A Disaster in Waiting

On January 28, 1986, the Challenger air shuttle disaster occurred. The shuttle broke apart 73 seconds after takeoff. The cause: a flaw in the design of the O-ring seals on the solid rocket boosters which were not designed to withstand very cold temperatures. This flaw was previously known by managers at NASA (since 1977) but was never properly addressed. The day before the launch, engineer Roger Boisjoly, who worked for the company that developed the solid rocket boosters, warned his senior managers of this flaw and vehemently advised against permitting the Challenger launch to occur. His concerns were ignored by his managers, NASA managers and the head of NASA’s rocket booster program, Lawrence Mulloy. The launch went forward and 7 crew members were killed when the shuttle exploded. After the disaster, President Reagan appointed the Rogers Commission to investigate the accident. The commission ultimately found that, in addition to the issue with the O-rings, NASA’s organizational culture and decision-making processes had been key contributing factors to the accident, with NASA violating its own safety rules. Why do I share this story? Because it is a case study in how groupthink and workplace ethics (or lack of) can affect decision-making.

This is akin to what is occurring in the healthcare industry today. The corporatization of medicine is a testament to the violation of workplace ethics due to the need to meet metrics and increase profits. Hire individuals with little to no medical training and convince the public they are equivalent to physicians. Who cares about the healthcare outcomes? They are not germane to this business. Legislators, unable to break away from groupthink and possessing no desire to address the potential safety hazards to patients, pass laws allowing what should be illegal to become legal. Physicians are required to attend medical school and complete a residency, both of which must be accredited. Non-physician practitioners (NPPs), in SOME cases, have no such ENFORCED requirement. For instance, one need only possess a nursing license and one can become a NP, get certified and practice in any facility he/she wishes. The NP program may or may not be accredited. NO ONE CHECKS. Physicians must pass three licensing exams and 1-2 specialty boards, depending on their specialty, before they can be considered an expert in their chosen field of practice. And everyone checks before we are hired. Not so with NPPs. All they have to do is claim they are specialized and legislators and hospitals/employers accept it as fact. NO ONE CHECKS. Physicians must remain supervised for a minimum of 7 years before independence is granted. NPs in particular, who have no license to practice medicine, can in fact, practice medicine in 22 states and the District of Columbia without a medical license and without mandatory supervision. No consistent minimum number of years of supervision required. Straight from an online degree mill and into your local ED, hospital or clinic. No questions asked. AND NO ONE CHECKS BECAUSE NO ONE CARES TO CHECK. NPs claim studies that demonstrate equivalent or better healthcare outcomes compared to primary care physicians. NO ONE CARES that those studies used poor methodology. NO ONE CARES that those studies are based on supervised rather than unsupervised NPs which would make the study more relevant. Nope, it is more important to expedite access to care without confirmation of quality and be damned with the consequences. Then at least legislators can say they did something.

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No VALID studies exist attesting to whether the care provided by non-physician practitioners (NPP) is sub-standard because no one expected nurses, PAs, psychologists (seeking prescription writing rights), chiropractors (claiming to practice primary care) or optometrists (lobbying for the right to perform eye surgery) to perpetrate physicians. Why would anyone perform a study for comparison when these disciplines and medicine are incomparable and distinctly separate? Unless one has an unseemly agenda? No one asked who would address the fallout from these bad decisions. No one asked who would treat the complications. No one asked who would pick up the pieces. Because those making the decisions to pass these unacceptable laws simply refuse to acknowledge that there is concomitant damage as a result of their actions. Instead, they claim that no such evidence exists. However, absence of evidence is not evidence of absence. It just indicates that NO ONE HAS CHECKED. Again.

Well we, Physicians for Patient Protection (PPP), are Roger Boisjoly. We are yelling “Don’t launch!” And legislators (and some physicians) are the senior managers ignoring the warning by those possessing the expertise to tell them that what they are about to do will lead to a disaster. Because we are treating the victims of those disasters today. One difference between the NPP fiasco and the Challenger accident is that the ramifications of these unfortunate decisions will not be visibly manifested — for years. When they are, it will be on a scale unprecedented by any previous issue affecting the public. Then legislators and physicians cannot claim that they were not given notice. They were. And they knew. THEY JUST DIDN’T CARE.

