Sunday, February 20, 2011

University of Wisconsin, Department of Family Medicine is not Responsible? (Updated with Video)

Update~And so it begins!

The University of Wisconsin medical school says it's investigating reports that doctors from the school handed out medical excuse notes to protesters at the state Capitol this weekend.

Doctors from numerous hospitals set up a station near the Capitol on Saturday to provide notes to explain public employees' absences from work. One of those doctors was Lou Sanner, who practices family medicine at the University of Wisconsin School of Medicine and Public Health. Sanner said he had given out hundreds of notes to protesters and many he spoke with seemed to be suffering from stress.

UW Health said Sunday that any doctors who distributed notes did so on their own behalf. The school didn't specifically mention Sanner but said it was looking into cases involving any of the school's doctors.
I have a few additional thoughts regarding yesterday's post on the Professional Misconduct of the physicians giving out sick notes to unionized protestors. Although I still think egos have preceded intellect, they weren't entirely stupid and I suspect have taken some precautions. For instance, the notes that were handed out in no way identifies The University of Wisconsin or The Department of Family Medicine. While it is clear that at least some of these doctors are employed there, time was taken to make these notes as generic as possible. The contact email is from a gmail account, not the more professional that would be used for department business. Likely,, is being used as a proxy and was created specifically for this action. I could be wrong, of course, and perhaps someone with more IT skill than I could find out when this account was created.
With that being said, there are some potential problems for the university and the department. Patrick McKenna is identified on the UW DFM staff and directory page as a PGY 3. This is a resident in his 3 and final year of post graduate training and as such cannot operate independently as the Department of Medical Education is responsible for his actions. Furthermore, the ACGME is the governing body that credentials hospitals and medical centers to provide post grad training and would likely take a very jaundiced view of this. You may be unaware, but over the past several years there has been a significant increase in the regulations and requirements required of the Med Ed department. Specifically as it relates to work hours. How this extracurricular activity will impact that is unclear, but these are questions his employers will soon be asking. For what it's worth, the ACGME has withdrawn the accreditation of programs that fail to meet these requirements. John's Hopkins comes to mind.

Finally, I wonder what carrier is covering this groups malpractice insurance. You can't just set up shop, see everyone on the street and pretend everything is great. This type of action opens these folks up to an incredible liability risk and without required documentation in a medical record or follow up they are sitting ducks to an opportunistic lawyer. If I were a betting man, I would wager that their malpractice insurance is obtained through the Universities Family Medicine Department. I would expect these rates to rise significantly if not dropped outright for this negligent behavior. You see, once you enter into a contract with a patient, you are responsible for them, even if it is on a streetcorner. Hope they didn't miss a stroke in progress or the ever so rare zebra, dermatomyositis.

It will be fascinating to see how this plays out and of course the details thus far are limited, but by all accounts this was stupid!


Unbelievable, Kathy Oriel, is quoted in an article at wkow~

Reporter asked, "Do you think you could get in trouble?" Dr. Kathy Oriel said, "Certainly, we think its worth the risk to support the people, and we feel very strongly these are officials who would really like to be in school, and in their classes, but they're put in a position where they really have no choice."

Don't know who Kathy Oriel is? She happens to be the Madison Residency Program Director!. She of course should know better. It is of course very benevolent of her to sacrifice her time outside of the clinic and hospital as an unaffiliated licensed physician, but what of the affiliations of her residents who cannot disconnect themselves from their residency program. Are they aware, as Dr. Oriel seems to be of the potential, ramifications of this action? Surely they aren't filling out excuse slips as unlicensed resident physicians because that would be well beyond their pay grade.

Linked at Protein Wisdom, thanks Darleen!

Links Galore~ Thanks Instapundit, PJ Tattler, Tigerhawk, The One and Only Tammy Bruce!
In other news:

Lonely Keith Olbermann Tweets 134 Times in Last Week
Doctors' Notes Being Handed Out at Wisconsin Teachers Union Rally
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  1. Public display of a willingness to commit fraud certainly cannot sit well with either their governing professional board or their insuror(s). This goes directly against any future claims of credibility.

