Surgery Center of Oklahoma Blog

I have moved the blog to a new location.  Internet searches can’t find this blog attached to our website so we’re moving it off site to a new spot.  Here it is.   This is an exciting development for the blog and for the surgery center, as our facility will be much easier to find for those needing affordable surgical help.  We are also developing a FaceBook page for the surgery center that is also a very exciting development.  All new blogs will be displayed there, as well.  I hope that the FaceBook page will provide a forum for many discussions about the applicability of the free market to the practice of medicine and many other topics.

Check out our new site and look, and let me know what you think.

G. Keith Smith, M.D.

Garth Brooks wins.  The jury actually wanted to award him more money than the judge had instructed them was the maximum.  According to news reports, the jury took all of fifteen minutes to decide the amount of the punitive damages.  Brooks got his $500,000 back and an additional $500,000 in punitive damages, the maximum according to law. 

Brooks afterwards praised the jurors for their courage (hmm..why would this verdict require courage?).  The Integris spokesman stated that they would consider an appeal.  Yes, he said that.

One of my partners made a great point yesterday regarding this lawsuit.  Imagine for a moment that you are an MBA student at Harvard or the Wharton School of Business.  The professor places the following scenario before the class for discussion:  You operate a large not-for-profit business that receives a $500,000 donation from a local celebrity with whom a misunderstanding subsequently ensues.  Do you: A)give him his money back as he requests or B)go to court to fight it out, all the while knowing that your brand is now covered in mud?

The answer to this is so clear there must be more to the story.  There has to be.  Here are some questions.  Who was the source of the email to the CEO,  Moore, from the Integris Foundation that was so damning in this case, the one that stated Integris’s intention to make Garth Brooks work hard as hell to get his money back?  Rumor has it that an audio recording of someone at Integris Foundation calling Brooks “a dumb country singer” was influential with the jury as well.  What exactly is the relationship between Integris and the Integris Foundation?  What on earth was going through the minds of the folks at the Integris foundation when they took this giant celebrity on?  Why was Moore hung out to dry?  Was he taking a fall for someone else?  Someone at the Integris Foundation, perhaps?  If Moore was rogue in his actions, Integris would have fired him and given Brooks his money back, I think.  The newspaper said that Integris made $200,000,000 in one recent year.  What?  I thought they were not-for-profit.  That’s pretty good for going broke from their emergency room losses for the indigent.  Oh.  And I guess they really did need the revenue from the provider tax!   Where did this money go?  Did it go to the Integris foundation?  Is this just a spill over company serving to soak up the giant profits of this outfit?  How can anyone watch all of the TV commercials and print materials coming from Integris and take them and their supposed “mission” seriously now?  How can someone not see an affiliation with Integris at this point as a black mark, a liability?  Think they’ve overdone the cost-shifting thing a bit?  Think that insurance companies that funnel people they cover to Integris preferentially will have some explaining to do regarding their arrangements with this bunch?

I could go on.  My point is that this lawsuit has raised more questions than I think the folks at Integris would have liked.  It sounds to me like Brooks hit a brick wall in his attempts to get his money back and sued them, only to find Integris all too willing to return it.  But by that time Brooks was pissed, and rightly so.  Moore, the Canadian Valley CEO,  wasn’t acting on his own, more than likely, although he certainly took the fall for the mothership.   How was he convinced to assume this role?  If Integris has the hubris to appeal this ruling, perhaps we’ll get answers to some of these questions.

I think I’ll call the Integris Foundation and offer them $50 for the naming rights for their next building.  Might be the best offer they’ll get for a decade.

G. Keith Smith, M.D.

This article is worth reading.  The author is partly right, but mostly wrong.  Basically, the author busts Romney on the fact that Romneycare is the same as Obamacare.  Ouch.  The only thing worse for Romney is his pathetic attempt to convince everyone otherwise.

I would like for you to notice something in Romney’s remarks and continue to look for it in all of the articles on health care that you see.  Notice how the focus has changed from the cost of care to making sure that everyone has coverage.  In the beginning of the “health care debate,” the focus was on the high cost of health care.  The focus now is clearly on “making sure that everyone has insurance.”

Pardon me for returning once again to Murray Rothbard.  Cui bono?  Who benefits?  Put on your cynical hat for a moment and think about it.  I think one clue to the answer is to look back at those who lobbied hard for Obamacare and Romneycare.  The American Hospital Association and the medical corporate giants pushed hard for this because with everyone forced to buy/carry insurance, hospitals will be paid for any and everything they charge/offer.  The insurance industry was supportive because everyone will be required to buy/carry their product.  The worst nightmare for this cartel is for price transparency to rear its head and result in  a price war.  Healthcare price deflation would take a lot of wind out the foul bag fueling the cause for universal coverage.  Imagine if the price of care was actually affordable.  There wouldn’t such a pressing need for insurance coverage.  Ouch.

