SSM Says Goodbye To Bottled Water
Starting June 1, 2008, SSM Health Care stopped offering bottled water at its 20 facilities in Missouri, Illinois, Wisconsin and Oklahoma due to the environmental impact of making, transporting and disposing of the plastic bottles. SSM won't provide bottled water for meetings or sell it in cafeterias or vending machines. Patients and guests will get water in cafeterias using recycled cups. Employees are being encouraged to use reusable bottles or cups for their own use. (St. Louis Business Journal, May 28, 2008)
Green Seals for Hospital Construction and Renovation
New hospital and nursing home building projects will have to be environmentally friendly to win state approval under sweeping regulations proposed by Massachusetts health authorities. If the measure is endorsed by the state's Public Health Council this fall, Massachusetts will become the first state to link health care construction to green standards. The guidelines emphasize using materials that conserve energy, installing water saving faucets, using refrigerant s that limit ozone depletion and providing bicycle racks to encourage employees to forgo automobiles. Under the Department of Health proposal, health care facilities seeking to expand or renovate would have to abide by green building standards but not achieve the highest ratings which can be prohibitively expensive. Three of the largest hospital expansions in New England have already embraced green construction standards by incorporating foliage on roofs, using windows that let natural light into interior corridors and floors that eliminate the need for noxious cleaning solvents. (Boston Globe, June 12, 2008)
Green Sister Advocates for Sister Mother Earth
"Environmental Tips from the Green Franciscan Sister," a column in a Marian Medical Center publication in Santa Maria, CA, is one way Sr. Janet Corcoran spreads the word about the importance of saving water. "Sister Mother Earth" needs help," Sr. Janet told the National Catholic Reporter Jan. 11, 2008. "It's a matter of getting people to think more consciously about what they're doing."
The Franciscan Federation's website provides a link to the "Think Outside the Bottle" campaign, urging people to pledge to choose public tap water over bottled water and "support the efforts of local officials who prioritize strong public water systems over bottled water profits." The campaign is part of Corporate Accountability International which says that demand for bottled water in the first world threatens water supplies in other parts of the world. According to CAI, 17 billion barrels of oil (enough to fuel more than one million American cars for one year) were used to make plastic bottles for water. Most of the bottles end up in landfills or as litter. (California Catholic Daily, June 12, 2008)
Underinsured Face Big Gaps in Coverage
The number of Americans who have health insurance but cannot afford adequate medical care continues to climb. About 25 million Americans — or approximately one of every five adults younger than 65 with health insurance — lack sufficient coverage to protect against financial hardship if they end up in the emergency room or become seriously ill, according to a study released in June by the Commonwealth Fund. "We're moving in a direction where you can be insured all year and still face medical bankruptcy," said Cathy Schoen, the study's lead author and a senior vice president for research and evaluation at the Commonwealth Fund, a private foundation in New York specializing in health research.
