Menguji Palu Hakim untuk Satu Kasus Malpraktek

JAKARTA -- Akhir Januari setahun lalu, seorang wartawan lepas bernama Eko Warijadi meninggal dunia karena penyakit malaria. Tak ada yang salah dengan penanganan dokter yang dilakukan terhadapnya. Sayangnya, tim dokter dari Rumah Sakit Islam Cempaka Putih yang menanganinya mengakui penanganan medis yang dilakukan mereka tidak optimal lantaran si pasien terlambat dibawa ke RS tersebut.
Ihwal keterlambatan itu sendiri disebabkan, sebelumnya almarhum dibawa ke RS Haji Pondok Gede yang salah mendiagnosa penyakit si wartawan. Penyakit malaria yang dideritanya didiagnosa sebagai penyakit tifus yang otomatis ditangani dengan standar medis untuk penderita penyakit tifus.
Malang tak dapat dihindari akibat salah penanganan itu. Namun, sang istri yang juga seorang wartawati di situs berita detik.com merelakan kepergian si suami. Meski, diyakininya apa yang dialami oleh pasangan hidupnya itu adalah malpraktek dalam dunia kedokteran.
Tak demikian halnya dengan apa yang dilakukan oleh Indra Syafri Yacub yang kehilangan istri Ny Adya Vitry Harisusanti alias Ny Santi pada 19 Desember 2003 di RSCM. Syafri, yang warga Jalan Rajawali Selatan Jakarta Pusat mempersoalkan perlakuan medis yang didapatkan dari tim dokter terhadap istrinya dari sejumlah RS yang berbeda dalam kurun waktu dua bulan. Diantara diagnosa yang berbeda itu, menurut kuasa hukum Syafri dari LBH Jakarta, Taufik Basari adalah luka usus, kista, tumor kandungan dan miyoma.
Berihwal dari muntah darah yang dialami oleh Ny. Santi, berbagai dokter dari RS yang berbeda pun mendiagnosanya dengan hasil yang berbeda-beda. Tragis, ia menghembuskan nafas terakhir karena pemasangan alat suntik infus di bagian leher kanannya. Pemasangan infus itu sendiri dilakukan oleh tenaga medis yang tidak berhasil menemukan pembuluh darah nadi di tangan yang bersangkutan.
Kasus ini pun saat ini tengah berproses di Pengadilan Negeri Jakarta Pusat (PN Jakpus) melalui gugatan perdata yang diajukan Syafri kepada RSCM, RS Pelni Petamburan dan RS PMI Bogor serta delapan orang dokternya. Setelah digelar persidangan pertama pada 18 Maret 2004, PN Jakpus memberikan tenggat waktu 22 hari bagi kedua pihak untuk mediasi. Dalam tahap pertama mediasi ini sendiri, kedua pihak belum juga menemukan kata sepakat.
Gugatan ganti rugi senilai materiil Rp 47,3 juta dan imateriil Rp 3 miliar atas tuduhan malpraktek yang dilakukan pihak tergugat di persidangan perdana yang digelar di Pengadilan Negeri Jakarta Pusat, Kamis (18/3). Gugatan itu dirincikan; Rp 17,8 juta kepada RS PMI Bogor, Rp 25,5 juta terhadap RS Pelni, dan sisanya ditanggung RSCM.
Dasar gugatan perbuatan melawan hukum yang dilakukan oleh para tergugat adalah tindakan-tindakan para tergugat melanggar Undang-Undang Kesehatan No. 23 Tahun 1992. Para tergugat juga dinilai melanggar Kode Etik Dokter dan Kode Etik Rumah Sakit dengan tindakan yang dilakukan terhadap istri Syafri.

Bukan Pemaaf
Dua kasus di atas adalah cukilan dari sejumlah kasus serupa yang terjadi di berbagai wilayah di Tanah Air. Dan, sayangnya tingkat kesuksesan membawa masalah ini ke ‘meja hijau’ juga masih rendah sekali.
Padahal, seperti di AS yang sudah sangat maju dunia medisnya, kesalahan medis di dunia kedokteran berdasarkan laporan Institute of Medicine Amerika Serikat pada tahun 2001 saja telah membunuh hampir 100 ribu penduduk Amerika per tahun.
Sedang di Tanah Air, menurut sejarah praktek kedokteran di Indonesia, baru satu dokter yang izinnya dicabut karena terbukti melakukan malpraktek. Dan, jika tidak salah, belum ada tenaga medis yang dipidanakan oleh pengadilan lantaran kasus malpraktek. Ini membuktikan bagaimana sulitnya membawa kasus tersebut ke muka hukum.
Persoalan dasar hukum untuk mengugat memang masih menjadi polemik. Singkatnya, beberapa kasus malpraktek yang dibawa ke pengadilan justru tidak dimenangkan oleh penggugat. Bahkan, definisi malpraktek sendiri masih menjadi perdebatan. Kalangan medis menilai perbuatan malpraktek bukanlah tindakan kriminal biasa.
Hakim, jaksa dan aparat penyidik di bidang ini menurut mereka seharusnya adalah orang yang benar- benar mengerti soal istilah medis, penerapan dan konsekuensi dari penanganan medis terhadap pasien dan penyakitnya. Karenanya, wacana pengadilan khusus untuk hal ini pun sempat mengemuka dan ada dalam draft Rancangan Undang- undang Praktek Kedokteran yang hingga kini belum disahkan.
Salah satu jalan meretas proses hukum atas kasus ini, menurut Ketua Yayasan Pemberdayaan Konsumen Kesehatan Indonesia (YPKKI) Marius Widjajarta bisa dengan berdasarkan UU Perlindungan Konsumen dan UU Kesehatan No. 23/1992.
by:www.sinarharapan.co.id

Dokter ”Kejar Setoran” Memicu Malpraktek

JAKARTA – Mata Murnawati berkaca-kaca menahan tangis. Walau sudah tiga tahun peristiwa itu berlalu, masih terlekat jelas bagaimana Oka, putrinya, kehilangan nyawa. Barangkali hati ibu setengah baya ini tak terlalu perih kalau kematian Oka normal-normal saja. Namun nyawa Oka melayang dalam usia begitu muda, 5,5 tahun, justru karena tindakan malpraktek dokter.
”Tiga orang dokter di sebuah rumah sakit anak terkemuka di Jakarta terlibat dalam malpraktek yang membuat anak saya meninggal. Padahal rumah sakit tersebut sudah menjadi langganan keluarga saya selama sepuluh tahun,” ungkap Murnawati kepada pers dalam acara peluncuran buku Sang Dokter di Jakarta baru-baru ini.
Oka yang demam disertai muntah-muntah selama satu malam tidak mendapat perawatan apa pun dari dokter di rumah sakit. Padahal Murnawati tidak kurang ”rewel” memohon agar dokter segera menangani putrinya.
”Dokter pertama hanya menuliskan resep tanpa menyentuh putri saya. Dokter kedua justru menegur saya yang tidak memberi minum, padahal anak saya selalu muntah tiap kali disuapi sesuatu. Dan dokter ketiga lagi-lagi cuma menjanjikan akan memberi resep, menyentuh anak saya pun tidak,” ujar perempuan ini dengan nada terisak. Baru setelah anaknya menghembuskan nafas terakhir, seluruh tim medis berdatangan.
Murnawati tidak diam saja terhadap peristiwa ini. Ia menghadap direktur rumah sakit dan mengadukan semuanya. Sang direktur berjanji akan menindak tegas dokter-dokternya. Tapi hari berganti minggu dan minggu berganti bulan, ketiga dokter tersebut tetap bebas merdeka berpraktek di rumah sakit yang sama.
Ibu tiga anak ini tak patah semangat. Ia bahkan berani mengadu ke Menteri Kesehatan (Menkes) saat itu, Dr.FA. Moeloek. Namun sampai era Menkes saat ini, Ahmad Sujudi, kerja keras Murnawati belum mendapat titik cerah. Sekarang ibu ini tengah menunggu proses tuntutan terhadap ketiga dokter tersebut melalui Lembaga Bantuan Hukum (LBH) Jakarta. Ia tak tergoda dengan tawaran uang ganti rugi sebesar Rp10 juta dari rumah sakit. Tuntutan ganti rugi yang diajukannya Rp 1,5 miliar, tanpa bergeming sepeser pun.
Murnawati hanya salah satu dari warga masyarakat yang dirugikan oleh kesalahan ahli medis berprofesi dokter. Menurut Dr. Hendrawan Nadesul, dokter sekaligus kolomnis pemerhati masalah sosial, antara dokter dengan pasien ada satu jurang yang luar biasa dalam.
”Dari hari ke hari, dokter menjadi tambah pintar berkat makin banyaknya kasus dan pergaulan sesama dokter. Tapi di sisi lain pasien tak pernah bertambah pintar. Mereka adalah orang awam yang polos, lugu dan pasrah pada apa kata dokter,” papar Hendrawan yang banyak mengasuh rubrik konsultasi kesehatan di media massa ini.
Ibarat kata, kalau ada pertandingan antara tim dokter melawan tim pasien maka selamanya tim pasien tidak akan pernah bisa menang melawan. Kondisi memprihatinkan macam inilah yang kerap terjadi di Indonesia.
Memang tidak semua dokter berlaku sewenang-wenang terhadap pasien. Semua kembali pada tipe dokter macam apakah ia. Dr. Bahar Azwar, penulis buku Sang Dokter mengategorikan dokter di Indonesia ke dalam empat tipe.
”Pertama adalah dokter dengan jurus ”angin puyuh”, yakni terdapat di banyak klinik swasta. Rata-rata pasiennya 40-50 orang per hari. Ia buka praktik dari pukul 16.00 sampai pukul 22.00. Dikurangi waktu untuk acara makan ringan, sembahyang, berarti ia memberi waktu enam menit per pasien,” papar dokter yang berpraktik di Rumah Sakit Siaga Raya, Jakarta ini pada kesempatan serupa.
Tipe kedua adalah dokter ”ban berjalan”. Bahar memberi contoh dokter kebidanan di sebuah rumah sakit swasta dengan pasien rata-rata 30 orang, sedangkan jam praktiknya hanya dua jam. Para pasien akan disuruh antri di beberapa tempat tidur sekaligus. Saat memeriksa tempat tidur pertama, pasien lain disuruh membuka baju, begitu seterusnya. Mirip dengan tipe ”angin puyuh”, dokter jenis ini harus cepat bertindak dan menekankan efisiensi.
Dokter ”memukul angin” adalah tipe ketiga. Di sini terjadi di mana sekali periksa, seorang dokter langsung memutuskan agar pasien dioperasi tanpa banyak perundingan dengan pasien atau keluarganya. Dan tipe terakhir adalah yang jarang ditemui di kota besar, yakni dokter ”amanah”. Biasanya dokter ini ada di desa-desa terpencil, di mana pasiennya tidak bisa membayar dengan uang nominal.

MALPRAKTEK DAN TANGGUNG JAWAB HUKUM PROFESI DOKTER

Kamis, 8 Juli 2004 02:47:27

Oleh: Humphrey R. Djemat, SH., LL.M

Dalam rentang dua bulan terakhir ini, media massa marak memberitahukan tentang kasus gugatan/ tuntutan hukum (perdata dan/ atau pidana) kepada dokter, tenaga medis lain, dan/ atau manajemen rumah sakit yang diajukan masyarakat konsumen jasa medis yang menjadi korban dari tindakan malpraktik (malpractice) atau kelalaian medis.