  2. Public employees helping other public employees to commit fraud in order to protect public employee salaries & benefits. I'm shocked, shocked I tells ya.

  3. certainly speaks ill of their ethics and professionalism. I'd like to see some consequences for falsely issuing passes to the teachers who falsely claimed to be sick so they could attend. Also, some consequences for the teachers.

  4. You greedy selfish exploitive employers, why can't you just shut up and lose your houses by not able to pay the raised property taxes so you can finance my retirement funds and 4 months vacation each year?

  5. I hope she loses her license to practice medicine.

  6. There are worse possibilities for the physicians involved. Fraudulent claims by government employees for sick leave are fraud on the government.

    If the physicians involved do not have adequate records showing that they actually examined the striking teachers they wrote medical excuses for, they might be liable for fraud on the government just as much as the teachers, as well as criminal conspiracy.

    A finding that a physician wrote a knowingly false official medical absence excuse for a government employee has major consequences which very possibly include decertification for MedicAid claims, as that is a state-operated program. This could financially cripple a physician, particularly if there are federal Medicare and private insurance rules allowing, or requiring, decertification of physicians who are decertified from MedicAid for fraud.

    If Wisconsin allows taxpayer suits concerning fraud on the state government, we might see an exciting race to Wisconsin courthouses next week by attorneys filing class actions against these physicians.

    Tom Holsinger

  7. Family Medicine departments across the country are well-known to be infected with leftists, socialists and other touchy-feely "do-gooders". Many national and state physician associations have been co-opted by these numbskulls who have way too much time on their hands, causing trouble for the rest of the physicians who are too busy to get involved. I'm not surprised these actions have arisen from the family medicine doctors.

  8. Using a false e-mail account is an indicia of FRAUD. In fact, the excuse writers are aiding and abetting the employee's fraud.

    But, as in most states the Medical Board is only concerned about physicians who proscribe necessary pain killer for terminal cancer patients to alleviate great suffering. Those guys, they will harass. These PC physicians will get away scot free.

  9. That reminds me. I will not let a "family practice" physician touch me. That's where the med students who can't get into a better residency wind up.

  10. How do you know the pgy3 doesn't have a license. I had one as a PGY 1, a soon as I passed my boards. I think what is being done is reprehensible but I think your facts need to be checked.

  11. Wisconsin also has a false claims act which makes it illegal to "knowingly" aid a false medical claim. "Knowingly" is defined pretty broadly, and would probably include showing up at an event advertised as a "sick out" and passing out doctor’s notes.

    Also, the medical license law have provisions that make this a grounds for losing a license. These are non-trivial abuses of a privilege that the doctor has been granted, and that privilege should be closely reviewed for these physicians.

  12. 30YearProf,

    The auditors at Wisconsin's Department of Health Services are not the same as the Wisconsin Medical Examining Board.

    A physicians' certification to be reimbursed by the Wisconsin Department of Health Services for treatment of MedicAid patients can be removed for fraud on the government without anything at all being done to his medical license by the Wisconsin Medical Examining Board.

    Tom Holsinger

  13. The UW Family Medicine dept is actually a very large and highly-respected one. There were only a few members of this dept at the protest. Please don't crucify the entire dept.

  14. A PGY3 has a license, but is not allowed to function as an independently credentialed provider. Until graduation, they are practicing on the license of their training staff. Training staff actually bear the responsibility for a PGY3's malpractice. The residence may, however, comsider remedies like probation for unprofessional conduct.

    Also, the other residents can't be happy with those who have put the accreditation of their program at risk.

    Also, the whole department might not have gone, but the whole department could suffer. The ACGME would not sanction individuals, but the departments residency training program. This could be a very big deal.

  15. I'm very aware of the possible consequences to the department, and the entire UW. As a former student there (not part of the family medicine program), I am really disheartened by these events.
    Show your support by marching in protest,if you feel you must, not by writing these notes.

  16. Just so long as it isn't Lupis...
    (sorry, couldn't resist)

  17. By signing fake medical excuses she is participating in a fraud against the state and local governments for money. She is helping employees deceitfully obtain money [sick pay] to which they are not entitled. She might as well be helping them commit an insurance fraud.

