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The UAPD Pulse – By Stuart A. Bussey, M.D.

Health Care Reform Lessons From Haiti

February 22, 2010

By Dr. Stuart A. Bussey, UAPD President

Say what you want about slow or disjointed medical relief efforts in Haiti. Yes, there is chaos and immense human suffering. Hundreds have been saved and hundreds of thousands have not. But at least there are no insurance companies or attorneys making things worse.

Whether you work for a state or county employer or are under the thumb of an insurance payor, you have to acknowledge a certain degree of awe and envy of the providers on the ground in the Caribbean. There are no formularies to follow, no prior authorizations, no claims or utilization review, no attorneys, medical directors or hospital administrators looking over your shoulders in the makeshift ORs. Just doctors helping people. For those of us fortunate enough to have volunteered service in the Third World, a grateful smile is adequate reimbursement.

Governments around the world are now passionately responding with ingenuity and flexibility to this enormous health crisis, superimposed on an already impoverished nation. It is “health care reform” in the extreme. In contrast, our own health care reform proposal is staggering to an uncertain finish line. If any insurance reforms are passed, they will be few—pre-existing condition may be allowed, policy rescissions and lifetime caps disallowed. It would be just a start. Payors, however, will likely retain most of their administrative and bargaining power over doctors. Moreover, they may control greater numbers of patients if there is any individual mandate to buy their products.

It’s a far cry from the hands-on health care delivery going on now in Haiti. Perhaps we should educate our insurance executives. Let’s airlift them over to Port-au-Prince to do triage and assist with amputations.

A Second Opinion

November 22, 2009

By Dr. Stuart A. Bussey, UAPD President

We know it has become increasingly difficult to navigate the political waters of medicine without bumping into a rock or two. A jealous manager or nurse, or even a colleague, can level the “D” word at you. The label “disruptive” can elicit a cascade of aggravation, recrimination and fear in a doctor. It can also threaten your career.

Over the years our UAPD staff and stewards have done an outstanding job in allaying these fears and mending fences. But because of the high stakes involved, sometimes a second opinion is in order. Beginning a year ago our Executive Board began discussing the idea of subsidizing some form of legal assistance for our members, especially for those doctors who need help in deciding whether to fight or settle a disciplinary action. This decision could hinge on an obscure interpretation of a law or practice. Prior to the recent UAPD Triennial meeting the Board passed a resolution to create a legal consultation fund for UAPD members.

Here’s how it will work. The fund can be applied to any current UAPD member who receives a formal written notice involving suspension, termination or limitation of medical staff privileges, or who faces any Medical Board action. The etiology of these actions must have begun while the doctor was an active UAPD member. If approved by a three person screening panel, our Union will provide up to $500 in legal fees per case per year. The panel of attorneys available for these consults will be determined by UAPD. In creating this fund UAPD is responding to requests by our members. We will modify this program over time to meet the needs of our members. If you would like to see a copy of the resolution, check out the UAPD website or call the Oakland office.

State of Our Union in 2009: Standing Tall and Carrying the Message

October 15, 2009

By Stuart Bussey, M.D., J.D., UAPD President

Good morning, UAPD Colleagues, Brothers and Sisters! During a Town Hall meeting this summer an internist stood up and asked his Congressman this question,” Who speaks for the doctors who pull this country’s Health Care wagon?” This short and interesting query triggered a flood of emotions for me, a solo Family Physician of 25 years. Read more …

Report from the UAPD Triennial Convention

October 15, 2009

More than 150 UAPD members from across the state attended the 2009 Triennial Convention and Leadership Weekend in San Francisco. The theme of the meeting, “UAPD On The Move,” was fitting as the attendees stayed on the move themselves during two days packed with exciting and enriching activities.

Read more …

Part of the Solution

September 22, 2009

By Dr. Stuart A. Bussey, UAPD President

As I listened to Obama explain his calculus of health care reform to Congress, I thought of four groups responsible for the present morass. Of course, there are the private insurers who routinely deny coverage to sick people and payments to providers, so they can make their 30% profits. Then there are the malpractice attorneys: they are the invisible pit bulls in our exam rooms, forcing us to practice defensive, expensive medicine. Our patients, who engage in harmful and unhealthy behaviors—overeating and drinking, drugs, dangerous sexual practices—are also responsible for many chronic and costly diseases and morbidities. And sometimes…there’s us docs. We have occasionally, at least unwittingly, performed unnecessary tests, visits and surgeries. We have made medical mistakes though we strive to do no harm.

To help solve the health care dilemma doctors must become architects of health care. We need to shape and push the 2.3 trillion dollar health care wagon, not pull it like harnessed oxen. It will be tricky. We need to shift the focus of care from sickness to wellness, to primary care and prevention—without devaluing the important innovations of specialty medicine. Reviewing the recent UAPD survey, our Union doctors support a public option, which would allow greater care access to millions of poor and uninsured. Our Public sector doctors already do this by virtue of their admirable county and state service. Our private sector doctors need to stand up to greedy attorneys and insurers by advocating for stronger tort and insurance reform. In this regard UAPD continues to weigh in with other groups in Sacramento and Washington.

