Q & A: Mandated care

October 17, 2008

Q. Does the government’s role in mandating medical services, either judicially or legislatively, negatively influence standards of care?

“Absolutely. They have a lot of good intentions, but they’re not working. We’ll have better health care in Massachusetts if we allow the doctors to police themselves. The Massachusetts Medical Society is fine. Tribunals are fine. At this point in time, there should be one moral and ethical mandate: to provide universal health care. Any other regulatory interference with the doctor-patient relationship is negative. I don’t tell lawyers how to practice law, or firefighters how to fight a fire. The U.S. has the resources and the ability to ensure that every sick person receives medical care. Beyond that, get out of my office.”

— Eric Ruby, M.D.

Chief of Pediatrics, Morton Hospital and member of the Mass. chapter of the American Academy of Pediatrics

“In my experience, the state’s role in mandating insurance coverage for medical services has had a significant positive impact on the availability of quality patient care. … [W]e must be mindful that legislative mandates may affect premiums. … There is also some concern that mandates for specific methods of treatment may become obsolete or be found ineffective as medical science and technology advance. … Legislators should anticipate the eventual emergence of new technologies and advancements in patient care before approving any new mandate, and they should continue to regularly review existing mandates to ensure their compatibility with current standards of care.”

— Rep. Peter J. Koutoujian,
D-Waltham

Chair of the Joint Committee on Public Health

“I would hope that any legislation concerning mandates would always be driven by applicable medical standards of care, without provisions woven in that reduce patients’ rights to legal recourse if they are victims of inappropriate care. If a piece of legislation results in substandard care due to a cost issue, that’s a problem, particularly for those who cannot advocate for themselves, such as the elderly or the poor. The bottom line is no legislation should obviate the physician’s responsibility to provide the appropriate standard of care. The patient’s right to that care is sacrosanct.”

— Annette Gonthier-Kiely
Medical malpractice attorney, Salem

“There are occasions where the government’s efforts to regulate the provision of medical services, including the manner by which individual physicians provide that care, have had a significant deleterious impact on the quality of care provided. My recent experience with some of the policies of the Board of Registration in Medicine speaks loudly to the effect of intrusive regulation on the maintenance of appropriate standards. Professional staff members of the board had created such a hostile environment between licensed practitioners, the government, hospitals and patients that there were a growing number of highly qualified Massachusetts physicians who periodically considered, or decided on, relocating to other jurisdictions. Recent changes in the composition of the Board hopefully will lead to the establishment of a more productive environment.”