We have been delivering affordable care at the prices listed on our website for four years now.  Our pricing has been used by patients to leverage area hospitals to lower their prices.  Our pricing has allowed Canadians abandoned by their government system to obtain care.  Our approach has been consistent with free market principles unlike the approaches raining down from these corporate shills.

G. Keith Smith, M.D.

Dan O’Connor writes in the trade journal “Outpatient Surgery,” about the distracting personal electronic devices in the operating room.  He says that more and more doctors and staff are surfing the web and are “glued to their gizmos and gadgets, oblivious to the patient lying before them.”

He is partly correct.  More and more doctors and staff are horribly distracted in the operating room and in other clinical areas.  They are distracted by the computers installed to create digital medical records.  This is the ultimate distraction, one that can ostensibly be justified.  You see, it’s sort of OK in some people’s minds to ignore patients because they are struggling to enter all of the data in to the hospital computer.  Walk in to any operating room with electronic medical record keeping and the circulating nurse will have his/her back to the patient for almost the entire case, frantically typing, hoping to complete the operating room record prior to the case’s conclusion.  This is the new and dangerous distraction introduced into the clinical area that has left patients feeling more abandoned than ever.  This is the new and dangerous distraction that serves as a justification for nurses’ absence from the patient’s bedside and their lack of patient contact. 

The electronic medical records industry has bought a lot of advertising and passed a lot of money around.  Their lobbyist and mouthpiece in the beginning was Newt Gingrich.  This industry has been very effective in selling their product and fending off the naysayers.  I have talked about the disaster of the electronic medical record in the operating room in other blogs.  The idea that this technology’s introduction to the operating room is somehow not distracting to patient care and “personal electronic medical devices” are, strikes me as strange and incredibly inconsistent.

We do not have computers in our operating rooms at the Surgery Center of Oklahoma.  We do not keep electronic medical records. 

Don’t plan to.

G. Keith Smith, M.D.

My doctor (yes, I have one other than myself) has opted out of Medicare and almost all insurance plans.  Let me tell you why this is so wonderful.  You see, I know that she is working for me.  She has my best interests at heart, not that of the insurance company, not that of her employer (she is, of course, independent and self-employed), not the interests of Uncle Sam.  She is old school.  She spends a lot of time educating her patients about their conditions, advises what she believes to be the best course of treatment and makes darn sure that the patient owns the responsibility for their disease and its management.  I believe that her approach to medicine is becoming more and more rare (and that much more valuable and in demand).  She is hard to get into.  Her schedule is booked.  Many of her patients are Medicare patients, but they continue to see her even though Medicare never enters the picture.  I hope that anyone reading this blog is lucky enough to have a doctor that is truly your advocate, working for you without compromise. 

A friend of mine recently called me needing help getting in to see a specialist.  I made the call to the physician and he promptly contacted my friend and told him that he didn’t accept his insurance.  My friend called me disappointed and asked me to find him someone else to see.  Now keep in mind my friend isn’t what anyone would call “poor.”  I said,”..are you nuts?”  “Don’t you know what you have stumbled in to?”  “He doesn’t take your insurance because he doesn’t have to!”  I recommended that he call this physician back and tell him that he wanted to see him and that they could deal with each other without involving the insurance company. 

It seems that just when I think that the medical world has completely lost its way, I think about my doctor and how she operates and practices.  Then I hear about physicians like the one to which I sent my friend.   Understand that these doctors are at war with every fiber of what mainstream medicine represents.  These are extremely tough, principled individuals that are determined to stay the course in spite of pressure, threats, you name it.  They represent what Albert Jay Nock called the “remnant.”  Think about the doctor I’ve written about who accepts a cup of coffee from one of his Medicare patients as payment in full.  I understand he took a plate of cookies recentlyas payment.  Chickens, vegetables, ironing services and home-cooked meals are acceptable payment methods for one of my very favorite physicians here in the Oklahoma City area!

I am fortunate and honored to have known many members of the medical “remnant” over the years, even more fortunate to claim my physician and many of my partners as members of this group.  “To the remnant!”

G. Keith Smith, M.D.

In case you have been out of the country or have been living in a hole, Garth Brooks is suing Integris hospital system for breech of promise.  He is arguing that a $500,000 donation solicited from him by Integris was to result in a women’s facility in Yukon named after his mother.  No such naming occurred.  He wants his money back.  Integris said “no.”  Integris says they promised no such thing. Off to the court house.

Garth Brooks is no fool.  He has sold 5 million more albums than the Beatles.  He is second only to Elvis Presley in sales of solo albums.  He is credited with making country music a worldwide phenomenon.  He is no stranger to contracts and deals.  More than a talented musician, he is a good businessman and well-liked by the people close to him.  Who does Integris think they are messing with?

