Dallas Morning News: series on palliative care

This is quite a remarkable series of articles on end-of-life care and in particular palliative care at Baylor University Medical Center. Short of watching the amazing 6-hour documentary by Frederick Wiseman ("Near Death"), this is as close as most of us will get to the true in-hospital experience until it happens to one of us or someone we love. All of the articles are collected in one place,

WSJ (gasp

WSJ backs incentives for organ donation

I know it will not come as a surprise that the house organ for American capitalism thinks a market for buying and selling human organs would produce a better system than the one we have now (100,000 patients on waiting lists, four times as many as were on lists when the current system was enacted into law in 1984), but maybe -- this time, at least -- they're right. Today's opinion piece, "

Vatican issues 3rd major bioethics pronouncement in 21 years

First, it was Donum Vitae (The Gift of Life) in 1987, followed by Evangelium Vitae (The Gospel of Life) in 1995. Now the Vatican has given us its third major pronouncement on bioethics in over 2 decades with Dignitas Personae (The Dignity of the Person), released today. The instruction was issued by the Congregation for the Doctrine of the Faith (formerly headed by Pope Benedict XVI) and (as the

Mission vs. Money: WSJ profiles Mt. Sinai Hospital in Chicago

Interesting multi-media report in today's on-line WSJ ("Pursuing Charitable Mission Leaves a Hospital Struggling" (may require subscription)) about the financial pressures on nonprofit Mt. Sinai. Here's the video:

Cleveland Clinic addresses financial conflicts of interest head-on

Today's Times has an interesting piece on the Cleveland Clinic's new policy ofpublicly reporting the business relationships that any of its 1,800 staff doctors and scientists have with drug and device makers. The clinic, one of the nation’s most prominent medical research centers, is making a complete disclosure of doctors’ and researchers’ financial ties available on its Web site, http://

13-year-old refuses heart transplant

The story of Hannah Jones is provoking some strong reactions -- both positive and negative -- in the U.K. The 13-year-old girl has refused a heart transplant without which her doctors say she has only months to live. Hannah's reasoning: potentially lousy quality of life and the possibility that the anti-rejection medicine will trigger a relapse of the leukemia she's been treated for since she was

Larry Gostin's "Public Health Law" text in new edition

The great just got better.No public-health law library would be complete without Larry Gostin's Public Health Law -- Power, Duty, Restraint. Originally published eight years ago, PHL was always more than simply a good place to start your research: Gostin's opus had depth to match its breadth.Well, now the second edition of PHL has been published by the University of California Press (it also

Health insurers agree to drop pre-existing condition exclusion

You read that right. According to an article in today's New York Times, the two big health-insurance industry associations have agreed to enroll all applicants, regardless of pre-existing condition. The catch? They will only do so if Congress requires all citizens to have health insurance.The industry's concern is pretty easy to understand: moral hazard. Without a requirement of universal

Washington passes PAS ballot measure

The State of Washington became the second state in the U.S. to legalize physician-assisted suicide. Initiative 1000 passed 58-42, according to the Seattle Post-Intellgencer. The measure looks virtually identical to the Oregon Death With Dignity Act, which was enacted in 1997. The law becomes effective in 120 days after the Nov. 4 election: March 4.It's a matter of time before PAS is legal in a

Interesting report from The Commonwealth Fund:More than two-thirds of respondents to the latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey believe the way we pay for health care in the United States must be fundamentally reformed. Fee-for-service payment--the most prevalent system throughout the country--is not effective in encouraging high-quality, efficient care,

Tax-exempt hospitals and "community benefit"

Excellent discusion by John Colombo over at Nonprofit Law Prof Blog, ostensibly about the recent GAO report, Nonprofit Hospitals: Variation in Standards and Guidance Limits Comparison of How Hospitals Meet Community Benefit Requirements (GAO 08-880), but also about current thinking as to whether nonprofit hospitals should be tax-exempt in the first place. His conclusion:Though I've mellowed on

