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ABLEnews MedNotes

                    American Medical News (3/14/94)

No Consensus on Reform (1)
  "Rather than clearing the air, March winds appear to have blown new
  clouds to the health care horizon. More than a year has passed since
  President Clinton first sketched out a plan to reform the United
  States health system. But Congress seems no closer to a compromise
  today than it was then. Debate, rather than coalescing around one or
  two proposals, seems to be branching out. Financing, even more
  problematic, has grown more dubious as opposition to an employer
  mandate assumes higher visibility. Lack of consensus among Democrats
  has forced tow House committees to put off deliberations. President
  Clinton's bill in trouble in both committees and will not even serve
  as a starting point in one."

Groups Press New Campaign for Tort Reform (1)
  The Health Care Liability Alliance, a united front of business,
  insurance, and medical groups--that have paid up to $100,000 to
  join, is lobbying to see that radical revisions in US tort laws are
  included in any health care reform enacted by Congress. Meanwhile,
  the Manhattan Institute is peddling an alternate "early offer of
  settlement" system that organized medicine has rejected in the past.

Antitrust Suit Could Bode Ill for Integrated Systems (1)
  "In a test case for managed care, the Wisconsin Blues have charged
  the Marshfield Clinic and its HMO with creating an illegal monopoly
  to control physician prices and services in rural Wisconsin. The
  insurer's suit challenges a basic tenet of integrated delivery: that
  close physician affiliation improves care and costs for patients and
  insurers. ...A verdict against Marshfield, experts say, could leave
  Geisinger Health Plan open to antitrust challenges...Ironically, the
  Clinton administration has cited Marshfield as an example of how
  integrated delivery could improve care in rural areas under health
  care reform."

Quality Control: Putting Doctors on the Front Lines (2)
  "Though billed as the key to physician control of quality oversight
  under health reform, the proposed Regional Professional Foundations
  have gotten little support from the house of medicine...RFPs are a
  little-known, sketchily drawn piece of the White House reform plan.
  Their last-minute inclusion accelerated the proposed phase-out of
  the PROs [peer review organizations]...Of course, the idea might
  never go anywhere. It's found only in the Clinton plan; the other
  major reform proposals contain only passing mentions of quality
  improvement components." CURE Comment: Further evidence of the short
  shrift given quality of patient care by most so-called "reformers."

State Reform Momentum Builds (3)
  "Chances are national single-payer legislation won't make it out of
  committee this year. But there's a real possibility it will be
  passed in a state where residents are used to taking a risk:
  Alaska...Meanwhile managed competition proponents will be watching
  efforts in Kentucky and Pennsylvania, both likely testing grounds
  for that concept...Vermont is under mandate to pass a
  universal-coverage plan this year--managed competition is the best
  bet--while significant measures also may pass in Iowa, Ohio, and
  Wisconsin. New Mexico just closed its session with a package that
  includes voluntary alliances and Medicaid expansion. It's easier, of
  course, for states to take risks, because the scale is smaller and
  the compromises easier to achieve. But whether state leaders think
  federal reform is dead or want to get a head start in case it
  revives, they're moving like never before...Florida, Minnesota,
  Oregon, Tennessee, and Washington started implementing their
  revolutionary plans this year."

Pennsylvania Blues Set to Become First Blues Plan to Own Hospitals (3)
  "The difference between insurers and providers just got fuzzier. In
  what observers say would be the first time a Blue Cross plan has
  owned a hospital, Independence Blue Cross intend to merge with
  seven-hospital Graduate Health System. Both parties are based in
  Philadelphia."

AZT Found to Reduce Perinatal HIV Transmission Risk (4)
  "The medical community was elated when federal officials announced
  last month that AZT therapy had reduced the risk of perinatal HIV
  transmission by two-thirds among infected pregnant women in a
  government-funded clinical trial. But the excitement was tempered by
  lingering questions about the effectiveness of zidovudine (AZT) for
  other HIV-infected persons. And the long-standing debate over
  mandatory HIV testing will likely be reignited in light of the
  findings."

