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ABLEnews MedNotes

                    American Medical News (1/3/94)


Some Fast Track CLIA Relief Coming in '94? (1)
  Clinical Laboratory Improvement Amendments of 1988 regulations went
  into effect in 1992, bringing all clinical laboratories, including
  those in physicians' offices, under federal monitoring. But,
  according to the Centers for Disease Control and Prevention (CDC)
  some CLIA-easing regulations are "on a fast track."

Reform Passage Seen This Year (1)
  "A marathon hearing schedule notwithstanding, Congress is still
  'standing at the bottom of a very tall mountain' as it struggles to
  enact health reforms. That's the assessment of five key Hill health
  staffers who see major obstacles ahead...Most see some room for
  compromise over the plan's use of an employer mandate...The premium
  caps Clinton would use to enforce limits on national health spending
  are viewed as its weakest link...All foresee some tough fights based
  more on regional interests than party affiliation."

GOP Reformers Push Medical IRA Plans (1)
  "Making Americans spend their own money for health care has long
  been the conservatives' solution to high medical costs...The GOP and
  AMA plans would encourage people to buy cheaper policies with high
  deductibles and stash the premium savings in personally owned,
  tax-free medical savings accounts (MSAs) to cover routine bills...If
  they have to spend their own money, 'patients would control costs by
  not going to the doctor until they need to,' argues Robert Tenery
  Jr., M.D., president of the Texas Medical Association, which led the
  drive to reorient AMA policy. He believes that's preferable to the
  alternatives: global budgets or rationing by physicians in HMOs
  [health maintenance organizations]." CURE Comment: This is like
  offering the patient a choice of arsenic, strychnine, or your
  "personally owned" plastic bag. No wonder Harvard health care
  pollster Robert Blendon rates this sink-or-swim approach a hard sell
  since "the average citizen hates high deductible coverage."

Time to Act on Breast Cancer (2)
  In 1991, breast cancer activists convinced the National Institutes
  of Health to establish am Office of Women's Health. In 1992, they
  persuaded Congress to set aside $210 million in the Department of
  Defense budget for breast cancer research. In 1993, the Department
  of Health and Human Services convened a conference to draw up a
  national battle plan.

Number of Uninsured Jumps (2)
  38.5 million Americans under 65 lacked health insurance at some
  point in 1992.

Dr. Kevorkian Free--Again (2)
  Retired pathologist has engineered 20 deaths since 1990, including 5
  since Michigan outlawed assisted suicide.

HIV Transmitted by Surgeon (2)
  to five patients in single day of minor surgery in Sydney,
  Australia.

Artificial Heart Tested (2)
  CardioWest heart had been banned by government.

HIV Resistance Noted (2)
  People with drug-resistant HIV strains are three times as likely to
  die as those with other strains, researchers report.

Who's Responsible for Holding Down Costs? (3)
  "The Pitch: Under Clinton's plan, employers pay 80% of adjusted
  premiums for all employees. The Curve: But premium cap (at 7.9% of
  payroll, far less than companies currently spend) could kill
  employer cost-control initiatives. The Pitch: Gramm proposal lets
  individual set aside funds annually to tax-free medical IRAs to
  cover health care costs. The Curve: But participants could be
  tempted to skimp on preventive care and pocket savings. The Pitch:
  Republicans and conservative Democrats believe individuals, not
  employers, should pay for health insurance. The Curve: Even with
  penalties, individuals could dodge coverage. And individual mandate
  looks enough like a tax to sink reform prospects. The Pitch:
  McDermott's single-payer system limits individuals' health spending
  to 1.45% tax on wages. The Curve: People have no financial incentive
  to use health resources responsibly."

Data Bank Access Debate: Any Middle Ground? (3)
  "Revealing 'repeat offenders' listed in the National Practitioner
  Data Bank is seen by some as a compromise to consumer demands for
  full access. The Clinton administration has proposed such limited
  data-bank access... Rep. Ron Wyden (D-OR), who has long sponsored
  legislation to open the bank, is considering a similar
  approach...But...organized medicine vehemently opposes any public
  access to the 3-year-old repository."

