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ABLEnews MedNotes

                    American Medical News (1/24-31/94)

Insurers Race to Bring HMOs to New York (1)
  "At the end of 1992, 83% of Aetna's enrollees working for small and mid-
  size employers in New York City were covered by indemnity plans. By
  September 1993, 84% were in managed care plans. Just a year ago, insurers
  in New York were complaining that physicians would not join their managed
  care networks. Today, physicians--particularly specialists--are
  complaining that they can't sign up because many panels are filled...
  These dramatic reversals illustrate New York City's sudden interest in
  managed care. Most of the Big Five insurers--Prudential, Aetna, CIGNA,
  Travelers, and Metropolitan Life--are developing their own provider
  networks, Meanwhile, strong regional players have a strong head start on
  the market."

Get Off Reform Fence, Celeste Warns (1)
  "There's a time and a place to express reservations. If you want a voice
  later, you better get in the front row of supporters now." --ex-Ohio
  governor, Richard Celeste, chief pitchman for the Clinton health plan,
  drawing groans from the state medical society leaders at AMA's 20th
  Annual State Health Legislation Meeting.

Tennessee Reform Tempest (2)
  2,200 of the 7,200 doctors enrolled in Blue Cross and Blue Shield of
  Tennessee's preferred provider organization PPO dropped out when the
  Blues made participation in the state's controversial substitute for
  Medicaid: TennCare mandatory for its PPO physicians. At any rate, that's
  how many dropouts, Blue Cross-Blue Shield admits to, but observers
  suggest they may underestimate the fall-out by as much as 1,000.

Abortion Rights Group Widens Agenda (2)
  National Abortion Rights Action League becomes National Abortion and
  Reproductive Rights Action League yet still will be known as NARAL.

Vaccination Pushed (2)
  More than 10% of two-year olds are not immunized, the Centers for Disease
  Control and Prevention (CDC) reports.

Glenn Wants Experimentation Review (2)
  Sen. John Glenn (D-OH) seeks government review of every experiment done
  on human subjects this year, but the Clinton administration has yet to
  determine how many Americans were subjected to Cold War radiation
  experiments.

Organ Donations Up (2)
  7% in 1993.

Marijuana Ban to Be Reversed? (2)
  Clinton officials in the Public Health Service are reconsidering the Bush
  administration's ban on medical use of marijuana.

Doctor Gets Call From the White House (2)
  38-year-old cardiologist, Lt. Cmdr. Dervilla Mairin McCann, MD, leaves
  Camp Pendleton to serve two-year tour as White House physician.

Prevention Seen as Best AIDS Hope (3)
  "I look at these young mothers and think, why is no one reaching them?
  Prevention is really the only tool we have, but I see so many people
  still involved in risky behaviors." --Gwendolyn Scott, MD, director,
  pediatric AIDS program, Jackson Memorial Hospital-University of Miami
  School of Medicine.

ACOG Backs Training for Nonphysicians for Abortions (3)
  "I think the ideal would be physicians performing them. But as a
  pragmatic thing, if there are not enough physicians who are trained or
  willing to do the procedure, other options will have to be considered."
  --William Andrews, MD, president-elect, American College of Obstetricians
  and Gynecologists. Forty-three states and the District of Columbia outlaw
  abortions performed by nonphysicians and Roe v. Wade authorized states to
  enact such "doctors-only" requirements."Abortion surgery is something
  that is very difficult to do. It's not done easily and there's a lot that
  can go wrong. Even for a senior surgeon like myself, it's not without
  risk. It can have complications--even in the first trimester." --Brian
  Finkel, DO, Phoenix, AZ abortionist.

Infant Mortality Commission Is Axed; Budget Cuts Blamed (3)
  Credited with calling attention to America's deplorable infant mortality
  rate--21st among developed nations--the National Commission to Prevent
  Infant Mortality fell to the axe of "downsizing" government on December
  31, 1993 despite the goals of health promotion and disease prevention
  professed by administration and congressional health care reformers.

Vermont Has Rocky Start to Reform-Linked Negotiating Rights (4)
  "Provider bargaining in Vermont is off to a less than auspicious start.
  Formal negotiating between the state and providers is a new concept that
  will take time to gain acceptance, even though it is standard in other
  countries that have national insurance programs." --John Marshall, legal
  counsel, Vermont States Medical Society.

HIV Insurance Restrictions Hit in ADA Cases (6)
  As the first post-ADA cases involving AIDS patients' rights in employer-
  administered health plans move through the courts, protection from
  discrimination seems to be outweighing employer autonomy. Last year, the
  US Supreme Court upheld a Houston, TX music company's $5000 lifetime cap
  on AIDS coverage but that decision preceded implementation of the ADA,
  which is expected to change the legal landscape.

