I’m not supporting or excusing sexual abuse.

When you have videotaped yourself or somebody else in a sexual act, it’s hard to say that didn’t happen. Also, when you have kiddy porn all over your computer, that’s hard to deny. And, when you use state money to travel to other countries to have sex with minors, that is hard to even believe.

But that doesn’t change the fact that today the media seem to enjoy a good story, true or false, especially if it has to do with doctors or Medicare and Medicaid fraud. The problem with these allegations is “guilty until proven innocent” is the norm. This mindset is a perverse spin on the presumption of innocence. Countries where innocence is not presumed include China, North Korea and Mexico, and of course the State Medical Boards and Medicaid fraud units.

Yes, times change. Before Roe vs. Wade, abortion was illegal. Doctors or others who did abortions and patients who had the abortions could be put in prison. This state of affairs was similar to what happened with the 18th Amendment on Prohibition, ratified on January 16, 1919, which prohibited the manufacture, sale, transportation, possession and consumption of intoxicating liquors.

On December 5, 1933, the 18th Amendment was repealed by the 21st Amendment because it was neither effective nor safe. In other words, it did not do what it was supposed to do, and it caused a whole new batch of problems, mainly revolving around illegal manufacture, sale, distribution, possession and consumption of intoxicating liquors. So, the Prohibition Amendment simply drove alcohol underground to organized crime and the government lost control of safety and taxes. So the Prohibition Amendment did not stop the consumption of alcohol, which was the goal.

Roe v. Wade was the Supreme Court’s decision, similar to the 21st Amendment, to make abortion legal and safe (for the mother and the doctor). Abortion laws and their enforcement before Roe v. Wade drove abortion underground just as the Prohibition Amendment drove everything related to alcohol underground. Many women died at home from infection or bleeding rather than risk going to prison or dragging the family name through the mud.

The other problem, which remains today (and has returned with overriding Roe v. Wade) is lack of equality. In other words, if you can pay for a good and safe abortion, you could get one, and if you can’t afford a good abortion, you have to take what you can get in terms of consequences, including death. The times are a changin' so much that we have rotated 360 degrees back to pre-Roe v. Wade days. And then some.

Catholic institutions now own approximately 40 percent of hospitals and clinics in the U.S. I have 45 years of Catholic hospital experience. In one of the hospitals, although we couldn’t do tubals or vasectomys, care was pretty much as usual. One of thes nicest Catholic hospitals I ever worked in held monthly staff meetings in the evening. Food was prepared by a chef and carafes of wine were at each table. Today, there would be no end of complaints about this gentle camaraderie which we all enjoyed.

Later on, I moved to a small town with a smaller hospital and naturally we couldn’t do tubals or vasectomies. The nuns had sent many good doctors out of town for doing vasectomies in their off-site clinics. This little hospital illustrated exactly what generally happens with Catholic healthcare. It is Catholic first and healthcare second. It has never been anything else.

I didn't realize it, but the nuns had completely redefined the kind of pelvic surgery which was allowed. In other words, it didn’t matter what the American College of Obstetricians and Gynecologists (ACOG) thought of surgery, or for that matter, even insurances. I was called before a board of three nuns to be castigated for pelvic surgeries I had done. One was an indicated hysterectomy on a woman well past childbearing age.

On the other hand, these nuns were extremely earnest in rooting out all signs of Santa Claus at Christmas, but this didn’t give any thought to preventing avoidable deaths.

So, when I read the story about a Catholic hospital offering a bucket and towels to a woman who needed healthcare for being in the process of miscarrying, I was not surprised. Anna Nusslock showed up at her local hospital 15 weeks pregnant with twins and in severe pain. The doctor gave her bad news. The twins she and her husband had desperately wanted were not viable. In addition, her own health was in danger and she needed emergency treatment to prevent hemorrhaging and infection.

The hospital, Providence Saint Joseph, was in the small northern California city of Eureka. The hospital refused to provide the care Ms. Nusslock required because doctors could detect fetal heart tones. California Attorney General Rob Bonta filed a lawsuit against the hospital, detailing Ms. Nusslock’s dangerous experience and alleging the hospital violated state laws when it discharged her with an offer of a bucket and towels and told her to go elsewhere for what the Attorney General considered to be standard medical care.

Let’s suppose the hospital could not participate actively in this miscarriage. But they should have known there was a danger, they could have put the patient in an ambulance and sent a doctor or a midwife with the patient in the ambulance to the next nearest hospital.

Having dealt with hospitals for the better part of the last 45 years, I know that the cardinal sin of any hospital is to provide a service for which they might not get paid. It would be interesting to know how much this hospital charged this patient for the bucket and towel. Lack of reimbursement is likely one reason the hospital did not put this patient in an ambulance and provide a doctor or a midwife to go along with her in the ambulance, which would have provided comfort, consideration, care, and safety.

Another thing which does not change over time is state or federal government belligerence, which once again, is coming to the scene in the form of the lawsuit, filed by the California, Attorney General, Rob Bonta. It would have been most reasonable to talk with the appropriate Catholic hierarchy to try to come up with a compromise that would address patient comfort, consideration, care, and safety. A lawsuit will not do that under any circumstances, and simply will get the hospital, the Catholic hierarchy, and all of the doctors to be more frightened and more defensive than they have been before.

This government belligerence is a very broken record, as far as state and federal government action, and is totally unproductive. It’s a remarkable waste of state money as well as insurance and hospital money, and will produce no reasonable result, except as indicated above, fear, expense and defensiveness, preventing access to needed healthcare.

If the state of California or any other state is so terribly worried about Catholic healthcare, they could very easily put a hold on Catholic healthcare hospital purchases or Catholic hospital construction in the state.

This isn’t rocket science and sensible solutions do exist. This problem does not need to be aggravated by belligerent and inappropriate actions of the Attorneys General of any state or federal government.

A sensible and effective solution is it hand and should be utilized.

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