Protecting Doctors During COVID-19 w/Dr. Nisha Mehta

– Hey Z-Pac, it’s your boy Dr. Zubin Damania, ZDogg MD if you’re nasty. Welcome to the ZDoggMD show. There has been a lot of talk in COVID land about how frontline healthcare professionals, particularly nurses and doctors et cetera, but doctors in particular we’re not talking a lot about how are we keeping them safe from things like malpractice from the loss of their livelihoods during COVID and other things along those lines. Well, today’s guest is a practicing radiologist in Charlotte, North Carolina. She’s also a huge advocate for frontline healthcare professionals, leading groups of around 90,000 people across social media and advocating for real change. And we’re gonna talk about things that are in the works today that’ll actually make life better for physicians and other frontline healthcare workers when this is all over. Dr Nisha Mehta, did I say that right Nisha?

– Basically, Nisha Mehta.

– Yeah Mehta, see I’m supposed to be Indian. I was named after Zubin Mehta.

– It’s okay, I appreciate the effort. I think it was good.

– There we go, lets launch into it.

– For a first try, it was great.

– So what are you working on right now? What are the concerns ’cause you and I have talked about this, what are the real concerns that people are showing on the front lines because the press doesn’t talk about these things, so we have to advocate.

– Yeah so I mean I think, I’m probably speaking to the choir here but really when we talk about all the things that we’re talking about with malpractice protections and practice protections and all of these things, we see and grieve this stuff all day but I think the public obviously doesn’t see a lot of what physicians face on a daily basis. And so they’re kind of out there thinking, of course the positions will be fine. And I think that they don’t realize how much stuff is going on in the background and how much COVID-19 is impacting positions on so many different levels. So they see the front stuff, they see the frontline piece all the time. You’re hearing about PPE everywhere, those stories get out because they have a lot of sex appeal. But then there’s all these things that don’t have that same appeal to the media and I’ve been, I’ve talked to basically every major news outlet in the last two or three weeks and nobody wants to run certain ones of these stories. So I’m really grateful to you for I’m giving me the chance to talk about this stuff.

– So Nisha you’re saying that tort reform isn’t sexy? Is that what you’re telling me? Because I can’t think of anything sexy.

– And you know what, there’s a lot of trial lawyers that would appreciate us not talking about those things and so there’s a lot of special, I mean it’s not just the media. When I’ve been on the phone with a lot of different congressional leadership and nobody really wants to talk about tort reform because nobody wants to do it but what I keep trying to emphasize to people is that really it’s really hard as a physician to go out there on the front lines right now and know that your family could be at risk for what you’re doing. And I don’t even know if the word is getting out even some physicians that how much exposure they have to liability right now because I think we always just assume people take care of us but that’s not always the case.

– So tell me more about that because I need to understand better because I’ve gone through this a bit and it’s kind of terrifying. The idea that if you go help somebody or you practice out of the scope of your practice and something happens later on, you’re still legally liable like any kind of malpractice. I mean it’s, it’s insane.

