(Bloomberg Businessweek) -- Last year, Jessie Harrell went to see her gynecologist for a routine appointment. She’d been seeing Dr. Tim Baird for 14 years, ever since she showed up at the hospital in labor five weeks early. He’d been on call that morning, and she’d been reassured by his calm demeanor, even as he delivered her first child via an emergency cesarean section.
(彭博商业周刊)——去年，杰西·哈勒尔去看她的妇科医生进行常规预约。自从她提前5周出现在医院，她已经看了14年的蒂姆·贝尔德医生了。那天早上，他一直在值班，即使是在他通过紧急剖腹产为她生下第一个孩子时，她也对他的冷静感到放心。
But this time, right before Harrell’s visit, a staff member in Dr. Baird’s office in Jacksonville, Fla., called and asked her to watch a video on the medical group’s website. She clicked a link and saw an attractive actress in an immaculate office explaining a new policy. All of Dr. Baird’s patients, Harrell learned, needed to sign a form agreeing to “binding arbitration,” a legal concept that meant she was waiving her right to a jury trial in the event of medical malpractice.
但这一次，就在哈勒尔到访之前，贝尔德博士在佛罗里达州杰克逊维尔的办公室里的一名工作人员说，他打电话给她，请她观看该医疗组织网站上的一段视频。她点击了一个链接，看到一位迷人的女演员在一间完美的办公室里解释一项新政策。哈勒尔了解到，贝尔德医生的所有病人都需要签署一份同意“有约束力仲裁”的表格，这是一个法律概念，意味着她放弃了在发生医疗事故时由陪审团审判的权利。
When she objected, the woman on the phone told her she could see Dr. Baird one more time, but she’d have to find a new practice after that. In the exam room the doctor began as he always had, by asking Harrell about her two daughters. He was apologetic about the new requirement but said it was out of his hands. His office and dozens of other locations in his medical group had been sold to Lindsay Goldberg, a New York-based private equity firm with more than 100 physician offices and surgery centers across Florida. This was the new reality, he said, whether he liked it or not.
当她表示反对时，电话里的那个女人告诉她，她可以再去看贝尔德医生一次，但之后她得找一个新的诊所。在检查室里，医生像往常一样开始询问哈勒尔关于她两个女儿的情况。他对新的要求表示歉意，但说这不是他能控制的。他的办公室和医疗集团的其他几十个地点都被卖给了Lindsay Goldberg。Lindsay Goldberg是一家总部位于纽约的私人股本公司，在佛罗里达州拥有100多家医生办公室和手术中心。这就是新的现实，他说，不管他喜欢与否。
Harrell was heartbroken, and not just because she trusted Dr. Baird. Harrell is a lawyer—she has her own appellate firm in Jacksonville—so giving up a constitutional right would’ve been bad enough. What made it even worse was that she recognized every page of the agreement the office was asking her to sign. In 2016 she’d successfully argued a case that involved a woman who’d sued her gynecologist, a doctor with a large group called Women’s Care Florida, after signing an almost identical form.
哈勒尔很伤心，不仅因为她信任贝尔德医生。哈勒尔是一名律师——她在杰克逊维尔有自己的上诉公司——所以放弃宪法赋予的权利已经够糟糕的了。更糟糕的是，她能认出办公室要求她签署的每一页协议。2016年，她成功地解决了一起案件，该案涉及一名女性起诉她的妇科医生，这名医生来自一个名为“佛罗里达女性护理”(Women’s Care Florida)的大型组织，在签署了一份几乎相同的表格后。
It was a horrible story: Her client, who had symptoms of early labor, arrived late to an appointment and was turned away, with the doctors’ office rescheduling for four days later. A day before the new appointment, she gave birth to a stillborn baby. Under normal circumstances, the patient would’ve been able to go through the state’s legal process, which meant either agreeing to arbitration or moving to trial. Women’s Care, though, insisted on enforcing the binding arbitration agreement, which meant she (as well as her husband and then-unborn child) had already given up their rights.