Satu kasus dugaan malpraktik sempat mengemuka menimpa Augustianne Sinta Dame Marbun. Dugaannya, lantaran dokter salah mendiagnosis dengan memberikan antibiotik berdosis tinggi terkait dengan rencana operasi pengangkatan rahimnya, ginjal advokat Hotman Paris Hutapea itu mengalami kerusakan.

Konon, masih banyak kasus semacam ini yang sering terjadi di Tanah Air, namun tidak terungkap secara luas ke tengah masyarakat. Tidak sedikit pula, korban malpraktik yang menjadi cacat atau bahkan meninggal dunia.

Saya mencatat ada berbagai faktor yang melatarbelakangi munculnya gugatan-gugatan malpraktik tersebut dan semuanya berangkat dari kerugian psikis dan fisik korban. Mulai dari kesalahan diagnosis dan pada gilirannya mengimbas pada kesalahan terapi hingga pada kelalaian dokter pasca operasi pembedahan pada pasien (alat bedah tertinggal di dalam bagian tubuh), dan faktor-faktor lainnya.

Lepas dari fenomena tersebut, ada yang mempertanyakan apakah kasus-kasus itu terkategori malpraktik medik ataukah sekedar kelalaian (human error) dari sang dokter? Untuk diketahui, sejauh ini di negara kita belum ada ketentuan hukum ihwal standar profesi kedokteran yang bisa mengatur kesalahan profesi.

Pada gilirannya, antara malpraktik dan kelalaian sulit dibedakan. Jadi tidak ada kesamaan batasan yang baku dari istilah malpraktik. Dan, pada akhirnya, kondisi ini menyulitkan korban menggugat dokter ke pengadilan.

Sementara itu, pihak Ikatan Dokter Indonesia (IDI) menegaskan dokter bisa disebut melakukan malpraktik apabila melanggar standar prosedur (Kompas, 23 Januari 2003).

Menariknya, definisi malpraktik relatif beragam. Ada yang mengatakan tindakan seorang dokter dikategorikan malpraktik medik jika memberikan pelayanan di bawah, atau yang bertentangan dengan standar pelayanan medik yang berlaku, melakukan kelalaian berat sehingga membahayakan pasien, atau mengambil tindakan medik yang bertentangan dengan hukum.

Malpraktek juga menunjuk pada tindakan-tindakan secara sengaja dan melanggar undang-undang terkait, misalnya, UU No.23 tahun 1992 tentang Kesehatan (ada motif tertentu). Saya tidak hendak terjebak pada diskursus seputar definisi dan pemahaman tentang malpraktik.

Saya hanya ingin mengingatkan sudah merupakan keniscayaan, tak jauh berbeda dengan profesi advokat, sejatinya dokter tidak semata-mata menjalankan profesinya dengan logika komersial, tetapi juga mengemban predikat sebagai profesi mulia (officium nobile). Dengan kata lain, ada fungsi kemanusiaan yang bersanding dengan prof it oriented pada profesi dokter.

Dunia profesi kedokteran Indonesia telah memiliki satu pedoman perilaku profesi dokter, yaitu Kode Etik Kedokteran Indonesia (Kodeki).

Sayangnya, meski mengatur tentang segala tindakan yang harus dilakukan atau tidak seharusnya dilakukan seorang dokter dalam menjalankan profesinya, kelemahannya tidak mencantumkan secara tegas apa dan bagaimana sanksi bagi pelanggar. Yang diberlakukan baru sebatas sanksi etika dan sanksi moral.

Bertitik tolak dari kesimpangsiuran penegakan hukum pada kasus-kasus dugaan gugatan malpraktik dokter saat ini serta kelemahan pada Kodeki, sudah saatnya dunia profesi kedokteran memiliki kesamaan definisi dan pemahaman tentang malpraktek medik – diatur secara tegas dan komprehensif dalam sebuah peraturan perundang-undangan.

Karenanya, kehadiran UU Profesi Kedokteran secara mendesak sifatnya demi terciptanya prinsip-prinsip kepastian hukum baik bagi masyarakat (perlindungan hukum sebagai konsumen jasa medik) maupun bgi dokter sendiri (tanggung jawab hukum profesi) serta berdayanya organisasi profesi dokter.

Gayung memang bersambut. Saat ini DPR RI (Komisi VII) dam Pemerintah (Depkes RI) tengah menggodok Rancangan Undang-undang tentang Praktik Kedokteran (RUU-PK).

Satu hal penting yang patut diapresiasi pada RUU-PK adalah rencana pembentukan satu badan independen (mirip Majelis Kehormatan pada organisasi advokat) yang berfungsi mengatur disiplin profesi dokter.

Badan independen yang terpisah dari Konsil Kedokteran dan terdiri atas anggota IDI, anggota masyarakat, serta pihak-pihak lain termasuk ahli hukum itulah yang akan menilai apakah satu kasus dugaan malpraktik terkategori melanggar kode etik profesi ataukah tindakan malpraktik yang melanggar hukum dan karenanya pantas dilimpahkan ke peradilan umum.

Saya sangat memaklumi apabila ada sementara kelompok masyarakat yang menolak konsep badan independen ini. Ada kekhawatiran, manakala terjadi kasus yang diduga malpraktik dimana ada masyarakat telah menjadi korbannya dan kemudian mengajukan gugatan hukum, kasus ini tidak akan memenuhi rasa keadilan yang mengusik diri korban malpraktik.

Bisa jadi keputusan yang diambil Badan Independen nanti sangat kental dengan aroma proteksi karena cenderung dilandasi oleh subjektivitas dan solidaritas profesi (esprit de corps).

Namun, berangkat dari positive thinking bahwa kalangan kedokteran Indonesia mengedepankan profesionalisme, saya melihat keterlibatan anggota masyarakat dan pakar hukum di dalam badan independen tersebut diharapkan akan mencegah berkembangnya kondisi yang kontraproduktif sebagaimana dikhawatirkan di atas.

Terakhir, saya sepakat dengan masukan dari Ketua Umum PB IDI agar DPR RI – Pemerintah melakukan uji publik untuk menakar sejauh mana draft akhir pembahasan RUU-PK telah mencerminkan aspirasi masyarakat akan perlindungan hukum serta menciptakan satu standar praktik kedokteran yang mampu memberikan tanggung jawab hukum pada profesi dokter.

Hanya saja, sebelum itu dilakukan, DPR RI dan Pemerintah sepantasnyalah melibatkan berbagai kelompok masyarakat, termasuk dari kalangan LSM dan organisasi profesi terkait, yang selama ini getol melakukan advokasi kepada korban malpraktik agar UU-PK kelak benar-benar merupakan cerminan dari kepentingan masyarakat banyak.

Bagaimana, sebuah UU yang aspiratif akan berujung pada terciptanya kepastian hukum, dan terutama keadilan bagi masyarakat. Setiap produk hukum memang semestinyalah semata-mata untuk kepentingan masyarakat.

*) Penulis adalah Praktisi Hukum dan Ketua AAI (Asosiasi Advokat Indonesia) DKI Jakarta.

Sumber : Suara Pembaharuan. Kamis, 8 Juli 2004

RS. Siloam Diduga Lakukan Mal Praktek

Ade Irma Efendy, 37 tahun, warga Jalan Gunung Merapai, Kelurahan Lengkong Wetan, Serpong, Kabupaten Tangerang, melaporkan Rumah Sakit (RS) Siloam Gleneagles ke Kepolisian Resor (Polres) Metro Tangerang, Kamis (27/5). "Rumah sakit itu melakukan mal praktek," kata Ade Irma Efendy yang didamping kuasa hukumnya, Yasrin Febrian Marly, SH di Tangerang, Jumat (28/5).

Kasus berawal ketika ibu beranak satu itu memeriksa kandungannya ke dokter Anthonius Heri yang membuka praktek di salah satu apotik di kawasan Bumi Serpong Damai. Kepada dokter tetap keluarganya itu, Ade mengeluhkan adanya flek merah pada celana dalam di saat kehamilannya yang masih berusia 15 minggu. Melihat lemahnya kondisi Ade, Anthonius menyarankan untuk pemeriksaan lebih lanjut ke RS Siloam.

Pada 16 April 2004, sekitar pukul 20.30 WIB, Ade bertemu lagi dengan dokter Anthonius dan memeriksakan diri di RS. Siloam Gleneagles. Setelah diperiksa dengan ultra sonografi (USG), pihak dokter menyatakan, kandungan Ade dalam kondisi baik dan sehat. Tapi, untuk menguatkan kandungan itu, Ade harus istirahat. Nah, dokter menawarkan Ade untuk beristirahat di rumah sakit. "Karena tidak ingin terjadi apa-apa, saya memilih untuk dirawat di rumah sakit saja," kata Ade.

Kemudian, Ade dimasukkan ke ruangan bersalin dan salah satu perawat langsung memberi infus kepada Ade berdasarkan petunjuk dokter Anthonius. Saat memberi infus itu, perawat tidak didampingi dokter. Sepuluh sampai lima belas menit kemudian, obat infus ternyata bereaksi terhadap kandungan Ade. Kandungan Ade mengalami kontraksi dan janin keluar, sehingga mengakibatkan kelahiran premature (abortus terancam) sehingga meninggal.

Akibat peristiwa itu, kata Yasrin Febrian Marly, jiwa Ade tergunjang. "Kami sudah meminta pihak rumah sakit untuk menyelesaikan kasus itu. Tapi tidak ada titik temu, walau sudah berulangkali berunding. Akhirnya, kami menempuh jalur hukum pidana dan perdata," kata Yasrin.

Sementara itu, pihak RS Siloam membantah jika pihaknya sudah melakukan mal praktek. "Abortus Imenen (aborsi dalam proses) dikarenakan kondisi dan situasi pasien saat itu memang membutuhkan perawatan intensif. Dugaan, pasien mengalami keguguran setelah meminum obat yang diberikan dokter, tidak benar. Karena pemberian obat selalu diberikan sesuai dengan petunjuk dokter, dan diagnosa juga dilihat dari kondisi pasien," kata Manajer Operasional RS Siloam, Andre.

Ketika ditanya nama dan jenis obat yang diberikan kepada Ade, Andre enggan menyebutnya. Andre hanya mengatakan, "jika memang keguguran itu disebabkan efek obat yang diberikan, itu kejadian tak terduga. Karena obat itu sering diberikan kepada pasien yang berkondisi sama".

Menurut Andre, Ade memang pelanggan RS Siloam. Proses persalinan Ade kali ini adalah kedua-kalinya. Saat kelahiran anak pertama, persalinan berjalan lancar. "Persalinan kali ini, kondisi pasien memang harus ditangani dan dirawat dengan serius. Bukan kondisi kandungannya yang mengkhawatirkan, tapi kondisi ibunya," kata Andre.
by:www.tempointeraktif.com

Dugaan Mal Praktek, Polisi Panggil Perawat RS Siloam

Kepolisian Resor Metro Tangerang memanggil tiga perawat Rumah Sakit (RS) Siloam Gleaneagles untuk diperiksa pada Rabu (2/6). Pemeriksaan terkait dengan dugaan mal praktek yang dilakukan rumah sakit swasta itu terhadap korban Ade Irma Effendi, 37 tahun.

