Medical news |patient's rights | Malpractice|lawyer

Prescription drugs present own problems

2007-07-01T16:26:00.000-07:00

Saving money, including those with private or government insurance, is an appealing option. Thus the new emphasis on $4 generic drugs.

There are multiple large chain stores and an increasing number of independent drug stores who offer similar programs.
However, there are multiple issues to consider carefully with your doctor and/or pharmacist before using the $4 program.

If you shop for drugs at more than one pharmacy, it is possible that the dispensing pharmacy is unaware of other medications you are taking. This could result in "double dosing" or taking drugs that are not compatible.

Using one pharmacy for all of your prescriptions allows the pharmacy staff to review your medical conditions and the medications that you are currently taking prior to filling a prescription. If your medical condition requires several different medications, the possibility for the patient or caregiver to make an error can be increased.

Reading the label on the generically dispensed pharmacy labels becomes confusing. For example: the commonly ordered drug Novasc would be labeled Amlodipine Besylate and Soma would be labeled Simvistatin.

Further, different manufacturers may color their generic products differently.

Patients often take their medications by memory — for instances taking the "small pink pill" in the morning, a "triangular pill" midday etc. Some patients either can't or won't check the bottle before taking a pill, but they depend on the familiarity of shapes and colors.

The $4 drugs are very useful and safe if the patient knows what they are taking. When in doubt, call your pharmacy.

by MARY CATHERINEDELLASALLa

East Stroudsburg

Pharmacy error led to premature birth, suit says

2007-07-01T16:24:00.001-07:00

Two years ago, Antoinette Lewis' baby was born prematurely. She claims her pregnancy complication was a result of a "misfilled" prescription received at a CVS Pharmacy and is suing the company for more than $50,000.

Lewis filed her suit individually and on behalf of her new born with the Jefferson County District Court on June 25. Judge Bob Wortham, 58th Judicial District, will preside over the case.

According to the plaintiff's original petition, on June 30, 2005, Lewis was pregnant when she had a prescription filled at the CVS on Avenue A.

"Defendant through its employees, agents, and servants, misfilled the prescription. Plaintiff subsequently suffered complications due to the misfilled prescription, was forced to deliver the minor plaintiff by C-section prematurely, and both suffered injuries due to the negligence of the defendant.

The suit goes onto to say Lewis presented CVS with a prescription for an antibiotic, and instead received Vytorin.

"Defendant failed to properly administer the correct medication, the plaintiff was pregnant, and the Vytorin caused complications with the pregnancy, and subsequently caused early delivery."

Vytorin is a cholesterol-lowering medicine distributed by Merck/Schering-Plough Pharmaceuticals. The official Vytorin Web site warns that the drug should not be taken by pregnant women.

"Vytorian is a prescription tablet containing two medicines, ezetimibe and simvastatin, and isn't right for everyone, including women who are nursing or pregnant or who may become pregnant, and anyone with liver problems," the site says.

Lewis alleges the pharmacy was negligent for failing to properly fill the correct medication, failing to recognize her symptoms, and "failing to engage in recognized and acceptable practices in the medical profession to limit the likelihood and probability of infection following the treatment provided by the defendant."

"Plaintiffs allege that the defendant violated the duty of care they owed to Lewis to exercise that degree of care, skill, and diligence ordinarily possessed and used by other members of the medical profession in good standing under the same or similar circumstances," the suit said.

Lewis is suing for physical pain and suffering in the past and future, mental anguish in the past and future, lost wages, loss of earning capacity, disfigurement in the past and future, physical impairment in the past and future, and past and future medical expenses.

Lewis is demanding a trial by jury and is represented by attorney Brett S. Thomas of the Roebuck & Thomas law firm.

Case No. A179-565
By David Yates www.setexasrecord.com

Vaad Refuah: Improving The Quality Of Hospital Care

2007-07-01T16:23:00.001-07:00

Question: Where do you turn for help if someone is hospitalized? Answer: Vaad Refuah.

Mrs. Shapiro spent her last days in a hospital with constant attention from her devoted family. Her children took turns sitting by her bedside, wiping her brow and cooling her parched lips with ice. When she passed away, the family at least had the satisfaction of knowing that they had done everything possible to relieve her suffering and alleviate her pain. What they didn’t realize, however, is that despite their loving vigilance, Mrs. Shapiro was not receiving adequate medical care.

The chevra kadisha, while washing the body, discovered that yet another patient had passed away with Stage III or IV bedsores. These are deep, black craters usually in the sacrum, back or ankles where the skin, muscles, or bone have been eaten away. Mrs. Shapiro, along with 1 million other Americans, half of whom are over 70, was suffering from excruciating, but largely avoidable, decubitus (bed sores). Elderly patients who are confined to bed are at the highest risk due to their thinner skin and weaker circulation and immune systems. Had this family been aware of this potential problem, they would have made a simple request to the nurses to turn her every two hours and check her body for early signs of bedsores to prevent this painful complication.

Bedsores, unfortunately, are not the only problems that call for extra attention from the families of patients who are staying in a health care facility. At least one study shows that 5-6% of all patients acquire nosocomial infections in hospitals each year. These infections are usually highly resistant virulent strains. It is within the patient’s rights and responsibility to ask respectfully if the health care worker has washed his or her hands. There are also times when a family should discreetly ask that the patient be moved due to the danger of cross infection from a roommate. In addition, errors in prescription drugs for hospitalized patients have recently soared. If the patient was not informed that his doctor changed his medication, he should immediately request confirmation. The number of unnecessary surgeries and the resulting greater need for second opinions also warrants consideration.

How are the family members, who are already over-strained, worried, and tired, able to assume this role of guarding the patient from medical error without knowing the ‘ins and outs’ of the hospital process? To address this problem, a team of rabbonim, askonim, medical professionals and volunteer workers has created a patient advocacy group, Vaad Refuah. Vaad Refuah does not give medical advice. They only guide the patient and his family through the maze of health care bureaucracy in order to increase the quality of health care for all patients.

Mrs. Krausz, who supervises 14 volunteers who are on call through Vaad Refuah’s helpline, offers the following advice to all patients and their families:

Appoint a friend or family member to be a spokesperson to liaise with the hospital staff. Even a patient who can take responsibility for his own health care still needs a spokesperson to act as his advocate.

The spokesperson is invited to contact the Vaad Refuah helpline about how to avoid preventable complications and how to effectively intervene with hospital staff.

With polite respect, the spokesperson should try to resolve all care problems with the local nursing or care-giving workers.

Medical problems should be discussed with the doctor who is managing the case. In those instances where there is no managing doctor, the spokesperson should communicate with all the appropriate doctors who are involved in the case.

If any problems arise, the spokesperson should be in touch with Vaad Refuah. For Lutheran, NY Methodist, Long Island College, and Maimonides hospital, Vaad Refuah has established communication channels where, if necessary, they will intercede to help acquire the appropriate cooperation from the hospital. For patients in other hospitals, Vaad Refuah can advise the spokesman how to talk to the hospital and, where possible, the Vaad may be able to facilitate communication.

The Vaad will maintain a database of problems encountered in each hospital. The information collected will be provided to the management of each hospital to assist in effectuating needed improvement. Unclean conditions, employee neglect of duties, and other violations should all be reported to the Vaad. (Forms can be obtained at www.vaadrefuah.org.)

Positive feedback, either general or relating to the actions of specific staff, should be reported to the Vaad, who will pass praise along to the hospitals. This will create a culture of caring in which the efforts of conscientious staff will be made known. Conversely, the Vaad will apply pressure on the hospitals to change by publicizing negative data when necessary.

All information given to the Vaad is kept in strict confidence. There is no need to fear retaliation from hospital employees.

The Vaad has thus far made several major changes in local Brooklyn hospitals. They have convinced hospital management to improve emergency room procedures, establish more hand washing stations, implement stricter hand washing compliance, improve the staff/patient ratio, provide more diligence in turning patients, and computerize bed availability tracking. Future plans include expanding the Vaad’s computerized patient satisfaction program to more hospitals, introducing more medical prevention practices, and educating the community and health workers about the most effective methods of communication.

The Vaad performs these services through its network of volunteers in order to help our local communities secure the best possible health care. For more information or to join the volunteer staff, call 1-877-REFUAH, 1-877-973-3824 or visit www.vaad
refuah.org.

Vaad Refuah Meets Maimonides Trustees. On June 24, an historic conference took place in Borough Park between the Rabbinical board of Vaad Refuah and the Trustees of Maimonides Medical Center to tackle healthcare concerns facing the Borough Park/Flatbush/Bensonhurst communities.

The roster of esteemed attendees included: Rabbi Yisroel Tzvi Brody, Manchester Dayan; Rabbi David Eichenstein, Burshtyner Rebbe; Rabbi Shloime Gross, Belzer Dayan; Rabbi Shraga Hager, Kosover Rebbe; Rabbi Yakov Horowitz, Rav Telshe Minyan, Rosh Hayeshivah, Beis Meir; Rabbi Yechiel Kaufman, Rav D’khal Anshe Sefard; Rabbi Yakov Perlow, Novominsker Rebbe; Rabbi Yisroel Reisman, Rav Agudath Yisroel Madison Branch, Rosh Yeshivah Torah V’daas; Rabbi Yechiel Mechel Steinmetz, Skverer Dayan; and Rabbi Chaim Yakov Tauber, Bobover Dayan. The other participants were board members of Vaad Refuah, along with community representatives on the Maimonides Medical Center Board of Trustees including Abraham Biderman, Moshe Hellman, Andrew Kohen, Chaim Leshkowitz, Peter Rebenwurzel, Alfred Schonberger and Rabbi Aaron Twersky.

Concerned with the quality of healthcare our families receive at local hospitals as well as the need for the various community organizations to work together to ensure the best possible service within halachic parameters, the rabbonim initiated this meeting as a follow-up to a prior meeting held between the Vaad Rabbinical Board and Hatzoloh representatives. At the conference, attendees were updated on the efforts the Vaad has made to date on infection control, respiratory care patients, wound-care and decubiti (bed sores/pressure sores).

The Vaad has a close working relationship with the Bikur Cholims of Borough Park, Flatbush and Bensonhurst. It also meets regularly with Hatzoloh, sharing information of common concern and coordinating activities to maximize community efforts for the improvement in the quality of healthcare service delivery.

While the Vaad has made great strides in assisting individual patients and their families by helping them navigate hospital bureaucracy, advocating on their behalf and intervening to expedite their needs, effecting systemic changes is significantly more laborious and requires the close cooperation and assistance from the Hospital Board of Trustees.

The community representatives on the Maimonides Medical Center Board of Trustees expressed their eagerness to assist in this effort by collaborating with the Vaad in assuring that the Maimonides Administration continues to pay proper attention to community concerns, responds promptly to issues raised by the various community organizations, and implements needed changes in a timely fashion. The Vaad highly commended Maimonides Medical Center Board of Trustees for their commitment to partner in this vital mission.
by www.5tjt.com

Computerized Doctors' Orders Reduce Medication Errors

2007-07-01T16:22:00.001-07:00

Doctors are famous for sloppy scribbling -- and handwritten prescriptions lead to thousands of medication errors each year. Electronics to the rescue: U.S. hospitals that switched to computerized physician order entry systems saw a 66 percent drop in prescription errors, according to a new review of studies.
Illegible handwriting and transcription errors are responsible for as much as 61 percent of medication errors in hospitals. A simple mistake such as putting the decimal point in the wrong place can have serious consequences because a patient's dosage could be 10 times the recommended amount.

Drugs with similar names are another common source of error, such as the pain medication Celebrex and the antidepressant Celexa, or the tranquilizer Zyprexa and the antihistamine Zyrtec.

"These medication errors are very painful for doctors, as well as the patients. Nobody wants to make a mistake," said Tatyana Shamliyan, lead review author and a research associate at the University of Minnesota School of Public Health.

The University of Minnesota researchers looked at 12 studies that compared medication errors with handwritten and computerized prescriptions from in-hospital doctors. Nearly a quarter of all hospital patients experience medication errors, a rate that has increased from 5 percent in 1992, according to the study.

Medication errors include prescribing the wrong drug or incorrect dosage or administering a drug at the wrong time or not at all. "Most errors typically go undetected unless they led to an adverse event," said review co-author Robert Kane.

In addition to improving patient safety, computerized systems make life easier for pharmacists. "They don't have to decipher the chicken scratch," said Karl Gumpper, director of the pharmacy informatics and technology section of the American Society of Health-System Pharmacists, based in Bethesda, Md. Pharmacists frequently have to call the prescribing doctor or interview the patient because of problems in deciphering handwriting.

Currently, only about 9 percent of hospitals have computerized prescription systems. Some hospitals have stand-alone systems, while others have computerized prescriptions as part of an electronic medical record system.

Each year, more health systems implement computerized order entry systems and more will do so as electronic medical records become more common. "It's a growth industry," Kane said.

A small handful of institutions, including Brigham and Women's Hospital in Boston and Vanderbilt University Medical Center in Nashville, have been leaders in integrating computerized prescriptions, experts say.

It takes 12 to 36 months to implement computerized prescribing system, Gumpper said. Currently, no industry standard system exists. Some hospitals use systems created in-house, while others use commercial products created by companies such as Epic Systems, based in Verona, Wis. or McKesson Corp., based in San Francisco.

Some systems guide doctors through the prescription process, asking questions that might help avoid errors. Some even use voice recognition.

There are two reasons why more hospitals have not switched to electronic prescription systems, says Arthur Levin, director of the Center for Medical Consumers in New York. First, "Physicians, like most of us, don't like change," he said. In addition, electronic prescription systems are costly and difficult to integrate into the complex, sometimes-chaotic hospital structure.

Regardless, in hospitals with a computerized prescription system, the number of medication errors dropped, especially among adult patients. However, the rate of one type of error --prescribing the wrong drug -- did not decrease, and in five studies, the number of adverse events from drug errors did not decrease.

Each year, more than one-half million patients sustain injuries or die in hospitals from adverse events, according to the study.

In hospitals with a higher number of medication errors -- more than 12 percent -- computerized systems made the biggest improvement, the researchers found.

Medical schools in the United States rarely address penmanship. It is the same in Russia, says Shamilyan, who studied there. However, at least one medical school in the United States, Indiana University in Indianapolis, teaches penmanship to students in hopes of avoiding errors.

As nearly every industry becomes more computerized, Levin says the doctor's prescription pad should go the way of scarification used in the 19th century for bloodletting. "Written and verbal orders should be a no-no," he said.

Reference; Shamliyan TA, et al. Review of the evidence: impact of computerized physician order entry system (CPOE) on medication errors. Health Services Research online, 2007.

Note: This story has been adapted from a news release issued by Center for the Advancement of Health.
by www.sciencedaily.com

Call Kurtis: Medical Board Investigation

2007-07-01T16:19:00.000-07:00

An 82-page report shows the medical board is still failing to protect all of us from doctors who abuse alcohol and drugs.

Linda, Becky, Tina, Ken-- just some of the faces of people who believe they're living the consequences. If you looked beneath the clothes of some patients you would see something horrifying. They blame damages on a doctor who battled a dangerous addiction, and on the state's significant errors.

We know of more than 30-patients who say plastic surgeon Dr. Brian West made medical mistakes while treating them. The medical board knew Dr. West had a drinking problem, and had two drunk driving convictions. The first, after crashing his car in 2000 on the way to the hospital to treat a patient. The state had the power to take away his license to practice.

Instead, they let him enroll in the medical board's alcohol diversion program, a secret program where they're supposed to keep an eye on substance abusing doctors with random alcohol and drug tests in an effort to protect patients.

We learned, the state wasn't giving doctors those tests as often as required, and the testing was done on days doctors could anticipate. In November, with the Dr. West case in front of him, the head of the medical board admitted his agency failed.

While in the program, Dr. West cut into Becky Anderson so many times, she never looked or felt the same. Tina Minasian ended up with permanent scars from a body tuck that went wrong. Ken Mickulecky says his late wife Sharon was left with a massive flesh eating infection that kept her from getting the cancer treatment she needed.

“He put his finger without a glove in my wife's wound. When he came into examine her, she said smells like he's got alcohol on his breath. I said, no, doctors wouldn't do that,” said Ken.
Back in November Medical Board Executive Director Dave Thornton admitted the diversion program's problems of the past, but claimed they have been fixed.

“If your doctor is an alcoholic, and is in the program, he's not gaming the system. The system is working now the way it’s supposed to be working and the way it should have been working all of these years,” said Thornton.

Fast forward to a state audit that was just released. The audit states that what he says is not true. Although there have been some improvements, many doctors in diversion are still given drug and alcohol tests on days they can anticipate.

The report shows during the audit 13 doctors failed their tests. Yet, only three of them were immediately removed from practice.

“These are doctors who retain their license to practice medicine who are allowed to practice medicine, are chemically dependent. This board is supposed to be monitoring doctors, it doesn't,” said Julie D'angelo Felmeth, who has audited the program twice.

D'angelo Felmeth says there have been five audits in 27 years and each one shows the same exact issues with diversion-- A program she says has no room for error.

“They've had decades to fix these problems, which have been repeatedly identified for them and the problems and the programs have never been a priority to the medical board,” said D'angelo Felmeth.

In fact, a member of the board's executive committee even admitted it during a meeting last week. The problematic program caught the attention of state lawmakers in 2005 who passed a law stating the diversion program needs to be fixed by July of next year, or it'll go away.

Earlier this year State Senator Mark Ridley-Thomas, the head of the legislative committee that oversees the medical board, drafted a bill to keep the diversion program going for an additional two years.

“Ultimately saving doctors is better than disposing of them,” said Senator Ridley-Thomas.

We showed him our investigation, and he admitted what the state allowed to happen here is upsetting.

“It should be long before you get there, this problem is dealt with,” said Senator Ridley-Thomas.

He points out, his bill to extend the program was drafted before the latest audit, but instead of killing his legislation he says he'll beef it up, to hold the medical board accountable.

“Shape up this program, or it will not longer exist,” said Senator Ridley-Thomas.

That message went out two years ago, and the program still has major problems putting patients at risk.

“Let me simply say there's a new sheriff in town. And the chair of this committee will push for accountability, and that's essentially what we're doing now,” said Senator Ridley-Thomas.

Knowing this is the fifth audit in 27 years, and all of the same concerns keep coming up. Audit after audit some might question why should this program be extended for another two years.

“That's a legitimate question. This is a program under strict scrutiny. Either they perform as intended, or there is no defense for continuation. It requires a significant time on task to straighten some of these things out,” said Senator Ridley-Thomas.

That bill is still being talked about at the capitol. It has to pass the State Senate and Assembly by September, or the program is set to go away next July. It's supported by the medical board and the California Medical Association, which historically contributes a large amount of money to the campaigns of state lawmakers.

At the Beverly Hills Surgical Institute in Long Beach, Dr. West still practices, and has always refused to comment on this issue. The state has a case against him for what happened to several patients. It will be the fall before a judge decides if he should lose his license.
by Kurtis Ming cbs13.com

Physician order entry system reduces error

2007-07-01T16:17:00.000-07:00

The incidence of medication errors can be reduced by implementing a computerized physician order entry (CPOE) system, according to a review of several studies conducted by researchers at the University of Minnesota.

The review, recently published in the online journal Health Services Research, analyzed 12 studies conducted between 1990 and 2005 that compared the number of handwritten and computerized medication errors made by hospital physicians. Medication errors, which include prescribing the wrong drug, ordering an inaccurate dosage, or administering a drug at the wrong time, dropped by as much as 66 percent in United States hospitals that switched to a CPOE system. Illegible handwriting and transcription errors account for more than 60 percent of medication errors.

Patient safety is our final goal, said Tatyana Shamliyan, lead review author and a research associate at the University of Minnesota School of Public Health.Evidence from these studies show that computerized systems can reduce mistakes, but unfortunately less than 50 percent of hospitals have implemented these systems. There is a lot of work to be done in the future.

The rate of medication errors experienced by hospitals has skyrocketed from only 5 percent in 1992 to nearly 25 percent today. The review found that of these hospitals, CPOE systems were most beneficial when the rate of medication errors was more than 12 percent.

The Institute of Medicine has already identified medication errors as a major threat to patient safety and has endorsed electronic prescribing of medication as an effective method in correcting the problem.Medication errors are a central aspect of improving hospital safety. CPOE can help that process, says Robert Kane, M.D., review co-author.

Hospitals would be short-sighted not to use it. Kane also notes that CPOE systems can be combined with existing computerized medical records, creating a central location for physicians to efficiently enter and view past and present patient prescriptions and medical history.

While the review found that the number of medication errors dropped as a whole, the incidence of one type of error, prescribing the wrong drug, did not decrease. In five of the twelve studies, the number of adverse events from drugs errors did not decrease. More than one-half million patients suffer injuries or death from adverse events, causing up to $5.6 million annually per hospital, according to the review.
by www.news-medical.net

When Minority Patients Have Insurance And A Medical Home, Their Health Care Improves

2007-07-01T16:16:00.000-07:00

Providing minority patients a "medical home" in which they have a regular doctor or health professional who oversees and coordinates their care would help eliminate racial and ethnic health disparities and promote more health care equity, says a new report from The Commonwealth Fund. The report, based on a 2006 survey of more than 2,830 adults, shows that linking minority patients with a health care setting that offers timely, well-organized care where they can routinely seek physicians and medical advice can help them better manage chronic conditions and obtain critical preventive care services.
According to the report, Closing the Divide: How Medical Homes Promote Equity in Health Care, in 2006 nearly one-half of Hispanics and more than one of four African Americans were uninsured at some point during the year. In contrast, 21 percent of whites and 18 percent of Asian Americans lacked coverage. In addition to being the groups most likely to go without health insurance, African Americans and Hispanics are least likely to have a regular doctor or source of care. While health insurance coverage is an important determinant of whether people can obtain essential care, the authors say insurance alone cannot eliminate racial and ethnic disparities in health.

"Insurance coverage helps people gain access to health care, but the next thing you have to ask is 'access to what?'" says lead co-author Anne Beal, M.D., senior program officer at the Commonwealth Fund. "We found many disparities in care; however, disparities are not immutable. This survey shows if you can provide both insurance and access to a true medical home, racial and ethnic differences in getting needed medical care are often eliminated," she adds.

According to the report, patients have a medical home when they:

* Have a regular provider or place of care
* Report no difficulty contacting a provider by phone
* Report no difficulty getting advice or medical care when needed on weekends or evenings
* Always or often find office visits well-organized and efficiently run

Although there are many places that are already functioning as models of such care, what most limited a health setting from being designated a medical home in this survey was the ability to dispense medical advice or care after hours or on weekends, according to the report. Only two-thirds of adults who have a regular provider or source of care report that it is easy to get care or medical advice after hours. Among all groups surveyed, Hispanics have the hardest time seeking care or advice after hours, and they are least likely to have a medical home.

The survey shows that, when they have a medical home, the vast majority of adults of all races say they can always get the care they need when they need it. Nearly three-quarters of adults with a medical home report getting the care they need compared with only 52 percent of those with a regular provider that is not a medical home and 38 percent of adults without any regular source of provider.

Key survey findings on the role of a medical home in eliminating health care disparities:

* Racial/Ethnic Disparities Are Still Common.
* African Americans and Hispanics are less likely to be insured, and less likely to have a regular doctor or source of care.
* Hispanics are least likely to have a medical home; only 15 percent of Hispanics report having a medical home compared with 28 percent of whites, 34 percent of African Americans and 26 percent of Asian Americans.

Preventive Care Is More Routine.

* Minority adults with a medical home experienced no disparities in receiving preventive care reminders, which significantly improve rates of routine screening for conditions such as heart disease and cancer. For example, eight of 10 adults who received a preventive reminder had their cholesterol checked in the past five years compared with half of adults who did not get a reminder.
* Two-thirds (65%) of adults who have a medical home receive preventive reminders, according to the survey.

Chronic Care is Better Managed.

* Adults with a medical home are better prepared to manage chronic conditions such as diabetes or hypertension. Only 23 percent of adults with a medical home report their doctor or doctor's office did not give them a plan to manage their care at home compared with 65 percent who have no regular source of care.
* Forty-two percent of hypertensive adults with a medical home report that they check their blood pressure and it is well controlled compared with 25 percent of those without a medical home.

Having Health Insurance Matters.

* More than half of insured adults received a reminder from a doctor's office to schedule preventive visits compared with only 36 percent of uninsured adults; when African American and Hispanic patients are insured, they are just as likely as white adults to receive reminders to schedule needed preventive care.

Community Health Centers and Other Public Clinics Are Important Providers of Care to Vulnerable Patients.

* Although they care for a large proportion of uninsured, low-income, and minority adults, patients report that community health centers (CHCs) or other public clinics are less likely to have all four characteristics that comprise what the survey defined as a "medical home." Twenty-one percent of CHCs or public clinics have all four indicators of a medical home, compared with 32 percent of private doctors' offices.
* The main reason CHCs and other public clinics do not function as medical homes is because patients say they have more difficulty getting medical advice or care in the evenings or weekends. Since these safety net providers play a critical role in the care of vulnerable patients, the authors say it is important to find ways to support CHCs and public clinics becoming medical homes.

Promoting standards for the medical home through public reporting of performance and rewarding providers that meet these performance benchmarks would go a long way toward improving the way care is delivered and eliminating disparities, say Commonwealth Fund authors.

"We know the medical home is a promising model of care for narrowing health care disparities and providing patients with much higher quality care in terms of prevention and chronic disease management," says Fund Executive Vice President Stephen C. Schoenbaum, M.D. "Adopting policies to encourage practitioners to embrace this model would improve care for everyone, particularly those in safety net settings," he adds.

Methodology

The survey was conducted by Princeton Survey Research Associates International from May 30 through October 19, 2006. The survey consisted of 25-minute telephone interviews in English or Spanish among a random, nationally representative sample of 3,535 adults at least 18 years of age living in the continental United States. The report restricts the analysis to the 2,837 respondents ages 18-64. The sample was designed to target African American, Hispanic, and Asian households and it classifies adults by insurance status and annual income. The survey has an overall margin of sampling error of +/- 2.9 percentage points at the 95 percent confidence level.

The Commonwealth Fund is a private foundation working toward a high performance health system.

Note: This story has been adapted from a news release issued by Commonwealth Fund.
by www.sciencedaily.com

GOVT SORRY FOR ERROR

2007-07-01T16:14:00.000-07:00

A COURT clerk's mistake is why Dickson Tan Yong Wen ended up getting the extra strokes.

This was revealed in a joint statement by the Law and Home Affairs ministries yesterday.

'Unfortunately, when the warrant of commitment was prepared by the Court Officer (that is, court clerk who assisted the judge with the administrative aspects of the case), the Court Officer erroneously reflected on the warrant of commitment an additional three strokes to one of the charges,' the statement said.

Tan was found guilty of abetting an illegal moneylender. He was convicted and sentenced on 28Feb.

The statement said that prison officers followed proper procedures when administering the caning on 29Mar this year.

This included verifying with the prisoner that the number of strokes of caning as specified in the warrant of commitment was correct.

Tan also did not raise any objection to number of strokes when he was interviewed during his admission process to prison on 1 Mar.

On the day of the caning, statement said, Tan acknowledged on the Inmate's Events Sheet that eight strokes was correct. And just before he was caned, Tan confirmed once again to the prison officers and the Medical Officer that the number of strokes were correct.

The Subordinate Courts has since taken various steps to tighten the processes. These efforts include checklists for Court Officers in preparing warrants of commitment and layers of additional checks for warrants of commitment, the statement said.

It also added that the Government regrets the error.

'The Government has also offered to refer the case to mediation. In negotiations so far, Tan's settlement sum has escalated from an initial amount of $150,000 to $3m (out of which he said he would donate $2.7m to charity), made on a without prejudice basis. This could not be accepted by the Government.'

The statement also said the court officer had resigned over the incident.
By Tay Shi'an
newpaper.asia1.com.sg

A $962,120 medical bill error

2007-07-01T16:13:00.000-07:00

The patient didn't have to pay, but it's still a useful lesson for others, an economist says.
Helen Dorroh White thought she was doing the right thing when she called a health insurance company to question a nearly $1-million medical bill. Instead, she said, no one seemed to care.

White, a Glendale lawyer, was closing the financial affairs for a deceased client when she came across the insurance statement. It showed a $962,120 bill for her client, Dusanka Mlinarevich, who spent four days at Glendale Adventist Medical Center after suffering minor injuries in a fall at her Burbank home last year.

That struck White as odd, she said, because the hospital had told her the bill was $48,106.

Concerned about the discrepancy, White called the health insurance company, Long Beach-based SCAN Health Plan.

"My first question was, 'Is this some kind of typo or some mistake?' " said White, 73. A customer service representative paid little heed, White said, and insisted that the amount was correct.

"She didn't even bat an eye," White said.

Fearing fraud, White wrote a letter to the U.S. attorney's office and contacted The Times.

After inquiries from a reporter, SCAN's vice president of marketing, Sherry Stanislaw, said the company found a computer glitch that was producing erroneous claim reports for customers.

Actual billings and payments were not affected, Stanislaw said. She confirmed that Glendale Adventist's bill was for $48,106 and said that SCAN paid a negotiated rate of $4,350 and that Mlinarevich, who died in August at age 78, was assessed a $150 co-payment.

Because patients are responsible only for co-payments and deductibles, few consumers ever take a close look at their medical bills, said Devon Herrick, a healthcare economist and senior fellow at the National Center for Policy Analysis.

To help keep rising healthcare costs in check, more consumers should do what White did, Herrick said. "Most insurance companies will agree that they'd want their enrollees to scrutinize their bills."

SCAN said the computer glitch was being investigated. Stanislaw conceded that her customer representative should have heeded White's concerns and contacted a supervisor. The company is sending White a new claim statement, she said.

White wasn't completely pleased.

"It is easy to blame the computer. Well, who programs the computers?" she asked. "The last I checked, computers didn't program themselves."
By Daniel Yi, Times Staff Writer

Why King-Harbor must die

2007-07-01T16:12:00.001-07:00

We must admit that the patient can't be saved -- and move on.
FOR FOUR YEARS, Los Angeles County officials have been dithering and bickering over what to do about Martin Luther King Jr.-Harbor Hospital.

Those who believe it must be closed argue that patients are dying because of substandard care and that there is little indication that anything — including downsizing by 80%, firing hundreds of staff members and changing the hospital's ownership and leadership — has worked to overcome its staggering problems. Opponents counter that King-Harbor served 47,000 emergency room patients in South Los Angeles last year and that, even with all its flaws, a bad hospital is better than no hospital at all.

So how are we to know whether the benefits of closure outweigh the risks of keeping the hospital open? As the state Department of Health Services, the federal government and the Los Angeles County Board of Supervisors all contemplate the possible demise of King-Harbor, how are we to determine whether the time has indeed come?

This much we know: There are no perfect hospitals. A seminal study by the Institute of Medicine conducted in 1999 found that 44,000 to 98,000 patients die from medical mistakes in the United States each year — the equivalent of a commercial jet crash every day. The average hospitalized patient suffers one medication error daily, according to another report from the institute, and patients in intensive care units experience nearly two mistakes in their care each day.

Until recently, we approached problems of poor quality and safety by admonishing doctors, nurses and hospitals to try harder, underscoring these exhortations with threats of malpractice lawsuits. But eventually it became clear that that was not enough. As Albert Einstein observed, we cannot solve our problems with the same thinking we used when we created them.

What we've learned in recent years is that most errors are not committed by incompetent doctors or slacker nurses but by well-trained, committed caregivers working in environments that are simply too complex for any human to get it right every time. This epiphany has led us to embrace what is known as "systems thinking" — in which we aim to create systems and structures that anticipate errors on the part of fallible workers and catch those errors before they cause harm.

By implementing relatively simple system fixes — such as double-checking before administering dangerous medications, marking surgical sites on patients' skin with indelible ink to ensure that we don't operate on the wrong body part, implementing computerized prescribing systems and limiting resident work hours (to less than 80 a week) and the number of patients assigned to each nurse (to no more than five) — we have begun to move the safety needle in the right direction.

Evidence is emerging that medical errors are decreasing and that hospital death rates in the last five years have fallen. Certain problems once felt to be inevitable, such as hospital-acquired infections, can be all but eliminated by widespread implementation of a series of safe practices, including religious attention to hand-washing and the use of other sterile techniques.

But even as we chalk up some safety victories, there remain problems so stubborn that they can't be solved by changing procedures and implementing new systems. The question is — because even the best hospitals will commit terrible, even lethal, errors every year — how do we know when a hospital is so bad that it should be deemed unfit for patients?

This question has been brought into sharp focus by the extraordinary saga of King-Harbor. What is so shocking about the story is not that the initial reports in 2003 showed scores of safety problems, although the breadth and depth of the problems far exceeded the usual litany. Nor is it the tale of a resource-poor hospital serving indigent patients struggling to make ends meet; those problems exist everywhere. Nor is it that the organizational chart of King-Harbor needed reshuffling — reorganizations of failing enterprises, guided by consultants, are a dime a dozen (not counting the price of the consultants, of course).