这是一个可怕的故事:她的客户有早产的症状，预约迟到了，被拒绝了，医生的诊所被重新安排在了四天后。在新预约的前一天，她生下了一个死胎。在正常情况下，患者本来可以通过该州的法律程序，这意味着要么同意仲裁，要么进行审判。然而，妇女的照顾，坚持执行有约束力的仲裁协议，这意味着她(以及她的丈夫和当时未出生的孩子)已经放弃了他们的权利。
Harrell and a colleague, Bryan Gowdy, had argued during the appeal that the Women’s Care agreement was unenforceable under state law. The Florida Supreme Court sided with them, saying the agreement was void. And yet somehow here it was again. In the three years since she’d won, Women’s Care had been bought by Lindsay Goldberg, which then bought Dr. Baird’s practice, too. The medical group had continued using the form—in the hope, she guessed, that even an unenforceable arbitration agreement would be enough to dissuade a malpractice victim from suing.
哈勒尔和他的同事布莱恩高迪(Bryan Gowdy)在上诉期间辩称，根据州法律，妇女护理协议不可强制执行。佛罗里达州最高法院支持他们，称该协议无效。但不知何故，它又出现了。在她获奖后的三年里，“妇女护理”被林赛·戈德堡(Lindsay Goldberg)收购，随后又收购了贝尔德医生的诊所。医疗集团一直在使用这份表格——她猜测，希望即使是一份无法执行的仲裁协议也足以阻止医疗事故受害者起诉。
It was an outrage, she thought, as she walked out of Dr. Baird’s office. “Why would I agree to that after hearing the Supreme Court say it was unfair to patients?” Harrell asked in a Zoom interview with Bloomberg Businessweek from her home. In the background, Archer, a rescue greyhound who once raced under the name Miami Hurricane, lazed on a white sofa. Harrell’s face tightened as she spoke. “People shouldn’t be put in this take-it-or-leave-it position after having been shown a five-minute video on arbitration propaganda.”
当她走出贝尔德医生的办公室时，她想这真是一种暴行。“在听到最高法院说这对病人不公平之后，我为什么要同意呢?”哈勒尔在家中接受彭博商业周刊采访时问道。背景中，一只名叫阿彻(Archer)的救援灰狗懒洋洋地躺在白色沙发上，它曾经以迈阿密飓风(Miami Hurricane)的名字参赛。她说话时，哈勒尔的脸绷紧了。“人们不应该在看了一段五分钟的仲裁宣传视频后，就摆出一副要么接受要么放弃的姿态。”
The argument for arbitration hinges on the rising costs imposed by malpractice lawsuits, which some policymakers and doctors say have made medicine more litigious and led to worse care. One in three babies in the U.S. is delivered via C-section, a procedure that, compared with vaginal delivery, is more expensive for patients, requires a longer recovery period, and carries higher risks of infection and blood loss—but which is less likely to result in a lawsuit if complications occur during labor, at least according to the American Congress of Obstetricians & Gynecologists. The group has said that limiting physician liability would cause C-section rates to drop.
主张仲裁的理由在于医疗事故诉讼造成的成本上升，一些政策制定者和医生说，这使得医疗更容易引发诉讼，导致医疗状况恶化。三分之一的婴儿在美国是剖腹生产,一个过程,与阴道分娩相比,更昂贵的患者,需要更长的恢复期,感染和带来更高的风险和血液损失,这是不太可能导致诉讼的并发症发生在劳动,至少根据妇产科医师美国国会。该组织表示，限制医生的责任将导致剖腹产率下降。
Advocates of arbitration contend that it’s a sensible alternative to resolving disputes in a trial. Arbitration, they say, frees doctors to treat patients more holistically and to worry less about how a treatment decision might play with a jury. But it has also helped enable a trend that has very little to do with patients’ well-being: the rise of private equity in medicine. Over the past decade, almost 4,000 independent clinicians in women’s health have come under private equity ownership, according to a study published in August in the Journal of the American Medical Association. The figure is likely much higher, according to the study’s authors, but the deals aren’t uniformly disclosed.