New Evidence that Cigarette Ads Targeted Teenage Girls (5)
  "New research presents the most compelling evidence to date that
  youth-oriented cigarette ads encourage minors to pick up the habit,
  said John Pierce, PhD, director of a cancer prevention
  program...(at) the University of California, San Diego...A major
  target of youth anti- smoking efforts is the ad campaign that
  features the cartoon character Joe Camel. RJR reported increased
  sales of its Camel brand after the campaign was launched, but said
  those resulted from adult smokers switching brands...Maura Ellis, a
  spokeswoman for RJR,...confirmed that a female character would be
  added to the campaign. 'That character is not intended to target
  women, but is simply the natural progression of our advertising
  campaign."

Surgeon General Takes Anti-Smoking Message to Kids (6)
  "Several times I've been criticized directly by kids when I've
  spoken at schools. They ask why do you guys always talk ABOUT us,
  and not TO us?" --Michael Eriksen, ScD, director, Office on Smoking
  and Health, Centers for Disease Control and Prevention. But the 23rd
  report on smoking and health from the Surgeon General's office since
  1964 comes in two forms: a 314-page version for the general public
  and  a 12-page edition that targets sixth graders.

Perot to Doctors: Devise Own Plan (6)
  "You have the trust of the American people because you've earned it.
  Congress has no trust." --former independent presidential candidate
  Ross Perot, addressing 400 members of the American College of
  Surgeons in Dallas. The Texas billionaire urged them to develop
  their own plan, pledging the support of his organization.

IRS Searching for Doctors' Unreported Incentives (8)
  Federal law requires hospitals to report any income, incentives and
  benefits they provide physicians to the Internal Revenue Service.
  The IRS matches these 1099 forms against the 1040 or 1120 returns
  filed by the doctors themselves. A 1992 pilot computer match in the
  Pittsburgh area has escalated to Richmond, Virginia and throughout
  the Southeast: Alabama, Arkansas, Florida, Georgia, Louisiana,
  Mississippi, North Carolina, South Carolina, and Tennessee. And the
  program "could be replicated in other districts as well," according
  to an IRS spokesman.

Passage of Clinton Bill Tops AFL-CIO Priorities (8)
  "We intend to campaign as hard as we can for as long as we can."
  --Lane Kirkland, president, AFL-CIO. Labor leaders boasted their
  members would ante up $10 million to boost the Clintons' plan--five
  times what they spent fighting the Prez on the North American Free
  Trade Agreeement (NAFTA).

Report Reiterates Need for Women's Clinical Research (9)
  "At first glance, the idea that women should be included as subjects
  in clinical research seems simple and straightforward. But, as a
  recent report from the Institute of Medicine illustrates, pursuing
  that goals raises complex ethical, legal, and scientific
  questions...'Justice requires women and men to be treated equally in
  the pursuit of clinical research,' said Daniel Felderman, MD,
  co-chair of the IOM report committee and dean for medical education
  at Harvard Medical School. 'This involves striving for equal
  allocation of resources, providing equal opportunity for both sexes
  to participate in clinical studies, and renouncing the protectionism
  previously accorded women of reproductive potential.'...The basis
  for exclusion was the widely accepted argument that women of
  childbearing age--pregnant women in particular--shouldn't be given
  experimental treatments because of potential risk to their
  offspring." ABLEnews Editor's Note: In the case of nontherapeutic
  experiments, I believe this argument still bears weight. As the
  AMNews reminds us, "The unanticipated negative effects of
  thalidomide and diethylstilbestrol, or DES, on pregnant women in the
  1950s and 1960s reinforced this 'protectionist' approach."
  Protecting vulnerable human subjects, including such involuntary
  subjects as unborn babies, is a mark of civilization, not
  repression.

Cooper Backers Eye Individual Coverage Rule (10)
  "Backers of the bipartisan health system reform sponsored by Reps.
  Jim Cooper (D-TN) and Fred Grandy (R-IA) are looking for a way to
  achieve universal coverage more quickly under their proposal. Rep.
  Calvin Dooley, a California Democrat, said the 60 Democratic and
  Republican sponsors os the 'Clinton Lite' bill are exploring whether
  to require people to purchase health insurance. Dooley, one of three
  politicians invited to talk to doctors and medical society
  executives about system reform, made his remarks at the AMA National
  Leadership Conference [in San Francisco]...Rep. Richard Armey, a
  Dallas conservative who chairs the House Republican
  Conference,...flatly denied the need for a system overhaul,
  asserting that fewer than 3% of the population go without health
  insurance for more than a year. 'Universal coverage, which really
  means a new entitlement, is impossible without some kind of
  government purchasing monopoly and a government defined benefit
  package, and, ladies and gentlemen, these are things Republicans can
  never accept.'...Armey urged [doctors] to lobby patients directly
  against the Clinton and Cooper-Grandy bills. 'I would argue that it
  is not only appropriate but necessary for you to give your patients
  your best understanding about anything that threatens health care
  security.'...'The way you practiced medicine 20 years ago is not
  going to be an option in the future,' [presidential health adviser
  Ira Magaziner] said. 'Over half the employers who provide health
  insurance do not provide a choice of plan to employees. The status
  quo will continue unless you remodel the forces.'"

