The California Medical Board has cleared a Southern California physician of hastening the death of a patient by giving morphine. The patient was dying and Dr. Luke gave the morphine to help the patient with his pain. He was given a reprimand for inadequate record keeping. The Board has a rule that it protects physicians who adequately treat pain but the problem is that some investigators and physicians have different ideas of what the word adequately means. The Board originally revoked the license of Dr. Luke but then after the attorney asked for a reconsideration only gave the minor slap. This shows that they did the right thing but aged the doctor by twenty years before they finally did it. Dr. Luke also lost staff privileges at the hospitals because of this kangaroo proceedings. The Board needs to get its act together and not do these draconian methods to physicians. I hope the hospitals now decide to give this good physician back his privileges and retract their report to the Data Bank. Lotsa luck.
The Medical Board of North Carolina is considering changes in it's policies. These include expanding their power via the legislature. They want to issue public letters of concern, public reprimands, probation, levy fines and require treatment and remedial programs. They also want control over pharmacists and nurse practitioners. They want to scrutinize practitioners that return to practice. They want disciplinary panels of only a part of the Board to be needed to hear cases. They also want the ability to fine hospitals money for failure to report to the Board any malpractice payments, suspensions, revocations or limitations of privileges. The Trial Lawyers are for the changes but believe they should go further. The Boards of Nursing and Pharmacy are obviously against some of the changes asked for. Top
After the Morales fiasco, where the Federal judge stated that the injection method of execution was cruel and unusual punishment since it was possible that the prisoner may feel the injection, California has revised its protocol for execution. It will use hart monitoring equipment to determine heart cessation, but will not use an anesthesiologist to determine the unconscious state of the patient. There is only a redacted policy available to the public and it mentions no medical personnel to be present. The final decisions should be interesting. Top
The OIG has excluded Miami's South Beach Community Hospital from participation in Medicare or Medicaid. The reason was non compliance with a CIA that stemmed fro a false claim. The hospital had closed prior to the OIG action.
The US Senate will begin hearings on non profit hospitals and whether or not they meet definitions of charity. The main thing they will look at is clarification of standards for being a non profit. The IRS has found no significant difference between for profits and non profits in how they treat the community. A Senator is also concerned regarding the non profit hospital's use of for profit subsidiaries as well as some of the salaries for the CEOS.
Washington has a new law that looks to prevent back injuries, the #1 injury to healthcare workers. The law states that each hospitals must do a 24/7 plan to establish safe patient handling with lifts. At my hospitals we had surgilifts for years and had one accident that resulted in a patient fall. The amount of back injuries did decline but since the lifts cost money there was a steady decline in their use and a steady increase in back injuries. The Washington law provides for tax credits for hospitals that invest in lift equipment.
In Portland, Oregon, the Physician's Hospital has been taken off the immediate jeopardy list by the CMS. It still must submit a plan of correction by mid May. Physician's is an acute care hospital that the community hospitals don't like since it is owned by the physicians.
The University of California Irvine's transplant program has been put on probation. This allow the program to continue with their kidney and pancreas transplant programs but not liver. They will have to prove that their programs meet the standards for staffing and patient care. This is less of a penalty than St. Vincent of LA received for their lying about their program. Top
The American Hospital Association wants to keep the physicians under its thumb. The Association has sent a letter to the Joint about the proposed revisions to the new MS 1.20 standard. The standard makes it more difficult to take portions of the bylaws out of the documents and put them in other places that would make it easier for the hospital to have changed with the consent of the medical staff at large. They focus the argument away from the above and state that they believe that the new rule will not provide quality improvement. They also want flexibility with their medical staffs to design governance (read control the staffs). I have not heard anything from the AMA since January, 2005. The CMA has recently offered a primer on the semantics of 1.20 without discussing the new 1.20 itself. The New York and Ohio Medical Association have been more direct in the support of the MS 1.20. They are speaking for the physicians in regard to this most important attempted power grab by the hospitals. The AMA needs to again write regarding the AHA response and follow the lead of Ohio and New York to tell it like it is.
