[Jimmc414]

It's easy to make this a story about top surgeon with a God complex, but the bigger story is the regulatory environment that allows this to happen.

A doctor was billing Medicare for seeing up to 70 patients a day - more 15-minute visits than any other doctor in the entire United States. No regulator noticed this or acted?

Multiple insurance companies paid for 11 years of Stage 4 lung cancer treatment without ever requiring proof the cancer existed. Not one claims adjuster or medical reviewer caught this.

Hospital administrators let him make himself both oncologist AND primary care physician for his patients, creating a closed system with no oversight. They let him take over end-of-life care despite concerns about suspicious deaths.

When hospital CEOs tried to question his practices, he organized campaigns to force them out. Hospital administrators chose protecting revenue over protecting patients.

The medical board failed. The DEA investigated but only pursued civil penalties. Law enforcement seems uninterested in investigating multiple suspicious deaths.

What's most disturbing - after all this came to light, his medical license was renewed in 2023. He can still practice medicine and prescribe drugs today.

The whole thing exposes how profit incentives in healthcare can override patient safety at every level and the regulatory framework that we pay to protect us is part of the problem.

How do we fix a regulatory system that fails at every level to protect patients?

[griomnib]

The story does an excellent job of spreading blame, as evidenced by the figures you cite from the article.

But a journalist’s job is to weave those facts into an actual story, which they’ve excelled at.

This deserves Pulitzer consideration.

[0xcde4c3db]

(Context note: I started writing this as a top-level comment, but I think it ultimately fits better as a concurring reply here.)

For all of the galling failures described in this story, I see it first and foremost as an indictment of the (non-)system. If a plane has a rough landing that results in so much as a sprained ankle, we expect everyone involved with that flight to be up to their eyeballs in an NTSB investigation that will produce a thorough and authoritative account of the failure. Alaska Airlines Flight 1282 (aka the 737 Max door plug blowout) officially resulted in 3 minor injuries, and that was a massive scandal that prompted a tidal wave of scrutiny against Boeing and perhaps a dozen high-profile pieces about how its engineering culture was undermined by McDonnell Douglas's management culture. At least as many people have evidently been fatally poisoned at St. Peter's.

But we apparently can't investigate medical failures with even a modest fraction of that level of robustness because... uh... reasons. The knee-jerk deflection is that medicine is messy and doctors are due a certain amount of deference for judgment calls in the context of the situation; are the same points not also true of aviation and pilots? Suppose that Dr. Wiener is entitled to walk away a free man because of a non-blame-oriented culture of dispassionate root cause analysis. In that case, we're due (and he's due, for that matter) a very detailed and public accounting of exactly where the failures occurred, whether they're his or others'. But maybe we're just not ready to look this shit in the eye.

(I'm also making a note to myself to double my usual donation to ProPublica this year; they've been kicking ass at the sort of muckraking that we haven't seen nearly enough of in the past 15-20 years)

[nine_zeros]

> How do we fix a regulatory system that fails at every level to protect patients?

By removing the profit incentive and making the medical system just a job.

No more shareholders or execs or CEOs or partners.

Doctors can work in government sponsored facilities for a salary. No itemized CPT codes with varying costs.

No incentive to cheat.