    If she is not disciplined by both the state and her university, something is very wrong in Wisconsin.

  18. They have no reasonable expectation of privacy at a protest. Thus, if one accepted that the physicians actually "assessed" these protesters it is in violation of HIPAA since anyone could capture the video. If it is not a genuine "assessment" then it is fraud.

    - drjohn

  19. As a physician myself with 13 years of experience including 9 years in academic medicine with direct supervisory responsibility over residents and fellows, and the husband of a family practice resident physician I'd like to make the following comments:

    -EVERY medical resident has a medical license. What they MUST have is a TRAINING license that lets them practice in a hospital or outpatient clinical setting under supervision during their residency.

    Their malpractice coverage as a resident is issued specifically to cover their activities as a supervised resident. If they go "off the farm", so to speak and start to practice outside the scope of their residency, they may not be covered.

    -SOME medical residents ALSO obtain have "full" medical licenses that let them practice independently outside the context of their residency reponsibilities. For example, residents who want to "moonlight" in the emergency dept may get full medical licenses to legally do so.

    Whether or not their malpractice insurance as a resident will cover this "moonlighting" depends on the exactly specialty, what they do, whether or not their residency sanctions their coverage, etc.

    -Its only medical fraud in the typical usage of that term if someone has been billed for these services. In this case, I doubt that anyone received a bill for these false medical excuse notes.

    -Malpractice coverage really only matters here if writing the false notes is likely to lead to a malpractice claim. . .which is virtually impossible. No patients have been medically injured here.

    -Writing medical notes on patients without examining them is unethical. Lying about patients medical conditions in written notes is also blatantly unethical. I'd think that both things could result in sanction from a State medical board (though I wouldn't actually expect such a sanction to happen here). It *might* be possible for a physician to lose their board certification for this degree of unethical behavior, though again, I doubt it will actually happen here.

    -If the director of a medical residency program were writing false medical notes for strangers at a political rally, she SHOULD lose her job. That's an embarrassment to the residency program and sponsoring hospital. Any medical resident caught doing that sort of thing should be expected to lose their job too. Again, I doubt that this will actually happen here either, but that would be the "angle" I'd be pushing for in this case.

    -Lastly, on "family medicine" residents being the worst of their respective classes, in SOME cases that's true. But certainly not in every case.

    My wife, who was competitive for various residencies in various specialties (and who was actively recruited by the surgery dept at her med school), specifically chose to do her residency in family medicine just because the residency was was available at the local rural hospital where I work.

    For her to do a "better" medical residency would have required her to move to a different part of the State (or a different State altogether). I'd either have had to quit my job and try and find another one (not easy in my particular specialty) or we'd have to have lived physically separated in two different places for 3-6 years (not good for either of us, or our two small children!).

    Ultimately, doing a residency in Family medicine was a reasonable compromise for her, and I can say with a high degree of confidence that she's at least as good at outpatient medicine as any typical internal medicine resident of equivalent training. In some areas (like doing procedures) she's better because her program has emphasis on that where was other specialties don't.

  20. I moonlighted frequently when I was a PGY-3. While I think what these docs did is reprehensible, as long as they did it on their own time I doubt they broke any residency-related rules. I agree they probably "practiced" without adequate insurance though.

  21. The health system is probably either self-insured or insured by the state. These physicians would not have done what they did if they'd ever had discussions with a risk manager. They have a physician-patient relationship with everyone who holds a release they have signed. They have taken on legal liability for medical conditions that they did not detect in their "examination." Further, they conducted their interviews and examinations in public and discussed their patients medical conditions in front of others. That's probably a violation of HIPAA as well as a waiver of physician-patient privilege.

  22. For David:

    Medical residents know they aren't supposed to practice outside of their residencies without explicit permission of the residency program director. The standard contract medical residents sign with their programs makes this clear.

    I remember quite that when I was resident and I wanted to "moonlight" I had to get explicit written permission from my dept chairman. He granted it, but not first without interviewing me about what exactly I was going to do, where, when, and made sure that the residency program director felt I was up to it in terms of skill level.

    Now any resident who is "moonlighting" without permission could expect to be sanctioned by their medical residency. The sanction could range from what amounts to a slap on the wrist, all the way to expulsion from the program.

