“The greatest mistake in the treatment of diseases is that there are physicians for the body and physicians for the soul, although the two cannot be separated.”
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.
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.
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.
[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.
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?
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.
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).
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.
The New Jersey Star Ledger (via WSJ Health Blog) comments on the mail and email and calls Merck recieves asking them to put Vioxx back on the market. How does the ridiculous Consumer Union respond?
A skeptic from Consumers Union says: “A person’s conviction that something is helping them or that only one thing will help them is often erroneous. The impact may be exaggerated.”
Are you kidding me? Big Brother knows what is best?
Vioxx Helped A Lot Of People
The fact all the information wasn’t out there about Vioxx’s risk was a terrible shame. I don’t know what to believe in terms of whether there was some element of deliberate deception in that. But…when it comes to drugs, as long as:
1) There is some benefit from taking it
2) All the risks are out in the open
…then people and their physicians should be able to weigh the risk versus benefits for themselves. They shouldn’t have the FDA do it for them (yeah, yeah Vioxx was ‘withdrawn’ by Merck).
Dr. Rosenbaum, a highly regarded pediatric ophthalmologist who had been regularly harassed by animal-rights activists for his research work with cats and rhesus monkeys at the Jules Stein Eye Institute at UCLA, noticed a device underneath his luxury sedan. The bomb squad was dispatched to the scene and hauled away a makeshift — but deadly — explosive. A faulty fuse was the only reason it didn’t go off.
For several years now, Rosenbaum and other faculty members at UCLA Medical Center have been targeted by animal-rights activists outraged by their experiments on primates. The researchers have endured crank phone calls, menacing e-mails and intimidating threats screamed over bullhorns in the middle of the night in front of their homes.
But with the attempted bombing of Rosenbaum, and the attempted Molotov cocktail bombing last year of UCLA researcher Lynn Fairbanks in Bel-Air, activists are no longer content with talking a mean game — they now want blood.
One Of Dr. Rosenbaum’s Many Experiments
There’s not really a word for those that would escalate the situation like this other than nutcase. Amongst them you find Dr. Jerry Vlasak.
Vlasak, a tall and lanky man with short salt-and-pepper hair and a faded goatee, settles into a booth and begins speaking excitedly, and somewhat loudly, about his obsession.
“I think the animal-rights movement has been way too slow in taking radical actions,” he says. “And they’ve been way too nice.”
Vlasak understands that his medical background gives the animal-rights movement a certain amount of cachet. Journalists come to him for quotes, and he gives them. In a 2004 interview with the London Observer, he said, “I don’t think you’d have to kill too many [researchers]. I think for five lives, 10 lives, 15 human lives, we could save a million, 2 million, 10 million nonhuman lives.”
The question is, is this the guy you want operating on your splenic laceration? A man with so little respect for human life. Better hope he doesn’t get word of a million cats drowning while in the middle of operating on you; he’d be obligated to race to their rescue and leave you cut open there I imagine.
Research at the Jules Stein Eye Institute has led to advances in gene therapies to treat inherited, blindness-causing diseases, and UCLA is credited with a breakthrough for curing visual loss in patients with the eye disease known as Stargardt’s. Rosenbaum and its other leading physicians who do key work on such diseases have plenty of supporters.
[Chancellor] Abrams recently changed UCLA policy regarding Freedom of Information Act requests. The university will no longer make public its medical research documents, according to UCLA vice chancellor for research Roberto Peccei.
Vlasak insists the experiments with rhesus monkeys and cats are unnecessary — a claim [vice chancellor Roberto Perccei] meets with open disgust. “They’re always using these things in a way to hype it up!” Peccei says. “Let them take us to court for not providing the documents.”
Via e-mail, Vlasak retorts, “They obviously feel like they have to hide not only the details of what’s going on in their research labs, but now they are going to try to hide from the public, at a public institution no less. If they were not ashamed of what they are doing, they should be willing to openly display what is going on there.”
We’re not looking at the future here, where all species will be accepted by the general public as equals. These violent animal rights activists aren’t pioneers. They aren’t revolutionaries. They’re nutcases. They’re prophets only in their own minds.
Federal officials dealt a fatal blow Friday to long-troubled King-Harbor Hospital, announcing that the public medical center had failed a critical inspection and would lose the $200 million it needed to continue operating.
The emergency room was permanently closed late Friday, and Los Angeles County officials plan to halt in-patient services at the landmark hospital within two weeks.
In the most recent review, a 13-member team of federal regulars found that King-Harbor failed to meet eight of 23 national standards for patient care.