An Integris email (it’s unclear whether it is the Yukon CEO, Moore, that wrote this or someone at the Integris Foundation where the money is) said “We may not deny Garth access to the money, however, we sure as hell can make him work to get it.”  Doesn’t sound like a not-for-profit, charitable outfit to me.  Integris went on to spend another 27 million at the Yukon facility, according to news reports.  Wonder where they got that dough?

Seriously.  Did the Integris crowd think that they were so big and bad that they could wage war with Garth Brooks and somehow come out on the rosy smelling side in the public relations game?  Did they think that emails like the one mentioned above (I’m sure there are others) wouldn’t surface?  The Integris bunch apparently sells the naming rights to their facilities for much more than $500,000, it seems.  Garth balked at a solicitation of 15 million to name an entire facility after his mother.  I guess that $500,000 just isn’t enough money to get the attention of this not-for-profit outfit.  So….why didn’t they just give it back if $500,000 doesn’t mean enough to them to name the building after his mother?  Did they say “no” to Brook’s request for the return of his donation, thinking that they could chisel the other $14,500,000 from him they originally desired?

Oh.  Then there’s this.  How many times has Integris sold naming rights to their facilities?  How many millions have they successfully solicited?  How much do you think they paid for the naming rights of the NBA facility?  I think these are all very interesting questions and have led me to believe that this little not-for-profit organization is acting as if they care about money very dearly, maybe even enough to make a profit, certainly enough to go to war with the giant Garth Brooks.  Integris has been on a spending spree lately,what with the new hospitals, aggressive buying of physician practices and ad campaigns.  Where did they get all of this money?  Their charges for the same procedures we do at our facility are many times what we charge.  Think this charitable, not-for-profit hospital has overdone the cost-shifting thing a bit?

Best of luck to the Integris Foundation in their future fund-raising attempts, particularly those that purport to return naming rights.  Keep in mind that it is large hospital systems like Integris that lobbied hard for Obamacare.  You know…they were going broke taking care of all of the uninsured people that came to their emergency room.  Garth Brook’s lawsuit provides an insight into just how interested in money and profit these “not-for-profit” outfits are.  The good news, I think, is that win or lose, Garth Brooks comes out smelling like a rose and Integris will suffer the scrutiny they have basically begged for.

G. Keith Smith, M.D.

Ok.  I promise I am working on it.  There is almost too much to blog about on this one.  Right now I’ll just say that the worst thing that could happen for the folks at Integris is to win this case.  He will write songs about them and they will sell in the millions.  Call it “Somebody Done My Momma Wrong” song, or something like that.  More later.

G. Keith Smith, M.D.

I have never met Rufus Fears.  I know several people that have attended his classes at the University of Oklahoma.  He has been held up as a credible scholar by the people at OCPA (Oklahoma Council of Public Affairs) for some time now.  He is a champion of limited government and regularly makes the case for scaling it back to one like this country’s founders intended.  His historical and philosophical justification for this is compelling and I would argue is libertarian or Jeffersonian.

Sometimes you can confirm what you think you know about someone by examining what their enemies say about them.  The gonorrhea socialist (I have described this condition in a prior blog) Richard Wells attacked Dr. Fears in our local paper today with a vicious letter to the editor.  His letter is the typical angry and vacuous rant of a crybaby socialist.  ”It’s not fair,” is screaming from the page!   The last jab at Dr. Fears is a long paragraph that says nothing but attempts to poke him in the eye at the very end…pathetic. It is safe to say this man has never read Bastiat.

I quote Mr. Wells from his letter:  ”Aside from the fact that this is the same House of Representatives that’s overspent, Fears’(sic) solution of ‘cut government spending, cut it again and then cut it some more’ ignores the fact that a considerable body of opinion recognizes that a solution to our very real fiscal woes must depend on more than simply cutting spending.  Many argue it must be a combination of reduced spending, increased revenue, finding more efficiencies in programs that are specifically costly and developing new skills in a changing labor force.”

Now keep in mind that Mr. Wells (it’s actually Dr. Wells, David Ross Boyd Professor of Political Science-Emeritus at O.U.) has a Ph.D.  He’s supposed to be a logical, rational guy.  You know, use his head.  Facts and figures kind of stuff.  He is talking about the economy.  What does he say?  He says that Dr. Fears has ignored the fact that a considerable body of opinion…..WHAT?  Later…“Many argue....”….WHAT?  That is the basis for his disagreement with Dr. Fears?  Really?  I’m laughing right now!  What kind of teacher was this guy?  I’m guessing that he has some prior beef with Dr. Fears.  Perhaps few attended his classes while Dr. Fears’ classes were standing room only.  The next time I am discussing the efficacy of a drug used in anesthesia, I will say, “..a large body of opinion has it that this drug is great,” and see what the other side says next!  ”Many argue that this drug is safe.”  Convinced, aren’t you?!