– Yeah so I think that that’s the thing is that we’re all being told, well not all of us but a lot of us have been repurposed or have been told that we’re gonna be doing these other things and what we may not realize is at the end of the day, we’re still physicians and we’re gonna be treated as physicians by malpractice lawyers. And so although we know, hey, we’re maybe doing something that’s outside of the standard of care but we’re doing the best with what we can and we’re following our democratic goals than doing no harm and all of those other things that we’ve promised that we’re going to do, other people are not necessarily going to see it that way. And so for example, if you are, let’s say an endocrinologist and you’ve been practicing for the past 15 years, well technically you’re board certified in internal medicine and if can get repurposed, there may be a trial lawyer out there a year from now who says, well that thing that you did with the vent wasn’t ideal and how do you explain that important certified medicine and they’re gonna slap a lawsuit on you. Whereas you’re saying, hey, I was helping out in a situation that was resourced for I was doing the best with what I could, I tried to get retrained but there has to be some Good Samaritan protection here. And what we’re seeing right now, at least in the bills that are in front of Congress in regards to all of this, there’s Good Samaritan protection but only if you don’t accept pay for what you’re doing. So if you get paid as a physician, so if you are employed by a hospital system and you are doing your job and they say, hey, can you help out in the ICU? A lot of the physicians I’ve talked to say, well I just assume that they’ve taken care of that liability thesis they’ve figured that out. Fact is, is that honestly we don’t have any real assurance that we have. So if something were to happen and you haven’t done it, I mean there’s no trial lawyer that’s gonna be gracious with you and say, well you haven’t practiced that in 15 years. They’re going to say, well aren’t you board certified in internal medicine and how do you respond to that? So there’s liability on that end of things. And then there’s also a whole other scope of liability that isn’t being talked about in terms of, a lot of us are practicing outside of the standard of care. So in radiology, we talk a lot about how many mammograms are being deferred right now for example, or how many screening, if you’re a dermatologist, how many skin biopsies are you deploying?

– Or a pediatrician who’s not able to vaccinate children and then if they get measles, who’s liable, right?

– Right.

– That’s the anti-vaxxers we know who’s liable. It’s the anti-vaxxers but that’s not what the trial lawyers will say, right.

– Right and then the GI, GI, colonoscopies. All these things that are screening things that we’re just practicing outside the scope of care because we’re trying to do no harm. We’re saying, okay, if you’re 72 years old right now, the last place you wanna be used in a medical facility and so we’re saying, let’s defer that mammogram and when you’ve had five negative mammograms in the past five years, the chances of you dying from having a low grade cancer that hasn’t popped up right now versus the chances of you dying from coming into the healthcare system and leaving your house are probably in the favor of you not leaving your house but you don’t have any protection right now on paper that says you can’t sue us for a misdiagnosis ’cause if the patient says, well, I was willing to come in for my mammogram and they told me not to come in. Who’s protecting the physician in that situation, right?

– And this is particularly frustrating because again, they’re asking us to risk our lives, right? They’re asking us to do these things that are out of scope of practice. They’re asking it. They’re even talking about a physician draft at one point where they were gonna bring in retired people and my wife who’s a radiologist like you, she’s like, if they ask me to manage event, I will tell them to go F themselves because I am not taking that legal liability because it’s been, even though she board certified in internal medicine and like you said, so she’s board certified in internal medicine and then went back and did radiology ’cause she’s like, I hate internal medicine ’cause she saw the light. They would have no impetus just throwing us under the bus. And what’s the worst about this is that if we die because we didn’t get appropriate PPE or proper support from a hospital system that employs us, I bet you we can’t sue them. We should try but I bet you that they would put the brakes on that. There’d be some kind of liability clause and some complicated contract you signed that says you can’t do it. So what are you fighting for then in terms of actionable items that we can actually make this better? And how can other frontline healthcare professionals help?

– Yeah, so as you’ve alluded to, we’ve got these communities online, you’ve got communities, I’ve got communities, many other people have got communities and as COVID-19 started to escalate, we were hearing from a lot of people about just all these things that they were worried about, not inadequate PPE, where are the malpractice protections? What happens to the residents who are being thrown out onto the front lines? Who’s protecting them? What happens to our practices which are going under? There’s practices that are shutting down all across the country right now because they can’t stay solvent with maintaining payrolls. Physician practices run at 50 to 60% overhead on average. So it’s very hard for a lot of people to keep their doors open. And we were saying, while you’re sending us out to the front lines and are you protecting us in any of these other realms or are you just telling us to go out there and do our job while you, by the same token are providing bailouts to casinos and all these other places.

– Can I interrupt for a second ’cause this is so important. An average physician practice, if they hire or staff, say a PA or a nurse practitioner that’s over $100,000 in payroll, they are disqualified from getting help from the federal government through the Cures Act. These small businesses are going under, these are our people, our tribe and they’re suffering even though they’re manning these front lines and so you’re saying, well we gotta fight for that.