Drug Industry Hits Clinton Price Plan (4)
  According to Dr. Philip Lee, assistant secretary for health, "Some
  new drugs have recently reached the market at a cost of $50,000 to
  $300,000 per patient per year." The administration wants to set up
  an advisory council on breakthrough drugs. Testifying before the
  Senate Committee on Labor and Human Resources, Gerald Mossinghoss,
  president of Pharmaceutical Manufacturers of America charged, "The
  council would be the first major step to reducing the industry to a
  public utility, chilling precisely the kind of research the
  government says it wants to encourage: high risk R&D [research and
  development] against the most intractable diseases."

As Market Grows, Recruiters Eye Physician Extenders (5)
  "Demand for extenders is so great that six months ago we switched
  our focus from placing physicians to placing physician assistants,
  and now plan to begin working with nurse practitioners and midwives.
  Groups and hospitals see them as a way to expand or test the water
  without going to the expense of hiring a new physician." --Joseph
  Hawkins, chief executive officer Merritt Hawkinsg and Associates,
  Irving, TX. CURE Comment: We do not believe the "Hamburger Helper"
  approach to medical care is in the best interests of patients.

Gun Control as Immunization (7)
  A five-year-old child's Christmas wish touched off Chicago
  pediatrician Katherine Christoffel's crusade against guns. The child
  asked for a bugle because "I want to wake my daddy." The boy had
  seen his father shot to death. "Gun violence should be treated like
  polio and tuberculosis and every other epidemic," claims Dr.
  Christoffel. "Guns are a virus that must be eradicated. We need to
  immunize ourselves against them."

Clinton Aides Target Risk Selection as Top Priority (9)
  "Risk selection, particularly the intentional exclusion of people
  with serious or chronic health problems, constitutes one of the most
  difficult obstacles to health security in the present system, says
  Judith Feder, PhD, deputy assistant secretary of the Department of
  Health and Human Services...Pitfalls would exist even under a
  reformed system, she acknowledged. Insurers could, for example,
  discourage higher-risk enrollees by giving them poor service or
  failing to contract with the kind of providers that can address
  special needs." CURE Comment: This is one of our concerns about any
  managed care plan's impact on people with disabilities,
  particularly, ones requiring specialized medical services. As Dr.
  Feder concedes, "Concerns have been raised that health plans will
  avoid contracting with leading treatment centers and specialists in
  order to avoid patients with serious health conditions."

Bit of Needle Left in Breast After Biopsy (10)
  Indiana appellate court rules action against radiologist, surgeon,
  and hospital should not be dismissed. (Wright v. Carter)

Test of Lovers' Kids 'Given in Friendship' (10)
  Florida appellate court finds charges of professional misconduct
  against a psychologist who administered Meyer-Briggs psychological
  tests to the children of his lover should be dismissed. The Board of
  Psychological Examiners had dismissed a complaint of sexual
  misconduct. (Brown v. Department of Professional Regulation)

Court Grants More Time to Prepare Case (10)
  Alaska Supreme Court affords liposuction patient more time in
  malpractice suit. (Johnson v. Siegfried)

Whole-Cell DTP Vaccine Not Defective (10)
  "A federal trial court in Maryland dismissed a product liability
  action by a 7-year-old mentally retarded patient who claimed her
  mental retardation was worsened by the pertussis component of a DTP
  vaccine she received." (Pease v. American Cynamid Company)