I hope to discuss these and other ideas with you next month at our free CME on Health Care Reform Legislation in San Francisco on October 2. It’s not too late to register. Call the Oakland office at 510-839-0193 to let us know you’re coming.

President Bussey Updates Members on Bargaining and Furloughs

February 12, 2009

Dear State Colleague:

This past Friday many of us experienced our first mandatory furlough day. Some doctors worked, some relaxed at home, many were still understandably confused. Are these furlough days really legal and will they be fairly implemented? Should federally monitored or funded doctors, such as those working in CDCR, DSS and DHCS/PHS, take any cuts at all? Superior Court Judge Marlette and the Governor seem to think so. But the Prison Receiver, Federal Agencies (CMS, Social Security), UAPD and other unions are still seeking legislative and legal answers to these questions. While legal work and political lobbying go on, I want to share with you some strategies UAPD is taking in our negotiations with the Department of Personnel Administration (DPA).

Those of you who have signed up for bargaining updates via e-mail or have visited the UAPD website (www.uapd.com) know that the Union has made a proposal to substitute voluntary leave days for furlough days. Under our voluntary leave proposal, doctors would be able to choose the number of unpaid leave days per month they would accept, and would have the ability to bank those days for later use. The online poll conducted by UAPD shows that about 66% of our members would be willing to take two voluntary leave days off (no pay, but time is banked) each month until 6/30/2010. We have presented the results of this survey to the DPA and continue to ask them to allow all UAPD represented doctors to choose voluntary leave days rather than face mandatory furlough days over the coming months.

And it is important that, whatever is negotiated, the plan is fairly applied to all doctors, which was not the case for the February 6th furlough day. The Union has learned that some departmental managers implemented the furlough program in a way that made the cut even harder to take—for instance, by requiring doctors to work on February 6th then distribute their unpaid time-off over the rest of their scheduled work days, making it impossible for these doctors to enjoy a full day without work. We have already communicated to the DPA the importance of the fair and consistent implementation of whatever cost-saving plan is negotiated.

Under either a voluntary leave or mandatory furlough plan, it is obvious that a 10% cut in staff time promises to create a 10% cut in services, not a good thing in a system already straining to treat all who need care. We are all aware of the State’s liberal use of contracted physicians and dentists to fill in coverage gaps. We have demonstrated to DPA and other Departments how expensive, wasteful and bad for patient care that contractors are. Our Bargaining Team has calculated that, in the past two years alone, the state has spent over $346 million in just CDCR contracts. Moreover, we have proposed some logical solutions to the problem. UAPD represented physicians should be offered Bargaining Unit 16 positions currently occupied by contractors. The State should freeze all contractor reimbursement increases. And the State should open positions that allow doctors to work extra hours. If hours become available, our members should have the opportunity to capture an additional appointment, as described in Section 7.13 of our MOU. Now is the time to break the State of California of its unhealthy addiction to contract workers, so we will continue to fight for these changes at the Bargaining Table.

Other important contract issues remain open. We are talking with the Receiver’s Office about being more flexible and creative regarding the prison on-call system, for example, by offering higher hourly reimbursement and CTO. Other solutions we’ve proposed include posting an additional appointment (Section 7.13) for prisons with particularly heavy on-call demands, allowing a pooled call arrangement amongst our members, and creating MOD opportunities. In addition we have already presented language to the State that would allow Medical Staffs to become more involved with peer review issues. Court sanctioned practices like PPEC and Mortality Review must not trample the rights of our members. There is already a significant bright spot in negotiations—we have been able to secure a written commitment that all bonus moneys earned by DSS physicians is pensionable. And we intend to propose a revitalized bonus plan for these doctors.

We thank UAPD members for their continued interest and support during the most difficult negotiations in memory. The U.S. and California are in dire economic shape today. But the budget will be passed. The Feds will help our state recover. The economy will improve. In the meantime, our Bargaining team continues to fight for fairness and accountability.

To receive e-mail updates and participate in online polls, please update your e-mail address by visiting the “Contact Us” page on the UAPD website (www.uapd.com) or by sending an e-mail with your name and work location to the UAPD Oakland Office (uapd@uapd.com). Check the UAPD website frequently for new developments.

In Solidarity,

Stuart A. Bussey, M.D., J.D.

UAPD President

UAPD President Stuart A. Bussey, M.D., J.D. – Elected August 2006

August 14, 2006

Stuart A. Bussey, M.D., J.D., is the third President of the Union of American Physicians and Dentists (UAPD) since its inception in 1972. Dr. Bussey brings to the position a wealth of working experience. At various times in his life he has been a truck and taxi driver, agricultural worker and general contractor, a Peace Corps volunteer, radio show host, elementary school teacher, flight surgeon and pilot, attorney, medical director, and family physician. He has been a member of a Teachers’ Union, the Teamsters, and most proudly a UAPD member since 1990. Dr. Bussey believes deeply in the principles of unionism, especially as it relates to the medical community.

