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Text File | 1993-03-11 | 24KB | 433 lines

ABLEnews MedNotes

                        AMERICAN MEDICAL NEWS (3/1/93)

Cut Medicare to Ease Deficit? (1)
  President Clinton's proposal to reduce federal spending $500 billion over
  5 years, squeezes $56 billion from Medicare, including $15 billion in
  1997. A document prepared for Hillary Clinton's task force says her plan
  would increase federal health costs by $30 to $90 billion in 1997. Health
  care price controls, last tried by President Nixon in the early 1970s,
  are more likely to benefit private insurers than the government.

Stakes High for Federal Guide on Cataract Surgery (1)
  A host of ophthalmology groups blast a proposed federal guideline on
  cataract surgery as a biased document that will ultimately be used to
  ration care. In a preemptive strike, they issue a rebuttal guideline days
  before the Agency for Health Care Policy and Research (AHCPR).

Streamlining Medicaid Waivers Is No Easy Task (1)
  Welfare reform advocates praise President Clinton's directives to stream-
  line the Medicaid waiver process and to reopen negotiations on provider
  taxes, but critics doubt administrative proclamations can do the trick.
  "Easy to say, tough to do," concludes Allen Dobson, PhD, author of "The
  Role of Waivers in Health Care Policy," an analysis funded by the Kaiser
  Family Foundation.

Who Will Aid the Executioner? (2)
  When convicted murderer Martsay Bolder was executed on January 27 in
  Missouri, on nurse mixed the lethal drugs and another nurse inserted the
  catheter that delivered them. And it wasn't the first time nurses have
  helped execute 7 of the 8 Missouri inmates to die by lethal injection. A
  physician set the line for the first lethal injection execution in 1989.
  "Regardless of the personal opinion of the nurse on the moral appro-
  priateness of capital punishment, it is a violation of the ethical
  tradition of nursing and its Code for Nurses to participate in taking
  human life." --American Nurses Association (ANA).

US Drops Move for Doctor Mandate (2)
  In its final rule establishing procedures for lethal injection executions
  in federal cases, the Justice Department, in the face of protests by the
  American Medical Association (AMA) and other medical groups, eliminates
  provisions requiring the presence of a physician.

Union Can't Bar Benefits for HIV (2)
  A labor union's revision of its health plan to exclude benefits for HIV
  treatment violates the Americans with Disabilities Act (ADA), an Equal
  Employment Opportunity Commission (EEOC) official rules.

Assisted Suicides Now Total 13 (2)
  for Jack Kevorkian, MD, with the killing of 70-year old man by carbon
  monoxide. The death is the fifth engineered by Dr. Death since December
  15 when the Michigan governor signed a law banning assisted suicide to
  take effect March 30. Kevorkian vows to defy the law.

AIDS Author has HIV (2)
  Randy Shilts, who wrote a history of the AIDS crisis for the San Francisco
  Chronicle, was diagnosed with AIDS the day he finished writing "And the
  Band Played On" in 1985. He discloses the results now "because of rumors
  within the gay community."

Throwing the Judges Out (3)
  Since 1988, the Texas Medical Association (TMA) has led a coalition of
  interest groups opposing state Supreme Court justices with a history of
  "activist" interpretation of the state constitution. Today, seven of the
  nine justices on the bench were endorsed by the Texas Civil Justice
  League. "The most important lesson from our experience has been that
  liability reform is not a one-dimensional issue that can be dealt with by
  visits to the legislature. The legislative process is notoriously clumsy,
  and compromise is its hallmark. But the evolution of the tort system is
  shaped as much or more by court decisions." --Kim Ross, TMA director of
  public affairs.

Future of Fetal Tissue Bank Lies in Political Decisions (3)
  Banks at Indiana University, the National Disease Research Interchange,
  the University of Minnesota, the University of Utah, and the University
  of Washington, established to collect tissue from spontaneous abortions
  and ectopic pregnancies and to study the feasibility of their use in
  transplant research and therapy may be axed by President Clinton.

