HealthLawProf Blog

Tort Reform and Medical Costs

NYT's freelance writer, Anne Underwood, interviews Tom Baker, professor of law and health sciences at U. Penn School of Law, about tort reform and its potential impact on lowering health care costs. This issue has raised interest from scholars and politicians alike:

Medical tort reform is moving to the fore of the health care debate. On Sunday in The New York Times, former Senator Bill Bradley, Democrat of New Jersey, argued that one way to gain support of both Democrats and Republicans might be to combine universal coverage with tort reform. Mr. Bradley also suggested that medical courts with special judges could be established, similar to bankruptcy or admiralty courts.

On “This Week With George Stephanopoulos,” Senators Orrin G. Hatch, Republican of Utah, and John Kerry, Democrat of Massachusetts, seemed to agree that medical malpractice lawsuits are driving up health care costs and should be limited in some way. “We’ve got to find some way of getting rid of the frivolous cases, and most of them are,” Mr. Hatch said. “And that’s doable, most definitely,” Mr. Kerry replied.

Read the interview here.

NY's Campaign to Temper Obesity: "Are You Pouring on the Pounds?"

NYC Department of Health and Mental Hygiene just launched a new public awareness campaign to address over-consumption of junk foods and sodas and resulting obesity. The city launched a similar campaign to address tobacco use and feels that this effort, which will include 1,500 Subway posters, will be successful. Surveys will be conducted in the upcoming weeks to gauge New Yorkers' response to the ads. Read more from LA Times here.

 

(Image from LA Times)

Hospital Executives' Anxieties about Reform

Washington Post examines the concerns of one hospital executive in light of health care reform.

Anxiety is running high among hospital executives as they ponder the ever-changing proposals on Capitol Hill. Wary of changes to payment formulas and fiercely protective of their franchise, industry groups are spending millions to lobby Congress. They also pledged $155 billion in Medicare and Medicaid savings in a deal with the White House in hopes of avoiding a deeper restructuring that could cost them more.

Medical Bills and the Middle Class

Nicolas Kristof of the NYT highlights one woman's story of how cracks in the health care system tore apart her family when her husband was diagnosed with early onset dementia. Because her husband required long-term care, hospital workers suggested the two divorce in order to prevent the family from losing everything.

A study reported in The American Journal of Medicine this month found that 62 percent of American bankruptcies are linked to medical bills. These medical bankruptcies had increased nearly 50 percent in just six years. Astonishingly, 78 percent of these people actually had health insurance, but the gaps and inadequacies left them unprotected when they were hit by devastating bills.

How Choice Factors into Health Care Reform

NYT columnist David Leonhardt analyzes whether personal choice can be a part of health care reform.

Health insurers often act like monopolies — like a cable company or the Department of Motor Vehicles — because they resemble monopolies. Consumers, instead of being able to choose freely among insurers, are restricted to the plans their employer offers. So insurers are spared the rigors of true competition, and they end up with high costs and spotty service.

He argues that the Wyden-Bennett Bill of 2007 offers more choice than current versions of health care legislation:

The best-known proposal for giving people more choice is the Wyden-Bennett bill, named for Ron Wyden, an Oregon Democrat, and Robert Bennett, a Utah Republican, who introduced it in the Senate in 2007. There are other broadly similar versions of the idea, too. One comes from Victor Fuchs, a Stanford professor sometimes called the dean of health economists, and Ezekiel Emanuel, an oncologist and an Obama health-policy adviser.

In the simplest version, families would receive a voucher worth as much as their employer spends on their health insurance. They would then buy an insurance plan on an “exchange” where insurers would compete for their business. The government would regulate this exchange. Insurers would be required to offer basic benefits, and insurers that attracted a sicker group of patients would be subsidized by those that attracted a healthier group.

Managing Health Policies in South Africa

Will the S. African government make addressing the AIDS epidemic a more critical focus of its administration? With leading scientists urging the government to take action, the answer may be yes.

Leading South African scientists challenged the governing party on Monday to break with its deeply flawed record on AIDS and public health, spurring the country’s new health minister to say that he and his party shared their diagnosis of systemic problems and were determined to repair them.

The decision by the health minister, Dr. Aaron Motsoaledi, to embrace the often withering assessment of his party’s failings, laid out in six papers published online Monday by The Lancet, a medical journal based in London, provided a strong signal that the governing party’s new leadership intended to shake up a badly managed health system.

Moving Toward Increased Hospital Transparency

Embracing a policy of transparency at hospitals benefits patient and hospital, one test study found. After adopting the model four years ago, findings indicate that at the University of Illinois Medical Center in Chicago, disclosing medical errors upfront has actually led to a decrease in lawsuits by 40%.

“How we respond to these events defines who we are as individuals, organizations and our professions as a whole,” says McDonald, who is both a pediatric anesthesiologist and a lawyer by training. “Open and honest communication between caregivers and their patients and families starts the process of healing and closure – for both the patient and the caregiver.”

