How Stupid Do They Think We Are? – Plutocrats Using Logical Fallacies to Defend the Health Care Status Quo

In the early 21st century, the debate about health care reform in the US ramped up.  The result ultimately was the Patient Protection and Affordable Care Act (PPACA, ACA, “Obamacare”), which arguably improved access to health care, made some reforms in the regulation of health care insurance, but did not affect the fundamental reliance of the US on employer-paid, for-profit health care insurance to finance health care for many patients.  Nor did it really affect the issues we discuss on Health Care Renewal (look here for details).

After the tumultuous election of President Donald Trump, the debate started up again with his and his party’s attempt to “repeal and replace” Obamacare.  Arguably, Obamacare ended up damaged but not repealed.  Once again, the issues we discuss on Health Care Renewal were ignored, including threats ot the integrity of the clinical evidence base, deceptive marketing, distortion of health care regulation and policy making, bad leadership and governance, concentration of power, abandonment of health care as a calling, perverse incentives, the cult of leadership, managerialism, impunity enabling corrupt leadership, and taboos, or the anechoic effect.  (Look here for a detailed discussion. )

It is time once again to discuss health care reform in the US.  Now the push is from the Democrats and the left, with the stated goals of making care more universal, and perhaps decreasing or even ending the role of for-profit commercial health care insurance companies.

It is no surprise that those who benefit the most from the current system (even as modified by Obamacare) are rushing to its defense. 

Dark Money to Defend Commercial Health Insurance

We already discussed  how large health care corporations, including pharmaceutical and biotechnology companies, have been using dark money to funnel money for distinctly partisan purposes, to defeat whom they perceive as too left-leaning politicians, almost all Democrats.  They seem to fear such politicians might promote health care reform efforts that would be based on “anti-free-market, anti-business ideology,” that is efforts to decrease the role of commercial, for-profit health insurance in financing health care.

More recently, the focus has shifted to Democratic proposals for government run single-payer, or “Medicare for all” health insurance. In early January, 2019, the Hill reported

Thomas Donohue, the president and CEO of the Chamber of Commerce, on
Thursday vowed to use all of the Chamber’s resources to fight
single-payer health care proposals.

‘We also have to
respond to calls for government-run, single-payer health care, because
it just doesn’t work,’ Donohue said during his annual ‘State of American
Business’ address.

The US Chamber of Commerce historically has had many executives of big health care corporations on its board.  We listed 10 such members in 2015.   It also historically has received financial support from some corporations.  We listed 17 in 2018.

Then later in January, The Hill reported that a group called Partnership for America’s Health Future started digital ads attacking “Medicare for All.”  The Hill stated its

members include major industry players such as America’s Health Insurance Plans and the Pharmaceutical Research and Manufacturers of America

So here we have the leaders of big health care corporations funneling corporate money into propaganda campaigns to defeat government run single payer health insurance, an old policy idea that suddenly is looking politically credible.  Current US regulation and practice allows them to hide the exact amounts spent on such campaigns by processing them through dark money organizations.

Such stealth health policy advocacy is now not new.  What is surprising now is how some top leaders are willing to jump into
the debate themselves, rather than just trying to manipulate public opinion through
public relations/ propaganda proxies.  Here are some telling examples. in chronological order.

Quest Diagnostics CEO Attacks “Medicare-for-All” Using an Appeal to Authority, an Argument by Gibberish, the Non Sequitur Fallacy, (and an Incomplete Comparison) 

On January 24, 2019, Yahoo Finance reported

A top health care CEO is sounding the alarm on ‘Medicare for All,’ an idea gaining steam in political circles, including from newly-elected Rep. Alexandria Ocasio-Cortez (D-NY).

Most people don’t understand the basics of health-care economics in the United States,’ said Steve Rusckowski, chairman & CEO Quest Diagnostics (DGX), in an interview with Yahoo Finance editor-in-chief Andy Serwer at the World Economic Forum in Davos, Switzerland….

