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ABLEnews MedNotes

                    American Medical News (1/10/94)

AMA Panel on Guidelines Sorts Good from Misguided (1)
  "There are now more than 1,600 guidelines developed by 60 organizations,
  on everything from eating disorders to bypass surgery. Yet their quality
  varies as much as their topics. As one Institute of Medicine expert
  notes, some are scientifically sound but others have been developed
  'rather cavalierly.'"

North Carolina Optometrists Widen Their Scope of Practice (1)
  "In a development sure to catch the eye of physicians nationwide, North
  Carolina optometrists have won official state approval to bill Medicaid
  ...for such (advance medical) treatments as fetal monitoring, diagnostic
  ultrasound, and laser surgery...Physicians in North Carolina and
  elsewhere see the development as the latest alarming chapter in the
  ongoing push by nonphysicians to expand practice privileges...
  Specialists, such as neurologists, dermatologists, and plastic surgeons
  ...say optometrists have neither the training nor skill to perform many
  of the procedures for which they can now seek state payment. Physicians
  warn that patient safety will be jeopardized if optometrists actually try
  to exercise their wider practice authority."

Doctors Pay Up 6.5% in '92; Specialists Benefit Most (1)
  For the last two years physician income has outpaced inflation, the
  opposite was true for the previous three years. The AMA's annual survey
  found median physician income rose 6.5% to $148,000 in 1992, while
  inflations increased 3%.

Boom Year (2)
  "New data from the nation's largest HMO [health maintenance organization]
  trade group may give physicians, especially specialists, cause for
  concern: Enrollment growth is accelerating, which could lead to a
  physician surplus. If the cynics are right and health reform leads to
  nothing but a few giant group-model HMOs treating everyone, then half of
  all physicians had better start thinking of finding new jobs...The AMA
  said there in 1988 there were 223.7 physicians per 100,000 population...
  But group-model HMOs were using only 120 physicians per 100,000 enrollees
  in 1992, according to the 1993 HMO Industry profile, published by the
  Group Health Association of America Inc."

Ranks of Uninsured Grew in 1992 (2)
  by 6% over 1991, according to the Employee Benefits Research Institute.
  But the puzzling fact that the purported surge in uninsured left no
  measurable impact on the industry's financial results for 1992 has
  prompted some to call the government's data into question. "I'm unaware
  of any supporting economic data that there has in fact been an increase
  in the uninsured in the past 12 months," concludes Thomas Prince, PhD, of
  Northwestern University's Kellogg Graduate School of Management.

Ickes in Charge of Health Bill (2)
  New York lawyer Harold Ickes, son of Franklin Roosevelt's interior
  secretary, is named deputy chief of staff by Clinton.

CLIA Accreditor Approved (2)
  The Health Care Finance Administration authorizes the private Commission
  on Laboratory Accreditation to accredit doctors' office labs under the
  Clinical Laboratory Improvement Amendments of 1988.

Genome Map Unveiled (2)
  Covers nearly 90% of the DNA that holds the estimated 100,000 human
  genes.

US Rejects TB Payment Request (2)
  US Agency for International Development turns down World Health
  Organization's request for the United States to pay a third of the tab of
  a new tuberculosis program ($3 million).

Experts Put HIV Case in Perspective (2)
  Poor infection-control procedures suspected in first reported case of a
  patient with AIDS infecting four other patients in an Australian
  physician's office.

Bill Seeks to Boost Organ Supply (2)
  in Pennsylvania.

Braving the New World (3):

Reform or Not, Managed Care Is shaping the Future
  "Solo ophthalmologist David Brownley, MD, recently pulled up roots after
  23 years in Los Angeles and moved to a small Ohio town. Otherwise, he
  figured managed care soon would have put him out of business...Physicians
  today are braving a tidal wave of change in medicine. The upheavals are
  economic, political, technological, ethical, and, most of all, personal.
  While some doctors are riding the wave successfully, others are going
  under or scrambling for shore. But they're finding there's no safe
  ground. This is just the beginning. In the next few years, observers say
  the bulk of care in most urban areas will be delivered through HMOs and
  preferred provider plans. That's coming even in areas where there is
  little managed care now...The new arrangements could squeeze physicians'
  income and autonomy."