主张仲裁的人认为，与在法庭上解决纠纷相比，仲裁是一个明智的选择。他们说，仲裁使医生可以更全面地治疗病人，也可以减少对治疗决定如何与陪审团打交道的担心。但它也促成了一种与患者福祉几乎没有关系的趋势:医疗领域私人股本的兴起。《美国医学会杂志》(Journal of the American Medical Association) 8月份发表的一项研究显示，在过去的十年中，近4000名独立的女性健康临床医生被私募股权公司收购。研究报告的作者说，这个数字可能要高得多，但这些交易并不都是公开的。
The Covid-19 pandemic, during which doctors’ offices shut down temporarily and furloughed staff, is only accelerating this trend. The average medical office’s revenue has dropped 32% this year, according to a survey released in November by the American Medical Association, even as rates for malpractice coverage have gone up by as much as 30%. Private equity firms, on the other hand, raised billions from investors this year and have been buying up struggling practices on the cheap.
Covid-19大流行期间，医生办公室暂时关闭，员工休假，这只会加速这一趋势。美国医学协会11月发布的一项调查显示，今年诊所的平均收入下降了32%，而医疗事故的保险费率却上升了30%。另一方面，私人股本公司今年从投资者那里筹集了数十亿美元资金，并一直在廉价收购举步维艰的业务。
The private equity playbook involves acquiring practices in fields such as dermatology, gastroenterology, and obstetrics and rolling them up into enormous medical networks with hundreds of doctors’ offices and thousands of individual doctors under a single brand. For these big practices, arbitration may be especially useful. Jury trials, even in the era of tort reform, can still lead to awards in the tens or even hundreds of millions of dollars for plaintiffs. Juries, understandably, are likely to have less sympathy for a well-capitalized Wall Street owner than for a grieving mother who’s been treated poorly.
私募股权的剧本包括获得皮肤病学、胃肠病学和产科等领域的实践，并将它们整合到庞大的医疗网络中，在一个品牌下拥有数百家诊所和数千名医生。对于这些大的实践，仲裁可能特别有用。即使在侵权法改革的时代，陪审团审判仍然可以为原告带来数千万甚至数亿美元的赔偿。可以理解的是，陪审团对一个资本雄厚的华尔街老板的同情可能会少于对一个受到虐待的悲伤母亲的同情。
In arbitration, the plaintiff (in this case the patient) and the defendant (the owner of the medical practice) each pick an arbitrator. The third arbitrator is generally a neutral party, and the trio’s decisions are usually final. The process can be much faster than a jury trial, which can mean lower legal fees. Crucially for private-equity-owned medical groups, arbitration is almost always conducted in private, which means that big brands can avoid the negative publicity that comes with a lawsuit. Jury trials, on the other hand, are a matter of public record. When malpractice verdicts are rendered, patients can use that information to figure out which doctors to avoid and which ones to seek out.
在仲裁中，原告(在这种情况下是病人)和被告(医疗机构的所有者)各自挑选一名仲裁员。第三名仲裁员通常是中立的一方，三人的决定通常是最终的。这个过程比陪审团审判要快得多，这意味着更低的法律费用。对于私募股权所有的医疗集团来说，至关重要的是，仲裁几乎总是在私下进行，这意味着大品牌可以避免诉讼带来的负面宣传。另一方面，陪审团审判是一个公开记录的问题。当医疗事故判决公布时，患者可以利用这些信息来确定应该避免哪些医生，应该寻找哪些医生。
Arbitrators are usually lawyers or retired judges, but they don’t have to follow legal precedent, and they don’t necessarily even need to explain their decisions. They also, critics say, have an incentive to favor corporate defendants because arbitrators generally want to get rehired and, as a result, tend to come up with lower payouts. In cases in which arbitrators side with a malpractice victim, awards can be strictly limited. By law in Florida, the maximum pain-and-suffering award in arbitration is $250,000 for each person filing a claim.