Mr Rusckowski implied that he knows a lot more about health care economics than most people, so most people should listen to him.  Thus, he began with an implied logical fallacy, the appeal to authority.

He then presented the justification for his argument.

‘The majority of people get their health care from their employers, and the majority of healthcare costs are paid by employers and employees,’ he said. ‘If you look at the $3.5 trillion spent on healthcare costs, that portion is actually funding the Medicare and Medicaid programs throughout this country.’

The syntax was fractured, and so this was incoherent and confusing. In particular, it was not clear to what “this portion” referred.  $3.5 trillion? Health care costs paid by employers and employees?

The context of  his use of that phrase did not help.  Note that US total health spending was reported to be approximately $3.5 trillion in 2017 by the US Center for Medicare and Medicaid Services (CMS)
However, that was total health spending, not just the amount spent by
Medicare and Medicaid.  Furthermore, Medicare and Medicaid are funded by
sources other than employers and their employees.  While employers and employees pay tax on employee income to fund Medicare, general funds from the federal government, and from state governments funds Medicaid. Furthermore, many employers pay parts of their employees’ private health insurance premiums, while the employees make up the difference in premiums. Self-employed people may may for their own insurance, etc, etc.

Mr Ruskcowski, not to put to fine a point on it, seemed to speaking
gibberish, and would use this gibberish to justify his next point.  So
in formal terms, he used the logical fallacy of an argument by gibberish.

When incomprehensible jargon or plain incoherent gibberish is used to
give the appearance of a strong argument, in place of evidence or valid
reasons to accept the argument.

In any case, Mr Rusckowski went on to argue that he

remained skeptical of a Medicare-for-all plan funded by corporations and
employees. ‘I don’t think [corporations and employees] can afford to
provide that access as described.’

However, not only were his earlier statement gibberish, they were not clearly arguments in support of his contention that corporations and employees cannot “afford to provide that access as described.”  So this appeared to be an example of the logical fallacy of the non-sequitur.

Mr Rusckowski’s total compensation as CEO of Quest was over $10 million in 2017, as estimated by Bloomberg News.  So it is perhaps not surprising that is self-interest in preserving the status quo was strong enough to motivate him to jump into the debate.  One would think, however, that someone who managed to become a rich CEO of a medical diagnostic company could manage to be a bit more logical.

Anyway, he has some strange bed-fellows in this cause, including two billionaires who are not directly involved in health care corporations, but who have obviously benefited from the current economic status quo.

Michael Bloomberg and Howard Schultz Used the Incomplete Comparison Fallacy

Two billionaires provided striking examples of one logical fallacy. 

First, from the New York Times, January 29, 2019:

Mr. Bloomberg, the former New York City mayor who is considering a 2020 bid on a centrist Democratic platform, rejected the idea of ‘Medicare for all,’ which has been gaining traction among Democrats.

‘I think you could never afford that. You’re talking about trillions of dollars,’ Mr. Bloomberg said during a political swing in New Hampshire, which holds the nation’s first primary in 2020.

‘I think you can have ‘Medicare for all’ for people that are uncovered,’ he added, ‘but to replace the entire private system where companies provide health care for their employees would bankrupt us for a very long time.’

Second, from CNN on January 30, 2019:

‘Why do you think Medicare-for-all, in your words, is not American?’ CNN’s Poppy Harlow asked Schultz on Tuesday.

‘It’s not that it’s not American,’ Schultz said. ‘It’s unaffordable.’

‘What I believe is that every American has the right to affordable health care as a statement,’ Schultz said, lauding the Affordable Care Act, otherwise known as Obamacare, as ‘the right thing to do.’

He added, ‘But now that we look back on it, the premiums have skyrocketed and we need to go back to the Affordable Care Act, refine it and fix it.’

He argued that the Democratic progressive platform of providing Medicare, free college education and jobs for everyone is costly and as ‘false as President Trump telling the American people when he was running for president that the Mexicans were going to pay for the wall.’

