GLOBAL NEUROLOGY REPORT: WORLD ASSOCIATION FOR MEDICAL LAW CONFERENCE

World Association for Medical Law (WAML) Congress

World Association for Medical Law (WAML) Congress

The 50th Anniversary Meeting and 23rd World Association for Medical Law (WAML) Congress was held on 9-14 July 2017 in Baku, Azerbaijan.  Leading international experts from around the globe discussed topics related to GlobalHealth, Medical Law and Bioethics.

Drs. James C. Johnston, Mehila Zebenigus and Guta Zenebe presented recommendations for improving relations between developed and developing countries through guidelines that focus on ethically advancing collaborative partnerships to improve health care. This topic followed Dr. Johnston’s lecture last year at the WAML meeting in Los Angeles, USA discussing the medical, ethical and legal problems that arise when Western countries engage in short term medical missions to resource limited nations, resulting in medical paternalism, doctor tourism and actual harm to the very patients that are most desperate for help.  Specific examples of these problems were presented at both meetings, along with clear guidelines on how to avoid the harmful effects of these self-serving missions.

Drs. James C. Johnston and Mehila Zebenigus also discussed concerns related to neuroimaging for the patient presenting with headache. They recommended deleting the currently used guidelines because those guidelines are outdated, and have been a contributing factor in the continuing misdiagnosis of headache disorders.  Dr. Zebenigus discussed the management of the patient with headache in Ethiopia.

Drs. Thomas P. Sartwelle, James C. Johnston, Berna Arda and Mehila Zebenigus highlighted the concerns related to using electronic fetal monitoring in sub-Saharan Africa, how that procedure causes more harm than good, and wastes scarce resources that would be better used helping children with cerebral palsy.

In terms of disclosure, Drs. Zebenigus and Johnston are Directors of the non-profit organization Global NeuroCare® which focuses on advancing neurological services in sub-Saharan Africa and particularly Ethiopia, and is actively involved in all of these areas.

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GLOBAL NEUROLOGY REPORT: TRIANGULAR COOPERATION

Dr. James C Johnston

Triangular Cooperation | Dr. James C Johnston

Global NeuroCare is a non-profit organization dedicated to advancing neurological care in developing regions, especially sub-Saharan Africa and particularly Ethiopia.  It is one of the few non-government organizations to hold Special Consultative Status with the United Nations ECOSOC, which allows Director and Neurologist Dr. James C. Johnston to actively participate with the UN intergovernmental bodies, decision makers and related organizations.  Additionally, Global NeuroCare is accredited by the World Health Organization, and affiliated with the Office of the Special Adviser on Africa.

On behalf of Global NeuroCare, Dr. Johnston presented several statements over the past few years to the UN High Level Political Forum, the Commission for Social Development and the Integration Segment.  Four of these statements have been adopted and published, focusing on advancing collaborative partnerships between the North and South in an effort to improve healthcare in Africa.

Dr. Johnston emphasized the importance of ensuring that relationships between the North or developed countries and the South are based on sustainable, collaborative, ethically congruent partnerships that truly benefit the South, as opposed to the short term medical missions that are so harmful to developing regions.  Successful partnerships will allow sub-Saharan African nations to develop functional capacity building, thereby becoming self-sustainable, further advancing patient care, physician training and medical research.

These types of North-South partnerships can be even more effective by encouraging South-South and triangular cooperation.  South-South cooperation is the process whereby two or more developing countries pursue individual or shared objectives through exchanges of knowledge, skills and resources.  This is not a substitute for, but rather a complement to North-South partnerships.  In triangular cooperation, partnerships between two or more developing nations are supported by a developed country or even multinational organizations.

For example, Global NeuroCare focuses on advancing neurology in Ethiopia where Dr. Johnston serves as an Honorary Professor of Neurology in the Addis Ababa University Department of Neurology Residency Training Program.  This program has graduated 32 board certified neurologists over the past decade.  However, there are no local opportunities for advanced neurophysiology training, so Dr. Johnston arranges for the resident physicians to attend the University of Siena, Italy for 6 month fellowships.  This requires separate funding which has been provided through scholarships sponsored by a Canadian based neurophysiology society.  Thus Global NeuroCare coordinates Ethiopian training through Italy with financial support from Canada and, in turn, as an example of South-South cooperation, the Ethiopian physicians return to train their colleagues as well as physicians from other African nations.