Seton Hall Law Review Symposium

Preparing for a Pharmaceutical Response to Pandemic Influenza:A Seton Hall Law Review SymposiumOctober 23-24, 2008Seton Hall University School of LawNewark, NJCo-Sponsored byThe Center for Health & Pharmaceutical Law and theGibbons Institute of Law, Science & Technologyat Seton Hall University School of LawNewark, New JerseySeton Hall Law School’s Center for Health and Pharmaceutical Law, the

Pay for the best care, save money

Cary Grant is supposed to have said it's cheaper in the long run to buy the best shoes possible -- they will hold up better, last longer, look better over time than the supposedly less expensive alternative. It turns out that health care may work the same way. Here are the opening paragraphs of a Bloomberg News story posted yesterday (and brought to my attention by a student in my health law

Insurer to pay $225M settlement in Medicaid coverage-denial suit

The Kaiser Network has picked up on a report from Reuters that Amerigroup has settled a qui tam whistleblower suit in which it was accused of denying coverage to Medicaid beneficiaries who were pregnant or had health problems. (Under the law, Amerigroup was obligated to provide coverage for a Medicaid enrollees.)Amerigroup claims its enrollment practices were intended to meet the objections of

Pediatric DCD in the news

Today The Washington Post has an article -- Infant Transplant Procedure Ignites Debate -- that builds on yesterday's AP article about three cases in which infant hearts were harvested under a "donation after cardiac death" ("DCD") protocol, which all transplant centers are required by UNOS and HHS. The details of each center's protocol may vary.On the crucial issue of how long to wait before

"For better or worse, for richer or poorer, in sickness and in health . . . "

How to pick a life partner, 2008-style: "Let's see. . . . Good personality? Check. Kind to small animals and young children? Check. Reasonably communicative and okay with intimacy? Check. Excellent health care insurance? DOUBLE CHECK!!" That's the message in yesterday's New York Times article, Health Benefits Inspire Rush to Marry, or Divorce.It's a sign of the times. As HLS Prof. Elizabeth

U.S. health care reform: can 8 out of 10 Americans be wrong?

The latest from The Commonwealth Fund is a report based upon a Harris Interactive survey that sought the opinions of a sample of 1,004 adults about our health care system. Here's a summary of the results:Overall, the telephone survey of a representative sample of 1,004 adults age 18 and older reveals that the health care delivery system does not serve the public well — eight of 10 respondents say

Congresswoman Slams Religious Right's Assault on Science's "Edgier" Side

Scientific American has an on-line interview with Colorado Rep. Diana DeGette, who recently published, "Sex, Science and Stem Cells: Inside the Right Wing Assault on Reason" (Congresswoman Slams Religious Right's Assault on Science's "Edgier" Side). Here's their intro:Six-term Democratic Congresswoman Diana DeGette owns a dubious distinction: She is one of the two co-authors of the bill that

New Study Looks at Uninsurance Among Immigrants

New Study Looks at Uninsurance Among Immigrants[from today's Kaisernetwork.org's Daily Health Policy Report]Although U.S.-born residents still make up the majority of uninsured U.S. residents, the percentage of uninsured documented and undocumented immigrants is growing, according to a study released on Tuesday by the Employee Benefit Research Institute, the Kansas City Star reports. EBRI

Latest health-related reports from GAO

Electronic Health Records: DOD and VA Have Increased Their Sharing of Health Information, but More Work Remains. GAO-08-954, July 28, 2008 (43 pages).http://www.gao.gov/docdblite/details.php?rptno=GAO-08-954Emergency Preparedness: States Are Planning for Medical Surge, but Could Benefit from Shared Guidance for Allocating Scarce Medical Resources. GAO-08-668, June 13, 2008 (53 pages).http://