"Ketiga perawat adalah tim medis RS Siloam yang menangani perawatan Ade Irma," kata Kepala Satuan Reserse dan Kriminal Polres Metro Tangerang, Ajun Komisaris Polisi Asep Adisaputra di Tangerang, Selasa (1/6). Ade Irma adalah pasien langganan RS Siloam yang merasa dirugikan karena mengalami keguguran setelah ditangani dan diberi obat oleh pihak rumah sakit. Lantaran diduga pihak rumah sakit sudah melakukan mal praktek, Ade Irma melaporkannya ke Polres Metro Tangerang, Kamis (27/5).

Menurut Asep, ketiga perawat akan dimintai keterangan seputar proses terjadinya keguguran. Dalam laporannya, Ade Irma tidak memasukkan RS Siloam ke dalam penuntutan, melainkan menuntut kelalaian seorang dokter yang menanganinya.

Ade Irma yang didamping kuasa hukumnya, Yasrin Febrian Marly, SH mengatakan, kasus berawal ketika ibu beranak satu itu memeriksa kandungannya ke dokter Anthonius Heri yang membuka praktek di salah satu apotik di kawasan Bumi Serpong Damai. Saat memeriksa kehamilan keduanya yang berusia 15 minggu, Ade Ade mengeluhkan adanya flek merah pada celana dalam kepada dokter tetap keluarganya itu.

Melihat kondisi Ade yang lemah, Anthonius menyarankannya untuk diperiksa lebih lanjut ke RS Siloam. Saat dilakukan pemeriksaan dengan ultra sonografi di RS Siloam pada 16 April 2004 malam, pihak dokter yang juga terdapat dokter Anthonius itu menyatakan, kandungan korban dalam kondisi baik dan sehat. Tapi, untuk menguatkan kandungan, dokter menawarkan Ade untuk beristirahat di rumah sakit atau di rumah. "Karena tidak ingin terjadi apa-apa, saya memilih dirawat di rumah sakit saja," kata Ade.

Setelah Ade dimasukkan ke ruangan bersalin, salah satu perawat langsung memberi infus. Walau tidak didampingi seorang dokterpun, si perawat mengatakan, infus diberikan berdasarkan saran dokter Anthonius. Sekitar 15 menit kemudian, obat bereaksi dan kandungan Ade mengalami kontraksi. Alhasil, janin bayi dalam kandungan Ade, keluar yang mengakibatkan kelahiran premature (abortus terancam) dan meninggal dunia.

Bantahan mal praktek jua sudah diberikan pihak rumah sakit. "Tidak benar, pihak rumah sakit melakukan mal praktek. Abortus Imenen (aborsi dalam proses) terhadap pasien, dikarenakan kondisi dan situasi pasien yang saat itu memang membutuhkan perawatan intensif. Tidak benar, pasien mengalami keguguran setelah meminum obat yang diberikan dokter. Karena pemberian obat selalu diberikan sesuai dengan petunjuk dokter dan diagnosa juga dilihat dari kondisi pasien," kata Manajer Operasional RS Siloam, Andre.
by:www.tempointeraktif.com

Bookkeeper admits theft from office

A Dunmore woman employed as a bookkeeper at a local medical practice will pay back more than $200,000 she admitted stealing on the job.





Catherine Aydin, 40, was in federal court Friday to plead guilty to forging and cashing checks from Regional Foot and Ankle Center in Scranton. She faces 10 years in prison and $250,000 in fines.

The center’s owner, Elmo Baldassari, D.P.M., said it’s likely Ms. Aydin stole $400,000 or more since 2000. Ms. Aydin’s attorney, William Peters, said the amount is somewhere on the “low side of $200,000 to $400,000.”

Assistant U.S. Attorney Francis Sempa said the exact amount of money she’ll have to pay back will be determined before she’s sentenced in late August.

An internal audit done at the medical center in fall 2006 uncovered several checks that had been forged between January 2000 and October 2006, according to Mr. Sempa.

When confronted by FBI investigators, Ms. Aydin admitted to forging checks to herself and for cash. She said she used some of the money to pay off credit card bills and other household expenses.

“It was certainly regrettable on her part,” Mr. Peters said Friday afternoon. “ She’s very sorry. If she could turn back the clock, she would.”

In court Friday, Ms. Aydin answered U.S. District Judge Thomas I. Vanaskie’s questions in a soft voice.

After Mr. Sempa summarized the details of the case, the judge asked Ms. Aydin how she pleaded. “Guilty, your honor,” she said simply.

Ms. Aydin will remain free pending sentencing.
by:www.thetimes-tribune.com

TB patient ID‘d as Atlanta attorney,

ATLANTA - The tuberculosis patient under the first federal quarantine since 1963 is a 31-year-old personal injury attorney who practices law with his father in Atlanta, a federal law enforcement official said Thursday.

The patient, who has a rare and dangerous form of tuberculosis, arrived at Denver‘s National Jewish Medical and Research Center for treatment Thursday, walking under his own power after flying from Atlanta with his wife and federal marshals.
by:www.newsone.ca

Ex-director of clinic convicted of fraud

Thefts from Medicare alleged

By Sofia Santana
South Florida Sun-Sentinel
Posted June 2 2007


FORT LAUDERDALE · A Tamarac woman who used to be a clinic director has been convicted of being involved in a long-running scheme that siphoned $10 million from Medicare, the U.S. Attorney's Office said Friday.

The conviction is among the latest in a wave of Medicare fraud cases hitting South Florida federal courts this year. Authorities throughout the region have become increasingly aggressive in monitoring doctors, medical supply companies and other medical treatment providers.

A jury found Yvonne May Richards, 59, guilty Wednesday of conspiracy and fraud charges, prosecutors said. She was indicted last year on charges that from 1996 to 2003, she helped steal money from Medicare while working at the now defunct Oakland Community Health Center Inc. The Oakland Park center provided psychiatric evaluations and treatment.

The scheme, investigated mostly by the FBI, included fake bills to Medicare, the creation and forging of fraudulent medical records, and kickbacks to assisted-living facilities that directed their residents to the center, regardless of whether the residents needed treatment, prosecutors said.

Former clinic owners Bernard Graves Jr., 49, and his wife Althea Graves, 37, both of Stuart, and social worker Neil Leder, 50, of Tamarac, also were indicted in the scheme. The trio pleaded guilty to conspiracy charges earlier this year, and each could face up to five years in prison.

Prosecutors said the money went mostly toward the Graves' living expenses, including home décor and nanny pay.

The Graveses and Leder are scheduled to be sentenced within the next two months, and Richards' sentencing date has not yet been set, according to court records.
by:www.sun-sentinel.com

Toddler's death ruled homicide

MARTINSBURG, W.VA. - The death last week of a 2-year-old Martinsburg-area boy has been ruled a homicide, Berkeley County Prosecuting Attorney Pamela J. Games-Neely said Thursday.


Games-Neely declined to release the cause of death for Ny'eal Ezra Mills or any other findings by the state Office of the Chief Medical Examiner in Charleston, W.Va., where an autopsy was performed. The child's name was released by Berkeley County Sheriff's Lt. Gary Harmison.


"The investigation is hot and heavy right now," Games-Neely said
Emergency officials received a report about 11 a.m. May 24 that the child was in cardiac arrest. The boy was taken to City Hospital from his home at 191 Moonlight Lane, east of Martinsburg off W.Va. 45, and pronounced dead at the hospital. Medics could not revive the child.


Police said the child's medical history was not consistent with cardiac arrest and described the boy's death as suspicious.


Berkeley County Sheriff W. Randy Smith said Thursday that no arrest warrants were issued in the case, and he clarified that he had not received written notice of the child's manner or cause of death from the state medical examiner's office.


Smith said he believed the child's funeral service was Thursday in Frederick, Md., where the boy's mother and her boyfriend are staying.


While sheriff's deputies were at the hospital talking with family members of the boy, they learned that a male family member had contacted the child's relatives from the boy's home and indicated he was "very upset" and intended to cause harm to himself as a result of the death, police said.


Police said they could not find the man after they arrived at the residence. Hours later, the returned wearing a long gray shirt that appeared to have a substantial amount of blood on the front of it and blue jeans that also appeared to be splattered with blood. His wrist also was bleeding.


Police said the man was the boyfriend of the child's mother and that he was treated for self-inflicted injuries at City Hospital. Smith said the boyfriend was released from the hospital.

by:www.herald-mail.com

Cause of Fausnaugh's death uncertain

Tiffany Revelle -- Record-Bee staff
NICE -- More than two months have passed since the body of Nice resident Michael Eugene Fausnaugh, 39, was found in a dirt turnout by Highway 29's southbound lane. After three were held for his murder, the District Attorney's office chose not to file charges.

A pair of construction workers on their way to a work site stopped to tighten down their load, and found Fausnaugh's body in the early afternoon hours of Thursday, March 22. They reported the sighting to jail staff at the nearby Juvenile Hall facility, and Lake County Sheriff's Office deputies found the body at milepost marker 515 north of Mockingbird Lane in Upper Lake.

Highway 29 was closed between its intersections with the Nice-Lucerne Cutoff and Highway 20 for more than four hours, and detectives were on-scene until 3 a.m. gathering information.

Now, Public Information Officer Cecil Brown of the Lake County Sheriff's Office says further investigation hinges on a pathologist's report to determine the cause of his death.

"We're still waiting for information to come back from the pathologist," said Brown. "The District Attorney's Office can't make decision about who to charge and what to charge them with until we get that."
Specifically, he said they're looking for "information regarding the extent of the injuries, and whether one or more of the injuries contributed to his death," said Brown.

According to a March 27 LCSO press release, witnesses reported seeing Fausnaugh with Jamie Martin, Terri Kenney and Shamus Maroney the evening before his body was found at the Middle Creek Campground on Elk Mountain Road in Upper Lake. Witnesses told detectives that Fausnaugh had what appeared to be "significant head injuries," and described how Maroney, Kenney and Martin put Fausnaugh in their vehicle and left, reportedly to seek medical attention, according to the report.

Nice resident Maroney, 27, was already in custody after a March 23 arrest for a parole violation, and a murder charge was added after initial investigation.

Martin, 20, of Lucerne, and Kenney, 48, of Nice, were released March 29 under Penal Code 825, which essentially states that a defendant must be arraigned within 48 hours of the arrest. The District Attorney's Office has one year to gather evidence sufficient to refile, according to Lake County Jail staff.

"It's a complex case," said Brown. "There are a series of questions that can't be answered until the pathologist's report is done."

"The detectives from the Sheriff's office and the Lake County District Attorney's Office are involved in discussions about what crimes may have been committed and who is responsible, and they're determining what charges would be appropriate," said Brown. "They can't make that determination until they have solid information from the pathologist regarding cause of death."

Lake County does not have a pathologist, he added, so evidence had to be sent out of county to an independent contractor. When asked how long the process can take, Brown said, "It can take a very long time." Several months and even years elapse in some cases, he said, largely because of reliance on outside laboratories to complete some of the tests typically run in homicide cases.

"We know a lot about this case already," noted Brown. "We're just waiting for the pathologist's report. I wouldn't call it a cold case."

Brown further noted that all deaths are initially viewed with some suspicion until detectives are satisfied that no crime was involved.

"Clearly we have to be able to prove in court why the person died. A pathologist is involved in all homicide cases because we have to be able to prove in court that a specific action caused a person to die," said Brown.