No, King-Harbor's problems are distinguished by their intractability. Other hospitals have had highly public errors or sustained withering press coverage but used these traumas to create a platform for improvement. Boston's Dana-Farber Cancer Institute, for instance, was transformed after a chemotherapy overdose there killed a Boston Globe healthcare columnist. Johns Hopkins Hospital in Baltimore, often rated as the nation's finest, was nearly brought to its knees by the error-related death of a young girl, but it used the tragedy as a springboard to develop a world-class safety program.

And other resource-poor county hospitals — such as San Francisco General and Harbor-UCLA — manage to provide high-quality care even in the face of budget woes and enormous caseloads.

But at King-Harbor, highly public disasters involving quality and safety have not managed to upend the status quo. Regulators have issued stern threats to yank funding or certification — but have then lowered the bar again and again. Leaders have been fired, organizational charts have been reshuffled and consultants have come and gone, and yet the shocking revelations — including numerous deaths from medication errors and lapses in monitoring — keep on coming.

When a patient can literally lie dying on the ER waiting room floor — a janitor mopping up around her — at a hospital whose every move is being scrutinized by the media and legislators, we know that the problems cannot be fixed by a better computer system, a few new bylaws or more intensive personnel training. The troubles run far deeper than that.

We physicians are socialized to believe in the possibility of redemption and healing — that the tumor can be excised, the obese patient will finally stick with that diet, the baby will emerge from the womb hale and hearty. This is mostly a good thing, but it can take us down dark alleys. For example, our "never say die" attitude sometimes leads us to over-treat patients with terminal illnesses, flogging them with another course of chemotherapy long after realistic hope is gone.

We now teach young doctors to recognize when cure is impossible and, at those times, to help guide patients and families toward what we have come to call a "good death." When offering this "palliative care," we focus on keeping the patient comfortable while encouraging loved ones to honor the past, come to terms with the present and make appropriate plans for the future.

With that in mind, we can never forget what King-Harbor represented at its christening: a shining light emerging from the dark shadows of the '60s riots. We must recognize the service of those committed, competent caregivers (and there were and are some) who struggled to provide high-quality care in a dysfunctional environment. We have to empathize with the patients who may be inconvenienced, or even harmed, when their local hospital — bad as it was — is no longer down the street.

But how can we stay silent in the face of overwhelming evidence that this hospital cannot ensure a decent level of safety, knowing that no patient with a choice would dare cross its threshold? How can we continue to focus on cure when hope has long since vanished? Surely, the resources being poured into that one last change in the organization chart, one more consultant engagement or one more staffing surge could better be used to ramp up the capacity of other hospitals' ERs and clinics to absorb King-Harbor patients.

King-Harbor is on life-support, and has been for years. The disease is a cancerous culture, and one more course of chemo won't help. It is time to orchestrate a "good death" — to focus on healing the community and making plans to care for the patients of South L.A. once this hospital is gone.
By Robert M. Wachter, ROBERT M. WACHTER is a professor of medicine at UC San Francisco and the author of "Internal Bleeding: The Truth Behind America's Terrifying Epidemic of Medical Mistakes" and the forthcoming "Understanding Patient Safety."

Error gave woman HIV, but Navy turns its back on her

2007-07-01T16:09:00.000-07:00

WINTER SPRINGS - Richelle Starnes' cell phone alarm beeps to interrupt her three times a day. It's her reminder: Take the medication.

Richelle is 26, a forward on the semipro Orlando Falcons soccer team, and the ring is a reminder she has HIV.

Now, however, she has enough pills to last into mid August. After that? That's a question she's wrestling with the Navy over.

It's the Navy that has been treating Richelle since she was 10. That's when she learned she was infected with HIV, an infection she and her family blame on the Navy. But as Richelle has become an adult, the Navy says it no longer will pay for her pills.

* * *

Richelle's parents and older sister were living near San Francisco in 1979 when her mother Kathy became pregnant. Her father was a radioman on a submarine. But soon after Kathy became pregnant, a painful lump on her side and bleeding sent her to a Navy doctor. He sent her home, missing signs she had an ectopic pregnancy, that a fertilized egg had implanted not in her uterus but in a fallopian tube.

A few days later, the tube burst. Kathy was rushed to the nearest hospital, not a Navy facility. She needed immediate surgery and a blood transfusion. The couple was told the Navy doctor would be reprimanded.

A year later, Richelle was born. It would be a decade before the family knew anything was wrong, that in an era before blood was tested for HIV, the blood Kathy had received was tainted.

* * *

Brown spots appeared on her mother's thighs in 1990. By then, the family was in Maryland, and her mother was sent to the National Naval Medical Center in Bethesda. Doctors saw the blood transfusion on her mother's medical charts and ordered an HIV test.

Richelle's parents told her and her older sister over ice cream. Richelle remembers crying, that her mother's pill case beeped when it was time to take medication, and being told she and her sister would have to be tested.

Dr. Richard Moriarty, then a Navy doctor, remembers thinking she didn't look like a child with HIV. A day after her 10th birthday, he told her family. Richelle was positive.

* * *

Some people didn't understand. In a home economics class, one classmate refused to cook in her kitchen. Another time, kids said they didn't want her swimming in a lake. When she went to college, her school and soccer coach knew, but she didn't initially tell friends.

She waited a semester, then told her soccer team. There were never any questions. But when she told her roommate, their relationship soured. By the end of the semester, Richelle was sleeping on friends' floors.

* * *

In graduate school, Richelle knew she wanted to study HIV policy and said so in introductions. Someone asked why, just making conversation.

"Because I'm HIV positive, " she said.

Her frankness impressed a classmate, Jeff Starnes.

They didn't know each other well, but in 2003 Richelle's mom died of complications from AIDS. Jeff sent Richelle a card.

They started dating, but Jeff was hesitant to kiss her. He went with Richelle to her doctors in Bethesda and asked a lot of questions.

They also went parasailing and hot air ballooning and to New York, where they saw the musical Rent. Her mom had wanted to do some of the same things, but never got the chance. Later, Jeff had another question. Would she marry him? She said yes.

But trouble started soon after. For years, Richelle had flown to Maryland to see her doctor and get medication. She'd participated in research studies and talked to medical students about her disease. With regular medication, her viral load - the amount of HIV in her blood - is undetectable.

* * *

In 2005, the Navy told Richelle she'd need to get treatment elsewhere. Her case did not satisfy the "compelling criteria" for a special designation that would extend her care, the Navy wrote.

Working through two congressmen, she's managed to get her care extended - one year at a time.

She and Jeff moved to Florida, where he works in law enforcement. Through artificial insemination and months of planning, they had a baby, Braden, last July. As a precaution, doctors had them feed the newborn tiny syringes of antiviral medication for weeks. Tests show he is HIV-free.

On June 22, she got her decision on care for this year. The Navy will let her see their doctors but will no longer pay for hospitalization or for her medication, which costs thousands of dollars a year.

"They can't make what they caused right, " Richelle said. "They can't bring my mother back. They couldn't promise me a future. What they could do was take care of the medical side of it."

The doctor and nurse who treated her as a child agree, and wrote the Navy. That promise was one reason the family never thought of suing and doesn't have a lawyer now.

The Navy reviewed the decision again at the request of Richelle's U.S. representative, Tom Feeney. Assistant Navy Secretary William A. Navas Jr. said he was sympathetic to the situation, but the program under which she got treatment was "not intended to provide lifelong care."

Without help from the Navy, Feeney, a Central Florida Republican, said he will look at writing a personal bill for Richelle, one Congress could pass to grant her care.
By ASSOCIATED PRESS

Amite mayor held liable in malpractice suit

2007-07-01T16:08:00.000-07:00

Also doctor, town’s chief sued for not treating patient
AMITE — A Tangipahoa Parish jury found that an Amite family physician’s failure to treat a diabetic patient’s rising blood sugar levels led to the ailing man’s dementia and institutionalization for the last three years of his life.

That same jury handed down an $814,079 award on June 22 for damages against Dr. Reggie Goldsby, who also is mayor of the town, for the pain and suffering of the late Marion Hendry and his only daughter, Tanya Hendry Sparks, court records show.

In 2000, Sparks, acting on her father’s behalf, filed a medical malpractice complaint in the 21st Judicial District Court against Goldsby and Hood Memorial Hospital in Amite. After that, she filed a lawsuit seeking damages in 2003 against Goldsby, his liability insurance company and the hospital.

The hospital was dropped from the suit before trial, Sparks’ attorneys said.

According to court records, Marion Hendry entered Hood Memorial Hospital in Amite for treatment of a swollen hand on March 13, 2000.

Eleven days later, he suffered from dementia and dehydration and his health had declined so severely that he was unresponsive. As a result, Hendry’s daughter had him transferred to another hospital, North Oaks Medical Center in Hammond, court records show.

Hendry, a retired high school teacher and former assistant superintendent for the Tangipahoa Parish School System, never recovered from his dementia and died three years later in an assisted living facility, said Hendry’s attorneys, Charles Moore and Patrick Boryles.

A medical examination board, a panel of doctors who determine whether medical personnel are at fault in malpractice complaints, found that Goldsby failed to treat Hendry, a known non-insulin dependent diabetic, for his rising blood sugar levels while under his care at Hood. That failure likely led to his failing health and dementia while at Hood, the board decided in April 2003, court records show.

The board found that Goldsby failed to follow “standard practices of care” in treating Hendry, according to court records.

However, the medical examination board did not link Goldsby’s mistake to Hendry’s permanent disability and dementia. Instead, a trial jury was charged in 2003 with determining whether Goldsby caused Hendry’s injuries, Moore said.

After a four-day jury trial and two hours of deliberations on June 22, the jurors found that Goldsby’s breach in care led to Hendry’s declining physical and mental health and eventual death on Nov. 28, 2003.

Goldsby did not return telephone messages seeking comment. His attorney, James Strain, also did not return calls, but his staff said Strain was in Shreveport Tuesday and Wednesday working on another case.
By DEBRA LEMOINE
Advocate Florida parishes bureau

Are doctors' malpractice premiums unfair?

2007-07-01T16:06:00.000-07:00

Insurance companies have said for years that they're paying more and more in medical malpractice claims as they push for caps on lawsuits, like the cap approved in Idaho. But a new study shows claims have been decreasing for seven years while the insurance premiums continued to rise. Report author Jay Angoff with the American Association of Justice says it looks like the insurance companies are overcharging doctors.

"The amount they project that they're going to be paying out in the future has decreased by 48 percent over the last four years, yet rates have been going way up," Angoff told SVO. "This makes no sense."

The insurance industry has criticized the report, saying it doesn't take into account all insurance company liabilities, and that profits are low in the malpractice sector compared to other insurance categories. Angoff based his report on company filings with state governments.

Angoff says doctors don't have time to do their own investigations of insurance company claims and don't seem to suspect anything is amiss.

"They believe what the insurance companies tell them about malpractice claims going up, when in fact, they're going down, and therefore they accept these rate increases."
By Gary Stivers

Pa. physicians fearing boost in malpractice insurance fees

2007-07-01T16:03:00.000-07:00

Pennsylvania's doctors, especially high-risk surgeons and physicians from the east who pay higher medical malpractice rates, worry that a state-mandated change in insurance could result in an overnight 25 percent increase in their premiums.

Any doctor who does the majority of his work in Pennsylvania is required by state law to carry at least $1 million in liability insurance. The first $500,000 is covered by the doctors through the private insurance market. The next $500,000 in coverage is purchased through the state's MCARE program, which charges doctors an assessment, then pays claims out of that group fund.But the state Department of Insurance is mulling a change that would require doctors to purchase the first $750,000 on the open market -- either through a private insurer, or through doctor-run organizations known as risk-retention groups and insurance exchanges.

The hope is that the state has recovered from what physicians groups billed a medical-malpractice crisis three years ago, and that there are enough insurers underwriting enough products to drive down costs organically.

Doctors say that's not the case yet.

"I believe that it could destabilize the medical malpractice marketplace," said Dr. Lewis Sharps, a spinal surgeon from Chester County, "and reactivate the crisis we faced from 2002 to 2004."

Dr. Sharps has a unique vantage point: In addition to being a high-risk surgeon, he's also the CEO of a medical insurer called the Positive Physicians Insurance Exchange.

His company paid for an actuarial analysis of what might happen if the shift takes place -- an orthopedic surgeon whose med-mal insurance was $60,000 annually would see the payment jump to $75,000.

"It's a very significant concern," Dr. Sharps said. "Many physicians don't even know this is going on."

What's going on is this: The Insurance Department is analyzing the state's marketplace to determine whether there's enough underwriting capacity to shift med-mal liability away from the state and into the private market. The shift, as a side effect, could save Pennsylvania about $70 million of the roughly $120 million that is now spent on MCARE abatements, which are financed by cigarette tax money.

High-risk specialists get full abatements in their MCARE assessments, meaning the extra $500,000 in coverage costs them nothing, wiping out what otherwise would be a bill of tens of thousands of dollars. Lower-risk doctors get a lesser abatement.

The insurance commissioner is supposed to issue a decision by this week regarding the shift, and changes, if they are authorized, would go into effect in January, without legislative authorization.

By law, the insurance commissioner reviews the marketplace capacity every two years -- the last time this happened, in 2005, then-Commissioner Diane Koken announced that there would be no change in the 50-50 split.

Doctors fear that this year could be different, because two years of relative calm on the med-mal front have led to more stable rates and new carriers. In the last three years, for example, about 30 new carriers have begun offering services in the state -- though that's not necessarily reflective of a fully healthy market, since most of those carriers do only a sliver of business here.

State Rep. Todd Eachus, D-Luzerne County, viewed as an ally of the medical community, said it's too early for the Insurance Department to declare the marketplace healed. That's because the full effects of the raft of med-mal reforms enacted in 2004 won't be known for another year or two.

"I really don't want anyone meddling with the Legislature's work at this point," the representative said. "It was a difficult debate. There was a lot of finger-pointing" among legislators, lobbyists, the medical community and attorneys. Mr. Eachus has sent a letter to the governor, asking him to delay the shift.

Doctors also hope to prod the state Legislature and the governor to reauthorize the state's MCARE abatement program, which expires annually. Much of the would-be cost of the state's insurance assessment is defrayed by the abatement fund.

Historically, renewal hasn't been a major political issue, in large part because of the persistence of the state's many doctors and surgeons' lobbying groups. In recent years, they've sought reductions in their medical malpractice premiums, a medical school loan repayment program, caps on "pain and suffering" jury awards and a change in litigation rules forbidding "jury shopping" -- the practice of moving a case from county to county in search of a jury more sympathetic to a given malpractice plaintiff.

Some legislators have complained of "doctor fatigue," while many doctors say the state hasn't gone far enough to make Pennsylvania an attractive place in which to practice, thanks to high med-mal rates and lower-than-average service reimbursements from insurance companies.
By Bill Toland, Pittsburgh Post-Gazette

Tourists gain better insurance protection - from 2009

2007-06-28T18:08:00.000-07:00

Millions of holidaymakers will enjoy greater protection when they buy insurance from travel agents and tour operators after the government yesterday announced a tougher regulation regime.

Ed Balls, the economic secretary to the Treasury, said some of the 20 million people who buy travel insurance each year were putting themselves and their families at risk by taking out cover that may not meet their needs.

Consumer groups welcomed as long overdue the news that the Financial Services Authority would police travel insurance sold with a holiday. Travel firms will have to meet statutory requirements on treating customers fairly, and customers will have access to the Financial Ombudsman Service if things go wrong.
But the move will not benefit the millions preparing to pack their bags for this summer's break or next year's holidaymakers; it will take effect from January 2009 after a further period of consultation.

The announcement follows research by Which? and others that has indicated that not only are travel agents' policies generally more expensive, but these firms often do not follow basic procedures when selling insurance. The FSA already regulates travel cover sold directly to people by insurers and brokers.

In November the Treasury expressed concern that half of all policies fail to provide guaranteed cover for medical expenses after a terrorist attack.

Yesterday Mr Balls said there was evidence that firms regulated by the FSA had more success in getting consumers to make an informed choice because they were better at guiding people through the sales process and explaining the key features and policy exclusions.

"Consumers in the future buying travel insurance sold alongside their holiday will get the same core regulatory protection and rights as consumers buying stand-alone travel insurance do now."

The announcement is a belated u-turn after the government in 2003 rejected demands for regulation, prompting much anger among consumer bodies. Which? said: "This finally offers consumers the protection they deserve."

Which? carried out research last year that found that two-thirds of travel agents failed to ask about people's medical histories and most did not explain what their policies covered.

Travel firms that decide not to seek FSA authorisation will be able to sell insurance on behalf of a regulated company.

The Office of Fair Trading yesterday announced it was embarking on a six-month "programme of work" with the credit card industry and consumer bodies to make the cost of credit cards easier for people to understand.

The OFT will look at how pricing information can be improved. This follows a super-complaint from Which? that highlighted how consumers were choosing cards without understanding all the issues that affect the cost.
by:Rupert Jones
money.guardian.co.uk

OC jury awards $11 million to man in medical malpractice case

2007-06-28T18:07:00.000-07:00

SANTA ANA – A 45-year-old man who suffered a stroke because doctors failed to treat an infection that spread to his brain was awarded $11.7 million in damages by a jury.

The jury on Friday awarded the judgment to Joey Crumes, who at the time he was treated in 2004 was working as a health technician at the San Onofre nuclear power plant.
Five days after Crumes went to a Mission Viejo hospital emergency room with a severe headache, he suffered a massive stroke that paralyzed him on the left side of his body, confining him to a wheelchair and bed.

The lawsuit was filed against radiologist Charles Aucreman and emergency room physician Andrew Lawson.

The jury found that both were negligent but that Lawson bore the responsibility for Crumes' injuries, said his attorney, Daniel Spradlin.

When Crumes went to the emergency room at Mission Hospital, he told doctors that in 1993 he was operated on for cancer in the right sinus area. During that operation, doctors removed a tumor, as well as his right eye and a portion of his sinus cavity.

Spradlin said Lawson ordered a CT scan, but Crumes ultimately was sent home with a painkiller and orders to seek further treatment if his condition worsened.

Five days later, Crumes lapsed into a coma, and doctors discovered an infection that had spread to his brain.

In the suit against the two doctors, Spradlin argued that had Crumes been treated properly when he went to the emergency room, he would not have suffered the stroke and become debilitated.

“A treating physician (of the coma) said Joey was sent home with a time bomb in his head,” Spradlin said.

Crumes spent 11 months in the hospital after the stroke.
source:www.signonsandiego.com

Surprising number in medical malpractice claims

2007-06-28T18:06:00.000-07:00

As a personal injury lawyer at a law firm which handles plaintiff's side, medical malpractice cases, I find the following reported numbers startling:

1. The majority of medical malpractice claims close without payment to the injured person.
2. Only 2% of medical malpractice victims make a claim.
3. 80% of the time the doctor or the hospital wins in cases that go to jury verdict

How to reconcile these statistics:
First, most Americans are not litigious and find the idea of making a claim against a doctor or hospital is distasteful. So, even though over 80,000 Americans are killed by medical negligence each year and many more are hurt, 98% of them never make a claim. They want to trust that their doctors are looking out for them and are forgiving errors because after all, doctors are human. so, it means that the vast majority of people who are killed or severely injured by medical malpractice never even contact an attorney.

The same study that showed that most claims never result in any compensation to the victim also showed that clients did not file medical malpractice claims immediately after injuries. Typically, according to the report, medical malpractice claims are not filed with insurance companies until about 15 to 18 months after the injury. Even though the statute of limitations for medical malpractice is two years in Virginia (VA), the injured patients are giving the doctors and hospitals time to correct their errors and waiting to see if the harm is permanent and catastrophic, before even bringing it to the attention of an attorney.

The batting average for Plaintiff's lawyers against the insurance defense lawyers in medical malpractice is hardest for me to understand. Part must be that some of the meritorious cases are resolved during the litigation process prior to jury verdict by way of settlement. Perhaps, the quality of the Plaintiff's bar handling these cases is not as good as it should be, given the complexity and specialized knowledge involved in trying medical malpractice cases. The ability of the doctor defendant to get his colleagues to circle the wagons and support him must account for some of the bad trial results for the injured patients. Even an experienced personal injury lawyer with a background in medical malpractice would typically only be able to find and afford one or two good quality experts to testify against the doctor on the standard of care, showing that the doctor committed negligent error. For every one good expert we have, the Defense is typically able to find 3 or 4 extremely well credentialed colleagues who will come to aid the doctor standing trial for his negligence. However, some doctor groups go a step further and deliberately try to put pressure on the few doctors who are independent enough to be willing to help Plaintiff's lawyers in these cases. Some medical organizations have threatened to revoke the membership of the physicians who dare to speak out about violations of standard of care. This conduct I think is extremely unethical. Plaintiff's medical malpractice lawyers and the doctors who are brave enough to come forward and tell the truth in court about other doctors errors really are heroes. They are the ones who are forcing the medical profession to take a hard look at itself and get rid of bad apples. Not only are we helping to get compensation for deserving people with terrible injuries, we are also holding up a mirror to the health care system to show where things are not being done as they should be.
source:norfolk.injuryboard.com

Lawyers battle over state malpractice proposal

2007-06-28T18:04:00.000-07:00

A hot issue among California lawyers -- whether tens of thousands of them should be required to tell prospective clients that they carry no malpractice insurance -- isn't just a legal abstraction to San Francisco attorney Paul Frassetto or the destitute businessman who recently approached him.

As Frassetto described it, the man had spent years refurbishing a low-rent San Francisco hotel to qualify it for a city-funded temporary housing program, and ran out of money as he finished the repairs. When he tried to file for bankruptcy, a local attorney mishandled the filing, the lender foreclosed on the building and the client lost his life's savings, more than $1 million in equity, Frassetto said.

It was only then that the client, whom Frassetto declined to identify, learned that his lawyer had no malpractice insurance or other assets that would cover his losses, he said.

Frassetto, who has spent the last 20 years suing fellow lawyers, said he has agreed to handle the man's malpractice case. But that's unusual, he said -- for the most part, he and his colleagues won't sign onto lawsuits against uninsured lawyers because their fees depend on winning an award for damages, and there's little prospect of collecting damages from an attorney without coverage. The clients, he said, are generally out of luck.

Such horror stories would be less common, Frassetto said, if the State Bar adopted a proposal before it to require lawyers who have no malpractice insurance to notify prospective clients of that fact, as well as the bar. The bar would post that information on its Web site.

"It's unfair to a client for a lawyer to represent them without having insurance," Frassetto said. Requiring lawyers to disclose that they don't have coverage "at least would let the client make an informed decision."

But opponents say such a rule would actually hurt more consumers than it helps.

Los Angeles attorney Diane Karpman, who writes a legal ethics column for the State Bar Journal, said the proposal would hit hardest at the lawyers least likely to be insured, those who represent lower-income clients and middle-income clients in small or one-person firms. Some would lose business; others would buy coverage to avoid public stigma, adding $4,000 to $7,000 a year to their operating costs, she said.

"Who's going to end up paying this? The poor and the middle class," Karpman said.

Her views are widely shared among lawyers. Nearly 80 percent of the more than 100 attorneys who have commented on the proposal to the bar oppose it. A resolution denouncing the plan was approved overwhelmingly by delegates of local bar associations at last year's State Bar convention.

"It sets up a two-tiered bar, those with insurance and those without," said Los Angeles attorney J. Anthony Vittal, co-author of the resolution with Karpman.

Another critic, attorney John Dutton of Auburn (Placer County), is a member of the State Bar Board of Governors, which is scheduled to take up the issue this fall. He said the proposal would unfairly brand uninsured lawyers with a "scarlet letter."

Malpractice insurance protects clients who lose money because of a lawyer's negligence -- missing a filing deadline, for example, or providing incompetent representation that affects the outcome of a case.

A lawyer's insurance status is "a highly relevant piece of information that a new client deserves to know," said San Jose attorney James Towery, a former State Bar president and head of a task force that drafted the proposal.

The proposed California requirement would be the most stringent of its kind in the nation.

Only one state, Oregon, requires lawyers to carry malpractice insurance. Twenty other states have insurance disclosure rules, but none requires that lawyers notify both the bar and their clients, officials say.

Most of California's 142,000 private lawyers are insured through their firms, but State Bar officials say about 1 in 5 is uninsured. Nearly all of those are in one-person or small firms, said bar official Starr Babcock.

The proposal before the bar's governing board would require that uninsured lawyers notify new clients and the bar, which could suspend lawyers who failed to comply.

The bar's Web site now lists lawyers' educational backgrounds and fields of specialty, and states whether they have been disciplined for misconduct. No public agency keeps records showing whether a lawyer has been successfully sued for malpractice.

Towery, who was appointed by the State Bar's then-President John Van de Kamp in 2005 to lead the organization's task force on malpractice insurance, acknowledged that mandatory disclosure would chiefly affect lawyers who practice by themselves or in small firms. But he said those lawyers' clients are among the ones most in need of protection against legal blunders.

Towery, a partner in a corporate firm, said small-firm lawyers typically handle cases involving issues such as consumer law, personal injuries, immigration, bankruptcy and family law. "When those lawyers make mistakes and don't have insurance, it really creates the potential to cause harm," he said.

But co-author Vittal, who handles business litigation as the sole lawyer in his Los Angeles firm, said compulsory disclosure would cause more harm than good. Prospective clients who learn that a lawyer is uninsured will probably be misled into thinking the lawyer is incompetent and go elsewhere, he said. Clients who get no such notice may be reassured, but they won't know whether their lawyers' insurance is enough to cover their cases.

The result, he said, will be that some lawyers serving needy clients will lose their practices, others will face discipline for conduct that "has nothing to do with ethics," and the bar will have done nothing to make insurance more available or affordable.

Babcock, who oversees the bar's low-cost insurance program for new lawyers, agreed that the organization "ought to have some kind of carrier of last resort." But he said such a program might require legislative action.

He said the disclosure proposal, now in its final round of public comment, would go before the Board of Governors for a vote in November and, if approved, would be submitted to the state Supreme Court for final review. Implementation is probably at least a year away, Babcock said.

Online resources

Information about the State Bar's proposal to require lawyers to reveal that they don't carry malpractice insurance can be found at:

links.sfgate.com/ZHJ
by:bob egelko, chronicle staff writer

Vitamins a good insurance policy

2007-06-28T17:55:00.000-07:00

It's estimated that half of all American adults take a daily vitamin supplement. Yet, in spite of the popularity of the pills, many wonder whether they're good for our health.

CNN learned more about vitamins from Dr. George Blackburn, director of the Center for Study of Nutrition and Medicine at Beth Israel Deaconess Medical Center in Boston, Massachusetts.

CNN: What do you say when asked by patients whether they should take vitamins?

Blackburn: I say take a simple, once daily vitamin or mineral that costs about 7 or 8 cents as insurance, not to help their health or treat a disease but to ensure that they don't have a vitamin/mineral deficiency. (Health Minute: Watch to learn more about the benefits of vitamins and supplements Video )

CNN: Is that general advice for a healthy person?

Blackburn: I think it's important to realize that most people taking vitamins and minerals are healthy. Very few Americans are sick other than for a short time and therefore they should be concentrating on a healthy diet: fruits, vegetables and whole grains. Unfortunately, only 25 percent of Americans do that, so it's for them that we want the once daily vitamin/mineral.

CNN: What about taking calcium and folic acid supplements?

Blackburn: We've built some of it into the food supply. Now the flour we get has folic acid in it that takes care of most of the folic acid problem. We're now facing a shortage of calcium and vitamin D. We prefer three servings [daily] of low-fat dairy, yogurt, and cheese. We're learning that we may need more vitamin D. If we see a person isn't getting a good supply of dairy and dark green vegetables we definitely are urging that they take a calcium supplement and a vitamin D supplement.

CNN: Are we at risk of getting too many vitamins because of fortified foods?

Blackburn: I don't think the fortification, the intake of vitamin and mineral fortification of food, has been other than good so far. It's not likely that a person is going to overdose in a food fortification. You would have to be taking a high dose, single supplement to worry about overdose.

CNN: Are natural vitamins better than synthetic?

Blackburn: They are the same. It doesn't matter when they are absorbed into the body whether they were synthetic or natural sources; most supplements are synthetic.

CNN: Is there any scientific proof that vitamin supplements are a magic bullet?

Blackburn: Any claim to preventing disease or extending life with vitamin/mineral supplements is unproved.

CNN: So what's your advice to patients who can't decide whether to take a vitamin supplement?

Blackburn: Concentrate on eating a healthy diet with dark green vegetables, whole grains and fruits. Start your day with a healthy breakfast and watch your portion control. If you're physically fit and eating a healthy diet you'll get things that are not in any supplement. The good news for people looking at supplements, if they just stay with one multivitamin a day they'll be safe.

by:Judy Fortin is a correspondent with CNN Medical News. Accent Health reporter Linda Ciampa contributed to this report.

Health plan protects China's poor

2007-06-28T17:53:00.000-07:00

Chinese hospital administrator Yang Xizhong is more than willing to talk about a new medical insurance scheme for farmers that has been extended to his county.

Waving his arms around enthusiastically, he explains how 90% of people in Chiping County, in Shandong province, now benefit from the government-backed scheme.

"Using this system, ordinary people really benefit," he says of the plan, in which the state pays part of the cost of the treatment.

"It solves the problem of going to see a doctor," he adds.

On a tour of the new wing of the Chiping County People's Hospital, Mr Yang introduces several bed-ridden patients who also give the new system their approval.

Farmers like these, Mr Yang says, would not have been able to afford hospital treatment before the introduction of the New Rural Co-operative Medical Scheme.

Success story

Even when you go outside the hospital - and away from Mr Yang's influence - people tell a similar story.

Twenty minutes drive away, in the village of Donglu, home to around 500 people, 75-year-old Huang Beiyou is recovering from treatment for an inflamed prostate.

A few months ago Mr Huang, who tends a herd of goats, spent more than 20 days in Mr Yang's hospital at a cost of around 10,000 yuan ($1,300). The government paid half.

"Before, when we became ill, we had to pay for it ourselves. Sometimes we couldn't afford the treatment so we didn't have it," he says.

Local communes used to pay for medical treatments

"But now the government reimburses part of the cost, so we can afford it more easily. This system is a lot better. The government is really looking after us."

The scheme that is receiving so much praise was first introduced in 2003 to a select few counties in China, but is now being rolled out to rural areas across the country.

In a keynote speech given in March this year at the National People's Congress, China's parliament, Premier Wen Jiabao said he wanted 80% of rural people covered by the end of December.

With the central government spending close to 10bn yuan ($1.3bn) on rural healthcare this year, the Chinese health ministry was able to announce that it had met that target just one month later.

The scheme itself is relatively simple.

Each farmer pays as little as 10 yuan ($1.3) a year to join the insurance plan. The government then adds a similar amount.

Each county can have slightly different rules, but in Chiping the local government will repay 30% of medical fees for treatment costing up to 2,000 yuan ($263), according to Mr Yang.

If the cost is between 2,000 and 5,000 yuan, the government pays 45%. Above that, it guarantees to pay half the cost.

New system

A new insurance scheme for the countryside became necessary after China introduced radical economic reforms in the 1980s.

Under the old system, farmers' medical costs were paid by local communes, but when these were disbanded, rural people were left to fend for themselves.

That left many people in the countryside unable to buy even basic medical treatment without seriously affecting their household finances.

The scheme has extended medical treatment to the poor

According to a popular countryside saying, a trip in an ambulance means a pig has to be sold at market, once a hospital bed has been slept in a year's farm earnings go down the drain and a serious illness requires 10 years of savings.

While experts both inside and outside China praise the new scheme for extending medical coverage to China's poorest people, there have also been some criticisms of the plan, not least over whether local governments have enough money to pay their share of the costs.

James Murray, of the humanitarian organisation Plan International, which runs medical programmes in Shanxi province, says rural areas have always received less health spending than China's towns and cities.

Rural areas have traditionally been allocated just 20% of total health spending, despite the fact that 70% of China's population live in the countryside, he says.

And he adds that if rural people are to enjoy all-round good health, there needs to be more emphasis on basic health education instead of just promising to reimburse farmers when they become ill.

"It's not only infrastructure, it's not only machines that are needed to achieve better health. The population needs to be aware of what causes diseases and how to prevent them," Mr Murray says.

He might be right, but that is not going to dampen the enthusiasm of health workers like Mr Yang about what has already been achieved.

by:news.bbc.co.uk

ABI: Popularity of personal private medical insurance grows

2007-06-28T17:52:00.000-07:00

For the first time in recent years, the number of subscribers to personal Private Medical Insurance (PMI) policies has grown year-on-year. Latest figures from the ABI show that in 2006, 1,030,000 people subscribed to personal PMI policies, an increase of 1.8% from 1,012,000 in 2005. Personal and corporate PMI plans now cover 5.9 million UK adults and children.

Commenting on the data, Nick Starling, the ABI’s Director of General Insurance and Health, said:

“Private Medical Insurance offers people greater choice of treatment and other services for a wide range of medical conditions and injuries. It also takes pressure off the NHS, so by buying PMI, people are effectively reducing the burden on Britain’s hard-pressed health service.