Physicians Struggle to Adjust in Rapidly Changing Environment
  "Medicine is facing changes so profound some compare them with social
  upheavals like the Industrial Revolution or the struggles of the
  immigrants in the New World. There are few hard data on how physicians
  are coping, but there is clearly much dismay. In a profession whose
  members long boasted of practicing forever, talk is rampant of early
  retirement and switching careers...Studies indicate that 35% to 50% of
  physicians would not choose medicine if they had to do it over again.
  Says attorney and financial planner Ronald J. Paprocki, 'At one extreme,
  they're so fed up with the bureaucracy that's occurring that they're just
  getting ready to step aside...On the other hand, the economics are such
  that they just can't step aside.'"

The Profession Isn't What It Used to Be (9)
  "Discussing medicine with retired general surgeon Lawrence Braslow, MD,
  age 80, and his 76-year-old wife, Edithmae Braslow, MD, a former
  anesthesiologist, offers a glimpse into what some would call medicine's
  'golden age.' 'There wasn't that much paperwork 20 years ago.' says Dr.
  Edithmae Braslow, who stopped practicing at age 56 to care for her
  mother. "I was never sued, never threatened. I enjoyed my relationships
  with other doctors and the patients.'...The story from the Braslows'
  eldest daughter, Judith Zacher, MD, 48, a plastic and reconstructive
  surgeon, is vastly different...Take the issues of autonomy and insurance.
  Dr. Zacher, who with two partners has a practice in Columbus, Ohio, is
  used to getting preauthorization for procedures that could be construed
  as cosmetic. 'But now, it's everything I do. The time involved is
  tremendous. And even if it's precertified, I still get hassled.' Once
  she's authorized treatment, she's often asked to follow up with another
  letter explaining why she authorized it. 'You're over a barrel. You have
  no choice...There's no way my parents went through these hassles,' she
  says.

Ohio Task Force Undecided on How to Finance Reform (10)
  And Health Reform Updates from Vermont, Colorado, Georgia, and Idaho.

25 Residents Honored for Community Involvement (12)
  by AMA at 1993 Interim Meeting.

Bill Would Regulate Transplant Tissue (12)
  "The absence if regulation leaves too much room for poor surgical
  outcomes, serious injury, and even death," charges House sponsor Rep. Ron
  Wyden (D-OR), who says "tissue distributed by one major bank in Virginia
  Beach, Virginia, LifeNet Transplant Services, resulted in HIV
  transmission to a number of recipients across the country. Three have
  since died from AIDS complications."

America's Sickest Children (13)
  "Gilbert, 9, is mentally retarded and autistic...He was eligible for
  services under a Medicaid preventative-care program, but his foster
  family was unaware of it. As a result, he went 3 years without
  preventative services and 2 years without a comprehensive physical
  exam...The nation had 442,000 foster children in 1991. more than twice as
  many as a decade earlier...The failure of states to provide adequate
  health care to the [children} in their custody has created a serious
  public health problem, say physicians and other child health advocates."

Even in Death, Physician's Legacy Fighting to Live On (16)
  "The argument could be made that life wasn't fair to Gerald I. Fradkoff,
  MD. It wasn't fair on the evening of April 30, 1992, when an arson-fire
  destroyed his 6-year-old family practice, one of hundreds of Los Angeles
  businesses lost in three days of rioting...And it wasn't always fair in
  the months that ensued, as the scrappy inner-city doctor struggled to
  rebuild--to start over at an age when many physicians flirt with
  retirement. Certainly, it wasn't fair on November 14, when Dr. Fradkoff
  died at age 59 after a short battle with brain cancer...But the story
  doesn't stop there. The Los Angeles County Medical Association--inspired
  by Dr. Fradkoff's persistence and his devotion to his patients in the
  medically underserved community--is working to find a way to keep his
  practice open."

Professional Unity (editorial) (17)
  "A rent in the fabric of organized medicine is a problem for the
  profession at any time. The stakes are unusually high today. To begin
  unraveling medicine's strong professional unity now, midstream in the
  health system reform debate, is to court disaster...Health system reform
  is invariably spoken of in value-laden terms--security, choice, and
  quality, to name just three...Financing is the key that will allow the
  nation to achieve all three...What should be clear--and alarming--is that
  none of the proposals now meet that standard...The standard should be
  that for every bit of philosophizing...there should be credible data to
  back it up. that applies to plans from both sides of the congressional
  aisle and from any philosophical persuasion. Those that can't do that run
  the risk of becoming irrelevant to the debate--and, frankly, they deserve
  to be."

