ABLEnews MedNotes

ABLEnews MedNotes

                         American Medical News (11/01

Huge Losses Force Employers to Get Tough on Health Costs (1)

   "As a result of large writeoffs taken this year for future retiree

   health benefits, American companies are facing serious scrutiny of

   their health care spending from board members and shareholders. This

   new accountability is driving employers to take drastic steps to

   rein in health care spending: eliminating indemnity coverage,

   restricting workers' choice of physicians, and forming provider

   networks."

No More Mr. Nice Guy (1)

   "Polls suggest that public euphoria surrounding the reform effort

   has dimmed since the president first sketched an outline of his

   proposal. Emboldened opponents have stripped off the kid gloves and

   dropped... the constant references to bipartisan cooperation that

   permeated Mrs. Clinton's week on Capitol Hill. Congressional dueling

   with more recent administration witnesses has been far more

   spirited."

Ruling Sets Limits on Informed Consent (1)

   "In a ruling some medical ethicists find disturbing California's

   highest court says informed consent law encourages frank discussion

   between physician and patient but can't dictate their contents."

   CURE Comment: The mercenary motivation of these "ethicists" is

   evident in AMNews description of the rejected complaint: "By failing

   to tell a cancer patient his [alleged] life expectancy, doctors

   breached the duty to get informed consent. Had the patient known, he

   would have foregone costly therapy and gotten his finances in

   order." (Arato v. Avedon)

What's OK in Recruitment? (2)

   According to critics, the proposed safe harbor shielding

   practitioner recruiters from federal fraud and abuse prosecution is

   so narrowly drawn as to be meaningless. "It's practical benefit is

   minimal. Until the government recognizes the need for physician

   recruitment at all hospitals, irrespective of their location, it's

   not providing any helpful guidance." --Sanford Teplitzsky, health

   care attorney.

California System Seeks Premium Cut (2)

   Health insurers are shocked by the California Public Employees

   Retirement System's demand for a 5% premium cut for their 900,000

   members.

Managed Care Savings? (2)

   A General Accounting Office (GAO) study finds little empirical

   evidence that managed care saves money.

Catheter Maker Pleads Guilty (2)

   C.R. Bard Inc. will pay $61 million in fines for selling untested,

   defective cardiac catheters between 1987 and 1989.

Druggists File Antitrust Suit (2)

   Retail druggists sue seven drug manufacturers for denying discounts

   offered mail-order and hospital pharmacies and managed care plans.

Uninformed and Undecided (2)

   Many Americans don't know the meaning of such terms as HMO and

   managed care, a Kaiser Family Foundation Survey finds. CURE Comment:

   Unfortunately, if the Clinton health plan is enacted they'll learn

   soon enough...the hard way.

Clinton Plan Delicate Balance (3)

   "Whatever else you say about it, the...Clinton Health Reform Plan is

   an intricate, ingenious house of cards in which each element is

   delicately balanced on many others. Pull one out, and the whole

   structure collapses. Yet physicians, insurers, employers, labor

   unions, and scores of other interest groups are threatening to blow

   the house down if the pieces they dislike are not removed.

   Washington sages say Clinton will have to do a significant amount of

   reshuffling to have any chance of passing reform."

States Assured of Reform Flexibility, But Legislators Wary (3)

   While Ira Magaziner, President Clinton's health adviser urges states

   to press ahead with their own health reforms to "work out the bugs

   together," Senator Christopher Bond (R-MO) has another reason. "Yes,

   by all means go ahead," he advises, as Clinton's health plan may

   never pass. "Once people realize how fragmented we are up here, this

   dog may not hunt at all." "I can count on one hand the number of

   times we've been promised grants and actually gotten them," says

   Theresa Atkinson, a Virginia legislative financial analyst. Adds US

   Representative Jim Cooper (D-TN), "I'm deeply worried you'll be left

   holding the bag."