“It is encouraging that more individuals are choosing to buy PMI for themselves and their families. PMI bought by companies on behalf of their employees has continued to increase in popularity too, helping to ensure that people can get back to work sooner after illness or injury.”

- ENDS -

Notes for Editors

1. The ABI has revised its data for corporate PMI in order to separate out all healthcare trust business. Previously, some companies had included healthcare trust business (schemes administered, but not underwritten, by insurers) in their PMI returns to the ABI. From now on we will publish data separately for 1) the total number of people covered by personal and corporate PMI schemes and 2) those covered specifically by corporate trust schemes.

2. In 2006, there were a total of 3,375,000 subscribers to PMI policies, up by 3.3% from 3,266,000 in 2005. This comprised 1,030,000 personal and 2,345,000 corporate subscribers, up from 1,012,000 personal (up 1.8%) and 2,254,000 corporate (up 4.1%) respectively in 2005.

3. Gross earned premiums in 2006 totalled £3.071bn, up by 4.4% from £2.942bn in 2005. Individual premiums rose by 4.2% from £1.449bn in 2005 to £1.509bn in 2006, while corporate premiums rose by 4.6% from £1.493bn in 2005 to £1.561bn in 2006.

4. A table giving full details of PMI sales, subscribers and people covered is available on the ABI web site, www.abi.org.uk.

5. The ABI is the trade association for Britain’s insurance industry. Its nearly 400 member companies provide over 91% of the insurance business in the UK. It represents insurance companies to the Government, and to the regulatory and other agencies, and is an influential voice on public policy and financial services issues. ABI member companies hold up to a sixth of all investments traded on the London Stock Exchange, on behalf of millions of pensioners and savers.
by:www.politics.co.uk

State budget has more for education, medical insurance for poor

2007-06-28T17:51:00.000-07:00

HARTFORD -- The General Assembly is expected tonight and over the weekend to approve overwhelmingly a new biennial budget that orders huge spending increases for education and health care while avoiding major tax hikes.

The plan also includes modest increases both for nursing homes and for private, nonprofit social service agencies, two components that received little new money under earlier proposals.
The budget won't include any income tax changes. Both the $500 tax break for middle-income families and the tax rate hike for households earning above $272,000 -- both Democratic proposals -- have been scrapped.

"When folks take a look back at this," Senate President Pro Tem Donald E. Williams Jr., D-Brooklyn, said late Thursday, "this will truly be viewed as the historic budget year it was."

House Minority Leader Lawrence F. Cafero, R-Norwalk, who led the push this spring to reject major tax hikes proposed by both Democrats and Republican Gov. M. Jodi Rell, predicted "overwhelming" Republican support for the final package.

"It's a compromise document," Cafero said, adding that while Republican lawmakers are wary of the spending growth, they are pleased to see major investments in health care and education.

The House of Representatives was scheduled to convene at 6 p.m. and begin the budget approval process by adopting the main appropriations and revenue bill.

Besides that measure, lawmakers also need to approve three technical policy bills to implement new and revised programs within the budget, as well as three or four bonding bills that will outline state government's capital program for the next two fiscal years.

House and Senate leaders say they hope to have all measures approved by both chambers by the end of Saturday.

Full details on the budget's bottom line were not available early today. Legislative leaders said general fund spending -- which covers the bulk, but not all, of government operations -- should grow by just under 9 percent in the coming fiscal year.

State government is operating this year with a $16.1 billion total budget, with a general fund of more than $14.8 billion.

Rell, who initially called for $660 million in new taxes and then reversed herself in May after state revenue forecasts improved, will score her biggest victory in terms of education.

The governor, who asked for more than $600 million in additional Education Cost Sharing grants to towns over the coming two years, will see a healthy share of that request in the final budget.

ECS grants will top this year's $1.6 billion level by $181 million in 2007-08, and will reach $261 million over current spending by 2008-09. That $442 million in additional ECS outlays is the largest increase in any budget since state government launched a major education grant system in response to the 1979 Connecticut Supreme Court's decision in the Horton vs. Meskill lawsuit.

Democrats, who control two-thirds of both the House and Senate, campaigned largely on a plan to bolster the state's faltering health care safety net.

And the budget reflects that priority, pouring more than $215 million total over the next two years into boosting state reimbursements to doctors, dentists, hospitals, community health clinics, and other care providers who treat poor patients on state assistance.

The budget also:

-- Expands the Husky health insurance program's eligibility rules for pregnant women.

-- Allocates $39 million to give nursing homes a 2.9 percent funding increase next fiscal year. Both Rell and the Democrat-controlled Appropriations Committee hadn't recommended any hike in their plans.

-- Provides for a 3 percent increase for private, nonprofit groups, with whom the state contracts to provide the bulk of social services in Connecticut. It was unclear late Thursday whether that increase would begin with the start of the fiscal year on July 1, or on Oct. 1 -- a date when several past nonprofit rate hikes had taken effect.

Rep. Denise W. Merrill, D-Mansfield, said she and many other Democrats are disappointed that Rell wouldn't allow an income-tax hike on wealthier households so that middle-income families could receive a tax break. But she added that the health care and education increases will make a huge difference.

"We are talking about large increases in very important programs," Merrill said, adding many of the health care rates had been neglected for a decade.

Rep. Henry Genga, D-East Hartford, said "I'm disappointed that the property tax relief we wanted isn't there," referring to a Democratic proposal to boost the property tax credit within the income tax system from $500 to $1,000. "I think the Republicans did what they wanted to do: protect the rich," he added.
by:Keith Phaneuf, Journal Inquirer

Private Medical Insurance gaining popularity

2007-06-28T17:49:00.001-07:00

Despite Tony Blair’s claims this week at King’s Fund event to launch four reports into the health service, that there have been “real and transformative reductions” in NHS waiting lists since 1997, more people are turning to the private sector, according to research by the Association of British Insurers (ABI).

ABI figures show, that for the first time in many years, the number of subscribers to Private Medical Insurance has grown year on year.

In 2006, 1,030,000 people has private medical insurance polices, and increase of 1.8% from 2005’s figure of 1,012,000.

“Private Medical Insurance offers people greater choice of treatment and other services for a wide range of medical conditions and injuries,” said Nick Starling, Director of General Insurance and Health at ABI.

“It also takes pressure off the NHS, so by buying PMI, people are effectively reducing the burden on Britain’s hard-pressed health service.

“It is encouraging that more individuals are choosing to buy Private Medical Insurance for themselves and their families.

Private Medical Insurance bought by companies on behalf of their employees has continued to increase in popularity too, helping to ensure that people can get back to work sooner after illness or injury.”
by:www.fairinvestment.co.uk

Popularity of medical insurance increases

2007-06-28T17:48:00.001-07:00

More people from the UK are opting for private medical insurance, a new study has found.

According to the Association of British Insurers (ABI), 2006 was the first year in recent times when the number of people opting for private medical insurance (PMI) increased.

ABI figures show that 1,030,000 people subscribed to PMI policies during 2006 - compared to 1,012,000 the year before.

This represents a 1.8 per cent increase and now personal and corporate PMI plans cover around 5.9 million UK adults and children.

"Private medical insurance offers people greater choice of treatment and other services for a wide range of medical conditions and injuries," explained Nick Starling, the ABI's director of general insurance and health.

"It also takes pressure off the NHS, so by buying PMI, people are effectively reducing the burden on Britain's hard-pressed health service.

"It is encouraging that more individuals are choosing to buy PMI for themselves and their families."

Mr Starling also pointed out that more companies seemed to be buying medical insurance for their workers.

Recently, another spokesperson for the ABI said that people who were obese were likely to find their medical and life insurance premiums increase.

"Lifestyle factors could have a bearing on the premium that you pay - and it's likely that different insurers will use different measures to determine lifestyle factors," Jonathan French, press officer for the ABI, explained.
by:www.moneyhighstreet.com

Good counsel: Medical care on vacation

2007-06-28T17:47:00.001-07:00

Even under the best of circumstances, illness and troubles can find you on vacation.

Fortunately, many vacation and resort areas have doctors or other health care providers available for consultation. They may work in an urgent care facility or clinic, or be on call to come to your location.

These services are generally charged at a premium. Many will not accept out-of-town insurances, so payment at the time of service will be expected. Reimbursement may be possible once back home, but plans vary widely. (See "Check your insurance," below.)

If the need for antibiotics or another medication arises while you're traveling, you'll probably need to have a local evaluation. There are very few circumstances when phone consultation alone can safely result in ordering antibiotics. An on-site evaluation and decision is almost always better for care and safety of the patient.

Primary care office staff may, however, have helpful suggestions for how to manage a problem while away from home and can be consulted before seeking out care on the road. The staff also may be able to help with over-the-counter solutions.

A little forethought can go a long way in easing the pain of unexpected illness or injury on your trip.

Check your insurance: Before you leave, it's important to learn what your insurance policy says about coverage out of the home area. Emergencies are almost always covered, but other situations requiring medical care may not be. Find out whether you need to notify the company of medical expenses within a certain period of time and how to do that correctly.

Fill your prescriptions: Most places will have a pharmacy for basic needs. Should you or your child take medication for a chronic condition, however, have plenty on hand for the trip. In fact, plan ahead so you'll have enough to last you after getting home, to lessen the urgency of getting your prescription filled.

When flying, pack chronic medications in your carry-on bag to lessen the risk of loss or any delay in getting them. Your primary care provider at home may be able to phone in refills and out-of-town pharmacists often will accept them, but this is less than ideal.

Pack a first-aid kit: You can cover most anticipated needs by packing pain and fever reducers, an antihistamine (such as Benadryl or Loratidine) and first-aid supplies. This is especially important if your journey will take you off the beaten track.

by:Dr. Catherine A. Goodfellow is a pediatrician with Genesis Pediatrics in Gates.

7 Tips for Selecting Long-Term Care Insurance

2007-06-28T17:42:00.000-07:00

by Newswise — As the massive Baby Boomer generation braces for retirement, many are turning to long-term care insurance to prepare for potential age-related care.

Long-term care insurance helps cover the costs of assisted-living facilities, nursing homes and at-home care. To receive coverage for a specific period of time, policyholders pay a premium based on age, health and the type of plan. According to trade group America’s Health Insurance Plans, a typical long-term care policy bought in 2002 with inflation protection added would cost a 50-year-old $1,134, while a 65-year-old would pay $2,346 and a 79-year-old would fork out $7,572.

In addition to covering the cost of their own health care, many of the nation’s approximately 78 million Baby Boomers are also pitching in to help pay for the medical needs of an elder parent.

"More than a quarter of those responding to the NAELA Elder Issues National Survey made long-term care arrangements for themselves or a family member," said G. Mark Shalloway, CELA, president elect of NAELA. Of that group, the majority chose nursing homes – which typically cost more than $75,000 a year – over assisted living or home-based care. The NAELA national survey of elder issues polled 1,001 Americans aged 35 and older about aging issues such as concerns about growing older, long term care, elder debt, healthcare insurance costs, Medicare Part D, living wills, retirement, and elder abuse.

About 8 million Americans now own long-term care insurance protection, a number that has risen in recent years. Elder law attorneys nationwide, however, have seen a subsequent escalation in the number of grievances and lawsuits filed against the insurers. The majority of those complaints allegedly stem from unnecessary delays and unfair regulations related to the claims process.

To avoid the complications and possible surprises, NAELA offers several tips on choosing long-term care insurance:

1. SELECT THE RIGHT KIND OF COVERAGE. Home Health Care Coverage, for example, means you receive insurance benefits covering in-home care services provided by a licensed or registered practice nurse or therapist. Respite Care guarantees a facility will offer some help – about one to two weeks each year – to those caring for a homebound person. Adult Day Care can also help, ensuring assistance is provided during the day for recreational, therapeutic and personal care.

2. REQUIRE ADMITTANCE TO ALL LEVELS OF CARE. You should be able to use any skilled, intermediate or custodial care facility without having to start at the highest level of care. Skilled care, for example, is the highest level an individual can receive outside of hospital confinement and requires constant medical attention from licensed medical professionals under a physician’s supervision. Intermediate care, which is handled by a licensed practical nurse, involves occasional nursing and rehabilitative care.

3. AVOID POLICIES WITH A PRIOR-HOSPITALIZATION REQUIREMENT. "Make sure your policy does not require hospitalization before benefits are paid," said Shalloway. Typically, certain conditions must first be met – usually by measuring a person’s ability to do one or more "activities of daily living" such as bathing, eating or dressing – before benefits are activated for nursing home care or assisted living. Preferred policies will require the insured to be unable to do two of the "activities of daily living" rather than rely on a "medically necessary" standard.

4. SELECT HIGHLY-RATED POLICIES. Financial strength is important, helping determine the insurer’s long-term survival and whether they can pay future claims. "Look for a company that has an "A+" rating from A.M. Best Co. and a triple "A" rating from at least one other service,’ says Shalloway. Policies from the same insurer vary from state to state, so verify the information is appropriate for your particular region.

5. SECURE FRONT END UNDERWRITING TO HELP IMPROVE YOUR INSURANCE PLAN. Front end underwriting requires an attending physician’s statement at the time of application and can help protect against claim denial due to underwriter mistakes. Expect the procedure to take up to a month and a half.

6. KNOW THE DIFFERENCE BETWEEN "GUARANTEED RENEWABLE" AND "NON-CANCELABLE." Non-cancelable means the policy stays in force as long as the premium is paid and the insurance company is unable to raise the premium. Guaranteed renewable means the insurance company can’t drop the policy unless you skip payment, but premiums can be raised for all policyholders within a particular group.

7. OBTAIN INFLATION ADJUSTMENT. Since medical costs increase with inflation, you should consider obtaining an inflation adjustment factor. The three most common types of inflation protection are indexed, simple percentage and compounded percentage. Indexed is initially the cheapest, but might not protect you down the road. Simple Inflation Protection sets a fixed annual percentage increase. Compounded Protection is best, but typically the most expensive.

These are just some options to consider when evaluating long-term care insurance plans. Long-term care insurance is more complicated than life insurance or health insurance, so it’s best to consult with a financial planner, Elder law attorney or insurance professional prior to any decision-making.

``No Worry'' from Humana Makes Health Care Costs Predictable for Small Businesses in Michigan

2007-06-28T17:41:00.002-07:00

New, three-year health insurance packages cap annual premium increases at 6-percent or lower
Addressing the particular challenges faced by small businesses, Humana Inc. (NYSE: HUM) is introducing a series of new health insurance packages designed to alleviate the financial stresses of increasing health insurance costs. Dubbed No Worry, these packages offer predictable health care expenses over a three-year period and plans that gradually transition passive health care users into informed and active health care consumers.

Available for businesses in Michigan with 51-99 employees, employers may select one of 35 three-year No Worry packages. Each package presents a unique combination of predetermined health insurance plans for years one, two and three that provide actionable information and tools leading employees toward increased consumer engagement. For example, a No Worry package might include a traditional PPO plan in year one, Humana’s consumer-engaging CoverageFirst plan in year two, and a high-deductible health plan compatible with a Health Savings Account (HSA) in year three.

With No Worry, Humana guarantees the annual premium rate increase for medical insurance will not exceed 6 percent, well below industry cost trends, for the two subsequent years. Employers can qualify for an even lower 4.5 percent medical premium rate cap in the second and third years by adding dental coverage and meeting other requirements like having 90-percent of their employees complete a Humana Health Assessment.

No Worry was developed in response to feedback from small businesses and independent insurance agents and brokers.

“We asked small business owners what their key concerns were with respect to health benefits for their employees, and the same concepts resurfaced again and again,” said Denise Christy, president of Humana’s Michigan market. “They want predictability, a long-term solution to rising costs and a hassle-free process. We listened, and the result is No Worry.”

“Three-year contracts eliminate the need for benefit selection each year, saving small employers valuable time and energy. The rate increase cap ensures predictable health benefits costs, enabling more accurate budgeting and long-term financial planning for small businesses. We’re confident that Humana’s consumer-driven tools and programs encourage behavior changes that result in wiser health-care consumers and healthier, more productive employees, and our rate guarantee demonstrates that,” added Christy.

In addition, employers can add dental and/or life insurance to their No Worry package, and Humana will guarantee that the annual rate increase for dental will not exceed 2.9 percent in years two and three, and that there will be no annual rate increase for basic life insurance in the second and third years.

“Managing a small business is fraught with difficult decisions. Forgoing health benefits because they’re unaffordable is not an option any business wants to consider,” said John Crusse, director of small business sales for Humana’s Michigan market. “Humana’s No Worry program offers a long-term solution to this dilemma by holding down cost while still offering employees meaningful benefits and choice.”

Humana will quote No Worry beginning July 1, 2007, for Michigan employers whose health plans take effect on September 1, 2007 or beyond.

About Humana

Humana Inc., headquartered in Louisville, Ky., is one of the nation’s largest publicly traded health benefits companies, with more than 11 million medical members, including more than 170,000 in Michigan. Humana offers a diversified portfolio of health insurance products and related services – through traditional and consumer-choice plans – to employer groups, government-sponsored plans, and individuals.

Over its 45-year history, Humana has consistently seized opportunities to meet changing customer needs. Today, the company is a leader in consumer engagement, providing guidance that leads to lower costs and a better health plan experience throughout its diversified customer portfolio.

More information regarding Humana is available to investors via the Investor Relations page of the company’s web site at http://www.humana.com, including copies of:

* Annual report to stockholders;
* Securities and Exchange Commission filings;
* Most recent investor conference presentation;
* Quarterly earnings news releases;
* Replays of most recent earnings release conference call;
* Calendar of events (includes upcoming earnings conference call dates, times, and access number, as well as planned interaction with research analysts and institutional investors);
* Corporate Governance Information.
by:home.businesswire.com

Property taxes reduced in final North Allegheny budget

2007-06-28T17:41:00.001-07:00

By David Guo, Pittsburgh Post-Gazette

The North Allegheny school board's best guess concerning next year's budget has turned out to be wrong, not that many taxpayers are expected to mind.

The board unanimously approved a $110.2 million spending plan June 20 that calls for a 0.38-mill reduction in the property tax rate, or $38 on a home assessed at $100,000. The new rate will be 19.34 mills.

The new figures were $1.3 million lower than those in the preliminary package approved in January, a savings that finance director Mike Hopkins primarily attributed to his getting a better handle on payroll costs such as medical insurance, salaries and retirement.

Fifty-six employees wound up retiring this year, a total that was higher than Mr. Hopkins had anticipated in January. Thirty-four were teachers. The district will work over the summer to determine how many positions can be filled based on fall enrollment, retirement costs and the lower salaries paid to new hires.

The other major factors were utility bills and general insurance premiums that should be lower in 2007-08, as well as a less expensive photocopying lease and revised costs for sending students to the A.W. Beattie Career Center in McCandless.

Mr. Hopkins identified four areas of major cost increases totaling about $3.07 million, including salaries, retirement benefits, medical insurance and charter school payments.

He also cautioned the board that certain factors could affect the bottom line that were largely beyond North Allegheny's control -- the ongoing county tax reassessment case and the politically volatile 2008 state budget.

About $700,000 in North Allegheny refunds prompted by property owner appeals of the 2002 base-year assessment have been accounted for, but there's still $900,000 worth unresolved. Based on prior experience, he suggested that the district could expect to win half.

In Harrisburg, meanwhile, the GOP-controlled state Senate has approved a $27 billion budget that is $300,000 less than the version backed by Gov. Rendell and the Democrat-controlled House. The budget battle is far from over, since the House is set to push for restored funding for mass transit and, perhaps, education.

Left unsettled is what the district's state subsidy will be, an amount that should cover 18.3 percent of the district's budget next year -- about half of what the statewide average is, but nonetheless a vital revenue source.

"Funding could be altered dramatically by the Harrisburg showdown that comes in the next few weeks," Mr. Hopkins said.

The largest slice of the North Allegheny budget remains for instructional items including teacher salaries, benefits, supplies and services. More than $44 million goes for salaries, primarily for the district's 580 classroom teachers whose average salary is $69,138.

About $15.1 million goes for instructional-budget benefits, an amount less than had been anticipated because of higher employee contributions for health insurance.

The support services part of the budget includes annual salaries for 37 administrators averaging $96,542, with benefit-cost increases proportionately the same as for teachers.

Board members universally praised Mr. Hopkins and financial analyst Sherri Ludwig for being able to craft such a detailed plan despite an accelerated budgeting process prompted by state Act 1 mandates and property tax reform.

Still, at least three board members were concerned that a larger tax cut might have been possible, given a budget surplus of about 8 percent. The 8-percent cap is often referenced in school tax debates since it is the most a district can hold in reserve if it wants to get state approval for a millage increase.

"I think this body needs to keep an eye on this fund balance," said Alan Shuckrow. "If we have another surplus next year, I think we have to look at ourselves and say we need to be returning some of this surplus to the taxpayers," he said.

Ralph Pagone was disappointed the tax break was so meager, while Scott Cunningham later said that he would have preferred a tax cut tied to a smaller fund balance of about 7 percent, which would still allow the district to cover a year's worth of bond payments.

The three had opposed last year's tax increase.

Medical Bills Costly With And Without Insurance

2007-06-28T17:40:00.001-07:00

A new University of Florida study shows three millions Floridians under the age of 65 are living without health insurance.

But whether or not you have insurance, you could still be racking up those medical bills.

On Sunday, Scott Rosenbluth attended a fundraiser for his friend Aaron Nichols. Nichols is currently in a coma after being in a car crash on Memorial Day.

Rosenbluth knows all too well how costly medical bills can be. He is currently in remission from cancer.

"Even with medical insurance, the costs are still a little bit significant,” Rosenbluth said. “There's a deductible. His family with be paying for the rest of their lives."

The weekend benefit for Nichols raised over $5,000.

Rosenbluth says personally, he doesn't have health insurance. It's not a choice. Insurance companies have labeled him as a high risk case.

He isn't eligible for coverage for another six months.
by:www.cfnews13.com

Insurance firms destroying health care

2007-06-28T17:39:00.000-07:00

A letter to the editor regarding the health care system in Arizona missed the point of the real problems ("Medical liability is threatening Arizona's health care," Saturday).

There is a rapidly growing consensus that the primary problem with the practice of medicine today is clearly not the feigned "malpractice crisis" but rather the manner in which health insurers dictate and, in fact, intimidate physicians into accepting way too little reimbursement for the competent and beneficial care provided to their patients.

Insurance companies place physicians in completely untenable positions, namely, "Either go along with our pricing for your services or we will exclude you as a member of our physician panel." Studies over the past years have demonstrated that at the same time insurance companies are refusing reasonable reimbursements for physicians and medical groups, the insurance companies are reaping record profits.

Litigation is presently ongoing in other states involving doctors challenging the practices of health insurers in this regard but, to date, I know of no such endeavor within the state of Arizona.

If Arizonans want our physicians to be available for us and our hospitals to remain open and financially solvent, the relationship between insurance companies and physicians needs to be dealt with, either through legislation or by way of judicial action. In that regard, perhaps the legal community could serve the medical community very well.

Wouldn't such an alliance be helpful to all of us? - Steve Ryan, Scottsdale

A $962,120 medical bill error

2007-06-28T17:20:00.000-07:00

he patient didn't have to pay, but it's still a useful lesson for others, an economist says.
Helen Dorroh White thought she was doing the right thing when she called a health insurance company to question a nearly $1-million medical bill. Instead, she said, no one seemed to care.

White, a Glendale lawyer, was closing the financial affairs for a deceased client when she came across the insurance statement. It showed a $962,120 bill for her client, Dusanka Mlinarevich, who spent four days at Glendale Adventist Medical Center after suffering minor injuries in a fall at her Burbank home last year.

That struck White as odd, she said, because the hospital had told her the bill was $48,106.

Concerned about the discrepancy, White called the health insurance company, Long Beach-based SCAN Health Plan.

"My first question was, 'Is this some kind of typo or some mistake?' " said White, 73. A customer service representative paid little heed, White said, and insisted that the amount was correct.

"She didn't even bat an eye," White said.

Fearing fraud, White wrote a letter to the U.S. attorney's office and contacted The Times.

After inquiries from a reporter, SCAN's vice president of marketing, Sherry Stanislaw, said the company found a computer glitch that was producing erroneous claim reports for customers.

Actual billings and payments were not affected, Stanislaw said. She confirmed that Glendale Adventist's bill was for $48,106 and said that SCAN paid a negotiated rate of $4,350 and that Mlinarevich, who died in August at age 78, was assessed a $150 co-payment.

Because patients are responsible only for co-payments and deductibles, few consumers ever take a close look at their medical bills, said Devon Herrick, a healthcare economist and senior fellow at the National Center for Policy Analysis.

To help keep rising healthcare costs in check, more consumers should do what White did, Herrick said. "Most insurance companies will agree that they'd want their enrollees to scrutinize their bills."

SCAN said the computer glitch was being investigated. Stanislaw conceded that her customer representative should have heeded White's concerns and contacted a supervisor. The company is sending White a new claim statement, she said.

White wasn't completely pleased.

"It is easy to blame the computer. Well, who programs the computers?" she asked. "The last I checked, computers didn't program themselves."
By Daniel Yi, Times Staff Writer

Clarian Health Making Changes to Insurance Plans

2007-06-28T17:08:00.000-07:00

Clarian Health is announcing changes to employee medical insurance plans in order to promote healthier lifestyles. Beginning in 2008, all employees wishing to enroll in Clarian-sponsored plans will have to report all potential health risks, including whether they use tobacco. A health risk charge of $5 per paycheck will be assessed to employees who have used tobacco within six months of their health risk assessment completion date. Beginning in 2009, employees will also have to participate in a complete health screening.
saw the introduction of Clarian Health’s mission strategy: A Call to Change. Through billboards, television and radio commercials, as well as community events and health fairs, Clarian has issued a call to all citizens of Indiana to take control and improve their health. Not only did Clarian issue a call, but the organization and its employees are acting on it.

There is no shortage of news stories or political speeches about the rising costs of health care, how much money and productivity companies lose due to employees who are sick and cannot work, or how unhealthy lifestyle habits such as smoking are affecting Hoosiers and resulting in higher hospital utilization.

Year after year, headlines remind us that Indiana has had the dubious distinction of being one of the most unhealthy states in America. However, there has been no significant improvement in this status and a comprehensive solution is nowhere in sight.

As Indiana’s health care leader, Clarian has been a leader in exploring ways to better manage and reduce the cost of health care. Like other organizations, Clarian is looking for ways to help improve the health status of its employees. Focusing on health prevention and wellness, Clarian is actively working to improve its employees’ health by incenting and empowering them to lead healthier lifestyles.

Beginning in 2009, all Clarian Health employees who elect to participate in the organization’s medical insurance plans must complete a health screening (body mass index, LDL cholesterol, glucose, blood pressure) and Health Risk Appraisal (HRA).

In 2008, the HRA is necessary for enrollment in company-sponsored plans with employees self-reporting their health risk results. One self-reported health risk will be a statement of tobacco use or non-use status.

Also new in 2008 will be a health risk charge of $5 per paycheck for medical plan participants who have used tobacco within six months of their HRA completion date. This is an effort within our health plan changes to provide an incentive for employees to adopt healthier lifestyle habits.

“Any employee currently enrolled in medical coverage or electing coverage during open enrollment will need to complete the HRA to obtain coverage under the medical plan as of January 1, 2008,” said Steve Wantz, senior vice president of Administration and Human Resources. “Clarian has carefully weighed the pros and cons as well as conducted research surrounding this approach, including a timed series of focus groups with Clarian employees,” added Wantz.

“Clarian Human Resources and associates from Clarian’s Wellness staff have structured this program based on measurements and guidelines from the National Institutes of Health and the National Heart, Lung and Blood Institute,” stated Brian O’Connor, director of Benefits for Clarian.

Clarian is notifying employees of the medical plan well in advance to ensure they “know their numbers” and allow employees time to address any personal areas of risk with their doctors before the screening and before the 2009 benefit changes go into effect.

Clarian will offer free screenings for blood pressure and BMI during the summer and fall of 2007 for employees interested in obtaining these health measurements. The organization will offer a variety of resources and support, as well as education about health risks, to employees who “know their numbers,” and who want to make positive change toward improving their health and lessening their health insurance premium costs.

“The information provided in the HRA will not be used to exclude anyone from our medical insurance plans,” said O’Connor. “We hope that employees learn about one or more health risks they may not have been aware of, they will take steps to protect their health and, by addressing those risks, no longer fall into a high-risk category for some or even all of the risks identified by the time the 2009 plan changes take effect.”

Wantz added, “This is really part of our Call to Change mission communications strategy. This time, we are asking employees to make a personal call to change.”

Employees who have a health risk they would like to address or want help quitting tobacco can find help through a variety of resources at Clarian.

A reasonable alternative will be in place for those employees for whom it is unreasonably difficult or medically inadvisable to satisfy the standard for any particular health risk due to a medical condition.

“We are as committed to the health and well-being of our employees as we are to that of our patients,” stated Wantz. “As both a premier health care provider and employer, Clarian is in a unique position to provide the necessary resources and support to our employees seeking to improve their own health and make that personal change.”

Source: Clarian Health

Over USD 6Mn paid to insured retirees in Morocco in 2007

2007-06-28T16:36:00.000-07:00

The hospitalization expenses paid off by the national fund of insurance "Caisse Nationale des Organismes de Prévoyance Sociale" (French acronym CNOPS) to insured retirees and their claimants, reached some USD 6Mn for the year 2007, revealed, here Wednesday, Moroccan Employment Minister, Mustapha Mansouri.

Speaking at the House of Representatives' (lower house) question time, the minister noted that the Mandatory Health Insurance (AMO) enabled some 74,929 new insured to benefit from health coverage.

The minister said services concern preventive and medical care.

The AMO guarantees risk insurance and fees of medical services following sickness, accident, delivery or physical rehabilitation to the insured and his family members, with the exception of cosmetic surgery.

With the AMO and the Medical Assistance Regime (RAMED), which is destined to the economically destitute population, the overall number of the population benefiting from medical insurance in Morocco will reach 50%.
by:www.map.ma

Two Models of Health Care Rationing

2007-06-28T16:34:00.000-07:00

Sick and Sicker

Everyone knows that Canadians live longer and have lower infant mortality rates than Americans. In Sicko, Michael Moore suggests that a Canadian-style medical system would solve this problem. Surprisingly, the evidence indicates that it would not.

A cross-border team of 17 researchers (including high-profile supporters of the Canadian system) examined a variety of medical problems, including cancer, coronary artery disease, chronic illness and surgical procedures. With the single exception of end-stage kidney disease, where Canadian patients fared better, they found no consistent difference in patient outcomes between the two nations.1 As I have argued elsewhere, the United States has the worst health statistics in the industrialized world because it is the most unequal society in the industrialized world.2

Although Canada's medical system does not produce generally better patient outcomes, it is more equitable and far more economical. In 2003, the average American spent almost twice as much for medical care as the average Canadian. Exorbitant medical bills are a constant worry and a major cause of personal bankruptcy. Profit-taking is responsible for the high cost of American medicine. However, the Canadian system is also subject to market forces.

Contrary to popular belief, Canada does not have a single-payer medical system. Government pays about 70 percent of medical costs, including most hospital and physician care. Individuals and private insurance companies pay the remaining 30 percent for prescription drugs, dental and vision care, ambulance, medical devices, home care and other services.

To contain costs, both the United States and Canada ration medical care, but they do this in different ways. In the U.S., more than 47 million people have no medical insurance at all. The Institute of Medicine estimates that 18,000 people die every year as a result. In Canada, lack of access is more equitably spread across the population in the form of long waits for assessment and treatment. We don't know how many Canadians die while waiting for treatment, because no one is counting the bodies.3 The Canadian model of rationing is sick, and the American model is sicker because it unfairly discriminates against those who cannot pay. Neither is good enough. Medical care is a human right and should not be rationed at all.

Disgust with the American medical system has built support for HR 676--The United States National Health Insurance Act--a single-payer system where medical care would be publicly financed and privately delivered. Winning HR 676 would be a tremendous victory. However, the Canadian experience shows that private delivery of medical care opens the door to parasitical profit-taking.

The Canadian experience

Until the 1960's the American and Canadian medical systems were nearly identical. Those with the highest incomes obtained the lion's share of medical services even though those with the lowest incomes experienced the most illness. The logical solution was a government-run system to provide medical care for all, but doctors and private insurers rejected what they called "state medicine and socialism."

During the upturn of the 1960s, the pressure grew for universal health care. To contain demand, the federal government launched a Royal Commission to "study" the problem. The Canadian Labour Congress (CLC) made its preference clear.

"We favor a system of public health care that will be universal in application and comprehensive in coverage. We favor a system that will present no economic barrier between the service and those who need it. We are opposed to any provision which will require some people to submit themselves to a means test in order to obtain service. We look to a system of health care that will be regarded as a public service and not as an insurance mechanism."4

The public-service model, where government is both payer and provider, was rejected. Instead, the Medical Care Insurance Act of 1966 established a publicly-financed system that would be administered and delivered by the private sector, "free of government control or domination."