    Either way, the ACGME would have little to do with this, if the residents actions were not sanctioned by the residency program itself.

    In this case, it looks a lot more interesting. If in fact the residency program DIRECTOR were there signing bad notes and she brought along residents to help her, that is a BIG DEAL.

    The residents could claim "our residency program director said it was OK, so we thought this was OK with the residency program". Its arguable how credible this is, but if medical residents really did go out there with the sanction of their residency program director, I don't see how the residency itself could get the residents in trouble.

    But the program director? Ouch. . .. If this is true, she SHOULD be in a HEAP of trouble.

    If I were her dept chairman, and I found out that she brought medical residents into this sort of unethical scheme, she's be INSTANTLY stripped of her directorship of the residency and (assuming I had the power to do so) likely fired.

    Even if she acted solely on her own, I think this sort of public ethical breach would still require me, as hypothetical chairman to remove her from directorship of the medical residency.

  23. All of them should have their licenses removed for a minimum of 5 years. Period.

  24. Nice to know about the 'ethical' aspects. The Republican Atty General of Wis should evaluate the fraud - entitling an absent teacher to claim illness.

    At least these young lefty doctors are getting their opporunity to 'stick it to the man!'.

  25. Thanks for the more complete, and accurate, description of the nuances of the scope of practice while a physician is still in training.

    I disagree about the fraud, however, in that these notes are specifically aimed to defraud the state of Wisconsin into paying for a day of sick leave. The Wisconsin False Claims Act is pretty broad, and it might encompass what was done here:

    20.931 False claims for medical assistance; actions by or on behalf of state.

    (1) In this section:

    (b) "Claim" includes any request or demand for medical assistance made to any officer, employee, or agent of this state.

    (c) "Employer" includes all agencies and authorities.

    (d) "Knowingly" means, with respect to information, having actual knowledge of the information, acting in deliberate ignorance of the truth or falsity of the information, or acting in reckless disregard of the truth or falsity of the information. "Knowingly" does not mean specifically intending to defraud.

    (dm) "Medical assistance" has the meaning given under s.49.43 (8).

    (e) "Proceeds" includes damages, civil penalties, surcharges, payments for costs of compliance, and any other economic benefit realized by this state as a result of an action or settlement of a claim.

    (f) "State public official" has the meaning given in s. 19.42(14).

    (2) Except as provided in sub. (3), any person who does any of the following is liable to this state for 3 times the amount of the damages sustained by this state because of the actions of the person, and shall forfeit not less than $5,000 nor more than $10,000 for each violation:

    (a) Knowingly presents or causes to be presented to any officer, employee, or agent of this state a false claim for medical assistance.

    (b) Knowingly makes, uses, or causes to be made or used a false record or statement to obtain approval or payment of a false claim for medical assistance.

    (c) Conspires to defraud this state by obtaining allowance or payment of a false claim for medical assistance, or by knowingly making or using, or causing to be made or used, a false record or statement to conceal, avoid, or decrease an obligation to pay or transmit money or property to the Medical Assistance program.

    (g) Knowingly makes, uses, or causes to be made or used a false record or statement to conceal, avoid, or decrease any obligation to pay or transmit money or property to the Medical Assistance program.

    (h) Is a beneficiary of the submission of a false claim for medical assistance to any officer, employee, or agent of this state, knows that the claim is false, and fails to disclose the false claim to this state within a reasonable time after the person becomes aware that the claim is false.

  26. I'm so glad my tax dollars are used to support people like this good doctor.

    Ignore the elections and use Greek riots to intimidate people. Maybe Greek black markets that defund the state further are the next step.

  27. Maybe these residents believe (or believe that they can make a vaguely credible claim) that they are covered under the Wisconsin "Good Samaritan" law, which allows doctors to treat people in accidents without risk of malpractice.

    Bottom line, the residents will at most be chastised at best. And, as seems likely, these residents will proudly display (and may well frame) these letters as affirmation of their lefty union credentials.

  28. What do you think is the political orientation of the UW Dept of Medicine, and of the various government and professional organizations that oversee doctors and medical schools?