Medicaid Waiver Plan Could Spur Innovations (3)
  "Clinton's election, followed by his recent directive [to create a means
  for research and demonstration waivers to bypass a formal approval process]
  ...is generating an enormous amount of interest in waivers and could undo
  the chilling effect of Oregon's [waiver application] rejection." --Allen
  Dobson, PhD, vice president, Lewin-VHI. CURE Comment: Those who recall
  the Oregon rationing scheme's violation of the ADA may feel a chill of
  their own at Clinton's apparent rubber-stamp approach to state social
  engineers who may devalue the lives and rights of persons with
  disabilities.

Senator Urges Medicine to Be Flexible on Health Reform (4)
  One day after American Medical Association (AMA) Board Chair Raymond
  Scalettar, MD, advises the National Leadership Conference that "not a
  single advocate for medicine is part of the president's process of
  change," Sen. Jay Rockefeller (D-WV) dangles the carrot of tort reform
  and waives the stick that doctors must come to the table without hard and
  fast "theologies" on global budgeting and other controversial "reforms."
  CURE Comment: And who speaks for patients, as big government, with or
  without big medicine, wheels and deals?

Doctors in the Field Uneasy Over Mrs. Clinton's Role (4)
  "The danger in excluding the health system--physicians, hospitals,
  insurance companies--is that you incur their suspicion and create an
  element of doubt about your ultimate goal." --Thomas Reardon, MD, member,
  Physician Payment Review Commission (PPRC). "In my experience, when
  there's a White House Task Force and members don't feel their views are
  being addressed, they can go to the president and discuss their problem.
  But that dynamic gets changed when the person leading it is the presi-
  dent's wife." --Gail Wilensky, PhD, senior fellow, Project Hope.

Congressional Report: Freezing Doctors' Pay Is one Option (4)
  The Congressional Budget Office (CBO) reports that freezing physician and
  hospital rates next year would wring $30 billion from the Medicare budget
  over the next 5 years. Raising Medicare premiums from 25% to 30% of
  program costs would do the same. And increases in co-payments and
  deductibles might shift $50 billion in cost to the patient.

FDA, Drug Makers Enter Era of Good Feeling Over User Fees (5)
  User-fee legislation enacted by Congress last year feeds a love feast
  between the Food and Drug Administration (FDA) and the pharmaceutical
  industry. Fees paid by prescription-drug makers will be used to hire FDA
  staff to speed approval of new drugs, a process now averaging 20 months.


California Rate Cuts Suggest Managed Competition Works (7)
  "Calpers hasn't proved to us that managed competition works." --Robert
  Boorstin, health aide to President Clinton. "We don't know if we're
  raising or lowering systemwide costs." --Tom Elkin, California Public
  Employees Retirement System (Calpers) health benefits chief. CURE
  Comment: Works for whom?

DC Blues Probe Raises Specter of Federal Oversight (8)
  During his 5-year tenure as president of Blue Cross and Blue Shield of
  the National Capital Area, Joseph Gamble racked up $447,007 in travel
  expenses. From 1988 through 1991, executives spent $9.1 million in DC
  Blues' monies for travel, including repeated trips on the supersonic
  Concorde at rates more than double first-class air fares.

Blues Association Tightens Standards for Its Plans (8)
  "These tougher financial and ethical standards must, however, be coupled
  with an equally tough enforcement policy to ensure that they are not
  ignored, like some of the current standards of the national association
  have been in the past." --Sen. Sam Nunn (D-GA).

Doctor Shootings Force Hospitals to Reconsider Security (9)
  "The first few days, the reaction from the staff was anger, anxiety, and
  fear...They're going to separate the patient waiting area from physicians
  with bullet-proof glass...They're also talking about metal detectors.
  Because of the increasing number of people who don't have insurance
  coverage, the demand on public hospitals exceeds our ability to cope with
  it. Patients certainly have to wait and there's anger there." --Gail
  Anderson, MD, chairman, Department of Emergency Medicine, L.A. County-USC
  Medical Center, where three emergency room physicians were shot by "a
  disgruntled former patient." A receptionist and a female urology resident
  were taken hostage. 32% of doctors surveyed at a Long Island, NY hospital
  said they had been threatened by patients. 12% said they were struck.