仲裁员通常是律师或退休法官，但他们不必遵循法律先例，甚至不必解释他们的决定。批评人士说，他们也有偏向公司被告的动机，因为仲裁员通常都希望获得重新聘用，因此往往会获得较低的薪酬。在仲裁员支持医疗事故受害者的情况下，裁决可能受到严格限制。根据佛罗里达州的法律，仲裁裁决的最高赔偿金额为每人25万美元。
Of course, speed and privacy can make arbitration appealing to plaintiffs as well, and the decision to seek arbitration is usually voluntary—and occurs after malpractice. By contrast, binding arbitration agreements, which patients have to sign before receiving any care, have historically been seen as infringement of their rights. Since the early 2000s the American Arbitration Association and the American Bar Association have said their members shouldn’t participate in these kinds of cases.
当然，速度和隐私也会使仲裁对原告产生上诉，而寻求仲裁的决定通常是自愿的——而且发生在渎职之后。相比之下，有约束力的仲裁协议，即病人在接受任何治疗之前必须签署的协议，历来被认为是对他们权利的侵犯。自21世纪初以来，美国仲裁协会(American Arbitration Association)和美国律师协会(American Bar Association)一直表示，其成员不应参与这类案件。
But the financial industry has long embraced binding arbitration—especially when setting employment policies, a trend that critics say has been used to cover up decades of discrimination and sexual harassment—and has helped fuel the rise of the practice in medicine. Over the past few years, agreements like the one Harrell’s client signed have become pervasive in admission packages for nursing homes, another business popular with investors. Lawyers and insurance brokers say they’re also starting to show up in plastic surgery, women’s health, and other industries that private equity investors are consolidating.
但金融业长期以来一直支持有约束力的仲裁——尤其是在制定雇佣政策时，批评者称这种趋势被用来掩盖数十年来的歧视和性骚扰——并帮助推动了医学实践的兴起。在过去的几年里，像哈勒尔的客户签署的这样的协议已经在养老院的准入方案中普遍存在，这是另一项受到投资者欢迎的业务。律师和保险经纪人说，它们也开始出现在整形手术、女性健康以及私募股权投资者正在整合的其他行业。
The insurance industry has encouraged this trend by offering better terms to physician groups that can get their patients to preemptively waive their right to a jury trial. The former chief medical officer of Women’s Care Florida, John Murphy, lists under “Key Achievements” on his LinkedIn page that binding agreements have lowered the OB-GYN group’s liability insurance costs 20% a year. “The fact that they discount insurance tells you what’s going on,” says Thomas Edwards, a malpractice attorney in Jacksonville. “They know it will reduce or eliminate awards even in cases where somebody committed malpractice.”
保险行业通过向医生团体提供更好的条款来鼓励这一趋势，这些医生团体可以让他们的病人先放弃他们的陪审团审判的权利。佛罗里达州妇女护理中心(Women’s Care Florida)的前首席医疗官约翰·墨菲(John Murphy)在他的领英(LinkedIn)主页上列出了“关键成就”，称有约束力的协议使妇产科集团的责任保险费用每年降低了20%。杰克逊维尔的医疗事故律师托马斯·爱德华兹说:“他们对保险打折扣的事实告诉了你发生了什么。”“他们知道，即使是在有人玩忽职守的情况下，赔偿金也会减少或取消。”
This binding arbitration isn’t necessarily good for doctors, who often care about their reputations and their relationships with patients more than they care about improving profits or preserving the brand equity of their investor-owners. Arbitration agreements can turn patients off, and some physicians say they’d prefer the option of fighting charges in court if they’re accused of wrongdoing, giving them a chance to clear their name publicly. “Arbitration has the real potential to remove some of the rights providers have under a more traditional insurance policy,” says Peter Reilly, who leads the North American health-care practice for insurance broker Hub International Ltd. “There’s some value there if you get a reduced premium, but I’m not sure it’s in the physician’s best interest.”