The failures included a lack of supervision of emergency-room patients who are a danger to themselves and others; patients who were placed at risk of exposure to tuberculosis; and staffers who were unable to correctly calculate dosages for medications administered to pediatric patients.
[I]npatient treatment will be provided at Harbor-UCLA Medical Center, Rancho Los Amigos National Rehabilitation Hospital and at private hospitals under contract with the county.
You have to feel bad for Drew SoM, although they severed their ties with King-Harbor several months ago, the hospital’s collapse gutted their residencies’ ACGME accreditations. I don’t know how much of a this burden is on them, they did dump the vast majority of their Trustees and their President in the aftermath of this fiasco but I still feel for them…they graduated a class of 21 this year! Yikes.
It sounds like the county commissioners are saying all the right things about getting a quality hospital for south LA. Let’s hope that happens.
I’m living off educational loans. The federal government backs these loans thus making me a better investment for the loan company and lowering my rate on them. As well, for a small portion of my loans, the government is actually subsidizing the interest I’m accumulating…they’re actually paying off the interest that is accumulating on those loans while I’m in school.
It’s a sweet gig. It’s also troublesome in some respects. It sits like a big flashing red light atop my wild haired libertarian rants. Every time I bad mouth government public assistance - largely in the form of denouncing government’s responsibility to guarantee health care - there are my federally subsidized loans sitting in the corner in a box labeled hypocrisy.
There’s some truth to that which I’ve admitted but comparing the subsidization of education loans to ‘welfare’ programs is hardly equivocal.
The chief point is this: subsidizing loans for medical school is an investment. The government is going to get back those education loans they subsidize for medical students…and many times over.
I’ll earn considerably more as a physician than with merely my bachelor’s degree in hand. And those earnings will generate tax revenue. New tax revenue.
Health care spending isn’t a fixed pie. It isn’t like if I wasn’t a physician that all my income would merely go to other providers. The fact is we have a shortage of health care providers in this country. And, perhaps sadly, health care supply creates it’s own demand. The more health care resources available, the more they’re used and the saturation point appears to be pretty well away in most areas. The point is, a large portion of my earning as a physician will be new…not merely income that would’ve gone to other providers if I wasn’t a physician.
I can’t imagine that those tax revenues don’t easily, easily surpass any interest payments or loan defaults the government picks up for medical students. There’s risk, as in any investment. Some students will default, some will drop out of school, some will leave the country, etc. But on the whole it’s likely a remarkably safe investment.
This can’t be said for government subsidized health care. Yes, it generates some increased productivity by providing for healthy working hours, but considering the great majority of health care expenses are made on behalf of the elderly and the chronically ill who are not going to be revenue generators no matter the money thrown at their health…well the point is clear.
As an investment is not why anyone supports subsidized health care. Arguing the pros and cons of government funded health care isn’t the point of this post. All I’m trying to do in this article is “justify” some of the more startling un-libertarian aspects of my life.
There’s a little bit of hypocrisy left of course. I don’t think it’s the government’s place to be perpetuating it’s revenue with this kind’ve investment. But, education loans for medical school are hardly in the same handout category as government guaranteed health care. Because of that, I’m comfortable cashing my loan check while still denying that government should redistribute wealth in the form of guarantying health care for all.
Dr. Lei over at Eye on DNA has Grand Rounds up this week. I haven’t had a chance to go through and pick out my personal favorite submission but just sampling the work makes it look like a great week. Go check it out.
I did my undergrad work in USC's School of Cinema-Television Cinematic Arts. I have a Bachelors of Fine Arts in Writing for Screen & Television. I loved it, but a future of waiting tables and taking meetings with B-List producers was not for me.
This blog is ostensibly to discuss healthcare policy and maybe educate a few of my fellow medical students. But it will stray into current events, politics, and other science topics when they draw my interest
Other odd notes about me:
I've skied half the resorts on this list (Squaw Valley/Lake Tahoe, Snowbird/Park City, Whistler, Taos, Vail)
I "played" lacrosse in high school and through a club level team in college
Nothing on this website is to be taken as medical advice. I am not a physician. Please consult a physician concerning any health related questions.
This blog is entirely self funded. It accepts no advertising or other supporting revenue. The author has no relevant financial relationships to disclose.
Unless otherwise noted the media on this blog is under the copyright of the blog author, used under a Creative Common or free use license with appropriate accreditation or is in the public domain. If you believe images or video posted on this blog are copyrighted works used inappropriately please contact me.
Endorsements
"Please be more precise in your practice of medicine than you are in your blogging!"
- Mark Lanier