More Patients Using EDs for Nonemergency Problems (9)
  Fueled by the uninsured, the use of emergency departments for nonurgent
  care is growing, placing increased financial strain on hospitals. From
  1985 to 1990, 85% of hospitals saw more patients with nonurgent con-
  ditions in their EDs. In 1990, 43% of ED visits were deemed nonurgent.
  "EDs can't continue to cover for the deficiencies in our costly and
  increasingly inadequate system of care without compromising our primary
  mission--to provide high quality, life-saving care to anyone who needs
  it." --Arthur Kellerman, MD, director, Regional Medical Center ED,
  Memphis, TN.

Public Might Accept Taxes if Insurance Were Guaranteed (10)
  56% of respondents say they would pay an average of $400 a year in taxes
  on employer-provided health insurance benefits in exchange for a
  guarantee of continued coverage should their job status change. CURE
  Comment: Robbing Peter to pay Paul is particularly risky when the
  government is doing the robbing.

Study Looks at the Link Between Farmers and some Cancers (10)
  The federal government will spend $15 million to study why farmers have
  higher rates of non-Hodgkin's lymphoma, brain cancer, and leukemia.

Idaho Pushes Guaranteed Insurance for Small Businesses (11)
  to provide care to 160,000 uninsured. Other Health Reform Updates.

Rural Doctors Would Benefit From Several New Bills (11)
  improving the financial rewards to doctors and hospitals.


Pennsylvania Considers Women's Health Package (12)
  Sen. Allyson Schwartz's package mandates coverage of elective steri-
  lizations, abortions, and genetic counseling and testing. Taxpayers'
  yearly tab would be at least $8.6 million.

Kentucky Wants More Immunizations (12)
  The $3 million Kentucky hopes to receive from President Clinton's
  proposed $300 million boost in federal immunization funding could buy
  more vaccines and hire more public health nurses.

Many Don't Seek Mental Health Care (12)
  National Institute of Mental Health (NIMH) study finds less than a third
  of the 30% of Americans with mental or addictive disorders seek help.

Health Care Industry Funnels Money to Sen. Wofford (12)
  Harris Wofford, the Pennsylvania Democrat who rode the health reform
  railroad to a 1991 US Senate seat has received $74,000 from political
  action committees (PACs) with a financial stake in such reforms.

Patient Falls and Falls Again; Hospital Liable (14)
  A patient falls from the x-ray table after her thyroid scan. She tries to
  get back to her wheelchair, but the wheels are not locked, and she falls
  again, incurring a compression fracture of her spine. A Louisiana
  appellate court finds her $93,750 jury award "not improper." (Austin v.
  St. Charles General Hospital)

Fall Off Hospital Commode, Death (14)
  The night before a patient who had a pacemaker inserted is expected to go
  home she falls from a commode after a nurse leaves her to attend another
  patient. Discharged four days later, her condition deteriorates and she
  dies. A $180,000 negligence verdict is upheld by the Arkansas Supreme
  Court. (Jefferson Hospital Association v. Garrett)

Suspension for Lie About Certification (14)
  A physician repeatedly advises a medical school and affiliated hospitals
  that he was board certified in internal medicine and cardiology. Neither
  is true. He is fined $10,000 and his medical license is suspended for a
  single year, as upheld by a New York appellate court. (Somberg v. Sobol)

Good Samaritan OB Immune from Liability (14)
  With a mid-forceps application, an obstetrician delivered a baby,
  weighing 3000 grams with quadriplegia and cerebral palsy. Since the woman
  was not the doctor's patient and he did not receive a fee for the
  emergency delivery an Illinois appellate court held he was immune from
  liability under the state's Good Samaritan statute. (Roberts v. Myers)

Staff Privileges Are Privileged (14)
  Florida appellate court squashes trial court order to provide copies of
  physician's application for privileges at three hospitals to mother
  alleging negligent treatment of son's fractured thumb. (Cruger v. Love)

Hospital Minutes Privileged (14)
  Florida appellate court squashes trial court order to provide copies of
  hospital pharmacy and therapeutic committee to drug manufacturer claim-
  ing hospital misuse. (Good Samaritan Hospital v. American Home Products
  Corp.)

Where Does the Money Go? (15)
  "For the first time, physicians are losing income. We need tools to
  minimize it." --Mike Hutchens, practice management consultant.  Cost
  accounting allows a doctor to determine the profitability of a service or
  product line and provides cost benefit information when deciding whether
  to buy a new technology.