Global NeuroCare plays a crucial role in coordinating this type of triangular coordination, which is the most effective means of ensuring sustainable capacity building leading to self-sufficiency that will truly advance healthcare in sub-Saharan Africa.

Global Neurology Report: The WHO ‘Neurology Atlas’ Second Edition

Emergency Room in Ethiopia

The World Health Organization (WHO) published the first comprehensive report (Neurology Atlas) on the
status of neurological care and services throughout the world over a decade ago. This compilation provided a
unique and invaluable source of data on the rapidly increasing burden of neurological disorders, and the available neurological services in 109 countries. It highlighted the large disparities between neurological care in the developed and developing nations, and provided critical information for medical specialists, healthcare planners, policy makers and national training programs. This Atlas provided the first detailed picture of the global situation for neurology, and the updated second edition was released in September 2017. It may be accessed here (http://apps.who.int/iris/bitstream/10665/258947/1/9789241565509-eng.pdf).

This updated Atlas reviewed 132 countries comprising 94% of the world’s population and the data will continue to be helpful to policy makers, although the findings were not surprising and may be summarized as follows:

(1) Neurological disorders are a significant cause of the global disease burden, which was thoroughly addressed in the Global Burden of Disease studies.

(2) Neurological disorders are disproportionately high in developing regions, which are also plagued by resource limitations and severe shortages of healthcare workers.

(3) Neurological conditions are expected to grow exponentially in the future.

The Atlas report focused on several key areas including legislation for neurological disorders, financing of neurological services, social welfare support, workforce data, available neurological services and informational gathering systems. As expected, sub-Saharan Africa fared the worst, with the lowest proportion of healthcare workers, the most limited services and poorest geographical distribution of those services. There were 0.04 neurologists per 100,000 people in the WHO African region, compared to 4.75 per 100,000 people in high income countries.

In Ethiopia, for example, where Dr. James C. Johnston serves as an Honorary Professor of Neurology with the Addis Ababa University neurology residency training program, there is one neurologist for every 3-4,000,000 people, and most of those neurologists are in the capital city Addis Ababa. This ratio, although exceedingly poor compared to the WHO recommendation of at least one neurologist for every 25,000 – 100,000 people, represents a significant improvement since before inception of the program in 2006 when there was one full time neurologist for the one hundred million people in the country.

Dr. Johnston established the non-profit organization Global NeuroCare (www.GlobalNeuroCare.org) to advance neurological services in developing regions. Global NeuroCare holds Special Consultative Status with the United Nations ECOSOC and fully supports the self-sufficient, sustainable Ethiopian neurology residency program. This program has made a significant and measurable difference in the Horn of Africa, graduating 32 board certified neurologists with 21 more physicians in the three year training, improving the lives of tens of thousands of people.

On behalf of Global NeuroCare, Dr. Johnston discussed the healthcare concerns affecting developing nations at the 2016 and 2017 United Nations High Level Political Forums, the 2017 United Nations Commission for Social Development, and at the World Association for Medical Law conferences in Los Angeles (2016) and Baku (2017). One of the main concerns impeding development stems from academic medical centers with global health programs that engage in short term medical missions which are tantamount to doctor tourism, fail to provide any substantive benefit to the developing nations, and cause more harm than good. He presented guidelines to improve sustainable, ethically congruent, collaborative partnerships focused on capacity building to advance neurological services in sub-Saharan Africa, using Global NeuroCare’s focus on Ethiopia as a model plan.

James Johnston – Telling the other side of Tenet Hospitals

Neurologist and Attorney Dr. James C. Johnston is not surprised that Tenet Hospital was indicted again in 2017 for insurance fraud in an ongoing investigation by the FBI Healthcare Fraud Unit, Department of Justice and Office of the Inspector General. Just a few months ago Tenet plead guilty to insurance fraud, sham contracts, bribes and kickbacks, paying the Department of Justice over $516 million to settle criminal and civil charges. For the past two decades Tenet has repeatedly entered settlements with the government over insurance fraud, illegal kickbacks and related crimes, paying several billion in fines, earning the label as “one of the most despicable healthcare companies in the United States.” A simple google search of ‘Tenet fraud’ leads to thousands of articles on this company’s appalling misbehavior and abuse of patients.