How to Fashion a PRO (Peer Review Organization) for the Future (3)

   "PROs would need a major makeover to gain a role in the health

   system envisaged by President Clinton, experts say. Physicians may

   welcome the change, but some consumers are wary....'Uncle Sam will

   not be a watchdog,' Barbara Gagel, director of the federal Health

   Standards and Quality Bureau, which oversees the PROs, told the

   American Medical Peer Review Association's annual meeting. 'The

   power will shift to the purchasers and users of health care.'" CURE

   Comment: And who shall protect the users--whose interest lies in

   increasing access to medical care--from the purchasers--whose

   interest lies in restricting access to medical care? 

Specialty Societies Back Efforts to Expand RBRVS (4)

   While most specialty societies support the Health Care Finance

   Administration's initiative to expand the use of resource-based

   relative value scale to services not covered by Medicare, they find

   much to criticize in HCFA's proposals. "The medical profession has

   long been concerned that Medicare's budgetary constraints will have

   a chilling effect on positive developments in medical practice and

   the delivery of care., and the rules' discussion of payment for care

   management services suggests that this concern is valid." --AMA/

   Specialty Society RVS Update Committee. 

Business Anything But United on Health Reform Plan Front (6)

   "We presently pay over $200 million a year for health care benefits

   for our employees." Under the Clinton plan costs would rise to $700

   million. "As much as we might like to, retail employers simply

   cannot absorb the massive costs of this health care reform plan."  

   --Anthony Palizzi, executive vice president and general counsel,

   Kmart Corporation.

Labor Leaders Back Clinton Plan, But Wary of Details (6)

   While AFL-CIO president Lane Kirkland says the White House health

   care initiative "offers the best hope for achieving our long sought

   goal of universal coverage," many union leaders are concerned about

   its provisions, and are divided between single-payer and employer-

   mandate advocates. "I see the health care proposal the president has

   outlined as dead on arrival in Congress. That will be so compromised

   and changed, we won't even recognize the final product. Depending on

   the final package, we'll decide." --William Owell, executive vice

   president, United Food and Commercial Workers Union.

A Picture Worth 1,000 Numbers (7)

   "Alphanumerics are primitive. The mind assimilates visual images

   much quicker and with greater retention than letters and numbers." -

   -Michael Lesser, MD, internist, cardiologist, inventor of Graphical

   Interface for Intensive Care, Holmes Regional Medical Center,

   Melbourne, FL.

Oregon Health Reform Architect to Run for Governor (8)

   "The architect of Oregon's landmark health reform legislation,

   emergency physician John Kitzhaber, MD, announced his candidacy for

   governor October 16. In his announcement statement, Dr. Kitzhaber

   vowed to undertake a positive campaign against 'the politics of

   polarization.'"

Safety of Imported Tissue Questioned (8)

   "The fine print indicates these products have not always ben

   collected under sanitary conditions...These products are being

   marketed directly to US physicians without the provision of any

   health records on the donor or data on the methods by which tissues

   have been treated or preserved." --Rep. Ron Wyden (D-OR), chairman,

   House Small Business subcommittee.

Doctors Need Continued Training in Heart Failure (9)

   As the mortality rate from congestive heart failure--which affects

   three million Americans--continues to rise, a considerable number of

   primary care physicians may be hindering the progress of CHF

   patients through treatment deemed detrimental, an AMA survey

   finds.17% of the doctors said they'd use calcium channel blockers to

   treat CHF but "data suggests they can raise mortality rates" in CHF

   patients, notes Dr. Michael Horan, director for heart and vascular

   diseases at the National Heart, Lung, and Blood Institute.

Wrongful Death of 'No Code' Patient (10)

   At the request of the family of a 67-year-old patient, a do-not-

   resuscitate (DNR) order was entered in his chart. Subsequently

   nurses refused a request for portable oxygen during a move to a

   private room. The patient was pushed no more than 15 feet when he

   suffered extreme respiratory distress and died shortly thereafter.