Speaking to the commonality of using a pathologist in the investigations of deaths in Lake County, Brown said, "If the attending physician is willing to attest to the cause of death based on known medical history and conditions, then we don't involve the pathologist. In other cases when we are not satisfied that we can determine the cause of death, then a pathologist would be involved. A great number of the deaths investigated by the coroner's office are from natural causes."

by:www.record-bee.com

U.S. ATTORNEY ANNOUNCES $101 MILLION IN HEALTH FRAUD CHARGES

MIAMI-R. Alexander Acosta, U.S. Attorney for the Southern District of Florida; Jonathan I. Solomon, Special Agent in Charge, Federal Bureau of Investigation, Miami Field Office; Melody Jackson, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General, Atlanta Regional Office; Anthony Mangione, Special Agent in Charge, U.S. Immigration and Customs Enforcement, Miami; and Bill McCollum, Attorney General, State of Florida, today announced criminal health care fraud charges against 16 defendants for fraudulently billing Medicare approximately $101 million.
MIAMI-R. Alexander Acosta, U.S. Attorney for the Southern District of Florida; Jonathan I. Solomon, Special Agent in Charge, Federal Bureau of Investigation, Miami Field Office; Melody Jackson, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General, Atlanta Regional Office; Anthony Mangione, Special Agent in Charge, U.S. Immigration and Customs Enforcement, Miami; and Bill McCollum, Attorney General, State of Florida, today announced criminal health care fraud charges against 16 defendants for fraudulently billing Medicare approximately $101 million.

All-Med Billing Corp. Indictment, U.S. v. Mabel Diaz, et al

On May 22, 2007, a Miami federal grand jury returned a 46-count indictment against eight defendants in United States v. Mabel Diaz, et al., No. 07-20398-Cr-Ungaro. The indictment charges Mabel and Abner Diaz, wife and husband, with operating All-Med Billing Corp. ( All-Med ), a Miami medical billing company, and executing a scheme to submit tens of millions of dollars in fraudulent claims to Medicare from 1998 to 2004 for reimbursement for durable medical equipment ( DME ) and related services. The indictment alleges that All-Med submitted approximately $80 million in false claims on behalf of 29 DME companies. The claims were allegedly fraudulent in that the equipment had not been ordered by a physician and/or had never been delivered to a Medicare patient. As a result of the submission of the fraudulent claims, Medicare paid the DME companies approximately $56 million. The indictment also seeks forfeiture of the fraud proceeds and substitute assets, including real estate of the Diazes. The Diazes were additionally charged with conspiracy to launder the proceeds of the alleged All-Med billing fraud scheme. Also charged in the All-Med billing fraud scheme was All-Med employee Suleidy Cano.

Other defendants charged are Amry Garcia, Davel Hernandez, and Rene Raimundo Hernandez. They are charged with conspiring to defraud Medicare in their operation of A-1 Durable Medical Equipment and Supplies, Inc. ( A-1 ), a Miami DME company. According to the indictment, A-1 received approximately $2.1 million in response to fraudulent claims that were submitted to Medicare by All-Med.

The indictment also charges defendants Jose Luis Palma Jr. and Luis Gonzalez with conspiracy and Medicare fraud in connection with the operation of Simply Medical Services Inc. ( Simply Medical ), a Miami DME company. In addition, Gonzalez was charged with Medicare fraud in relation to another DME company, Premier Medical Service. Inc. ( Premier ). As a result of fraudulent claims alleged to have been submitted by All-Med on behalf of Simply Medical and Premier, Medicare paid over $3.7 million.

If convicted of the conspiracy and health care fraud charges, each of the eight defendants faces a maximum punishment of 10 years imprisonment per count. The Diazes face an additional 20 years imprisonment on the money laundering charge.

Indictment: U.S. v. Jose Tomas Iglesias, et al.

On May 22, 2007, another indictment charged defendants Jose Tomas Iglesias, Marco Antonio Marrero, and Leslie Gonzalez, Case No. 07-20399-Cr-King, with conspiring to defraud Medicare in connection with the fraudulent submission of $6.8 million in DME-related claims during 2006. The claims concerned a Miami DME company named Bridge Medical Equipment Inc. According to the indictment, Medicare paid Bridge approximately $1 million in response to the bogus claims, which were for DME items that were neither prescribed by doctors nor delivered to Medicare patients.

Iglesias was also separately charged with several counts of illegally laundering the fraud proceeds through the cashing or depositing of various checks and with aggravated identity theft by using another's Florida driver's license in connection with the health care fraud scheme.

If convicted, the three defendants face 10 years imprisonment on the health care fraud charges. Iglesias faces up to 20 years imprisonment on each of the money laundering charges. Finally, Iglesias faces a mandatory consecutive two-year prison term on the aggravated identity theft charge.

Indictment: U.S. v. Alejandro De La Victoria

On May 22, 2007, defendant Alejandro De La Victoria, the owner of Precise Medical Services Inc., a Miami DME company, was indicted, Case No. 07-20397-Cr-Gold, on fraud charges for submitting approximately $3 million in fraudulent DME claims to Medicare during several months in 2006, and receiving approximately $1.4 million in payments. De La Victoria faces up to 10 years in prison on each of the six health care fraud charges.

Indictment: U.S. v. Maria Oliveros-Garay

On May 15, 2007, defendant Maria Oliveros-Garay was indicted on four counts of health care fraud in connection with a Medicare billing fraud involving Abue Medical Equipment, Inc., a Miami DME company. According to the indictment, Case No. 07-20377-Cr-Cooke, Oliveros-Garay submitted approximately $3.8 million in fraudulent DME-related claims to Medicare in 2006, of which Medicare paid approximately $1.5 million. If convicted, Oliveros-Garay faces up to 10 years imprisonment on each count.

Informations: U.S. v. Mario Mira and U.S. v. Eduardo Ruiz

On May 23, 2007, the U.S. Attorney's Office filed two separate informations against two individuals in separate DME-related fraud cases. In one case, Case No. 07-20405-Cr-Martinez, defendant Mario Mira was charged with one count of health care fraud in connection with Mario & Clara Medical Supply Inc., of Miami, a DME company that submitted at least $2.5 million in fraudulent DME claims to Medicare in 2006. Mira faces a maximum term of imprisonment of 10 years.

In the second case, Case No. 07-20406-Cr-Jordan, defendant Eduardo Ruiz was charged with one count of health care fraud in connection with EZ Medical Inc., a Tampa DME company. According to the Information, Ruiz caused the submission of approximately $5.3 million in fraudulent DME claims in 2005 by misappropriating and using the Medicare identification numbers of Miami-Dade beneficiaries. Medicare paid approximately $1.38 million on these claims. Ruiz faces a maximum prison term of 10 years.

Guilty Plea: U.S. v. Eredio Prieto

On May 24, 2007, defendant Eredio Prieto pled guilty in Case No. 07-20333-Cr-Huck, to one count of money laundering. The charge arose out of Prieto's use of a shell corporation, Royalty Group Investment Corp. ( Royalty Group ). According to court records, Prieto deposited proceeds of health care fraud, involving south Florida health care companies, into Royalty Group bank accounts and then engaged in financial transactions to launder approximately $147,000 in Medicare funds in 2006. Prieto faces a maximum of 20 years imprisonment. Sentencing is scheduled for Aug. 22, 2007.

Mr. Acosta commended the investigative efforts of the Federal Bureau of Investigation; the U.S. Department of Health and Human Services, Office of Inspector General, Atlanta Regional Office; the U.S. Immigration and Customs Enforcement, Miami; and Office of the Florida Attorney General. These cases are being prosecuted by Assistant U.S. Attorneys Marc Osborne, David Frank, Luis M. Pérez, and Jeffrey Marcus.
by:presszoom.com

TB Patient Faces 2 Months in Hospital

The man quarantined for a drug-resistant form of tuberculosis settled in Saturday for what could be a two-month hospital stay by taking antibiotics and fielding phone calls.

Andrew Speaker, the first person placed under federal quarantine since 1963, had breakfast and spent much of the day on the phone with well-wishers, his nurses at National Jewish Medical and Research Center reported.

Accompanied by his new bride, the 31-year-old Georgia attorney also used a laptop to communicate from his second-floor isolation room, equipped with an exercise bicycle and a TV, hospital spokeswoman Geri Reinardy said.

Speaker was taking antibiotics to battle a tennis ball-sized infection in his lung, Reinardy said. Doctors said his treatment could include surgery to remove the infected tissue if the drugs don't work.

Tests so far indicate Speaker's risk of spreading the infection are low, doctors said. No medical briefings for the news media were planned during the weekend.

Doctors hope to determine where Speaker contracted the disease, which has been found around the world and exists in pockets in Russia and Asia. The tuberculosis was discovered when Speaker had a chest X-ray in January for a rib injury.

Some hospital staff marveled at the attention the case has generated, Reinardy said.

"It's just another day in the life of National Jewish," she said. "When I go over to his floor the nurses say, 'What's the big deal? We deal with this all the time.'"

Since 2000, National Jewish has successfully treated two other patients with extremely drug-resistant strains of TB, known as XDR. Dr. Gwen Huitt said they were under quarantine in their home counties, then placed under quarantine in Denver once they arrived at National Jewish, driven there nonstop by family members.

On Friday, Speaker repeatedly apologized to the dozens of airline passengers and crew members he may have exposed while on a trans-Atlantic flight last month.

Speaker has said he, his doctors and the CDC all knew he had TB that was resistant to some drugs before he flew to Europe for his wedding and honeymoon. But he said he was advised at the time by Fulton County, Ga., health authorities that he was not contagious or a danger to anyone. Officials told him they would prefer he didn't fly, but no one ordered him not to, he said.

by:abcnews.go.com

Border alert on TB patient disregarded

The Atlanta man defied instructions to stay put overseas after doctors realized he had a deadly strain of the disease.
By Jia-Rui Chong, Stephanie Simon and Nicholas Riccardi, Times Staff Writers
June 1, 2007


DENVER — A man infected with an extremely dangerous strain of tuberculosis was waved into the United States at a border crossing even after a routine check of his passport set off an urgent warning, authorities said Thursday.

Andrew Speaker, 31, a personal-injury lawyer from Atlanta, arrived at the Canadian border May 24 after disregarding explicit instructions from the Centers for Disease Control and Prevention to remain in Italy — where he was on his honeymoon — for fear of spreading his potentially deadly strain of TB.
Speaker's father-in-law is a microbiologist at the CDC in the Division of Tuberculosis Elimination. Robert Cooksey issued a statement Thursday saying that he "wasn't involved in any decisions my son-in-law made regarding his travel, nor did I ever act as a CDC official or in an official CDC capacity with respect to any of the events in the past weeks…. I would never knowingly put my daughter, friends or anyone else at risk from such a disease."

Cooksey also said that he had never tested positive for TB and was certain that Speaker did not contract the lung ailment from him or from the CDC's labs.

Speaker knew he had a severe strain of TB before departing to marry Cooksey's daughter, Sarah, on a Greek island in mid-May. He only found out later, when he was in Rome, that it was the rarest and most lethal of TB strains, resistant to most antibiotics.

Very few hospitals in the U.S. are equipped to handle that strain of TB; early Thursday morning, Speaker and his wife were flown by private air ambulance to one of them, National Jewish Medical and Research Center in Denver. He looked tanned and fit upon arrival — he has never exhibited any symptoms of TB infection — but he wore a blue mask, as did his entourage of doctors and nurses.

Speaker will remain in an isolation room in Denver for months as a medical team tries to wipe out the bacteria in his lungs with powerful antibiotics and, if necessary, surgery.