I look forward to meeting Dr. Fears some day and maybe even calling him a friend if men like Mr. Wells are his enemies.

G. Keith Smith, M.D.

I think there are several different ways to look at the SOPA legislation.  You could believe that it is simply delivering on a promise to the TV/music/movie industry, having accepted bribes (campaign contributions) from them.  I would certainly be in that camp with you if you believed that.  You could believe that the sponsors of this bill are actually concerned about intellectual property rights and believe that this legislation is a proper role for government in that confiscation of property is involved.  I would probably not be in that camp with you if that is what you believe.  Here’s why.  The concept of intellectual property and whether it actually is property, has been and is fiercely debated.  I doubt that our wonderful leaders in D.C. are up on the latest in this struggle amongst intellectual giants.  Note, too, that leading the pack attacking this bill are those who would benefit most from the extreme protection of intellectual property:  those in the software/computer/online industry.  I find that interesting.  Inconsistencies like this make me wonder what is really behind a bill like this.

That brings me to my point.  Is there something hidden, some hidden purpose behind a bill like this?  One doesn’t have to be a paranoid schizophrenic to ask this question.  Many times, I think, there are anonymous “ghosts” who benefit from bills like this.  ”Let’s tell everyone that we need this to fight terrorism so they won’t know what it’s about.”  ”Let’s tell them that it’s for the children so no one can politically stomach questioning this bill.”  You get the idea.  You think this hasn’t happened?  Really?

Cui bono?  Who benefits?  Rothbard, once again.  I would encourage you to mash all legislative initiatives through this filter.  When the answer emerges, I think we have a better idea of why we get the laws we have.

Who benefits from Mao Tse Tung-like control of the internet here in the USA?  Do you ever have these thoughts, that powerful men are corrupted by their desire for even more power and would do anything to get it?

Who benefits from all of our medical records being in a digital database?  Ah..you’ve heard how safety will be promoted if any emergency room on the planet instantly knows your meds and allergies and medical history, haven’t you?  Or is there something else driving this?  When medical rationing begins none of this information will be used to cull out the “too expensive to treat” group, will it?  Do you ever have these thoughts?

I think that SOPA is a window into the world none of the really powerful wants us to ever see.  This is incredibly heavy-handed martial law, police state kind of stuff.  I think more  people will begin having these skeptical, cynical thoughts as time goes by and as more of this kind of swill raises its head.

G. Keith Smith, M.D.

Someone very near and dear to me has suggested that I do a blog about the Stop Online Piracy Act.  I had been thinking about doing this but hadn’t made the connection with health care until she pointed it out.  Here goes.  Simply, SOPA is like any other bill that comes before the gang in D.C.  It bestows an advantage on one group at the expense of another.  Very simple.  All you have to do is identify the players. 

Murray Rothbard (I keep coming back to him) took this a step further.  He said that governments are historically formed in order to bestow an advantage on those wanting the government, an advantage  that was otherwise not available to them through free and mutually beneficial exchange.  I mentioned Rothbard at breakfast with some Congressmen last month and they confirmed that his idea was indeed correct.  The vast majority of legislation concerns granting an advantage to one group over another, usually in the form of placing the less well-funded group at a disadvantage.

So who are the players in SOPA?  Check this out.  This site reveals the source of the money given to one of the sponsors of SOPA, so-called conservative Texas legislator Lamar Smith.  Look at the money he received from cable companies and the TV/Movie and Music industry.  Take a look at this guy.  Look at the sources of his loot.  I could go on.  Every one of these goons makes their fortune by ripping off one group (in this case the taxpayers) to benefit another.  Now on the floor of the senate or the house, the members must obey certain rules, rules that prohibit a member from musing about the motives of their fellow members when it comes to legislation proposed.  Outside of those chambers we operate under no such constraints.

But can you imagine if the links on which you just clicked above were mysteriously blocked out, unavailable for your viewing?  That is the power that this SOPA would give our magnanimous tyrants.  Ignorant of the bribes they receive for the favors bestowed, one would  be in no position to accuse them of the double dealing that characterizes their activities and plunder. 

Can you imagine that blogs like this would be allowed to exist if the health care gangsters had their way with internet content?  Can you imagine that the large and powerful hospital associations would allow transparent and online pricing to continue to embarass them every day as they continue the charade of their “not for profit” establishments? 

The political leaders of our federal and local governments will give us the police state they all desire if we let them.  Congratulations to all whose anti-SOPA efforts have raised awareness of this horrible  legislation.  We must remain vigilant if we hope to keep these fascists and their jack-booted legislation at bay.

G. Keith Smith, M.D.