So both billionaire Bloomberg and billionaire Schultz stated that Medicare-for-all would cost too much.  Yet neither addressed how much our current health care system costs.  However, as a subsequent op-ed in the Washington Post by Paul Waldman pointed out, it only makes sense to talk about affordability in the context of a comparison with a reasonable alternative, say, the current health care system:

there is one thing you absolutely, positively must do whenever you talk about the cost of a universal system — and that journalists almost never do when they’re asking questions. You have to compare what a universal system would cost to what we’re paying now.

there have been some recent attempts to estimate what it would cost to implement, for instance, the single-payer system that Sen. Bernie Sanders (I-Vt.) advocates; one widely cited study, from a source not favorably inclined toward government solutions to complex problems, came up with a figure of $32.6 trillion over 10 years.

That’s a lot of money. But you can’t understand what it means until you realize that last year we spent about $3.5 trillion on health care, and under current projections, if we keep the system as it is now, we’ll spend $50 trillion over the next decade.

Again, you can criticize any particular universal plan on any number of grounds. But if it costs less than $50 trillion over 10 years — which every universal plan does — you can’t say it’s ‘unaffordable’ or it would ‘bankrupt’ us, because the truth is just the opposite.

These are text-book examples of the fallacy of incomplete comparison.

By the way, buried amongst his use of gibberish and non-sequiturs, Quest Diagnostics CEO Rusckowski also opined that Medicare-for-all would be unaffordable without any reference to the costs of the status quo, and hence also provided an example of an incomplete comparison.

The Waldman op-ed noted

The fact that these two highly successful businessmen — whose understanding of investments, costs and benefits helped them become billionaires — can say something so completely mistaken and even idiotic is a tribute to the human capacity to take our ideological biases and convince ourselves that they’re not biases at all but are instead inescapable rationality.

Maybe.  However, it may also be a tribute to their arrogance bred by decades of public relations (which Bernays thought sounded better than “propaganda“) and disinformation meant to soften up the minds of the public so that they will follow the lead of the rich and powerful.  

Schultz Also Added an Appeal to Tradition (or to Common Practice)

Also on January 29, the Washington Post reported that

Schultz referred to a town hall hosted Monday night by CNN in which Harris embraced a ‘Medicare-for-all’ single-payer health insurance system and said she would be willing to end private insurance to make it happen.

‘That is the kind of extreme policy that is not a policy that I agree with,’ Schultz said on ‘The View,’ adding that doing away with private insurers would lead to major job losses.

That’s not correct. That’s not American,’ Schultz said on CBS. ‘What’s next? What industry are we going to abolish next? The coffee industry?’

Presumably, by saying “that’s not American,” Schultz means that is not what we have always done, that is not what has been traditional American practice, begging the question of whether that practice could be ill-advised.  Thus Schultz appeared to ladle on an appeal to common practice, otherwise known as an appeal to tradition

As an aside, the quote also suggests that Schultz’s real concern is not with the affordability of Medicare-for-all, particularly in comparison with that of the current system, but with the financial health of the insurance industry.  But that is for another day….


So, to protect against the dread “Medicare for all,” that is, proposals for a government single-payer health insurance system to replace our current practice of financing health care through large, mainly for-profit  insurance companies, we see an acceleration of public relations/ propaganda paid by undisclosed donors, that is, via dark money.  We also see prominent multi-millionaire and billionaire executives laying down a barrage of logical fallacies to support the status quo. 

It is hard to believe that the defenders of the current system are not mostly self-interested.  That status quo has made some people very rich.   

It is also hard to believe they are stupid.  However, a close reading of their arguments suggests they may think we are stupid, or at least befuddled by repeated public relations/ propaganda/ disinformation campaigns.

In 2011, we wrote,

Wendell Potter, author of Deadly Spin, has provided a chilling picture of health care corporate disinformation campaigns and the tactics used therein.