这种有约束力的仲裁对医生来说并不一定是好事，因为他们通常更关心自己的声誉和与病人的关系，而不是提高利润或维护投资者所有者的品牌资产。仲裁协议可能会让病人反感，一些医生说，如果他们被指控有不当行为，他们宁愿选择在法庭上对抗指控，让他们有机会公开洗清自己的罪名。“仲裁确实有可能删除一些供应商的权利在一个更传统的保险政策,”彼得·赖利说领导北美国际中心医疗实践保险经纪人有限公司”有一些价值,如果你得到一个溢价下降,但我不确定它在医生的最佳利益。”
Women’s Care started as a small obstetrics and gynecology practice in 1998 in Tampa, but by the time Harrell took it to appellate court in 2015, it had expanded to include 27 practices in the Tampa Bay area and elsewhere in Central Florida. Harrell had started her career at a big corporate firm, Foley & Lardner, where she spent seven years as a commercial litigator, defending claims against Walmart Inc., Bank of America Corp., and other companies. The job was life-altering financially for Harrell, who was the first in her family to go to college, but it was hardly fulfilling, and she eventually left for Creed & Gowdy, a smaller appellate firm in Jacksonville that specializes in, among other things, personal injury cases that wind up in federal or state appeals court.
女性护理始于1998年坦帕市的一家小型妇产科诊所，但到2015年哈勒尔向上诉法院提起诉讼时，该诊所已经扩展到坦帕湾地区和佛罗里达州中部其他地方的27家诊所。哈勒尔的职业生涯始于一家大公司Foley & Lardner，她在那里做了七年的商业诉讼律师，为沃尔玛(Walmart Inc.)、美国银行(Bank of America Corp.)和其他公司的索赔辩护。哈勒尔的工作是改变一生的财务,谁是第一个在她的家庭去上大学,但是它并不满足,她最终离开了信条& Gowdy,较小的上诉公司在杰克逊维尔,专门,除此之外,人身伤害案件在联邦或州上诉法院。
Working for victims was gratifying, and arguing appeals was an intellectually rigorous process that played to her strengths. Her client in the Women’s Care case, Lualhati Crespo, had clearly been mistreated, as Harrell saw it. Crespo had been denied care, then was denied her legal rights, because she’d signed the agreement. “Doctors take the Hippocratic Oath to ‘Do no harm,’ and that puts them in a position of trust,” Harrell says. “You’re relying on them for advice when you step through that door. And then you go in, and you’re led to believe that if something goes wrong, arbitration is going to be best for you. I feel like they are betraying the trust of their patients.”
为受害者工作是令人满意的，申诉是一个智力上严谨的过程，这发挥了她的优势。在哈勒尔看来，在妇女护理案中，她的当事人卢阿哈蒂·克雷斯波(Lualhati Crespo)显然受到了虐待。克雷斯波被拒绝照顾，然后被剥夺了她的合法权利，因为她签了协议。哈勒尔说:“医生们遵循希波克拉底誓言(Hippocratic Oath)，‘不伤害任何人’，这让他们处于值得信任的地位。”当你踏入那扇门的时候，你是在依赖他们的建议。然后你进去了，你被引导着相信如果出了什么问题，仲裁将是最适合你的。我觉得他们背叛了病人的信任。”
As she studied the case, Harrell says her sense of indignation grew. Her parents hadn’t been able to afford health insurance, and she frequently had to skip checkups. In college, after seeking treatment for migraines, she discovered she had about 10 cavities. “I really have an appreciation for medicine, because I haven’t always had access to it,” she says.