The relentless rise in the cost of medical care, combined with a growing number of insurance plans that require patients to pay a higher portion of the medical bills, has led to a 60 percent increase in the number of underinsured adults from 2003 to 2007, according to the study. The Commonwealth Fund first calculated the number of underinsured in 2003 when it estimated that 16 million Americans lacked sufficient coverage. As the nation debates how best to improve its health care system, including how to insure the increasing number of Americans without coverage, policy makers also need to discuss the quality of available coverage, said Karen Davis, president of the Commonwealth Fund. "Lack of insurance is only part of the problem, as even the insured have serious gaps in coverage," she said. The fund's estimate is based on a survey conducted last year of adults under 65 years old who had insurance throughout the year. Persons were considered underinsured if out-of-pocket medical expenses were ten percent of their income, or five percent if they were low-income adults or had insurance deductibles that exceeded five percent of income. (New York Times, June 10, 2008)
Cost Concerns Drive Even the Insured To Forgo Treatment
Growing numbers of Americans, many with health insurance, are delaying or forgoing medical treatment because of cost concerns, according to a report from the Center for Studying Health System Change. About 20 percent of the respondents to a 2007 survey of 18,000 people said they had postponed or gone without needed medical treatment at some point in the year, up from 14 percent in a 2003 survey. Of those who said they scrimped, 69 percent cited cost as a reason. "As health care costs increase, more of these costs are shifting to people and families," often as large deductibles or other requirements that patients pay a significant share of their care out of their own pockets, said Peter Cunningham, lead author of the report from the Center for Studying Health System Change. Cunningham said the weakening economy may have been a contributing factor to patients' behavior last year but that they also may simply have "reached a tipping point" in terms of being able to afford care amid a steady rise in medical costs. The center is a nonpartisan policy research group in Washington that receives funding from the Robert Wood Johnson Foundation, the Kaiser Family Foundation and the federal government among others. (Wall Street Journal, June 26, 2008)
High Cost of Failure
In 2000, the Institute of Medicine (IOM) estimated that the "annualized cost of the diminished health and shorter lifespan of Americans who lack health insurance is between $65 - $130 billion for each year of health insurance forgone. These costs skyrocketed to $102 - $204 billion in 2006 according to an analysis of updated costs by the New America Foundation, a nonprofit public policy institute based in Washington, D.C. The estimates reflect economic growth and increases in the number of the insured. The new estimate does not include spillover costs or cost shifting that occurs when providers attempt to recoup lost revenues from unpaid bills by raising rates for the services and when insurers raise premiums in response. The cycle of cost shifting inextricably links the uninsured to rising health care costs and premium rates for the insured. ("Cost of Failure: The Economic Losses of the Uninsured," New America Foundation, www.newamerica.net/health_policy)
Millions Miss Out On Existing Coverage Simply From Lack of Knowledge
Providing education, information and resources can help people who lack health insurance find out about available options and help hospitals deal with the rising ranks of the uninsured. In April 2008, the Foundation for Health Coverage Education in San Mateo, CA collaborated with hospitals in utilizing the Internet to provide information and an online application system for government-sponsored programs that are available to the uninsured. The organization's website, www.coverageforall.org contains an easy, five question quiz so people can determine their eligibility. (Philip Lebherz, Opinion section, Modern Healthcare, June 16, 2008)
Patients with advanced cancer often don't know how long they have to live or how chemotherapy will affect their lives, according to a study in June in the Journal of the American Medical Association. Only 37 percent of doctors told patients how long they had to live, even when patients asked for the information the study said. Sometimes, patients don't understand what their doctors say or perhaps hear what they want to hear. Patients may also ask for aggressive, painful therapies that have no hope of help. More than 20 percent of Medicare patients who have advanced cancer start a new chemotherapy regimen two weeks before they die, said study co-author Sarah Harrington, assistant professor at Virginia Commonwealth University School of Medina in Richmond. These patients may miss the opportunity to mend relationships, seek spiritual counseling or create important documents such as advance directives. "In the last few weeks or months of a patient's life, a lot of good work can be done," said Harrington, a specialist in palliative care. Patients frequently learn more about their prognosis from other patients in the waiting room than from their doctors, authors say. (USA Today, June 11, 2008)
Doctors Miss Cultural Needs, Study Says
As researchers ponder growing evidence that blacks have worse outcomes than whites in the treatment of chronic disease, they often theorize that members of minorities suffer disproportionately from poor access to quality care. A new study of diabetes patients has found stark racial disparities among even patients treated by the same doctor. The study attributed the differences less to overt racism than to a systematic failure to tailor treatments to patients' cultural norms.
"It isn't that providers are doing different things for different patients," said Dr. Thomas D. Sequist, lead author of the study and assistant professor of health care policy at Harvard Medical School. "It's that we're doing the same thing for every patient and not accounting for individual needs. Our one-size-fits-all approach may leave minority patients with needs that aren't being met." As an example, counseling black or Latino patients with diabetes to lower carbohydrate intake by cutting rice from their diets may not be a realistic strategy if rice is a family staple. "We may be listing fruits and vegetables that are part of one person's culture but not another," Dr. Sequist said. "We're not giving them information they can use. Published in The Archives of Internal Medicine, the study said that socioeconomic factors like income or insurance status explained 13-38 percent of the racial differences. But, much larger racial disparities — from 66-75 percent — were in patients treated by the same doctor. Adjusting for clinical differences among patients did not change the findings. (New York Times, June 10, 2008)
Editor's Note: Students from the Center for Health Law Studies and Student Writers Association at Saint Louis University School of Law contributed the following items to this column. Kelly Dineen, assistant dean for academic affairs and instructor of health law, supervised the contributions of health law students Shane Levesque (JD/PhD anticipated '10) and Phillip Terrell (JD/MHA anticipated '11).
