Meet Patty & David Skolnik:
Before 2001, Patty & David were an upwardly mobile professional couple who were travelling the country helping to establish successful pre-schools. They moved from Texas to Colorado in 1998 and were joined by their son, Michael in 2000. While Patty and David were on the fast track in their careers, Michael became an EMT and began the Arapahoe Community College to get his Associates Degree. Michael’s passion for helping others, led him to a career choice as a pediatric nurse. The idea of legislative advocacy or contacting their elected officials was far from their minds. They had never written, called or contacted an elected official before.
But all that changed on September 21, 2001, when at the age of twenty-two, the Skolniks’ only son Michael went under “the knife” for a brain surgery he would never recover from. The Skolniks were told by the neurosurgeon that Michael needed brain surgery right away, even though their family physician looked at the same results and told them “good news. Michael does not need surgery.” They were told there was a cyst on Michael’s brain, but a cyst was never discovered during the surgery. They were not told that even if there was a cyst that it was not the cause of Michael’s symptoms. (He passed out once in July and once in September). They were not told that the surgery was not necessary. They were not told that there was a less-invasive alternative brain surgery. They were not advised of the risks. They were not advised that their son would also be getting a craniotomy. They were also not advised that this surgeon lacked experience in this brain operation. They were not advised of all of the financial and referral relationships, which would ultimately dictate much of Michael’s medical care.
The surgery took more than twice as long as it was supposed to and the aggressive rooting around in his brain caused swelling and hemorrhaging of Michael’s brain. When Michael awoke, he could no longer speak, was paralyzed on one side of his body and was fifty percent blind in both eyes. He had a serious seizure disorder and was now psychotic and required 24-hour care.
Following the surgery, Michael was convalescent, had 82 MRI’s, and was in and out of hospitals, rehab, ICU, and 24-hour homecare with the Skolniks keeping constant vigil with their son. The medical expenses for his care reached $4.8 million. After 32 excruciatingly painful months, Michael eventually succumbed to multi-organ failure and died nearly three years after the brain surgery on June 4, 2004 at 5:35PM. David will tell you that Michael really died the day of the surgery. The Skolniks lost their only son and were haunted by the knowledge that this was preventable had they known all they would later learn.
Before the surgery, Patty Skolnik had checked out the profile of the neurosurgeon on the website of the Colorado Board of Medical Examiners and nothing unusual came up so she assumed they were in good hands. What she did not and could not know was that this neurosurgeon was being sued for the death of another patient in Atlanta and had operated on the wrong disc and disabled another patient in Atlanta.
There is no way they would have allowed this person to open and prod in their son’s brain had they known this background. The realization that patients had no meaningful access to finding out important information about their doctors, set the Skolniks on a mission that would change law forever in Colorado and in many states around the country.
Patty was galvanized into action right away whereas it was more difficult initially very for David to publicly share his grief. Patty Skolnik created the Colorado Citizens for Accountability, which would later become a national group, Citizens for Patient Safety.
In 2007, Patty contacted me and said she wanted to run a bill that would increase transparency of critical information about doctors online so all patients could research their physicians to help make informed decisions. Patty and David knew that they didn’t want anyone else to ever go through what they did. Patty did not live in my district but was told she needed a “can-do” legislator to help. Somehow she got my name, we met and went to work right away.
Our first challenge was that Patty had contacted me at a time in our legislative session when we were past our bill deadlines. Further, Colorado limits each legislator to five bills per session and I already had five bills. We could get a “late bill” or “extra bill” only with the permission of leadership. For Patty, there were no obstacles only items she needed to get done. She got a meeting with Speaker Andrew Romanoff and with what I would later call “Patty Power” she got his permission to give me both an extra bill and to introduce one after the deadlines.
Our next step was to figure out what specifically we needed and wanted in our bill. Patty’s focus was on two problems: (1) relevant background was not made publicly available on the state’s website; and (2) a doctor could move from state-to-state and that prior disciplinary history would not necessarily get captured and made available. So we divided up the work. I had our Legislative Council do a research memo on what information each state’s Board of Medical Examiner’s made available online and I asked Patty to create a “wish list” of all information a patient should have the right to know when choosing their doctor.
Patty found a good resource in Public Citizen who had recently completed a report comparing the content on the state’s Medical Board websites. She identified Massachusetts as a state that seemed to be ahead of the curve on these transparency issues. The “wish list” started to take shape.
A patient should be able to know what education, training, certifications or specialties a doctor had. A patient should have easy access to the disciplinary history or malpractice history of a physician in any state. A patient should also be able to find out if the provider had ever been turned down for malpractice insurance, lost drug prescribing or hospital privileges and the nature and extent of the financial ownership relationships a provider has with other medically related companies and investments.
We gave the full wish list to the drafter and began to work on the hard part — getting it passed. Patty met with every legislator and said, “I’m a mom. I would like a meeting with you and to take a few minutes to show you a video.” The video was an excerpt about Michael’s story on the Today Show. One meeting at a time, she moved people, and began to grow our support. Many legislators were surprised to find out that we didn’t already make this information available online.
Patty met with the Colorado Medical Society, who to our great delight was supportive of the effort. It was important to them to include a disclaimer to give people some context on the malpractice information basically stating that some specialties are inherently higher risk than others. We discussed it and decided that was factually true, didn’t hurt the bill and having the support of the medical society made our job easier.