The province of Quebec took a different route. Pressured by workers' demands that culminated in the 1972 General Strike, Quebec incorporated medical services into a broad social benefits system, paid for and provided by the provincial government. The Quebec working class is rarely credited for producing the most comprehensive medical system in North America.

The assault on Canadian medicare

The ink was barely dry on the Medical Care Insurance Act before the federal government began cutting funds for health and social services. The 1974 recession and the recessions of the early 1980s and the early 1990s were followed by deeper cuts. As the cost of medicare was downloaded from the federal government to the provinces, the principle of equal access was eroded.

Private corporations rushed into the breach created by under-funding. The more medical services were removed from the public realm, the more individuals had to pay out of pocket, purchase insurance to cover the gap or go without.

To reassure nervous Canadians that medicare was safe, the Canada Health Act of 1984 guaranteed universal and equal access to medical services, but provided no funds to make this possible. Behind the scenes, government was committed to "growing" the private medical industry.

In 1994, the Ontario government concluded, "To have the effective launching pad it needs, the health industries sector must expand its share of its own home market. Steps must be taken to ensure that, as in other countries, the domestic market supports the development of globally competitive companies." One of these steps was to eliminate regulations mandating a minimum level of daily care for Ontario nursing-home residents.

In 1997, the federal government declared "Promoting Canadian companies as global health-keepers is the main objective driving the strategies and plans of the government for the medical devices, pharmaceutical and health-services sector."5 And in 2004, Canada's Supreme Court ruled that, "The Canada Health Act [does] not promise that any Canadian will receive funding for all medically required treatment."

Behind the mask of "health-care reform" and "restructuring," the Canadian medical system has been handed, piece-by-piece, to private industry in a manner similar to the dismantling of Britain's National Health Service6 --publicly-provided health care is under-funded to the point of crisis, then denigrated for its inadequacies. The private sector is proclaimed the only possible savior, and opponents are ridiculed as old-fashioned and sentimental. When the market fails to deliver, we are told we must adapt to "the new reality." The strongest opposition to this process has come from organized health-care workers.

Canadian hospitals, which by law must be non-profit institutions, became a battleground as unionized workers resisted wage cuts and contracting-out of housekeeping, information systems, food preparation, laboratory and other services to private, non-union companies. In 1981, Ontario hospital workers launched a province-wide strike, defying back-to-work legislation and the jailing of union leaders. Unwilling to broaden its challenge to neoliberal social policy, the union caved and the strike was defeated. Most small, local hospitals were closed. Those that remained open were merged into giant conglomerates managed by business consultants.

Privatization has decimated services. Families stagger under the burden of sick, injured and frail relatives who were previously cared for in hospital, rehabilitation and chronic-care facilities. In-home nursing care is scarce or pricey.

Tens of thousands of hospital nursing jobs have been eliminated at the same time that average hospital stays have been cut, so that fewer nurses care for much sicker patients. Hospital food lacks nutrition and infectious diseases plague hospitals that are no longer clean.7

As hospital out-patient clinics closed, patients were sent to family doctors (GPs) for follow-up. The downloading of medical services has created a crisis at the primary-care level. By 1998, 62 percent of Canadian physicians reported that their workload was too heavy, and more than half said that their family and personal life were suffering. By 2000, only 39 percent of Ontario GPs were accepting new patients. By 2006, fewer than 10 percent were accepting new patients. People typically wait months to see a specialist and more months for treatment. Patients grow sicker and die while they wait.

Quebec's model health-care system has been damaged severely by funding cuts. In 2005, Canada's Supreme Court ruled that lack of timely access to treatment in Quebec was serious enough that the province could no longer prohibit private funding for medically necessary services. Similar legal challenges are expected in the other provinces.

Unless the public system is resuscitated with a major transfusion of funds, it's only a matter of time before private hospitals begin servicing those who can pay to go to the front of the line. Ironically, while Americans long for a Canadian-style medical system, that system is disintegrating under the pressure of market forces.

Why ration medicine?

The capitalist class will pay anything to defend and extend its power. No ceiling has been set on spending to win the war for Middle-East oil. In contrast, there is fierce resistance to funding any services for workers beyond the minimum required to keep them productive. As the competition for capital increases, most governments are reducing their investment in health, education and social services --robbing the public sector to boost the profitability of the private sector. No nation and no medical system are immune to the relentless drive for profit.

The American medical system will be reformed. Ordinary people want medical services. Business complains that the cost of medical benefits is hurting their profits and global competitiveness; they want to transfer these costs to the public sector. Because Americans pay almost 90 percent more per-capita on medical care than Canadians do, rationalizing the medical system would offer fantastic cost savings. The real question is how it will be reformed.

The key demand is for affordable medical care. With almost 60 percent of the American workforce making less than $15 an hour, affordable care would have to be free. That shouldn't be a problem. A nation that can find the money to pay for war can find the money to pay for universal health care --in theory.

In practice, capitalism prioritizes cost-efficiency over human need by "industrializing" social services. The work of medicine is dissected into components that are individually priced and parceled out. The profitable parts are handed to the private sector and the unprofitable portions remain in the public realm or are abandoned altogether. While applying industrial methods to medicine is cost-effective from a business point of view, it fragments health care. Planning health services to meet population needs and integrating prevention and treatment, hospital and community care become impossible.

Winning HR 676 would be a definite step in the right direction. However, we need to go further. Eliminating profit from the medical system requires public financing and public delivery of services (socialized medicine). More than that, all health and social services must be provided as a human right --fully funded, fully integrated and with no rationing. If capitalism cannot meet these basic needs, then we need to construct a socialist society that can.

Dr. Susan Rosenthal has been practicing medicine for more than 30 years and has written many articles on the relationship between health and human relationships. She is also the author of Striking Flint: Genora (Johnson) Dollinger Remembers the 1936-1937 General Motors Sit-Down Strike (1996) and Market Madness and Mental Illness: The Crisis in Mental Health Care (1999) and Power and Powerlessness. She is a member of the National Writers Union, UAW Local 1981. She can be reached through her website: www.powerandpowerlessness.typepad.com

By Dr. SUSAN ROSENTHAL, M.D.

UniCare Life & Health Insurance Company Launches SecurePack for Small Businesses

2007-06-28T16:29:00.000-07:00

Many small business owners want to offer life and disability insurance as part of a comprehensive benefits plan, but believe they cannot afford it. UniCare Life & Health Insurance Company's SecurePack, specifically designed for small businesses, offers life insurance, disability insurance and employee assistance program (EAP) in an affordable and convenient benefit package.

SecurePack is available to small businesses with 2-99 employees. Five packages are available. Each includes a different level of:

- Group Term Life Insurance, delivering a timely benefit payment for the family if an employee passes away. - Accidental Death and Dismemberment, paying an additional benefit if an employee dies or faces a covered loss - like the loss of a limb - in an accident. - Dependent Life Insurance, paying a benefit to the employee if a spouse or child passes away. - Disability Insurance, providing temporary income to employees if they cannot work because of an illness or injury. This protection includes pregnancy.

"SecurePack offers solutions that can help small employers attract and retain great employees. There are no medical questionnaires and no mid-year rate changes," said Nicholas L. Brecker, president of UniCare's Life and Disability business. "SecurePack makes it easier for small businesses to provide these valued benefits to their employees."

Many small businesses owners also recognize that EAP can be helpful to their employees. SecurePack includes the InTouch, an EAP that offers:

- Ongoing support including toll-free, 24/7 telephone counseling, and referrals to financial and legal resources. - Convenient resources including access to child care and elder care databases, as well as additional Web site resources including on-line will preparation. - Face-to-face counseling including three sessions per year for employees with a disability and six sessions per year for beneficiaries dealing with the loss of a loved one - at no cost to them. - Human resources support is also available to help small groups through difficult situations, like alcoholism in the workplace. Employees don't have to fill out medical questionnaires as long as they sign up during the enrollment period.
"We are committed to providing small businesses with affordable, integrated and comprehensive benefits," said Jimmy Lee, vice-president for individual and small group business at UniCare. "When combined with medical insurance, SecurePack is one way small business owners can help deliver greater financial and health security for their employees."

Life and disability products are underwritten by UniCare Life & Health Insurance Company. For more information on UniCare Life & Health Insurance Company's SecurePack visit www.unicare.com.

UniCare benefits products are offered in Illinois and Indiana by UniCare Health Insurance Company of the Midwest, in Texas by UniCare Health Insurance Company of Texas and in all 50 states and the District of Columbia by UniCare Life & Health Insurance Company. UniCare Life & Health Insurance Company, an Indiana corporation, UniCare Health Insurance Company of Texas, a Texas corporation, and UniCare Health Insurance Company of the Midwest, an Illinois corporation, are separately formed and capitalized subsidiaries of WellPoint, Inc., an Indiana corporation. For self-funded plans UniCare acts as a claim processor and does not insure benefits under the plan.

Media Contact: Jerry Slowey Tony Felts (805) 557-6754 317-287-6036 jerry.slowey@wellpoint.com tony.felts@anthem.com

SOURCE UniCare

When Minority Patients Have Insurance And A Medical Home, Their Health Care Improves

2007-06-28T16:24:00.000-07:00

Finding Credible Mini-Medical Insurance Plans

2007-06-28T15:41:00.000-07:00

Download this press release as an Adobe PDF document.

Limited medical insurance plans are not created equal. Many plans in the market are priced cheaply but offer few real benefits which can cause frustration for both employees and providers. But, with a few helpful tips, employers can find credible plans at reasonable costs.

Orlando, FL (PRWEB) June 28, 2007 -- Its no secret that double-digit healthcare premium increases over the last several years have forced many employers to reduce or cancel healthcare benefits altogether. A number of insurance carriers have responded by offering limited medical plans for groups, sometimes referred to as mini-med plans or limited benefits insurance. In order to attract greater employee participation, some plans are designed based on how much the employer is willing to contribute and are offered for as little as $20 per month. But at the same time, such low cost plans provide very little real coverage and can create more confusion and frustration for providers and consumers than the benefits are worth.

But, there are credible limited medical plans available in the market place, and savvy employers can learn the differences and pick plans that provide valuable benefits at reasonable costs. So, how can employers who can't afford major medical group plans find reasonably priced limited medical insurance plans?

First, review the benefit plan summary to check for minimum coverage amounts for:

Hospitalizations: According to Christopher Lang, President & CEO of AgelessCare, $500 per day is the lowest credible daily rate. If possible, employers should purchase a plan with a rate that mirrors average negotiated hospital per diem rates of between $900 and $1,100. "If the daily benefit level is lower than $500, don't bother buying a plan that includes inpatient hospital coverage since it won't be worth the extra premium cost or hassle for providers and employees," says Lang.
Doctor Visits: Primary care office visit fees normally range between $65 and $120 per visit. Look for at least $40 per visit since this will often fund a good share of the cost of basic follow up visits, particularly if the provider offers a self-pay rate when the appointment is booked.
Accident Medical Expenses: Many high cost medical bills result from accidents. "Be careful to find a plan that is not limited to one-fixed amount per year, but instead, pays at least $1,000 per accident with a low deductible," cautions Lang.
ER Visits: Many limited medical plans include very small benefits for ER, such as $100 or less per visit. But, an average bill can range between $500 and $750 per visit. Lang says the per-visit ER benefit should be at least $250 to cover a meaningful portion of a typical bill.

Once the employer finds an insurance agency offering a credible mini-med plan, they should ask whether the agency has experience working in the healthcare provider community. Knowledgeable agencies should also understand why employees seek healthcare and how to help them maximize the limited medical insurance benefits provided.

About AgelessCare:
AgelessCare, LLC is a licensed general insurance agency serving more than 40 states. Product offerings include health and life insurance, healthcare discount programs, and nurse hotline services for groups. For more information, visit http://www.agelesscare.co

Error kills would-be doctor

2007-06-22T15:48:00.000-07:00

OUR SPECIAL CORRESPONDENT

by:www.telegraphindia.com

Dileepan Raj, the boy said to have carried out a Caesarean section.

Lucknow, June 21: A Dileepan who isn’t a doctor has been performing surgery in Tamil Nadu, but a Dilip who deserved to be one has died here after being denied by a computer error.

Six days after Dilip Gautam, 19, hanged himself from disappointment at failing the Uttar Pradesh Combined Pre-Medical Test, a corrected merit list today showed his name.

It also had the names of hundreds of others the original results had left out. A probe committee has admitted that 75 per cent of the original list was erroneous because of “a programming error”.

“What can we say? We are stunned. It has cost the life of a young man who aspired to be a doctor,” said Dilip’s uncle Pratim Gautam, speaking a day after news broke that a doctor had allowed his 15-year-old son, Dileepan, to perform a Caesarean in his hospital in Tamil Nadu.

Dilip’s friends, who said the youth was “above average” as a student, have demanded action against officials. “We want the government to punish the university officials,” said Rajat Sharma, who too finds his name among the successful candidates after being left out.

Dilip’s family said the young man had locked himself in his room on the evening of June 14, the day the erroneous results were published, and refused his dinner. The next morning, he was found hanging from the ceiling.

Other students expressed their frustration in a different way. Hundreds took to the streets across the state on June 14, stoning cars and vandalising shops. Many threatened to move court.

The Mayavati regime, eager to build a reputation for good governance, acted fast and set up a nine-member probe panel on June 15. When the tests were held, Mayavati was not in power.

The investigation found that the computer programming had been faulty and the results were not “cross-checked manually”.

The mess prompted Poorvanchal University vice-chancellor K.P. Singh, the examination committee chairman, to put in his papers. “I am taking moral responsibility,” he said, “but I assure you the errors were not intentional.”

The state government today publicised the correct answers to all the questions, and promised to make available to students their answer scripts if they doubted the evaluation.

Doctor apologies prevent lawsuits for medical malpractice

2007-06-22T15:47:00.000-07:00

New Virginia (VA) law allows doctors and hospitals to apologize to the people they hurt by medical errors and not have it used against them in court. This law was part of a compromise worked out between doctors and lawyers in a recent Legislative Session.

Getting this law passed was a smart play by the medical malpractice insurance lobby. Allowing the doctors to do an early apology may prevent them from being sued even when they made a clear error causing serious injury.

In our firm's decades of helping families who have been harmed by surgical or medical mistakes, we have found that often the bedside manner of the healthcare provider makes a big difference. Frequently a reason that the client has contacted a law firm about medical malpractice is not being treated well by the doctors. If someone had simply been outwardly caring, many times the patient would not contact a personal injury lawyer at all. Sometimes, it is the bad bedside manner that causes the patient to call us, even when there was a catastrophic injury caused by a clear violation of the medical standard of care. These patients are more upset by how they were treated, than what has happened to them from the standpoint of the medical result.

I agree with the idea of the new law which is to have surgeons and hospitals be able to admit an error and take responsibility without having that used against them in the lawsuit. This might cut down on the anger that leads to prolonged litigation. However, what would be even smarter would be for the risk managers at the hospitals and the doctor's insurance companies to also follow up with concept called "full disclosure/early offer". Under this method of handling medical mistakes, the meritorious claims will be dealt with promptly. The doctor and the health care providers would be in a position to be able to be honest and frank about what had happened in the treatment. In health care systems where this is being used, the Plaintiff's attorneys handling medical malpractice cases have been receptive. Things can be worked out by having two professionals sitting across the table discussing a claim it without all the expense and drama associated with full blown litigation.

Such a system is a far cry from what normally happens in Virginia (VA). Typically in Virginia (VA) any medical malpractice case has got to be fully litigated the insurance companies, before the doctors will take the case seriously. As Plaintiff's personal injury lawyers, we typically have to hire numerous expensive experts to prove what the doctor did wrong and how that caused a serious and permanent injury to the client. Only once we have shown our cards and have this proof in hand will the insurance companies handling the medical malpractice claim even discuss settlement. Unlike an automobile accident claim where the vast majority of cases are resolved without the need for litigation, medical malpractice cases in Virginia (VA) typically are hard fought, knock down, drag out battles. I think our medical malpractice clients would be very receptive to a more human and civilized method of resolving these conflicts. I hope that this new concept catches on. Some of the best healthcare systems in the world, including John's Hopkins Medical in Maryland (MD), are trying this approach.
by:virginiabeach.injuryboard.com

Flashback to ‘baby-friendly’ clinic

2007-06-22T15:46:00.000-07:00

IMA member recounts month-old camcorder show by father of ‘boy surgeon’

M.R. VENKATESH

Mathi Surgical and Maternity Nursing Home in the heart of Manapparai town. Picture by Bhoopathy

Manapparai (Tamil Nadu), June 22: Dr K. Murugesan’s hospital here wears its badge proudly. At the entrance is displayed an Indian Medical Association certificate declaring the Mathi Surgical and Maternity Nursing Home “baby friendly”.

It’s a 15-year-old “baby surgeon” that has now brought the hospital under the national spotlight.

The IMA’s local branch, whose members say they watched a video of Dileepan Raju doing a Caesarean section at his father’s clinic, claims it had informed the association’s state and national chapters early in May.

But not much was done till a leak, presumably by a local doctor, raised an outcry on Wednesday.

The “baby friendly” tag came a few years ago after an assessment by the IMA’s national task force. Along with the certificate are displayed photographs of “rare surgeries” at the hospital, including the delivery of male triplets.

The rarest of these, local doctors say, was the one to which they were treated at an IMA meeting on May 6. Dr Venkata Prasad, secretary of the IMA branch in Manapparai, 40 km from Tiruchirappalli, confirmed that it was Dileepan doing the operation on video — an allegation Murugesan has denied.

A senior IMA official said that at the meeting, Murugesan sprang a surprise by “asking to show the video of a Caesarean”.

The meeting had been convened for guest lectures by a urologist and an orthopaedist. “But we allowed Dr Murugesan to show the CD, as we usually do when doctors want to present some unique case,” said the official, who didn’t want to be named.

“I am Dr Murugesan, giving spinal anaesthesia (to the patient) and my son is doing the surgery,” the father allegedly said as his camcorder tape started showing the pictures on a screen with the help of a projector and a laptop.

Shell shocked

“We were shell-shocked and looked at each other in utter disbelief. The screen showed the surgery being done by his teenage son, a Class X student (he is now in the first year of plus II). Murugesan, who’s a surgeon, himself administered anaesthesia without the services of an anaesthetist,” the IMA doctor said.

When the boy pulled the infant out, “we could see it was a malformed baby — there was a lump on its back”. He clarified that the operation was successful and the lump had nothing to do with the surgery being done by unskilled hands.

“There was an uproar. But Dr Murugesan wanted to take this to the media and, apparently, to the Guinness World Records,” the doctor said. “We pleaded with him not to; we told him this was unethical. But he wouldn’t listen.”

The local IMA’s complaint, sent to the state chapter the next day after an emergency meeting, says: “He (Murugesan) reacted very arrogantly and threatened to sue the local IMA without accepting his mistake.”

The emergency meeting passed a resolution making it clear that the local IMA was “in no way responsible for his way of practice”.

“We had to collectively condemn this, else Dr Murugesan may have tried to gain mileage out of the screening at an IMA meeting,” said the local IMA secretary, Dr Prasad.

“Our role ended after reporting the matter to higher authorities. We did it so we would not be hauled up for remaining silent spectators to an unethical practice by a fellow doctor.”

Dr M.M. Nazurudeen, the chapter’s president, who wasn’t at the meeting where the video was allegedly shown, said: “We condemned this very strongly.”

Sources said the state chapter wrote to Murugesan asking him to explain his action. The doctor, they said, denied the allegation. The matter seems to have rested there despite the local doctors’ eyewitness account.

CD confusion

The line of patients at the hospital had thinned today. Murugesan and his gynaecologist wife Gandhimathi, also alleged to have been present at the Caesarean, attended to patients but kept away from the media.

Their lawyer, Kasturi, did the talking.

“The boy only watched the operation done by his father,” the lawyer said. “It doesn’t violate any law as people are televising operations these days.”

Kasturi claimed that Murugesan had shown the video because the patient — a relative — had two uteruses, which is unnatural.

The IMA complaint speaks of Murugesan showing a CD but the lawyer said: “There is no CD.”

The reference to a CD could be an error because some doctors said the video was shown directly from a camcorder.

The investigators’ problem is compounded by the failure of the patient, Neela, to file a complaint. Efforts to trace her have been unsuccessful. Her parents’ home at Pallarnatham village, 20 km from Manapparai, was locked this afternoon.

The local doctors now seem to hold the key to the case. Some of them have spoken to the investigators, led by the district revenue divisional officer.

“The probe will be over in another three days and once we get the full report, we will decide on the next course of action,” said Tiruchirappalli collector Ashish Vachhani.

by:www.telegraphindia.com

No medical error in treatment of the late professor

2007-06-22T15:44:00.000-07:00

There was no medical error in the treatment of the pathology professor Karposh Boshkovski.

The special panel comprised of doctors at the Thoracal Surgery Department at the Skopje Clinic Center established today, announcing their finding as a response to the anonymous letter suggesting that Boshkovski was inadequately treated.

Nevertheless, the Health Minister Imer Selmani unveiled plans for setting out a new probe to be carried out by an expert commission.

The results of the Pathology Institute showed that Boshkovski died as a result of severe damaged of the aorta.
by:www.makfax.com.mk

Assembly Passes Moriarty.Greenstein.Fisher Bill Requiring Public Reporting Of Hosptial Errors

2007-06-22T15:43:00.000-07:00

(TRENTON) - The Assembly today passed legislation Assembly members Paul Moriarty, Linda R. Greenstein, and Douglas H. Fisher sponsored to require annual public disclosure of serious medical mistakes made in New Jersey.

"Vital consumer information like hospital error reports should not be hidden away from public scrutiny," said Moriarty (D-Gloucester). "Patients shouldn't have to wonder if a clerical error will leave them recovering from an operation they didn't want or need."

The Moriarty/Greenstein/Fisher legislation (A-4327) would seek to make the public aware of the number of serious preventable adverse events that occur at each health care facility in the state. The legislation would require that a report be made available to the public that would list how many of these events took place at each facility. The report would not include identifying information about patients and facility employees to avoid exposing the facility to greater legal liability.

"Going to a hospital for an operation or procedure is stressful enough without having to worry about whether the hospital staff might make a mistake," said Greenstein (D-Middlesex). "Allowing the public access to hospital error reports will improve patient peace of mind and continue to place New Jersey at the vanguard of patient safety."

According to the bill sponsors, hospital error reporting is already required under New Jersey's 2004 "Patient Safety Act," which established a medical error reporting system for health care facilities in an effort to minimize errors. These reports, however, are not readily available to the public.

"Knowing that the public will have access to error reports will make hospitals work that much harder to ensure patient safety," said Fisher (D-Cumberland). "And that knowledge should make every visit to the hospital a little less unnerving."

The bill would require the Departments of Health and Senior Services (DHSS), in consultation with Human Services (DHS), to prepare a report on hospital performance on patient safety measures. The report is to include, at a minimum, the number of serious preventable adverse events that have resulted in either:

Death;

Loss of a body part:

Disability or loss of bodily function lasting more than seven days or still present at the time of discharge from a health care facility.
The report would be presented in a format which enables comparison among health care facilities in particular facility categories with respect to the information. In the event of general hospitals, the information is to be included in the New Jersey Hospital Performance Report annually issued by DHSS that measures the performance of general hospitals in the Senate. The report would be available to the public via the DHSS Web site: http://www.state.nj.us/health.

The provisions of the bill would become effective either one year after enactment or one year after the adoption of the regulations for the "Patient Safety Act," whichever comes later.

According to information from the Institute of Medicine, approximately 98,000 deaths occur nationally each year as a result of major preventable medical errors. In 2005, New Jersey hospitals reported 376 medical errors.
The Assembly passed the bill 74 to 4 with one abstention. It now heads to the Senate for further consideration.
by:www.politicsnj.com

Medical Error is the Fifth-Leading Cause of Death in the U.S.

2007-06-22T15:40:00.000-07:00

Clinical Information Systems Implemented to Prevent Errors and Enhance Patient Safety
WALTHAM, Mass. -- Millennium Research Group (MRG), the global authority on medical technology market intelligence has conducted a detailed and thorough analysis of the acute care clinical information systems (CIS) market and finds that a major driver in the US is the demand for improvement in patient safety.

Medical errors are the fifth-leading cause of deaths in the US, with up to 98,000 deaths annually. According to the new report entitled US Markets for Acute Care Clinical Information Systems, hospitals are adopting CIS to help them provide adequate, timely care and reduce the frequency of preventable errors.

"Medical errors in the healthcare system arise from miscommunication, physician order transcription errors, adverse drug events, or incomplete patient medical records," says David Plow, Senior Analyst at MRG. "Generally, medical errors are caused by overcrowded, understaffed clinical areas with complex workflow patterns, and incomplete or inefficient communication between clinical areas. Through the use of a CIS, professionals within each clinical area are able to access and use information pertinent to a patient's medical profile and history. As a result, CIS can effectively help prevent errors and enhance patient safety.

"The CIS market -- comprised of radiology information systems, pharmacy and medication management information systems, cardiovascular and cardiology information systems, laboratory information systems, emergency department information systems, and critical care information systems -- was valued at over $900 million in 2005. By 2010, revenues in the CIS market will exceed $1.5 billion.

MRG's US Markets for Acute Care Clinical Information Systems report includes coverage of all key industry competitors, including Misys Healthcare, Cerner, GE Healthcare, McKesson, Siemens Medical Solutions, Philips Medical Systems, MEDITECH, Systems, Picis, Heartlab, Camtronics, Epic Systems, Soft Computer, Allscripts, MEDHOST, Mediware, Orchard Software, Eclipsys, LUMEDX, Aspyra, Wellsoft, Stryker, Agfa Healthcare, Emergisoft, Amicas, CPSI, QuadraMed, DR Systems, Eastman Kodak, Emageon, Meta, Emdeon, Fujifilm Medical Systems, iMDsoft, Impac, InStar Systems, OptiMed, ScImage, CAOS, and T-System.

A CIS is a computer-based inpatient information system designed for collecting, storing, manipulating, and making available clinical information that is important to the health care delivery process.

It provides access to a patient's electronic medical record-clinical data storage technology that encodes the patient's previous medical history, responses to medication, test results, and current treatment.
by:www.eyeoutforyou.com

Doctors' beliefs can hinder patient care

2007-06-22T15:37:00.000-07:00

New laws shore up providers’ right to refuse treatment based on values
Lori Boyer couldn't stop trembling as she sat on the examining table, hugging her hospital gown around her. Her mind was reeling. She'd been raped hours earlier by a man she knew — a man who had assured Boyer, 35, that he only wanted to hang out at his place and talk. Instead, he had thrown her onto his bed and assaulted her. "I'm done with you," he'd tonelessly told her afterward. Boyer had grabbed her clothes and dashed for her car in the freezing predawn darkness. Yet she'd had the clarity to drive straight to the nearest emergency room — Good Samaritan Hospital in Lebanon, Pennsylvania — to ask for a rape kit and talk to a sexual assault counselor. Bruised and in pain, she grimaced through the pelvic exam. Now, as Boyer watched Martin Gish, M.D., jot some final notes into her chart, she thought of something the rape counselor had mentioned earlier.

"I'll need the morning-after pill," she told him.

Dr. Gish looked up. He was a trim, middle-aged man with graying hair and, Boyer thought, an aloof manner. "No," Boyer says he replied abruptly. "I can't do that." He turned back to his writing.
Boyer stared in disbelief. No? She tried vainly to hold back tears as she reasoned with the doctor: She was midcycle, putting her in danger of getting pregnant. Emergency contraception is most effective within a short time frame, ideally 72 hours. If he wasn't willing to write an EC prescription, she'd be glad to see a different doctor. Dr. Gish simply shook his head. "It's against my religion," he said, according to Boyer. (When contacted, the doctor declined to comment for this article.)
Boyer left the emergency room empty-handed. "I was so vulnerable," she says. "I felt victimized all over again. First the rape, and then the doctor making me feel powerless." Later that day, her rape counselor found Boyer a physician who would prescribe her EC. But Boyer remained haunted by the ER doctor's refusal — so profoundly, she hasn't been to see a gynecologist in the two and a half years since. "I haven't gotten the nerve up to go, for fear of being judged again," she says.

Doctors refusing treatment
Even under less dire circumstances than Boyer's, it's not always easy talking to your doctor about sex. Whether you're asking about birth control, STDs or infertility, these discussions can be tinged with self-consciousness, even embarrassment. Now imagine those same conversations, but supercharged by the anxiety that your doctor might respond with moral condemnation — and actually refuse your requests.
by:www.msnbc.msn.com

Air Sahara denies entry to cerebral palsy patient

2007-06-22T15:35:00.000-07:00

Rajeev Rajan, a disability activist who got the government of Chennai to bend its knees before him by getting two disabled friendly buses moving in the city was himself denied an entry into the aircraft by the ground staff of Air Sahara.

Humiliation did not stop there as the airlines also asked for police intervention. Inspite of the police officials identifying Rajan as a frequent flier due to his social activities, the airlines departed without him. Rajan who suffers from Cerebral Palsy was traveling from Chennai to Delhi for a meeting with the National trust, a government body.

According to Rajan, the ground staff refused him an entry as he was unescorted and he also did not have a fit-to-fly certificate. Upon contacting another private airline, SpiceJet for a ticket, Rajan was yet again turned down. Though the Jet Lite CEO Gary Kingshot admitted that such an incident occurred. “Jet Lite only followed IATA medical manual in respect of wheel chair passenger Mr Rajiv Rajan a cerebral palsy patient,” he said.

A SpiceJet spokesman said that the passenger did not contact them directly. “Jet Lite had asked us to take the passenger but we do not have a internal arrangement with them for passenger sharing. We would have taken him if he had made a fresh booking,” he said.

According to Javed Abidi, a social activist, “Any person suffering from cerebral palsy does not require an escort for travel. Simply because one looks different, does not mean he is unfit. Each person ought to be treated with utmost dignity.”

“Even after one whole day since the incident, there has been no intervention from the National Trust, Department of Disability (Ministry of social justice) or the Office of Chief Commissioner for disabilities is extremely distressing,” said Abidi.

Only recently an autistic child was refused admission into an Air Deccan flight in Bangalore. “While Indian, which is a government owned carrier is careful in dealing with the physically challenged while most private carriers acts irresponsibly as they do not have any policy for the disabled.”

As his next recourse, Rajan will file a PIL against these airlines. Even in the past Rajan has never shied away from fighting for his rights and yet again he would wrestle for justice inspite of his handicap. Disability Legislation Unit, a wing of Vidyasagar, a group of social activists from the South shall file a case in the consumer forum.

While most disability groups, led by Disabled Rights Group, a conglomerate of all disability groups across the country have asked for an unqualified apology from the two airlines; failing to which these groups shall go on a protest march.

Meanwhile, the Director General of Civil Aviation has issued a notice to the managements of SpiceJet and JetLite (Air Sahara's new name) asking for an immediate explanation. The airlines could face action if the DGCA is not satisfied with its reply.
by:www.hindustantimes.com

Airline says sorry for turning away cerebral palsy patient

2007-06-22T15:33:00.000-07:00

Social activists and members of communities for the disabled staged a two-hour dharna at the domestic airport in the Capital on Thursday, protesting Jet Lite airlines’ decision against letting cerebral palsy patient Rajiv Rajan board a flight on grounds of being unfit and not in possession of a fitness certificate.

Despite letters to the CEO of Jet Lite, Gary Kingshott, and the Civil Aviation Ministry, the Disabled Rights Group received no reply, leading to a two-hour demonstration of nearly 200 activists.

Social activists Vandana Bed, Kamaljeet Singh and Asha Mehra also took part in the demonstration. Some protesters even threw black paint on Spice Jet and Jet Lite airlines’ windows.

“At 5 pm, some staff of the Jet Lite airlines offered a written statement, stating regret and tendering an apology to Rajiv Rajan for the treatment he received. The company admitted that it was at fault and stated the event occurred due to untrained staff,” said Javed Abidi, a prominent social activist present at the dharna.

Gary Kingshott, however, refuted such claims. “We regret the incident, but there is no reason for us to apologise to anyone,” said Kingshott. Jet Lite stuck to their stand that they had followed the norms set by the Internation Air Transport Association manual.
by:www.hindustantimes.com

Rights blow to elderly in private care

2007-06-22T15:27:00.000-07:00

housands of people who use hospital or school services contracted out by local authorities are without the protection of human rights laws, after a landmark ruling yesterday.

In a split 3-2 decision, the law lords ruled that private care homes contracted out to care for elderly people for a local authority are outside the scope of the Human Rights Act.

The judgment could affect up to 300,000 residents in England and Wales and also a range of other services contracted out to private bodies, such as intermediate treatment centres or foundation schools.

The law lords rejected the view that a private home is exercising a public function when it cares for people referred to it by a council. As a result, they said, it was not bound by the Human Rights Act and its residents could not claim protections under it.The ruling came in the case of an 83-year-old Alzheimer’s patient, whose lawyers argued that her threatened eviction from a private home would violate her right to family life.

Six months ago the Court of Appeal said that it was bound by previous rulings that a private care home could not be classified as a public body and was not covered by the Act.