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Natalie Newman MD

Dr. Natalie Newman is a residency trained, board­certified emergency physician who has been practicing for nearly 24 years. In 1991, she graduated from California State University in Sacramento, California with a degree in Biological Sciences. She then attended medical school at Case Western Reserve University in Cleveland, Ohio on an Army scholarship. As a graduating senior, Dr. Newman was presented with the Marjorie M. and Henry F. Saunders award for her compassionate care of patients within the family structure. After her graduation in 1995, she was accepted into the Emergency Medicine Residency at North Shore University Hospital in Manhasset, New York. Upon her graduation in 1999, Dr. Newman entered active duty service with the U.S. Army. Her first assignment was at Womack Army Medical Center in Fort Bragg, North Carolina. During her stint in the Army, Dr. Newman was deployed to Bosnia­Herzegovina(formerly Yugoslavia) where she was Chief of the Emergency Department at Eagle Base in Tuzla, Bosnia. She had the honor of serving under the command of Colonel Rhonda Cornum(now a retired brigadier general), a urologist, pilot and former prisoner­of­war during the Persian Gulf War. While in Bosnia, and as the only American female physician in the Balkans at that time, Dr. Newman was assigned as the personal physician for Queen Noor of Jordan during a humanitarian visit to a local hospital in Bosnia. After her return home to the U.S., she was promoted to Major and completed the rest of her Army service at Fort Bragg. Dr. Newman subsequently returned home to California where she continues to practice as a traveling physician and participates in multiple speaking engagements about the values of education, of which she is passionate. She is also a member of Physicians for Patient Protection, a patient and physician advocacy organization. 

  9 comments for “A Disaster in Waiting

  1. Natalie Newman, MD
    September 26, 2019 at 10:41 pm

    Correction for readers. I made a typo. The Challenger exploded on January 28, 1986, NOT January 26, 1986 as stated in the article. I sincerely apologize for the confusion.

  2. mamadoc
    September 26, 2019 at 9:53 pm

    And, when the worst happens it will be covered up. Wait and see.

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    • Natalie Newman, MD
      September 26, 2019 at 10:30 pm

      Can’t cover up hundreds of cases. Can’t cover up lawsuits. Can’t hide cases where no physicians were present. Whatever is in the dark will come to light. It is inevitable.

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  3. Alyson
    September 26, 2019 at 12:00 am

    Well done, Dr. Newman. Thank you for protecting patients and drawing attention to this ongoing, and building, disaster.

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  4. Jesse Lee Belville,PA-C
    September 25, 2019 at 3:39 pm

    So don’t get busy organizing in every state and on a federal level to protect Your turf as physicians. Take your Power back.
    I am a Physician Assistant -Certified. For 43 years. Primary Care, Family Practice, ER,some IM, cardiology, chronic pain practice. In 43 years I have had 2 or 3 Physicians properly supervise me and Educate me. Rest has all been me. Often behind my back , criticism of
    me to other PA’ s or MD’s. Not solving problem.. NO GUTS NO GLORY.. Now stop whining and Start Doing.. Or Not …The Choice is Yours

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    • David
      September 26, 2019 at 4:08 pm

      That’s easy to say, but not to do. I think the Dr. Newmans of the world have no problem with you. It’s the graduate of an online course now seeing patients that the problem. And it is impossible for physicians, except for “rainmakers” (ie interventional cardiologists, and they don’t give a sh-t) to stand up. You get labeled a “disruptive physician”, the MD equivalent of career suicide. So like a dog that’s been beat too much, we stand there and take it. The system needs to, and will collapse.

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    • Natalie Newman, MD
      September 26, 2019 at 10:34 pm

      I don’t whine, not my style. And PPP is doing what other physicians will not or cannot do. We have accomplished a great deal in the three years we have been in existence. And we are paying the price for it. Our motto is “Patients First. Always.” We stand by that. And we take the heat.

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  5. Bridget Reidy
    September 25, 2019 at 11:00 am

    I’m not sure the errors will ever get noticed on a grand scale, we’ve had great NP’s who began their careers with good supervision, and lousy ones barely or not supervised, for a long time. We should never have let “supervision” to be so undefined in the first place.

    I distinctly remembered one locum job where the doc across town “supervised” by signing the triplicates only. When he took a week off and I was supervising, I suggested reconsidering, or at least discussing with me, prescribing stimulants to a patient with poorly controlled hypertension. She told me she didn’t “prescribe” it because he had already been on it, despite writing a script at the visit.

  6. James Tinsley
    September 25, 2019 at 8:12 am

    So spot on! I was an engineer then and those pencil necks were trying to blame the engineers. I knew people in that community and they were furious. This will happen to us. The pencil necks will use metrics to show how doctors suck. Those who fail to learn history are destined to repeat it.

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