Texas Attorney General: Charitable Hospital Summit

For those interested in charity care and community benefits in Texas, the Texas Attorney General is hosting a "summit" on Tuesday, September 16, in Austin. The schedule looks pretty good, if a little basic, but it's the Attorney General's office, for crying out loud, and they do have enforcement authority for Health and Safety Code chapter 311 (though it would be nice to know whether the speakers

What it means to be uninsured in America

The New York Times has an article (Millions With Chronic Disease Get Little to No Treatment) today about the most recent Annals of Internal Medicine survey (abstract) of just exactly what health care services the uninsured with chronic conditions aren't getting. Here's a brief excerpt:The study, the first detailed look at the health of the uninsured, estimates that about one of every three

All hospitals have to pull their weight on uncompensated care

Tim Walters filed this op-ed piece Saturday in the Cleveland Plain Dealer: All hospitals have to pull their weight on uncompensated care. Seems MetroHealth, the nationally recognized public hospital in town, is in perilous financial condition. It is the largest provider of uncompensated health care in the state of Ohio, and if it goes under, Walters wonders what will happen to indigent patients

5th Circuit's decision in Poliner is out

Total win for Presbyterian/THR/medical-staff docs. HCQIA immunity for money damages held to apply to emergency suspension decisions during the fact-investigation phase of the peer-review process. Judge Higginbotham's opinion for a unanimous panel is here. It looks bullet-proof to me . . . . Pretty amazing saga, which I am sure won't be over until there's a petition for reconsideration/rehearing

Trying to Save by Increasing Doctors’ Fees

Trying to Save by Increasing Doctors’ FeesThat's the headline in this morning's New York Times' story about health plans (including Medicare) that are going to try to gin up some extra compensation for primary and preventive care in the hope that it will reduce more costly acute care down the road. Could it be? The dawning of the Age of Common Sense? Stay tuned . . .

Making Malpractice a Criminal Matter

The Wall Street Journal's Law Blog has an entry today on a criminal case brought against a physician at the Harvard School of Public Health. The case is described a little more fully in the Boston Globe. According to the Globe story, the physician -- Dr. Rapin Osathanondh -- was performing an abortion on a 22-year-old woman who died during the procedure. Dr. Osathanondh was subsequently charged

The vaccine-autism debate: a lecture

From Mary Holland at NYU comes notice of this lecture:THE VACCINE-AUTISM DEBATE:WHY WON'T IT GO AWAY?David Kirby, AuthorEvidence of Harm - Mercury in Vaccines and the Autism Epidemic: A Medical ControversyThursday, June 26, 20086:30 - 9:00 PMNYU School of Law 40 Washington Square South,Vanderbilt Hall, Room 204RSVP REQUIRED: kirbylecture@gmail.comFREE AND OPEN TO THE PUBLICDavid Kirby,

Med mal premiums in Mass., 1975-2005

Marc Rodwin, one of the most innovative and consistently interesting health law scholars around, has published (with others) in the May/June issue of Health Affairs a very useful study of med mal premiums in Massachusetts (described as "a high-risk state") over the 30-year period of 1975-2005. Here's the abstract:Massachusetts has the fourth-highest median malpractice settlement payments for all

American College of Physicians: E-Health Recommendations

The ACP's new report, E-Health and Its Impact on Medical Practice, is presented on their news page. The challenge of moving physicians to electronic health records is daunting. This is from the press release:Health care may be the fastest growing industry, but it has been slow to adopt the use of technology. While orders at fast food chains are now entirely automated, most physician offices and

Two Versions of End-of-Life Care

The New York Times had an interesting article Friday (In New York City, Two Versions of End-of-Life Care) on variations in end-of-life care -- not the usual comparison of EOL expenditures between geographically disparate locations, but this time between well-off private hospitals and public facilities a couple of miles apart within the same city. The data come from the Dartmouth Atlas of Health

Cash Before Chemo

The Wall Street Journal ran a chilling Page One story yesterday: Cash Before Chemo: Hospitals Get Tough (link may require paid subscription). Here's a little video teaser:Once again, it's all too easy in the U.S. system to find yourself underinsured for a serious illness, and when you're underinsured, you might as well be uninsured.