    They will all find reasons to look the other way, and no person who took part in this will face any real punishment.

  29. Anonymous Physician,

    Fraud on the government is a much broader legal term than fraudulent billing. Fraud on the government includes wrongful acts done with the intent to aid someone else's fraudulent claim.

    Persons who agree to act in concert to commit a wrongful act (fraudulent sick leave claim) form a civil conspiracy, which here is fraud on the government.

    Posters indicate that Wisconsin has a "qui tam" statute allowing taxpayer suits to sue persons making fraudulent claims against the State of Wisconsin. See:

    This means that any citizen of Wisconsin can file a class action against the teachers making fraudulent sick leave claims, and against the physicians who wrote their sick leave excuses.

    The physicians involved who did not make contemporaneous written records of their examinations of the teachers they wrote sick leave excuses for will have a very difficult time escaping a finding of liability here.

    And all conspirators are liable for the acts of each other member of the conspiracy, i.e., the physicians found liable as civil conspirators with the teachers making false claims, would (each separately) be liable for the ENTIRE amount of wrongful sick leave payments made by the State of Wisconsin to the striking teachers

    My major point, however, is that it might not be necessary for any official Wisconsin state entity, other than a civil trial court, to do anything to wreck the medical careers of these physicians. Lawyers, judges and juries can do it without any official medical being involved.

    Here is how that works. A trial court finding that a physician is civilly liable for fraud on the government might (I'm not familiar with Wisconsin law) be useable as a sort of presumption (the legal term is collateral estoppel) by the Wisconsin Department of Health Services to the same effect - the doctor made a fraudulent claim which disqualifies him/her from receiving MedicAid payments.

    If this is indeed so, Wisconsin taxpayers could als bring qui tam suits to recover any future MedicAid payments to the physicians fourd liable for fraud on the government.

    Tom Holsinger

  30. If someone is unethical enough to use one of these doctors' notes for sick leave would they be too ethical to sue the doctor or the university if they later became ill with something that could have (should have) been found if they had actually been examined?

  31. What these doctors did was unethical and possibly illegal, but I would bet that there will be no consequences -- none.

    The state medical board will give them a pass and local prosecutors won't touch this. Their bosses (assuming they are not in independent practice) won't touch them either. Too much hassle, and if they are state workers, I'd bet the boss is sympathetic.

    This, of course is why corruption grows. It is less power that corrupts than immunity from the consequences of one's actions. While power grants immunity so does indifference.

  32. If you thought you were engaging in civil disobedience of a sort, (skipping work), but you thought you ought to have a doctor's note just in case,you have declared yourself to be a sniveling, cowardly sponge.

  33. David- "A PGY3 has a license, but is not allowed to function as an independently credentialed provider."

    I don't believe that is true. It wasn't when I was a surgery resident in another state and reading through the Wisconsin license requirements it doesn't seem to be so today. I think you can be a resident and practice within the confines of the program without a state license but you can apply for a state license once you 1) graduate from an accredited medical school, 2) complete all three parts of the USMLE and 3) complete 12 months of post-grad training (PGY-1). Part 3 of the USMLE can't be taken until step #3 is completed. Then you apply for a license and if granted you can practice general medicine in the state. I knew residents who moonlighted in ERs for extra money after the first year. Today that would be hard to do since hospitals are going to require specialty training in Emergency Medicine in most cases but one could work in an Urgent Care Center.

    30yearProf- "I will not let a "family practice" physician touch me. That's where the med students who can't get into a better residency wind up."

    My wife, also an MD, who graduated summa cum laude and was elected to Phi Beta Kappa as an undergraduate and to Alpha Omega Alpha, chose to go into Family Medicine. I don't agree with what these FPs did and think they should be censured severely for it, but you can take your arrogant, Ivory Tower attitude towards all FPs and piss-off.

  34. Anonymous says, -Its only medical fraud in the typical usage of that term if someone has been billed for these services. In this case, I doubt that anyone received a bill for these false medical excuse notes.