AMA Describes Two-Pronged Approach to System Reform (10)
  "One prong is an intensive, and extensive, effort to educate and
  lobby each member of the House and Senate who is directly working on
  health system reform. The second prong will rely on a remarkable
  grassroots campaign. From the offices of individual physicians in
  every corner of the land, reaching right into the corridors and
  committee rooms of Congress, we will create a full-court press to
  beat back the bureaucrats who would force their way into your
  examining rooms." --Lonnie Bristow, MD, chair, AMA Board of
  Trustees.

AMNews Wins 27 Design Awards (10)
  from the Society for Newspaper Design. AMNews was outranked by only
  five other papers: El Mundo (Madrid), The New York Times, the San
  Francisco Examiner, the Anchorage Daily News, and the Detroit News.

Before Their Time (11)
  "Every 84 minutes, an elderly person commits suicide. It's not what
  anyone expects of the Golden Years. 'The message a lot of older
  persons get from society is that you are not valuable people,
  particularly if they are sick and are draining health care
  resources,' said James E. Spar, MD, coordinator of clinical
  geriatric services at the Neuropsychiatric Institute of the
  University of California, Los Angeles. 'The message they get is: 'If
  you're depressed and thinking about suicide, good for you.' Contrary
  to the view that suicide is a problem confined primarily to
  teenagers, the elderly have the nation's highest suicide rates,
  according to the National Center for Health Statistics."

Society Sends Suicidal Message (12)
  "The image that flickered across the TV screens in early February of
  retired pathologist Jack Kevorkian, MD, being cheered in a church by
  supporters of physician-assisted suicide sent a chill up the spines
  of many experts on elderly suicide. 'The message he is communicating
  to people who say they want to die is exactly the opposite of what I
  want to communicate,' said James E. Spar, MD, of UCLA's
  Neuropsychiatric Institute. 'Kevorkian says: 'If you're so miserable
  then it's OK to end your life.' I say 90% of suicidal people have a
  treatable mental illness. If you want to help them, treat their
  mental illness.'" CURE Comment: For the rest of this thought-provoking
  article, see SU9403.* wherever ABLETEXT files are found.

Medical Students Help Pediatric 'Buddies' Recover (12)
  "Tina Harris will never forget 'a special little boy' with cystic
  fibrosis she met in 1991, during her general pediatrics rotation at
  Yale-New Haven Hospital. 'He was bout 14,' she said, 'but looked
  only 8 or 9. Even with an oxygen mask, he struggled to breathe...'
  Overwhelmed with a desire to help, she sought out the attending
  physician. Then she talked with other physicians, nurses, and social
  workers. She proposed to address the social, emotional, and
  psychological needs of seriously ill children by matching them with
  medical students, who could serve as mentors to help patients and
  families cope...'If you want to get a job done, get Tina,' Sally E.
  Shaywitz, MD, pediatrics professor at Yale School of Medicine and
  faculty adviser for Just for Kids, the group that Harris founded."

Why Physicians Don't Do Better (13)
  "Physicians say they don't have time to learn about suicide, 'but if
  you give them a long list of things and ask what they want to know
  more about, suicide always comes out near the top,' said Bryan
  Tanney, MD, associate professor of psychiatry at the University of
  Calgary Faculty of Medicine...In the late 1970s, Dr. Tanney began to
  survey the training health professionals received. 'And the results
  were horrific,' he said. 'Fewer than half the psychologists in the
  United States hear anything about suicide in graduate programs. In
  medicine, it's probably worse.'"

