Parker Wishik
Re: "Charity Hospital
venue disputed," Metro, May 6.
Despite the day-to-day comforts of life, New Orleans -- like all of Louisiana -- is still in dire need of an
economic windfall. One key element in economic development is higher
education, and the LSU/VA hospital is an opportunity to infuse jobs, money
and development into the community.
Louisiana's
budgetary situation has both the health care and higher education communities
concerned about the future, as the state can constitutionally cut funding to
both. As a student government leader at LSU highly involved in discussions
regarding higher education and Louisiana's
budget, I can't stress how important it is for progress on the hospital to
accelerate.
Building this cutting-edge facility will give a
desperately needed shot in the arm to the city's health care and will plant
seeds for growth and progress that a higher-ed
institution provides. This opportunity needs to be capitalized on before it
disappears.
New Orleans
has a wealth of history, and the culture will survive. The LSU/VA hospital is
a virtual jackpot, and the city holds the ticket. Don't let it pass you by.
Parker Wishik
Baton Rouge
http://www.nola.com/news/t-p/letterstoeditor/index.ssf?/base/news-13/124201930854830.xml&coll=1
[BACK TO TOP]
By Bill Barrow
Capital bureau
BATON ROUGE -- Architects recently unveiled
renderings for the teaching hospital that Louisiana State University System
executives and state facilities managers have envisioned for lower Mid-City
since before Hurricane Katrina.
The three concepts vary, but all depict a massive
medical complex -- three wings of in-patient beds, a clinic building, a
diagnostic and treatment wing with the emergency department, a parking garage
and a central energy plant -- that would reach every block in an area bound
by South Claiborne Avenue,
Tulane Avenue,
Galvez Street
and Canal Street.
But, in fact, fewer than half the structures in the drawings actually make up
the proposed $1.2 billion, 424-bed hospital.
Architects dubbed that "phase one" as
they presented the drawings. The rest of the buildings -- duplicates of
everything except the energy plant -- are designated as "future"
construction in "phase two."
It is not unusual for such a venture to include
several stages with room for expansion. Various documents drafted during the
federal planning process have referred to the "future needs" of
both the state complex and the adjoining U.S. Department of Veterans Affairs
hospital, slated to be built across Galvez to South Rocheblave Street.
Yet the renderings raise new questions about the
project, particularly given uncertainty about how the state will pay for
"phase one" and the lack of any timetable, bed count, cost estimate
or financing source for "phase two."
House Speaker Jim Tucker, R-Algiers, said he
supports a new hospital. But after following its planning since LSU shuttered
Charity Hospital after Katrina, Tucker said he
was unaware there was a second phase. "I thought the $1.2 billion was
soup to dessert."
Sandra Stokes, spokeswoman for the Foundation for
Historical Louisiana, is among the leading voices pushing for the state to
abandon plans for building a new hospital and instead gut and rebuild in the
Charity building in the downtown medical district.
"We're concerned about where the money is
coming from," she said, "and then it becomes a question of why are
we taking twice as much land as we need for potential future growth when it
will take eight to 10 years for the first phase to come to fruition. . . . It
starts to appear like a land grab."
--- Focusing on financing ---
A major question is when, or even if, the second
phase will be needed.
Dr. Fred Cerise, vice president for LSU's
health-care division, said a second round of construction "will be
dependent on the successful operation of the new (business) model" that
calls for attracting more insured patients than historically patronized
Charity and University hospitals.
State Health Secretary Alan Levine said he was
unaware of a second phase until queried by a reporter, but he said he is not
surprised.
"The bigger issue is the financing,"
Levine said. With looming reductions in federal compensation for indigent
care and "uncertainty with the national plan for expansion of Medicaid,
lenders (necessary for initial construction) will want to understand how this
will impact the business plan. LSU should be planning for that," he
said.
The difficulty is making reliable predictions
about the behavior of health-care consumers and the demand for in-patient
beds in a region where the population remains in flux after the Katrina diaspora.
Cerise said he is confident the hospital can
attract more paying patients because LSU faculty physicians will steer paying
patients to new facilities, which was not the case with the old Charity or
with the interim functions in the University
Hospital building.
Both the state and VA hospitals are in the
"public comment period" for the design phase in a process designed
to satisfy federal laws for U.S.
government construction. The state is subject to those rules because it plans
to use its still-undetermined compensation for Katrina damage to Charity to
build the new hospital.
The VA, which has secured its financing, is
targeting a 2012 opening date. Cerise said the state hospital can open in
2013.