Capitation Formula Doesn't Make Sense for Family Physicians (let-ed) (17)
  "Can someone explain to me why we family physicians are not crying foul
  from the mountaintops?...As gatekeepers, we have enormous
  responsibility...As if getting paid a pittance (average $80 to $120 per
  patient per year) for all services wasn't enough, we are expected to put
  half of that into a risk pool in case. God forbid, some patients get
  seriously ill. There is an obvious incentive to do as few investigations
  and specialist referrals as possible to reduce drawings from the risk
  pool, but, once again, the family doctor will assume the responsibility
  and the risk." --Michael Pina, MD, Garland, TX. CURE Comment:
  Responsibility--perhaps-, but the greatest risk is borne by the patients
  endangered by these managed care slush funds that promote health care
  rationing.

Health Reform Needs to Come From Within (letter-editor) (17)
  "It's just not doctors who disagree...Speaking from my experience in
  private practice, I do not know any of my patients who would support
  Clinton 's proposal. Almost all of them would support freedom of choice
  and a true market alternative...As physicians and Americans we must
  believe in freedom and accept personal responsibility as the burden that
  freedom brings...The receivers of health care must take responsibility
  for their health and their use of the health care system." --Debra Monde,
  DO, Lathrop, CA.

Don't Close Military Medical School (letter-editor) (18)
  "As a second-year medical student at USUHS [the Uniformed Services
  University of Health Sciences] and a nine-year Army veteran, I am
  convinced that this closure will adversely affect national health care
  reform and the quality of medical care provided for men and women serving
  in the US armed forces." --Shean Phelps, Silver Spring, MD. ABLEnews
  Editor's Note: For the complete text of this letter, se GI401.* wherever
  ABLETEXT files are found.

Wrongful Life Suits a 'Horrible Prospect' (letter-editor) (18)
  "What a horrible prospect for doctors today" To be charged with not
  having murdered another human being and punished for it in a society that
  claims to be trying to reduce the violence in homes and to our children."
  --Morris Powell, MD, Bullhead City, AZ. ABLEnews Editor's Note: For the
  complete text of this letter, see EU401.* wherever ABLETEXT files are
  found.

After Medical School: How Quickly They Forget (op-ed) (19)
  "Problems are developing from without our profession that adversely
  impact patients' ability to obtain the medical care of their choice and
  physicians' rights to treat...as they feel appropriate...
  Physicians...often also focus on just the problems that affect their our
  own specialty. Frequently these physicians forget that many other areas
  of medicine are also adversely being impacted...With many somewhat
  divergent voices, the whole process sometimes weakens medicine's ability
  to face problems that affect all of the profession." ----Robert M.
  Tenery, Jr., MD, president, Texas Medical Association.

Overly Broad Statute Ruled Unconstitutional (20)
  The Georgia Supreme Court ruled a state law prohibiting persons other
  than physicians, dentists, podiatrists, and veterinarians from performing
  "any surgery, operation, or invasive procedure in which human or animal
  issue was cut, pierced, or otherwise altered by the use of any mechanical
  means, laser, ionizing radiation, or the removal of foreign bodies from
  within the tissue of the eye" was unconstitutional. (Miller v. Medical
  Association of Georgia)

Off-Label Use Isn't Standard of Care (20)
  "A $3.4 million malpractice verdict against two physicians and a hospital
  should be vacated, a Pennsylvania Superior Court ruled. A 17-year-old
  patient suffered a severe brain injury when he was struck by a car...He
  was comatose and in need of special care and was flown by helicopter to a
  university hospital. He remained in coma for about 50 days. During his
  stay at the hospital hew was treated by a neurosurgeon. His elbows and
  hips became permanently flexed from heterotopic ossification. He also
  developed a decubitus ulcer [ABLEnews Editor's Note: Commonly called a
  "bed sore."] The patient and his family filed suit...The complaint stated
  that administration of the drug [Dridonel] would have prevented calcium
  from forming in the joints. If the patient had received more frequent
  physical therapy, his joints would not have flexed to such a degree. It
  also claimed that turning him more frequently would have prevented the
  decubitus ulcer." (Maurer v. Trustees of the University of Pennsylvania]
  ABLEnews Editor's Note: My father lived in coma from February 26, 1981 to
  September 23, 1990, when he died at the age of 75. Most of that time, Deo
  gratias, was spent living with us: his family at home. The only
  contractures Dad ever got came when the V.A. hospital that was
  threatening not to allow him to come home barred my mother from visiting
  him more than a few minutes a day thus effectively denying us the
  opportunity to continue his range of motion. He never got a decubitus
  ulcer AT home.