He will not be able to take his customary jogs. He'll have few visitors. His only view of the outside world will be a patch of grass and a few patio chairs. The antibiotics used to treat him may cause severe nausea, seizures, hearing loss and kidney problems. Still, his attending physician, Dr. Gwen Huitt, said Speaker was in good spirits.

"He's very relieved to be in Denver and moving on to the next stage in his life," she said.

Speaker has said his desire to get treated in Denver — where he'd been told the best specialists worked — compelled him to rush back to the U.S. from his honeymoon, taking a secretive, circuitous route to avoid being flagged as a health risk at American airports.

His defiance potentially exposed hundreds of airline passengers and crew to tuberculosis. It also could expose Speaker to lawsuits from those fellow travelers, should they become infected.

"There's a general duty not to put any [others] at undue risk," said Gregory Keating, a law professor at the University of Southern California. "I think he's got a problem."

Authorities said Speaker did not break any laws because at no point during his international travel was he under a court order to stay put.

From Rome, Speaker and his wife flew to Prague and then to Montreal. They drove to the border crossing at Champlain, N.Y. At the checkpoint, both their passports set off warnings when scanned into a computer. The alerts instructed the guard to isolate and detain Speaker, and immediately call health authorities.

But the inspector, who has since been removed from border duties, apparently concluded that the travelers looked healthy. They spent no more than two minutes at the checkpoint before crossing into the U.S., said Homeland Security Department spokesman Russ Knocke.

The lapse at the border outraged Sen. Charles E. Schumer (D-N.Y.), who called for a federal investigation.

"Today it was one sick and very irresponsible person who slipped through, but tomorrow could bring much worse," Schumer said. "There is just no excuse for this. God forbid this was someone bent on doing us harm."

As soon as Speaker crossed the border, he moved to comply with federal authorities. On May 25, as he and his wife drove south from Albany, he answered a cellphone call from the CDC, which had been frantically trying to reach him, and agreed to check himself into an isolation unit in a New York City hospital. From there, he was transferred to his hometown of Atlanta, where he was kept in a hospital room under armed guard.

When he arrived in Denver on Thursday morning, U.S. Marshals escorted his ambulance to the hospital. His is the first federal government-ordered isolation since 1963.

Speaker's medical odyssey began in January, when he injured a rib and went in for a chest X-ray. The picture showed a lesion in his lung. His physician suspected TB, even though Speaker had none of the classic symptoms: no fever, no night sweats, no coughing up blood.


by:www.latimes.com

Woman found beaten, left in alley dies

A woman who was found injured from an assault Thursday in an alley off West St. Catherine Street died yesterday, according to the police and the coroner's office.

The woman, whose name has not been released pending notification of next of kin, died at University Hospital.

Police are investigating and have not yet identified a suspect, said Alicia Smiley, a police spokeswoman.

Anyone with information is asked to call the anonymous crime tip line at 574-LMPD.

Police look for suspect in robbery at BB&T branch
Police are searching for a man who robbed the BB&T on Dixie Highway near Upper Hunters Trace yesterday afternoon.

The suspect, described as a white male in his late 40s or early 50s and about 5-foot-8, handed a note demanding money to a teller about 3:45 p.m.

The man fled the bank with a small amount of cash, said Detective Larry Duncan of the Louisville Metro Police robbery squad.

Anyone with information is urged to call the anonymous crime tip line at 574-LMPD.

Careless smoking blamed for fire in Highlands
Careless smoking was blamed for a fire that damaged three apartments in the Highlands yesterday afternoon.

The fire began about 3:45 p.m. in a three-story apartment building at 113 St. Francis Court off Bardstown Road, said Maj. Mark Abner of Louisville Fire & Rescue.

A man who lives on the third floor mistakenly thought a cigarette was out when he put it in an ashtray on his balcony. The cigarette caught a table on fire and the fire spread to the wood siding of the building and into the attic, Abner said.

"We believe it was purely accidental," Abner said. All occupants of the building escaped without injury.

Firefighters had control of the blaze in 14 minutes, but the man's apartment had extensive damage and two second-floor apartments also were damaged.

The Red Cross was called in to help residents in the damaged units find places to stay.

Louisville physician settles civil fraud case
A Louisville physician accused of receiving illegal kickbacks from a medical-equipment supplier for improperly recommending their equipment to his patients has chosen to settle civil-fraud charges.

Dr. Ricky Collis agreed to pay a $240,561 settlement, though he denied any wrongdoing, according to a release from the U.S. attorney's office this week.

Collis and businesses in which he was involved, Interventional Rehabilitation of Kentucky PSC, Kentucky Rehabilitation Institute and NovaMed Pain Management, also agreed to enter a five-year integrity agreement with the state Office of the Inspector General for the U.S. Department of Health and Human Services.

Under the settlement, federal prosecutors maintained Collis received improper inducements from Conti Medical Concepts at 3006 Eastpoint Parkway as well as from company owner Tony Conti and his wife, Victoria Conti, the company's vice president.

Collis provided more referrals than any other physician for patients to obtain back braces from Conti Medical that later were billed to Medicare, Medicaid and other federal programs, according to the U.S. attorney's office.

Tony Conti and his company have been charged with conspiracy to falsify medical records, alteration of medical records and making false statements relating to health care. Conti, the company and Victoria Conti are charged with offering a kickback to improperly induce referrals from a physician.

Ali center to create 'Patchwork for Peace'
The Muhammad Ali Center is inviting people to take part in a "Patchwork for Peace" project.

The center plans to make several denim quilts that will be sent to refugees living in war-torn countries such as Uganda, Sudan and Burundi.

A quilting session will be held from noon to 4 p.m. June 10 at the center, 144 N. Sixth St.

People are asked to collect and donate old blue jeans for the project. The denim will be cut into quilt blocks and decorated with expressions and ideas of peace and hope.

Blocks will be displayed in the Ali Center throughout the summer. They then will be sewn together into quilts by volunteers and sent overseas.

Free meals for children to begin Monday

More than 160 sites around Louisville will begin serving free meals on Monday to children 18 and under.

The Community Action Partnership program, which runs through Aug. 10, served 9,000 children about 493,000 meals last summer.

by:www.courier-journal.com

Elder abuse suspect takes stand

By STARLA POINTER
Of the News-Register


When Mistydawn Viles took the stand in her own defense Friday, she said Anthony "Tony" Viles wanted her to do all the things she is accused of doing.

She said the elderly man wanted to subsist on fast food and macaroni with cheese. He wanted to live in a trash-filled house without medical care. He wanted to give her a house and access to thousands of dollars from his checking account.

No, the former caregiver answered when her defense attorney asked if she ever pressured the disabled, bedridden 78-year-old.

"You can't pressure Tony," she said. "He's stubborn. He'll do what he wants."

Viles, 30, is accused of 13 counts of abuse and exploitation between June 1, 2005, and July 1, 2006. She has pleaded not guilty to one count of aggravated first-degree theft, six counts of first-degree theft, three counts of attempted theft, two counts of first-degree criminal mistreatment and one count of second-degree criminal mistreatment.

Social workers and psychology professionals found Rinkes incapable of living independently, or handling his own finances, when he was removed from his Newberg home in June 2006.

But Viles, who had served as his primary caregiver during the previous year, said she always considered him completely in control of his faculties and fully capable of making his own decisions.

"You guys are the ones who say he has dementia," she said under cross-examination by Deputy District Attorney Ladd Wiles. "He was perfectly fine before he came out of his home."

She said, "I do care about him," sounding irked that Wiles would question her sincerity. "Tony was like my grandfather."

During her defense testimony, Viles said spoke conversationally. She sometimes laughed affectionately as she recounted Rinkes' habits, such as demanding real cheese on his burgers and spurning her effort to add fruit to his diet.

She said she encouraged him to see a doctor, concerned about rapid and continuing weight loss. But she didn't push it, she said.

Mostly, she said, she simply did whatever Rinkes asked, whether it was bringing him Coney Island dogs from the Dairy Queen, purchasing PowerBall tickets in his name or drawing up an agreement under which he supposedly sold her one of his rental houses for $1.

At his direction, she said, she withdrew thousands of dollars in cash from his bank accounts. She put much of the money into his wallet, which he kept under his mattress, she said, but also spent cash on food, diapers and maintenance work on his rental properties.

Viles said Rinkes was completely aware and supportive of her writing checks to cover her own phone bill, cable bill and credit card statements. He also authorized her to write checks to cover her brother's utilities, and to draw up lease/purchase agreements that gave her siblings dirt-cheap rent as long as he remained alive and the right to buy their houses from his estate for $400 after he died.

"I seems crazy, but Tony was who he was," she said. "He was always like that. He gave people things and said it wasn't like he could take it with him."

Viles was the second witness to take the stand after defense attorney Carol Fredrick started presenting her side of the case late Thursday afternoon.

Her mother, Pattie Meyers, was the first to testify on her daughter's behalf. Her sister and brother followed Viles on the stand.

The jury trial started Tuesday with opening statements. Wiles went on to call numerous witnesses, including Rinkes' former renters, medical and social work professionals and a Newberg police detective.

Rinkes appeared Wednesday as a witness for the prosecution. He testified that he never intended to give away any of his rental houses, nor did he intend to pay Viles' bills or credit card debts.

He said he did ask Viles to cash about one check a month for him so he would have money on hand. But he did not give Viles permission to write checks on his account.

Rinkes didn't complain about her caregiving, however. He said she came in daily to change his diaper and do some cleaning, leaving the house as he liked it.

He acknowledged losing 65 pounds or more during the year she cared for him, but said she fed him food that he favored, and he always had some left over.


by:www.newsregister.com

Suspect in check swindle case surrenders

MINNEAPOLIS -- A Minneapolis man has surrendered to authorities after allegedly helping to spend part of a nearly $2.6 million check mistakenly mailed to the woman he lived with, prosecutors said Friday.

Charles Calvin Lockhart, 28, and Sabrina Walker, 37, are charged with theft by swindle in the case. Because of a clerical error, a check from the state of Minnesota to Hennepin County Medical Center was instead deposited in Walker's checking account.

According to the Hennepin County attorney's office, Walker and Lockhart spent the money to purchase cars, jewelry, limousine services and investment services. They say Walker waited a month before calling the state Department of Human Services to inquire about the check.

Walker was jailed Tuesday and remains jailed, with bail set at $200,000. After he turned himself in, Lockhart's bail was set at $200,000, and he also is in jail.

by:www.postbulletin.com

Special-ed aide gets probation

Former instructor pleaded no contest to child abuse
BY KAREN MAESHIRO, Staff Writer
LANCASTER - A former special education instructional aide in the Palmdale School District was sentenced Friday to three years' probation after she pleaded no contest to two misdemeanor counts of child abuse.

Gloria Kleeh, 61, who was unable to be in court because of her ailing health, also was banned from working as a teacher or teacher's aide and from being with children without adult supervision during her probation period.

"The People feel the defendant's medical condition is such that she is physically unable to serve a jail sentence or community labor," Deputy District Attorney Lauren Crais said. "Although the defendant's medical conditions are legitimate, they in no way excuse her conduct. Her violent actions toward children were abhorrent and inexcusable."

Crais requested that Kleeh also be placed on house arrest, but Commissioner John Murphy denied it, citing Kleeh's acute medical condition, which was not specified. She is housebound and facing the possibility of serious surgery, he said.

"She can't get out of the bed she's in. She is unable to leave the house without assistance given her present condition," Murphy said.