The patient, identified only as YL, has lived at the home since January last year, when she was placed there by her local authority, Birmingham City Council.

The home, which cannot be named for legal reasons, is run by Southern Cross Healthcare, which wants to remove the woman because of disagreements with her relatives.

Liberty, the human rights group, which was represented in the case, said that the law lords’ reasoning “seems to have been largely that private care providers are motivated by profit and governed by contract rather than public service values”. Its lawyer, Anna Fair-clough, said: “It is open to Parliament to be the last court of human rights and enact specific care home legislation to prevent local authorities from contracting out of dignity for Britain’s elderly.”

Gordon Lishman, director-general of Age Concern, said: “This is a catastrophe for the 300,000 vulnerable older people who live in independent care homes.”

The Alzheimer’s Society said: “All care home residents should be protected by the Act. This is a basic entitlement, which should not be compromised by the type of home they live in or the source of funding. We urgently need legislation to close this glaring loophole.”
by:business.timesonline.co.uk

Asbestos suit by former BHS teacher settled for $3.8 million

2007-06-22T15:25:00.000-07:00

BLOOMINGTON — A former Bloomington High School teacher who died in March received about $3.8 million in settlements from an asbestos lawsuit filed last year, according to documents filed in McLean County Circuit Court.

Daniel Malcolm and his wife, Nancy, agreed to settle claims against several defendants, including Pneumo Abex Corp, a manufacturer of asbestos.

Malcolm was a Bloomington High School teacher from 1968 to July 1994 and worked at a foundry at Caterpillar’s East Peoria plant from June to August 1964.

The complaint filed in May 2006 states that Malcolm was exposed to asbestos at the school and foundry assignments. That same year, Malcolm was diagnosed with mesotheloima, a disorder commonly linked to exposure to asbestos.

The settlement agreements allocate a portion of the funds to Malcolm’s wife, who has been obligated for her husband’s medical expenses, said court documents.
by:www.pantagraph.com

Former UTSW doc files whistleblower suit against med school

2007-06-22T15:24:00.000-07:00

A former division chairman at the University of Texas Southwestern Medical Center at Dallas is suing the school, alleging he was retaliated against for voicing concerns about residents performing unsupervised procedures on Parkland Hospital patients.

Dr. Larry Gentilello was chairman of the division of burn, trauma and critical care at UT Southwestern and held the C. James Carrico MD Chair in Trauma. Gentilello, in a lawsuit filed last week in a Dallas County District Court, said he was removed from both positions after voicing concerns about what he felt were violations of Medicare and Medicaid rules. The lawsuit was filed under Texas' whistelblower act.
John Walls, assistant vice president for public affairs at UT Southwestern, declined to comment on the allegations because of pending litigation.

According to the lawsuit, Gentilello observed that UT Southwestern trauma residents were performing surgical procedures on patients at Parkland Hospital without the supervision of attending trauma surgeons.

"The patients at Parkland typically consist of indigents and are primarily minorities," according to the suit. "On the other hand, when patients are being treated at Zale Lipshy, attending physicians are present at the time that the patients are treated and during the time that surgical procedures are performed. Of course, the patients at Zale Lipshy are not indigent."

Parkland Hospital declined to comment on pending litigation. The hospital was not named in the suit and is not accused of wrongdoing in the lawsuit.

In March, he received a letter from a UTSW official, Dr. Robert V. Rege, saying he was being stripped of his chair positions. Rege sets the policies regarding presence of attending physicians during surgery and had the power to investigate the allegations, the suit contended.

Gentilello said in the lawsuit that he believes he lost the positions because he reported the "illegal patient care and supervisory" practices he observed.

by:jsjordan@bizjournals.com | 214-706-7106

St. Jude Medical Receives European Approval to Sell OptiSense Pacemaker Lead

2007-06-22T15:20:00.000-07:00

ST. PAUL, Minn. (AP) -- Heart device maker St. Jude Medical Inc. said on Friday it received European approval to sell its OptiSense pacemaker lead.

Pacemaker leads are the thin wires that deliver and sense electrical impulses from the heart.

The OptiSense lead is designed to allow more accurate sensing of the heart's upper chamber, or more specifically, the right atrium, and to block out signals from the heart's lower chambers, according to the company.

The greater sensitivity allows doctors to be more accurate and flexible in programming the pacemaker to suit the patient's needs, the company said.

St. Jude shares fell 62 cents, or 1.4 percent, to $42.80 in afternoon trading.

Questions or comments about this story should be directed to Wallace Witkowski of AP Financial News at 212-621-7190.
by:biz.yahoo.com

Abortion procedure caused death, lawsuit alleges

2007-06-22T15:18:00.002-07:00

The mother of a Riverside woman who died of toxic shock syndrome after allegedly undergoing an abortion procedure at Planned Parenthood filed a malpractice suit against the organization and a Riverside County hospital this week.

The lawsuit alleges that Edrica Goode, 21, went to a Planned Parenthood clinic in Riverside for an abortion Jan. 31 and that a nurse inserted cervical dilators, used to gradually expand the cervix in preparation for second-trimester abortions, despite the fact that Goode had a vaginal infection.

The dilators, which are shaped like small sticks and consist primarily of seaweed, became a conduit that spread the infection to the rest of her body, the lawsuit alleges.

Goode, a Riverside Community College student who enjoyed traveling and reading, died Feb. 14.

"My daughter made a choice, but she didn't choose to die," said Aletheia Meloncon, Goode's mother, who said her daughter hadn't told her she was seeking an abortion. "A lost dog gets more attention than my daughter did. This has really torn at my family."

Goode did not return to the clinic to have the dilators removed, even though the devices are supposed to stay in place only one or two days, the lawsuit states.

According to Goode's patient profile at Planned Parenthood, which is in her mother's possession, Planned Parenthood mailed two letters to Goode stating the dilators needed to be taken out.

But Meloncon said the family never received the letters. She also contends that Planned Parenthood should have taken more aggressive steps to contact her daughter.

Vince Hall, director of communications for Planned Parenthood of San Diego and Riverside counties, said his office could not comment on pending litigation. But he said that the "health and safety of our patients is our highest priority."

Planned Parenthood bills itself as the "nation's leading sexual and reproductive healthcare advocate and provider." Its services include abortion procedures; emergency contraception; screening for breast, cervical and testicular cancers; and counseling.

Goode's is the third known death among Planned Parenthood patients in California in the last four years. Holly Patterson, 18, of Livermore, Calif., died of an infection after a nonsurgical abortion in 2003. Diana Lopez, a 25-year-old Huntington Park woman, bled to death a year earlier after her cervix was punctured during the procedure.

Meloncon's lawsuit was filed in Riverside County Superior Court on Tuesday.

After the dilators were inserted, Goode began to experience fevers and started vomiting, Meloncon said. She became mentally unstable, not knowing what the day was and acting aggressively, her mother said.

The dilators are meant to stay in place over one night, and the abortion usually occurs the following day.

With her condition deteriorating, Goode was taken to Riverside County Regional Medical Center in Moreno Valley on Feb. 4.

A hospital blood test confirmed that Goode was pregnant, and Meloncon said she asked that a pelvic examination be performed. The hospital, the lawsuit contends, said it couldn't perform one because Goode would not consent.

"She was confused and disorientated," Meloncon said. "It was totally out of character for what her behavior normally is."

After staying in the medical ward five days, Goode was transferred to a psychiatric unit and then immediately returned to the medical ward, the lawsuit contends. Before the transfer, the lawsuit states, Goode received a gynecological consultation, but no pelvic examination was performed to remove the seaweed sticks.

"If it wasn't for the negligent medical care that Edrica Goode received, she would be alive today," said Jack M. Schuler, Meloncon's attorney.

A Riverside County Regional Medical Center spokesperson said the hospital could not comment on a pending lawsuit.

After Goode returned to the medical ward, her condition continued to deteriorate, Meloncon said. The hospital, she said, performed a pelvic examination Feb. 13 and found the seaweed sticks and gauze. Goode had a miscarriage that day and died the next.

A Riverside County coroner's report listed the causes of death as toxic shock syndrome, prolonged retention of laminaria cervical dilators and intrauterine pregnancy.

"They need to do things different so that patients won't be in risk of great injury or death," Schuler said.
by:www.latimes.com

Mother blames Riverside abortion procedure for daughter's death

2007-06-22T15:18:00.001-07:00

The mother of a woman who died after a Planned Parenthood abortion procedure filed a lawsuit blaming malpractice for her daughter's toxic shock syndrome death.

Aletheia Meloncon filed the Superior Court lawsuit this week, claiming her daughter Edrica Goode, 21, died Feb. 14 because cervical dilators used in advance of second-trimester abortions were left in too long.

Goode allegedly went to a Planned Parenthood clinic in Riverside for an abortion on Jan. 31 and a nurse inserted the dilators, which are usually left in overnight before an abortion.

The suit said Goode, who didn't return to the clinic to have the dilators removed, had an infection and the dilators became a conduit, spreading it throughout her body.

"My daughter made a choice, but she didn't choose to die," Meloncon said. "A lost dog gets more attention than my daughter did. This has really torn at my family."

Planned Parenthood mailed two letters to Goode stating the dilators needed to be taken out, but Meloncon said the family never received the letters. The woman said Planned Parenthood should have been more aggressive in contacting her daughter.

Vince Hall, director of communications for Planned Parenthood of San Diego and Riverside counties, said his office could not comment on pending litigation.

With her condition deteriorating, Goode was taken to Riverside County Regional Medical Center in Moreno Valley on Feb. 4. A blood test confirmed Goode was pregnant, and Meloncon said she asked that a pelvic examination be performed.

But the hospital said it couldn't perform one because Goode would not consent, the suit said.

"She was confused and disorientated," Meloncon said. "It was totally out of character for what her behavior normally is."

The hospital performed a pelvic examination Feb. 13 and found the dilators. Goode had a miscarriage that day and died the next, the lawsuit said.

The hospital also declined comment because of the pending lawsuit.

The coroner's office listed the causes of death as toxic shock syndrome, prolonged retention of laminaria cervical dilators and intrauterine pregnancy.
Information from: Los Angeles Times, http://www.latimes.com

Malpractice lawsuits are lawyer's cup of tea

2007-06-22T15:17:00.000-07:00

Jeffrey A. Walker, who made partner at Snyder, Walker & Mann in 2004 at the age of 33, has made a name for himself as an up-and-coming trial defense attorney, winning as lead counsel in a number of complex medical malpractice disputes.

Walker has been fascinated with various aspects of the medical profession ever since his college days, although he opted to pursue a legal career rather than attend medical school. Of particular interest, Walker has handled and tried multiple cases involving cardiology and gastroenterology issues.

His experience is broad in the area of medical malpractice, managing a diverse caseload of medical matters also involving related claims of fraud, elder abuse, premises liability, indemnity and medical devices. In addition, he has handled general liability cases that involve disputes over property ownership, premises liability, catastrophic injury, trucking liability, E&O coverage disputes, regulatory defense, breach of contract and legal malpractice.

Walker graduated from Southwestern University School of Law in Los Angeles in 1995 with a juris doctorate. In 1992, Walker completed his undergraduate work at the UC Riverside, where he earned a bachelor's degree in economics and a minor in psychology.

Walker is a member of the Association of Southern California Defense Counsel, the Defense Research Institute, the Southern California Association of Healthcare Risk Management and the Professional Liability Underwriting Society. He is also a member of the Riverside, San Bernardino and Los Angeles Bar Associations.

Walker sat down for Six Questions with Business Editor Michael Rappaport this week.

Question: Doctors are spending huge amounts on malpractice insurance. What effect is this having on certain specialties, such as obstetrics?

Answer: Unfortunately, higher insurance premiums are becoming commonplace even for nonspecialized practices.

For higher-risk practices, such as obstetrics, the impact of higher premiums has placed a heavy burden on specialists, leaving those doctors feeling: (1) like they don't want to specialize any longer; (2) that they need to be more selective about where to practice and what patients to accept (which works against higher-risk and HMO patients); and (3) resentful about paying so much to protect themselves.

Q: People seeking tort reform sometimes overestimate the cost of lawsuits on medical care. What is the significance of litigation in the overall picture?

A: Litigation can be costly, burdensome and an extreme deterrent. Litigation is a necessary evil, as most claims can, and should be, challenged through our legal process.

There are premium increases related to claim frequency, reporting mandates to state boards and federal databanks, and "reputation" damage for those in repeated or drawn out litigation.

In turn, litigation leads to fear, fear leads to premature, excessive or unnecessary settlements, and payouts and litigation costs become a focal point for promoting tort reform.

Q: Your mission statement talks about "cost-effective" defense. What do you mean by that?

A: SWM provides a "cost-effective" defense by having a streamlined litigation team assigned to each matter, a working expertise with the medicine, being heavily invested in technology to accomplish tasks faster and with greater precision, and by ensuring that the firm's successes are measured solely by what is in the client's best interest.

We believe in forming partnerships with our clients for every step in their defense, thus developing effective strategies early on in the process, and determining whether cases need to be settled versus tried.

Q: How have people changed as far as their willingness to sue over bad outcomes?

A: It has been my experience that litigation over "bad" outcomes has, and will always be, heightened where one of three scenarios exist.

First, a sense of not understanding what happened and no one willing to answer the tough "what," "how" and "why" questions; second, the grieving process can be so overwhelming that comprehension of the outcome is virtually impossible to fathom; and third, having a sense that none of the providers cares about or acknowledges the loss or bad outcome.

When one or all three exist, the willingness to sue is far greater.

Q: What's the toughest sort of malpractice case for a jury to understand?

A: In my experience, the tougher cases for a jury are those when the emotions or sentiments of a case are far easier to relate to than a technical medical procedure or treatment.

What sounds "reasonable" to a jury years later in retrospect is not always what was necessary, prudent or even recommended years before at the time the care was rendered.

Today's society is far more skeptical, and is much more willing to accept that which is familiar ("that sounds about right") versus what a doctor or expert will testify to is actually done in the medical trenches.

Q: How do we solve the problem of high malpractice insurance costs while still protecting patients from bad doctors?

A: If I had the answer to this question, I could easily claim my seat in Congress. Simply put, there is no clear answer.

Malpractice costs are costly being balanced with supporting our health-care community, offering quality treatment to patients, and trying to weed out the bad apples.

Insurance companies do reward "good" physicians with reduced premiums and rebated renewals. There are also a growing number of high-risk insurance organizations for high-risk doctors, which require the insured to carry high SIRs (self-insured retentions), thus requiring the riskier doctor to pay for some of any judgment or settlement.

These types of retention groups may be a way to contain malpractice costs by segregating those health-care providers deemed to be higher risks.
by:www.dailybulletin.com

$7.7M settlement in malpractice suit

2007-06-22T15:15:00.000-07:00

MORRISTOWN: A 23-year-old Sussex woman who is a paraplegic due to an unde tected spinal tumor won a $7.7 million settlement yesterday in a medical malpractice lawsuit, her attorney said.

Cindy Hotalen's case was about to go to trial before Superior Court Judge Thomas Harper in Morristown when the parties reached the settlement, said Jeff Korek, the Englewood attorney who worked on the case with his associate, Michael Fruhling.
The defendants were: Radiologic Associates of Northern New Jersey and Pennsylvania; Matthew T. Skalla; Neuro Specialists of Morris-Sussex; In fanta A. Stephen; the Orthopedic Center; Mark Rieger, Spine and Orthopedic Center of New Jersey and doctors David Basch, Allan L. Gardner and Eugene Hrabarchuk, according to court papers.

In 2001, Hotalen, then 17, went to a physician complaining of numbness in her right leg. Radiologists misread her MRI, Korek said. The MRI report followed her over the next two years as she sought help for her condition, Korek said.

She finally was diagnosed with the tumor in 2003, after another MRI was performed. Over the years, the condition worsened and she is now ex pected to be in a wheelchair for the rest of her life, Korek said.

"Anyone who doesn't understand why there should not be curbs on malpractice suits should look at this case," Korek said.

The tumor, had it been de tected early, had a 95 percent cure rate, he said.

Public rallies around

abused 'bait' dog DENVILLE: The township's animal control officer has received phone calls from more than 60 people offering to provide a home or foster care or contribute toward the medical bills for a dog found on the side of Route 10 last week.

Authorities believe Benson -- named for a police officer who helped retrieve him -- is a greyhound and Labrador retriever mix and was used as a bait dog to train other dogs to fight. He was covered with more than 50 old and new bites, police said.
by:www.nj.com

Soroka ER doctors found negligent in two medical malpractice cases

2007-06-22T15:14:00.001-07:00

Two recent rulings by the Be'er Sheva Magistrates Court reveal medical malpractice at Soroka Medical Center's emergency room.

In one case, an emergency room doctor told a patient with a transplanted kidney to take a medication that severely damaged the kidney, although the patient himself warned the doctor against giving him the drug and begged him to consult a specialist.

In the second case, a Soroka emergency room physician who was treating a woman for facial injuries left pieces of the patient's teeth embedded in her tongue, which were discovered only months later.
Judge Tahar Shahaf handed down the verdicts in a civil suit brought by the patients against the Clalit Health Maintenance Organization, which operates Soroka. The judge criticized the doctors harshly and last week awarded NIS 100,000 in damages to the kidney patient, including damages for pain and suffering, emotional distress and fear of losing the kidney. Two weeks ago, the judge set damages for the woman with the injured face at NIS 80,000.
The 47-year-old transplant patient, from southern Israel, received a kidney from his sister about a decade ago. In September 2001, he went to the Soroka emergency room complaining of back pain. He informed Dr. Yefim Shot, who examined him, that he had a transplanted kidney.

Shot recommended that he take the anti-inflammatory drug Vioxx. The patient told the doctor that he had been instructed not to take medication of this type. According to his lawyer, Dr. Shai Feuerberg, the doctor responded "impatiently and even rudely" and "was angry at the patient," who asked him to consult a kidney specialist. In fact, after taking the medication, the patient suffered muscle and joint pain, fever, weakness and chills, and considerable damage to the kidney was diagnosed.

He was hospitalized in December 2001 and was told that he would have to go back on dialysis and prepare for another kidney transplant. Eventually, however, the transplanted kidney began to function again.

The judge said the doctor had violated "all the proper rules" and standards expected of an emergency room. She rejected Shot's argument that he only suggested that the patient take the medication and advised him to consult his family doctor first.

Soroka responded that "the hospital is studying the verdict and considering its steps," but noted that the court determined that there was no damage to the kidney.
The woman who sustained injuries to her face had fallen down the stairs in her home in Rahat, near Be'er Sheva. She was treated in the emergency room by Dr. Ella Even-Tov, who at the time was in her first year of residency in ear, nose and throat medicine. The patient was diagnosed with a cut to the tongue and was prescribed mouth rinses and painkillers. However, she continued to suffer pain and complained of a strange feeling in her tongue. A few months later, it was discovered that two tooth fragments, which had not been discovered during her initial treatment, were embedded in her tongue. The woman said that she suffered neurological damage to her tongue.

The court determined that the treatment the woman received in the emergency room was "negligent and insufficient." Even-Tov, she noted, "did not see fit to carry out primary, urgent and necessary tests," such as an x-ray, which would have caught the problem in time; nor did she refer the patient to the hospital's mouth and jaw clinic.
Even-Tov told the court that she did not refer the patient to the clinic because if she did so with every patient who suffered cuts to the tongue, the clinic would be overloaded. She also said that if foreign bodies like teeth are not identified by tests in the emergency room, "a lot of energy and public money should not be wasted" in locating them, "because they can't cause many problems"

In her ruling, the judge said that Even-Tov's statements were "unacceptable and insufferable" and that "in retrospect, at the forefront of the doctor's mind was not the good of the patient, but rather that of the system employing her." The judge also said that the Clalit HMO physician in Rahat, Dr. Nasri Yusef, had been negligent in not refering the patient to a specialist earlier.
Soroka said that it intended to appeal the ruling, since according to the information in its possession, the damage to the patient was entirely caused by the fall and not by the medical treatment she received.
by:www.haaretz.com

Delta Opens Medical Malpractice, Professional Liability Division

2007-06-22T15:13:00.001-07:00

Delta General Agency announced the formation of a professional liability division with specialized focus on medical malpractice coverage. The company has tapped Marla Timmons, senior health care and professional liability broker, to lead the division.
Timmons will be based in Houston and guided by Dave Van Tiem, senior vice president.

Timmons has many years insurance experience and in the last ten years developed significant expertise in the health care segment of the industry. She has worked for several large insurance brokerage firms including Willis, Sedgwick James and Aon. She was also an account executive in the health care division of a large Houston wholesaler.

Prior to joining Delta, Timmons was a senior health care broker for Aon's Healthcare Practice Group. Her responsibilities included marketing primary and excess medical professional liability for hospitals, physician groups, nursing homes, and miscellaneous / allied healthcare accounts.

Timmons has obtained her Associate in Risk Management (ARM), Certified Insurance counselor (CIC), Associate in Surplus Lines (ASLI) and Associate in Insurance Service (AIS) designations. She has been the instructor of several insurance education courses for insurance professional organizations, insurance brokers and a community college.

Medical malpractice risks served by the new unit include: physicians, surgicenters, home health agencies, medical staffing agencies, specialty and community hospitals, medical clinics, imaging centers, and counseling/social service organizations.

Source: Delta General Agency

New rules in malpractice cases

2007-06-22T15:08:00.000-07:00

New rules designed to speed up medical malpractice cases have been established in Madison County.

The changes include a requirement of mediation in malpractice cases, as well as the appointment of a panel of circuit judges to review those cases.

The changes, announced by Chief Judge Ann Callis Monday, were created by the Medical-Legal Committee formed during the spring to address malpractice issues.

The rules were formed after the committee met with a number of people, ranging from members of the Illinois State Medical Society and representatives of local hospitals to a number of attorneys.

Under the new rules, the court will hold a case management conference in which deadlines for depositions, as well as other legal matters and possible settlements, will be addressed.
Allmedical malpractice suits will have to go into mediation within 90 days of the completion of depositions. A circuit or associate judge not assigned as the trial judge will act as a mediator, unless all involved agree to an alternate mediator.

All parties must attend the mediation sessions and must "act in good faith," and a report from the mediator will be sent to the trial judge.

All medical malpractice suits must also be reviewed by a panel of circuit judges. The Medical Malpractice Review Panel will include Circuit Judges John Knight, Barbara Crowder, and David Hylla.

For all medical malpractice suits involving incidents prior to Aug. 25, 2005, if the court grants a motion to dismiss without prejudice - meaning the case may be refiled - due to procedural issues involving a certificate of merit, the plaintiff will have 45 days to file an amended certificate of merit.

The certificate, which is usually filed at the same time as the lawsuit, but not always, is a document from a doctor saying that the suit has merit.

"The new rules are designed to get them settled without a trial," said Hylla, who chaired the committee. "I think it's going to be very beneficial as long as both parties come to the mediation and bargain in good faith.

"We're very optimistic," Hylla said. "Our goal is not just to push cases, our goal is for just results."

He noted that the mediation will be beneficial for both sides in malpractice suits, in part because of the expense involved because of expert testimony and other matters.

Hylla said the idea of mediating such lawsuits is becoming more common.

"It's going to take a while to see how mediation will go," he said. "(Medical malpractice) is a relatively small percentage of the cases we have, but they are important cases.
by:edwardsvillejournal.stltoday.com

Patient claims surgery increased back pain

2007-06-17T18:52:00.000-07:00

Johannes Quelle has brought a medical malpractice lawsuit against Dr. Robert Phelps, claiming the physician failed to perform the "normal procedure" on him.

Quelle filed his original petition with the Jefferson County District Court on May 31. Judge Bob Wortham, 58th Judicial District, will preside over the case.

According to the plaintiff's petition, Quelle had a history of back problems and back surgeries. He was complaining of pain following one back surgery and on June 9, 2005 another surgery was performed.

"Dr. Phelps violated the duty of care ... and was negligent during the course of the treatment given to plaintiff on June 9, 2005," the suit said.

The suit faults Dr. Phelps with the following acts of negligence:

* The standard of care for Defendant would require that he be knowledgeable on intrathecal narcotic pumps and possible complications related to the pump and how to treat them. Defendant was not knowledgeable in this area of medicine.

* The defendant performed surgery upon the plaintiff wherein he severed and removed a portion of the intrathecal narcotic catheter, which was not the normal standard procedure when treating a small seroma.

* The seroma was not life threatening and the defendant should not have operated on the Plaintiff for there was no medical emergency reason to do so.

* Given the history of the plaintiff, the defendant, upon examination and finding a small seroma on plaintiffs back, should have referred the patient back to the original physician.

As a direct and proximate cause of the defendant's negligence, plaintiff was caused to endure pain and suffering and further surgical procedures," the suit said.

"Consequently, the plaintiff has never gotten the same pain relief as before and continually suffers from low back pain and leg pain. Prior to the Defendant removing the intrathecal catheter or a portion thereof, plaintiff had pain relief approaching 80 percent," the suit added.

Quelle is suing for past and future medical expenses, mental anguish and physical pain.

"Plaintiff alleges that the above-captioned incident injured his body as indicated above," the suit said. "In the event the evidence shows that there was any pre-existing problems with any of these parts of his body, then plaintiff alleges that the incident aggravated and/or exacerbated any such pre-existing condition or problems."

Quelle is represented by Gerald Eddins of the Eddins & Bennett Law Firm. He is demanding a trial by jury.

Case No. A179-412
by:www.setexasrecord.com

Melanoma patient wins malpractice suit

2007-06-17T18:49:00.000-07:00

DOWNTOWN SAN DIEGO – A terminal skin cancer patient whose doctor missed his symptoms has won a $5.7 million malpractice judgment from a San Diego Superior Court jury.
Under a 1975 law, the money Regis M. Reilly and his wife actually stand to collect will be reduced to about $2 million, his lawyer, N. Denise Asher, said Wednesday.

Beyond the money, the verdict, delivered last week, is significant because “my clients can hear someone tell them that they have heard them and they understand,” Asher said.

“This was a particularly wicked cancer,” Asher said. “It grew very fast and it needed to be caught immediately.”

Reilly, 54, said in his lawsuit against dermatologist James C. Powers that the doctor failed to biopsy a cyst when Reilly went to see him for bumps on his shoulder in August 2006.

“Essentially, the doctor just missed it,” Asher said.

By the time Reilly was referred to another doctor in December, Asher said, the cancer had spread. She said Reilly underwent surgery to remove the cancer from his shoulder three times but it had metastasized to other parts of his body and was determined to be terminal.

Had the cancer been caught in its early stages, Asher said there was a 95 percent chance that Reilly would have recovered. He is now confined to his home and receives 24-hour care.
by:www.signonsandiego.com

Judie Rappaport: My 87-year-old dad wears a Speedo in public; it's embarrassing!

2007-06-17T18:45:00.000-07:00

DEAR JUDIE: My 87-year-old Dad is wearing a Speedo bathing suit at his condo pool because his new girlfriend (88) thinks he looks sexy! Are they crazy? I'm mortified. What can I do to end this humiliation?

Celeste, Vero Beach
DEAR CELESTE: End your embarrassment by staying out of Dad's pool area. This is not about you. Dad's bathing suit is within legal limits, he's wearing the proper attire for a pool, and he's enjoying his life.

DEAR JUDIE: When I found out my favorite 81-year-old uncle had terminal cancer, I immediately went to Pennsylvania to help. My aunt, 80, has her own health issues and was glad to see me. She was always there for me when I needed her and I wanted to return her love by relieving her of the responsibility of taking care of my uncle. After I set up live-in home care, called Hospice, went grocery shopping, cleaned, cooked — everything I could think of — my aunt changed from nice to cool and resistant to my help. What happened?

Penny, Stuart

DEAR PENNY: I can hear readers saying, "I could use help, Penny, come to my house!" If they actually expressed those feelings, that would constitute an invitation. Taking charge of your uncle's needs was your aunt's domain. Unless she invited you or agreed to your help before your visit, your loving and well-meant reaction must have felt like an invasion of her privacy.

Call your aunt and apologize. Tell her how much her love and kindness meant to you through the years. Show your love and respect by asking her permission, "Can I help?" If she declines, say you love her and not to hesitate to call if she needs help or just wants to talk. Send cards, write warm letters, and call her frequently to respectfully repeat your offers and expressions of love.

DEAR JUDIE: I'm concerned about Mom's care in her nursing home. She's fallen twice, amazingly with no damage, but I don't think she should be falling at all. What's my next step?

Phil, Stuart

DEAR PHIL: Accidents happen, but falling twice suggests problems. Visit the director of nursing and ask for details: Where was the fall? Who found her? Could Mom's medications cause dizziness? Who examined her to determine whether she was injured? What was the cause of her fall? Has the staff made arrangements to prevent another fall?

Ask to attend the patient care conference (staff meeting to discuss Mom's plan of care). Keep records of the dates you visit, whom you talk to, questions asked, answers given and other problems witnessed or discussed. If the nursing home refuses to answer your questions or Mom falls again, file a formal complaint with the Agency for Health Care Administration at (888) 419-3456 (www.ahca.myflorida/com/contact). Your written record will help. Stay involved. Supportive family members often help improve the level of care for nursing home patients.
by:www.tcpalm.com

Man Leading Nation in $10 Billion Suit On Behalf of America’s Fathers Speaks Out!

2007-06-17T18:41:00.000-07:00

The poor poverty stricken man who is pursuing a $10 Billion Civil Suit against the State of Oregon, the Federal Government and 49 other States on behalf of himself as lead plaintiff and hundreds of thousands of fathers across the nation has given this author permission to publish his account of his current circumstances for the public record.

“On May 13th, 2007 I got a letter from an attorney who I paid $100 to review my case. The first attorney who reviewed my case over the phone without any documentation also charged me $100. The first attorney referred me to the second attorney. The second attorney consulted with a third attorney more her superior and qualified to deal with my “complex” case.

"The letter dated May 7th, 2007 included a copy of the original letter sent from the same attorney who had not responded since getting paid the $100 for more than a month.

The original letter was dated April 24th, my 51st birthday which I spent alone crying for several hours on the shores of the Pacific Ocean in Venice Beach because I have not been able to see my two minor children, age 5 and 11 for more than three years.”

Originally the father had contacted the law firm just to get child visitation rights established by getting a court appointed attorney for the children who live in Eugene, Oregon.

The mother, over the past 13 years has had the man arrested on at least five occasions on false charges given to various local police, mostly after arguments about money and how to discipline the children.

Some of those charges included a felony which the father pled no contest to but which prevents the father from getting a job as a licensed real estate sales person in California, a profession in which he was successful prior to moving to California. A hearing with the State of California is set for August on that issue.

A no contest plea is treated the same as pleading guilty and usually avoids lengthy and costly trials, but leaves a permanent record on any mans life, barring him from many rights and opportunities, something which isn’t always explained by lawyers and judges to those accused of things they didn’t really do.

After much patient waiting by the father, the law firm finally wrote him a letter stating that in order for the law firm to represent him, he had to agree to authorize them to file a motion to appoint Robert Loveland or some other qualified psychologist to conduct a comprehensive custody evaluation for the purpose of generating a comprehensive custody and parenting time recommendation pertaining to the father, the mother and his two minor children,.

The letter stated that the law firm would prefer to use Dr Loveland who works out of Portland but provided no information about him, his practice or his qualifications. The letter went on to state that there are a few other qualified psychologists in Eugene who would also suffice. Their fees range from $4,000 to $6,000 and the father would need to pay that up front, directly to the psychologist.

It is a well documented fact that “the psychiatric profession is made up of more quacks and idiots than all the mental institutions in the world combined, their pseudo science is full of jargon not even a rocket scientist could fathom, and psychology is nothing more than the brainwashing gibberish that lists more than ten thousand ‘mental disorders’ that only exist as idea’s and concepts in the minds of the people who invented them and who perpetually and ignorantly foist their pseudo knowledge and phony wisdom upon the unsuspecting victims erroneously seeking their help”, at least according to the philosophy of Scientology – “The Science of Knowing How to Know”.

Unfortunately, the mental health profession leaves much to be desired for society. If it really were a mental health profession, we would have no crime, no war and no insanity, or at least these things would be diminishing in the world rather than expanding.

Any human being who looks around at current planetary conditions could easily see from doing a tiny bit of research that the psychiatric profession has co-opted the legal and justice system in America.

Every lawyer and judge in America has been duped into believing that these “experts” know something about how to improve the conditions of their patients. The exact opposite is true.

Just take a look at how much more profitable drug companies are today than they were thirty years ago. The greatest demand for prescription drugs comes from those written by psychiatrists. And psychiatrists are also the largest direct and indirect stockholders in publicly traded drug cartels.

Without justice, there can be no peace, without love, there can be no peace, without peace there can be no love, without love, there can be no justice, without justice, there can be no love, and there are no absolutes of these things, peace, love, justice, but they are interlocked into triangular degrees of sanity...for as one side of the triangle of peace, love and justice diminishes in power, capacity or application, the other two sides diminish correspondingly, and these three sides of the triangle are the building blocks of a sane civilization.

To the degree that peace, love and justice are blocked in any society, to that degree that society is insane, and there comes a point when insanity reaches a point where that society is doomed. Just ask any Roman, Greek or Babylonian...what went wrong?

