A “Conversation” with Representative Ami Bera, MD
by Sherry L. Blumenthal, MD, FACOG
Past Chair, Pennsylvania Section of ACOG
Obstetric Trustee, Board of Trustees, PAMED
I attended a session at the University Of Pennsylvania Leonard Davis Institute Of Health Policy on Friday, March 21, 2014. The featured speaker was Ami Bera, MD, Democratic Congressman from CA-07, and co-sponsor of the Safe Harbor Bill (House Resolution 4106) with Representative Andy Barr, a Republican lawyer from Kentucky. The bill was introduced on February 28, 2014 and has no Senate sponsor yet.
HR 4106 would provide some protection for a physician who, when sued for a poor outcome, actually followed the guidelines or standards of his/her specialty in that geographic region. A panel of three physicians of that specialty would look at the case and give a recommendation. The resolution does not limit the right to sue or include caps, but, if enacted, it would provide some sense of security if a physician is practicing good medicine but has a poor outcome in spite of their efforts. An example would be one of us who follows the recommended cervical cancer screening guidelines, does not do yearly cytology on designated low risk women, and is sued when a rare patient is diagnosed with cervical cancer.
Dr. Bera, who has received support from the OB/GYN PAC, also discussed his views of the Affordable Care Act and SGR Repeal. He supported the bill and voted for it, even after an amendment that led most House Democrats to vote against the bill. We will most likely once again get a short-term fix and have to start all over again next year. This is a major disappointment to medical societies.
Dr. Bera is on the House Science and Technology Committee and supports ACOG in our efforts to keep legislators out of our exam rooms. As we all know, not everyone on that committee accepts science as evidence when making decisions. One of the physicians at the fundraiser held after the March 21st session mentioned the “gag-rule” in Pennsylvania about discussing the health effects of fracking when patients inquire. Again, this is government (Commonwealth of Pennsylvania) interference with the practice of medicine. It also violates our first amendment rights. Dr. Bera also gave the example of a bill passed in Florida that prohibits physicians from asking patients if there is a gun in their home. He was appalled that physicians could not ask a suicidal patient that question in an attempt to prevent a death!
Dr. Bera addressed the changing healthcare landscape where ACOs will replace the usual fee-for-service system. The reasons are primarily economic, but the hope is also that reducing variation in the way care is delivered for specific diagnoses will also improve quality. For instance, most of us are already seeing restriction by our hospital departments in elective induction of labor before 39 weeks. Those of us still in private practice may not be too happy about the changes that are already occurring and inevitable, but we will soon have no choice. Dr. Bera believes that these organizations should be privately run, a concept with which most of us can agree. We certainly do not want more government interference in the practice of medicine.
The theme of this year’s Congressional Leadership Conference was an emphasis on “Purple,” meaning supporting bills that have bipartisan support. Dr. Bera believes, as does ACOG, that bipartisanship is needed to overcome the frequent stalemates in Congress. While many of the members are very reasonable one-on-one and want to do the right thing, partisanship returns when a vote is cast. Dr. Bera does agree with ACOG that we need more physicians in Congress. I am certainly glad that he made the decision to run and wish him luck in his re-election campaign.
On March 31, 2014, the Congress passed another "patch" defeating SGR Repeal. It was a blatant political move.