Jury of Peers (editorial) (15)
  "Contrary to popular belief--at least as measured in Washington,
  DC--not every safeguard for the public begins and ends with a
  government regulation or an act of Congress. In the case of the
  medical professional, peer review by local medical societies could
  be a powerful resource for the protection of patients. That is if
  county medical societies were allowed to do peer review and they
  demonstrated the will to follow through."

RICO Decision a 'Serious Defeat for Individual Liberties' (let-ed) (15)
  "I do not share your enthusiasm for the recent Supreme Court
  decision allowing the Racketeer Influenced and Corrupt
  Organizations, or RICO, Act to be used against pro-life
  demonstrators. (Editorial, February 14)... RICO was drafted to give
  federal prosecutors a new weapon against the Mafia and other
  organized crime. Its very title makes this clear. But the bill has
  now become a weapon against the First Amendment, and against
  citizens who mount a public challenge to majority opinion--whether
  that majority supports a woman's right to choose, a drugstore's
  right to segregate its lunch counter, or a utility's right to place
  a nuclear power plant near a city. The court's decision is a victory
  for Big Government, and a serious defeat for individual liberties."
  --Mark Buchanan, MD, Forest Hills, PA.

'Anti-Abortion'? No, the Term Is 'Pro-Life' (letter-editor) (15)
  "Your editorial entitled, 'Beyond dissent' seems innocent enough on
  the surface. Certainly to bang a drum against radical, wild-eyed,
  violent protesters, particularly those labelled 'anti-abortion'
  lulls most people into the politically correct camp of
  indoctrination. The very least you could do would be to use fair
  terminology in your descriptions. Anti- abortionists are actually
  'pro-life.' Anyone labeled 'anti-anything' is automatically put in a
  negative light. Pro-choicers wouldn't appreciate being called
  'pro-death' or anti-life.'" --Larry Richardson, MD, Humble, TX.

No Gatekeeper for the Clintons (letter-editor) (16)
  "The announcement that a cardiologist is joining a multi-service
  medical team as physician to President Clinton, his family, the
  White House staff, and Vice President Gore and his family, further
  exposes the hypocrisy of the Clintons and their reform plan. While
  they will receive specialty care, they seek to deny the American
  people comparable care, indeed, deny them choice. Where is the
  Clintons' 'gatekeeper' that decides if a test or procedure is
  cost-effective? Has their use of specialists been approved by their
  managed care plan? Obviously, they do not practice what they
  preach." --Ruth Feldman, MD, Flemington, NJ.

Public Won't Permit Themselves to Be Enslaved (letter-editor) (16)
  "It was a delight to read 'My Opinion' in the January 17 issue by
  Daniel T. Cloud, MD, concerning the so-called Clinton health
  plan...Dr. Cloud has performed a great service in exposing most of
  the shortcomings of the plan. The American people will not permit
  themselves to be enslaved by a program that causes its health care
  system to revert to the level of the British health care
  establishment following World War II. America is too heterogeneous
  to fit into a mold dreamed up by a group of administration advisers
  who are mostly law school graduates...short on maturity and
  experience in the real world." --E.W. Schmidt, MD, Odessa, TX.

Tired of Hearing Negatives About Care Today (letter-editor) (16)
  "I am upset about the constant articles and letters depicting the
  negative side of medicine. The [commentary] by Dr. Cloud was
  especially upsetting...Yesterday in my office I had a 20-year-old
  woman who I thought would make a good physician and I encouraged her
  to enter medicine. Why don't you profile medical groups like ours
  that are doing well and provide patient care and doctor
  satisfaction." --Michael Norman, MD., Redland, CA.

Put Policies to a Vote (letter-editor) (16)
  "The AMA should poll all of the members and let them vote as to what
  they want the AMA to do. I just don't feel that we should allow a
  few people in the AMA to make major decisions for all the members on
  something as critical as reform." --John Davis, MD, Oklahoma City, OK.

Dr. Christoffel Responds to Profile (letter-editor) (16)
  "I am writing in response to the profile of me in the January 3
  AMNews...I did not say that guns are 'viruses.' This is obviously
  not true! My point is more complex...I do not advocate getting rid
  of all guns! I do support the American Academy of Pediatrics'
  position, calling for a ban on handguns, assault weapons, and deadly
  airguns." --Katharine Kaufer Christoffel, MD, MPH, Chicago, IL. AMN
  Editor's Note: AMNews stands by its reporting of the story.