In particular,

Mr Potter recounted how deceptive PR campaigns subverted the health care
reform plans of US President Bill Clinton, reduced the impact of
Michael Moore’s movie, ‘Sicko,’ and helped to remodel the recent health
care reform bill to reduce its threat to commercial health insurers.  He
further noted how PR distracted public attention from the growing
faults of a health care system based on commercial health insurance, and
how practical and legal safeguards against abuses by insurance
companies were eroded.

Furthermore, Mr Potter

described ‘charm offensives;’ the deliberate creation of distractions,
including the planting of memes for short-term goals that went on to
have long-term adverse effects; fear mongering; the use of front
groups, including ‘astroturf,’ (faux disease advocacy and/or grass roots
organizations), public policy advocacy groups, and tame (and
conflicted) scientific/professional groups; and intelligence gathering. 
He provided some practical advice for detecting such tactics. For
example, be very suspicious of policy advocacy by groups with no
apparent address or an address identical to that of a PR firm, or with
anonymous leaders and/or anonymous financial backing.

Now it is 2019, once again health care reform is in the air, and once again the defenders of the status quo are hard at work.  Now, they are even wealthier than they were 10 years ago, and have even more sophisticated tools, like social media and its hacks, at their disposal.  Still, however, their arguments are ultimately built on sand.

As I did in 2011, it makes sense to quote Wendell Potter

onslaught drastically weakened health-care reform and how it plays an insidious and often invisible role in our political process anywhere that corporate profits are at stake, from climate change to defense policy.
[Potter, Huffington Post]


The onslaughts of spin will not stop, the distortions
will not diminish, and the spin will not slow down. To the contrary,
spin begets spin, as the successes of corporate PR functionaries
increase the revenues of their employers, further funding their
employers’ efforts to create a more hospitable climate for their
business interests. Americans are thus being faced with increasingly
subtle but effective assaults on their beliefs and perceptions. Their
best defense right now is to understand and to recognize the
sophisticated tactics of the spinners trying to manipulate them.

Most important is a singular mandate: Be skeptical.
[Potter, Huffington Post]

I still hope that summarizing some of Mr Potter’s amazing points will help us all to be much more skeptical.

You heard it here first.

Long-term Care Infection Prevention Training

TO: SNF, Long Term Care Facilities in Colorado 

FROM: Colorado Department of Public Health & Environment (CDPHE)

The Infection Prevention Unit, within the Healthcare Associated Infections Program of the Disease Control and Environmental Epidemiology Division, will be offering a FREE two-day infection prevention training event focused on reducing healthcare associated infections within the long-term care environment. See attachment for more details. 