PBS Frontline: "Sick Around the World"

This Tuesday, "Frontline" takes a look at the U.S. health care system by comparing what we have against other countries who manage to provide better access and produce better outcomes at a lower cost. Here are three preview clips:Here's the press release on the program:FRONTLINE presentsSICK AROUND THE WORLDTuesday, April 15, 2008, at 9 P.M. ET on PBSFRONTLINE TRAVELS TO FIVE COUNTRIES IN SEARCH

Some basic health-reform lessons

Paul Krugman's excellent op-ed yesterday -- Health Care Horror Stories - New York Times -- ought to be required reading across the country. There is plenty to debate about how to fix our health care system, and he's made it clear in past columns that he favors Hillary's universal-coverage-now over Obama's phased-in plan. And there is still debate (here and here) about whether the opening story in

More medical records abuses

It seems that UCLA Medical Center had a serial HIPAA violator on its payroll (until he or she was fired last year for checking out Britney Spears' medical record). See: More UCLA records abuses - Los Angeles Times. We knew this was wrong even before HIPAA, didn't we?

Law review call for papers: "Preparing for a phamaceutical Response to Pandemic Influenza"

Seton Hall Law Review SymposiumPreparing for a Pharmaceutical Response to Pandemic InfluenzaCo-sponsored by the Health Law & Policy Program’s Center for Health & Pharmaceutical Law and the Gibbons Institute of Law, Science & TechnologyOctober 23-24, 2008Seton Hall Law SchoolNewark, NJCall for PapersSeton Hall Law School’s Center for Health and Pharmaceutical Law and the Seton Hall Law Review will

In my Law, Literature and Medicine class, the poem "Gaudeamus Igitur" by John Stone -- eminent cardiologist and medical educator and poet-essayist par excellence -- is always a hit (you can listen to an NPR story that includes a snippet of the poem). It was written as a graduation valedictory at the Emory University School of Medicine, and it provides a wonderful review of the medical school

Are antibiotics futile for nursing home patients with advanced dementia?

Today's New York Times has a piece about a recent article in the Archives of Internal Medicine in which the authors question the use of antibiotics to treat infections in nursing home patients with advanced dementia. The study concludes:This prospective cohort study demonstrates that antimicrobial exposure among nursing home residents with advanced dementia is extensive and steadily increases

Location, location, location.

It's the punchline to an old joke, but this time it's deadly serious. According to a recent article in Pediatrics (summary; abstract here - full text here), "Black babies with very low birth weights are nearly twice as likely as their white counterparts to be born at New York City hospitals with high risk-adjusted neonatal death rates." The first and last paragraphs of the article's Discussion

Donation after cardiac death and the LA story

The papers are all over yesterday's story about the prosecution of a young surgeon in Los Angeles who is accused of hastening a patient's death (or, to be less circumspect but at least as accurate about it, of killing a patient) in order to procure organs for transplant. Here's how the New York Times' front-page story begins:On a winter night in 2006, a disabled and brain damaged man named Ruben

Organ donation, transplant discussed on NPR

Weekend Edition - Sunday had a very fine segment this morning on organ donation.Given what they were trying to do with this piece, there probably wasn't time to portray the personal impact of donating and receiving, convey some of the statistics about the various waiting lists, provide a brief overview of some of the evolving strategies for increasing organ yields, AND discuss some of the

Human experimentation research request

From Jim DuBois, PhD, DSc, Mäder Endowed Professor, Department Chair and Center Director, Center for Health Care Ethics & Becky Volpe, Graduate Assistant, Center for Health Care Ethics:We are studying the personality and environmental factors that contribute to major ethical breaches in the areas of medical practice and research. An example of a major breach would be the Tuskegee syphilis trial.