Kleeh was charged with two misdemeanor counts of cruelty
to a child by inflicting injury. The victims were a boy and a girl, both 7 at the time of the fall 2004 incidents at Manzanita Elementary School.
The mother of the boy, Jennifer Alvarado, told the court she no longer trusts people and is fearful that her son might fall victim to abuse again.

"I'm scared to take my 2-year-old to day care," Alvarado said. "It's not fair for her to walk away without her being punished."

Sareena Haff said her daughter has nightmares, tried to commit suicide three times and has been placed in a facility out of the Antelope Valley area.

"I want justice done for all the children," Haff said.

Alvarado only became aware of the incident involving her son when she got a subpoena in July 2005 from the Los Angeles County District Attorney's Office regarding Kleeh's case, according to the attorney who has filed several civil lawsuits against the district.

One of the lawsuits alleges that the boy and his classmates were subjected to abuse, including "closed fist punches to his head, poking of his chest with a stick, beatings on body with a pipe, pushing and holding (him) down ... to his desk, and verbal degradation and abuse."

According to police documents, school officials did not report any of the incidents to local authorities as required by state law, the lawsuit said.

The criminal case was filed after authorities were contacted by witnesses, the lawsuit said.

District officials said a substitute teacher and a substitute aide had witnessed an incident involving the boy and reported it to the principal, and authorities were contacted. The parents, however, were not notified, officials said.

by:www.dailynews.com

A theatre of death: behind the curtain

ON JULY 2, 1976, the USSupreme Courtlegalisedcapitalpunishmentafteramoratoriumof 10yearson executions.Sixmonthslater, executionsresumedinUtah,withthe death byfiring squad of Gary Gilmoreforthekillingofmotel manager Ben Bushnell. Death by firing squad, however, came to be regarded as too bloody and uncontrolled. (Gilmore's heart, for example, did not stop until two minutes after he was shot, and shooters have sometimes weakened at the trigger, as famously happened in 1951 in Utah when the five riflemen fired away from the target over Elisio Mares's heart, only to hit his right chest and cause him to bleed slowly to death.) Hanging came to be regarded as still more inhumane. Under the best of circumstances, the cervical spine is broken at the second vertebra, the diaphragm is paralysed, and the prisoner suffocates to death, a minutes-long process. Gas chambers proved no better: asphyxiation from cyanide gas took even longer than death by hanging, and the public revolted at the vision of suffocating prisoners fighting for air and then seizing as the ability to use oxygen shut down. In Arizona in 1992, for example, the asphyxiation of triple murderer Donald Harding took 11 minutes, and the sight was so horrifying that reporters began crying, the attorney general vomited, and the prison warden announced he would resign if forced to conduct another such execution. Since 1976, only two prisoners have been executed by firing squad, three by hanging, and 11 by gas chamber.

Many more executions were by electrocution, which was thought to cause a swifter, more acceptable death. But officials found that the electrical flow frequently arced, cooking flesh and sometimes igniting prisoners - postmortem examinations often had to be delayed for the bodies to cool - and yet in some cases, it took repeated jolts to kill. In Alabama, in 1979, for example, John Louis Evans III was still alive after two cycles of 2600 volts; the warden called Governor George Wallace, who told him to keep going, and only after a third cycle, with witnesses screaming in the gallery, and almost 20 minutes of suffering, did Evans finally die. Only Florida, Virginia and Alabama persisted with electrocutions with any frequency, and under threat of supreme court review, they too abandoned the method.

Lethal injection now appears to be the sole method of execution considered sufficiently humane - largely because it medicalises the process. The prisoner is laid supine on a hospital gurney. A white bedsheet is drawn to his chest. An intravenous line flows into his arm. Prisoners are first given 2500 to 5000 milligrams of sodium thiopental, which can produce deathall by itself by causing complete cessation of the brain's electrical activity, followed by respiratory arrest and circulatory collapse. Death, however, can take 15 minutes or longer with thiopental alone, and the prisoner may appear to gasp, struggle or convulse. So 60 to 100 milligrams of pancuronium is injected one minute or so after the thiopental to paralyse the prisoner'smuscles.Finally,120to240 milliequivalents of potassium is given to produce rapid cardiac arrest.

Officials liked this method. Because it borrowed from established anaesthesia techniques, it made execution more like familiar medical procedures than the grisly, backlash-inducing spectacle it had become. The drugs were cheap and routinely available. And officials could turn to doctors and nurses to help with technical difficulties, attesttothepainlessnessandtrustworthiness of the technique, and lend a more professional air to the proceedings.

But medicine balked. In 1980, the American Medical Association (AMA) ruled against physician participation as a violation of medical ethics. Its 1992 Code Of Medical Ethics further clarified the ban, saying it was unacceptable for members of "a profession dedicated to preserving life" to pronounce death at an execution, because the physician is not permitted to revive the prisoner if he is found to be alive.

States,however,wantedamedical presence. In 1982, in Texas, the state prison medical director, Ralph Gray, and another doctor, Bascom Bentley, agreed to attend the country's first execution by lethal injection, though only to pronounce death. But once on the scene, Gray was persuaded to examine the prisoner to show the team the best injection site. Still, the doctors refused to give advice about the injection itself and simply watched as the warden prepared the chemicals. When he tried to push the syringe, however, it did not work. He had mixed all the drugs together, and they had precipitated into a clot of white sludge. "I could have told you that," one of the doctors reportedly said, shaking his head.

Afterwards, Gray went to pronounce the prisoner dead but found him still alive. The doctors were part of the team now, though; they suggested allowing time for more drugs to run in.

Today, all 38 death-penalty states rely on lethal injection. Of 1045 murderers executed since 1976, 876 were executed by injection. Against vigorous opposition from the AMA and state medical societies, 35 of the 38 states explicitly allow physician participation in executions. To protect participating physicians from licence challenges for violating ethics codes, states commonly promise anonymity and provide legal immunity. Nonetheless, several states have produced the physicians in court to vouch publicly for thelegitimacyandpainlessnessofthe procedure. Despite the immunity, several physicians have faced licence challenges, though none has lost as yet.

States have affirmed that physicians and nurses - including prison employees - have a right to refuse to participate in any way in executions. Yet they have found physicians and nurses who are willing to participate. Who are these people? Why do they do it?

Among the 15 medical professionals I located who have helped with executions, four physicians and one nurse agreed to speak with me; collectively, they have helped with at least 45 executions. None were zealots for the death penalty, and none had a simple explanation for why they did this work. The role, most said, had crept up on them.

Dr A has helped with about eight executions. He was extremely uncomfortable talking about the subject. Nonetheless, he agreed to tell me his story.

Almost 60 years old, he is well respected in his small town. One of his patients - the warden of the nearby maximum security prison - complained during an appointment of difficulties staffing the prison clinic and asked if the doctor would be willing to see prisoners there occasionally. Dr A said he would. He'd have made more money in his own clinic but the prison was important to the community, he liked the warden and it was just a few hours of work a month. He was happy to help.

Then, a year or two later, the warden asked him for help with a different problem. Executions were to be carried out in the prison. He needed doctors, he said. Would Dr A help? He would not have to deliver the lethal injection - just help with cardiac monitoring. The warden gave the doctor time to consider the request.

"My wife didn't like it," Dr A told me. But he felt torn. "I knew something about the past of these killers." One of them had killed a mother of three during a convenience store robbery and then, while getting away, shot a man who was standing at his car pumping gas. Another convict had kidnapped, raped and strangled to death an 11-year-old girl. "I do not have a very strong conviction about the death penalty, but I don't feel anything negative about it for such people either. The execution order was given legally by the court. And morally, if you think about the animal behaviour of some of these people " He decided to participate, he said, because he was only helping with monitoring, because he was needed by the warden and his community, because the sentence was society's order and because the punishment did not seem wrong.

At the first execution, he was instructed to stand behind a curtain, watching the inmate's heart rhythm on a cardiac monitor. Neither the witnesses on the other side of the glass nor the prisoner could see him. A technician placed two IV lines. Someone he could not see pushed the three drugs, one right after another. Watching the monitor, he saw the normal rhythm slow, then the waveforms widen. He recognised the tall peaks of potassium toxicity followed by the fine spikes of ventricular fibrillation and finally the flat, unwavering line of an asystolic cardiac arrest. He waited half a minute, then signalled to another physician, who went out before the witnesses to place his stethoscope on the prisoner's unmoving chest. The doctor listened for 30 seconds, then told the warden the inmate was dead. Half an hour later, Dr A was released. He made his way through a side door, past the crowd gathered outside.

In three subsequent executions there were difficulties, though, all with finding a vein for an IV. The prisoners were either obese or previous intravenous drug users, or both. The technicians would stick and stick and, after half an hour, give up. This was a possibility the warden had not prepared for. Dr A had placed numerous lines. Could he try?

OK, Dr A decided. Let me take a look.

This was a turning point, though he didn't recognise it at the time. He was there to help, they had a problem, and so he would help. It did not occur to him to do otherwise.

In two of the prisoners, he told me, he found a good vein and placed the IV. In one, however, he could not find a vein. All eyes were on him. He felt responsible for the situation. The prisoner was calm. Dr A remembered the prisoner saying to him, almost to comfort him: "No, they can never get the vein." The doctor decided to place a central line, an intravenous line that goes directly into the chest. People scrambled to find a kit.

I asked him how he placed the line. It was like placing one "for any other patient", he said. He decided to place it in the subclavian vein, a thick pipe of a vein running under the collarbone, because that is what he most commonly did. He opened the kit for the triple-lumen catheter and explained to the prisoner everything he was going to do. The man was perfectly co-operative. Dr A put on sterile gloves, gown, and mask. He swabbed the man's skin with antiseptic.

"Why?" I asked.

"Habit," he said. He injected local anaesthetic. He punctured the vein with one stick. He checked to make sure he had a good, nonpulsatile flow of dark venous blood coming out. He threaded a guide wire through the needle, a dilator over the guide wire, and finally slid the catheter in. All went smoothly. He flushed the lines with saline, secured the catheter to the skin with a stitch, and put a clean dressing on, just as he always does. Then he went back behind the curtain to monitor the lethal injection.

Only one case seemed to really bother him. The convict, who had killed a policeman, weighed about 350lbs. The team placed his intravenous lines without trouble. But after they had given him all three injections, the prisoner's heart rhythm continued. "It was an agonal rhythm," Dr A said, a rhythm with a widened appearance on the EKG, going only 10 or 20 beats per minute. "He was dead," he insisted. Nonetheless, the rhythm continued. The team looked to Dr A. His explanation of what happened next diverges from what I learned from another source. I was told that he instructed that another bolus of potassium be given. When I asked him if he did, he said: "No, I didn't. As far as I remember, I didn't say anything. I think it may have been another physician." Certainly, however, all boundary lines had been crossed. He had agreed to take part in the executions simply to watch a cardiac monitor, but just by being present, by having expertise, he had opened himself to being called on to do steadily more, to take responsibility for the execution itself. Perhaps he was not the executioner. But he was damn close to it. And he seemed troubled by that.

I asked him whether he had known that his actions violated the AMA's ethicscode."Ineverhadany inkling," he said. The humaneness ofalethalinjectionDrAwas involved in was challenged in court, however. The state summoned him for a public deposition on the process, including the particulars of the execution in which the prisoner required a central line. His local newspaper printed the story. Word spread through his town. Not long after, he arrived at work to find a sign pasted to his clinic door reading: "THE KILLERDOCTOR."Achallengetohis medical licence was filed with the state. If he wasn't aware earlier that there was an ethical issue at stake, he was now.