The lawyer wrote that they would ask the Court to order the mother to pay some portion of the cost of the psychiatric evaluations, but that request would not be ruled on until the close of the case, so the father would need to front the money.

This case involves complicated histories on both parents’ parts of allegations of drug and alcohol abuse, alleged domestic violence, criminal allegations and convictions, all of them now expunged, etc.

The mental health, domestic violence and chemical dependency issues render this case complex and it would not serve the father or the children to go forward without the assistance of a mental health professional skilled and trained in custody evaluations, all according to the opinion of one attorney and her senior legal partner.

“In general, it is a given understanding among the legal profession that these types of cases are dictated solely by ‘the children’s best interests’ but the complicated circumstances render it exceedingly difficult to flesh that out”, said the lawyer.

The law firm insists that the father resort to a custody evaluation conducted by a qualified mental health professional / custody evaluator. “The ONLY issue before the court in a custody/parenting time case is ‘what will serve the children’s best interests?”, according to the lawyer.

How many psychiatrists does it take to figure out what is in the best interests of a child and what say do the children have in the matter if they wish to see their father regardless of what their mother tells them about him?

According to research conducted online, Dr. Ira Daniel Turkat, PhD says that “Divorce related child visitation interference is a national problem, affecting six million children.

"Such interference may be acute or may represent chronic disorders, such as Parental Alienation Syndrome and Divorce Related Malicious Mother Syndrome. In certain cases, visitation interference is accompanied by vicious behaviors toward the noncustodial parent, including violence and violations of law.”

It would appear that if the children’s best interests were at the real core of all child visitation issues in the current legal system, there would not be six million children crying at night before bed time for their Daddy’s, let alone the six million plus fathers who have been psychologically trained to “bite the bullet, be a man, hang tough, and be strong”, but who suffer great grief from their losses nevertheless, and are currently powerless to enforce their rights as fathers and men.

The psychologist would meet and observe the father, the mother, and the children, any other significant people in the children’s lives, which in this case includes an alcoholic grandmother who is financially supporting the mother who is on welfare and who works for another law firm in Eugene.

The psychiatrist would have numerous interactions with the parties and the children; he would sift through and investigate all the allegations and circumstances. The father would need to fly up from Los Angeles to Eugene at least 3 times for that purpose.

That could prove difficult for a man who himself is now on food stamps, is collecting unemployment and is on the waiting list for surgery at UCLA Medical Center involving three hernias and other internal complications which have caused internal bleeding on and off for the past five years. The man is very close to being permanently disabled.

The lawyer went on to say they would file a motion to set a hearing to occur about 21 days from the date of filing to establish a temporary parenting time / access plan for the father and the children.

This would moist likely result in initial supervised parenting time for the father. In light of the history of this case, most critically the fact that the father has been out of the children’s lives for so long, even assuming that it is on account of mom’s bad behavior, and the fact of alleged abuse, and the fact that the father has filed numerous, lengthy and somewhat renting pleadings on his own behalf in the State and Federal court system, the judge’s will be likely to err on the side of caution when it comes to assessing the father’s emotional and mental stability.

This all according to the attorney who is too obviously also a woman.

In other words, if you file renting complaints using the Court system without an attorney your emotional and mental stability are in question? Could only a woman could come up with that kind of logic, or is this ingrained within the legal profession – “if you need a lawyer you are mentally incompetent”.
“What the father and half the men in this country are not aware of is that if you hire an Esquire, a member of the BAR, you are basically stating and admitting to the court and the world that you are mentally incompetent and unable to represent yourself before society on the particular case in question, according to Master of Psychology drop out, Karl Chromy of Portland, Oregon. Chromy studied psychology for twelve years at Portland State University and never graduated.

After becoming a professional psychology student he eventually became permanently disabled after a hockey accident. Is there any connection between accidents and psychiatrists? Another story indeed!

In this instance, according to the attorney, parenting time would realistically need to begin on a supervised basis, but with the assistance of parenting time supervisors and several successful interactions between the father and his children, parenting time would likely expand, hopefully in fairly short order. Why does a father need supervised visits when the mother and grandmother kidnapped his children and haven’t allowed them to see their father for over three years?

The lawyers say they know a good supervisor in Eugene and told the father he could fly up from Los Angeles twice a month or more to visit. There is only one crime in America. That crime is not having enough money to take care of your own personal business affairs and satisfy your personal needs.

Unfortunately the true criminals who create scarcity in this world – the Bankers and the Lawyers – are the ones in control of the global economy, so is it any wonder that well over $50 billion is now owed in back child support by more than a million hard working fathers from the 50 states? After all, 99.99% of Congress is composed of lawyers.

The lawyers said that “after a few months, they would seek to release the supervision requirement and expand the visits. If you impress the evaluator, you could anticipate less frequent, but lengthy visits in California, to coincide with your kids’ academic breaks”.

So if all courts deal in the best interests of the child then why would anyone need to impress an evaluator? Why would the BAR be set so high that it excludes 95% of all hard working men from seeing their children by creating an invisible tax of unaffordable legal services?

The children always know the truth deep inside – they already know who really loves them from a distance, like God might admire his children and let them make their own mistakes, and they also know who tortures them with daily doses of verbal abuse and lies. The dichotomy is real! It is mothers who raise most men in this country. The women’s movement has seemed to have forgotten that fact.

Unfortunately, according to Dr. Turkat “the desire for ongoing and liberal visitation between child and nonresidential parent has frequently not kept pace with actual practices. The Children's Rights Council (1994) estimates that six million children in the United States have their visitation interfered with by the custodial parents.

“Two surveys support the range of this problem. Arditti (1992) reports that approximately 50% of divorced fathers relate that their ex-wife has interfered with visitation with their offspring. Similarly, approximately 40% of custodial mothers admit denying their ex-husband visitation in order to punish him (Kressel, 1985). In some cases, visitation interference has been associated with malicious unlawful acts against the father of such children (Turkat, in press). On rare occasions, a parent may actually kidnap the child.”

Kidnapping is defined as when “A child was taken in violation of a custody agreement, court order or decree, the kidnapper failed to return a child at the end of a legal or agreed-upon visit, with the child being away at least overnight. An attempt was made to conceal the taking, or the whereabouts of a child, or to prevent contact with the child. The child is transported out of state, or there is evidence that the abductor had the intent to keep the child indefinitely, or to permanently alter custodial privileges,” according to the Federal Bureau of Investigation.

In this particular case the woman took the children from Reno without the father’s knowledge after the woman found out through confidential emails with business associates that the father intended to divorce the mother and give her $2.4 million as a settlement of their marriage thereafter.

Where that money was to come from is a whole different story, perhaps even a book or a movie. It took the father three months to find the children living with the children’s grandmother in Eugene, Oregon. The woman abandoned the home in Reno.

In 2008, there will be an estimated 5 million divorces, affecting more than 5 million children. Out of those families that are being broken up by a financial, economic and legal system that destroys incentive and continues to ship jobs overseas, while the cost of gas skyrockets at home, on any given day, at least 1,000 children will be taken away from the other parent without their knowledge and kidnapped away according to the National Crime Information Center.

There are more than 40 million children in America today, living with a single parent who is separated, or divorced. In 2008 there may be more than 2 million additional new divorces as millions of families lose their homes to foreclosures from the housing depression that is well underway and could last another decade.

150,000 divorces a year, or 1 in 7 involve child custody battles. Today’s average marriage will last about five years. Single-parent families have increased by over 1000% since 1960 as have divorces.

Not politics, law nor religion have provided an effective antidote to this spreading social disease.

The lawyers told the father that he would need to deposit $2,500 into their client trust account. Can anyone really trust bankers and lawyers these days?

“In light of our review of your financial history and circumstances, we are not willing to proceed with less than that up front. With a custody evaluator on board, however, that really minimizes, potentially, the amount of work that the attorneys have to do. At any time that your trust account balance fell below $1,200, you would need to deposit an additional $500 within one week of being so notified,” wrote the lawyer to the poor father.

There is only one thing worse than being insane. That is “not knowing” that you are insane. The court system that the legal profession has dreamed up and foisted upon the fathers of America is insane and they do not know it, but fathers all over the country do and they will eventually do away with the entire lot in the process of seeking justice.

As a homeless man once wrote in a poem written for a song for a soundtrack of a yet to be finished major screen play, “The Bankers and the Lawyers they all fall down”.

A group of people in California known as Fathers for Justice are now in discussions to form a legal offense fund to change the laws and mandate equally shared parenting time, regardless of the circumstances surrounding disputes among couples and their legal separation issues. Their recent support of Alec Baldwin at a rally for father’s rights was very well publicized elsewhere.

Another group out of Indiana is moving forward with their class action lawsuits in each state of the union. To demonstrate how insane lawyers and politicians have become, the following story should give the reader a tiny peek into absurdity.

According to Glenn Sacks, “It would be difficult to make California's controversial domestic violence policies more irrational and unfair to men, but Senator Sheila Kuehl (D--Santa Monica) is trying.

“California law has long excluded men and their children from receiving state-funded DV services, even though research demonstrates that a third of domestic violence-related injuries are incurred by heterosexual males caused by women.

“The legislature reiterated this exclusion last fall by passing AB 2051, which references services for ‘battered women’ 31 times yet never once mentions "male victims," "men," or even simply ‘victims.’

While California funds over 100 domestic violence shelters for women, there are only two facilities in the state which even accept male victims, and both of them are in remote areas.

Recently Kuehl and the California Senate Judiciary Committee took the state's DV policies to a new level of absurdity by passing a law to address the issue of domestic violence and...Pets!

Kuehl's SB 353 amends Section 6320 of the Family Code so that women claiming domestic abuse can more easily gain custody of the family's pets. The bill also allows women to obtain restraining orders which prevent alleged abusers from having contact with their pets.

While legislators focus on protecting dogs, cats, rabbits and hamsters from being exposed to domestic violence, they've failed to offer any services to men, and still the children’s longsuffering weeps, deep into the night, asking, where is my Daddy?

Isn’t it amazing that intelligent people practicing law cannot come up with simpler solutions that are really in the best interests of their potential clients’ children? Is there anything more important to the future survival of the human race than our children?

Has the United States Government, the State of Oregon and many of their attorney’s, employees and agents also become unwitting accomplices in what appears to be a developing story of kidnapping?

This is the third article written by Alex S. Gabor on the subject of individual father’s rights versus the State and Federal Government. A book, “Domestic Family Terrorism” by the same author is in the works, seeking a publisher.
by:www.americanchronicle.com

Lung patient sues for clean oxygen

2007-06-17T18:33:00.000-07:00

Firm says it's never had other complaints
Littleton - Norman "Jack" Newell, 75, who is battling chronic lung disease, has spent a decade trying to get clean breathing oxygen, according to a suit he and his former wife filed in Jefferson County District Court this month.

Jack and Linda Newell allege that Apria Healthcare Group Inc., a supplier of home oxygen breathing equipment, has delivered equipment visibly contaminated with mold and insect parts.

That, the Newells contend, led to additional lung infections and required several trips to hospitals for Jack Newell.

"His immune system can't fight anything off anymore," Linda Newell said. "People expect their medical equipment to be clean, safe and healthy, and it's not."

Apria Healthcare officials said in a statement that they have repeatedly offered the Newells an opportunity to use another supplier of home oxygen, and the couple has refused.

The U.S. Food and Drug Administration inspected Apria's Littleton facility in 2005 and issued no citations, said Lisa Getson, executive vice president of Apria at the company's Lake Forest, Calif., office.

The FDA also inspected the site in 2001 and did find problems, according to a report.

"The facility was not maintained in a clean and sanitary condition," the 2001 FDA inspection document concluded.

The problems noted include:

No tracking mechanism to ensure preventive maintenance was done in accord with company or manufacturer recommendations.

Dirt coating two of 37 oxygen units.

Dirty and torn fiberglass ceiling insulation hanging down over storage areas.

Company staff could not determine if one randomly chosen oxygen unit had been cleaned between patients, the inspectors noted.

The staff claimed they received only one complaint in the previous year, but it "was not the complaint that prompted this inspection," according to the report.

Apria's Getson said only the Newells have complained about the cleanliness of her company's oxygen delivery systems.

"In the 10 years these patients have used our service, Apria has cared for at least 1 million other oxygen patients across the United States, and we have not had any complaints," Getson said.

The company is certified for 18 years by the Joint Commission, a company that evaluates health organizations, Getson said.

Still, Linda Newell said inspections aren't catching problems.

Nine 3-foot-tall oxygen tanks stand to the side of Jack Newell's bed, in the wood-paneled room in which he has spent the past six months.

Linda Newell cleans the oxygen containers with bleach mixtures and sends water condensation bottles through her dishwasher on a sanitize cycle.
by:www.denverpost.com

Fatherly advice from Cape dads

2007-06-17T18:29:00.000-07:00

Being a parent, as almost any mom or dad will tell you, is the single most challenging and important job you will ever have. The hours can be grueling, but the joys can be unsurpassed.

So for Father's Day, we sought out some of the brave men who took on that job and asked what advice they would give to other men about to embark on the most critical task of their lives: becoming a great dad.
We found men with toddlers and ones with grandchildren, some with one or two children and one with five. Their advice varies, but much of it centers on a few key principles: Spend time with your children; savor that time; be there for them; and recognize that life is not about you anymore.

And they wouldn't have it any other way.

Chris Guyette of Hyannis, who has a 15-month-old son and 18-year-old daughter

"Be prepared for big changes! You are going to have another life in your house!�

"You will appreciate the little things in life that you used to take for granted, like taking the time to study your child's face and learn their little quirks. You learn more about yourself and how fast life changes at any given moment. Our son gives us something new to look at every day — a Cheshire Cat grin, a new word. Appreciate those little things, and value every minute, because it is all those little moments in life that will lead him or her to the bigger moment in life when they are adults.

"And those little milestones will never repeat, so keep a scrapbook so you can reflect back when your child is

older. Treat older kids and teens with respect, and understand that each child is an individual, and understand those differences — you have to be a chameleon, changing parenting tactics from child to child to suit their personalities, while being fair and equitable between them all."

Bob Johnson of Centerville, who has four grown daughters and two grandchildren

"My kids and family always come first, and I never treat one daughter better than the others. I have always tried to reason with them and explain my decisions, and I think by doing that, we have a very open, talkative relationship. Don't preach to your children, rather talk to them and explain right and wrong.

"Keep them away from drugs, which can destroy their lives.

"My door will always be open to my children, no matter what they have done or what trouble they may be in. I brought them into this world, and it is my responsibility to protect them and provide for them."

n Mark Sundman of Sandwich, who has an 18-year-old son and 14-year-old daughter

"I have always taught my children that the best way to avoid getting into drugs is simply to never try it. If you never try it, you will know for sure that you will never desire it or become addicted to it.

"My children and I are very close, and I think that is because we participate in things together that we like. Many parents go to soccer games or gymnastics but don't actually participate. My son and I love mountain biking together, and my daughter and I are into music (she is in a hand-bell choir, and I am learning the guitar)."

Dan MacDonald of Mashpee, who has two daughters, ages 2 and 3

"Being a father changes your perspective — life is not about you anymore, it is about your kids. You start to enjoy things that you haven't enjoyed in 30 years when you are a dad. You appreciate the small things in life and the absolute joy of watching them grow."

n William Murphy of Brewster, who has four grown sons

"I think that you realize that the world doesn't revolve around you anymore — that your kids come first, and you need to be there for them, no matter what. And you need to realize that your children will follow in your footsteps — they see you as their role model, and so you need to make sure that they are learning from you what you want them to learn. You can inadvertently be a bad role model if you are not careful."

Lee Flanagan of Bourne, who has a 4-year-old son and 2-year-old daughter

"The rewards of being a parent go along with the effort you put in. Be 100 percent involved — don't be a part-time father. Being a dad is not a spectator sport. There is a huge difference between being a 'father' and being a 'dada' — anyone can be a father, but you must really work at it and devote the time and effort to your children to become a dad."

Rob O'Regan of Forestdale, who has a 4-year-old son

"You learn as you go. Being a dad fills up so much empty space that you never even knew was there. I couldn't imagine my life without him. You have to love them unconditionally. Go with the flow, and have rules, but be flexible as well. Do things with them every day, because the time goes by amazingly fast.

"Children make you remember the simple joys of life and how exciting the smallest feat can be."

Steve Tordone of Sagamore Beach, who has a 4-year-old daughter and 2-year-old son

"I am still learning, and it is always a learning process. I never thought I could love someone as much as I do my children. Be patient with your children, and realize that your time is no longer your own."

Justin Bousquet of Mattapoisett, who has a 1-year-old son

"Bringing up another human being is enormous work. Be patient, because when you look back when they get older, you realize it wasn't so hard. You understand more about yourself as a man as well, and you eventually realize that being a dad gets easier as long as you put your children first."

Jeff Allen of West Barnstable, who has an 8-year-old son and 5-year-old daughter

"Sleep while you can, have great patience, and get a good sense of humor. Your life will change, but don't give up your passions — expose your children to your hobbies and what you enjoy. Take them to restaurants and on vacations from the time they are babies, and they will be easy to go places with and do things with as they grow, because they are used to it."

Bernie Milton of Sandwich, who has three grown children and four grandchildren

"You learn patience and moderation. You may get the urge to be really angry, but you must learn to moderate that anger and understand that they

make mistakes. Treat them like adults, even when they are young."

n Gary Cardeiro of Falmouth, who has a 21-year-old son and four daughters, ages 16, 15 and 13-year-old twins

"Be part of your children's lives — go to sporting events, school functions — it will run you ragged, but you will never regret it."

Steve Pothier of Sandwich, who has two daughters, ages 24 and 21

"Learn patience, and don't be quick to judge them, especially as teens. You need to let them make mistakes, even though it may cause you pain as you watch them learn from their falls."
by:www.capecodonline.com

Focus review: Care in the community

2007-06-17T18:22:00.000-07:00

Healthcare provision in the community is taking shape. Kirsty Osei-Bempong asks how prepared laboratory medicine is for these changes.
The publication of the white paper: ‘Our health, our care, our say: a new direction for community services’ and news that a progress report on the Carter pilots will be available this autumn, serve as stark reminders that the government’s modernisation plan is continuing to take shape.

But how prepared are the clinical and medical laboratory professionals in adapting to these changes? Central to many of the topics discussed at Focus 2007 was the changing and potentially greater role patients could play in managing their health. Presentations from patients during one seminar session provided a novel approach to thrashing out such contentious issues as patient ownership of results, their right to information and the role of the high street in healthcare provision.

“The internet is the inevitable path that pathology is going down,” said Mary Ann Cameron, a lay member of the Royal College of Pathologists, who regularly sources her health information from the web. “And information is going to belong to the patient and be more easily accessible.”

But while this may be true, ensuring the information is of good quality is vital. It is up to clinical pathologists to control and disseminate this, urged Sir Muir Gray, programme director of the UK National Screening Committee and director of clinical knowledge, process and safety for the National Programme for IT, in his opening ACB address. “In the 21st century, knowledge is the key element to improving health. In the same way that people need clean, clear water, we also need clean, clear knowledge,” he said.

Cameron recalled an example of how misleading information impacted on her life. Although three home-kit pregnancy tests she performed came back negative, she later discovered she was pregnant with twins. Doris-Ann Williams, director-general of the British In Vitro Diagnostics Association agreed, expressing concerns over the proliferation of non-regulated tests that are being sold online – opening up potential risks to users. The plethora of misinformation around requires a collective effort by everyone within laboratory medicine to disseminate the right message. Sites such as Labs Tests Online provide an example of how information requests can be managed appropriately.

Even on a day-to-day level, laboratory staff have a unique role to play as knowledge providers. Brigid Stacey, nurse director and chief operator officer at Walsall Hospital NHS Trust, kicked off the patient’s view session by recounting the time when her daughter required medical assistance after exhibiting symptoms linked to cystic fibrosis.

Although it eventually turned out that her daughter did not have the condition, she urged laboratory staff to use their knowledge to help give patients greater understanding of what tests are being performed and why. “You perform these tests day in day out but you don’t realise what it means to us. It’s a really scary time. It’s not an everyday test – for us it’s the future of our lives,” she said.

For some patients like Catherine Goodyear, who spoke about living with Graves’ Disease, having knowledge about her condition helps her to have some control over how it is managed. She believes that patients have a role to play in sharing their experiences with doctors. “It’s not the results the matter so much for me but how I feel,” she said. “When I feel changes in my body, I know when my dose needs to be increased.”

Standardisation

Discussion also threw up issues of standardisation and concerns about the consequences of community healthcare if it is not regulated. One patient, Geoff Hayward, shared his findings from a comparative assessment of his cholesterol level results at a high street pharmacy and an NHS hospital laboratory over a three-year period. He found wide variation in results between the high street store and the NHS lab. On one occassion his high street result was 2.69mmol/l compared with 6.4mmol/l at the NHS. Hayward says the pharmacy claimed its kits were calibrated weekly to ensure accuracy.

“You’ve got to question the validity of the tests in the high street chemist,” he said. “It also raises concern about how other patients or clients are being affected by the mismatch of results.”

But session chair Dr Danielle Freedman, of Luton and Dunstable NHS Foundation Trust, believes the situation has the potential to become much worse. She raised her concerns about a government proposals that could see 80% of surgery conducted outside the laboratory setting. She said:“I think on the back of what we’ve seen from Geoff, it’s going to get much worse.”

And as more healthcare provision is channelled into the community, healthcare professionals will be faced with the mammoth task of responding to the varying needs of their patients. One histopathologist from the Wirrall pointed out that while there may be many patients that want details of their results, there will be those who are ambivalent and others that simply don’t want to know. “How do I decide which patient fits into which category?” he asked.

Similarly, it is all very well some patients requesting more information, but laboratory professionals will have to now tailor the information to suit the varying level of understanding a patient has on his or her condition.

“There is much to consider – what information to endorse; the cost implications; the need for training; the additional time needed to dedicate to patients; and if you can afford to spend that time deciding which patients to disclose that information to. These are the questions we need to discuss – and how we are going to react to this growing interference.”
Commissoners

And pathology managers have a strategic role to play in educating commissioners on the vital role diagnostics play within healthcare provision.

Professor David Whitney, a senior fellow at the Centre for Health Planning and Management at Keele University, urged pathology managers to put health, as a whole, on its clinical directorate agenda and take the lead when it comes to decision-making.

“When did you have health as opposed to health treatment services on your clinical directorate meeting? Talk about the health profile of their community, the health pathways, about how diabetes and cardiology fits into this framework. Focus on the wider care pathways and see how pathology might fit into that,” he asked.

Increasingly, diagnostics need to be seen as the 'front end of the hospital' because of the vital role it plays in informing GPs and clinicians in subsequent decision-making processes, Whitney explained. But this requires active communication with commissioners and a change in the way that pathology interacts with the rest of the NHS. .

“You have to understand where PCTs are coming from, invite the director of commissioning into your directorate to understand what their aspirations are and if they don't have any, inform and shape them. It's a fantastic opportunity at the moment and it's probably a one-off opportunity, given the changes that are around but pathology has a real opportunity nationally and locally to inform change and debate,” he said.

His discussion also centred on the white paper document Options for the future of Payment by Results: 2008/09 to 2010/11, which was launched on 15 March 2007 and is open for consultation. The paper puts forward proposals for future developments in PbR including tariff setting, coding and classification, expanding the scope of PbR, and supporting health policies through financial reform.

He says: “In the report, pathology is not mentioned once which could be a threat but also an opportunity.” He says, it is an opportunity for pathology managers to ask themselves what they want from PBR for pathology or if they want a separate tariffs.

“That with or without the help of the secondary care environment, PCTs will take control, so it is important for them to get involved. Change is being dictated by all sorts of intiatives. Pathology should be driving that now because if they don't drive it, PCTs will drive it in their own way and particularly when practice-based commissioners come on board.

Basically, the future is up to you. Focus 2007 with its theme 'beyond the laboratory', attempted to do more than just giving visitors an snapshot of the challenges they will be facing but also preparing them to be able to deal with them.
by:www.mlwmagazine.com

Doctor or Drug Pusher?

2007-06-17T18:20:00.000-07:00

Corrections Appended

Ronald McIver is a prisoner in a medium-security federal compound in Butner, N.C. He is 63 years old, of medium height and overweight, with a white Santa Claus beard, white hair and a calm, direct and intelligent manner. He is serving 30 years for drug trafficking, and so will likely live there the rest of his life. McIver (pronounced mi-KEE-ver) has not been convicted of drug trafficking in the classic sense. He is a doctor who for years treated patients suffering from chronic pain. At the Pain Therapy Center, his small storefront office not far from Main Street in Greenwood, S.C., he cracked backs, gave trigger-point injections and put patients through physical therapy. He administered ultrasound and gravity-inversion therapy and devised exercise regimens. And he wrote prescriptions for high doses of opioid drugs like OxyContin.

McIver was a particularly aggressive pain doctor. Pain can be measured only by how patients say they feel: on a scale from 0 to 10, a report of 0 signifies the absence of pain; 10 is unbearable pain. Many pain doctors will try to reduce a patient’s pain to the level of 5. McIver tried for a 2. He prescribed more, and sooner, than most doctors.

Some of his patients sold their pills. Some abused them. One man, Larry Shealy, died with high doses of opioids that McIver had prescribed him in his bloodstream. In April 2005, McIver was convicted in federal court of one count of conspiracy to distribute controlled substances and eight counts of distribution. (He was also acquitted of six counts of distribution.) The jury also found that Shealy was killed by the drugs McIver prescribed. McIver is serving concurrent sentences of 20 years for distribution and 30 years for dispensing drugs that resulted in Shealy’s death. His appeals to the U.S. Court of Appeals for the Fourth Circuit and the Supreme Court were rejected.

McIver’s case is not simply the story of a narcotics conviction. It has enormous relevance to the lives of the one in five adult Americans who, according to a 2005 survey by Stanford University Medical Center, ABC News and USA Today, reported they suffered from chronic pain — pain lasting for several months or longer. According to a 2003 study in The Journal of the American Medical Association, pain costs American workers more than $61 billion a year in lost productive time — and that doesn’t include medical bills.

Contrary to the old saw, pain kills. A body in pain produces high levels of hormones that cause stress to the heart and lungs. Pain can cause blood pressure to spike, leading to heart attacks and strokes. Pain can also consume so much of the body’s energy that the immune system degrades. Severe chronic pain sometimes leads to suicide. There are, of course, many ways to treat pain: some pain sufferers respond well to surgery, physical therapy, ultrasound, acupuncture, trigger-point injections, meditation or over-the-counter painkillers like Advil (ibuprofen) or Tylenol (acetaminophen). But for many people in severe chronic pain, an opioid (an opiumlike compound) like OxyContin, Dilaudid, Vicodin, Percocet, oxycodone, methadone or morphine is the only thing that allows them to get out of bed. Yet most doctors prescribe opioids conservatively, and many patients and their families are just as cautious as their doctors. Men, especially, will simply tough it out, reasoning that pain is better than addiction.

It’s a false choice. Virtually everyone who takes opioids will become physically dependent on them, which means that withdrawal symptoms like nausea and sweats can occur if usage ends abruptly. But tapering off gradually allows most people to avoid those symptoms, and physical dependence is not the same thing as addiction. Addiction — which is defined by cravings, loss of control and a psychological compulsion to take a drug even when it is harmful — occurs in patients with a predisposition (biological or otherwise) to become addicted. At the very least, these include just below 10 percent of Americans, the number estimated by the United States Department of Health and Human Services to have active substance-abuse problems. Even a predisposition to addiction, however, doesn’t mean a patient will become addicted to opioids. Vast numbers do not. Pain patients without prior abuse problems most likely run little risk. “Someone who has never abused alcohol or other drugs would be extremely unlikely to become addicted to opioid pain medicines, particularly if he or she is older,” says Russell K. Portenoy, chairman of pain medicine and palliative care at Beth Israel Medical Center in New York and a leading authority on the treatment of pain.

The other popular misconception is that a high dose of opioids is always a dangerous dose. Even many doctors assume it; but they are nonetheless incorrect. It is true that high doses can cause respiratory failure in people who are not already taking the drugs. But that same high dose will not cause respiratory failure in someone whose drug levels have been increased gradually over time, a process called titration. For individuals who are properly titrated and monitored, there is no ceiling on opioid dosage. In this sense, high-dose prescription opioids can be safer than taking high doses of aspirin, Tylenol or Advil, which cause organ damage in high doses, regardless of how those doses are administered. (Every year, an estimated 5,000 to 6,000 Americans die from gastrointestinal bleeding associated with drugs like ibuprofen or aspirin, according to a paper published in The American Journal of Gastroenterology.)

Still, doctors who put patients on long-term high-dose opioids must be very careful. They must monitor the patients often to ensure that the drugs are being used correctly and that side effects like constipation and mental cloudiness are not too severe. Doctors should also not automatically assume that if small doses aren’t working, that high doses will — opioids don’t help everyone. And research indicates that in some cases, high doses of opioids can lose their effectiveness and that some patients are better off if they take drug “holidays” or alternate between different medicines. Pain doctors also concede that more studies are needed to determine the safety of long-term opioid use.

But with careful treatment, many patients whose opioid levels are increased gradually can function well on high doses for years. “Dose alone says nothing about proper medical practice,” Portenoy says. “Very few patients require doses that exceed even 200 milligrams of OxyContin on a daily basis. Having said this, pain specialists are very familiar with a subpopulation of patients who require higher doses to gain effect. I myself have several patients who take more than 1,000 milligrams of OxyContin or its equivalent every day. One is a high-functioning executive who is pain-free most of the time, and the others have a level of pain control that allows a reasonable quality of life.”

All modern pain-management textbooks advocate “titration to effect” — in other words, in cases where opioids are helping, gradually increasing the dosage until either the pain is acceptably controlled or the side effects begin to outweigh the pain-relief benefits. But the vast majority of doctors don’t practice what the textbooks counsel. In part, this is because of the stigma associated with high-dose opioids, the fear that patients will become addicted and the fact that careful monitoring is very time-consuming. And most doctors have received virtually no training in medical school about managing pain: many hold the same misconceptions about addiction and dosage as the general public.

And even pain specialists can be conservative. Sean E. Greenwood died in August at age 50 of a cerebral hemorrhage that his wife, Siobhan Reynolds, attributes to untreated pain. Greenwood was seeing various pain specialists. What makes his undertreatment especially remarkable is that he and his wife founded the Pain Relief Network, an advocacy group that has been the most vocal opponent of prosecutions of doctors and financed part of the legal defense of many pain doctors. “Here I am — I know everyone, and even I couldn’t get him care that didn’t first regard him as a potential criminal,” Reynolds said.

According to the pharmaceutical research company IMS Health, prescriptions for opioids have risen over the past few years. They are used now more than ever before. Yet study after study has concluded that pain is still radically undertreated. The Stanford University Medical Center survey found that only 50 percent of chronic-pain sufferers who had spoken to a doctor about their pain got sufficient relief. According to the American Pain Society, an advocacy group, fewer than half of cancer patients in pain get adequate pain relief.

Several states are now preparing new opioid-dosing guidelines that may inadvertently worsen undertreatment. This year, the state of Washington advised nonspecialist doctors that daily opioid doses should not exceed the equivalent of 120 milligrams of oral morphine daily — for oxycodone or OxyContin, that’s just 80 milligrams per day — without the patient’s also consulting a pain specialist. Along with the guidelines, officials published a statewide directory of such specialists. It contains 12 names. “There are just not enough pain specialists,” says Scott M. Fishman, chief of pain medicine at the University of California at Davis and a past president of the American Academy of Pain Medicine. And the guidelines may keep nonspecialists from prescribing higher doses. “Many doctors will assume that if the state of Washington suggests this level of care, then it is unacceptable to proceed otherwise,” Fishman says.

In addition to medical considerations real or imagined, there is another deterrent to opioid use: fear. According to the D.E.A., 71 doctors were arrested last year for crimes related to “diversion” — the leakage of prescription medicine into illegal drug markets. The D.E.A. also opened 735 investigations of doctors, and an investigation alone can be enough to put a doctor out of business, as doctors can lose their licenses and practices and have their homes, offices and cars seized even if no federal criminal charges are ever filed. Both figures — arrests and investigations — have risen steadily over the last few years.

Opioid drugs have been used to treat pain for decades, mostly for acute postsurgical pain or the pain of cancer patients. But in January 1996, Purdue Pharma helped increase the use of these drugs by introducing OxyContin — oxycodone with a time-release mechanism. Oncologists and pain doctors were the principal prescribers of opioids. But Purdue introduced the drug with an aggressive marketing campaign promoting OxyContin to general practitioners and the idea of opioid pain relief to doctors and consumers. The product’s time-release mechanism, Purdue claimed, allowed steadier pain relief and deterred abuse.

