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1994-03-23
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[The following issue may be freq'd as MN940131.* from Lincoln
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other BBSs carrying ABLENEWS files. Please allow a few days for
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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.]
A Fidonet-backbone echo featuring disability/medical news and
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...For further information, contact CURE, 812 Stephen Street, Berkeley
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