Parents' Consent Required for DNR (12)
  "The consent of both parents of a child on life support systems was
  required to remove treatment or implement a 'do-not-resuscitate '
  order, the Georgia Supreme Court ruled. In May 1991, a 13-year-old
  girl who had experienced medical problems since birth was admitted
  to a hospital after a mild choking episode. Over the following few
  weeks,...she became limp and unresponsive. Her physicians believed
  she had a degenerative neurological disease, but there was no
  certain diagnosis. In late May she was placed on a [ventilator], and
  in June physicians inserted feeding and breathing tubes...They
  discussed with her parents the possibility of a DNR order in case of
  cardiac arrest. Her mother agreed, but her father did not...In early
  September...the hospital bioethics committee...recommended that the
  hospital support the mother's desire to enter a DNR order and
  decrease medical treatment...The court held that only if there was
  no second parent, or, of the other parent was not present, would the
  consent of one parent be legally sufficient to issue a DNR order.
  The trial court was correct to enjoin the hospital from implementing
  such an order, or from removing treatment, without both parents'
  consent, it said." (In re Jane Doe, a Minor) CURE Comment: We have
  defended families where hospitals have sought to terminate life-
  sustaining treatment AGAINST the desires of both parents (such as
  Philip Rader). Nor do we believe a child with a disability should be
  sentenced to death because both parents may deem her a burden, for
  example.

Plastic Surgery Leaves Larger Scar (12)
  After surgery for a ruptured cervical desk resulting from an
  automobile accident, the patient was left with a keloid scar about 7
  by 1 cm on her neck. She elected reconstructive surgery by a
  board-certified specialist. "Instead of the small scar previously on
  her neck, the patient had a massive keloid scar along the front of
  her neck. The patient claimed she had not been told the risk of
  scarring and would not have agreed to the operation if she had known
  there was a risk of a disfiguring scar." The Mississippi Supreme
  Court ruled the trial court should not have dismissed her claim of
  lack of informed consent. (Barner v. Gorman)

When Children Molest Children (13)
  "San Francisco--Not long after the venerable Town School for Boys
  opened its doors for the new academic year in September 1992, a
  first-grade student confided to his mother that he had been sexually
  molested on campus. The person he accused was 7 years old. Following
  a months-long investigation, police and child-protection workers
  concluded that the abuser had coerced between 8 and 17 classmates
  into participating in such sexual acts...Evidence that adults
  physically abuse children first jolted the national
  consciousness,about 30 years ago. A new shock followed in the
  1970s--that adults sexually abuse children. Then, in the early
  1980s, child-protection workers recognized that adolescents were
  engaging in sexually abusive behavior. Another shock wave hit the
  late 1980s, when therapists first described cases of sexual abuse by
  preadolescents."

Anti-Violence Group Conference Set for February (16)
  Physicians for a Violence-Free Society scheduled their first annual
  conference for February 4 to 6 at the Mark Hopkins Hotel in San
  Francisco, CA. Other Public Health Updates.

Still a Ways to Go (editorial) (17)
  "In a six-part series of special reports, concluding in this issue,
  AMNews examines how the Clinton plan and others address the
  president's six overarching goals...Here's a quick glance at our
  findings: Security. Translated, that means universal coverage. The
  mechanisms vary from employer mandate to individual mandate to
  government-as-payer to no specified financing method at all. Key
  trade-off: the more security is guaranteed, the larger the
  government's role in the health care system. Choice. All proposals
  claim to provide it. Most would encourage the trend to channel
  patients into managed care, with the possible exception of single
  payer. Market-based plans redefine choice as choice of health plan
  rather than physician. Quality. Approaches range from hands-off to
  practice profiles and report cards. Key concerns: Premium caps and
  global budgets could threaten quantity of care, which many equate
  with quality; medical savings accounts create a disincentive to
  prevention. Savings. Shaky forecasts plus uncertainty about how the
  plans' strategies would affect the cost of care result in one of
  reform's biggest unknowns. Simplicity. Proposed new bureaucracies
  raise the specter of continued red tape. Single-payer seems simplest
  but requires faith in the government. Universal claims forms and
  electronic claims processing are offered to reduce paperwork
  burdens. Responsibility. The threat of reform has already cooled
  health care inflation. In the long run, would individual, employer,
  or government responsibility for health care most effectively hold
  spending in check?" CURE Comment: Should "holding spending in check"
  be the god of our health care system? For another perspective on
  these six goals, see CURE's report: The Health Security Act: Social
  Insecurity.