Fed Chief, others chime in on health care crisis at symposium
Ben Bernanke, chairman of the Federal Reserve, in a daylong symposium of the Senate Finance Committee told Congress that "health spending would 'rise relentlessly' unless lawmakers overhauled the system." Both Democratic and Republic party representatives predicted the symposium would ultimately lay the groundwork for upcoming health care legislation in the next year. Senator Max Baucus (D-Montana) felt that some sort of "federal health board" might be one part of the solution, especially with regard to technical policy decisions such as setting proper reimbursement rates for procedures. In the alternative, Bernanke suggested establishing a commission like the Federal Reserve Board to set health policy. Ultimately, both Democrats and Republicans alike agreed that Americans should be insured, but that they should also have a choice in what form that insurance may be, with private health plans competing in a market against government programs. Large American employers are also poised to begin demanding real changes in the health care system. Intel Chairman Craig R. Barrett said firms like Intel are frustrated with the general inefficiency of the health care system: "[Almost every other industry] has automated itself and now pays less for better quality." (New York Times, June 17, 2008)
Major health care centers reap the benefits of implementing policies of disclosure
Prompt notification of medical errors to patients, rather than their concealment, has led to dramatic decreases in malpractice litigation and associated costs according to the Universities of Michigan and Illinois, which have spearheaded a growing national initiative that may lead to a needed fundamental change in the doctor-patient relationship. Traditionally, according to medical malpractice lawyers, most patients become angry plaintiffs in the event of an error due to its being hidden from them and the ensuing fear of its repetition. However, given the ever-rising costs of malpractice insurance and consumer insistence upon action against medical errors, a few institutions, including those above and others like Johns Hopkins, Harvard, and Stanford, are attempting to counter lawsuits before patients resort to them. Timely disclosure of medical errors accompanied by sincere apologies and fair compensation may work to restore the integrity of relationships between doctors and patients, with success coming by this approach in numerous documented cases (most involve quick settlement by the health care provider in monetary form or gratis treatment to resolve the error). Both the American Medical Association and the American Hospital Association have adopted similar standards encouraging disclosure, with 34 states enacting laws protecting doctors' apologies by blocking their admissibility in courts. (New York Times, May 18, 2008)
Gap in medical record-keeping methods may soon be addressed by government-sponsored initiative
While 51 percent of larger practices with 50 or more doctors have adopted newer electronic medical records systems, a recent survey published in the New England Journal of Medicine found that fewer than 9 percent of doctors in small practices (which represent nearly half of the country's doctors in sum) have emigrated to computerized records. Slow adoption by small practices is largely due to economic factors, as Dr. Paul Feldan, one member of a three-doctor practice in New Jersey echoed, "The idea of electronic records is terrific. But if we don't see patients, we don't get paid." For his office, Dr. Feldan calculated an average expense of $15,000 to $20,000 per doctor, not including the costs of making the transition in the form of temporarily reduced patient loads and training and support time. The other issue surrounding the technology transition is whom exactly doctors' expenditures in making the change will benefit. Private and government insurers will save money in the form of less paper handling and fewer unnecessary tests through their direct connection to office records, and patients stand to benefit as well in the form of fewer prescription mistakes and improved delivery of preventative care. To partly resolve this inequity in funding, the government announced the week of June 12 plans to spend $150 million in incentives for to doctors to digitize paper records, helping up to 1200 small practices. (New York Times, June 19, 2008)
Private genetic testing firms fall under stiff state regulatory scrutiny
