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Archive for August, 2007

Monday, August 27th 2007

Did They Make THe Ana Pou Case Go Away?

I never did follow Dr. Pou’s case too closely. She was the ENT doc, who during Katrina was accused of euthanizing, or at least helping along, the deaths of several patients at a New Orleans area hospital.

The state’s attorney backed away from the accusations after a grand jury failed to indict Dr. Pou. However, now questions are coming out concerning if the DA stuffed away the opinions and reports of the physicians he brought in as experts. Five experts who all agreed that the deaths represented homicides.

[A]ll five forensic specialists believe the medical evidence warranted a trial. All five said that the medical charts, toxicology and autopsy reports they reviewed indicate that deliberate overdoses the pain killer morphine and the sedative Versed led to the deaths of the nine patients.

[...]

“Accidental overdoses would need to have occurred nine times between 12 noon and 3:30 p.m., all on one floor, to every patient who was left on the floor,” Young wrote. ” Again, it is noted that morphine was not ordered for seven of the patients and Versed was not ordered for any. Therefore it seems highly unlikely that nine patients died on the same floor on the same afternoon of accidental overdose.”

Did the grand jury considering the case even see the reports filed by these forensic experts? They certainly never heard them testify.

In a decision that puzzled the five experts hired by the state, New Orleans District Attorney Eddie Jordan never called them to testify before the grand jury. What remains unclear, because of grand jury secrecy laws, is whether the grand jury even saw the experts’ written reports.

It certainly sounds very fishy. It seemed to me that a lot of medicine, at least the population in the health care community that is online, rushed to Dr. Pou’s defense following Katrina. Indeed, I appluaded the charges being dropped. But I was clearly negligent in delving into the details of the case, and a story like this makes you wonder.


Pretty Strong Accusations

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Sunday, August 26th 2007

SCHIP Enrollment

I still think a lot of this is on the outreach and marketing programs, along with the complexity of enrolling. With my opinion stated once again, Health Affairs Blog looks at how to improve CHIP enrollment.

Sunday, August 26th 2007

What Is Going On In Cali?

Admittedly, I”m not completely up on what is going on concerning California’s universal healthcare attempts. But what is this fight over taxing health care providers versus taxing businesses to help pay for the coverage?

California Gov. Arnold Schwarzenegger says he will veto legislation to require business owners to devote a portion of their payroll to employee health care.

The proposal by Assembly Speaker Fabian Núñez, D-Los Angeles, and Senate President Pro Tem Don Perata, D-Oakland, would require employers in the Golden State to earmark at least the equivalent of 7.5 percent of their payroll for their workers’ health care.

The Govenators plan is…

To bankroll the program, the governor proposed a 4 percent “provider tax” on hospital revenues, 2 percent on doctor revenues and 4 percent on employers with at least 10 workers if they do not provide health insurance.

I know you’re supposedly generating new paying patients, but this sounds like BS. I wonder what the CMA’s position is on these provider taxes.

Saturday, August 25th 2007

I Knew It Wasn't Your Fault

How much does a fat promoting virus contribute to obesity?

As an alternative, Drs. Magdalena Pasarica and Nikhil Dhurandhar of Louisiana State University used the virus to infect fat tissue taken from people undergoing liposuction. Pasarica reported that more than half the stem cells in the tissue were converted to fat cells and began growing as they accumulated and stored fat.

Once fat cells are formed in the body, she noted, they never go away. They can be shrunk, but they remain, waiting for a fresh infusion of fat so they can begin growing again.

Thursday, August 23rd 2007

Where's The Vioxx Money?


Merck Is Holding All The Cards?

A New York Times article looks at how few have gotten paid from their Vioxx suits.

[N]one of the 45,000 people who have sued Merck, contending that they or their loved ones suffered heart attacks or strokes after taking Vioxx, have received payments from the company. The lawsuits continue, for now in a state of legal limbo, with little prospect of resolution.

In combating the litigation, Merck has made an aggressive, and so far successful, bet that forcing plaintiffs to trial will reduce the number of Vioxx lawsuits and, ultimately, its liability.

Promising to contest every case, Merck has spent more than $1 billion over the last three years in legal fees. It has refused, at least publicly, to consider even the possibility of an overall settlement to resolve all the lawsuits at once.

The strategy’s successes, from the view of Merck and its shareholders, are clear. In the last year, the company has won most of Vioxx cases that have reached juries. Though its stock plunged immediately after the Robert Ernst verdict, it has since risen 80 percent, easily outpacing those of other big drug makers. And estimates of Merck’s ultimate liability, once as high as $25 billion, are now closer to $5 billion, said C. Anthony Butler of Lehman Brothers.

I’ve sounded like a schill for pharma on this blog when it comes to Vioxx but you cannot read these case reports and news articles of individual suits and not be stunned. People with incredible risk factors for MI and CVD or with diagnosed CAD, who take Vioxx for two weeks and then want to put some responsibility for their MI on the drug? Not even a physician could sit up there with a straight face and give a completely accurate percentage for Vioxx’s contribution to the plantiff’s heart attack (versus all their other risk factors) in most of these cases. And we want twelve lay men and women, who have nothing better to do than serve on a jury, to sort it out?

Get real. I continue to applaud Merck for fighting every single Vioxx case.

Thursday, August 23rd 2007

CHIP Is For Who?