    Here's one lawyer's opinion for what it's worth. Writing false medical excuses might not be "medical fraud". But if it is written with the writer's knowledge that it will be used by the recipient to obtain any benefit from state or local government, it is just plain garden variety fraud against the paying government. It may subject the excuse writer to civil suit by the defrauded government to recover benefits to the recipient(s) resulting from the fraud. Such fraud would also be a criminal offense under the laws of most states.

    Whether a malpractice (technically "errors and omissions") insurance carrier would have the duty to defend the accused or to pay in the event of liability could only be ascertained by the precise language of the policy. I have seen policies which would cover such alleged activity.

  35. I was writing when Tom Holsinger was commenting and covered some of the same material. I agree with Tom's analysis.

  36. I am one of the docs quoted yesterday on Instapundit, and found my way here. I've been in academic medicine since my graduation from medical school about 30 years ago. I formerly directed a fellowship training program (advanced training, one step beyond residency training). I was also a resident long, long ago.

    Residents with a full, permanent license to practice (12 months as a resident plus passing Step 3 of the USMLE, as noted above) can practice outside their residency, but also as noted above, the ACGME (the credentialing agency that regulates post-graduate medical training) requires that residents obtain the permission of their program director prior to engaging in such practice. This is a quality-control step designed to keep residents from over-extending themselves (e.g., excessive moonlighting). A resident physician with a full license could hand out work excuses (ignoring the fraud issues correctly referenced by vngagvet for a moment), but she/he would require permission from their program to do so, as that is clearly considered medical practice.

    Residency program directors are charged not only with running the residency, and thus ensuring proper training and education of the residents, but are also charged with maintaining the moral and ethical standards of the program. Universities have an associate or vice-dean over the various program directors -- this is required by ACGME. As you might imagine, most universities, even the most liberal, will not allow anything that would threaten their accreditation in any way.

    With that in mind, I'm astounded by Dr. Oriel's behavior. Were I the vice-dean at UW-Madison's medical school overseeing the residency programs, she and I would be having a conversation, and it wouldn't be pleasant. Her behavior and that of the residents at this rally is clearly unethical.

    One cannot hand out work excuses for fictitious reasons, without a proper medical evaluation, in the open that compromises confidentiality. That these work excuses will be used to allow the teachers to claim 'sick days' and thus collect pay to which they aren't entitled, and that the doctors very likely know this, means that the doctors are engaged in a conspiracy to defraud the state. That places the doctors at risk not just for sanction by the local prosecutor but by the medical board as well. It is an amazing risk for them to take with their careers, and it makes me wonder if the culture at UW Madison, and in the Department of Family Practice, is such that these doctors considered themselves immune to sanction.

    I hope Mark L, above, is wrong, but I would not bet against him.

  37. That faculty/staff search page does not turn up doodley for Patrick McKenna.

  38. @Paul, its because he isn't a faculty or staff, he is a resident in training....

  39. Here's Patric McKenna.

  40. Fraud? Malpractice is the moneymaker. If you got one of these handouts and had a condition a normal examination would have revealed, you are toast. No follow-up or referal makes a good malpractice case. I am sure a good Democrat trial attorney would be happy to handle it.

  41. Washington has adopted the Uniform Disciplinary Act and so have many other states including, I believe, Wisconsin.

    Some examples that may apply:
    (1) The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person's profession, whether the act constitutes a crime or not.
    (7) Violation of any state or federal statute or administrative rule regulating the profession in question, including any statute or rule defining or establishing standards of patient care or professional conduct or practice;
    (13) Misrepresentation or fraud in any aspect of the conduct of the business or profession;

    Any state where the Dr. is licensed could take action, as well.

  42. Excuse me, these are felonies. Also every valid prescription must be written on a printed pad that includes full info on the doctor, including his DEA ID number. Mere hand-written notes do not suffice.

    These bogus scripts are sufficient cause for revocation of license and dismisal from employment.

  43. It is entirely possible that someone could file a complaint with the WI Board of Medicine. Typically, the Board will then ask the doc to write a letter explaining their actions. If the response is sufficient, it may end there. If not, further action ensues, and the doc will need a defense. Typically, that is provided by the doc's malpractice carrier. However, if the carrier determines that fraud was committed, they do not have to defend. So the doc would be on their own, having to pay for their own defense.
    Hmmmm, think anyone will file a complaint?