Infection Prevention Spring Workshop

Medicare For All-An Idea Whose Time May Have Come

With the 2020 Presidential election looming on the horizon and
tortuous months of political speeches one thing that clearly sets the Democrats
apart from the Republicans, currently in control of the national purse strings,
is their vocal promotion of healthcare access and protections for all.
Republicans raced into Congress on the anti-Affordable Care Act platform only
to learn that voters like their government sponsored healthcare, resulting in their
rout in the midterm elections last November. This article reviews the motive,
financial implications, and method to assess a national Medicare Plan.
The United States spends 40% to 60% more for healthcare than
any other industrialized country and this does not produce improved health or
better outcomes than nations spending considerably less per capita. In 2017 the
U.S. spent $10,224 per person for healthcare, as tracked by the Petersen-Kaiser
Health System Index Tracker. (Cox, 2019) This total is 28%
higher than when my book, Unraveling U.S. Healthcare-A Personal Guide was
published in 2013. (Winter, 2013) The next closest
country in medical spending was Switzerland which still spent 28% less than the
U.S. France, whose health system provides family clinics, coverage for all, and
high tech services spent $4,902, less than half of the U.S. And Australia spent
only $4,543 per capita for their national healthcare system. Canada spent
$4,826 per person for their national healthcare program. Everyone of these
industrialized nations are capitalistic in terms of business, but they offer healthcare
to all of their citizens.
The cost of healthcare in the U.S. is impeding resources
that could be used to improve education, rebuild critical infrastructure such as
bridges, and improve the quality of life for most families. By refusing to enact
and enforce national healthcare policy the nation continues to be overcharged
by profiteers who gouge the American public. The government has the domain to negotiate
better policies for drugs, medical devices, and reimbursements at the clinic/hospital
level. However, only Bernie Sanders from Vermont, had the political will to
actively run on a platform for nationalizing healthcare. This phenomenon all
changed with the mid-terms and public polls show a size-able majority of the
American people want government run healthcare. Families are tired of being
forced to spend more on their health insurance than for housing.  Diabetics are forced to skip their doses,
because of the high cost of insulin, which has resulted in deaths. Even seniors,
who have benefited greatly from Medicare, the Bush Medicare Modernization Act
which provided drug coverage, and the Affordable Care Act which closed the
doughnut-hole exclusion for drugs are still gouged for the cost of care. A
public case could be made that Medicare enrollees are better off in terms of
healthcare access and coverage than working class families in the United States.
This situation is untenable financially and politically. The 2020 election will
give us a chance to see how far the American people are willing to go to reform
their expensive and exclusionary health system.
In 2003, I was part of a team of graduate students at the University
of Washington School of Public Health and Community Medicine who analyzed a
single payer health system. In fact, I published an article on it in this
column in 2009. My
role, as an MHA student, was to come up with a financing model that was
plausible. For a 3% increase in the payroll tax, born equally by employees and
employers, which currently funds Medicare and Social Security, we could
implement a national healthcare program.
 A second way to fund
healthcare is through an income tax increase, which is how most other nations
do it. Crucial information which would inform any financing of a citizen’s
initiative would include the 2020 census findings. However, Trump and his administration
aren’t anxious to conduct this census and are still seeking to restrict access
and questions based on citizenship and other factors.
Social programs are consuming a larger portion of the
national budget, which is normal for an aging population. Republicans like to brag
about defense budget increases yet rail at any increase in spending for
entitlements for our residents. Higher taxes are necessary to even meet the
current Social Security and Medicare projects, which must be addressed.
U.S. Proposed Federal Budget-2018
Defense, includes security for national nuclear supply,
Veterans Affairs, Homeland Security, State Department, Afghanistan, Iraq,
Syrian wars; Does NOT include discretionary private contracting which
consumes another 10-20%
Social Security- paid through trust fund until 2032@1.046 trillion
Medicare-partially funded by payroll tax Medicaid-100% paid from general fund@1.037
Proportion of Federal Budget
The federal budget item that is growing the fastest is the
national deficit, which the Trump Administration exploded with it’s corporate
and wealth tax cuts in 2018. Currently the deficit is 985 billion dollars or
22% of the federal budget. (Amadeo, 2019)
Any healthcare program in the U.S. will include private
insurance at some level, as Medicare, the healthcare expansion model currently
does. The idea that the behemoth private medical insurance industry will go
away is wrong. However, private insurance has a much higher administration cost
than Medicare/Medicaid, which uses 6% of cash inflows for overhead as opposed
to 15-20% for the private sector. And you can expect that the insurance
industry/medical/pharma lobby, which is the largest and most well-funded of the
shark infested Washington DC lobbying cabal will be drafting the details, just
like they did for the Affordable Care Act. They succeeded in eliminating the Medicare-for-all
idea during the Obama Administration, but that was just buying time. The longer
the nation waits to draft a sane health policy the costlier it will be for the
tax payers.
Many employers would thankfully get out of the medical insurance
business. Also, a national health policy which has the same costs everywhere,
would create an even playing field for business competition and innovation. It
will also greatly reduce regulatory costs, which are the bane of clinical staff
everywhere. Efficiency could go up in clinics because the doctors and nurses
would have more time to actually see patients instead of processing insurance paperwork.
Finally, with national healthcare policy, we could also fund
the scary shortage of primary care providers, by providing free medical
education (and maybe forgiveness of school loans) to those who go into primary
care, such as pediatrics, family practice, and obstetrics.
Obviously, we will have to enact some type of policy which
will mute the overcharging, take back control of generic drug prices, create
true price transparency for services, and quit gouging American families. We
can hardly expect the Millennials, whom will have to clean up our mess, to pay
higher and higher payroll taxes and not get anything in return. We can start by
offering affordable healthcare for all, which won’t happen under the current,
reimbursement-based-on-the-prevailing-inflated-cost method of pricing.
And this is the health policy maven signing off encouraging
you to learn as much as you can about healthcare systems outside the U.S. so
that we can build a better one for our people.