--- Pitch for Charity renewed ---
Stokes and others who oppose the new hospital's
site have seized on the latest drawings in their efforts to steer the state
away from the lower Mid-City footprint, which though blighted includes
historically and architecturally significant structures.
More than 50 groups -- planning organizations,
neighborhood and health-care alliances -- have urged Gov. Bobby Jindal to initiate a new review of whether Charity Hospital could be gutted and a new
hospital fashioned using its steel frame and limestone shell. Jindal has made no public movement in that direction.
Even if her group's $550 million estimate for
rehabilitating Charity is low, Stokes said it is certainly cheaper than the
total of what appears on the latest drawings. The foundation's alternative
addresses expansion by calling for the state to take control of the existing
VA property next to Charity, with the Veterans Administration building its
new hospital on a smaller portion of the lower Mid-City footprint.
Walter Gallas, director
of the New Orleans
office of the National Trust for Historic Preservation, said the current
plans set up a "worst-case scenario" that the state completes
initial construction but never expands and finds no other uses for the land.
That would leave the new hospital complexes
isolated from the existing medical district and hinder plans for an
integrated New Orleans
biomedical corridor, Gallas said.
--- Backing the plans ---
Kurt Weigle, president
of the Downtown Development District and a supporter of the state's project,
said he sees nothing wrong with the hospital plans. "The question in my
mind is how do we best use this extra land in the
meantime," he said.
A March 13 document from the state's designers
said they left vacant parcels along "the edges" of the footprint --
along Canal and Tulane -- "to promote the interim use of space" via
"public-private partnerships to encourage commercial development at
these edges until . . . expansion."
State officials said the same thing during last
month's public presentation of the schematics.
Weigle
said he thinks that can work, particularly if the state, his organization and
the Regional Planning Commission work to market the land.
But Tucker, the House speaker, said he is
skeptical that private investors will build on land with no long-term
guarantees of occupancy.
Cerise said there is a possibility, not reflected
in the plans, for LSU's faculty physicians, who now practice privately across
the region, to come together in office buildings on the campus. That would be
permanent, he said.
State facilities chief Jerry Jones said he doesn't
think the land would be used for construction at all before hospital
expansion. He said it likely would be "surface parking" and
landscaping.
Besides, he said, whatever is on paper now is
preliminary: "The hospital may look nothing like what's on those
drawings."
http://www.nola.com/news/t-p/frontpage/index.ssf?/base/news-12/124193365680400.xml&coll=1
[BACK TO TOP]
Kenneth W. Bickford
Re: "Committee OKs bill giving board hospital
control: Measure would take authority from LSU," Page A2, April 30.
I wouldn't blame anyone for wondering what to do
with Rep. Jim Tucker's proposal regarding the LSU hospital. Tucker's House
Bill 830 would create an independent board to run the Interim LSU
Public Hospital
and the proposed teaching hospital in lower Mid-City.
While my only involvement with medicine is as an
occasional patient, the prospect is that I shall become a much better
customer as the years roll along.
It helps to consider the motivations of the
parties involved. Tulane University has an interest in maintaining control
so that it can provide medical training -- beyond what is already offered by
its private hospital -- to its students, most of whom are from outside of Louisiana and a majority of whom will not practice in Louisiana once their
training is finished.
LSU has a mission to train the next generation of Louisiana doctors and
nurses.
Only our public university has a motive that is
purely public in nature.
For the life of me, I cannot imagine why anyone
would put a stumbling block between our public hospital and its unfettered
use as a training ground for the men and women who are going to take care of
us in the future.
I recently read in these very pages that Louisiana is facing a
shortage of medical personnel that will reach crisis proportions in the
not-too-distant future.
Rep. Tucker, desperate to find a peaceful solution
at any cost, has indeed found the costliest of solutions.
Kenneth W. Bickford
New Orleans
http://www.nola.com/news/t-p/letterstoeditor/index.ssf?/base/news-13/1241847112206190.xml&coll=1
[BACK TO TOP]
Where are Jindal's priorities?
Eliot Levin, LCSW
Gov. Bobby Jindal
selling Louisiana
on the road? How does he explain that higher education and health care are no
longer his priorities for our state?
By the way, what happened to transparency?
Congratulations to Gov. Jindal.
He is becoming as big a disaster for our state as Mayor Ray Nagin is for New
Orleans, and that is quite a feat.