Underwriting Groups Report Better Financial Performance (8)
  Three of 10 medical malpractice joint underwriting associations are
  insolvent and one of the largest--in New York state--took a serious turn
  for the worse in 1992, according to a report by the Alliance of American
  Insurers.

AMA Opposes Free Drug Samples for Family Use (9)
  "A lot of doctors have to change their ways." --John Glasson, MD,
  chairman, AMA Council on Judicial and Ethical Affairs, on the
  Association's policy opposing a common physician custom: accepting free
  samples of drugs and other gifts for personal or family use.

Military Managed Competition Test in Contract Battle (10)
  "If the government's recent attempt to use managed care to hold down
  military health care spending is an example of what can be expected under
  President Clinton's proposal, then maybe lawmakers should think twice.
  After two years of proposal development and bidding, a $3.5 billion
  contract awarded under the Defense Department's Civilian Health and
  Medical Program of the Uniformed Services, or CHAMPUS...is now mired in
  legal challenges that threaten to delay implementation...The CHAMPUS
  contracting process, in which the Department of Defense had four
  companies bid to provide HMO and IPO coverage, was seen as a test for the
  president's reform proposal for banding citizens together in large pools.
  Observers fear that legal protests similar to that the CHAMPUS contract
  faces could become a regular--and costly--feature of a national managed
  care system."

New Hampshire Governor Seeks More Funds for Health Reform (10)
  Plus Louisiana, Kentucky, New Jersey, and Iowa Health Reform Updates.

Medicare Board Seeks Nominees (10)
  to serve on the Health Care Finance Administration's Practicing
  Physicians Advisory Council.

Unhealthy Education (11)
  "Children who might never have considered tobacco use to be an option are
  taught that they must make a decision about using tobacco. Not
  surprisingly some decide to try it." --Joseph DiFranza, MD, associate
  professor of family and community medicine, University of Massachusetts
  Medical School, Worcester, MA, on youth education programs developed by
  the tobacco industry. ABLEnews Editor's Note: Wouldn't the same principle
  apply to presenting other risk-laden behaviors such as "safe sex" as bona
  fide choices for minors to make?

Grants Awarded to Study Doctor-Patient Communication (12)
  by Miles Institute for Health Care Communication. Youth Health items.

CDC Study Puts Number of HIV-Infected at about 1 Million (12)
  Research suggests the rapid spread of HIV may have peaked in the mid-
  1980s and is relatively constant. "The real number may be a little under
  or a bit over [the Centers for Disease Control and Prevention estimate]
  but it's not 10 million." --Geraldine McQuillan, MD.

Getting Kids to Say No to 'Old Joe' (13)
  While adult smoking rates have declined by more than a third since the
  Surgeon General's first Report on Tobacco and Health in 1964, smoking by
  high school seniors has remained steady at 1 in 5. Every day 3,000
  American children light up for the first time.

Blind to Patient's Wife-Beating, Doctor finally Sees the Pain (13)
  "Laura and Paddy were going to need lots of help to save their marriage.
  She was a battered and enabling wife. He was a violent and abusive drunk,
  neatly concealed in polite society. After several months of counseling,
  Laura was finally able to confront her husband. To hang on to her, he
  voluntarily entered a residential drug and alcohol rehabilitation
  program. But all the love and Librium on earth could not replace his
  desire for Scotch and soda, and he left the program 4 days later. Laura
  walked out on him. His children refused to speak to him. He was left in a
  house that echoed loneliness." --Adrienne Ann Drake, MD.

Nicotine May Help Rats to Pay Attention (15)
  "Nicotine may act as a stimulant for neurotransmitters. The question is
  what does that do to patients with ADD [attention deficit disorder]? Does
  it improve these symptoms?" --Keith Connors, psychologist, Duke
  University. Tobacco Updates.

Program Promotes Women Physicians as Mentors (15)
  The Medical Career Exploration patch program developed by the Washington
  State Medical Association pairs Girl Scouts with women doctors. Mentors
  seek permission from patients and Scout parents before inviting the girls
  to observe discreet encounters. Parents may choose to accompany their
  daughters.