Works Cited
Amadeo, K. (2019, January 21). US Federal Budget
Breakdown-The Components and Impact on the US Economy
. Retrieved from The

Cox, B. S. (2019, February 10). How does health
spending in the U.S. compare to other countries
. Retrieved from
Petersen-Kaiser Health System

Winter, R. E. (2013). Unraveling U.S. Healthcare-A
Personal Guide. In R. E. Winter, Unraveling U.S. Healthcare-A Personal
(pp. 31-35). Rowman & Littlefield.


This article was written by Roberta Winter, a freelance
journalist and health policy analyst in the Seattle area.

Emergency Preparedness- Updates to Appendix Z of the State Operations Manual (SOM)

To: Administrators and Directors,

The Centers for Medicare and Medicaid Services (CMS)) has made revisions, effective immediately, to Appendix Z of the State Operations Manual (SOM), which is the Interpretive Guidance for Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers. These are not changing any requirements, but just adding some clarifications. You can view or download the revised Appendix Z at: 

Changes are highlighted in red italics.

The main revisions include: 

– (Definitions) CMS is adding “emerging infectious diseases” or “EIDs” to the current definition of all-hazards approach, after determining that is critical for facilities to include planning for infectious diseases within their emergency preparedness programs. Examples of EIDs include Influenza, Ebola Virus, Zika and others.

– (Tag E-0004)It added EIDs to the list of hazards that facilities should include as their conduct their risk assessments. 

– (Tags E-0015 and E-0042) Alternate Source Power and Emergency Power Standby Systems, clarifies that facilities should use the most appropriate energy source or electrical system based on their facility’s risk assessment and as required by existing regulations or state requirements. Whatever alternate source is selected must meet local and state laws, manufacturer requirements and Life Safety Code requirements. If a facility chooses a portable and mobile generator (rather than permanent generator), then the LSC provisions, e.g. generator testing/maintenance/etc under NFPA guidelines would not apply, except for NFPA 70-National Electrical Code. 

These updates are NOT related to the proposed rule changes published in the Federal Register September 20, 2018, related to reducing the regulatory burden on facilities in meeting the emergency preparedness requirements. We still await guidance on the outcome of that proposed rule. 

If you have questions regarding the emergency preparedness rule, please contact or Melanie Roth at CDPHE,

HHA IDR Committee Meeting

To: HHA providers


The HHA IDR Committee will meet 1/22/19 at 10:00 a.m. at the Department. The public is welcome to observe or listen to the committee discussion by calling 1.712.770-8066 and entering conference code 666158. Information on the location of the meeting will be available at the security desk in building A.

Elaine Sabyan

1294 Meeting and Chapter 2 Rule Revision Stakeholder Meeting

To: all Health Facilities


Meetings are open to the public.

When: Feb. 7, 2019 from 10:30 a.m. – 12:45 p.m. (1294 meeting will be from 10:30 a.m.-11 a.m. and Chapter 2 from 11 a.m. to 12:45 a.m.)