We Physicians Talk, But They're Not Listening Out There (op-ed) (16)
  "All too often when seeing patients for follow-up visits, doctors
  are chagrined to find that their instructions were not followed.
  What happened? Did the physicians fail to give their patients the
  proper instructions? The answer is probably no. Most likely the
  patients were told exactly what their chart and the labels on the
  medicine bottles indicated. They weren't listening...This analogy
  can also be applied to the medical profession as it attempts to
  advise our nation's elected leadership as they undertake the
  monumental problems of health system reform. We are trying to tell
  them, and even though it is for their own good, many just aren't
  listening...Physicians have unique expertise and perspective. We
  must continue to give advice as to what could happen to the quality
  of medical care in this country if our leadership makes the wrong
  choices about health system reform. as with our own patients,
  however, we can only hope that those with the influence and power to
  make the decisions will listen." --Robert M. Tenery, Jr., MD,
  president, Texas Medical Association.

Guns Are Part of 'Immune System' (letter-editor) (17)
  "Guns are a part of the immune system of society, a deterrent to
  crime. As with autoimmune disease, it can turned around against
  itself. Another part of the immune system, keeping violent criminals
  in prison, is not doing its job. A gun ban for citizens is a set up
  for a 'police state.' The real virus is the breakdown of family
  support and inculcation of values." --Mary Otto-Mainfort, MD,
  Farmville, VA.

Guns Are Tools (letter-editor) (17)
  "Guns are tools, for good or ill. The proliferation of guns is a
  result of the collapse of order in our society, not a cause. People
  don't feel safe on the street or in their own homes and very
  realistically try to find a way to defend themselves. On thing is
  for certain: if you outlaw handguns they would become as valuable as
  cocaine, and many billions of dollars could be devoted to fighting
  the handgun problem, instead of the crime problem." --Ben Hill
  Passmore, MD, El Paso, TX.

Gun Control Stance Makes 'No Sense' (letter-editor) (17)
  "I don't believe that gun control is the providence of your
  [publication]...Your article promotes a simplistic approach to the
  problem of violence in our society that makes absolutely no sense
  whatsoever. Instead, I would like to see you work to educate people
  about guns and gun safety." --David Kresnicka, MD, Marion, IA.
  ABLEnews Editor's Note: For an article I wrote addressing this topic
  in a personal capacity [i.e., not on behalf of CURE or ABLEnews],
  see "Gun Control or Self Control: The Moral Crisis Behind the
  Headlines," Tradition, Family and Property,  January-February, 1994.

Cars Were Targeted Once Too (letter-editor) (17)
  "No one disputes the incorrect use of guns may result in tragic
  events. But if we, as either physicians or citizens, seriously wish
  to eliminate an item of hardware with the intent of maximally
  reducing trauma and family tragedies, we should start with the
  automobile--the misuse of which has caused vastly more medical,
  social, and 'heart-wrenching' problems than have guns. During the
  first two decades of this century, the automobile generated heated
  arguments. Many conscientious and well- educated people advocated
  that it should be prohibited, not only because it was perceived to
  be a major physical threat..but it also was...an item of 'moral
  degradation!' However, society has discovered that proper education
  and training regarding automobiles, along with appropriate penalties
  for those who abuse automobiles, is a far better solution than is
  their elimination." --David Pfendler, MD, McMinnville, OR.

Nurse Removes Staples From Wrong Patient, Physician Liable (18)
  "As the nurse removed the staples, the patient's skin split open to
  reveal the subcutaneous fat layer. The nurse checked the charts and
  realized she was working on the wrong patient. The physician under
  whose direction she was working was liable for $125,000 in damages,
  the Mississippi Supreme Court ruled." (Meena v. Wilburn)

Emergency Hospitalization (18)
  "A hospital, an ambulance services, police officers, and the city
  were not liable for emergency hospitalization of a patient thought
  to be mentally ill, the Nevada Supreme Court ruled. The patient was
  served with divorce papers at home in June 1988. When she threatened
  to shoot her husband, he called the hospital and asked for a
  clinical evaluation team to come out...She later filed suit claiming
  the hospital, ambulance service, police and city forcibly entered
  her home and hospitalized her against her will. A trial court
  dismissed the complaint and imposed a $2,500 sanction against her
  attorney for filing a frivolous action. On appeal,...the sanction
  was overturned. The attorney was attempting in good faith to have
  the trial court recognize a new cause of action fro invasion of the
  patient's privacy, the court said." (Marshall v. District Court)