One of the fastest growing new sectors of the biotechnology industry is a group of companies whose services purport to offer clients directly administered genetic testing for use in health and lifestyle planning. However, both California and New York State Departments of Public Health have recently cracked down on the firms' solicitation of citizens in those states. Among the firms, whose offerings range in price from $1,000 to $350,000 and some of which also include diet advice and genetic tests for single conditions such as baldness or Alzheimer's disease, the general posture toward the state governments' efforts to require such firms' licensure is one of non-necessity. "We think your genetic information is a fundamental part of you," said Anne Wojcicki, founder of 23andMe, a California-based company with financing aid from Google (whose co-founder happens to be Ms. Wojcicki's husband). "This doesn't say you have a disease. It says you carry a genetic predisposition for the disease and should talk with a health care professional," said Mari Baker, the chief executive of Navigenics, also based in California. Nonetheless, state offices of laboratory policy and planning in California and New York take issue with how casually genetic testing firms tend to characterize their services. California's latest action in the form of 13 cease-and-desist letters to various firms was spurred by consumer complaints about the cost and accuracy of the tests. Kathy Hudson, director of the Genetics and Public Policy Center at Johns Hopkins University, felt it was "not surprising that the states are stepping in [...] to protect consumers, because there has been a total absence of federal leadership." (New York Times, June 26, 2008)
Circuit court says hospitals may lawfully charge uninsured patients higher rates
In a decision appealing from a prior grant of summary judgment, the U.S. Court of Appeals for the Third Circuit affirmed on June 24 a lower court's finding that a class action lawsuit filed against multiple New Jersey health systems had no court-obtainable remedy. (DiCarlo v. St. Mary Hospital, 3d Cir., No 06-3579) Alleging breach of contract, breach of the covenant of good faith and fair dealing, unjust enrichment, breach of fiduciary duty, and violation of the New Jersey Consumer Fraud Act, plaintiff DiCarlo claimed that the hospitals' practice of charging uninsured patients higher rates than the discounted ones it charged Medicare, Medicaid, and privately insured beneficiaries was wrongful and discriminatory. Earlier in 2006, the district court held that hospitals do not breach their agreements to provide services at reasonable rates or breach the duty of good faith and fair dealing by charging uninsured patients more than those paid by managed care organizations or government programs. "What Plaintiff is asking the Court to do here is, put simply, to solve the problems of the American health care system, problems that the political branches of both the federal and state governments and the efforts of the private sector have, thus far, been unable to resolve," said the district court opinion written by Judge Dickinson R. Debevoise. (BNA Health Law Report, July 3, 2008)
Report finds access to medical care dropping for uninsured and insured
Issued June 26 by the Center for Studying Health System Change, the report entitled Falling Behind: Americans' Access to Medical Care Deteriorates, 2003-2007 finds that in recent years insured people experienced faster growth in unmet medical needs (a 62 percent increase) compared with uninsured people (a 33 percent increase). This trend worked to narrow the access gap between the insured and uninsured population. "We can no longer say health care is a problem of the uninsured. This is proof that we have a system that is unraveling," said Rick Kellerman, chairman of the board, American Academy of Family Physicians. By the report, which surveyed about 18,000 people, in 2007, one in five Americans (or about 59 million people) reported not receiving or delaying needed medical care, up from one in seven in 2003. Rising health care costs, health insurance-related problems, and health system-related problems appear to be the major contributors to the declining access to care, the report indicated. Kellerman also referenced another disturbing trend: the primary care doctor shortage, which will only exacerbate problems alongside growing out-of-pocket expenses and bureaucratic difficulties encountered by consumers and their own insurer. (BNA Health Care Policy Report, June 30, 2008)
First phase of New Jersey universal health care plan passes legislature