哈勒尔说，当她研究这个案例时，她越来越感到愤慨。她的父母没有能力支付医疗保险，她经常不得不跳过体检。上大学时，她寻求偏头痛的治疗后，发现自己有大约10颗蛀牙。她说:“我真的很喜欢医学，因为我并不总是能接触到它。”
During oral arguments, Florida Supreme Court Justice Barbara Pariente noted that the binding arbitration agreement presented patients with a false choice. A Florida statute says if both parties don’t agree on arbitration, they can go to trial. The agreement Crespo had signed said she and Women’s Care could agree to go through either the state’s arbitration process or a separate binding arbitration with rules set by the medical group—but a trial was not an option. It reminded the judge of the song Hotel California: “You can check out any time you like, but you can never leave.” In a 5-to-2 decision, the court noted that Florida already had laws designed to prevent frivolous suits and said the Women’s Care agreement was “clearly favorable to one party.” (Women’s Care appealed to the U.S. Supreme Court, which declined to hear the case.)
在口头辩论中，佛罗里达最高法院法官芭芭拉·帕里恩特指出，具有约束力的仲裁协议给了病人一个错误的选择。佛罗里达州的一项法规表示，如果双方不同意仲裁，他们可以进行审判。克雷斯波签署的协议称，她和妇女护理组织可以同意通过国家仲裁程序，或者根据医疗团体制定的规则进行单独的有约束力的仲裁，但不可以进行审判。它让评委想起了《加州旅馆》这首歌:“你可以随时退房，但你永远不能离开。”在5比2的裁决中，最高法院指出，佛罗里达州已经有旨在防止琐碎诉讼的法律，并表示妇女护理协议“显然对一方有利”。(妇女关爱组织向美国最高法院提出上诉，最高法院拒绝审理此案。)
It was over—or at least that’s what Harrell thought when she read the Florida decision, feeling a sense of pride at having won her first case before the state’s highest court. But three years later she found herself walking into Dr. Baird’s office carrying a copy of the decision under her arm, streaked with yellow highlighter.
一切都结束了——至少哈勒尔在读到佛罗里达州的判决时是这么想的，她为自己在该州最高法院赢得了第一个案子而感到自豪。但三年后，她发现自己腋下夹着一份用黄色荧光笔标记的判决书走进贝尔德医生的办公室。
Lindsay Goldberg had bought Women’s Care in September 2017, nine months after the ruling. Since then, Women’s Care had rapidly expanded—to the point that its providers now deliver 1 out of every 10 babies in the state. As it acquired more practices, including the one in Jacksonville’s Southside neighborhood where Harrell went, each group adopted the binding arbitration form, requiring all of its 500,000 patients in Florida to sign.
林赛·戈德堡在2017年9月，也就是判决9个月后购买了女性护理。从那时起，妇女护理迅速扩大，现在该州每10个婴儿中就有1个由妇女护理人员接生。随着它获得更多的实践，包括哈勒尔去的杰克逊维尔南部社区，每个组织都采用了具有约束力的仲裁表格，要求其在佛罗里达州的所有50万名患者签署。
Surprisingly, even though the document is not legally enforceable, there’s nothing preventing the company from asking patients to sign it and refusing to treat them in the future if they don’t, according to more than a dozen legal experts interviewed for this story. “It’s not illegal, but it raises serious questions about what message you are sending to patients,” says Andrew Bolin, a defense attorney in Florida. “Women who sign the form will assume it’s enforceable.” That means, he says, that many who feel they’ve received substandard care won’t even consider hiring a lawyer. And even if they do try to find one, some attorneys may be unfamiliar with the court decision and choose not to take their case because of the agreement. As Harrell puts it, the practice “is tricking people into giving up their legal rights.”