– Yeah, exactly, so I mean, I feel like it’s been a long time since we’ve stepped up and really taken charge of what it is that we need for ourselves in order to be successful. And I think that COVID-19 has really escalated that because before, when it was all these people coming at us from all these different directions in terms of people who wanted a piece of the healthcare pie, obviously a huge industry, a huge portion of the GDP. And there’s all these people dipping their hands into it. And before they were taking money away from physicians, which obviously was a problem, but I think this really escalated it because now you’re saying, well, not only are we gonna take money away from you, we’re also going to have you risk your lives and we’re gonna have you, your families potentially sacrifice long term because of you being in the profession that you are in and people are starting to say that’s it, that’s enough, we can’t do everything for everyone and not have anybody to protect us. And so what came from that is really this, well, I kinda wish it wasn’t three Ps in it because I mess it up every time I say it. So now I say key three PA instead of CPPPA because it’s kind of like spelling Mississippi when I was in elementary school so it was just too much with the Ps but basically what that stands for is COVID-19 Pandemic Position Protection Act. And what it is is a 14 page document that we’ve given to many members of Congress including senior congressional leadership at this point, outlining on the basis of feedback from these communities of over 100,000 positions. What it is that we think that we need to be successful and be able to go to work every day and do the job that we’re being asked to do without having to worry about so many of these external factors like malpractice and who’s gonna take care of our families if we were to pass away and what happens to those $300,000 in student loans that we’ve refinance but now our families are inheriting for example. So all of these things that people don’t really wanna talk about but when we’re out there saying, hey, are we gonna make this decision to go and practice in this environment? In the back of our heads, they’re all things that we’re worried about in terms of our own health and in terms of our family safety. And so this document basically outlines all of those things that we feel like we need to do to protect physicians, whether it’s mental health coverage for all the things that you’re gonna see. People are seeing their colleagues dying, they’re seeing really young people dying. I mean there’s a lot of this stuff that’s gonna have longterm impact that we haven’t really drawn out yet but they’re all things that are important. And I think if we wanna maintain a healthy position workforce, and it’s not just physicians by the way, there’s language and there are also other healthcare workers, there’s language in there for technicians, there’s language in there for everyone who’s really stepping up to the front lines right now. So we call it the Physician Protection Act because it was put forward by a group of physicians and some of the things in their specific positions but certainly we’re really hoping that obviously everybody gets PPE. Everybody who for some reason becomes either disabled or dies as a result of exposure to COVID as part of their work on the front lines should have some basic protections in place to be able to protect their families.

– Yeah and it’s important that we do this together as physicians and then also with other healthcare professionals ’cause together we have a strong, strong voice. You mentioned that, you’re talking about like almost 100,000 physicians represented across social media who are coming together. That’s one 10th of all licensed practicing physicians in the country, I don’t think AMA, they’ll say they have that many but they don’t like actual active members. They absolutely don’t so this is so, so important to actually have us, I’ve said this before, COVID is the catalyst that’s gonna burn the old system down and rebuild it physician and clinician led in a way that’s really gonna be transformative. There was just an article in Stat News today about they looked at the data now from mid February to April 12th, 20% of all COVID infections in the U.S. are in healthcare workers. If that doesn’t cause us to take our pitchforks out and say, hey, we’re not lifting another finger until you give us what’s in the CPPPA, you listen to the 100,000 healthcare professionals that are saying, hey, we sacrificed our twenties where we might sacrifice our lives. You were saddled with loan debt. We’re running small businesses that barely operate under 50% overhead. We’re in danger of being sued at any minute by vicious, nasty, horrible trial lawyers that are unethical and just are it, I mean the whole, and again and again but then in return we promise that we will hold accountable when we do make real errors and we will be open and transparent and we will have transparent prices and we will lead in a way that our administrators haven’t done. All of that is gonna be crucial and this is a platform. It’s one of the few platforms I’ve seen that’s come out that’s so unified. It’s so hard to lead physicians. It’s like herding cats, right? They all wanna go in different places.