'Report Card' Is Wrong Term (letter-editor) (17)
  "The use of the term 'report card' implies that evaluators have the
  information needed to fairly evaluate performance and also that a
  teacher-student relationship exists. Neither is often the case. As I
  noted in a recent editorial..., claims-data bases are frequently too
  incomplete and too inaccurate clinically to reach definitive
  conclusions about the quality of care." --Peter Dans, M.D., deputy
  editor, Annals of Internal Medicine, Philadelphia, PA.

Help Smokers Quit Instead of Ignoring Them (letter-editor) (17)
  "The refusal of Mark Jameson, M.D., to accept smokers into his
  practice is a testament to how poorly equipped physicians are to
  practice primary prevention, and how warped our 'health care' system
  has become...Let's face facts: America's $800 billion-plus medical
  system is largely supported by...lifestyle-related, preventable
  diseases...How has our medical system dealt with this paradox? By
  training physicians to use high-tech surgeries and medications to
  treat the symptoms of these diseases, and by offering a myriad of
  screening tests to make early diagnoses, in lieu of real
  prevention." --James Craner, MD, MPH, Reno, NV.

Guns Save Lives, Too (letter-editor) (18)
  "The most recent and best data available suggest that every year
  good Americans use guns 800,000 to 2.4 million times to defend
  themselves and their families--that represents as many as five lives
  protected per minute, 75 lives protected by a gun for every life
  lost to a gun." -- Edgar Suter, M.D., chair, Doctors for Integrity
  in Research and Public Policy, San Ramon, CA.

Wrongful Life Suit Infuriating (letter-editor) (18)
  "Your recent article about a lawsuit for 'wrongful life' absolutely
  infuriated me...What a disgrace that our legal system allows such
  harassment of a physician. Why not encourage suits against the
  parents, far more involved in the creation of this so-called
  'wrongful life'?...If any of them knew of a genetically transmitted
  disorder in the family history, maybe he or she should be faulted
  for having progeny." --Ralph Levin, M.D., San Mateo, CA. CURE
  Comment: While we resolutely reject the TAB bias inherent in the
  oxymoronic concept of 'wrongful life,' and while we suspect Dr.
  Levin's suggestion may be Swiftian, there is a real danger that the
  gene police may follow his ill advice, as the case of Los Angeles
  t.v. anchor Bree Walker-Lampley, who has ectrodactyly, and her then
  unborn child chillingly demonstrated.

How Mandated Individual Coverage Would Work (op-ed) (19)
  "Whether or not health care is a right, purchasing health coverage
  is an obligation. It is the individual who most take positive steps
  to obtain health care insurance...The administration bill is not the
  only credible bill in Congress and we worry about its effect on
  jobs. Job-lock, lay-off of marginal employees, increase in part-time
  or temporary employees and other tactics to escape an employer
  mandate are high prices to pay for universal coverage."  --Susan
  Adelman, MD, past president, Michigan State Medical Society.

Gowns Join Towns (21)
  "Something funny is happening on the way to health system
  consolidation: Academic practice plans, which have survived for
  years without worrying much about the bottom line are becoming
  penny-pinchers. In this world of increasing managed care and looming
  health reform, it's not just the private group practice that are
  looking to integrate and become full health care delivery systems."
  CURE Comment: It should be noted that, as the AMNews reports,
  academic practice centers "often act as health centers of last
  resort for the poor"--a refuge threatened by managed care.

What's Good and What's Bad in the New Tax Code (22)
  Taxes and Business.

  [The above listing, prepared for ABLEnews by CURE, includes all
  significant articles  and a representative selection of the remainder.]

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