February 26, 2005
Oscar Buzz for Bioethics-Drenched Fight Film
I guess by now everyone's either seen "Million Dollar Baby" or read about it. "The Aviator" may be the odds-on favorite, but MDB is at least in the running. If you're still trying to figure out what's up with MDB, here's a good discussion of the euthanasia issue. And Art Caplan has a take on this, as well. [tm]
February 26, 2005 | Permalink
February 25, 2005
Bird Flu and Cock Fighting in Thailand
Reader Christina Solis has pointed to this NPR report on the government of Thailand's regulation of cock-fighting as a mechanism to reduce the chances of chicken-to-human transmission: "Disease experts say that could start a flu pandemic that would kill millions of people around the world." [tm]
February 25, 2005 | Permalink
February 24, 2005
New Futility Dispute at Mass. General
Some years ago, it was the Gilgunn case (unreported, but still famous). Now Massachusetts General Hospital is back in court in another futility dispute. According to an article in the Boston Globe (for which, many thanks to reader Jay Cortellini), Barbara Howe has ALS and has been an in-patient at MGH for five years. At least since 2003, the hospital has wanted to withdraw life-sustaining treatment from Ms. Howe:
[D]octors have said that Howe is ''locked in" her own body, and in June 2003, the head of the hospital's end-of-life committee, Dr. Edwin Cassem, a Jesuit priest and psychiatrist, wrote that ''the patient's status has surpassed an acceptable limit endangering her integrity, dignity, humanity, and basic human rights."
The hospital says the patient has recently taken a turn for the worse, and that ventilator support "is inappropriate and harmful, indeed inhumane." Everyone is back in court to find out who has the authority to decide whether Ms. Howe continues to live on the vent. [tm]
February 24, 2005 | Permalink
I don't know if you have been following the many stories (see here, here, here and here) about the Bird Flu, but it does appear that the it is still around and spreading, and thus should be something that we all learn about quite soon. Some are predicting that if it becomes highly contagious in humans, the resulting epidemic would be worse than SARS. Radio Free Europe reports on a World Health Organization (WHO) conference:
UN officials are warning that the bird-flu outbreak in Asia poses the "gravest possible danger" of becoming a global human threat. At a conference under way in Ho Chi Minh City chaired by the World Health Organization (WHO) and the United Nations' Food and Agriculture Organization, the current situation of the virus is being assessed -- and many experts say the bird-flu virus has become more complex and could develop into a human virus.
WHO's Western Pacific regional director, Shigeru Omi, raised concerns. "It is now being found in animals such as cats and tigers, that were not previously considered susceptible to influenza A viruses," Omi told Reuters. "Not only that, it is more pathogenic than the strain found in Hong Kong in 1997. This suggests that the virus is evolving in ways that increasingly favor the start of a pandemic.""The important thing for all of us is that if the [avian flu] virus becomes highly contagious among humans, the health impact in terms of deaths and sickness will be enormous, and certainly much greater than SARS."
February 24, 2005 | Permalink
Helpful Not-for-Profit Link
If you have interest in not-for-profit hospital litigation (or perhaps have to keep an eye on such cases), the following link may prove helpful: http://www.nfplitigation.com/NotForProfit/disclaimer.aspx
Thanks to Jim Tomaszewski for the weblink. [bm]
February 24, 2005 | Permalink
February 23, 2005
Children's Hospitals on Building Binge
Interesting story from the AP (courtesy of Yahoo!): "Children's Hospitals in Renovation Boom." The story refers to a 2003 study that tracked over $2.3 billion in renovations and other new construction at only four facilities.
Of particular note to health lawyers:
The boom stems from changes in U.S. health care that have given children's hospitals a larger share of a shrinking market, said Lawrence McAndrews, president of the National Association of Children's Hospitals. With managed care's emphasis on hospitalizing only the sickest patients, most children needing hospital care are now sent to children's hospitals.