If signed by Governor Jon Corzine, the measure approved by both houses of the New Jersey Assembly would implement the first phase of a comprehensive reform of New Jersey's health care system that has universal coverage as its ultimate goal. Currently, some 1.25 million New Jersey residents are uninsured, with 250,000 children among them. "Rather than encouraging bad health practices by forcing the uninsured to seek emergency room care, we would be allowing people to get regular check-ups and receive care for medical problems before they become serious health concerns," said Joseph Vitale, chair of the Senate Health, Human Services and Senior Citizens Committee. Taking effect one year after the bill's enactment, provisions in it would require all children 18 and younger to have health insurance through an employer-sponsored or individual health benefits plan, Medicaid, or the NJ FamilyCare Program. FamilyCare uses state and federal funds to provide free or low-cost health insurance to low-income families; this most recent legislation would expand eligibility criteria to include parents with income up to 200 percent of the federal poverty level. New Jersey estimates 13,700 parents and 8,200 more children would enroll for coverage in fiscal year 2009 if the bill is enacted, at a total cost of $8.8 million. By 2011, 12,100 more children are projected to enroll, with 40,200 adults, increasing costs by $43.6 million. (BNA Health Care Policy Report, June 30, 2008)
Cities struggling with rising indigent, uninsured health care costs urge federal action
According to a report issued June 23 by Families USA, a lack of federal action on universal health care is causing cities to pay more in health care costs themselves. A majority of the cities surveyed indicated that they faced problems of increased demand for services at community health clinics, increased demand for mental health and substance abuse services, family support services, and crowding in hospitals and emergency rooms. Some cities have had to face as well hospital and major trauma center closures, making provision of services for the uninsured even more difficult. All thirteen cities surveyed agreed that raising eligibility levels for Medicaid and the State Children's Health Insurance Program would ease the burden that uninsured individuals place on cities.
Some, such as San Francisco, have begun their own preventative health care initiatives. By paying a minimal enrollment fee not to exceed 5 percent of family income for those with income below 500 percent of the federal poverty level, those normally uninsured receive preventive and primary care through a network of cooperating public hospitals, health clinics, and some private providers. Ron Pollack, executive director of Families USA, said in a news release that he commends cities such as San Francisco for their efforts, but that cities alone "cannot solve the fundamental problems in America's health care system. This is ultimately a national problem, and leadership and action must come from Washington." (BNA Health Care Policy Report, June 30, 2008)
A new study published by the Robert Wood Johnson Foundation determined that referrals to physician-owned hospitals, surgery centers, and imaging facilities have increased considerably in the past decade. Higher utilization of such doctor-owned facilities has particularly correlated with imaging services. Moreover, the quality of care to be found at physician-owned surgery centers and hospitals is comparable to care provided at general acute-care hospitals, which are still maintaining profit margins despite the increased referral of cases to physician-owned facilities. "General hospitals appear to have adapted by entering into joint ventures with physicians, by employing physicians who might otherwise compete with the hospital, and by expanding their own focus on profitable services lines," researchers Sarah Goodell and Lawrence P. Casalino said in the study. Alongside this trend is an increased number of surgeries being performed outside traditional hospital settings; the researchers found that surgeries are being performed more often in physician offices and ambulatory surgery centers, most of which doctors own. (BNA Health Care Fraud Report, July 2, 2008)
'Neglected infections of poverty' highlight impact of lack of health care on minorities, those living in poverty
Published June 25 in the journal PLoS Neglected Tropical Diseases, a new analysis points out that diseases similar to those encountered in Africa, Asia, and Latin America are also occurring in high frequency among the poorest people in the United States, especially women and children. Caused by chronic and debilitating parasitic, bacterial, and congenital infections, these "neglected infections of poverty" are understudied and not well known even by physicians and public health experts.