   The Idaho Supreme Court finds the hospital and nurse liable for

   compensatory and punitive damages for wrongful death reducing the

   lower court's award to $4800. CURE Comment: No, that is not a typo,

   the man's life was judged worth less than $5,000. For information

   regarding the dangers of involuntary DNR, request "DaNgeR DNR" from

   CURE at the address below. (Manning v. Twin Falls Clinic & Hospital)

Needle Exchange Program Permissible (10)

   despite Drug Paraphernalia Act which prohibits delivering hypodermic

   needles knowing they would be used to inject controlled substances

   illegally, Washington state's Supreme Court holds. Spokane County

   Health District v Brockett)

Facsimile Affidavit Was Timely Filed (10)

   in negligence case, Georgia appellate court rules. (Waldroup v Green

   County Hospital Authority) 

No Negligence in Fatal Rhizotomoy (10)

   finds Texas appellate court. With a 20-year history of facial pain,

   the 63-year-old patient had undergone seven operations before this

   percutaneous stereotactic radiofrequency rhizotomoy. "The physician

   started the procedure by inserting a needle electrode through the

   side of her face. He then had an x-ray taken to see if the electrode

   was placed properly...Awaiting the results he noticed the patient

   was not reacting or awakening in the usual manner. He withdrew the

   electrode and had her taken for a CT scan. When he read the x-rays,

   the physician saw the needle had not penetrated the intended...site 

   ...The patient lapsed into a coma and died four days later." (Warner

   v. Hurt)

Advising Aspirin Is 'Reasonable Prudence' (10)

   The issue says New York appellate court was whether the physician

   was negligent in failing to advise the patient not to take aspirin

   before a colonoscopy to seek and remove polyps. (Safier & Vogelman

   v. Kalvin)

Rushing to Report Cards (editorial) (19)

   "Report cards raise very serious concerns. It would be extremely

   dangerous to adopt approaches to measuring quality and utilization

   data that are misleading, that discourage doctors from doing their

   best for their patients, or that are just outright wrong."

Really Two Patients in Doctor's Office (letter-editor) (19)

   "As I was taught in all my basic medical sciences, when a pregnant

   woman comes to a physician's office, there are really two patients.

   A complete examination of the pregnant woman would reveal two

   different heartbeats, two different genetic makeups, two different

   growth rates, two different brain wave patterns--in short two

   different patients. It is only when I count the number of wallets

   that I arrive at the number one. Is this how we decide who receives

   our paramount care?" --Paul Hoover, MD, Hermitage, PA.

Independent Agreements a Right (letter-editor) (19)

   "I don't believe that there is any law in this nation that precludes

   two consenting adults agreeing to exchanging a service for a

   mutually acceptable price, even if the purchaser of the service has

   a preexisting contract with another provider. If this assumption is

   correct, the authority to penalize or even criticize a physician and

   a Medicare beneficiary...who exercises the right to contract

   independently with a nonparticipating provider." --CS Poliakoff, MD,

   Colorado Springs, CO.

Course Teaches Communication Skills Early (letter-editor) (19)

   "We have initiated a course, 'Introduction to Clinical Medicine,'

   which introduces students to actual patients....A key component of

   this experience focuses on the student-doctor/patient relationship."

   --Mary Ann Harvey, director of public relations, College of

   Osteopathic Medicine of the Pacific, Pomona, CA.

Physicians Have a Duty to Report (letter-editor) (20)

   "If physicians do not police the medical profession how can we heal

   ourselves as health care professionals? The malpractice nightmare is

   a living reality for negligently injured patients who understandably

   seek legal counsel when colleagues cover up rather than fess up."

   Edwin Zinman, DDS, San Francisco, CA.

Doctor a 'Wonderful Example' (letter-editor) (20)

   "Wendy Ring, MD, 'Improving access by taking the clinic to the

   people' (AMNews, September 6)...is a wonderful example of the kind

   of physician the medical establishment is trying to revisit." --

   Yvette, Miller, MD, Dallas, TX.