In fact, 26 years ago, in 1991, Dr. Johnston was practicing in Texas at one of the Tenet Hospitals, at that time a chain of 116 hospitals that engaged in insurance fraud, bribes, kickbacks and performed unnecessary surgeries and procedures. Dr. Johnston refused to participate in the fraudulent schemes, referred his patients to other hospitals, and contacted the Department of Justice with a whistle-blower complaint against Tenet hospitals.

A hospital-based group of four physicians, one already repaying the government for Medicare insurance fraud, retaliated with an extortion attempt, bribing several workers’ compensation patients to make false allegations against him. The physician involved in Medicare fraud was married to the district attorney, who filed specious charges against Dr. Johnston that culminated in a lengthy court battle. At the time, terrible things were said about Dr. Johnston. The New York Times printed a biased story before the conclusion of this ordeal.

In the end, Dr. Johnston prevailed – Judge Barbara Marquardt heard all the evidence at trial and dismissed the false allegations against him as “pure fiction,” declaring him innocent of any wrongdoing. The Texas Medical Board also reviewed all the evidence and cleared Dr. Johnston of any misconduct or illegal act, found him innocent, and concluded that he maintained the highest professional standards, exceeding the standard of care. So did every other medical board where Dr. Johnston held a license. The New York Times refused to print a follow up story on Judge Marquardt’s findings or the final medical board decision, leaving their misleading story languishing on the internet for the past quarter of a century.

Dr. Johnston’s complaints, along with those of several other physicians at various Tenet Hospitals between 1991-1994 led the Department of Justice, FBI and Office of the Inspector General to investigate, eventually forcing Tenet to sell off a number of hospitals and pay a $900 million fine for billing fraud and related illegal activities. Several of the doctors making false accusations against Dr. Johnston lost their medical licenses, had to repay the government for fraud, and one ended up in prison. The district attorney and his assistant were investigated by the FBI and resigned from office.

The medical community members that know the whole story hold the highest respect for Dr. Johnston – he made a huge personal sacrifice to do the right thing, and stand up for his patients.  James C. Johnston, MD, JD has practiced neurology for 30 years and his reputation as a physician, attorney and member of the community is absolutely spotless.

World Association for Medical Law

 

World Association for Medical Law pic

World Association for Medical Law
Image: wafml.memberlodge.org

Consultant Neurologist Dr. James C. Johnston is a Barrister of the High Court of New Zealand, a Fellow of both the Australasian and American Colleges of Legal Medicine, and an active member of many other professional organizations including the World Association for Medical Law (WAML).

Organized in Ghent, Belgium, in 1967, the purpose of the World Association for Medical Law is to encourage the study and discussion of health law, legal medicine and ethics, for the benefit of society and advancement of human rights. The aim is to promote the study of jurisprudence, legislation and ethics of developments in medicine, health care and related sciences; to address any matters that involve issues of medical and health law; and to encourage research and development in medical law.

The official publication of the WAML is the journal ‘Medicine and Law,’ which has been published for almost 40 years with authors from over 100 countries. The Kennedy Institute of Ethics labeled this journal as a “priority journal.”

The 50th Anniversary Meeting and 23rd WAML Congress was held on 9-14 July 2017 in Baku, Azerbaijan with major sub-themes including medical law and bioethics. Drs. Mehila Zebenigus, Guta Zenebe and James C. Johnston presented a discussion on improving relations between developed and developing countries through guidelines that focus on advancing collaborative partnerships to improve health care. This topic followed their lecture last year at the Los Angeles, USA meeting discussing the medical, ethical and legal problems that arise when Western countries engage in short term medical missions to resource limited nations.

Drs. Mehila Zebenigus and James C. Johnston also discussed concerns related to neuroimaging for the patient presenting with headache. They recommended deleting the currently used guidelines because those guidelines are outdated, and have been a contributing factor in the misdiagnosis of headache disorders.

Drs. Thomas P. Sartwelle, James C. Johnston, Berna Arda and Mehila Zebenigus presented a poster highlighting the concerns related to using electronic fetal monitoring in sub-Saharan Africa, how that procedure causes more harm than good, and wastes scarce resources that would be better used helping children with cerebral palsy.