Children's hospitals are "repackaging" themselves to attract patients and top doctors, and children-centered features are a key ingredient, McAndrews said.
Reminds me of the boom in psych hospitals and psych units within hospitals, as investors chased the higher (non-DRG) reimbursements that were available in the late 1980's and early 1990's. That led to massive fraud and abuse charges and equally massive settlements. How much do you want to bet that we will be reading about government scrutiny of some children's hospital's recruitment and billing practices before year's end? [tm]
UN Panel: Ban All Human Cloning
As reported by the Food and Drug Law Institute yesterday in its "SmartBrief," a UN panel has approved a nonbinding resolution that recommends that all member nations ban all forms of human cloning. This could potentially include cloning-for-research, as well as reproductive cloning, which would be a setback for stem-cell research if member nations follow the panel's recommendation. Nature has a good story on this development. Wired is also listed as a source for FDLI's report. [tm]
February 22, 2005
Med Mal Premiums: What's the Cause?
The New York Times today ran an article entitled, "Behind Those Medical Malpractice Rates," by Joseph Treaster and Joel Brinkley. Their conclusions won't surprise anyone who has followed the literature on this subject over the past 20 years, though it does fly in the face of the publicity machines at various state medical and hospital associations, as well as the PR juggernaut launched and promoted by President Bush, who has been on the stump this past month in support of his damage-cap legislation.
Despite the rhetoric that med mal premiums are soaring because of the cupidity of the plaintiffs' bar and the stupidity of jurors, the authors paint a different picture:
[F]or all the worry over higher medical expenses, legal costs do not seem to be at the root of the recent increase in malpractice insurance premiums. Government and industry data show only a modest rise in malpractice claims over the last decade. And last year, the trend in payments for malpractice claims against doctors and other medical professionals turned sharply downward, falling 8.9 percent, to a nationwide total of $4.6 billion, according to data.
The authors conclude: "Lawsuits against doctors are just one of several factors that have driven up the cost of malpractice insurance, specialists say. Lately, the more important factors appear to be the declining investment earnings of insurance companies and the changing nature of competition in the industry. The recent spike in premiums - which is now showing signs of steadying - says more about the insurance business than it does about the judicial system."
And do the doctors benefit from caps on damages? Apparently not:
[S]ome researchers are skeptical that caps ultimately reduce costs for doctors. Mr. Weiss of Weiss Ratings and researchers at Dartmouth College, who separately studied data on premiums and payouts for medical mistakes in the 1990's and early 2000's, said they were unable to find a meaningful link between claims payments by insurers and the prices they charged doctors.
"We didn't see it," said Amitabh Chandra, an assistant professor of economics at Dartmouth. "Surprisingly, there appears to be a fairly weak relationship.
This is an article worth reading and saving, right along with the August 2004 testimony of GAO researchers ("Medical Malpractice Insurance: Multiple Factors Have Contributed to Premium Rate Increases") and the June 2003 report of the same title. [tm]
More on Terri Schiavo's Case
The AP is reporting (courtesy of The Washington Post) that the 2nd District Court of Appeal has allowed the stay to expire that had been preventing Terri Schiavo's husband-guardian, Michael, from removing her feeding tube. The story reports that her parents are going to ask a Pinella County judge for an emergency stay to give them enough time to file appeal papers. The New York Times story on the grant of cert. in Gonzales v. Oregon also reports that Terri's parents are asking for a stay, and goes on to state that they are planning to file an appeal in the U.S. Supreme Court. [tm]
More on Death With Dignity Act Case
Just to add a further observation onto Betsy's post (below) re: today's grant of cert. in Gonzales [substituted for Ashcroft] v. Oregon, No. 04-623 . . . The Oregon Death With Dignity Act won't be reviewed directly in this case, which is a challenge to the DOJ policy of prosecuting physicians who prescribe controlled substances in accordance with the Death With Dignity Act. The 9th Circuit's opinion, which struck down the DOJ policy, is here, and the SG's petition for cert. is here. According to an article on the New York Times' web page, the case won't be argued until after the October 2005 Term begins. [tm]