Being of such an insidious nature, those afflicted by such diseases often find themselves in an inescapable circle of poverty due to their effects on child development, pregnancy outcome, and productive capacity. Dr. Peter J. Hotez, author of the analysis and faculty member at the George Washington University department of Tropical Medicine, emphasizes that the enigmatic and hidden nature of these diseases "points to the urgent need to increase surveillance for these infections; use cost-effective existing drug control and treatment efforts; implement newborn screenings; and develop new drugs, diagnostics, and vaccines for these infections." (ScienceDaily, June 25, 2008)
Costs rise for patients with alcohol and drug abuse disorders
A study in the June issue of the Journal of Substance Abuse Treatment documents that 14 percent of patients admitted to the hospital have alcohol and/or drug abuse and addiction disorders. The coincidence of such disorders with other medical problems (99 percent had other problems in addition to substance abuse addictions) has led to a sharp increase in hospitalization and associated care costs, with hospital care for patients with substance abuse disorders increasing in cost overall by 134 percent between 1994 and 2002. Patient disorders varied by insurance status, with those on Medicare or Medicaid being more likely to have drug addictions, while privately insured patients more often had only alcohol abuse disorders. In either case, patients with alcohol abuse disorders accounted for the highest proportion of costs. "Understanding alcohol and drug abuse and addiction disorders' broad impact has implications for delivering better health care, decreased [alcohol and drug-related] illnesses and mortality, and reducing health care costs," said researchers in the study. (ScienceDaily, June 26, 2008)
Bush signs genetic nondiscrimination act into law
On May 21, President Bush signed into law the Genetic Information Non-discrimination Act (GINA), the first civil rights legislation of the new millennium. GINA will provide protections against discrimination based on an individual's genetic information in health insurance coverage and employment settings. "Since all of us are pre-disposed to at lest a few genetic-based disorders, we are all potential victims of genetic discrimination," said House Representative Louise Slaughter of New York, "Americans can finally take advantage of the tremendous potential of genetic research without the fear that their own genetic information will be used against them." The health insurance protections offered by GINA are set to go in effect 12 months from its May enactment, while employment protections will be in place in 18
months. Specifically, GINA protections extend to discrimination by health insurers or employers by prohibiting group health insurance plans and insurers offering group and individual plans from basing eligibility determinations or adjusting premiums or contributions on the basis of a person's genetic data. Issuers of Medigap policies are likewise prohibited from adjusting pricing or conditioning eligibility on the basis of genetic information. Finally, employers are prohibited from firing, refusing to hire, or otherwise discriminating with respect to compensation, terms, or other privileges of employment. None of the affected groups may request, require, or purchase genetic information, and are also prohibited from disclosing personal genetic information. (ScienceDaily, May 26, 2008)
California passes law requiring doctors to inform terminally ill patients of end-of-life care options
The California State Assembly passed a bill in May that requires doctors to inform patients with terminal illnesses of all legal end-of-life care options available, if the patients request that information. The bill, which is currently under consideration by the state Senate, would result in the first law of its kind within the U.S. It would mandate that physicians tell those patients with less than a year to live not only about the availability of hospice and palliative care, but also other alternatives used to accelerate the dying process, including palliative sedation and the refusal of nourishment. Those physicians who are unwilling or unable to comply with the law because of their personal religious or ethical beliefs would be required to refer the patient to another physician. Those who oppose the bill voice concerns regarding the state's increased involvement in the physician-patient relationship, and caution that the law might be an unwise intrusion. At the time of its report on the bill, the American Medical Association had no specific position on the appropriateness of the mandate, but it does maintain a policy that disapproves of euthanasia and physician-assisted suicide. (American Medical News, July 14, 2008)
International society proposes stem cell research guidelines
The International Society for Stem Cell Research is in the process of drafting a set of guidelines that it hopes will curb the risk posed by Web sites it says deal in stem cell "snake oil" treatments. The society, which will consult similar guidelines already drafted by various countries, said it hopes they will not only direct stem cell research in general, but will also educate the public on the state of stem cell technology so as to counteract the threat to patient safety posed by unethical and untested therapies. Although the guidelines have not yet been finalized, Reuters reports that they will denounce any therapies that have not undergone a clinical trial, and that they will make specific recommendations regarding peer review, informed consent, human test subject rights, and patient access. (Reuters, June 12, 2008)
