HealthLawProf Blog

Editor: Katharine Van Tassel
Creighton University School of Law

Tuesday, March 15, 2005

Ashes of Oregon's Mentally Ill

On Sunday, the New York Times ran an article on the forgotten remains of Oregon's mentally ill who had been committed to the Oregon State Hospital.  The article is stark reminder on how our society treated, and to a certain extent, continues to treat the mentally ill.  The article relates the conditions for the dead as well as the living.  It states,

Inside the room, in a dim and dusty corner of one of many abandoned buildings on the decaying campus of the Oregon State Hospital here, are 3,489 copper urns, the shiny metal dull and smeared with corrosion, the canisters turning green.

The urns hold the ashes of mental patients who died here from the late 1880's to the mid-1970's. The remains were unclaimed by families who had long abandoned their sick relatives, when they were alive and after they were dead.

. . . .

The hospital now houses about 730 patients in wards that patients and hospital officials say are overcrowded, drafty and decrepit. A majority of the patients were ordered there by the courts, in cases ranging from misdemeanors to murders.

Many of the patients are ready to leave, hospital officials say. But there are few places to send them, mostly, the officials say, because Medicaid cuts have sharply reduced financing of Oregon's medical system and curtailed options for patients outside the hospital.


March 15, 2005 | Permalink

Kass on the Hot Seat?

On March 8, Washington Post reporter Rick Weiss wrote that Leon Kass, chairman of the President's Council on Bioethics, had spearheaded (with Eric Cohen, editor of The New Atlantis) a "loose-knit group of about a dozen people" who had "been meeting since December . . . to devise 'a bold and plausible "offensive" bioethics agenda' to replace a congressional strategy that has been 'too narrowly focused and insufficiently ambitious.'"  ("Conservatives Draft a 'Bioethics Agenda' for President"

Today, the Post reports that Rep. Diana DeGette (D-Colo.) "yesterday requested that the inspector general of the Department of Health and Human Services investigate . . . . whether Kass acted inappropriately by helping to lead an effort to craft a legislative 'agenda' for Congress that would place new restrictions on embryo research and other areas of reproductive science." 

Whether you're a fan of Kass' or not, and whether or not you think he checked his First Amendment rights at the door when he accepted the chairmanship of the PCOB, working on an ostensibly political bioethics agenda seems an extraordinarily risky move by Kass that does not put the PCOB or his leadership in a particularly flattering light.   [tm]

March 15, 2005 | Permalink

Monday, March 14, 2005

New Health Law-related Blawg

We wish to extend a belated "Welcome to the blogosphere" to Prof. Adam Kolber at the University of San Diego School of Law, whose Neuroethics and Law blog is a good addition to the blogature.  Check it out!  [tm]

March 14, 2005 | Permalink

Impact of HIPAA on Small Towns

Small towns, where everyone knows everyone's business, are feeling the impact of the HIPAA privacy rule, according to an AP story ("Communities Adjust to Medical Privacy Laws") filed March 13 (courtesy of The Washington Post). [tm]

March 14, 2005 | Permalink

Mass General and ALS Patient's Family Reach Settlement

The family of Barbara Howe, a patient with amyotrophic lateral sclerosis, and Massachusetts General Hospital, have ended a two-year battle by agreeing that life-support for Ms. Howe would be withdrawn by June 30, according to an article in Saturday's Boston Globe:

Nurses referred to Howe as a ''war horse" and said she ''wanted everything done to maintain her; including CPR, antibiotics, and ICU." Howe seemed impervious to pain, her family marveled. ''In fact, she'd say to bring it on," [the patient's daughter, Carol] Carvitt's lawyer, Gary Zalkin, is quoted as saying in hospital records.

Carvitt said she has tried to fulfill her mother's wishes and believed she could still hear and maybe see her family. But after Howe's bones broke during routine turning and doctors had to remove her right eye because of corneal damage, her caregivers grew increasingly opposed to keeping her on a ventilator.