  44. The UW Family Medicine dept is actually a very large and highly-respected one. There were only a few members of this dept at the protest. Please don't crucify the entire dept.

    And many of my friends from Duke went into Family because that's what they really wanted to do. It's not fair to tar all family docs.

  45. In some areas (like doing procedures) she's better because her program has emphasis on that where was other specialties don't.

    exactly, One of my family doc friends went into family because she really liked doing procedures.

    Another one liked catching babies. unfortunately, OB/GYN malpractice insurance drove her out of that.

  46. sykes, writing a doctor's note isn't a "prescription".

  47. One other issue: any doctor in private practice gets patients who demand fraudulent medical excuses for absences from work or to qualify for disability insurance. You might be surprised how often patients insist that they are entitled to such "diagnoses," since "everybody does it.". Fortunately, most doctors refuse to accommodate these demands, but such blatant, public disregard for medical ethics does not make things easier for ethical physicians. Worse, it cheapens the value of a proper medical excuse. Will we soon be in a situation where employers will insist that patients be seen by a company doctor before authorizing an absence?

  48. For attorneys wondering about a collateral estoppel effect on a doctor's MedicAid billing certification from a qui tam judgment against the doctor for fraud on the government:

    It depends on the wording of the qui tam statute in question, and on case law interpreting the statute. The individual plaintiffs in such cases act as representatives of the government such that the latter might be (depending on statute & caee law) an involuntary plaintiff for whom collateral estoppel goes both ways. I.e., a judgment for the defendants and against the individual plaintiffs bringing the qui tam action would collaterally estop the government from seeking the same relief on the same alleged fraudulent payments.

    And, in that instance, a judgment for the individual qui tam plaintiffs woul collaterally estop the defendants in further proceedings by the government, or more qui tam plaintiffs, from denying that they had committed fraud on the government in the first action.

    The possibility of a government being collaterally bound by an adverse qui tam judgment, in those jurisdictions where that is the law, gives those governments an incentive to intervene in qui tam actions.

    I don't know if this is true for Wisconsin but, if it is, the physicians who wrote those prescriptions are in deep, deep trouble.

    Tom Holsinger

  49. The credibility of the Wisconsin Board of Medical Examiners is very much at stake here.

    Its failure to act against the physicians who wrote fraudulent illness notes for striking teachers might result in legislative action adding non-medical personnel to the Board appointed by the Governor.

    Tom Holsinger

  50. Time for some qui tam lawsuits and complaints to the Medical Examining Board. Ruin these doctor's lives and careers. Follow it up with fraud prosecutions for any goldbricking teacher who used one of these forgeries to steal from the Wisconsin taxpayers.

    Remember the words of Saul Alinsky: Individuals hurt sooner than institutions. Let's punish these felons without mercy.

  51. The doctors foolish enough to write fraudulent sick leave excuses might well compound their errors by doing something worse - trying to cover it up by writing fraudulent medical records after the fact. This would be in the great tradition of "It's not the substantive offense which gets you, but the coverup".

    Tom Holsinger

  52. AKA Linda-
    Teachers in the video were seen boarding public school buses to go to the rallies.
    WHO paid for the buses, and who paid for the bus driver's wages??

  53. I would expect that part of the defense of the nut that shot the Congress Woman in Arizona will be stress. What were these doctors thinking? This could be a goldmine for one evil enough to go commit an act of violence and then use the note diagnosing stress as the defense. Not to mention if two or more of these people discussed beating the man it is now conspiracy which is no laughing matter.

  54. Though I don't think that what they did is illegal, I think it's very fair to say that the majority of physicians in WI and all over the country aren't happy about this, and do not in any way support the actions of these physicians. Also, their FM program is a great program, and it would be very unfair to group them all as like-minded physicians, because I can personally assure you that they are not.

  55. I wrote an email to Dr. Oriel. I tried to be civil and pointed out my dissatisfaction with her actions as a healthcare professional. I wonder if she'll respond.....

  56. Documents are easily forged, said Barry Costello Monelle Delmonte, as he had a lunch of Fish and Chips with Dr. Oriel in Blackpool, Lancashire, last week.