Being Mislead Is Not Breech of Contract (20)
  A psychiatrist who had been verbally assured by the American Board of
  Psychiatry and Neurology that his Indian internship would satisfy
  certification requirements had no breech of contract against the
  organization for compelling him to do a one-year internship after
  completing his three-year residency, an Illinois federal appellate court
  ruled, finding the Board's misleading statement did not constitute a
  contract. (Patel v. American Board of Psychiatry and Neurology)

Chiropractors Get Licenses By Default (20)
  Two chiropractors licensed in Pennsylvania were entitled to be licensed
  in Florida, an appellate court found. The state Department of Regulation,
  Board of Chiropractic notified the chiropractors of their intent to deny
  their license applications 94 and 101 days after their completion,
  whereas state law requires action within 90 days. (Krakow v. Department
  of Regulation, Board of Chiropractic)

Psychologist Not a Health Care Provider (20)
  under the Florida Comprehensive Medical Malpractice Act, a district court
  of appeal found in a lawsuit brought by a patient who was receiving
  psychotherapy and marriage counseling from the psychologist when she
  discovered the psychologist and her husband--also a patient--were having
  an affair. (Groth v. Weinstock)

Civil Liability for Not Reporting Child Abuse (20)
  A father removed his daughter from his former wife's home in Texas and
  brought her to California, where she was examined by a clinical
  psychologist, who gave him a written opinion stating the girl had been
  sexually abused while in her mother's custody. Texas police and child
  welfare officials were advised of the report by the father and their
  California counterparts confirmed its content with the psychologist. The
  mother sued the psychologist for intentional infliction of emotional
  distress, libel, professional negligence, and negligent infliction of
  emotional distress. Reversing the trial court's summary judgment for the
  psychologist, the federal appellate court found he was not entitled to
  the immunity provided by the Child Abuse and Neglect Reporting Act
  because he had failed to comply with all its provisions. (Searcy v.
  Auerbach)

Are You Using the Right Person for the Job?
  "Managed care's growth is resulting in lower fees per unit of service--
  that's no secret. And it's also a near certainty that health system
  reform, whether legislated or not, will continue that trend. So to keep
  profits at least level, doctors are seeking ways to make their offices
  more efficient...That requires a careful evaluation of practice tasks and
  an equally careful matching of staff skills to jobs."

Withdrawal Plan Can Help Keep Down Retirement Taxes (22)
  "If you're like most physicians, during your working years you'll
  contribute to one or more qualified retirement plans. These could include
  pension plans, profit-sharing plans, Keoghs, SEPs, and IRAs...They all
  share tow major tax advantages--tax-deductible contributions and tax-
  deferred growth. And in most cases the contribution strategy is simple:
  Always contribute as much as possible as early as possible. It's at
  retirement that things get complicated. How and when you withdraw funds
  from tax-deferred accounts can have a tremendous impact on how much you
  keep and how much you have to turn over to Uncle Sam." --Joel Blau, CFP,
  AMA Investment Advisers Inc.

Old Director Is Ousted From Federal Policy Agency (27)
  One of the small remnant of high-ranking holdovers from the previous
  administration, J. Jarret Clinton, MD, administrator of the Agency for
  Health Care Policy and Research, reportedly will be replaced by Clifton
  Gaus, a senior adviser on health reform to Philip Lee, MD, director of
  the US Public Health Service. Dr. Clinton, a career official will be
  reassigned within the Public Health Service.

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

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...For further information, contact CURE, 812 Stephen Street,
Berkeley Springs, West Virginia 254511 (304-258-LIFE/5433).