Where: Colorado Department of Public Health and Environment
4300 Cherry Creek Dr. South
Denver, CO 80246
Conference room C1E
(visitors, please check in at the front desk in building A, doors near the flag pole) 

UPDATED Audio line: 669-900-6833, conference code: 882 201 285 
UPDATED Webinar: Zoom meeting (

To view the 1294 meeting agenda go to: 

To view the Chapter 2 meeting agenda go to:

Meeting documents, schedules and archived agendas are available on the department website : 

To sign up to receive email communications regarding Chapter 2 go to:

For further info:


Retaliation against physicians reporting EHR flaws that cause use errors? Physicians subpoenaed in Rhode Island, allegedly after reporting EHR risks

It appears that way to my eye.  First, on use errors (as opposed to user errors from carelessness):

“Use error” is a term used very
specifically by NIST to refer to user interface designs that will
engender users to make errors of commission or omission. It is true that
users do make errors, but many errors are due not to user error per se
but due to designs that are flawed, e.g., poorly written messaging,
misuse of color-coding conventions, omission of information, etc. From NISTIR 7804: Technical Evaluation, Testing and Validation of the Usability of Electronic Health Records. It is available at (PDF).

Now this:

Becker’s Hospital Review
Physicians subpoenaed in Rhode Island, allegedly after reporting EHR risks
Jessica Kim Cohen
January 25, 2019

The Rhode Island Department of Health reportedly has served at least four emergency room physicians at Providence-based Rhode Island Hospital with subpoenas, according to the Politico Morning eHealth newsletter.

The subpoenas allege the physicians participated in behaviors that fall under the umbrella of medical misconduct, on account of mistakes the physicians reported themselves. The mistakes, which didn’t injure any patients, reportedly were meant to draw attention to risks associated with the hospital’s EHR.

This is outrageous if accurate, especially considering the issues I raised in my Nov. 4, 2011 post “Lifespan (Rhode Island): Yet another health IT ‘glitch’ affecting thousands – that, of course, caused no patient harm that they know of – yet” at

The RI Dept. of Health owes the public an explanation.

The subpoenas primarily relate to medical scans, such as X-rays, which were mistakenly ordered by the physicians. EHR experts who spoke with Politico said these errors are common because it’s easy to click on the wrong icon or patient name in complex system interfaces.

That is classic “use error” and results from poorly-designed, mission-hostile user interfaces of bad health IT as defined by myself and Australian informatics expert Dr. Jon Patrick at at

Bad health IT is IT that is ill-suited to purpose, hard to use, unreliable, loses data or provides incorrect data, is difficult and/or prohibitively expensive to customize to the needs of different medical specialists and subspecialists, causes cognitive overload, slows rather than facilitates users, lacks appropriate alerts, creates the need for hypervigilance (i.e., towards avoiding IT-related mishaps) that increases stress, is lacking in security, compromises patient privacy, lacks evidentiary soundness permitting concealment of alterations, or otherwise demonstrates suboptimal design and/or implementation. 

I covered the issue of ‘mission-hostile health IT’ at a 10-part series in 2009 at

Physicians and EHR safety researchers have raised concerns over the subpoenas, suggesting that the department’s response could discourage future clinicians from voluntarily reporting medical errors.

Not “could.” 

Will, and likely by design in my opinion.  The ultimate motive for the subpoenas and those behind them, which may extend outside the DOH, needs to be determined.

“Anyone punishing individual providers for these events is punishing the wrong thing,” Jason Adelman, MD, chief patient safety officer at NewYork-Presbyterian Hospital in New York City, told Politico. “These are system issues, not the provider being reckless. The focus should be on things like EHR usability and safety.”

I am aware of patient injuries and deaths as a result of mis-clicks due to mission-hostile user interfaces that confuse users and lack appropriate safety alerts and notifications.  This includes ER mistakes.

The corporate response followed the expected boilerplate:

When asked about the subpoenas Jan. 25, Rhode Island Hospital spokesperson David Levesque [Director of Media Relations, Lifespan,] provided the following statement to Becker’s Hospital Review:

“Rhode Island Hospital is deeply committed to the safety of our patients and the continual improvement of our healthcare environment, including the processes our caregivers and staff follow. Furthermore, the hospital’s culture of transparency remains a point of pride and is unwavering. Rhode Island Hospital supports our world-class physicians, nurses and other staff and appreciate their tirelessly work in providing world-class healthcare.”

