Op-Ed: The Unexamined Life

(The contents of this article are the opinion of the author and not necessarily of the Gem State Patriot.)

I was approached last week by several members of the St. Luke’s medical and nursing staffs about an article that Dr. David Pate placed on his own blog regarding the actions of Dr. Ryan Cole and the inaction by our State Board of Medicine regarding Dr. Cole’s license to practice medicine in the State of Idaho. Considering an article that I wrote last week about a ruling written by Federal Judge Willian Shubb of the Eastern District of California IX U. S. Court that addressed many of the issues in Dr. Pate’s blog, I thought several other comments were in order. My article is referenced here along with a link to the ruling itself:

https://gemstatepatriot.com/blog/proven-science-cant-be-changed-by-legislation/

To be fair, there is another ruling in the IX district that is more in line with Dr. Pate’s thoughts, but if the full Court sides with Judge Shubb, many of Dr. Pate’s opinions—and it is important to remember that even though he is and MD. Esq. his thoughts and mine are just opinion. Dr. David Pate Esq. is a man to be respected. He is Board certified in Internal Medicine and Cardiology. Before retiring I was Board Certified in both Internal Medicine and General Surgery. Dr. Pate is licensed to practice medicine and law in Texas, and I am licensed to practice medicine in Idaho. Dr. Pate is a former CEO at St. Luke’s and according to IRS form 990 in the years 2018-2019 he made $18million in wages and benefits. His predecessors at Luke’s Gil Gilbertson and Ed Dahlberg never made close to that amount. There was a time in the late 70’s when Mr. Gilbertson took out a second mortgage on his home to help build the Anderson Center at Luke’s. The CEOs at St. Al’s up until the last Catholic Sister was CEO—Sister Patricia Vandenberg, never received a salary, but they had health benefits and a secure retirement at their Sister House in South Bend Indiana. These former CEOs were the epitome of “service before self”.

To me this is important—and again it is just my opinion, that non-profits like St. Luke’s and Al’s who receive over 60% of their revenues in fungible government transfer payments, and even more in subsidies and tax breaks, should not being paying executives the same way that for profit institutions pay their executives. The concept of “service before self” is implied in any non-profit wage negotiation in my opinion. This is another reason for audits of organizations that receive over $100million of transfer payments per year.

I believe my opinion about most of the allegations about Dr. Cole are formed from a more neutral position than Dr. Pate’s. I believe after reading his blog that many of his arguments are not grounded in either legal precedent or in the Idaho Code of Medical Practice. I know that with suspended Covid rules during the pandemic that many Idaho doctors practiced in a similar fashion as Doctor Cole. They have told me in their own words that is the case. I acknowledge that I may be wrong and that a Court may disagree with me. In the end that will be the only opinion that matters.

In my most humble opinion sitting on Governor’s Covid advisory Board and advocating for policies that accelerated Covid transfer payments to his former employer was wrong.  He states that he disclosed his potential conflict of interests but in Idaho law there is a second requirement and that is “declaration” and then when appropriate— recusal. And our Idaho State Legislators don’t demand an accounting and reconciliation of payments to providers that receive over $100million of transfer payments per year! Something about a “log in one’s own eye”…..to paraphrase. And just to ask—are Medicaid Funds “fungible”? Maybe audits are needed for more than one reason. Please know that I am not crying over “spilled milk”. I am crying at across the board incompetence and unaccountability.

Now briefly to a couple of the issues noted in Dr. Esq. Pate’s blog:

1. They never admit their mistakes. Did Dr. Pate ever admit that he was wrong? His Covid mitigation recommendations, treatment policy, advocacy for providers following Federally promulgated Covid algorithms to secure allocated Covid accelerated payments marginalized the relevance and importance of individual doctors advising individual patients? Mandates and algorithms replaced clinical prudence and temperance and hurt the doctor patient relationship for years to come. Government policies promulgated by physicians and non-physicians many who had never taken care of a sick patient at the bedside, created clinical chaos as doctors and nurses who did work at the bedside struggled with their consciences knowing that their patients could have been better served. “Do I keep my job or speak up?” That’s my opinion.
2. They make absolute, emphatic, and dogmatic statements. Did we mention “self-awareness”? That is like Dr. Esq. Pate has never listened to himself in his own echo chamber. Something about an “unexamined life” seems to be pertinent in this regard. Both sides in the Covid discussion made “absolute and dogmatic statements” In my opinion.
3. They will not back up assertions and claims from experts. Try Dr. Marty Makary from Johns Hopkins, or Dr. Jay Bhattacharya and Scott Atlas from Stanford, or the thousands of doctors and nurses and researchers from the Greater Barrington Declaration or even now “out briefs” from the Centers for Disease Control (CDC) and National Institute of Health (NIH) admitting mistakes that were made at the national level. Nothing from Idaho in this regard has been promulgated from the “Covid Advisory Experts” We will have to wait for Dr. Esq.’s book to come out this spring to learn how wonderful the Idaho Covid response was. That’s just my opinion.
4. They almost never disclose their financial or self (selfish) interest. Disclosure—declaration—recusal? Please remember that there never was a CEO at a non-profit hospital in Idaho who made $18million/2years until Medicaid Expansion. In my opinion as policies were being recommended to our Governor more than one member of his advisory committee should have taken themselves off the committee as advice was being made about extending “emergency orders” that increased Covid reimbursements and changed coding criteria to institutions they either worked at or represented in the past.
5. The issues regarding patient informed consent, standard of care, medical record keeping, and scope of practice should be presented on behalf of not only Dr. Cole, but for hundreds of medical practitioners in Idaho who operated under “suspended” telemedicine and “in person” standards of practice—different than a standard of care in Idaho as Dr. Pate should know. I do agree that these rules should be reviewed and updated by our legislature considering what happened under Covid, but to apply a standard only to Dr. Cole would be as a lawyer might say “arbitrary and capricious “but again I am not an Esq. Just my opinion.

 I could go on but I’m not Leo Tolstoy or David Pate MD Esq. for that matter. I’m not even an “expert”.

In my most humble opinion Judge Shubb of the 9^th US District got it correct. I recommend everyone to read his ruling. “The unexamined life is not worth living.”