Drug industry releases new policy banning some gifts to doctors
The Pharmaceutical Research and Manufacturers of America has issued a new set of voluntary guidelines governing the interactions of its member organizations with physicians, and these revisions will go into effect January 2009. This revised Code on Interactions with Health Care Professionals bans the distribution of gifts such as pens, mugs, and other small gifts to physicians by pharmaceuticals companies, and will require the companies' chief executives to signify in writing that their companies will comply with the new guidelines. The revised Code follows mounting concerns regarding the potential conflict of interest that may arise when physicians accept gifts from drug companies, a concern that has inspired some states to pass laws setting limits on the value of gifts to doctors. The revised Code does not, however, ban drug companies from delivering meals to medical offices, from inviting doctors to expensive restaurants for presentations, or from contracting physicians to act as consultants, or to speak on their behalf at medical conferences. (New York Times, July 10, 2008)
Rudeness and hostility by employees will jeopardize a hospital's good standing with top accreditor
The Joint Commission announced that a new policy effective January 1, 2009 will require all accredited facilities to implement a code of conduct that guides employee behaviors in the workplace, and establishes "a formal process for managing unacceptable behavior." Furthermore, the Joint Commission will include both rude language and hostility on its list of occurrences that may lead to "sentinel events," a term used by the Joint Commission to describe incidents that could cause serious injury to, or the death of, a patient. To maintain good standing and accreditation, hospitals are required to report all such sentinel events to the Joint Commission, which then takes steps to prevent that kind of incident from occurring again. Other sentinel events include hospital-acquired infections and the accidental removal of a healthy limb. The Joint Commission, which has been charged by Congress with ensuring the safety of American hospitals, says this change is necessary, because verbal abuse and hostility can compromise patient safety. Should a hospital lose its good standing with the Joint Commission, it may risk losing its eligibility to receive Medicare payments, which may have the effect of threatening the facility's financial stability. (Chicago Tribune, July 10, 2008)
Congress urged to pass law ensuring mental health parity
David Wellstone, the son of late Minnesota Sen. Paul Wellstone, has called on Congress to pass a bill requiring insurance policies that provide coverage for both physical and mental illnesses to do so in equal shares. The version of the bill passed in the House would require insurers to cover all mental illnesses, including addiction disorders, published in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders; however, the Senate's version did not have that provision. But while the House has agreed to drop that requirement in order to reach a compromise, the costs of the added coverage remain a point of contention. The Congressional Budget Office says that the bill would result in a $3.9 billion federal expense over 10 years. (Boston Globe, July 9, 2008)
Victims of African Pfizer drug trials rebuke settlement offer
The family members of children who were injured or killed following a test of the drug Trovan more than ten years ago in Nigeria has turned down a $10 million settlement offer by the company. The offer, which would be paid out to approximately 200 Nigerian families, would award $10,000 for each victim with "minor deformities," and $100,000 for each victim with "major deformities" or who died as a result of the drug trials. However, Nigerian officials call the offer "demeaning," considering that the company also offered to pay out $21 million to settle the parties' legal expenses. The lawsuit, which seeks $2 billion from Pfizer, was filed after a Nigerian panel determined in an extensive report that the drug company violated international law when it tested Trovan, which was not approved, on children in the Infectious Diseases Hospital in Kano, Nigeria. Authorities have also filed eight criminal charges against the company, including criminal conspiracy and voluntarily causing grievous harm. Pfizer says there is no evidence linking Trovan to either deformity or death. (Washington Post, July 9, 2008)
Study finds that emergency rooms have become a "dumping ground" for the mentally ill
A recent survey reports that 79 percent of U.S. hospitals said they commonly "boarded" psychiatric patients in waiting rooms because of the unavailability of mental health services. One-third of the hospitals surveyed reported that psychiatric patients were left in waiting rooms for an average of at least eight hours, while 6 percent reported that waiting room stays could last for an average of 24 hours. While there were a variety of reasons cited for the waiting room stays, the most common was the lack of immediately available services. And, in many states, these sorts of wait times are can be routine. Hospital officials in Austin, Texas have complained that the county's decision to limit the number of patients sent to a state psychiatric facility has resulted in more psychiatric patients stuck in emergency rooms. Similarly, Massachusetts has been criticized for a wait time for pediatric psychological services that can last for days. (AP, July 3, 2008)