– There’s so many different interests out there and so I think that’s part, I mean, we’ve done a horrible job in the past of coming together but I think the COVID has really brought people together and said, okay, these are things that we can all unite on. And it’s amazing how little controversy went into the wording behind this document as we were going forward. I thought it would be a lot more contentious of a process but everything that we put out and ask people to give feedback on, people were like, yes, absolutely, we need this, we need this, we need this.

– Do you think med school loans should be forgive? Do you think like med school tuition should be waived and people who are not graduating and that sort of thing?

– So that is probably the most controversial, actually, surprisingly the most controversial part of of this. And we went back and forth as a group actually talking about whether or not we wanted to ask for full student loan forgiveness or whether I mean, and I think that it’s important to note that everybody that signed their name on that document doesn’t necessarily approve of every single thing that’s in it. They’re just saying there are things in this document that I can stand behind. So even myself, I don’t necessarily agree with every single thing that’s in there but what we wanted to do was create a document that was representative of what everybody was asking for and just at least get it out there. And then hopefully people can advocate for the things that really speak to them. And I think for student loans, at the very least, we’re not allowed to deduct our student loan interest payments and other people are so what is that? We have half the student loans than everybody else sit on average and we can’t deduct our student loan payments on our texts forms which that makes no sense to me. So in my mind, if we could even get that where we are also allowed to deduct our student loan interest payments, that would be.

– That’d be a start, it’d be a big start. I agree and one of the interesting things is what you guys are doing is actually different than these change.org petitions everyone wants you to sign and this or that petition. This is like you’re putting it in front of Congress and saying this is what we demand so start working on this because and the question is what leverage do we have? ‘Cause I actually think a massive physician walkout would be something we don’t do it because hey, guess what, we took an oath not to do harm but the truth is at some point we have to stand up and say an existential threat of death, lack of support and financial ruin for ourselves and our family that matters, right?

– It matters, it does matter and I think that that’s something that I keep trying to talk when I’m talking on the phone with these legislators. I keep trying to tell them that there is this brewing discomfort amongst physicians where everybody is sort of saying, well at what point is it actually unethical for me to partake in this system? Because, when we aren’t going in there without PPE, we’re potentially at work serving as vectors potentially to hurt more patients. And are we actually doing anybody a service by doing this? And so I think that there’s a lot of ethical issues that have come up over the last few weeks that are really bringing into light what is it that we as physicians have an obligation to our patients to do in terms of speaking out so that we can actually have a sustainable healthcare system because if the entire frontline calls because nobody has PPE, well you’ve done the public and a huge disservice there. So, I mean, if you don’t take a stand about these things right now and say these are things that we absolutely need in whatever form that that stand is. I mean, I think a walkout would be, I think there’s a lot of challenges associated with that that I’m not willing to commit to right now but I think, I do think that it’s very important that we come together as a unified voice and say these things are unacceptable and if we really to be able to take on COVID-19 and every other challenge that’s gonna come because guess what, COVID-19 is not the last problem that’s going to happen in the healthcare system especially when we’ve been on this spiral that we’ve been on for the past decade or two. There’s a lot of changes that need to happen and if we’re not unified and say these are things that need to happen for us to be able to provide healthcare in this country and have a system that’s sustainable, we’ve done everyone a disservice. So I think we’re definitely needing standup.

