EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/76185
July 2012 EW NEWS & OPINION A novel approach to charitable care Chief medical editor's corner of the world by David F. Chang, M.D. 13 A t the 2012 ASCRS Winter Update meeting, I met attendee Jeffrey Liegner, M.D., and heard him share the amazing story of his newly opened free eye clinic during a workshop on ethics. Jeff originally practiced in Oregon before opening his solo private practice in New Jersey 15 years ago. In addition to being a volunteer attending at the New Jersey V.A. Hospital, he has spent the last 3 years developing a free community eye clinic that is entirely separate from his private practice. This is a remarkable story, and the reasons that he did this are both interesting and inspiring. I interviewed Jeff for this month's column, and I hope that you enjoy learning about how and why he separates this charity work from his own private practice. You can learn more at www.freeclinicnewton.org. David F. Chang, M.D., chief medical editor Dr. Liegner examines a patient at Free Clinic Newton Source: Dan Freel/New Jersey Herald Dr. Chang: Tell us what made you decide to organize a free eye clinic. Dr. Liegner: I set out to create a free clinic in my community in order to address certain frustrations that I have personally experienced in healthcare. In all our practices, and not just Watch a video about Free Clinic Newton on your smartphone or iPad using your QR code reader. (Scanner available for free at your app store.) Or view Dr. Liegner's video at: youtu.be/6WehUV6MBCs with ophthalmology, we are deliver- ing free care to the poor and under- served that is hidden inside our offices and not visible to the com- munity or the policy makers. In some ways, our profession has suf- fered an erosion of public recogni- tion and fundamental respect for the many wonderful ways we care for our citizens. This free clinic simply moves these patients receiving my charity care to a much more visible and highly regarded entity, now rec- ognized by our community for its charity. I call this the "Marcus Welby Effect" of restoring and reclaiming our altruistic position as respected healers and leaders. Second, this free care done in our offices and surgery centers carries with it the same liability exposure of any medical services we provide; in the past, when I performed free cataract surgery on an indigent pa- tient, I had to consider the risk expo- sure in my decision making. One pri- mary reason for American physicians going overseas on medical missions and performing free surgery on that country's local poor is the adversarial atmosphere of malpractice liability here in the U.S. This issue and liabil- ity exposure is completely and dra- matically altered inside a free clinic. The Federal Torts Claim Act (FTCA) and federal recognition of the free clinic provide federal protection for malpractice due to alleged events re- lated to this free care. Third, with the significant shifts in healthcare delivery and the gov- ernment's intrusion into the patient- doctor relationship, aggravated by job loss and a recession economy, I have been concerned about the pro- fession of medicine and my ability to serve our communities in the eth- ical manner I expect. The level of regulatory intrusion and high degree of clinic interference in our practices has not been seen before. The free clinic, which does not receive any state or federal dollars, becomes an oasis from bureaucracy and regula- tory excess. For some doctors, their volunteer hours in the free clinic in- vite a practice of medicine refresh- ingly different from their private offices. Fourth, the local emergency rooms, partly due to the Emergency Medical Treatment & Labor Act (EMTALA) and related government regulations, and partly due to our declining economy, are swamped with non-emergent problems from significantly poor individuals strug- gling with few healthcare options and limited dollars needed for sur- vival. The free clinic offers an outlet for people who can't afford a private practice option. Even Medicaid re- cipients, when they have time away from low-paying jobs, have a diffi- cult time finding a physician's office that is open and willing to take their government card. Next, I'm a believer that charity should be locally provided and supported by community citizens united to support local causes and help their less fortunate neighbors. And I object to state gratuities and federal entitlements that foster a sense of welfare without individual opportunity to rise out of it. In my opinion, the current shifts toward a greater entitlement to subsidized healthcare and a centralized federal delivery model will ultimately lead to our professional destruction and a worsening of our collective wellness. continued on page 14