Presidential Panel Recommends Speeding up Access to Swine Flu Vaccine

With universities and schools opening its doors, swine flu continues to spread. In Cincinnati, both Xavier University and University of Cincinnati have each reported cases of swine flu (See article here).On Monday, a presidential panel recommended increased access to the swine flu vaccine. Shots of the vaccine are being prepared but are not slated to be readily available until October. Reported the Washington Post:

The federal government should expedite the availability of a vaccine against swine flu, clarify how antiviral drugs should be used to fight the pandemic and designate someone at the White House to coordinate the nation's response to the virus, a presidential panel recommended Monday.

The system for tracking the spread of the new virus also should be improved and the Obama administration should take other steps to prepare for a second wave of infection expected to begin this winter, including the accelerated development of communications strategies, the panel concluded in an 86-page report.

P&G May Sell Drug Business

On the brink of selling its $3 billion prescription drug business to Warner Chilcott Ltd, P&G has raised interesting considerations about the state of the pharmaceutical market. WSJ believes that factors in P&G's decision to put the business on the market include increasingly tough competition from generic brand drugs and a recent lawsuit:

One reminder of that fact: A key issue in talks to sell the unit was a lawsuit over a patent dispute between P&G and a generics unit of Boehringer Ingelheim, the WSJ says. The suit involves P&G’s ulcerative colitis drug Asacol. P&G has won similar cases in the past, the article notes, including one against Teva that involved Actonel, the osteoporosis drug that is the division’s best-selling product.

FDA Requires Halt of Sale of Ibuprofen Creams

Eight companies were warned by the FDA that they are no longer permitted to sell ibuprofen creams.

Only problem is the Food and Drug Administration never said that was OK. So the agency warned eight companies they're out of line for selling the topical ibuprofen and told them to stop.

One of the companies, Wonder Laboratories (really), got dinged for selling IBU-RELIEF12, a cream containing ibuprofen, Arnica montana (or wolf's bane), and methyl salicylate, the smelly wintergreen stuff in Bengay.

Read more here.

Taxing Junk Food To Curb Obesity

LA Times examines whether taxing junk food, traditionally cheaper than healthier alternatives, will reduce obesity and encourage consumers to purchase more nutritious foods.

To make a significant dent in escalating rates of obesity, taxes would have to be steep and widespread. Two-thirds of states now impose a modest soft-drink tax -- the average rate is 5.2% -- and though the taxes are linked to a drop in body weight, the difference is extremely slight: about 3 ounces for a 5-foot-10, 279-pound person.

However, whether taxing junk food would be effective is debatable. Statistics suggest that while taxing cigarettes does curb consumer spending, it may be more difficult to alter consumer purchasing of junk foods.  

Health Care: Debating an Effective Public Option

Using San Fransisco as a model, NYT columnists debate a public health care option. 

TWO burning questions are at the center of America’s health care debate. First, should employers be required to pay for their employees’ health insurance? And second, should there be a “public option” that competes with private insurance?

Answers might be found in San Francisco, where ambitious health care legislation went into effect early last year. San Francisco and Massachusetts now offer the only near-universal health care programs in the United States.

Read more about the results here.

D.C. and VA Schools Requesting Sixth Grade Girls Receive HPV Vaccination

Schools in both D.C. and Virginia are requesting sixth grade girls receive Gardasil, the vaccine that was approved by the FDA in 2006 that protects against genital warts and cervical cancer. The vaccine is most effective if it is administered before girls become sexually active. Though both D.C. and Virginia have provided for opting-out of the requirement, proponents are hopeful that this legislation will protect million girls from cervical cancer. However, opponents voice concerns that the drug has not been tested enough. Such apprehension is what has prevented other states, such as Maryland, from making the vaccination mandatory.

Seniors - Driving and Staying informed of Potential Safety Risks?

Many elderly drivers are unaware that prescription drugs may affect their ability to drive safely, reported the Wall Street Journal.

In all, 69% of those surveyed took a medicine that could impair driving, because of possible side effects such as dizziness, drowsiness or blurred vision. But only 28% of respondents were aware of those issues. Only 18% had been warned about the possible driving risks by a doctor, nurse of pharmacist.

Moms in D.C. Apprehensive about Flu Vaccine

Some mothers-to-be in D.C. are concerned that a new swine flu vaccine has not been tested enough to be administered to pregnant women. Debate stems from the recent recommendation by the Centers for Disease Control and Prevention and American College of Obstetricians and Gynecologists that pregnant women receive the swine flu vaccination as a preventative health measure. A recent study in the Lancet medical journal study indicated that pregnant women are more likely to be affected by swine flu than other groups.  Read here.

End of Life Care

When only about one third of Americans leave living wills or specify end of life protocol, physicians and hospitals are left to consider the costs and benefits of end of life care themselves. Some issues that remain include:

Should a feeding tube be installed when the patient can no longer be nourished by mouth? Should a ventilator be attached when breathing independently becomes difficult? If the patient has severe dementia, should antibiotics be used if pneumonia develops? Should cardiopulmonary resuscitation be attempted if the heart stops beating?