Some 90% of his patients supported him, he said, and the state medical board upheld his licence under a law that defined participation in executions as acceptable activity for a physician. But he decided that he wanted no part of the controversy any more and quit. He still defends what he did. Had he known of the AMA's position, though, "I never would have gotten involved," he said.

Dr B spoke to me between clinic appointments. A family physician, he has participated in around 30 executions. He became involved long ago, when electrocution was the primary method, and continued through the transition to lethal injections. He remains a participant to this day. But it was apparent that he had been more cautious and reflective about his involvement than Dr A had. He also seemed more troubled by it.

Dr B, too, had first been approached by a patient: a "prison investigator" who said he had been hired to monitor the state's care of the inmates. Dr B did not really want to get involved. He was in his 40s then. He'd gone to a top-tier medical school. He'd protested the Vietnam war in the 1960s. "I've gone from a radical hippie to a middle-class American over the years," he said. But his patient said the team needed a physician only to pronounce death. Dr B had no personal objection to capital punishment. So in the moment - "it was a quick judgement" - he agreed, "but only to do the pronouncement".

The execution by electric chair. It was an awful sight, he said. "They say an electrocution is not an issue. But when someone comes up out of that chair six inches, it's not for nothing." He waited a long while before going out to the prisoner. When he did, he performed a systematic examination. He checked for a carotid pulse. He listened to the man's heart three times with a stethoscope. He looked for a pupil response with his penlight. Only then did he pronounce the man dead.

He thought harder about whether to stay involved after that first time. "I went to the library and researched it," and that was when he discovered the 1980 AMA guidelines. As he understood the code, if he did nothing except make a pronouncement of death, he would be acting properly and ethically. (This was before the 1992 AMA clarification that made pronouncing death at the scene a clear violation of the code but allowed signing a death certificate at a later time.) During the first lethal injections, he and another physician "were in the room when they were administering the drugs", he said. "We could see the telemetry the cardiac monitor. We could see a lot of things. But I had them remove us from that area. I said, I do not want any access to the monitor or the EKGs.' A couple of times they asked me about recommendations in cases in which there were venous access problems. I said, No. I'm not going to assist in any way.' They would ask about amounts of medicines. They had problems getting the medicines. But I said I had no interest in getting involved in any of that."

Dr B kept himself at some remove from the execution process, but he would be the first to admit that his is not an ethically pristine position. When he refused to provide additional assistance, the execution team simply found others who would. He was glad to have those people there. "If the doctors and nurses are removed, I don't think lethal injections could be competently or predictably done. I can tell you I wouldn't be involved unless those people were involved.

"I agonise over the ethics of this every time they call me to go down there," he said. His wife knew about his involvement from early on, but he could not bring himself to tell his children until they were grown. He has let almost no-one else know. Even his medical staff is unaware.

The trouble is not that the lethal injections seem cruel to him. "Mostly, they are very peaceful," he said. The agonising comes instead from his doubts about whether anything is accomplished. "The whole system doesn't seem right," he told me. "I guess I see more and more executions, and I really wonder It just seems like the justice system is going down a dead-end street. I can't say that lethal injection lessens the incidence of anything. The real depressing thing is that if you don't get to these people before the age of three or four or five, it's not going to make any difference in what they do. They've struck out before they even started kindergarten. I don't see executions as saying anything about that."

Themedicalpeoplemostwaryof speaking to me were those who worked as full-time employees in state prison systems. One who did agree to talk had fought as a marine in Vietnam before becoming a nurse. As an army reservist, he served with a surgical unit in Bosnia and in Iraq. He worked for many years on critical care units and, for almost a decade, as nurse manager for a busy emergency department. He then took a job as the nurse in charge for his state penitentiary, where he helped with one execution by lethal injection.

It was the state's first execution by this method, and "at the time, there was great naivety about lethal injection", he said. "No-one in that state had any idea what was involved." The warden had a protocol from Texas and thought it looked pretty simple. What did he need medical personnel for? The warden told the nurse that he would start the IVs himself, though he had never started one before.

"Are you, as a doctor, going to let this person stab the inmate for half an hour because of his inexperience?" the nurse asked me. "I wasn't," he said. "I had no qualms. If this is to be done correctly, if it is to be done at all, then I am the person to do it."

He didn't feel easy about it. "As a marine and as a nurse I hope I will never become someone who has no problem taking another person's life." But society had decided the punishment and had done so carefully with multiple judicial reviews, he said. The convict had killed four people even while in prison. He had arranged for an accomplice to blow up the home of a county attorney he was angry with while the attorney, his wife, and their child were inside. When the accomplice turned state's evidence, the inmate arranged for him to be tortured and killed at a roadside rest stop. The nurse did not disagree with the final judgment that this man should be put to death.

The nurse took his involvement seriously. "As the leader of the health care team," he said, "it was my responsibility to make sure that everything be done in a way that was professional and respectful to the inmate as a human being." He spoke to an official with the state nursing board about the process, and although involvement is against the American Nurses Association's ethics code, the board said that under state law he was permitted to do everything except push the drugs.

So he issued the purchase request to the pharmacist supplying the drugs. He did a dry run with the public citizen chosen to push the injections and with the guards to make sure they knew how to bring the prisoner out and strap him down. On the day of the execution, the nurse dressed as if for an operation, in scrubs, mask, hat, sterile gown and gloves. He explained to the prisoner exactly what was going to happen. He placed two IVs and taped them down. The warden read the final order to the prisoner and allowed him his last words. "He didn't say anything about his guilt or his innocence," the nurse said. "He just said that the execution made all of us involved killers just like him."

The warden gave the signal to start the injection. The nurse hooked the syringe to the IV port and told the citizen to push the sodium thiopental. "The inmate started to say, Yeah, I can feel ' and then he passed out." They completed the injections and, three minutes later, he flatlined on the cardiac monitor. The two physicians on the scene had been left nothing to do except pronounce the inmate dead.

I have personally been in favour of the death penalty. I was a senior official in the 1992 Clinton presidential campaign and in the administration, and in that role I defended the president's stance in support of capital punishment. I have no illusions that the death penalty deters anyone from murder, and have great concern about our justice system's ability to avoid putting someone innocent to death. However, I believe there are some human beings who do such evil as to deserve to die. I am not troubledthatTimothyMcVeighwas executed for the 168 people he killed in the Oklahoma City bombing or that John Wayne Gacy was for committing 33 murders.

Still, I hadn't thought much about exactly how the executions are done. And I have always instinctively regarded involvement in executions by physicians and nurses as wrong. The public has granted us extraordinary and exclusive dispensation to administer drugs to people, even to the point of unconsciousness, to cut them open, to do what would otherwise be considered assault, because we do so on their behalf - to save their lives and provide them comfort. To have the state take control of these skills for its purposes against a human being - for punishment - seems a dangerous perversion. Society has trusted us with powerful abilities, and the more willing we are to use these abilities against individual people, the more we risk and betray that trust.

My conversations with the medical personnel I had tracked down, however, rattled both these views - and no conversation more so than one I had with the final doctor I spoke to. Dr D is a 45-year-old emergency physician. He is also a volunteer medical director for a shelter for abused children. He works to reduce homelessness. He opposes the death penalty because he regards it as inhumane, immoral and pointless. And he has participated in six executions so far.

About a decade ago, a new jail was built near the hospital where he worked. The jail needed a doctor. So, out of curiosity as much as anything, Dr D began working there. "I found that I loved it," he said. Jails, he pointed out, are different from prisons in that they house people who are arrested and awaiting trial. Most are housed only a few hours or days and then released. "The substance abuse and noncompliance is high. The people have a wide variety of medical needs. It is a fascinating population. The setting is very similar to the ER. You can make a tremendous impact on people and on public health." Over time, he shifted more and more of hi

by:www.sundayherald.com

TB patient under microscope

As the Atlanta lawyer with a dangerous form of tuberculosis began treatment At National Jewish Medical and Research Center in Denver, government officials and the patient provided sharply divergent accounts of his 12 days of world travel.

The accounts seemed to agree only in the missed opportunities to head off what has become an international public health scandal.

The man, Andrew Speaker, has said that public health officials in Fulton County, Ga., told him a trip would not be risky. But those officials said that he had been clearly warned of the dangers.

In interviews, public health officials at the county, state, and federal levels all said that he should not have traveled and defended their handling of the case.

The finger-pointing extended to Canada, Greece, and Italy, where officials said they had received no word of Speaker's presence in their countries in time to take action. Italian officials said they had to take the initiative in calling the Centers for Disease Control in Atlanta to ask about rumors that a man with extreme drug-resistant tuberculosis was in their country.
The likelihood that Speaker might have infected other passengers is low, tuberculosis experts say, because the disease is not as contagious as illnesses like influenza.

But the risk was still real, and the bizarre case - which, thanks to the 24-hour news cycle, has become the most famous tuberculosis drama since "La Boheme" - calls into question preparations to deal with medical crises like influenza pandemics and even bioterror attacks.

In the sharpest contradiction in the accounts, Speaker said on Friday on "Good Morning America" that county health officials who met with him all but wished him bon voyage. Although they urged him not to travel to his wedding in Greece because of his tuberculosis, he recalled, they backed off under his father's lawyerly prodding.

Steven R. Katowsky, director of the Fulton County Department of Health and Wellness, said in an interview that the county had little power to detain Speaker, but insisted that they could not have made their warning more clear. "We told him that if you travel, you're putting people at risk," Katowsky said.

County officials said that Speaker did change his travel plans after the meeting. But instead of canceling his reservations for a wedding and monthlong honeymoon, he moved up the departure date, from May 14 to May 12 - too soon to get the follow-up letter from the county stating, "it is imperative that you are aware that you are traveling against medical advice."

Katowsky said: "We are talking about a person who both had the intent and the means to escape the jurisdiction."

Critics are blasting him as a modern-day Typhoid Mary after he boarded two trans-Atlantic flights despite warnings from health officials.

His friends say that's not the "Drew" Speaker they know.

"I know if he had any thought whatsoever that he would put others in harm's way, he absolutely would not have gone," said David Rich, a Nashville attorney who was Speaker's law school roommate.

"If you subtract this TB thing from Drew Speaker, he's really a pillar of the community," Rich said.

The young attorney met Sarah Spence Cooksey, an aspiring lawyer, at an Atlanta pub and handed her his fancy business card. When she called, she asked for "Mr. Speaker."

But the man she ended up flirting with was not Andrew, but his father, Ted, who practices law with his son.

The young couple's relationship blossomed. They stayed up late debating ethics, the law and politics. He called her and her young daughter "his girls." They got married in May in Greece, honeymooned in Europe, and friends say they were eager to get married life started.

Instead, the couple described by friends as loving, energetic and athletic is now at the center of an international health scare.

Medical biller accused of scamming $300G from GHI

NEW YORK - The accused brains behind a medical billing scam for phony neurosurgeries proved to be no brain surgeon himself, federal prosecutors said.

A Mount Vernon man who worked as a medical biller for a Hawthorne company concocted a scheme to submit bogus claims and post-operative reports to the insurer Group Health Inc. for 20 brain surgeries for three New York City municipal workers and their family members, federal authorities said. The scheme netted more than $300,000 for Charles Pritchett and his three alleged co-conspirators, according to federal prosecutors.