JCAHO has finally given up its for profit business of selling the information supplied to it by the hospitals. The organization was selling the information and was caught. After alot of stammering the organization finally admitted and made a decision to stop selling the hospital info. JCAHO is still interested in the green. They will give information to the hospitals but will charge for any customized reports. They, like the hospitals, are non profit in name only.
The Joint has also released the statistics on sentinel events. The have risen in almost every year and the hospital sector as 2/3 of them. The vast majority are patient suicide, wrong side surgery and post operative complications. Over 70% resulted in patient death and most were self reported. It does not seem as if the warnings are working.
To make nice with the hospitals who pay them and who they had double crossed by the attempted sale of the data, JCAHO has loosened up the amount of Recommendations for Improvement (RFI) they can receive before they get in trouble. They also have differentiated large and small hospitals (daily census under 100) with small ones needing less RFIs prior to going on probations. This is a concession to the bigger hospitals that pay more to the organization. Top
On the heels of the South Dakota legislation, Michigan has a new law signed by the Governor that requires the offering to a woman who wishes an abortion the viewing of an ultrasound picture of the fetus. The bill was amended to not require the viewing of the picture. There is no plan at present to sue to block the law. Top
The battle has started early this year. Congress passed a dumb rule many years ago which requires the money paid to the physician carrying for a Medicare patient to be revenue neutral. This is an impossibility since more is done as an outpatient and more people are becoming eligible for the program. Congress has passed a law each year to forgo the original law and increase the pay of the physicians. The AMA has started the early fight by stating without proof that physicians will stop taking new Medicare patients if the proposed 4.5% decrease for next year is not rescinded.
Starting in 2007, those on Medicare will have a means test to decide how much of the Part B premium they will have to pay. Currently all pay 25% of the premium of $88.20. This makes the true monthly premium cost for both the government and the patient $352.80. Starting next year singles with annual incomes between $80,000- $100,000 and couples with incomes between $160,000- $200,000 will pay 28%. That will continue to rise and in 2009 it will be 35%. Higher earning seniors will pay even more up to 80% in 2009. This is part of the 2003 Medicare prescription drug act. Top
The Wisconsin Governor has signed the bill creating a $750,000 cap on non economic damages in the state. This is $400,000 more than it was but at least it is a cap. Now it's up to the Supreme Court in later years to overturn it or not. Top
In a major move the Department of Health and Human Services is contemplating a change in the Data Bank rules. They are now soliciting comments until May 22. The new changes can be found starting on page 14135 of the Federal Register Vol. 71 No. 54 dated March 21, 2006. The new rules will expand the reporting by states to include not only individual practitioners but entities as well. The new law would also expand the rules as to who may query the Bank. The new law states any state agency can query, not just the state boards of medicine. Also allowed are all agencies administering federal healthcare programs even if just under contract, some law enforcement units, state Medicaid fraud control units and utilization and quality control QIOs as defined in the SSA Section. Top
For those that love universal health care but don't think of the law of unintended circumstances, look to England. The British Health Service has found that Erythopoetin (EPO) is too expensive to give to cancer patients. These patients will now linger in their anemic state for longer than necessary. This will lead to more blood transfusions with their potential expensive complications. Pence wise and Pound foolish.
In Connecticut, the law requires Medicaid patients to receive paid care in a nursing home. There is a loving family, Stango, that wish to care for the matriarch at home. They are not allowed to do this under the current Medicaid law. What they do want is the same money that Medicaid would have paid to the nursing home. The legislature is looking to change the state law to allow people to go home and have the payments follow the patient. Top
End of Life Care
Maryland has issued a guidebook to help patients decide on end of life issues. The booklet tells patients how to discuss their wishes with their physicians, make their health care decisions and cope with grief. It also explains Maryland law regarding advance directives. The booklet may be gotten at www.oag.state.md.
DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the time of publication. Nothing in this article constitutes legal advice. Readers should consult with their own legal counsel before acting on any of the information presented.