Many pain sufferers found that OxyContin gave them better relief than they ever had before. But Purdue misrepresented the drug’s potential for abuse. Last month, the company and three of its executives pleaded guilty to federal charges that they misled doctors and patients. The company agreed to pay $600 million in fines; and the executives, a total of $34.5 million. The pill’s time-release mechanism turned out to be easily circumvented by crushing the pill and snorting or injecting the resulting powder. By the late 1990s, OxyContin abuse was devastating small towns throughout Appalachia and rural New England. Pharmaceuticals, mainly opioids, are still widely abused — now more so than any illegal drug except marijuana. In 2005, according to the government’s National Survey on Drug Use and Health, 6.4 million Americans, many of them teenagers, had abused pharmaceuticals recently. Most got the drug from friends or family — often, in the case of teenagers, from their parents’ medicine cabinets.

At the time the OxyContin epidemic emerged, the D.E.A. had far more experience seizing illegal drugs like cocaine and heroin. According to Mark Caverly, the head of the liaison and policy section for the D.E.A.’s Office of Diversion Control, the OxyContin epidemic, however, required the agency to step up its antidiversion efforts. In 2001 the D.E.A. established the OxyContin Action Plan. The D.E.A. dispatched investigators to the most troubled states and trained local law-enforcement officials.

The basis of the physician-patient relationship is trust. Trust is especially valued by pain patients, who often have long experience of being treated like criminals or hysterics. But when prescribing opioids, a physician’s trust is easily abused. Pain doctors dispense drugs with a high street value that are attractive to addicts. All pain doctors encounter scammers; some doctors estimate that as many as 20 percent of their patients are selling their medicine or are addicted to opioids or other drugs. Experts are virtually unanimous in agreeing that even addicts who are suffering pain can be successfully treated with opioids. Indeed, opioids can be lifesaving for addicts — witness the methadone maintenance therapy given to heroin addicts. But treating addicts requires extra care.

Identifying the scammers is especially tricky because there is no objective test for pain — it doesn’t show up on an X-ray. In one British study, half the respondents who complained of lower-back pain had normal M.R.I.’s. Conversely, a third of those with no pain showed disk degeneration on their M.R.I.’s. The study suggested there could be a profound disconnection between what an M.R.I. sees and what a patient feels.

There are red flags that indicate possible abuse or diversion: patients who drive long distances to see the doctor, or ask for specific drugs by name, or claim to need more and more of them. But people with real pain also occasionally do these things. The doctor’s dilemma is how to stop the diverters without condemning other patients to suffer unnecessarily, since a drug diverter and a legitimate patient can look very much alike. The dishonest prescriber and the honest one can also look alike. Society has a parallel dilemma: how to stop drug-dealing doctors without discouraging real ones and worsening America’s undertreatment of pain.

In July 2002, an insurance agent was sifting through records in Columbia, S.C., and paused at the file of one Larry Shealy. Shealy was getting OxyContin from a doctor named Ronald McIver — a lot of it. “The amounts were incredible; it jumped out in my face,” the agent, who spoke on condition of anonymity, told me. “He was either selling them or taking so much he couldn’t live.” The agent did two things. He recommended to Shealy’s employers that they exclude OxyContin coverage from their health insurance plan — which they did. And he called the D.E.A. Two days later, a D.E.A. agent showed up in the insurance agent’s office with an administrative subpoena to collect Shealy’s file.

McIver wanted to be a doctor all his life, two of his daughters told me. But he taught and traveled for years before he finally enrolled at Michigan State University to become a D.O., or doctor of osteopathy, a more holistic alternative to a traditional medical education. (Osteopaths can do everything that traditional M.D.’s can do, including prescribe opioids.) He began practicing pain medicine in the late 1980s. He had a practice in Florence, S.C., which ended when he declared bankruptcy in 2000. He moved to Greenwood to start over, establishing his new office in a storefront next to a chiropractor.

McIver was, by the account of his patients, an unusual doctor in the age of the 10-minute managed-care visit. He usually saw about 6 to 12 patients each day. One patient I spoke with — who never got high-dose opioids — said that his first visit with McIver lasted four hours, and in subsequent visits he spent an hour or more doing various therapies. Many patients said their visits lasted an hour. Patients taking opioids had to sign a pain contract and bring their pills in at each visit to be counted.

Many doctors take little interest in the administrative side of their practices, but McIver’s neglect was epic. To save money, he employed mostly family. His wife, Carolyn, whose only medical training was from her husband, served as his assistant, giving shots and administering therapies. “His doctor’s office did not resemble my family’s doctor’s office,” said Sgt. Bobby Grogan, who was the investigator on the case for the Greenwood County Sheriff. While McIver’s treatment rooms were normal, his and his wife’s offices — off limits to patients — were a mess, according to pictures presented at McIver’s trial by Adam Roberson, the D.E.A.’s principal investigator. Used syringes, for example, overflowed their storage box. “His patient records were manila envelopes stuffed with receipts,” Grogan told me.

When I interviewed him in prison recently, McIver told me that his records were complete but scattered. He said that he and his wife, distracted by a series of family tragedies, had employed a series of temporary receptionists who had botched the filing. He and his wife were trying to piece them together. “The records were probably half in the office and half at home for me to work on at night,” he said. “I kept a box in the back of the car I worked on while Carolyn drove.”

Leslie Smith first came to see McIver in the fall of 2001. Smith was in his mid-40s and lived in Chapin, a small town near Columbia, a 60-mile drive from Greenwood. He filled out a medical-history form and told McIver that his wrists hurt so badly that he was getting only three or four hours’ sleep a night. He also said that a previous doctor helped him by prescribing OxyContin, and he mentioned the name of a doctor he said referred him. McIver examined Smith’s wrists. Smith walked out with an opioid prescription and an appointment to come back the next week.

Smith’s wrists did not hurt him, as he testified at McIver’s trial. He was addicted to OxyContin and Dilaudid, which he injected. He complained of wrist pain because it was plausible: he had injured one wrist previously, requiring an operation that left scars, and he had arthritis in the other. Until June 2002, Smith kept getting prescriptions.

Smith saw McIver every few weeks. He testified that he had track marks on his arm at the time but always wore long sleeves to cover them. He said McIver never saw them. McIver put him on an electric nerve stimulator every visit for 15 or 30 minutes on each hand and did osteopathic manipulations. He prescribed exercises. Smith bought a nerve-stimulator machine to use at home and told McIver it was helping. At McIver’s request he filled out a pain chart and reported that his pain rated a 5 or 6 upon awakening, reached 7 during the day and occasionally hit 9. “I answered all the questions exactly like I thought he’d want to hear them answered,” Smith testified. At one point McIver found a syringe in Smith’s pocket. Smith told McIver that he was going fishing later that day and that he used the syringe as part of his fishing equipment. That apparently satisfied McIver, who testified that his grandfather kept syringes in his tackle box to pump air into his bait.

Smith filled some of his prescriptions at the Hawthorne Pharmacy in West Columbia. There, Addison Livingston, the pharmacist, got suspicious. He noticed that Smith sometimes came in with other patients of McIver’s, despite the fact that McIver worked nearly two hours’ drive away. The patients obviously knew each other and would pick up large opioid prescriptions, paying cash and asking for brand-name drugs. Livingston called McIver, who confirmed he had written the prescriptions. At one point, McIver told Livingston that he, too, was suspicious, and that he had sent a letter about Smith to the state’s Bureau of Drug Control.

In February 2002, McIver wrote to Larry McElrath, a B.D.C. inspector, who read the letter at the trial. “Dear Larry,” it read, “There are several people out of the Columbia/Chapin area who have aroused my curiosity about their use and possible misuse of medications. Some are referred by [another doctor] and seem legitimate. . . . They all pay cash despite some of them having insurance with prescription cards. . . . When they are in the office, they sometimes make a show of not knowing each other. . . . The situation is made complicated by the fact that each has some real pathology with objective findings that would justify the use of opiates if their pains are as bad as they say. I have given them the benefit of the doubt, but I’m becoming less inclined to do so. I would appreciate it if you could make some discrete inquiries and let me know whether my concerns are justified. . . . I certainly don’t want to refuse help to someone who needs it. On the other hand, I want even less to be implicated in diversion or other improprieties.” He listed their names and Social Security numbers.

McElrath did nothing with the letter. “It’s incumbent upon the physician to have a trust with his patients,” McElrath testified at the trial. “Here there was nothing that I could assume or conclude that any crimes had been committed.”

Smith was the most damning of the several patients who testified against McIver. (Smith and the other patients mentioned here did not agree to be interviewed for this article, as they are suing McIver for alleged overprescription of addictive drugs. Such suits often prosper after successful criminal convictions, as civil suits are easier to win.) Smith had a confederate in Seth Boyer, who lived in Chapin and followed a similar pattern in his dealings with McIver: he exaggerated pains in his foot, never provided records from a previous doctor and had needle tracks that he later testified McIver never saw. At one point, Boyer told McIver that he had spilled a bottle of liquid OxyFast, another opioid. (In reality, Boyer had injected it.) McIver wrote him a prescription for a replacement — apparently a violation of his standard pain-medication contract, which had a “no early refills” stipulation.

But McIver ended up discharging Boyer in June 2002, when Boyer altered a prescription so he could fill it three days early. He wrote McIver three pleading letters of protest, to no avail. “I was looking for an excuse to discharge them, and with Seth I found it,” McIver told me. “I needed more than suspicion. With Les, he never actually did anything that allowed me to say, ‘O.K., here’s that concrete piece of evidence.’ ”

McIver may have felt he needed more proof, but medically he probably had enough. Pain specialists told me that doctors can stop prescribing a drug whenever the risks outweigh the benefits, which includes the risk of abuse.

Another drug-dealing patient of McIver’s was Kyle Barnes. She testified that she suffered from fibromyalgia, a chronic-pain syndrome, but exaggerated her pain to get higher levels of OxyContin and Roxicodone. She was addicted to those drugs before she began seeing McIver in July 2001. She also brought no medical records and drove three hours to each appointment. She got prescriptions on her second visit, during which McIver also did osteopathic manipulations and massage.

Barnes was in real pain. McIver did several different therapies at each visit. He set up an appointment for her at a sleep clinic, sent her for X-rays and put a cast on her wrist. He knew she had trouble paying for her medicines, and he contacted Purdue Pharma to see if she qualified for reduced-price drugs. She kept claiming the drugs were not helping enough and was soon taking 16 times the dose of OxyContin she took when she first saw him. One tip-off in her case should have been that she paid thousands of dollars a month in cash for her prescriptions, even though she was on Medicaid. She told McIver that her father and boyfriend were helping her buy them, which she later testified was partly true. But most of her income came from selling some of the drugs he prescribed, she testified. In December 2003, McIver told her that he would stop treating her unless she took a drug screen. She did nothing. Three weeks later he told her again. She never returned.

Another patient whose story was particularly troubling was Barbee Brown. Brown was not a drug seeker but a genuine pain patient seeking relief from Reflex Sympathetic Dystrophy. McIver gave her very high doses of OxyContin right away, before she produced any records from other doctors. This was especially disturbing, because she had been addicted to crack cocaine for three months in the year before she came to him.

Brown saw McIver at least twice a week for six weeks. He did a thorough physical exam and took a complete history. He used many different kinds of therapies. But he also started her — someone who had never taken opioids — on 40-milligram pills of OxyContin and allowed her to control her own dosing schedule. “As long as you are not having side effects, do not be afraid to take the doses you need to get out of pain,” he wrote to her. It was the same advice he gave many patients. “The number of milligrams does not matter. What matters is the number on the 0-to-10 scale.”

The medicine helped. Brown testified that she ranked her pain at 9 or 10 when she first got to McIver. After seeing him, it dropped to a 4. Her pain diary, which appears to be sincere, had various passages giving thanks that she met McIver. Brown did not become addicted. But allowing an opioid-naïve recovering crack addict to start on high-dose pills and control her own dosage, and telling her that her dosage didn’t matter, seems reckless.

McIver’s 30-year sentence was the result of the death of Larry Shealy, a 56-year-old man who suffered intense back and knee pain, in addition to many other health problems. He first came to see McIver in February 2002, with full referrals and records. He was on OxyContin before seeing McIver but complained that his pain was still terrible, so McIver doubled his dose. This allowed Shealy to go back to work in an auto body shop.

Shealy was not a careful patient. A month after he started with McIver, he took 15 OxyContin tablets in one day instead of the 6 he was prescribed. He was not harmed, but McIver testified that he asked Shealy to bring his family in so he could explain the dosing to them. At one point, McIver tried to taper down the OxyContin and replace it with methadone, but Shealy complained that the methadone made him drowsy. Shealy’s son, David, an auto mechanic, testified that the OxyContin pain relief also came at a price. He said he felt his father was overmedicated — often sleepy. Once, his father backed his truck into a tree.

Shealy died in his sleep early on the morning of May 29, 2003. He had OxyContin pills in his stomach, and his bloodstream contained alprazolam — Xanax — as well. The pathologist at McIver’s trial testified that the levels of drugs were consistent with the prescriptions McIver had been writing — the high levels that so alarmed the insurance agent. Shealy was taking five 80-milligram tablets of OxyContin every 12 hours, plus up to six 30-milligram tablets of Roxicodone every 4 hours for breakthrough pain, plus as much as 2 milligrams of alprazolam every 8 hours. The prosecution’s toxicologist, Demi Garvin, concluded that the OxyContin and Roxicodone caused Shealy’s death by respiratory depression. The pathologist testified that she looked up this dosage and found it to be a fatal level.

But there is reason for doubt. According to Shealy’s prescriptions, he had been taking the same dosage for at least two months, and possibly much longer. Pain specialists say that respiratory depression is extremely unlikely when dosage is consistent. In her testimony, Garvin agreed that what would be a toxic level in an opioid-naïve patient would be safe for someone titrated up properly. But she said she could not conclude he had been properly titrated, in part because she had not seen his medical records. Garvin declined to talk about the Shealy case with me because she is a witness for the Shealy family in their planned civil suit against McIver. But in a deposition for that lawsuit, she appeared to back away from blaming the OxyContin. She described her view as: “Hey, there’s a red flag here. This can certainly be your cause of death, but you need to go further in exploring whether or not it is.”

There was something else that might have caused Shealy’s death: he suffered from advanced congestive heart failure. The pathologist testified that he had 90 percent blockage in one coronary artery and 50 percent in another, and a greatly enlarged heart and other organs. He had a scar on the back wall of his heart that indicated he at one time suffered a heart attack. Opioids do not worsen heart disease and would likely have helped, because pain causes stress to the heart.

The testimonies of the patients Smith, Boyer and Barnes were the parts of the trial that most directly addressed the question of whether McIver intentionally wrote prescriptions for a nonmedical purpose. This is the relevant legal test for the statute under which he was prosecuted. Several Supreme Court and district court cases have made it clear that under the Controlled Substances Act, a doctor is guilty of a crime if he intentionally acts as a drug pusher.

The judge in the McIver case, Henry F. Floyd, told the jurors that bad prescribing is the standard for malpractice, a civil matter. “That is not what we are talking about,” he said. “We’re not talking about this physician acting better or worse than other physicians.” If McIver was a bad doctor — but still a doctor, with intent to treat patients — he was innocent. “If you find that a defendant acted in good faith in dispensing the drugs charged in this indictment, then you must find that defendant not guilty,” Floyd said. But Floyd also told the jury to take bad doctoring into account in deciding McIver’s intent.

This instruction — that bad doctoring does not prove intent but could be considered when weighing his intent — is subtle and potentially extremely confusing. It apparently confused the jurors. I spoke to two jurors, who told me their own views and characterized the jury discussion. The overwhelming factor, they said, was that McIver prescribed too much — the very red flag that alerted the insurance agent and set the case in motion.

The jurors I spoke with said that by far the most important testimony came from Steven Storick, a pain-management doctor in Columbia and the government’s expert witness. Reviewing the records of patient after patient, Storick consistently testified that there were too many drugs. “This amount of medication is just extremely high in a situation like this,” he said of one patient. This is “excessive,” he said of another. “That’s just an extremely high dose of drug,” he said of a third. Storick, who declined to be interviewed for this article, testified that if he had a patient who exhibited no objective evidence of pain, he would not prescribe opioids. He would not have titrated patients as rapidly as McIver did or given them discretion. He disagreed with McIver’s position that a doctor should try to bring a patient’s chronic pain down to a level of 2. He would stop titrating when a patient reached 5 out of 10.

The jurors took Storick’s caution to heart, in part, they told me, because it resonated with their own experience with opioids and fears of addiction. I asked Jo Handy, a tall, elegant woman who is now 39 and a real estate agent outside Greenville, why McIver was convicted. “It was the excessive prescriptions,” she said in an interview in her office. “Excessive, and the number of them. I’ve been on some pain medication. But along with some other jurors we were, like, ‘No — it’s too much.’ ”

Handy said she knew McIver’s treatment was excessive because Storick said so, and because of her own experience. “Thirty counts is normal,” she said. “He was giving 60 or 90. A few of us had been on prescribed medicine. I had female issues. You as a person know not to take so much of that medication. If you were, you had a motive. Me, I still have a whole bottle left.”

Christopher Poore, another juror, agreed that what swayed the jury was the volume of drugs prescribed. “The jury kept going back to the expert testimony of the prosecution’s expert,” he told me when I met him in Anderson, a town 40 minutes from Greenwood. “It was beyond. It was too much.” What should McIver have done, I asked, if he wanted to avoid jail? “He should have followed the convention more of what people are doing with pain medicine — not giving so much,” Poore said.

Poore, who is 40 and runs his family’s heating and cooling business, described himself as the juror most skeptical of the prosecution’s case. “There was another guy on the jury who said his sister-in-law had been taking pain pills and she had gotten addicted,” Poore said. “He said I was taking up for McIver. I said, No, I’m taking up for you and me and anyone else who’s on trial. I wanted to see rules, that this guy broke the rule. I never saw a rule he broke.”

In the end Poore voted to convict. As is always the case, the jurors were dismissed before McIver was sentenced. Poore told me he supposed McIver was in prison. When I said McIver was serving 30 years, he looked shocked.

Interviews with jurors and the judge’s sentencing decision indicated that photos of the messy conditions in McIver’s and Carolyn’s private offices also contributed to the impression that he was not a real doctor. Surprisingly, McIver’s contacts with law enforcement — the letter about Smith and the others was one of several — helped the prosecution’s case. “He called an officer about a patient,” John P. Flannery II, McIver’s appellate lawyer, explained to me. “There is no response. He gets zero. He took their silence as a sign everything was O.K. They take that as knowledge of drug dealing.” It mattered: the Fourth Circuit’s opinion rejecting McIver’s appeal said, “That Appellant knew or suspected his patients of drug abuse is reflected by the fact that he wrote to state authorities to express concern that his patients might be selling their medication.”

I asked Grogan, the local diversion investigator on the case, why he didn’t follow up on McIver’s suspicions. “I’m a cop, not a doctor,” Grogan said. “I can’t say to prescribe medication or not. How do I know he’s not trying to fish me for information?”

“He doesn’t have to call us to cut someone off,” Mike Frederick, the chief deputy at the sheriff’s office, told me. “This is no different than when regular illegal drug dealers will very often call us about other drug dealers. He did it most likely because he thought that person was a risk.”

I had assumed that McIver’s use of many different types of therapies would help his case, by showing he was not running a classic pill mill. But it may have hurt. During the appeal, the prosecutor William Lucius argued that the other treatments represented the profits of drug diversion. He addicted patients with high doses of opioids, Lucius contended, “so they would continue to come back to him” and “he could charge them for the treatments he gave.”

How typical is McIver’s case? On the D.E.A.’s Web site the agency lists some of the doctors who have been prosecuted, and their crimes. There are some strikingly obvious and egregious cases of shady dealings: a doctor who wrote prescriptions in a gas station for a person who wasn’t present; one who sold blank prescription forms; one who dispensed drugs to people who then shared them with him.

But not every doctor’s intent to deal drugs is as clear. McIver was a crusader for high-dose opioids, credulous with patients and sloppy with documentation — a combination unwise in the extreme. But some of his patients said he was the only doctor who ever brought them relief. Prosecutors never brought any evidence that he intended to write prescriptions to be abused or sold. They never accused him of profiting from his patients’ diversion except in collecting office fees. His patients who diverted or abused their opioids all testified they got their prescriptions by consistently lying to him. Nor is it convincing that his prescriptions killed Larry Shealy.

No one has analyzed the various prosecutions of pain doctors, so it is hard to determine how many of them look like McIver’s. The D.E.A.’s list is incomplete. There have been many cases like McIver’s, and most of these cases are not listed on the D.E.A.’s Web site. (One possible reason for this omission is that some of these cases are still being appealed.) And many cases that do appear on the list detail only vague crimes: convictions for prescribing “beyond the bounds of acceptable medical practice” or “dispensing controlled substances . . . with no legitimate medical purpose” — which is how the agency will most likely describe the McIver case if it ever includes the case on the list.

The D.E.A. claims that it is not criminalizing bad medical decisions. For a prosecutable case, Caverly, the D.E.A. officer, told me: “I need there to be no connection of the drug with a legitimate medical condition. I need the doctor to have prescribed the drug in exchange for an illegal drug, or sex, or just sold the prescription or wrote prescriptions for patients they have never seen, or made up a name.”

I read this statement to Jennifer Bolen, a former federal prosecutor in drug-diversion cases who trained other prosecutors and now advises doctors on the law. “That’s a good goal,” she said. “I don’t think they have yet reached that goal.” McIver’s case had no such broken connection, and in many cases the government has not produced testimony of intent to push drugs, providing evidence only of negligence or recklessness. In 2002, Bolen was one of the authors of a Justice Department document intended as part of a basic guide to prosecuting drug-diversion cases. The document, in the form of a reference card, dispenses with any need for a broken connection. It suggests that prosecutors need not prove a doctor had bad motives, that to be within the law a doctor had to prescribe “in strict compliance with generally accepted medical guidelines” and that doing an abbreviated medical history or physical examination is “probative” of lack of a legitimate medical purpose. The reference card was on the Justice Department’s Web site but was pulled, according to the Pain Relief Network, which provided the card to me. Bolen told me: “I have no problem saying that if the card was all there was, it was not acceptable. But it isn’t all there was.” She described the card as one piece of a more thorough training, but added that many prosecutors followed its theories.

Prosecutors are in essence pressing jurors to decide whether an extra 40 milligrams every four hours or a failure to X-ray is enough to send a doctor to prison for the rest of his life. One doctor, Frank Fisher, was arrested on charges that included the death of a patient taking opioids — who died as a passenger in a car accident. A Florida doctor, James Graves, is serving 63 years for charges including manslaughter after four patients overdosed on OxyContin he prescribed — all either crushed and injected their OxyContin or mixed it with alcohol or other drugs. “A lot of doctors are looking for safe harbor,” Caverly said. “They want to know as long as they do A, B, C, D or E, they’re O.K.”

The D.E.A. once thought that this was not an unreasonable desire. A few years ago, it worked with pain doctors to develop a set of frequently asked questions that set out what doctors needed to do to stay within the law. The FAQ recommended, for example, that doctors should do urine tests and discuss a patient’s treatment with family and friends. In October 2004, the FAQ were erased from the agency’s Web site. One reason was that one of their authors, who is a doctor, was about to use the list to testify on behalf of William Hurwitz, a pain doctor in McLean, Va. (Hurwitz was convicted on 50 counts of drug trafficking in 2004. His conviction was overturned, and he was recently retried and convicted on 16 lesser counts. He is awaiting sentencing.)

Caverly acknowledged the Hurwitz trial was one reason the FAQ were pulled, but said there were other reasons. He said such a checkoff list could tie the D.E.A.’s hands. “Some doctor’s going to pull that list of dos or don’ts out and say: ‘See, I’m O.K. I did these 10.’ But there’s a new wrinkle there — an 11th one the doctor didn’t do,” he said. Most important, he went on to say, the FAQ had stepped over the line to insert the D.E.A. into issues of medical practice. “We have to stay in our lane,” he said. “Those definitions are the professional community’s — not the D.E.A.’s.”

In a perfect world, such reasoning would make sense. But the agency is defining issues of medical practice in dramatic fashion — by jailing doctors who step over the line. It would not seem to be bothering, however, to draw the line first.

The dilemma of preventing diversion without discouraging pain care is part of a larger problem: pain is discussed amid a swirl of ignorance and myth. Howard Heit, a pain and addiction specialist in Fairfax, Va., told me: “If we take the fact that 10 percent of the population has the disease of addiction, and if we say that pain is the most common presentation to a doctor’s office, please tell me why the interface of pain and addiction is not part of the core curriculum of health care training in the United States?” Will Rowe, the executive director of the American Pain Foundation, notes that “pain education is still barely on the radar in most medical schools.”

The public also needs education. Misconception reigns: that addiction is inevitable, that pain is harmless, that suffering has redemptive power, that pain medicine is for sissies, that sufferers are just faking. Many law-enforcement officers are as in the dark as the general public. Very few cities and only one state police force have officers who specialize in prescription-drug cases. Charles Cichon, executive director of the National Association of Drug Diversion Investigators (Naddi), says that Naddi offers just about the only training on prescription drugs and reaches only a small percentage of those who end up investigating diversion. I asked if, absent Naddi training, officers would understand such basics as the whether there is a ceiling dose for opioids. “Probably not,” he said.

There is another factor that might encourage overzealous prosecution: Local police can use these cases to finance further investigations. A doctor’s possessions can be seized as drug profits, and as much as 80 percent can go back to the local police.

There are ways to prevent diversion without imprisoning doctors who have shown no illegal intent. They are increasingly used — but state authorities and doctors need to push even harder. The majority of states, South Carolina among them, do not yet have prescription monitoring — a central registry of prescriptions, which could help catch people getting opioids from several different doctors and pharmacies. Doctors should use more urine and blood tests, including screens that can tell quantities of drug present.

Last year, state medical boards took 473 actions against doctors for misdeeds involving prescribing controlled substances. In many cases, their licenses were pulled. Physicians can also lose their D.E.A. registration, and with it the right to prescribe controlled substances. A few dozen do every year, although there is considerable overlap with medical-board actions. Washington is the first state to recommend that only pain specialists handle high-dose opioids; other states are likely to follow.

But such guidelines are futile while there is one pain specialist for, at the very least, every several thousand chronic-pain sufferers nationwide. And even though pain is an exciting new specialty, doctors are not flocking to it. The Federation of State Medical Boards calls “fear among physicians that they will be investigated, or even arrested, for prescribing controlled substances for pain” one of the two most important barriers to pain treatment, alongside lack of understanding. Various surveys of physicians have shown that this fear is widespread. “The bottom line is, doctors say they don’t need this,” said Heit. “They’re in a health care system that wants them to see a patient every 10 to 15 minutes. They don’t have time to take a complete history about whether the patient has been addicted. The fear is very real and palpable that if they prescribe Schedule II opioids they will come under the scrutiny of the D.E.A., and they don’t need this aggravation.”

Proper pain management will always take time, but the D.E.A. can at least ensure that honest doctors need not fear prison. It should use the standard it claims to follow: for a criminal prosecution to occur, a doctor must have broken the link between the opioid and the medical condition. If the evidence is of recklessness alone, then it should be a case for a state medical board, the D.E.A.’s registration examiners or a civil malpractice jury.

Undoubtedly, such a limit will allow a small group of pill-mill doctors to escape prison. But America lives with freeing suspects whose possible crimes are discovered through warrantless searches or torture — and unlike other suspects, doctors who lose their licenses are as incapacitated as those behind bars. For cases without the broken connection, prosecution is too blunt an instrument. It runs too high a risk of condemning innocent physicians to prison and discourages the practice of a medical specialty desperately needed by millions of Americans.

Pain patients are the collateral victims here. It is worth remembering that the vast majority of McIver’s patients were not people who abused or sold their medicines. One of those who didn’t was a man named Ben, a tall, heavy man in his 50s who lives about 45 minutes from Greenwood. (He asked that his last name not be used because of the stigma still attached to taking opioid drugs.) Ben was once a mail carrier and a farmer and cattle rancher. But years of pushing 800-pound bales of hay wore out his back. In 2001 he had an operation to fuse the bottom three vertebrae. The few Vicodin his neurosurgeon prescribed did not control his pain. “I never had enough to get me through the night,” he said. “He wasn’t going to go any further than Vicodin — and he was doing me a favor by doing that, because his other partners wouldn’t have done as much as he did.” His neurosurgeon recommended he find a pain doctor. He started seeing McIver. The first examination, Ben said over coffee in a local Waffle House, was “extremely thorough — he had me crying. I hardly ever got out of there in less than two hours — he would be on top of me popping my back.”

And he got opioids. With his typical imprudence, McIver told Ben: “You don’t worry about it, take whatever you need to be pain-free, if it takes 2 pills or 10 pills. If you’re taking too much and slurring your words, you know to back off. Use some common sense.” At McIver’s request, Ben kept a diary of what he took and how much. He reached a top dosage of five 80-milligram pills of OxyContin four times a day — more opioids than Shealy was taking at the time of his death. “I never felt high,” he said. “They helped my pain. I could get out and work, use the bulldozer. I was working a 250-head cattle herd. I was doing everything relatively pain-free because of the drugs. They gave me my life back.”

When McIver was closed down, Ben was lucky enough to have a family physician he knew well who took over his case. But the new doctor took a very different approach. Ben now gets three 80-milligram pills of OxyContin a day, plus some breakthrough Roxicodone and 800 milligrams of Advil every four to six hours. “That’s it and I’m very, very lucky to have it,” he said. “My doctor is afraid they will say it’s over the limit. I now get about three hours’ sleep a night. I can stand for 30 minutes, maybe.” He can no longer handle ranching and has sold his cattle. He considers himself retired.

With Ben’s permission I talked to his current doctor, who said Ben was a good patient but had been taking way too much. “I thought Ben made an error,” he said. “He had been taking five or six times the recommended dosage. There are well-recognized levels, and you don’t step across the line. You may have to live with some pain.”

Opioids have immense power — both to harm and to heal. They can be life-destroying, but high doses allowed Ben to work, to be with his family, to be who he is. In its prosecutions of pain doctors, the government fails to recognize the duality of these drugs. Ben’s wife told me: “When Ben first went to Dr. McIver and filled out the form on what he used to be able to do and what he could do now, he cried. McIver said to him, ‘I’m going to get you back to doing what you used to do.’ And he did.”

Correction: June 12, 2007

An article on Page 48 of The Times Magazine today, about Dr. Ronald McIver, who is imprisoned for drug trafficking, gives an erroneous account of the trial testimony of one of his patients, Leslie Smith. Mr. Smith testified that he injected drugs that Dr. McIver prescribed; he did not testify that Dr. McIver sold the drugs.

Correction: June 12, 2007

An article on Page 48 of The Times Magazine today, about Dr. Ronald McIver, who is imprisoned for drug trafficking, gives an erroneous account of the trial testimony of one of his patients, Leslie Smith. Mr. Smith testified that he injected drugs that Dr. McIver prescribed; he did not testify that Dr. McIver sold the drugs.

by:www.blueridgenow.com

ACLU Brings Suit Against Arizona for Quarantine of Tuberculosis Patient

2007-06-17T18:18:00.000-07:00

The American Civil Liberties Union filed a lawsuit against Maricopa County, Ariz., for the conditions in which it is holding a tuberculosis patient in quarantine. The man, Robert Daniels, has a rare and particularly vicious drug-resistant form of tuberculosis.
Daniels was quarantined nine months ago after Maricopa County Public Health officials discovered he had been in public without a respiratory mask. The ACLU is not arguing against the man's quarantine. However, the group takes exceptions to the conditions under which the man is being held.

Daniel J. Pochoda, the director of ACLU of Arizona had this to say about the court action: "Individuals quarantined because of public health risks are held under civil rather than criminal laws. Robert Daniels is a sick patient who has been detained for non-punitive purposes and public health officials are legally and morally obligated to treat him in a humane manner," according to a press release on the ACLU's website.

According to the ACLU the man has been quarantined in the "jail" section of the Maricopa county hospital. Daniels is regularly stripped searched. The man is not allowed to exercise or go outside; his lone trip outdoors during his nine months of confinement occurred while he was shackled.

The ACLU says Daniels is subjected to round the clock lighting, as the lights in his cell are kept on at night. It was just a few weeks ago that Daniel was allowed to shower or make phone calls. Daniels is also prohibited from visits from family or friends and is not allowed to use the Internet or any other mechanism for facilitating social activities.

ACLU attorney Linda Cosme said: "It's psychologically damaging to exist in a vacuum without meaningful activities or opportunities to interact with others. By placing Robert Daniels in these deplorable conditions, the county clearly has no intention of helping him get better. For years, they've been aware of the need to create an adequate quarantine area for extremely ill patients, yet they've chose to ignore the needs of some of the most vulnerable people in Maricopa County in favor of harsh, jail-like conditions for people who are sick and accused of no crimes."

"I'm slowly dying in this room," Daniels said, according to the ACLU. "I didn't realize how serious this was, and I regret that, but nothing justifies the kind of treatment I've received in here. The solitary confinement starts to mess with your head and it has taken a serious toll on my body."
Daniels is a native of Russia; he has claimed that it was a cultural misunderstanding that led him to underestimate the seriousness of his condition. He was not familiar with tuberculosis and claims he did not understate the danger he posed to public health by appearing in public without a respiratory mask.
The ACLU is asking the court to issue a ruling requiring the county to hold Daniels in a hospital ward and treat him like a person with a severe illness, rather than a criminal. The group wants the judge to allow Daniels things like privacy, walking outdoors, computer access, and contact with family and friends.