令人惊讶的是，根据采访的十几位法律专家的说法，即使这份文件在法律上没有强制执行力，也没有什么能阻止该公司要求患者签署它，如果他们不签署，就拒绝为他们治疗。佛罗里达州的辩护律师安德鲁·波林(Andrew Bolin)说:“这并不违法，但它引发了一个严重的问题，那就是你在向病人传递什么信息。”“在表格上签字的女性会认为它具有强制性。他说，这意味着，许多觉得自己得到了不合格的医疗服务的人甚至不会考虑聘请律师。即使他们试图找到一个，一些律师可能不熟悉法院的决定，选择不接他们的案子，因为协议。正如哈勒尔所说，这种做法“诱使人们放弃他们的合法权利。”
Lindsay Goldberg declined requests for an interview but provided a statement on behalf of Women’s Care Enterprises. The private equity firm noted that Women’s Care has used binding arbitration agreements for more than 15 years. “These programs were instituted by and have always been developed solely by the physicians who own their practices,” the statement reads. “These physicians are committed to providing the highest quality patient care in an incredibly challenging legal environment for independent medical practitioners.”
林赛·戈德堡拒绝了采访请求，但代表女性护理企业发表了一份声明。这家私募股权公司指出，女性护理行业使用具有约束力的仲裁协议已经超过15年了。声明称:“这些项目是由拥有自己执业资格的医生制定的，并且一直都是由他们单独开发的。”“这些医生致力于在一个极其具有挑战性的法律环境中为独立执业医生提供最高质量的病人护理。”
It’s unclear how many other private-equity-backed groups use binding arbitration, because patient forms are generally kept private. They are well known to doctors, though, who see the agreements as part of a larger pattern in which investors roll up practices and then cut costs frantically in an effort to groom the business for sale, generally to an even larger company. A Businessweek investigation published in May found that some private-equity-owned medical practices buy cheaper, and sometimes substandard, medical supplies and hire providers who aren’t as well trained as doctors, such as nurse practitioners and physician assistants, to do work that would traditionally have been performed by an M.D. When all this results in substandard care, the arbitration agreements are in place to limit liability.
目前还不清楚有多少其他私募股权支持的团体使用了具有约束力的仲裁，因为患者的表格一般都是保密的。不过，医生们对这些协议都很熟悉，他们将这些协议视为一种更大模式的一部分。在这种模式下，投资者将大量的医疗服务打包起来，然后疯狂削减成本，以便把业务做好，然后出售给更大的公司。五月发表的《商业周刊》调查发现,一些私募股权所有医疗机构购买便宜,有时不合格,医疗用品和雇佣供应商不一样训练有素的医生,护士和医师助理等工作,传统上一直由医学博士,这导致不合格的保健、仲裁协议来限制责任。
On Dec. 7, PE Hub, a trade magazine, reported that Lindsay Goldberg had agreed to sell Women’s Care Enterprises, which also owns other women’s health groups in Kentucky and Southern California, to BC Partners, an even larger investment firm based in London. At least one of the groups in California also uses binding arbitration, though Women’s Care says the agreement was in place before Lindsay Goldberg invested. BC Partners didn’t respond to requests for comment.
12月7日，贸易杂志PE Hub报道，林赛·戈德堡已经同意将拥有肯塔基州和南加州其他妇女健康组织的Women 's Care Enterprises出售给总部位于伦敦、规模更大的投资公司BC Partners。至少在加州的一个团体也使用了有约束力的仲裁，尽管妇女护理说在林赛·戈德堡投资之前就已经有了协议。BC Partners没有回复记者的置评请求。
Harrell has since found a new doctor who left Women’s Care and doesn’t use binding arbitration agreements. “There’s nothing inherently wrong with investors buying medical firms, as long as doctors can practice the way they always had,” she says. But, she continues, “what seems like a business decision can affect patient care if it’s using this position of trust that doctors have to mislead patients to do something that’s not in their best interest.”
此后，哈勒尔找到了一位新医生，他离开了女性护理部门，不使用有约束力的仲裁协议。她说:“投资者购买医疗公司本质上并没有什么错，只要医生能够一如既往地行医。”但是，她继续说，“看起来像是商业决策的东西可能会影响病人的护理，如果它利用这种信任的地位，即医生必须误导病人，做一些不符合他们最大利益的事情。”