The scam fell apart when an internal audit by Manhattan-based GHI found so many brain operations clustered among three subscribers. GHI received claims for nine brain surgeries from one family and nine from another.

The third alleged co-conspirator submitted claims for brain surgeries for himself and his wife.

"We picked it up through the audit process," said Ilene Margolin, GHI's senior vice president for corporate affairs, "It raised red flags."

Pritchett, 39, of South Ninth Avenue, was arrested Thursday along with Dorothy L. Smith, 42, of Manhattan, and Michael Biscotti, 37, of Staten Island. A fourth suspect, Stanley Cannella, 36, of Manhattan, has not yet been arrested. It is unclear how Pritchett knew the other defendants. They were all charged with health care fraud and mail fraud in a six-count indictment unsealed in U.S. District Court in Manhattan.

Pritchett's lawyer Edward D. Wilford did not return calls seeking comment. Lawyers for the other defendants could not be reached for comment. Cannella's home number has been disconnected.

The scheme began in 2003 when Pritchett used his access to the medical billing company's computer to download legitimate insurance claim forms and post-operative reports from a Manhattan neurosurgeon, federal prosecutors said. Those forms provided the templates he would use for the next three years, federal authorities and GHI said.

Pritchett swapped out the two patients' identifying information for that of two of his alleged co-conspirators, Cannella and Smith, and started submitting bogus claims. On May 30, 2003, the first of the bogus claims was paid by GHI. The insurance provider cut a check for $14,142 to Cannella, who deposited it in his bank account, federal prosecutors said.

Between April 2003 and September 2006, Pritchett and Cannella submitted nine claims for reimbursement for brain surgeries on Cannella, his wife and his two sons. None of those procedures ever occurred, federal authorities said. But all of them were paid, to the tune of $142,268.

Smith and Pritchett submitted nine claims for Smith, her husband and their two daughters between June 2003 and December 2005. All nine claims were paid, including three for the same bogus operation. In all, GHI paid Smith $131,397 in phony claims, federal authorities said.

Biscotti and Pritchett submitted bogus claims for his and hers brain surgeries on Biscotti and his wife in March and June 2004, according to federal authorities. GHI paid Biscotti $31,041 for the two bogus claims.

After GHI did the internal audit, it launched its own investigation and then contacted the U.S. postal inspector and the U.S. Attorney's Office, Margolin said.

by:www.thejournalnews.com

DA to file sexual abuse charge against Manos

Dryden woman also charged with second-degree murder in death of 2-year-old niece
By Raymond Drumsta
Journal Staff

DRYDEN — Marie A. Manos now stands accused of murdering her 2-year-old niece, Grace Manos, while committing the crime of sexual abuse against her, Tompkins County District Attorney Gwen Wilkinson and state police announced Friday.

Manos, 34, was charged with second-degree murder, a class A-I Felony, in Dryden Town Court on Thursday. She is scheduled to be arraigned on the new charge in Dryden Town Court on Tuesday.
If convicted, Manos faces 25 years to life in prison.

Manos was originally arrested and charged with first-degree assault the night of May 15 after she allegedly held Grace under water in a bathtub while she was babysitting the girl at her apartment on Ringwood Road in Dryden.
Grace died the following afternoon at Upstate Medical Center in Syracuse, and a day later, Wilkinson announced that she was considering possible homicide charges against Manos.

In the wake of Grace's death, Wilkinson said that Manos had confessed on videotape, and that she was waiting for more evidence, including a post-mortem examination by the Onondaga County Medical Examiner's Office, before charging Manos further.

In a statement Friday, Wilkinson and state police revealed preliminary details of the post-mortem examination.

“Preliminary information recently provided by the Onondaga County Medical Examiner's office reveals that Grace Manos died as a direct result of injuries, which include asphyxia, blunt force trauma, drowning, and sexual abuse,” the statement said.

There was trauma from the sexual abuse, Wilkinson said, which was a “contributing factor” in the child's death, Wilkinson said. She would not comment on the possibility that Manos was bathing Grace to cover up the crime, though she said other charges would be presented to the grand jury.

“I laid this charge at this time because I felt the state of the evidence warranted it,” Wilkinson said. “Second-degree felony murder is the highest charge supported by the evidence. The prosecution's theory is that Manos was committing the crime of aggravated sexual abuse, and in the course of the crime, Manos inflicted the injuries that were the cause of Grace's death, she added.

Wilkinson and state police said Manos, who was unemployed, had been babysitting Grace about two times a week for the last two months, they said. No one else was in the residence at the time of the incident, they said.

Jennifer Manos, Grace's mother, came to pick up her daughter the afternoon of May 15, saw Grace's condition and made the first of two calls to 911, Wilkinson said.

In the first call to 911, at about 4:46 p.m., Jennifer Manos reported that Grace had fallen down, was conscious but not coherent, and was breathing, police said.

“It was further reported that (Grace) had swallowed a large amount of water while taking a bath,” police said.

The second call to 911, made by Marie Manos at about 4:53 p.m., reported that Grace was barely breathing, they added.

Two state troopers, Quentin Giles and Michael Burling, arrived at the scene and found Grace outside the residence, police said. Grace was unresponsive and not breathing, they added.

The Dryden Ambulance Squad arrived soon after, continued life-saving efforts and transported her to Cayuga Medical Center, police said. There, Grace's medical condition was stabilized and she was flown to Upstate Medical Center, they added.

Back at the scene, an investigation was begun immediately, police said. During the investigation, Marie Manos told investigators that Grace had been taking a bath, and that she had left Grace briefly unattended, police said.

Marie told investigators that when she returned, she found Grace submerged in the bath water, police said.

The investigation by police and the district attorney led them to believe, however, that Marie Manos intentionally held the child's head under water while she was in the bathtub, police said, and Marie Manos was arrested.

“The prosecutor did not see fit to advise me of the new charge, so I can't comment on it,” said William B. Sellers IV, the assigned counsel for Manos. He said he is in contact with Manos' oncologist, however, and that he has to address the issue of Manos' health with the court.

“She has metastatic breast cancer,” he said. “It's in her liver. There is no cure.”

Manos was receiving chemo therapy, Sellers said, and the treatments, which prolonged her life, are now “long overdue.” The cancer is not in remission, he emphasized, but can be slowed by the treatments.

“She either has to be released on bail to get treatment, or she has to be taken, as a prisoner, for treatments,” he said.

Manos is being held in Tompkins County Jail without bail. The investigation in ongoing, state police and Wilkinson said, and anyone with information they believe could help the case is encouraged to call the New York State Police Bureau of Criminal Investigation at (607)347-4440. All calls will be kept confidential, they added.

by:www.theithacajournal.com

Doctor's life unfolds as an alleged fraud

Richard Brown practiced illegally, grand jury says.
By Kathleen Brady Shea
Inquirer Staff Writer
On a leafy, well-traveled Tredyffrin Township thoroughfare, a sign in front of Richard A. Brown's split-level home identifies him as a practitioner of general medicine.

And practice he did for 22 years, but only with a fraudulently obtained license, prosecutors say.

In a blistering, newly released 17-page report, a Chester County grand jury declares him to be a fraud who never had a legitimate medical license, but nevertheless worked in area hospitals and illegally prescribed painkillers and other drugs.

He forged the paperwork that persuaded state officials to grant him his license, the report says. Even after he pleaded guilty to drug charges in 2003, his fraudulent credentials went undiscovered.

The grand-jury findings were filed Thursday in Devon District Court along with a criminal complaint charging Brown, 63, with 826 offenses, including illegal sale of prescription drugs, tampering with public records, criminal conspiracyand tax evasion.

Brown's wife, Janice Kressen Brown, 49, was also charged. She faces 11 offenses related to the alleged state income-tax fraud.

Joseph R. Podraza Jr., one of Brown's three defense attorneys, said the Browns would turn themselves in for arraignment on Monday.

"The Browns will aggressively defend against these charges," said Podraza, who said he had not had an opportunity to see the report until The Inquirer provided him with a copy.

For the last several years, the Browns have been battling a state attempt to seize the couple's $400,000 home and $700,000 in savings under drug forfeiture laws. Brown's allegedly fraudulent medical license was suspended in July 2004, court records said. He has been on five years' probation for the 2003 charge.

According to the new criminal complaint, investigators from the state Attorney General's Office and the Chester County District Attorney's Office began the second probe of Brown in July 2005 after receiving information that he had allegedly resumed his illicit activities.

The report describes convoluted medical education, rife with forgery.

The report accuses Brown, whose late father, Nathan, was a longtime family doctor in Phoenixville, of falsifying documents from two of the three foreign medical schools he attended in the 1970s: Universidad Autonoma de Guadalajara in Mexico, and the American University of the Caribbean on Montserrat.

Brown's goal was "to deceive the schools and the Pennsylvania Department of State into believing that he had completed the required course work necessary to obtain both a medical degree and a license to practice medicine and surgery," the report said.

Brown attended the Mexican school in 1971 and 1972, passing six of the nine courses, but prepared a transcript that had him completing 15 courses.

He received a medical degree from the Montserrat school in the early 1980s. To get the degree, he submitted forged evaluations claiming he performed clinical work at Bryn Mawr Hospital and Phoenixville Hospital. Hospital officials say that work never occurred, the report said.

Once back in the United States, Brown passed - on his fourth attempt - a state examination required for foreign medical graduates.

Before the grand jury, Tammy Radel from the Pennsylvania Department of State testified that she compared Brown's fraudulent foreign transcripts with the genuine records.

She said Brown "would not have been issued a medical license" if the department had known the transcripts it had on file were faked, the report said.

According to testimony from Tredyffrin Township Detective Sgt. John Bailey, Brown's resumé also contained inaccuracies.

Brown said he worked at Chestnut Hill Hospital for one year in 1991. The hospital's file indicates Brown was "extremely inadequate and dangerously incompetent" and was terminated after three months, the report said.

Brown's resumé also lists a one-year stint at Cooper University Hospital in Camden, where hospital officials said he was fired after five months, the report said.

Brown saw a variety of patients over the years. One, whom Brown treated for 10 years, was prescribed Adipex, a stimulant, once a day, the report said. Roger Farber, a board-certified neurologist and pain specialist from Bala Cynwyd, said Adipex is "not safe for long-term use," calling Brown "utterly irresponsible" for prescribing it, the report said.

After his arrest in December 2001, until his medical license was suspended, Brown continuing to sell prescriptions for controlled substances to six "drug-dependent" patients without office visits, the report said. One of his patients had to be weaned off Valium at Norristown State Hospital, the report said.

In addition, Brown and his wife "conspired to underreport their income, overstate deductions and benefit from a poverty credit which they were not entitled to claim" for tax years 2002 through 2005.

Louis Cabrelli, a state tax agent, testified that the tax improprieties included the Browns' contention that 100 percent of their residence was "used for Dr. Brown's business 24 hours a day, seven days a week, 365 days a year."

Cabrelli also cited Brown's illegal deduction of $27,321 in legal fees incurred after his arrest and the fact that the Browns had not filed a 2006 return or a request for an extension, the report said.

Podraza said he wondered whether the commonwealth was suddenly seeking more charges to bolster its effort to link Brown's assets to illegal activities, a prerequisite for seizure under drug forfeiture law.

"It is quite suspicious that the commonwealth is pursuing these charges when it is aggressively trying to pursue the forfeiture," said Podraza. "There certainly is another side to this story."

by:www.philly.com