Or should the patient receive just comfort care — treatment for pain, nausea, anxiety, depression and other debilitating symptoms — and be allowed to die a natural death?

Lacking guidance from patients and families, physicians who know better too often end up providing costly life support for the terminally ill even though there is no hope for an improved quality of life.

Dr Charles A. Bush, the medical director of Richard M. Ross Heart Hospital at the Ohio State University, believes this adversely impacts the health care system through higher costs and debilitating procedures for patients.

Conflicts of Interest? Doctors and Pharmaceutical Ties

Washington Post discuss a sensitive question many patients find themselves wondering but perhaps not directly asking their doctors - what companies their doctors have relationships with and how deep those ties run.  One market research company estimated that pharmaceutical sales spends $20 billion a year marketing directly to doctors.

As a response in 2003, D.C. enacted legislation to improve transparency among drug manufacturers. A national effort was initiated this year:

In January, Sen. Chuck Grassley (R-Iowa) and Sen. Herb Kohl (D-Wis.) introduced legislation -- the Physician Payments Sunshine Act -- that would require drug and medical device manufacturers to report payments to any physician of more than $100, whether as a gift or for research purposes, and to publish the information online.

But then again, complete skepticism of doctor-pharmaceutical sales relationships may not always be fair, as Chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic points out:

"We can't lose sight of the fact that it is potentially beneficial [to the public] for industry to interact with physicians, because someone needs to develop these drugs. I work with many pharmaceutical companies, and I believe it is my responsibility as a physician to facilitate the development of new therapies."

Good Sam in California

California may be suffering from a terrible financial crisis but Governor Schwartzenner has found time to sign legislation that raises the standard for lawsuits against non-professional medical individuals who aid others in emergency situations.  Law.com reports

One piece of compromise legislation, Assembly Bill 83, protects people who are not in the medical profession from being sued after they help someone at the scene of an accident, unless their actions rise to the level of gross negligence or recklessness. The "Good Samaritan" bill was introduced after the California Supreme Court ruled, in Van Horn v. Watson, No. S152360 (Cal. 2008), that only trained emergency medical responders were immune from liability under the state's Health and Safety Code. In that case, a woman who was rendered a paraplegic by an automobile accident sued the friend who had pulled her out of the car.

The bill was supported both by the Consumer Attorneys of California and the Civil Justice Association of California, a tort reform group. Christine Spagnoli, president of the consumer attorneys and a partner at Greene, Broillet & Wheeler in Santa Monica, Calif., said that the legislation broadens the number of people who are protected from liability.

"The bar has been set higher," she said. "People who do something and unintentionally cause additional harm aren't going to be faced with having to be potentially sued. It's really more for someone who is aware of the fact that what they're doing is not right and they're going to potentially cause harm and go ahead and do it anyway." . . . .

Conference Announcements: LatCrit XIV and LatCrit/SALT New Faculty Workshop

LatCrit XIV promises to be a rich and memorable conference.  Over 145 panel and work-in-porogress proposals were submitted.  We hope that many of you will be able to join us.  Please note that September 14th is the deadline both for conference early bird registration (at a discounted rate) as well as for the early bird LatCrit hotel rate of $189, but that Labor Day, September 7th, is the deadline for an even lower "earlier bird" room rates of $169 for Friday and Saturday and $179 for other nights -- significantly less than the hotel's standard room rate.  Our room block is selling very swiftly, and the hotel may sell out before these deadlines, so please do not delay in making your reservations.  Washington is hosting a number of large conferences around the LatCrit XIV weekend and hotel rooms outside of our block may be scarce and expensive.

The full preliminary conference program schedule for LatCrit XIV and the LatCrit/SALT New Faculty Development Workshop, hosted by American University Washington College of Law Oct. 1-4, has been released.  It is here:

www.tinyurl.com/LatCritXIV-program

 

Hotel and conference registration materials are here:

www.tinyurl.com/LatCritXIV-registration

 

And the conference theme narrative and initial call for papers/panels are here, although the submission deadline has long past and, absent cancellations, there will be no more panel and work-in-progress slots available (with the exception of commentators for works-in-progress colloquia):

www.tinyurl.com/LatCritXIV-call

 

Diane Rehm Health Care Townhall

In case you are interested in a slightly more friendly town hall discussion of health care issues, you may want to tune into the Diane Rehm show today to hear some of your fellow citizens ask questions about some of the potential issues the health reform bills hope to address and how.

10:00A Radio Town-Hall Forum on the Health Care Debate

Angry debates over changing the nation's health care system break out at public forums across the country. Now it’s your turn to participate in a radio town hall. Your questions and concerns on health care overhaul.

Guests

Ceci Connolly, reporter, The Washington Post.

Mary Agnes Carey, senior correspondent with Kaiser Health News. She most recently served as associate editor for CQ HealthBeat, a daily report on health care policy. She has also served as Capitol Hill Bureau Chief for CQ.

Carrie Budoff Brown, Health Care reporter for Politico.