Dr. James Keaney, Emergency
Physician, Author The Rape of
Emergency Medicine

The sole purpose of the Institute for Justice in Emergency Medicine (IJEM) is to decolonize the nation’s emergency departments from the rapacious slumlords posing as Wall Street-traded corporations known as contract management groups (CMGs), hedge funds and pseudodemocracies offering so-called services which front for the imposition of unnecessary third-party middlemen. These exploitationists are not only toxic to emergency physician well-being and resiliency but also constitute a public-health detriment to the communities in which the hospitals are located.

We propose a federal lawsuit against the Centers for Medicare and Medicaid for violation of the original intent of the Medicare Act of 1965 passed by both houses of Congress and signed into law by President Lyndon Johnson. The current transmutation or misallocation of Medicare-approved, clinically generated fees by bedside emergency physicians into vast administrative wealth for nonclinical work-and-make-work provides zero-point-zero real benefit to the American patients or to the clinical emergency physicians. Moreover, it constitutes a public health detriment to the communities in which the hospitals are located.

This is the central premise of the lawsuit; Institute for Justice in Emergency Medicine (IJEM) versus United States Secretary of Health and Human Services.

The gross violation of the original intent of the Medicare Act of 1965 is the diverting of taxpayer money which is specifically designated to pay bedside physicians to provide healthcare to the “Joe-the-Plumbers” and “Rosie the Riveters” of America to corporations providing emergency medical care according to the dictums of Bernie Madoff rather than the Oaths of Hippocrates and Maimonides. Tens of millions of dollars of Medicare money is being wasted on slick advertisements by CMGs to send scores of men in crisp blue suits with red ties and women in well accessorized Saks Fifth Avenue outfits to traipse all over the nation trying to outwit and capsize stable independent emergency medicine groups knowing full well the CMGs gumbo of doctors and their “Kulture” offer nothing but profits for the mothership with staggering commissions for themselves. This phenomenon of Mad Men marketing is undermining quality emergency medical care.

Sixty years of “separate but equal” didn’t work but ended up with Brown v Board of Education; sixty-five years of communism collapsed with the fall of the Berlin Wall; 45 years of CMGs hasn’t worked now requiring IJEM v HHS.

Currently, the attempts to reverse engineer the current perverse system which provides maximum passive income for a few shareholders and speculative hedge-funders have not been fruitful. The neurosurgeons who clip the most aneurysms and remove the most brain tumors have the highest income but the emergency physicians seeing the fewest emergencies make the most money. In the upside-down world of EM, making incremental changes is like Waiting for Godot. The medical crime of the century is happening before our eyes. And, in only one specialty. We need to reweigh the payment system for the benefit of patients and clinical physicians. A single court order would change the system into a civilized delivery of emergency medical care overnight which, indeed, was the original intent of the congressional act.