Last spring, Smoot refused the hospital's request to overturn Carvitt as her mother's healthcare proxy. But, the judge said, since Howe could not have foreseen all her medical complications, he told Carvitt to refocus from carrying out her mother's wishes to acting in her best interest.


March 14, 2005 | Permalink

Teaching Empathy

The AmNews reports on a recent large bequest to the Medical College of Ohio to teach of empathy and other aspects of kindly bedside manners to medical school students.  The AmNews reports,

The Ruth Hillebrand Clinical Skills Center, dedicated by the Toledo school this month, was borne of the estate of a New York psychologist who felt she had bad experiences with rude doctors. As the school told it, Hillebrand's doctor in New York called her late one night and told her she had mesothelioma. He said there was no treatment and no cure. Then he hung up.

The Ohio medical college is hardly the only school teaching physicians how to interact personally with patients. And there are programs in place for practicing physicians to brush up on their personal skills as well. This isn't because patients are saying, en masse, that their doctors are rude. Rather, they say they value physicians who have good bedside manners, which encompasses listening to and answering their questions and showing empathy and compassion when providing care.

. . . . .

A 2004 Harris Interactive poll of 2,267 U.S. adults found that respondents cared more that doctors listened to their concerns and questions than they did about doctors being up-to-date on the latest medical research and treatment. A review of 25 surveys on doctor-patient relationships in the March 10, 2001, The Lancet said doctors with good bedside manners had a better impact on patients than physicians who were less personal.

The article provides a good overview of what type of programs a variety of schools ar offering as well as information on what practicioners are doing in response to patient concerns in this area.  It sounds like a good idea to me.  I am sure that we have all had some negative experiences with doctors in our lifetime.  Helping prevent those experiences is not only better for patients, who are more likely to trust a doctor who appears to understand their condition, but also may prevent angry patients from filing lawsuits not to mention helping doctors with the new performance/patient satisfaction ratings that some health plans have put into place.

March 14, 2005 | Permalink

Basketball Brackets

Here are the copies of the Men's and Women's NCAA basketball brackets for those who plan to spend some valuable time over the next few days picking teams.  I cannot say that this is in anyway health-related and certainly not health law related - I am just hoping that my students read this post before class so that they aren't searching for and filling in brackets during class.

March 14, 2005 | Permalink

Sunday, March 13, 2005

New Health Reform Concept?

The New York Times Magazine today has an article by Roger Lowenstein ("The Quality Cure?") that looks at the health care reform proposals of Harvard economist and dean David Cutler.  In a nutshell, Cutler argues that - the high price tag for health care to the contrary notwithstanding - the U.S. should be focusing on improving quality, not reducing costs.  Cost reduction, he says, fails at the political and cultural level (American don't like to lose their health care freedom of choice) and ignores an often ignored reality: much of health care spending is effective and could be more so if economic incentives were designed to encourage better results.  We could even save money along the way.

Cutler is the author of last year's well received Your Money or Your Life (Oxford Univ. Press) and was a principal architect in the Ira Magaziner shop that produced the still-born Clinton health plan in 1993.  He has a number of health-related papers on his web page.

Although not mentioned in Lowenstein's article, an article in the June 2004 Harvard Business Review also made the case for increased focus on competition in quality.  Harvard's Michael E. Porter is the Bishop William Lawrence University Professor, and his article (co-authored with Elizabeth Olmstead Teisberg at the University of Virginia's Darden School of Business Administration), "Redefining Competition in Health Care" (excerpt), turned a lot of heads at the time, partly because it represented his first foray into the realm of health policy.  In it, the authors argue that "zero-sum competition" in health has resulted in the wrong level of competition, the wrong objective, the wrong forms of competition, the wrong geographic market, the wrong strategies and structure, the wrong information, the wrong incentives for payers, and the wrong incentives for providers.  The article goes on to describe the kinds of changes that would be needed to turn the system around.  A book-length version of their article is scheduled for publication by the Harvard B-School Press on June 2. (For the record, Porter is one of about 15 University Professors at Harvard and is literally a rocket scientist (B.S.E. from Princeton in aerospace and mechanical engineering).)  [tm]

March 13, 2005 | Permalink