Nice Story, Wrong State (letter-editor) (20)

   "We at the Iowa Medical Society were gratified to read the extremely

   flattering story 'Physician is welcome sight in rural Iowa town.'

   (AMNews, September 13). Positive coverage of Iowa in a national

   publication is always welcome. A mystery has developed. I had hoped

   to drop a congratulatory note to Joel Dye, MD...However, staff...

   have searched our data banks in vain for any mention o Joel Dye, MD

   ..We have also been unable to locate Butte County or a rural Iowa

   town called Arco. And as for the Lost River Hospital, well, we've

   apparently lost it!" --Eldon Hutton, MD, executive vice president,

   Iowa Medical Society, West Des Moines, IA. AMNews Editor's Note: "We

   goofed. The story was about Idaho."

The State of the Health Care System (op-ed) (21)

   "This year we mark the 10th anniversary on nationwide health care

   reform, enacted in 1995. Despite the promises made...things have not

   turned out the way they were supposed to...All Americans carry a

   health security card, but its worth is in question. Polls indicate

   the public feels less and less secure about their ability to have

   acute care in emergency settings when they need it. Many of our

   major trauma and public delivery systems have been downgraded, shut

   down, or are near closing." --Gary Krieger, MD, pediatrician, San

   Pedro, CA.

Lawsuit (23)

   "Aside from its possible financial consequences, being sued for

   malpractice is painful because it disrupts the normal doctor-patient

   relationship. Skepticism and doubt replace the trust patients would

   normally have for their physicians. Contention substitutes for

   collaboration, and suspicion casts a shadow over customary and even

   heroic efforts."

Proper Documentation Will Help You Survive an Audit (25)

   "In today's tenuous insurance climate, physicians face an increasing

   risk of being audited by insurance companies, Medicare and

   Medicaid." --Patricia Tinkelman, partner, Buchanan & Co.,

   Washington, DC.

Income Replacement Policy v. Disability Insurance (26)

   "Most professional business people have some form of disability

   income insurance. A disability policy maintains an income stream

   when an injury or illness keeps you from performing the duties of

   your occupation. But to receive a benefit under disability insurance

   you have to be diagnosed as disabled by a doctor and also meet a

   specified waiting period....Income replacement insurance...could

   meet your income security needs with less hassle than traditional

   disability insurance."

 If You Have an Inventory, You May Owe Vaccination Tax (26)

   Doctor's Business Calendar

City of Medicine Honors Three Health Care Leaders (27)

   1993 City of Medicine awards go to Sir James Black, MD, winner of

   the 1988 Nobel prize in Medicine for his pharmaceutical research;

   Donald Henderson, MD, director of the World Health Organization's 

   campaign to eradicate small pox; and David Rogers, vice chairman,

   National Commission on AIDS.

Insurer Lifts Cap on AIDS Benefits (30)

   Allied Services Division Welfare Fund drops $5000 limit on AIDS-

   related benefits termed violation of the Americans with Disabilities

   Act by the Equal Employment Opportunity Commission.

Dutch Expert Backs Euthanasia (31)

   Peter Heintz, MD, of Utrecht University, supports the Dutch

   government's "liberal policy on euthanasia," but many member of the

   New England Chapter of the American College of Obstetricians and

   Gynecologists remain unconvinced. "Euthanasia is the ultimate

   failure of medical science," responds John Gibbons, MD, conference

   chairman. CURE Comment: For a copy of CURE's statement in opposition

   to the latest euthanasia expansion in Holland, request "In

   Resistance to Euthanasia" from CURE at the address below.

[The above listing, prepared for ABLEnews by CURE, includes all major

articles in the cited issue and a representative selection of the

rest.]

...For further information, contact CURE, 812 Stephen Street, Berkeley

Springs, West Virginia 25411 (304-258-LIFE/258-5433).