As a rank and file member, steward, Board member, Vice President, and now President, Stuart Bussey has fought for the rights of both patients and UAPD physicians and dentists. His lobbying and testimony in both State and National legislatures has resulted in better salaries and working conditions for UAPD members, protection of peer review and civil service positions and prison health care reform. His meeting with Social Security officials in Washington, D.C., helped preserve hundreds of physician jobs. Dr. Bussey believes that all sectors of our union—private county and state—must communicate and learn from one another. This includes contract negotiation techniques, grievance filings and political strategies.

Dr. Bussey is one of a few hundred physicians in the country who is also an active attorney. As such he continues to apply his legal knowledge to defend UAPD members who are unjustly accused of wrongdoing. He has been affiliated as a Fellow of the American College of Legal Medicine since 1993. He is on the Editorial Board of their Legal Lessons Magazine. He hopes to use this affiliation to broaden UAPD’s legal resources. He also wants to forge alliances with other likeminded organizations.

Dr. Bussey has been a State of California Medical Consultant in the Social Security Disability Evaluation Division since 1990. He has had a solo family practice in Walnut Creek, California since 1984. As both employee and employer he understands the rights and responsibilities of the worker.

As for his academic credentials, Dr. Bussey graduated with honors from Dartmouth in 1968, has a masters’ degree in Human Development from the University of Chicago, an M.D. from Loyola Medical School, and a J.D. from Golden Gate University. He completed his family practice residency at the University of California Irvine in 1981.
In his spare time, Dr. Bussey likes to fly his Cessna 172 around the state, play and listen to music, golf and, spend time with his wife, Debbie, and 2 beautiful daughters, Laurel and Ellen.

“Cigarettes, Seatbelts and Guns”

November 30, -0001

By Stuart A. Bussey, M.D., J.D, UAPD President

We need more light instead of heat.

I’m not referring to global warming, but the emotionally charged arguments between those on opposite sides of the gun issue.  Everyone, including doctors, has differing opinions about gun access, hygiene and behaviors, and the role of government in regulating them.  What will help clarify this debate is thoughtful and comprehensive research on firearm violence in America.  Ever since medical minds analyzed TB and smallpox and developed strategies of quarantine and immunization, the scientific community has guided policymakers in important areas of public health.  It is time for our politicians to reframe the gun violence conversation from one of constitutional rights to one of solving a public health epidemic.  They have done this before.

Take the tobacco and cigarette problem.  Tobacco in America has been a staple since the 17th century, and cigarettes since the 19th.  They were smoked first by Southerners, soldiers, then everyone, as advertising flooded 20th century media.  But doctors began examining the data and speaking out.  In 1938 Dr. Raymond Pearl of Johns Hopkins reported in a scientific paper that smokers do not live as long as nonsmokers.  This triggered a line of epidemiological research that culminated in the 1964 Surgeon General’s 387 page report.  It clearly demonstrated that cigarettes were causally related to cancer in both men and women.  Federal and State regulations have since followed, which have helped protect the public from the effects of first and second hand smoke.  As a result morbidity and mortality from smoking has decreased.

Another public health campaign culminated with the installation of seatbelts and airbags in cars.  As early as the 1930s physicians equipped their own cars with seatbelts and urged others to do the same.  The AMA came out with a formal policy statement in 1954.  As more motor vehicle accidents and deaths occurred, public and private research by universities and the National Highway Transportation Safety Agency (NHTSA) increased.  By identifying the exact mechanisms of injury–ejection, head and neck trauma, etc.–the researchers helped legislators enact the best corrective measures.  The NHTSA has credited the use of seatbelts with saving over 15,000 lives every year.

Collecting relevant and accurate data is essential before suggesting solutions or regulating any public health problem, especially one as sensitive as firearm abuse.  The rights of responsible gun owners must not be abrogated.  Largely due to NRA pressure in the ‘90s, Congress eliminated research money earmarked for gun violence studies.  But after the recent Sandy Hook shootings, President Obama has charged the Center for Disease Control (CDC) to resume analyzing data on the who, when, and where of gun violence.  We need to use multivariate analysis and other statistical models to identify the actors and circumstances of homicides, suicides and accidents as a result of firearm use.  Then we can treat the problem with a more logical paradigm.  To that end, UAPD is sponsoring State legislation with our own member, Dr. Richard Pan, an Elk Grove pediatrician and Assemblymember.  We are seeking to collect data from every County in California to detect trends in firearm violence.  We will also be discussing similar studies with another UAPD member, Dr. Ami Bera, a US Congressman from the 7th District of California.

Regardless of our personal views on gun ownership and use, we doctors have a duty to keep our patients and their families healthy.  Unlike the state of Florida, which prohibits doctors from asking patients about their gun use, California allows us that freedom of speech.  We must continue to exercise  that right by educating our patients on safer personal and public health habits regarding cigarettes, seatbelts, and guns.