Michigan Insurers Form Big Network (16)
  Blue Cross and Blue Shield of Michigan, the Henry Ford Health Care
  System, and Mercy Health Services join in health plan including 20
  hospitals. Employees using doctors outside the network must pay 30%.

Reduce Your Liability for Pension Plan Investments (17)
  Doctors often act as trustees for pensions and profit-sharing plans,
  exposing themselves to liability as a plan fiduciary--an individual who
  must act in the best interests of the plan and its participants.

Most Money Spent on a Few (17)
  One percent of the population accounted for 30% of all health care
  dollars spent in 1987. The top 5 % accounted for 58%, while 50% ac-
  counted for 3%. CURE Comment: Demagogues propagandize the TAB majority to
  scapegoat the minority needing major medical services.

Have to Fire an Employee? Talk to Your Staff About It (20)
  And other Practice Pointers.

Helping Doctors Out of Illness Maze (editorial) (21)
  "The truth is that doctors, just like everyone else, can fall prey to
  physical and emotional problems. And once you enter the often bewilder-
  ing maze of denial and the search for the right treatment, you have to
  deal not only with your illness but the role reversal of being a doctor
  in need of help. When a doctor becomes sick, who heals the healer?"

Quantity of Discipline Actions Not Good Standard (letter-editor) (21)
  "There is nothing wrong with low numbers of disciplined physicians if the
  reason behind low numbers is that a process is working whereby only
  qualified, highly-trained physicians are being licensed." --Arvind Goyal,
  MD, president, Illinois Medical Society, Chicago, IL.

Why Primary Care Is Shunned (letter-editor) (21)
  I first met my future wife's father in 1968. At that time, this family
  physician had a thriving practice....Then, he was forced to stop
  admitting certain mentally disturbed patients for medications as the ACLU
  had found this to be violating their rights. Many of these pa- tients are
  now regulars at the garbage cans and homeless shelters." -- A.S. Miller,
  III, MD, Tulsa, OK.

Physicians Share Varying Views on Euthanasia

Focus on Life, Not Cutting It Short (23)
  "With proper attention to the needs of dying patients, perhaps the ques-
  tion of euthanasia will lose momentum, and we can concentrate on con-
  tinuing good quality of life rather than ending the lives of those with a
  less-than-tolerable existence." --Rebecca Bechhold, MD, specialist in
  oncology.

Death Option May Comfort Terminally Ill (23)
  "In the tradition of passive euthanasia, we 'humanely' permit patients to
  expire from pneumonias, for example, with the requisite dyspnea, anxiety
  and distress that accompany this all-too-familiar scenario... Our concern
  that we may be perceived as contributing to the death of our patients
  arises from the nostrum 'do no harm.' We adhere tenacious- ly to the
  Hippocratic tradition which states, 'I will neither give a deadly drug to
  anybody if asked for it, nor will I make a suggestion to that effect.'"
  --Nolan Weinberg, MD, specialist in internal medicine.

Active Euthanasia Is Simply Murder (23)
  "Should physician-assisted suicide be considered legal or ethical? Never.
  It is illegal to murder or commit suicide. It is unethical and
  religiously unthinkable for a physician to actively promote death....I
  feel physicians could not possibly respond to a patient's request for
  active euthanasia. The spin-off, commonly called 'the slippery slope,' is
  too treacherous." --E. Gordon Margolin, MD, specialist in internal
  medicine.

Maintain the Best Quality of Life (23)
  "None of us determined when we arrived on this earth, and to actively
  decide when to leave is not right. It is unethical for physicians to take
  active roles in such decisions. But physicians must also accept that they
  cannot save all patients." --Craig Cleveland, MD, specialist in internal
  medicine.

Avoid Suicides: Treat the Emotions First (24)
  "Fortunately, the request for assisted suicide is rare. It is important
  to realize, however, that the recent increased interest in this issue
  reflects our failure to deal effectively with the much more common
  challenge of helping patients cope effectively with the end of life. It
  is often fear and anxiety regarding pain, abandonment and loss of control
  that lead patients to contemplate suicide." --Barbara Morris, MD,
  specialist in internal medicine.