Doctor Wins Legal Fees After Hearing (18)
  "On June 1983, a mother experiencing premature labor was admitted to
  a [West Virginia] hospital. The hospital did not have a neonatal
  intensive care unit. The attending physician initially attempted to
  stop the mother's labor with medication. He did not use an
  electronic fetal heart monitor to determine fetal distress or
  transfer the patient to a high- risk facility for labor and
  delivery. The infant was born prematurely the next day. A few
  seconds after birth, the infant stopped breathing. The pediatrician
  chosen to treat the baby attempted resuscitation by intubation.
  About 2 1/2 hours later a team from a university hospital arrived
  and had to reintubate the patient because the tube had been placed
  in the esophagus instead of the trachea. The pediatrician did not
  have privileges at the hospital to care for premature infants
  experiencing complications. At age 8 the patient had severe to
  profound mental retardation, severe developmental delays, cerebral
  palsy, left hemiplegia, grand mal and petit mal seizures, attention
  deficit with hyperactivity, no meaningful speech, and aggressive
  behavior. His mother filed suit against the obstetrician for
  negligence...A jury returned a verdict in favor of the obstetrician;
  the patient appealed. The high court said a negligent physician was
  liable for aggravation of injuries caused by subsequent negligent
  treatment to mitigate the harm he caused. The trial court should
  have instructed the jury on the obstetrician's liability for the
  actions of the pediatrician and others. The court said the matter
  should be remanded for a new trial." (Rine v. Irisari)

Don't Get Fleeced When You Sign a Lease (19)
  "For many years, physicians have been limited in where they could
  lease office space. Managers of new buildings have been reluctant to
  sign leases with medical offices for a number of reasons, including
  the high foot traffic they generate and he belief that medical
  practices put a lot of wear and tear on the property. Likewise,
  physicians have sometimes been pushed to accept less-than-favorable
  lease terms because of the special needs of medical practice, such
  as extra plumbing. Above-average rents or building charges are not
  unusual. But that's changed in many urban markets. Because of a
  continuing glut of new office space, physicians are finding it
  easier than ever to find prime locations--and to negotiate highly
  favorable lease terms."

To Get Paid for Managed Care, Know Your Plans (20)
  "Managed care has changed the rules for reimbursement and
  collection. While collecting data at every stage of the patient
  encounter sets the stage follow-through is essential."

Despite Scrutiny, Practice Goodwill Does Have Value (21)
  "Dr. Marcus Willing has been thinking of accepting an offer from St.
  Acquisition Hospital to buy his medical practice...and hire him as a
  staff physician...Just then the phone rings. It's St. Acquisition
  chief financial officer with distressing news. The hospital's
  attorney says St. Acquisition could run into legal trouble if it
  pays too much for the goodwill of Dr. Willing's practice. But
  there's no trouble paying for the practice's tangible assets--minus
  liabilities of course. Dr. Willing looks around his office at the
  aging waiting room furniture, the phone and the leased computer
  system, the examination table and equipment--the sole tangible
  assets of his practice. Did these worn (and fully depreciated) items
  constitute the entire value of the practice he had painstakingly
  built over the years? Did the luster of his reputation and the
  devotion of his patients bring nothing to the bottom line?"

Telemedicine Passes International Test (21)
  as physicians from the United States and Saudi Arabia demonstrate
  technology they believe will revolutionize access to medicine.

AMA Rejects Federal Oversight of Quality, Calls for Local Measures (25)
  Many health reform plans--the Clinton plan in particular "ignore the
  quality evaluation and documentation activities of the private
  sector that have been going on for 60 years," says Dr. James Todd,
  executive vice president of the American Medical Association, who
  asks: "Why should the government re-create a wheel that's been
  working well for that long?"

  [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
  information, ABLEnews is carried by more than 260 BBSs in the US,
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  ABLEnews text files--including our digests: Of Note and Mednotes
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  Connect.

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