The ACLU is also asking the court to require Maricopa County to enact policies that will set up quarantine areas for people like Daniels that are the least restrictive as necessary to protect the public health. It is also asking the judge to order the state of Arizona to appropriate funding for quarantining patients with long-term illnesses.
by:www.associatedcontent.com

They're following in dads' footsteps

2007-06-17T18:15:00.000-07:00

In an increasingly mobile society, fewer people have the chance to follow their fathers into the family business. And when it happens, it isn't easy. Dad can have high expectations and be harder on the offspring than the other hired help.

But the rewards are many for those who work together, based on a sampling of several local people who have followed in their fathers' footsteps.

Perry Mader and daughter Kim Mader Bagley

Perry Mader founded his own insurance business four decades ago and built it into the nation's third-largest State Farm agency. Kim Mader worked at her dad's office after school but became a schoolteacher. That career lasted only one year.

"There was a terrible storm," Kim Mader said. "Dad had lots of claims, over 2,000. I worked through the summer of '89 for him. I loved it."

She never returned to teaching.

"When I started in this business, it was important to me that my customers knew all about the policies," she said. "I soon realized they cared more how much I cared about their problems."

After three years, she said, "Dad kicked me out, made me start my own agency."

She built a successful agency in Cleburne and married Craig Bagley, a State Farm regional manager.

When Perry Mader considered retiring, Kim and Craig offered to take over the agency.

He loved the idea.

"I wouldn't have trusted my friends to anyone else," Perry said. "I'd have stayed until they carried me out. But Kim took the new technology and used it to make the business better in ways I couldn't. I'm very pleased. She's taken what we did and did it better."

Dr. William Jordan and son Dr. Chris Jordan

Bill Jordan is an oncologist and president of The Center for Cancer and Blood Disorders, where Chris is also an oncologist.

"Suddenly, I looked up one day and he was a board member, a medical oncologist," William said. "Having him as a son, a friend and a colleague all rolled into one is quite special."

"We're partners, getting to share in the experience," Chris said. "It's nice to have someone with his experience to talk to about patients."

What's the biggest challenge? "For me it's making sure my father hat isn't on," William said. "I try to maintain a relationship as a colleague and not a parent."

"Creating my own footprints," Chris said. "This is a community that he's been extensively involved with and had a lot of success. I'm trying to create my own successes. My training and my philosophies are different from my dad's. Getting out of that shadow isn't easy."

They share goals.

"As oncologists, we're both working to give the patients not only greater quantity of life but quality of life," Chris said. "We're trying to do it in the most comfortable environment."

William gave his son early advice especially valuable to an oncologist. "He told me to never give a patient a false sense of hope," Chris said. "But at the same time treat them as if you're shooting for the best."

Lately, Chris returned the favor.

"He tells me not to work so hard," William said, "and to enjoy myself and my accomplishments more. He just took me on a trip to Argentina with five of his friends. It was a gift from Chris and Missy, his wife. I know he cares about me."

Stephen Coslik and son Erik Coslik

Stephen Coslik founded The Woodmont Co. 25 years ago as a one-person commercial real estate firm and built it into a 100-broker firm. When he was 14, Erik accompanied his dad to an International Council of Shopping Centers convention in Las Vegas.

"It was fantastic," Erik said. "My first year, I took out the garbage for the booth. The second year, my parents bought me a suit."

It was the mid-1980s. Decisions were made by executive teams.

"People would walk around making deals. The president of Service Merchandise walks into a meeting we were having and said, 'Where are we?' His chief lieutenant said, 'We're about $1 million away.' Then he poured popcorn on our site plan, proceeded to wow everyone with his personality, entertaining the whole conference room. We were trying to get them all back on track. Then as he was leaving, he said, 'You've got your $1 million. Let's do it.'"

After he left, I turned to my dad and asked, 'Is that the way deals are done?' He said, 'I have no idea, but I'll take it.'"

Erik has been fascinated with commercial real estate ever since that day.

"I would have supported him in whatever he decided to do," Stephen said. The best part about working with his son is "seeing his growth."

Working together has its challenges.

"Keeping a healthy balance," Erik said. "It would be all too easy to make everything about work. ... One of my prime motivations is to work with Dad, not just pass him in the hallway."

Dee Kelly Sr. and son Dee Kelly Jr.

Fort Worth attorney Dee Kelly Sr. formed Kelly Hart & Hallman L.L.P. in 1979 with Mark Hart Jr. and William Hallman Jr. The law firm grew into one of the most influential in North Texas, with 107 attorneys. Dee Kelly Jr., now managing partner, joined the firm in 1985.

One advantage of working with his son eclipses the rest. "I get to see him with a reasonable degree of frequency," Dee Sr. said.

Dee Jr. views his father as an important source for advice. "He's a great resource," Dee Jr. said. "He's got a wealth of information and experience."

There's at least one downside to working together.

"Keeping your personal life separate from the business side isn't easy. You manage as best you can," Dee Jr. said. "We don't have ground rules about it."

His professional style is a combination, Dee Jr. said. "There are things I'd like to duplicate. He's treated the lawyers in the firm with great respect over the years."

Their fondest recollection of working together is the same.

"The first time Dee won a case," Dee Sr. said. "That's always a big thrill for a lawyer. It's more fun if you're in the same profession as your son."

Mike Kwedar and daughter Lauren Kwedar

Mike Kwedar is chief executive of an investment adviso- ry firm with many doctors as clients. Lauren is vice president of Paige Hendricks Public Relations and handles PR for the firm.

"I started in the insurance business," Mike said. "It was pretty much life, health insurance and disability. We got a lot of doctors.

"Doctors spend years learning to be a surgeon. If something happens to their hands, they can still be a primary-care doctor, but not a surgeon."

A group of doctors in Weatherford asked Mike to review a real estate deal.

"Frankly they were getting screwed," Mike said. "I researched surgical centers and found it's really about ta- king care of the money." Mike and his investors decided to develop an ambulatory surgical center in the city. They retained Lauren to handle public relations.

"The best part is that I can contribute to the success of something he's so passionate about," Lauren said. "And he is passionate about patient care."

Mike is outspoken and candid about providing quality healthcare for a better price.

"Lauren labors endlessly to teach me that I seldom get in trouble for what I don't say," Mike said. "People don't seem to have much doubt about what I think. I now have five other guys depending on me. ... They happen to appreciate candor."

A downside for Lauren is the added pressure she places on herself in connection with the project.

"It's the increase in emotional investment," she said. "It's hard to say how it's different from any other client. There's a little bit more pressure."

Mike wasn't able to come up with a downside. "There's really no challenge," he said. "Everything Lauren and her firm has done has been well thought out. Her work ethic, I've never seen its like. You put that together with obvious talent, there's not much to complain about.

"I'm relentlessly proud of her."
by:www.star-telegram.com

Lawsuit blames woman's death on gastric procedure

2007-06-17T18:08:00.000-07:00

The family of a woman who died two weeks after undergoing bariatric surgery in 2005 has filed a lawsuit against her doctors and a Houston hospital.

The suit connected to the death of Freda Brantley, 48, is the latest lawsuit in recent months to follow the death of a local bariatric patient.

Lawyers for the Houston woman's family said she was discharged from a hospital after the June 6, 2005, vertical-banded gastroplasty without the appropriate treatment. She died June 21, 2005, from kidney failure, according to the lawsuit.

"After vomiting for two weeks, essentially she was malnourished, and that ultimately led to her death," said Todd Kelly, a lawyer for the Brantley family.

The suit, filed Monday, seeks unspecified damages against Dr. Nisar Ahmed, Dr. Beryl Harberg and Park Plaza Hospital. Ahmed did not return calls seeking comment, and Harberg could not be reached.

"While patient privacy laws prohibit us from speaking directly to this case, we will vigorously defend the integrity of our care, quality and services," Park Plaza Hospital officials said in a statement.

The hospital was designated a 2007 American Society of Bariatric Surgeons Center of Excellence. In March, the mother of a Houston woman who died a year after undergoing gastric bypass surgery in 2004 filed a malpractice suit against Houston surgeon Dr. Younan Nowzaradan and Houston Community Hospital. The suit followed the March death of Renee Williams, an 841-pound Austin woman who died from a massive heart attack two weeks after gastric bypass surgery.

robert.crowe@chron.com

West Haven attorney wants lawsuit involving Nigeria, Pfizer tried in U.S.

2007-06-17T18:07:00.000-07:00

hen the government of Nigeria filed a $7 billion lawsuit against Pfizer Inc. earlier this month, West Haven lawyer Richard Altschuler was so elated he picked up the phone and called his co-counsel in Nigeria — forgetting it was 3 a.m. in that West African nation.

"This is a total shock to us that the new government is bringing an action," said Altschuler, who sued both Pfizer and a previous Nigerian government in 2002 on behalf of the parents or guardians of 58 Nigerian children who in 1996 received an experimental drug made at Pfizer’s research facility in Groton.
Altschuler’s suit claims many of the children died or suffered severe injuries as a result of taking the drug Trovan. Pfizer officials say the children who received Trovan had better outcomes than those who did not.

The government lawsuit makes many of the same allegations that Altschuler has made.

"When I heard the news, it was overwhelming," said Altschuler. "I felt vindicated."

But while the massive government lawsuit, which includes the threat of criminal charges, could help Altschuler’s $2 billion civil lawsuit against the pharmaceutical giant, it could also hurt, he acknowledged.

"It helps my case, because the government is saying, ‘What you’re saying here is true,’" Altschuler said. "That’s a big wind behind my sails."

However, the Nigerian action could hurt Altschuler’s efforts to have his case tried in the United States rather than in Nigeria, since it indicates the government may now be interested in seeing that a trial takes place, he said. An earlier lawsuit filed by Altschuler in Nigeria never came to trial.

"It’s confusing as to what the government’s motive is," said Altschuler, who noted the government has changed twice since 1996. "It’s a little late in coming. And it’s really too good to be true."

Altschuler is scheduled to argue July 12 before the U.S. Court of Appeals for the 2nd Circuit in New York, in an attempt to have his lawsuit tried in the United States.

Trovan was administered to children who fell victim to a meningitis epidemic in Kano State in northern Nigeria in the spring of 1996. Kano State officials filed a separate, $2 billion lawsuit against Pfizer last month.

Pfizer officials traveled to Nigeria and treated 100 meningitis-infected children with the experimental antibiotic Trovan, while treating another 100 sick children — as control patients — with an approved drug, ceftriaxone. (Altschuler says 300 children were involved, but the Nigerian government and Pfizer say 200 children were involved.)

Altschuler claims Pfizer intentionally gave the control group low doses in order to make Trovan look better. Pfizer officials have denied that, saying the doses were appropriate to the weakened condition of the children.

Altschuler’s suit claims that Pfizer knew Trovan could cause liver damage and joint problems in children and failed to disclose those risks, that Pfizer failed to obtain informed consent from the parents or guardians, and did not obtain permission from the Nigerian government to carry out the tests. The children all were under age 18.

Altschuler claims Pfizer wanted to quickly carry out human trials of Trovan in order to hasten its approval by the federal Food & Drug Administration. Since that time, the FDA has restricted the use of Trovan to people in hospitals or nursing homes with life- or limb-threatening infections.

Bryant Haskins, a spokesman for Pfizer in the company’s New York City headquarters, said the allegations against Pfizer are not true.

"We believe that we conducted the clinical studies in Nigeria in a very ethical and upfront manner," he said. "Most importantly we believe the clinical study saved lives. We strongly disagree with many of these allegations."

Altschuler’s lawsuit, for instance, claims the company quickly administered the drug and returned to the United States after a short period, with no follow-up medical care.

But Haskins disputes that. "We were there for the duration of the study and we did a six-week follow-up after that," Haskins said. "We went back and met with any and all of the children and families involved in the clinical study. We did exams of all the patients we were able to examine and our doctors did not find any unusual side effects. No patients were found to have relapsed from the treatment."

Haskins also said Pfizer obtained "oral consent from the parents or guardians" after explaining the study to them.

Altschuler claims up to 34 of the children died after taking Trovan, and about 20 others suffered brain damage, loss of hearing or sight, loss of motor skills and amputation of limbs.

Pfizer officials, however, say the death and disability rate among Trovan patients was significantly lower than for patients taking other treatments, and that none of the deaths were linked to Trovan. Haskins said the children were given excellent care.

"During the clinical study, if we found that any patient required care beyond what was available there at the camp, we transferred them to the best medical facility available in Nigeria at our expense, and that was a teaching hospital nearby," he said. "Three patients were transferred to the hospital during the study."

In May 2006, the Washington Post revealed the results of a confidential report written in 2001 by the Nigerian Federal Ministry of Health that concluded Pfizer had violated international law by conducting "an illegal trial of an unregistered drug" without permission from the Nigerian government.

The Nigerian government has indicated it plans to pursue criminal charges as well as the civil suit, but Haskins said Pfizer has not been served with any criminal papers at this point.

In the July 12 hearing, Altschuler will appeal a federal judge’s 2005 ruling that his case should be tried in Nigeria. Altschuler argues that the Nigerian court system is too corrupt. He originally filed the lawsuit in Nigeria in 2001 and was unable to get a judge to hear it. There are no juries in the Nigerian court system.

"The first judge was removed due to corruption, and the second judge delayed the case for seven months, then turned it down," Altschuler said. "Then we were told there were no more judges available."

He also said the case should be tried here because Pfizer developed the drug and planned the Nigerian trials in Connecticut and New York.

Haskins disagreed. "The position that the court has taken and that we have agreed with is that you’re talking about Nigerian citizens living in Nigeria," Haskins said. "Any claims of personal injury should be heard in Nigeria."

Connecticut Attorney General Richard Blumenthal said his office has been monitoring the case for years. "We haven’t taken a position on whether there is jurisdiction in Connecticut. We’re continuing to monitor and review," he said.

The new lawsuit filed by the Nigerian government claims the nation has spent $500 million treating and compensating the families of children involved in the Trovan test.

Altschuler said he has seen no evidence the government has provided that magnitude of support to those affected by the trial. "I’m not sure why they have decided to bring suit," he said. "I think it may be political burlesque."

Altschuler’s Nigerian co-counsel, Etigwe Uwa, said the government’s actions have been "inconsistent."

"When a similar suit was filed earlier in Kano, the government sought to dismiss it on technical grounds," said Uwa, a barrister and solicitor in Nigeria.
by:www.nhregister.com

Patient Advocate Day

2007-06-17T18:03:00.000-07:00

Gov. Phil Bredesen has declared Tuesday Patient Advocate Day in an effort to promote accessible health care for all Tennesseans. Patients, caregivers and other members of the health care community are asked to express their support by wearing a blue or a gold ribbon.
This effort is sponsored by the National Patient Advocate Foundation (NPAF), a Washington-based organization that works to bring patients' viewpoints to the forefront of health policy discussions. The organization also helps patients from all socio-economic backgrounds obtain appropriate care when diagnosed with an illness.
NPAF and its nationwide network of volunteers address such issues as access to clinical trials and cancer screenings, patient concerns related to Health Information Technology and expansion of state Medicaid programs to cover those who are uninsured when diagnosed with cancer.
NPAF also collects objective data on patient access that is not sourced from government or insurance companies. When formulating policy positions and priorities, NPAF goes by aggregate data collected through case management activities of its sister group, the Patient Advocate Foundation, a national nonprofit organization that provides free assistance and mediation for access to health care, job retention and relief from medical debt crises.
by:www.memphisdailynews.com

Ohio pulled into executioner ID debate

2007-06-05T01:24:00.000-07:00

COLUMBUS — Ohio has found itself in the cross hairs of the latest national debate over the death penalty: Should executioners’ identities be protected?

The American Civil Liberties Union of Ohio begged the question with a wide-ranging request for state records seeking information on the May 24 execution of an inmate whose veins took 90 minutes to find and whose death came a record-setting 16 minutes after the toxic drugs began to flow.
Among other things, the ACLU asked for the names of Christopher Newton’s execution team — a group of volunteer medics and guards whose identities are routinely shielded by the state.

Though the hooded executioner is so common as to be iconic, the ACLU and other death penalty opponents say they have new cause for seeking complete information on the people carrying out state-sanctioned deaths by injection.

They point to the case of Dr. Alan Doerhoff, a participant in Missouri’s execution process who was revealed in press reports to have been sued for malpractice more than 20 times.

They also point to the December execution of Angel Diaz in Florida. An autopsy found the needles were pushed through Diaz’s veins into the flesh of his arms, possibly limiting the effectiveness of the drugs. A commission created afterward to study the incident called for more training and better protocols for executioners.

Richard Dieter, executive director of the Washington, D.C.-based Death Penalty Information Center, which opposes the death penalty, said the public can’t properly scrutinize the effectiveness of capital punishment without adequate information on those carrying it out.

“Public executions should be as public as possible,” he said. “They supposedly have nothing to hide, and as with anything government does, it benefits from more scrutiny. For medical personnel, yes, there may be a cost. But that’s sort of like the cost that the state, or all of us, bear.”

Nonsense, said Michael Rushford, president of the pro-death penalty Criminal Justice Legal Foundation in Sacramento, Calif.

“The ACLU, which has staked out its turf as severely against the death penalty, will use this opportunity to out someone involved in an execution, and use it to put these people at risk,” he said. “Unfortunately, that’s how important their cause is to them.”

Rushford said the American Medical Association has threatened to sanction doctors who assist in executions — because it is a violation of their oath to “first, do no harm.” So the push by death penalty opponents to make executioners’ names public, under the auspices of wanting to review their professional credentials, is meant to shrink the pool of willing volunteers and diminish the state’s ability to execute criminals.

“They (the ACLU) were against the gas chamber 30 years ago — they said there was only one humane alternative and that would be lethal injection,” he said. “Now they’re setting up this Catch-22, saying only a doctor can do that, and knowing the doctor’s association won’t let them do it.”

Executions in North Carolina have been temporarily halted after running into just such a hitch. State law that had simply required that a doctor be present during executions was taken further by a federal judge, who said the doctor needed to actively monitor the inmate for pain. Doctors faced disciplinary action by the state medical board for doing so, however, so the process is in limbo.

Missouri and California are caught up in similar legal battles over whether their states can be forced to involve doctors in executions who are prohibited by their profession’s code of conduct from facilitating a death. Though doctors do not currently participate in Ohio’s execution process, their role could also become an issue in the court battle also raging in this state.

Despite the obstacles they’ve faced, most states still balk at revealing the members of execution teams. Most notably, Missouri lawmakers passed a bill May 21 protecting the executioners’ anonymity and allowing them to sue anyone — including a news organization — who discloses their identity.

The Missouri prisons director has said the state welcomes public scrutiny of its lethal injection protocol and the education and work history of its execution team — just not the names and addresses of participants. Doerhoff’s services are no longer being used.

Dieter said he believes protecting the identity of executioners helps anesthetize the public to what takes place in the Death House.

“There is this distance that we want with the process,” he said. “That’s why lethal injection came about, sort of to give a more medicinal, antiseptic feel to it. Now it’s backfired in that it’s not working well.”

But Rushford said executioners have a job that will naturally subject them to attacks and deserve to be protected by government.

“The state should certainly monitor their background and training, but these people should be no more subject to ridicule than an abortion doctor who’s simply doing his job,” Rushford said. “The law should come down hard on anyone who uses someone’s legal profession to raise harm against them. It should be a hate crime.”
by:www.coshoctontribune.com

State's child car-seat law tightens

2007-06-05T01:22:00.000-07:00

Washington state's child car-seat law got tighter Friday, when new rules took effect requiring children to sit in car and booster seats until they are 8 years old or 4 feet 9 inches tall.

Medical experts say there are good reasons for the new law, which is one of the strictest in the nation.

Car crashes are the leading cause of death among children, according to Dr. Beth Ebel, who sees fallout from improper car seats when she works at Harborview Medical Center and at Seattle Children's Hospital and Regional Medical Center.

"It happens so often, emergency department physicians call it 'seat belt syndrome,' " the Washington Traffic Safety Commission said in a statement.

When a child is involved in a car crash at 30 mph, he or she experiences the same force as falling off the third story of a building, Ebel added.

"You have to pick your battles. This is the one their life depends on," said Ebel, who has three children.

"The data suggests that over half of the children (who) are killed in car crashes are unrestrained."

Parents also must do their part and properly fasten car and booster seat belts.

One of the problems is that an adult seat belt can slip off a child's pelvis onto their stomach. In a crash, the belt can crush a child's spleen, liver of intestines.

People caught ignoring the new rules face a $112 fine for each improperly buckled child.

The old rules required children to ride in a car seat until they were 6 or weighed 60 pounds.

Other rules include:

Babies must ride in rear--facing infant seats until they are a year old and weigh 20 pounds.

Placing a shoulder strap under an arm or behind a back is illegal.

People wanting to get a child seat checked out can visit one of the monthly car-seat inspection sites. The next one is Tuesday at St. Francis Hospital in Federal Way
by:seattlepi.nwsource.com

Vaccine-Induced Autism Victims in the Thousands Will Finally Get Day in Court

2007-06-05T01:20:00.000-07:00

Hearings will begin on June 11th at the U.S. Federal Claims Court to determine if autism is linked to vaccines and their components, including the mercury-based preservative thimerosal. As the Autism Omnibus Proceeding approaches, parents of children diagnosed with autism are calling attention to the conflicts of interest they believe continue to threaten the safety of vaccines.
Among the concerns cited by parents are the close ties between pharmaceutical companies and government regulatory agencies. A July, 2003 UPI investigation revealed the following:

- In two cases in the past four years, vaccines endorsed by the CDC were pulled off the market after a number of infants and adults appear to have suffered devastating side effects, and some died. Critics now worry about a possible link between vaccines and autism, diabetes, asthma and sudden infant death syndrome, among other ailments.

- Members of the CDC's Vaccine Advisory Committee get money from vaccine manufacturers. Relationships have included: sharing a vaccine patent; owning stock in a vaccine company; payments for research; getting money to monitor manufacturer vaccine tests; and funding academic departments.

- The CDC is in the vaccine business. Under a 1980 law, the CDC currently has 28 licensing agreements with companies and one university for vaccines or vaccine-related products. It has eight ongoing projects to collaborate on new vaccines.
Dr. Paul Offit, MD, former chairman of the Advisory Committee on Immunization Practices, which guides vaccine policy decisions at the CDC, embodies the conflicts of interest concern of parents. Dr. Offit has been a long-time defender of injecting mercury, a known neurotoxin, into infants and pregnant women. He is also co-patent holder of the RotaTeq vaccine with pharmaceutical giant Merck, a funder of his research for over a decade. Offit is speaking against parents today in support of the vaccine program and pharmaceutical companies at a press conference sponsored by Every Child by Two, a group also funded by pharmaceutical companies and supportive of injecting mercury into infants.
"In my opinion, as glaring as Dr. Offit's conflicts are, what's even more disturbing is that such close ties between vaccine policy decision makers and vaccine manufacturers are routine," said parent and National Autism Association board member Scott Bono. "The bottom line has become vaccine profit rather than vaccine safety. Children diagnosed with autism are suffering the consequences of an unprecedented greed, and their parents aren't going away until the public knows the full details of this man-made disaster."
by:www.medindia.net

Rip currents blamed for death of Brownsville man

2007-06-05T01:19:00.000-07:00

A trip to Boca Chica beach on Sunday turned out to be a deadly experience for one Brownsville family.

Jesus Rodriguez, 30, died after getting caught in a rip current, Sheriff Omar Lucio said.

“He was swimming in a rip current and his brother was able to pull him out and his sister who is CPR trained gave him CPR,” he said.

Lucio said Rodriguez was pronounced dead by Justice of the Peace Tony Torres at Valley Regional Medical Center.

Mark Edward Angel, 42, of Russell Kentucky, and Humberto Espinoza Molina, 18 of Matamoros both drowned at Playa Bagdad in Matamoros Sunday.

Coincidentally, the National Oceanic Atmospheric Association declared Sunday, June 3 to Saturday National Rip Current Awareness Week.

“A rip current is a return flow of water from the beach back out into the ocean,” said Tony Abbott, forecaster for the National Weather Service.

Abbott said the pile up of water causes a rip current to break.

“As the waves come in, you’ve got water coming onshore by wind or tidal activity. As it comes on shore it has to go somewhere,” he said.

Abbott advised the best way to avoid losing your life in a rip current is to swim across, not against the current and stay calm.

For more on this story read Tuesday's Brownsville Herald.
by:www.brownsvilleherald.com

Maine bill extends family leave protections to domestic partners

2007-06-05T01:18:00.001-07:00

AUGUSTA, Maine (AP) — A bill on its way to final enactment in the Legislature would broaden Maine's Family Medical Leave Act to include domestic partners.

The law already protects employees who take time off to care for spouses, parents and children with serious health conditions.

The bill given final approval Monday in the House of Representatives also allows employees to take time off from work to care for a sick domestic partner.

Maine's Family Medical Leave law allows those who've been employed for 12 consecutive months by the same employer to receive up to 10 weeks of family medical leave. Leave can be either paid or unpaid. The bill to extend leave to domestic partners faces a final vote in the Senate as early as Tuesday.

During a hearing in March, gay and lesbian advocates spoke in favor of the bill. But it also received support from those who said it doesn't just apply to gays.

State Rep. Troy Jackson, D-Allagash, said he's been registered as a domestic partner with his girlfriend since 2004. While his partner is provided with leave through her employer, Jackson said other similar unmarried couples would stand to gain protection under the bill.
by:www.fosters.com

NAIC To Treat 5 Drafts As Models

2007-06-05T01:16:00.000-07:00

BY JIM CONNOLLY
San Francisco -- NU Online News Service, June 4, 2007, 5:32 p.m. EDT

Members of the executive committee of the National Association of Insurance Commissioners granted full model status to 5 model proposals here Sunday during the NAIC’s summer meeting.

The measures that were allowed to advance as models are:

- Amendments to the Viatical Settlements Model Act.

- The Military Sales Practices Model Regulation.

- The Medical Malpractice Closed Claim Reporting Model Law.

- Changes to the Long Term Care Insurance Model Act, which include new producer training requirements.

- The Uniform Health Carrier External Review Model Act.

The NAIC executive committee deferred action on the Standard Nonforfeiture Law for Life Insurance draft and the Standard Valuation model law draft.

The executive committee was scheduled to vote today on whether it would send each of the proposals with full model status to the plenary -- the body that includes all voting members of the NAIC -- later today.

At press time, the NAIC plenary had approved the Viatical Model amendments.

An update on the progress of the other full-model-status measures was not immediately available.

The NAIC executive committee reviewed the proposals for full model status because of a new NAIC policy supported by Walter Bell, the NAIC president and Alabama insurance commissioner.

Under the new rules, the executive committee decides whether work products should be treated as models or simply as collections of guidance.

Advocates of advancing a measure as a model must show that involves matters that require uniform, national adoption and that many commissioners have made a significant commitment to implementing the model in their jurisdictions.

John Oxendine, Georgia insurance commissioner, and Sandy Praeger, NAIC president-elect and Kansas insurance commissioner, expressed strong support for the military sales draft, and Kentucky Insurance Director Julie McPeak spoke up for the Viatical Settlements model.

Supporters of the Standard Nonforfeiture Law for Life Insurance draft and the Standard Valuation model law draft asked that a decision on those proposals be deferred, because those models will be just 2 components of the work of the NAIC’s principles-based working group.

If the executive committee decided this week to advance the Standard Nonforfeiture Law project and the Standard Valuation projects as models, then the NAIC’s new model project procedural rules would give supporters only 1 more year to complete work on the models, according to Thomas Hampton, the D.C. insurance commissioner, who is chair of the principles-based working group.

The principles-based working group wants to take the time to synthesize the work of several different NAIC groups and then present that work product to the executive committee, Hampton says.

by:cms.nationalunderwriter.com

NAIC To Treat 5 Drafts As Models

2007-06-05T01:15:00.000-07:00

Two City Hospitals Give Up Fight Against Closure

2007-06-05T01:14:00.000-07:00

ALBANY — Two Manhattan hospitals targeted for closure by a special state commission are signaling that they have given up the fight to remain open, according to a source in the Spitzer administration.

Cabrini Medical Center in Gramercy Park and St. Vincent's Midtown Hospital, formerly St. Clare's Hospital, have indicated their intention to apply for millions of dollars in state and federal grants that are conditioned on compliance with the directives handed down by Governor Pataki's Commission on Health Care Facilities in the 21st Century.

Through a state program funded in part by the federal government, the Health Department is offering $550 million to 81 hospitals and nursing homes that have been forced to close, downsize, or undergo a major conversion. The money is intended to reimburse the institutions for the costs of complying with the commission's directives.

A spokeswoman for St. Vincent's Midtown, Marlene Bloom, said the hospital tried in vain to convince the Spitzer administration that it should stay open and would soon submit an application for the grants. "We have no choice but to be in compliance with the Berger commission," she said, referring to the commission's chairman, Stephen Berger.

A spokeswoman for Cabrini said the hospital has not applied for the grants and would not comment on whether it plans to do so.

Like many of the cash-strapped institutions that were ordered to close or accept drastic changes by the commission, the two hospitals initially responded with protest, arguing that they provided a critical service in their community and were capable of turning around their finances.

by:www.nysun.com

Medical marijuana law expanded

2007-06-05T01:13:00.000-07:00

MONTPELIER -- Steve Perry of Randolph Center welcomed news Thursday that a bill expanding eligibility for the state's medical marijuana registry would become law -- even though the governor refused to sign it.

Perry copes with a degenerative joint condition that causes severe pain and muscle spasms. Traditional painkillers fail to provide relief, he said, but marijuana has helped. Now he will be able to register with the Department of Public Safety and have protection from state prosecution while using the otherwise illegal drug.

The bill broadened the eligibility established in Vermont's 2004 law by allowing those with chronic debilitating conditions, not just life-threatening diseases, to participate in the program. It also increases the number of plants that participants may grow at home and reduces the annual registration fee from $100 to $50.

The marijuana bill is the fifth piece of legislation Gov. Jim Douglas has allowed to become law this year without his signature. Jason Gibbs, the governor's spokesman, said that generally Douglas exercises this option when he doesn't agree with the policy but recognizes a measure has strong support in the Legislature.

In the case of the marijuana bill, Gibbs said, "The governor has compassion for people who are suffering from debilitating diseases, but he can't in good conscience sanction a violation of federal law."

"Why wouldn't he veto it if that is the way he really feels?" asked Senate President Pro Tempore Peter Shumlin, D-Windham. "This is a wimp-out position." Shumlin criticized the governor for using the no-sign option so frequently.

Senate Majority Leader John Campbell, D-Windsor, agreed.

"I think what it says is that there was a lack of communication on many of the issues we were dealing with," Campbell said. "I would hope in the next session, if he or his staff have problems, we would have more in-depth conversations."

The four other bills Douglas let become law without his signature are:

H.274: This exempts providers of foster care to adults from counting their payment from this work as household income when calculating how much they owe in school property taxes -- if they pay based on their income. "While I gave serious consideration to vetoing this bill, I do want to support adult foster care providers and the important services they provide," Douglas wrote in a letter explaining his decision. "They should not be forced to bear the consequence of poor public policy developed by the Legislature.

H.78: This allows local voters to increase the number of signatures required on petitions requesting reconsideration or rescission of local votes. Douglas said the law could make it more difficult for towns to revisit decisions, but he let it become law because "it at least leaves to the voters the ultimate decision whether to change this time-honored tradition of local governance."

S.124: This allows the Legislature to hire consultants to review the planning the Douglas administration has undertaken to replace the state psychiatric hospital and to offer lawmakers options for new facilities. Douglas called this bill an infringement on the powers and duties of the executive branch of government and "a counterproductive exercise in micromanagement," but let it become law rather than further politicize the process.

S.39: This requires health insurance plans to cover prostate cancer screenings and services provided by naturopathic physicians. Douglas complained that the new mandates would increase health care costs.
Still restrictive

Vermont is one of 12 states that protect very sick people from prosecution for using marijuana.

Even with the new changes, "it is still going to be very conservative compared to some of the other states," said Dan Bernath, assistant communications director for the Marijuana Policy Project.

Campbell championed the expansion of eligibility and relaxation of the limits on the number of plants. A former police officer, he said he understood the governor's concern about passing legislation contrary to federal law. "We chose to look at the human side, to take a compassionate view."

Mark Tucci of Manchester is one of 35 Vermonters on the state's medical marijuana registry. Afflicted with multiple sclerosis, he said smoking marijuana provides relief from the pain and muscle spasms that awaken him many mornings. He uses about 2 ounces a month.

He had lobbied lawmakers to allow him to grow more marijuana at home. They agreed to a modest increase, but Tucci said Thursday that he still wouldn't be able to grow what he needs.

"It still forces me out on the black market," he said, "but it certainly helps."
by:www.burlingtonfreepress.com