I’ve talked before about where the line should be drawn concerning CHIP qualification. The government providing for children, whose parents can’t provide, is something else than the dream of ‘universal coverage’. There’s some reason to it, even from the libertarian end I’m occupying.

The question is which families should qualify for assistance in providing for their children’s health? Apparently, with the SCHIP renewal, Congress drew the line too low…

The Bush administration, continuing its fight to stop states from expanding the popular Children’s Health Insurance Program, has adopted new standards that would make it much more difficult for New York, California and others to extend coverage to children in middle-income families.

Administration officials outlined the new standards in a letter sent to state health officials on Friday evening, in the middle of a month-long Congressional recess. In interviews, they said the changes were aimed at returning the Children’s Health Insurance Program to its original focus on low-income children and to make sure the program did not become a substitute for private health coverage.

Noble goals, but I think trying to determine what ‘low income’ is when it comes to being able to afford health insurance for your children is a difficult deal.

The poverty level for a family of four is $20,650 in annual income. New York now covers children in families with income up to 250 percent of the poverty level. The State Legislature has passed a bill that would raise the limit to 400 percent of the poverty level — $82,600 for a family of four — but the change is subject to federal approval.

California wants to increase its income limit to 300 percent of the poverty level, from 250 percent. Pennsylvania recently raised its limit to 300 percent, from 200 percent. New Jersey has had a limit of 350 percent for more than five years.

More than $82,000 for a family of four? Even in NY; are you kidding me?

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Monday, August 20th 2007

Who Pays For Mistakes?


As The Saying Goes: Learn To Put Your Shoes On The Right Feet Before You Do Brain Surgery

Next year Medicare will not pay for some hospital mistakes.

Among the conditions that will be affected are bedsores, or pressure ulcers; injuries caused by falls; and infections resulting from the prolonged use of catheters in blood vessels or the bladder.

In addition, Medicare says it will not pay for the treatment of “serious preventable events” like leaving a sponge or other object in a patient during surgery and providing a patient with incompatible blood or blood products.

In many ways this short report spouts things that seem like common sense but there are things to be worried about in this move. Before I ramble off into my complaints know that I’m relatively consumer oriented for a health care provider (or future one). I believe P4P can work in the right situation, I believe in transparency and quality measure reporting.

That being said I have problems with what little I know about this CMS move. Healthcare is not selling a television or even cooking a steak; it is sadly more like commissioning a piece of art. Try returning that painting. I’m not saying there shouldn’t be real standards or that health care can’t learn something from the retail world, but let’s not pull out ridiculous cliches like “the customer patient is always right” or try to stamp some sort of “satisfaction guaranteed” deal on healthcare.

It doesn’t work that way.

We can all agree that things like leaving sponges inside of patients is unacceptable. No one should get extra cash for creating work for themselves. But bed sores and line infections? The problem I have here is that the burden is on the hospital to prove they didn’t cause something by neglect.

[A vice-president for the AHA] said that some of the conditions cited by Medicare officials were not entirely preventable. Commenting on the proposed rules in June, the American Hospital Association said, “Certain patients, including those at the end of life, may be exceptionally prone to developing pressure ulcers, despite receiving appropriate care.”

This isn’t them documenting and defending a procedure they did in order to collect a fee. This is them trying to disprove something. Is that really where the burden should be? I don’t see how that can be justified.

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Monday, August 20th 2007

Psychiatry Consult

Psych consult note on pt with emotional lability reads:

Axis III Diagnosis: s/p stepped on by elephant

A true diagnosis, but still humorous to read.

Sunday, August 19th 2007

Massachusetts: Universal Ain't The Right Word


They Should Totally Hire Me To Design Their State Seal

Word on the struggles of Massachusetts’ “universal” health care plan is nothing new. And I’m not really mocking them, I liked was accepting the plan so it is sad to see it fall short of it’s goals. Some sort of two tiered system is coming, despite my whining, and as far as plans come the Mass. plan had something for everyone…it was a good compromise which was is trying to spread the responsibility amongst all parties.

With all that said, once the struggles of any program hit the mainstream media you know they’re real. Just kidding. But here is MSNBC documenting the Massachusetts’ experiment.

The state has already backed off of “universal.” About 160,000 uninsured people in the state have incomes that are too high to qualify for subsidized health insurance — but too low to afford the lowest-cost unsubsidized plans. About 60,000 of these working poor won’t face a penalty for not getting insurance, but the 100,000 others are in a bind.

I think amongst the problems is that the private low cost insurance offerings Massachusetts was hoping/expecting have not materialized. Those that don’t qualify for subsidies are still facing premiums which are far above what the plan was hoping would materialize.

There are a bunch of other hurdles as well, but maybe this program will still achieve some “good” (as good as forcing people to pay for other’s insurance can be).

Friday, August 17th 2007

Yeah, The System Is The Problem…

…not the individuals who use it. A man throws his wife to her death off a balcony.

A man threw his seriously ill wife four stories to her death because he could no longer afford to pay for her medical care, prosecutors said in charging him with second-degree murder.

A discussion of his motive follows.

According to Jackson County Probate Court records, Criste Reimer had been in ill health for several years. Her weight had fallen to 75 pounds and she was partly blind.

According to the court records, she had no health insurance to pay for medical bills that ranged from $700 to $800 per week.

Two words: personal responsibility.