Death With Dignity Act to be Reviewed by Supremes
Scotusblog is reporting that the Supreme Court has decided to review Oregon's Death with Dignity Act which permits physician-assisted suicide. I am surprised that they decided to grant review and I really don't know what this means for the future of the Act. It has always been controversial to some but the courts (thus far) have firmly upheld it. [bm]
February 21, 2005
Controlling the Cost of Health Care
On the Nightly Business Report (PBS) tonight, they did a complete show on how to control the cost of medical care. They focused on some of the President's proposals to provide consumer accounts and discussed the failure to managed care to control cost in the late 1990s. It is amazing how quickly the cost of medical care add up and the different approaches are interesting to consider. I don't mind some of the European socialization models but they do not seem to be very popular in Congress. Anyway, it was an interesting and informative show. [bm]
Screening for Newborns
Today's New York Times has an article by Gina Kolata discussing a federal panel's recommendation to screen newborns for 29 rare medical conditions. This doesn't sound like a very controversial topic but as Ms. Kolata reveals, scientists and doctors are divided about the benefits of the tests and the potential for harm if false positives occur. She reports,
Proponents say that the diseases are terrible and that an early diagnosis can be lifesaving. When testing is not done, parents often end up in a medical odyssey to find out what is wrong with their child. By the time the answer is in, it may be too late for treatment to do much good.
But opponents say that for all but about five or six of the conditions, it is not known whether the treatments help or how often a baby will test positive but never show signs of serious disease. There is a danger, they say, of children with mild versions of illnesses being treated needlessly and aggressively for more serious forms and suffering dire health consequences.
It is a great read and would make a great article to stimulate class discussion concerning medical science and limits and the influential role of public health spending and recommendations. [bm]
February 20, 2005
The Future of Medicaid
It seems that not a day goes by without news of a governor discussing cuts or reforms that will have to be made to a state's Medicaid program. Whatever happens at the state level, however, it seems that no one is happy with what President Bush has proposed thus far. The AP reports that the Governors are united in their opposition to President Bush's proposed cut backs in Medicaid while also recognizing that they need to make some changes in how Medicaid works. The AP story states,
The governors are up against the Bush administration's effort to rein in costs as it seeks to cut the federal deficit, and also against advocates for the poor and for health care providers who worry that a push to "flexibility" is just another way to cut people from care and shortchange the medical profession.
Medicaid has grown steadily - state spending has risen 9 percent or more for each of the last four years. The fastest-growing share of Medicaid payouts are for the elderly, who are the most expensive to care for - an ominous sign as baby boomers age.
For further coverage of the Medicaid reform debate, the Maternal and Child Health Blog has some insightful stories and thoughts. [bm]
Health Incentives in the Workplace
Today's Washington Post has an article by that describes the health-promotion programs of various employers around the country. Some are definitely of the Big Brother variety, while others seem less invasive, more voluntary, and based upon positive incentives (often cash) rather than punishments.
As reported by the Post,
The degree to which companies can impose health-related requirements on employees varies across the country. Thirty states, including Virginia, plus the District of Columbia have laws preventing discrimination against smokers, while others, such as Maryland, do not. Thirteen states prohibit employers from regulating alcohol use during non-work hours. But only four states -- California, Colorado, New York and North Dakota -- have passed broader privacy laws protecting people's activities away from the job.
The employers' programs focus primarily upon diet, exercise, and nicotine and alcohol use. Though workplace-sponsored voluntary Weight Watchers® clubs, "Out to Lunch" exercise groups, and AA and smoking cessation programs have been around for a long time, lie-detector tests, mandatory urinalysis and weigh-ins, however, raise a host of issues. I've done a quick law-review search and not come up with much on this. Does anyone know of some good articles out there? [tm]