As one colleague of mine observed, “the hospital’s culture of transparency
remains a point of pride” seems to mean that “you can prosecute staff for
being transparent, and it is not a contradiction.”

I wrote Mr. Levesque regarding this story:

From: S Silverstein
Date: Tue, Jan 29, 2019 at 10:07 AM

Subject: Re: Physicians subpoenaed in Rhode Island, allegedly after reporting EHR risks

“Rhode Island Hospital is deeply committed to the safety of our patients and the continual improvement of our healthcare environment, including the processes our caregivers and staff follow. Furthermore, the hospital’s culture of transparency remains a point of pride and is unwavering. Rhode Island Hospital supports our world-class physicians, nurses and other staff and appreciate their tirelessly work in providing world-class healthcare.”


After the debacle I documented at , I think this is an outrage.

I am passing this story on to trial lawyers who will likely pass it to the national trial lawyer’s listserv.  I believe these actions are retaliation against the physicians.

I am aware of patient injuries and deaths following “wrong clicks” in ER’s.


Scot Silverstein MD

The stated source of the subpoenas, DOH, seems odd.  The hospital should strongly defend its doctors against DOH if the DOH was the sole source of the subpoenas and accusations of medical misconduct, not just provide boilerplate.  If DOH was influenced by some other party to take this action, that needs to be revealed.

I hope I am wrong about the retaliation issue, and that this has all been a misunderstanding.  Perhaps Mr. Levesque will clarify.  Perhaps the subpoenas against the physicians who reported the EHR use error issue were issued by the DOH to gain more information about the alleged EHR problems.  If not, I hope they will be summarily dropped. 

If not, I hope the matter gets wider attention, especially at a time when bad health IT is contributing considerably to clinician burnout per numerous studies and reports (see for instance my Jan. 23, 2019 post at  Burnout increases risk of medical error for everyone.

Supposed accusations of any type of “professional misconduct” are outrageous, and will have a chilling effect on other like-minded, candid clinicians (including nurses) confronting bad health IT.

— SS

OASIS D Classes *FREE*

To: Federally Certified Skilled Home Health Facilities Administrators, Directors of Nursing, OASIS Coordinators, Billing and Coding Personnel, Licensed Home Health Facilities Administrators

From: The Education and Technical Assistance (ETA) Branch of the Health Facilities and Emergency Medical Services Division (HFEMSD)

“OASIS D: Changes for 2019” webinar was aired on Dec 5, 2018. A replay is available at

ETA will offer classes on specific OASIS topics in Denver, La Junta, Grand Junction, Boulder and Craig featuring OASIS D items and guidance. You may choose to take sessions all at once or individually as your interest and needs dictate. All registration is first-come, first-served, even for sessions within a specific facility.

ETA reserves the right to cancel classes with low registration. Early registration is helpful.

OASIS D Basics (One Session): Course ID 1082008
This beginning three-hour class is how to get started with OASIS D.

OASIS D Item-by-Item (2 Sessions): Course ID 1082009
This practical application class reviews item-by-item data set completion. We will follow Mrs. Green’s assessment, which will require two sessions to complete. Attendance at both sessions is required to complete this class.

OASIS Quality Measures (One Session): Course ID 1066910
This course assumes familiarity with the OASIS D Item Set, covering more advanced content and application.

To see additional session details and register for on-site attendance for one of these offerings:
1. Go to 
2. Log in to your existing TRAIN account, or new users click “Create an Account”
3. Once you’ve logged in, or created an account, Search (top right) for the appropriate Course ID. (See above for desired training)
4. Click link for desired course.
5. Click the “Registration” tab.
6. Click the “Register” button for the session you wish to attend.
7. Remember to register separately for each desired course.

A detailed example of the above process (if needed)

Questions?: Please email