CENTRAL VIEW for Monday, May 28, 2001

Rural health care and public policy

Many years ago (some say not very long after Moses descended from the mountain carrying The Ten Commandments), this observer was studying law at the University of Oklahoma. One of the things remembered from Contracts I was this: parties to a contract may not contract to perform acts which are illegal or against good public policy.

The illegal part is pretty clear. For example: Joe contracts with Sam for Sam to murder Joe’s wife. Clearly illegal. If Sam fails to carry out the contract, Joe cannot sue Sam for breach of contract.

But the part about the non-enforceability of contracts that are against good public policy is pretty murky. Moreover, I can’t recall any examples from law school. So, I’ll try to make one up.

How’s this for public policy example? Dr. Marcus Welby is hired by the Sisters of Perpetual Guilt Medical System to provide primary patient care services to people living in a rural area where physicians and nurses are few and far between. Dr. Welby serves his patients very well and is much beloved by all with whom he comes in contact. In fact, he becomes the director of the clinic and he offers a wide variety of medical and informational services to the community.

But, in an attempt to cut expenses, the Sisters of Perpetual Guilt decide to eliminate Dr. Welby’s position at the rural clinic. No one finds fault with the quality of care he provides for his patients. No one finds fault with the way the clinic is managed. Apparently, based on seniority and his added managerial duties, Dr. Welby is making more money than the bean counters at the Sisters of Perpetual Guilt main office want to pay. Goodbye, Dr. Welby.

The bean counters do not plan to replace Dr. Welby. Clearly, the bottom line is more important to the bean counters than quality of care. The clinic will simply be minus one well-trained, highly competent and much beloved physician and the Sisters of Perpetual Guilt will have more money. And, hopefully, more guilt.

But wait. There’s more. When they recruited Dr. Welby to move from another state to come serve the rural area, they insisted that his employment contract include a “non-compete” clause. The clause says if Dr. Welby resigns or is terminated then he may not engage in the practice of medicine for three years in the county in which his former place of employment is located.

Now, if the size of the county were the size of some of the smaller counties back east, this might not be too great a hardship on Dr. Welby or his loyal patients. But what if the county were the size of Grand County, Colorado, which is larger than the State of Rhode Island and only slightly smaller than the State of Delaware?

Could anyone with an ounce of compassion for the sick think it is good public policy to enforce a “non-compete” clause so that it denies a rural area almost the size of the State of Delaware the services of a highly-skilled physician?

Maybe this observer is too idealistic. But it seems to me such an action would be against good public policy and, if it is not already, should be illegal as well. And, if it is not illegal, then it is high time that state and federal legislators take up this health-care issue and make such high-handed and arbitrary actions illegal in rural America.

One of the joys and challenges of writing a nationally syndicated column and being an occasional commentator for USA Today, is the opportunity to draw these kinds of issues to the attention of people with the power to make changes. I think this is one of those issues.

Just over 19 years ago in Lincoln, Nebraska, a 650-word essay appeared in the Lincoln Sun Newspaper as “Central View.” This is the 1000th edition of “Central View.”

William Hamilton is a nationally syndicated columnist and a featured commentator for USA Today.

©2001. William Hamilton.

Dr. Hamilton can be contacted at:

Email: william@central-view.com