Anative of Bourne, Mass, Richard G. Cowart grew up in South Mississippi. He graduated from the University of Southern Mississippi, where he served as Associate Student Body President. He earned his Doctor of Jurisprudence degree from the University of Mississippi School of Law in 1978. In law school he served as an editor of the Mississippi Law Journal, as state representative to the American Bar Association Law Student Division, and as a student member of the Mississippi State Bar Board of Commissioners.
From 1978 until 1995 Dr Cowart practiced law at the firm of Watkins, Ludlam & Stennis, based in Jackson, Miss. He became a partner, serving as Chairman of the firm's Business Department, as Chairman of its Health Law Group, and as a member of the Executive Committee. He later became a shareholder in the firm of Baker, Donelson, Bearman, Caldwell & Berkowitz, of Nashville, Tenn, and Jackson, Miss. There he serves as Chairman of the Health Law Department, and as a member of the Board of Directors. He is admitted to practice before the United States Supreme Court, the Fifth Circuit Court of Appeals, the United States Tax Court, the United States Court of Claims, and the Federal and State Courts of Mississippi and Tennessee.
Dr Cowart has frequently been honored for his leadership in many national, regional, and state organizations and projects in the areas of health care, education, and philanthropy. He was the 2004--2005 President of the American Health Lawyers Association. He is also active in his church, having served as Chairman of Deacons. He is currently the Regent at The Hermitage, the Home of former President Andrew Jackson. His presentations are many, addressing every aspect of the health care delivery system and of the relationship between physicians and health care organizations. He is the national columnist for Medical News, Inc. In his journal articles, Dr Cowart has dealt with serving health care clients, physician networking, and issues in the structure of medical practice. Dr Cowart was interviewed by telephone in April 2006.
QMHC: What is the focus of your work at this time?
RGC: I serve as counsel to hospital boards. In that capacity, I deal with issues of organizational priority, such as structure and architecture. This means that I am often dealing with medical staff issues, such as medical staff credentials, privileges, and discipline. I am not a trial lawyer.
These days physicians are under severe stress in the hospital setting. They have to accept hospital emergency department call systems, which many of them regard as unrealistic. There are enormous emergency department demands on neurosurgeons and general trauma surgeons. This is high-risk, low-pay work. Adding to the general stress is the resistance on the part of many medical staff members to our pervasive systems of data-driven quality evaluation.
Point one for us to consider here is that the evaluation of patient care in a hospital is an area of not only medical staffs but also institutional responsibility. The architectural platform for quality management is the hospital as an institution. Point two that affects the situation is the voluntary, fraternal structure of the medical staff. Historically, virtual complete responsibility for assessing patient care was vested in the organized medical staff. Because of the relationship effects, the traditional practice of leaving the evaluation of patient care quality entirely up to the medical staff is bound to generate limitations.
We need to have a different kind of quality management structure-a paid organizational unit similar to that in a big university hospital, not volunteers. You need to have the appropriate organizational architecture to develop a good evaluation program. This is not a matter to be controlled solely by the medical staff or other volunteers.
There are notable differences among the types of quality events, and in how to handle them. One aspect of good practice at the level of the individual practitioner is intervening early in the care process by introducing best practices. An example is the growing practice of administering beta blockers as soon as possible after an acute myocardial infarction. On the other hand, we are improving quality on the institutional level by analyzing length of stay and the proportions of early readmissions for the same diagnosis.
QMHC: Are you referring to the methods that will be used by the Medicare Administrative Contractors-the MACs?
RGC: Yes, these approaches can be implemented with the help of the databases that will be developed by the MACs. In past years, whenever the quality of care was challenged, the physicians banded together to protect one another. The trouble was, and is, that the immunities and confidentiality inherent in the traditional peer review process collide with the goal of transparency. Today, transparency, which is a consumerism-driven theme, is driving the review process. We have moved away from the heavy-handed punishing approach in evaluating the quality of care. We need to promote the voluntary disclosure and analysis of errors by physicians themselves.
QMHC: Does your schedule leave any time for hobbies or sports?
RGC: My avocation is tennis, for which I make time. [Editor's note: Although he did not mention it, Dr Cowart is a championship caliber player who is highly ranked in regional and state competition.] My three daughters, ages 25, 23, and 10, receive a good deal of my attention. We all like to travel, too, and we have done a good deal of it. Church-related volunteer activities receive a lot of my attention and time. In fact, my introduction to health law was the formation of a domestic group practice HMO, the purpose of which was to enable medical missionaries to come and go from Latin America without having to ramp up a professional practice each time. That organization remains in existence and operates a hospital and serves clinics in Central America.