Patty met with everyone she could and with every meeting our support kept growing. Hospitals began to see that this could be useful information to help make good hiring decisions. But here was the test – COPIC. COPIC is Colorado’s physician-owned malpractice carrier that underwrites most of the malpractice insurance in Colorado. They spend a great deal of their time and money resources in defending physician’s in malpractice actions. Yet, COPIC was also able to see that preventing malpractice in the first place with better information and education for consumers was a win-win for everyone. They too came on board. I was simply amazed.
There was another challenge. We did not want this to be a partisan bill. Both Democrats and Republicans go to the hospital. People of both political parties deserve good information with which to make good decisions. So Patty made sure she had a Democratic helper and Republican helper so that she could have these conversations on both sides of the aisle. It shouldn’t matter, but it sometimes does. The messenger can have everything to do with how the policy or bill idea is received.
Patty, with no legislative experience whatsoever, was able to get support for her idea at every turn. We met our next challenge when the drafter told us that we don’t name bills after people in Colorado. Patty, David and I wanted this to be the Michael Skolnik Medical Transparency Act. It was important to us that it bears his name, in his memory, and in his honor. The bill, after all, was about real people. It was about Michael. It was about the millions of people who enter a hospital every year and trust the advice of their physician. I told the drafter we were naming it the Michael Skolnik Medical Transparency Act. Period. And that was that.
I had a lot of work to do to live up to what the Skolniks deserved. They had been let down by a lot of people “in the system” and I felt a bit intimated by the responsibility of taking this on and doing it well. What if it failed? Fortunately, for Patty, failure was not an option. Meanwhile I did a significant amount of research on medical errors in our country. I found out that there are an estimated 98,000 preventable deaths to medical errors every year and that it was the 8th leading cause of death in the United States. I found out that a very small percentage of physicians are responsible for the majority of the malpractice incidents. I found other research suggesting that a doctor on average commits 13 acts of medical negligence before losing their license to practice medicine. Wouldn’t you want to know if your doctor was one of them?
Before we had our first legislative hearing in the House (I was in the House at the time), Patty had met with every member on the House Health and Human Services Committee. She asked for their support. I asked for their support. Patty brought a legion of unlikely and unusual allies to the table – all in support of the bill. We showed the video clip. Our allies testified in support offering many policy reasons why this level of transparency for informed decision-making was a good idea. Patty and David testified. Everyone forgot to breathe. Patty gave an explanation of what happened to their son and what information was and was not available to the public that could have meant a different outcome. It could have happened to anyone. It didn’t need to happen. Legislators began to see their children, their parents, and their spouse at risk for something similar. David testified and took a moment to begin. He pulled out his written comments, took a deep breath and paused. He put his prepared comments aside and told the committee that he needed to speak from the heart. He did and reached every soul in the room that day. They began to see that good information could be a matter of life and death for any of us. The bill passed unanimously on a vote of 11 – 0.
Our next challenge was a stop to the House Appropriations committee. While the bill didn’t cost much, there would be some need to re-program the state’s computers at the Department of Regulatory Agencies. We have a Balanced Budget Amendment in Colorado’s constitution so we cannot create any new law or policy without having a way to pay for it. (We also have TABOR, which has limited the state’s ability to raise revenue). We needed to find a way to pay for the technology changes and a little extra initial staff time to help physicians through the new filing system. By adding $13 – $19 to the renewal fee to the license we found our way to pay for it and the organizations representing physicians agreed to that. The Michael Skolnik Medical Transparency Act (HB07-1331) passed House Appropriations committee 13 – 0. The bill then passed the House on a final recorded vote of 65 – 0. It not only passed.
We asked Senator Lois Tochtrop to be the Senate sponsor on the bill because she is an experienced nurse and seasoned legislator. She agreed. In the Senate the bill was assigned to the Business, Labor and Technology committee and it passed after another round of strong testimony on a vote of 7 – 0. The bill then passed Senate Appropriations committee on a vote of 9 – 0. We were nearing the final stretch of the session and needed to get it passed. The bill passed the Senate on final recorded vote of 34 – 1. Only one “no” vote in the whole process — Not bad.
The Michael Skolnik Medical Transparency Act was signed by then Governor Bill Ritter, Jr. on May 24, 2007 with a signing ceremony.
The Board of Medical Examiners then took implementation of the Act to heart and included us in all key phases of implementing the bill. In 2009 we carried a “clean-up bill” to help with some logistical issues on implementation and to give clearer definitions to some of the requirements. That bill (HB 09-1188) also passed and the website went live with new and meaningful information now available in a complete physician profile as they renewed their licenses. In 2010 we extended the same type of provider transparency to other key health professionals (dentists, nurses, psychologists, chiropractors, acupuncturists, physician assistants, midwives, and physical therapists) in SB 10-124.
Patty and David Skolnik passed three bills in three years even though they never imagined that they would be involved in the legislative process. They didn’t stop there. They have continued to work on other key health care reforms and participating in educational efforts with providers and the public on patient safety. Colorado’s bill expanded the transparency available beyond most other states and ours has now become a model for other states. They proceeded to engage on public service announcements to help the public know that they now had a right to this information and where to find this information on health providers.
They did it for Michael. They did it for you. You can do it too.
When I told Patty and David I was writing this book, I asked if they had any advice for you or other people who might be interested in making or changing law. Patty said, “…that anyone can do it.” She said, “don’t be afraid of the process.” “Find a champion and they will help you.” David’s power is sharing the raw, unpolished truth and letting others see it for what it is. “Speak from the heart and reach people on a human level.”