An Open Letter to Hillary Rodman Clinton on Reform (op ed) (24)
  "Obviously, doctors will not continue to work days, nights and weekends
  without some financial gain. To be practical what percentage of health
  care dollars can be cut from doctors?...If patients have a financial
  stake in making the system efficient, you will see the entire population
  on the side of cost containment. Incentives to accomplish this include
  taxing all health care beyond a basic benefits package, and requiring
  large deductibles. --Susan Adelman, MD, past president, Michigan State
  Medical Society. CURE Comment: Sock-it-to-the-sick! I guess I never would
  have "chosen" to have that care-costing automobile accident if I had
  bigger deductibles. Suzy wouldn't have gotten cancer, and Johnny wouldn't
  have gotten AIDS. The fact is people will forgo needed medical care
  because they can't afford huge deductibles under such elitist schemes.

Tobacco Giant Wants Former Scientist to Shut Up (25)
  R.J. Reynolds is suing scientist Anthony Colucci, a former employee,
  claiming he tried to blackmail the company for a $5 million, 10-year
  consult contract in exchange for ending his public criticism of the
  tobacco giant. And other Tobacco Updates.

HIV Vaccine Enters Clinical Trial Stage (25)
  VaxSyn shows it can stabilize or lower the amount of virus in HIV-
  infected persons, spur immune response, and stop the loss of CD4 cells.
  And other AIDS Updates.

Losing Your Hair? Better Take Good Care of Your Heart (26)
  Younger men who grow bald on top may be at increased risk for a heart
  attack according to a study conducted at the Boston University School of
  Medicine School of Public Health.

Female Mental Patients More Violent, Less Predictable (26)
  "Judgments about male patients have some modest clinical utility, but
  clinicians had great difficulty predicting violence in women." -- Charles
  Lidz, PhD, and colleagues, University of Pittsburgh medical school's
  Psychiatry Department.

Race, Ethnicity Found Not to Be Factors in Crack Use (26)
  Despite research showing a higher rate of crack cocaine use by African
  Americans and Hispanic Americans, according to Marsha Lillie-Blanton,
  DrPh, and colleagues at the John Hopkins University School of Public
  Health, the difference is attributable to social characteristics and not
  race or ethnicity.

Reforming Workers' Comp Aim of Pennsylvania Bill (26)
  Caps physician payments at 117% of the Medicare fee schedule.

Building Better Doctors (27)
  From addictive substances to violent patients to the stress of having
  their decisions second-guessed by non-physicians, doctors are exposed to
  an array of problems threatening their ability to practice medicine at
  their "personal best."

Lesson of Health Reform Learned Through Tickets for Lunch (29)
  "'You know, anyone who thinks we'll have to ration health care could
  learn a lot from the experience with these tickets today,' she said,
  gesturing with the red ticket in her hand. 'What do you mean?' I asked,
  puzzled. 'I figure people can make reasonable choices for themselves
  within whatever limits are set. But it's human nature to resist having
  someone else make the decisions and distribute the resources in an
  arbitrary manner.'" --Linda Fisher, MD, chief medical officer, St. Louis
  County.

Visa Problem Forcing Doctor to Choose Between Career, Family (30)
  Jordanian Raed Jitan, MD, is a second-year resident in internal medi-
  cine at Marshall University School of Medicine. His wife, Alia, and two
  of their four children are living with him, but the US Embassy in Amman
  refuses to grant visas to his youngest children, 20-month old twins,
  because it is not convinced the family will return to Jordan when Dr.
  Jitan's residency is complete.

Faces of AIDS on Trading Cards (30)
  Instead of Jose Conseco, you get Rock Hudson. Instead of gum, a prophy-
  lactic. They're AIDS trading cards. "There have been some people who
  thought that these cards had a morbid cast to them." --Catherine
  Yronwode, co-owner, Eclipse Enterprises, whose earlier True Crime series,
  featuring criminals, racked up a million dollars in sales.

Bristol Puts Hold on Demand for Yew Bark (37)
  Bristol-Myers Squibb has a stockpile of 1.6 million pounds of yew bark,
  all it currently needs to make the anti-cancer drug Taxol.

California Blues Launches For-Profit HMO (37)
  19.5 million shares of non-voting stock raises $517 million for Well-
  Point Health Networks, a wholly-owned, for-profit subsidiary of Blue
  Cross of California.

[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).