Eighth Circuit rules that South Dakota doctors are required to tell patients before performing abortions that their fetuses are 'unique living human beings'
In July, the U.S. Court of Appeals for the 8th Circuit struck down a preliminary injunction against a South Dakota law requiring doctors to tell pregnant patients that their fetuses are "unique living human beings" before performing abortions. Although enacted in 2005, the law was immediately challenged by Planned Parenthood, which won an injunction that prevented the state from enforcing it until the presiding U.S. District Court judge could determine its constitutionality. However, the decision by the U.S. Court of Appeals overruled that order, and sent the case back to the District Court for trial. Although no date has yet been set, enforcement of the law went into effect almost immediately after the Court of Appeals decision was handed down. In addition to being required to tell patients seeking abortions that the procedure would "terminate the life" of the fetus, they are also required to inform patients that having abortions can make women suicidal and may cause other psychological harm. This requirement is only satisfied if doctors have the conversation with the patient no earlier than two hours prior to the procedure. The law works in tandem with a related statute, passed July 1, requiring doctors to ask their patients if they would like to see a sonogram of the fetus. (AP, July 18, 2008; Washington Post, July 20, 2008)
Consumer groups challenge university's patents on embryonic stem cells
Two consumer groups, the Foundation for Taxpayer and Consumer Rights and the Consumer Watchdog Foundation, appealed in July a decision by the U.S. Patent and Trade Office that the University of Wisconsin Alumni Research Foundation will continue to hold a patent on all embryonic stems cells in the United States. The groups criticize the agency for granting the patents, which are not recognized by any country outside the U.S., for so restricting U.S. scientists that their foreign counterparts are given a much greater advantage in their search for advances in stem cell research. The groups will argue against the agency's ruling on the grounds that the issuance of patents was not appropriate, given that, based on similar research conducted with other species, the development of human embryonic stem cells was "obvious." (San Diego Union-Tribune, July 21, 2008)
Study finds that kidneys obtained following cardiac death may decrease transplant disparities
Researchers at the Johns Hopkins Medical Institutions say that increasing the use of human kidneys obtained after cardiac death could have the effect of decreasing racial disparities in the allocation of these organs for transplantation. The study, which is to be published in October's American Journal of Nephrology, examined health outcomes for more than 100,000 adult patients who underwent kidney transplantation procedures from 1993 to 2006. The study found that black patients who underwent the procedure were more likely to experience increased survival rates when they received kidneys from black donors. The study also found that when black patients received kidneys from black donors following cardiac death, risk of kidney loss was reduced by 70 percent, and risk of death was reduced by 59 percent. Currently, black patients account for one-third of the Americans currently waiting for a donated kidney, but are 2.7 times less likely to receive a kidney than white patients, in part due to the fact that they are more likely to experience kidney failure following transplantation. The study found that, by using kidneys obtained following cardiac death, the nationwide supply of viable organs may be sufficiently increased, with the effect of bringing transplantation rates among black recipients increasingly in line with the rates of white recipients. (HealthDay, July 23, 2008)
In a landslide vote June 25, the U.S. House of Representatives approved a bill that would significantly expand the reach of the Americans with Disabilities Act by broadening the law's definition of "disability." The current law states that an individual has a disability for the purposes of the Act if he or she has a physical or mental impairment that substantially limits one or more major life activities, has a record of such an impairment, or is regarded as having such an impairment. The determination of exactly which conditions qualify for recognition as a disability under the ADA has been the subject of considerable litigation throughout the course of the Act's existence, resulting in several decisions by the U.S. Supreme Court that significantly reduced the availability of relief under the ADA for claims of employment bias. The current bill, which reverses the Court's limiting decisions in Sutton v. United Air Lines and Toyota Mfg. v. Williams, states that disability "shall be construed broadly," and indicates that a major life activity will be considered "substantially limit[ed]" if it is "materially restrict[ed]" by a condition. It also states that even episodic limitation on major life activities is sufficient to qualify as a disability, so long as the condition, when active, results in a substantial limitation. The bill goes even further by providing a non-exclusive list of major life activities, which includes a specific provision for major bodily functions. (Law.com, July 21, 2008)
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