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What are you supposed to do? The Feds say that there is a potential threat to the homeland, and the civic duty is to be vaccinated against smallpox. The medical community is split. Many think that the Feds are correct and are willing to do what they say. Others are not as sure. In the January 13, 2003 Modern Healthcare the editorial suggests that there is no danger to the populace except via the vaccinations. They state there is not a shred of evidence of any terrorist smallpox attack. They believe this is strictly a propaganda campaign and is being done for political purposes only. The problems with the mass inoculations are the cost being borne by the public health agencies and hospitals, the real threat to those inoculated and those they treat. All who are inoculated are potentially contagious for two to three weeks and should not see any patients especially any that are immune compromised. Who pays for that time off? Who is liable if the third party gets the cowpox and is harmed or dies?
There are now hospitals and clinics around the country that are not going to follow the federal position. The latest in the line are the Cooley Dickinson Hospital in Massachusetts. Their MEC voted unanimously not to be vaccinated nor have their staff vaccinated. As a side benefit to the hospital the political director for the state Department of Health stated that if someone did get smallpox they could not be sent to Cooley. In Charlotte, North Carolina, two hospital systems will not begin to vaccinate employees. These join Grady in Atlanta and Virginia University not to participate.
At the same time two major health labor unions voiced opposition to the plan. These are the 750,000 SEIU and the 350,000 American Federation of State, County and Municipal Employees. The CDC is sending out the vaccine soon and want states to begin the program as soon as they can safely do it.
The IOM has also come out in favor of holding off due to safety concerns. They met in December 2002 and their report is to be published soon.
The feds don't care about all that. They have started the shipment of the smallpox vaccine to the states. HHS Secretary Thompson is working to get compensation for time off work, medical expenses and any other costs. He wants to model a fund after the current vaccine compensation fund.
California has decided to accept shipment of the vaccine, but very slowly. The state wants assurances of federal payment if their are complications. Many, if not most, emergency workers were not going to volunteer to be vaccinated due to not knowing enough about the risks involved to them and their families and patients. There will be a shipment to LA County, however.
The first people in LA were vaccinated. LA had 9200 doses shipped and vaccinated 27 people.
The Massachusetts Nurses Association has stated their concerns about the vaccine program. They believe that the harm might outweigh the good.
The California Nurses Association, not known as shrinking violets, came out strongly against the program, calling it a political program only. Of course, the union is strongly political in its own right.
In Atlanta, most hospitals are following the lead of Grady and are not going to participate at this time in the smallpox program. The rationale is the same as in other hospitals that absent any viable threat of a smallpox attack, why risk side effects and potential death.
The start of the vaccination program got the start it so richly deserved. In the first state to take part, Connecticut, they got a grand total of four of a an anticipate 20 people volunteering for the inoculation. Top
President Bush announced his plan for malpractice reform. Basically he used the California model with the $250,000 limit on non-economic damages, only being liable for the percentage of harm caused, and punitive damages of either $250,000 or twice the economic damages, whichever is greater. This is the bill that passed the House last year but was defeated by the Democratic Senate, which is largely funded by the Trial Lawyers. The Democrats believe that stronger regulation of the insurance companies and not tort reform is the way to go. I don't understand why both cannot be achieved.
In Pennsylvania the fun is about to begin. The legislature has stated that Governor Rendel's plan for helping pay for physician's malpractice premiums this year is not a good plan. It was this plan that stemmed a walkout by Pennsylvania physicians several months ago. The plan was to take insurer's profit to pat down some of the premium. It was a plan that would not be fair to various parts of the state and their different malpractice insurers. It also did nothing for the required tort reform. It doesn't help that the Governor is a Democrat and the legislature is controlled by Republicans. Do I see a physician slowdown coming? Top
California insurers now must provide HIV + patients a standing referral to specialists in the disease. Top
The Joint Commission, after screwing up the investigation in Florida, is putting the onus on hospitals to do sentinel event root cause analysis on infections. The JCAHO believes that patient deaths from infection have not been reported to them. They want institutions to comply with the CDC's new hand washing guidelines. These guidelines advised alcohol based hand rubs plus soap and water as well as gloves. They also want the root cause analysis for all cases where there was a direct relationship between a nocosomial infection and death or major permanent loss of function.
Public Citizen has said this is another publicity stunt by the JCAHO. This was, of course, refuted by the JCAHO. They state these regs have teeth. They state these are sentinel events that must be reported. Indeed, Sentinel Events do NOT have to be reported, and in fact most are not due to loss of confidentiality.
Representative Pete Stark has taken JCAHO to task for becoming too chummy with the hospitals they survey. He has requested IG Janet Rehnquist to look at he new self-assessment procedure proposed by the Joint.
The JCAHO and NCQA have joined forces to accredit research programs. They want to be sure the human subjects rights are protected. They also want money. Top
The Virginia Legislature has passed a bill to give the Medical Board greater powers to discipline physicians. The article states that the bill will reduce the disciplinary standard from gross negligence to simple negligence, create a private letter of reprimand for minor offenses and increase penalties for hospitals and other health institutions for failing to report "bad doctors." I applaud the general idea but as usual the devil is in the details. I have no idea what constitutes a "bad doctor." Is it like the famous quote from the US Supreme quote relating to pornography, "I can't describe it but I know it when I see it." The legislature also seems to equate the loss of a malpractice case with a "bad doctor". This may or may not be true. It depend on the circumstances.
Along with the above bill, the legislators also gave abortions centers the obligation to abide by the outpatient surgical regulations. These include those things that are essential to good medical care; larger elevators and larger operating rooms. This law has nothing to do with patient safety and everything to do with making choice harder.
In the People's Republic of Massachusetts, the legislature is considering a bill that would punish physicians who repeatedly offend or intimidate patients and colleagues. The law would make doctors play paddy cake with their employers and patients and ignore the realities of supply and demand. When one offends patients, they will lose patients. The legislators are wanting to monitor this behavior as is a not surprising development in this most heavily regulated state. The medical board would develop a list of behavioral criteria to judge physician. These would include rudeness, demeanor with nurses, punctuality, behavior with patients, and vulgar remarks. This would be done by interviews with nurses and colleagues, obviously not competitors. When the idiot that proposed the bill was told that many physicians opposed it, his retort was "The ones that have that reaction probably need it." It should be interesting to see the legality of this suppression of speech and the vagueness of the charges. Even the Board is skeptical, but for the problem with funding not because it is a stupid and probably illegal idea. Top
First you see it and then you don't. The Bush Administration had sent a letter that states that if Medicaid patients in Managed Care Organizations use the ED for non emergencies, they may be liable for the costs. Now after unleashing a furor on that decision, they have reversed course and are allowing the prudent layperson standard to hold. Top
New Conditions of Participation
The Centers for Medicare and Medicaid Services has initiated a new COP. They are requiring of all hospitals a Quality Assessment and Performance Improvement requirement the there be a hospital wide focus to identify patient safety issues and reduce medical errors. The JCAHO has already done this but now even those accredited by the States must conform. They do not have to meet all the non essential items that the JCAHO has placed but do need to the basic things to help protect patients. All well run hospitals should already be doing these things. The COP also states that hospitals must devote enough resources to do the right things right. Top
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.