– You know what I think would be fun. Here’s some acts of civil disobedience we could do that, yeah okay, I’ma throw some out here. What if every single doctor and nurse refused to pay their taxes one year until the federal government intervened on tort reform and on paying us to actually have real outcomes instead of the money games that we’re playing now. What if we all refuse to chart another click in Epic or Cerner or McKesson until we got some of these assurances and had true clinical leadership leading our big organizations instead of the MBA parasites that have never touched patients. What if we actually decided we’re only gonna do the care we know our patients need and we’re not gonna document anything beyond what is absolutely necessary to the care of that patient and I don’t care. And if you don’t get paid as an organization, that’s on you, you figure out how to get paid. I’m gonna take care of patient. And there’s so many ways we could actually lever our power in this country. And the last thing I wanted to say is if we don’t join, and this is controversial in some physician circles but if we don’t join with our nurse and respiratory and dietician colleagues and our, if we don’t join together with them and present a United front, we will fall because they have numbers and a voice and we’re all in this together. So I think if we do that, I think we’ll see a lot of a lot of power.

– I mean, I definitely think here, there’s no question we all need to come together. Like you said, there’s less than 100,000, I mean less than a million practicing physicians in the United States. There are millions of nurses, there are millions of other healthcare workers and I think all of us coming together and saying, we know this system we work at day in and day out. We know what needs to happen. You’ve got to listen to us and take our feedback is, yeah, that’s a no brainer. I think we really have to come.

– Yeah, so tell me some calls to action for the Z-Pac here. How can we get involved? How can we help have a voice?

– So I mean, one thing that I think the congressional members that have seen this have been really impressed by is the speed at which we were able to increase numbers so we talked about a change.org petition. We do have one because we’re trying to get people, we’re trying to show people that we’ve got numbers. So there’s a change.org petition at change.org/help positions and the more signatures we can get on there, the better. It doesn’t have to be just healthcare workers, it can be your friends, it can be your family, it can be your patients that care about you, whoever. I think what we need to do is express that the public is behind us. So I always talk about, when I talk about physician advocacy, I’m always telling people, there may be less than a million of us but every single person in this country is a patient. And so if you can get patients on your side, we get a lot of leverage in Congress. And so I think we, we really need to make sure that we get numbers on that. I would love for people to write their senators to call their senators. I know those are more active things. We’re working on ways to make that easier in terms of just clicks but hopefully if you know a senator, you know a Congressman, reach out to them, say, hey, have you’ve heard of this CPPPA? Reach out.

– We’ve got to work on that name.

– I know I gotta work on that. But yeah, if you’ve heard of this legislation, please, will you support it? We need this, this is important. I don’t think that people understand how big of a deal it’s going to be. If people say, I’m not practicing because I don’t have malpractice protections or I’m not opening up my small business, my physician practice right now because it’s too risky and I can’t make it profitable and I’ve got too much overhead. Well, what happens when we don’t have basic healthcare in community level. Where do those people go? They go to the emergency room and they go to urgent cares. That is the worst place in the world to be right now. And so we need government officials to understand exactly how important it is to protect our positions and protect our position practices right now because otherwise we won’t have a physician workforce. I think we need to drive that home.

– I think we will and I think this episode will go partially towards that. You are gonna share with me links and I’m gonna put in the description. If people wanna join these different tribes on Facebook, maybe you can hit me with some links or some other way that people can get involved and we’ll put it in there and I’ll also link over to your website and different things like that. Nisha Mehta, you are the bomb and just ’cause my wife’s a radiologist doesn’t mean I play favorites. So far I’ve had two radiologists on the show talking about COVID which is great and what I wanna make sure that the Z-Pac understands is that if we don’t use this situation to incur meaningful change in the world for healthcare practitioners and their patients, we have dropped the ball. So we need to take this outrage and this hurt and this struggle that we’re feeling and actualize it into something that actually happens, that’s why I’m so glad.

– Channel it into something productive, absolutely.

– Instead of just throwing feces like we’re really good at doing, let’s throw feces at lawmakers and since the thing is transmitted fecal oral, then they’ll get to share it.

– Horrible.

– So I know, gross, right? It always, I always escalate it to a level that’s just disgusting. Z-Pac, do me a favor. Leave a comment about how you think you can help and what questions you have. Share this video, that’s so, so important and join us together and we’re gonna change this thing for the better. All right guys, Nisha, thank you.

– Thank you.

– Stay safe and we out, peace.