Noisy Valve Could Cause Physical Harm (16)
  A federal appellate court finds the manufacturer of an artificial heart
  valve may be liable for failing to warn about the "loud noise" it makes
  which caused the patient sleeplessness and despondency and pushed him
  into early retirement. (Braveman v. Baxter)

Emergency Techs Immune from Liability (16)
  A Michigan appellate court holds state law exempts emergency medical
  personnel from negligence claims involving the performance of their
  duties in the death of a 41-year-old man from cardiac arrest. (Pavlov v.
  Community Emergency Medical Service)

Hospital and Group Jointly Liable (16)
  for negligence of first-year resident who flushed a 20-month-old boy's
  intravenous line with potassium chloride instead of sodium chloride, a
  Minnesota appellate court affirms. The child sustained permanent brain
  damage resulting in mental and motor retardation. (Dang v. St. Paul
  Ramsey Medical Center)

Brass Knuckles a Concealed Weapon (16)
  despite hospital employee's claimed use as bottle opener, Ohio appellate
  court holds, supporting security guard. (McFinley v. Bethesda Oak
  Hospital)

No Informed Consent to Back Surgery (16)
  despite signed consent form for back fusion, a Louisiana appellate court
  rules. The form did not cite the risk of the well-known complication of
  nonunion, nor was the patient advised that there was a chance his pain
  would not be relieved. The third operation: a bone fusion was considered
  successful. (Givens v. Graccco)

Provider Taxes Wrong Approach (editorial) (17)
  "Lawmakers have figured out a new spot to put a toll booth--right outside
  the doctor's office. That's the wrong place in our opinion. It's easy to
  see the appeal of this particular toll, the state-imposed provider tax on
  physician revenues. Provider taxes create the kind of illusion
  politicians like best, that of a free ride for most taxpayers at someone
  else's expense."

It's Time We Hold Congress Accountable (op-ed) (17)
  "Many legislative proposals focus on the economics of [health care]
  reform, with concerns over patient care playing second fiddle...This is
  why we are telling Congress...Do not finance reform through cuts in
  medical services, especially those affecting services to the poor,
  elderly, and disabled." -- Lonnie Bristow, MD, chair, AMA Board of
  Trustees. CURE Comment: We couldn't agree more, doctor.

What Segment Will Be Expendable Next? (letter-editor) (18)
  "I applaud the letter by Ruth Feldman, MD, on mammography and cost
  containment (December 13, 1993). This gaffe in the administration health
  care reform package may be just the tip of the iceberg. What other
  segments of the population will be designated as expendable?... Average
  Americans may pay dearly for the ignorance, naivete, and fanaticism of
  those higher up." --Charles Artinian, MD, Bloomfield Hills, MI.

Fetus a Patient, Too (letter-editor) (18)
  "In response to the letter 'Really two patients in doctor's office'
  (November 1, 1993): as an obstetrician-gynecologist I applaud the comment
  that Dr. Paul M. Hoover made regarding a pregnant woman... The unborn
  child is as much a human being as the mother is." --H. Wade Westbrook,
  MD, Southhaven, MS.

CDC Chief: Doctors Have Role in New HIV Campaign (20)
  "Starting this month, 8 public service announcements will be aired during
  prime-time television. These ads will encourage 18- to 25-year-old to
  refrain from sexual activity that puts them at risk. But, in a departure
  from the past, other ads will strongly encourage young adults who are
  sexually active to use latex condoms to protect against HIV and the
  spread of HIV."  --David Sachter, MD, director, Centers for Disease
  Control and Prevention.

Are Your Employees About to Revolt? (21)
  "Behind every good doctor may be a staff ready with a plank for the good
  doctor to walk...Bad feelings, animosities, and repressed anger among
  staffers can poison a practice. Like many noxious items, blame often
  rises to the top when things go bad. Sadly, doctors have all too often
  isolated themselves from their staffs to the point that they don't know
  there's trouble until it's too late."

Watch Training Need When Empowering Employees (23)
  "Delegating the authority to decide if the circumstances are appropriate
  [to assume decision-making authority]  is the essence of a management
  philosophy called empowerment...Empowerment is being practiced by a
  number of successful service organizations, including Marriott, 4 Seasons
  Hotels, Scandinavia Airlines Systems, and Federal Express. There are,
  however, substantial costs associated with empowerment, which physicians
  should balance against the advantages to determine whether empowerment is
  appropriate for their practice." -- Robert Solomon, PhD, author, Clinical
  Practice Management.

Should Physicians Set Up a Separate Billing Office? (23)
  Practice Pointers.

Business Briefs (23)

Continuing Ed Boosts Staff Performance, Efficiency (24)
  "Today's managed care environment has placed a bigger burden on the
  medical practice and its staffing needs...Meeting the challenges of
  change in private practice requires physicians to make an investment in
  their staff. One of the most effective ways to do this is continuing
  education." --Judy Capka. founder, Professional Management Concepts.

Minnesota Physicians May Itemize Tax On Bills (24)
  Thanks to a temporary injunction secured by Health Pack, which represents
  doctors, dentists, pharmacists, chiropractors, and others, health care
  providers will be able to itemize a new 2% state tax on gross revenues.
  despite a state law to the contrary.

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

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