Advertisement
Eliot Levin, LCSW
Metairie
http://www.nola.com/news/t-p/letterstoeditor/index.ssf?/base/news-13/124201929454830.xml&coll=1
[BACK TO TOP]
The wrangling over governance of the New Orleans teaching
hospital could have implications for what the new facility eventually is
named. That detail doesn't directly affect patients but stokes passions in
many quarters. Many of the planning documents for the hospital refer to the
Louisiana State University Academic Medical Complex. But officials from Tulane University and other schools whose
students and faculty likely would work in the facility aren't so thrilled
with that idea. And House Bill 830 from Speaker Jim Tucker, R-Algiers, would
create an independent board not controlled by any of the participating
schools. There is a law on the books naming the existing Charity Hospital
for the late Rev. Avery Alexander, a civil rights leader and former state
lawmaker. Sen. Ed Murray, D-New Orleans, said recently that several New
Orleans lawmakers believe that name should be transferred to the new facility
whenever it opens. Dr. Fred Cerise, vice president for LSU's medical affairs
division, said "we're open to many options" for a name. But he also
pointed out that the business model for the proposed hospital depends on
attracting more paying patients than ever visited Charity or University Hospitals. Those patients, he said,
almost certainly would come only from referrals by LSU faculty physicians.
[BACK TO TOP]
While many health care providers are chafing about
the cuts in Gov. Bobby Jindal's 2009-10 budget plan, which calls for substantial reductions in most
Medicaid rates as of July 1, New Orleans-area hospitals are in line for a
welcome windfall from another spending bill that was introduced last week.
House Bill 879 by Speaker Jim Tucker, R-Algiers, includes $170 million for New Orleans hospitals
to help cover operating losses incurred since Hurricane Katrina. Hospitals on
the north shore would divide another $18 million, according to Health and
Hospitals Secretary Alan Levine. The money is coming courtesy of some
creative accounting involving federal block-grant financing made available to
Louisiana
as part of a disaster-relief bill that Congress approved last fall. Louisiana
Hospital Association President John Matessino said
hospitals lost $800 million as a result of the 2005 hurricanes and Hurricanes
Gustav and Ike in 2008.
[BACK TO TOP]
Barbara Tison
If Gov. Bobby Jindal
thinks state employees should be cut, let him start with his own salary and
that of the Legislature. These are all state employees. One quick way to save
the budget of the State Police would be to either stay home or move to Arizona near John
McCain who seems to be his mentor.
I know I am not alone when I speak of the
legislators being overpaid. They are certainly not worth what they think they
are. There are no obvious accomplishments for either Jindal
or the legislators.
People are supposed to have a voice and when
elections are held and all the speeches are given and the winners go to Baton Rouge, then it is
hoped that at least some of the promises made will be kept.
Jindal
speaks of a fund that he plans to use for various projects. How did we manage
to accumulate a fund without all the cuts he talks about? I know I am not the
only person who listened to his speech in which he told of the poverty status
of his parents when they arrived in Louisiana,
even to the point of borrowing money for his birth. Most of us call that the
"Charity Hospital" system, which certainly
utilizes Medicaid dollars and is staffed with state employees.
During any crisis such as hurricanes, it is the
state employees who are called on to work until needs are met at any and all
shelters in the state. There is no pay for this, maybe "K" time.
Some of the Medicaid cuts that have been made have been cuts to the elderly
who usually live on $500 to $600 a month.
I think that if everyone who waved a tea bag would
also vote, we might see a change in attitude from these people who hold a
heavy pencil with one hand and collect all they can with the other. I voted
for Jindal one time, it will not happen again.
Barbara Tison
Jena
http://www.thetowntalk.com/article/20090509/OPINION03/905090304
[BACK TO TOP]
AP
NEW LLANO, La. — Seven months ago, a nurse told Jan Veintidos he would never move or walk again. The
17-year-old junior at Pickering
High School wants to
return to show her she was wrong.
The nurse wasn't being cold or cruel — just
realistic, he said, considering the injuries to his neck and three vertebrae.
He recounts his emergency trip to LSU Hospital
in Shreveport after he tried to block an East Beauregard
High School linebacker
on Oct. 10.
"I couldn't talk and I had to mouth
everything," Vientidos said. "I remember
mouthing the question, 'Will I ever be able to move or walk again?' and she
answered, 'No, you won't."'
His injury was only one grade below the maximum —
the grade that left actor Christopher Reeves paralyzed from the neck down
from 1995 until his death in 2004.
But Vientidos is
walking, talking, and going to classes again at Pickering, where he was a wingback for the
football team and a college prospect as a 400-meter runner for the track
team.
He is not completely healed. He continues therapy
at the Louisiana
Rehabilitation Center in Leesville and recently began
to be able to use his hands as he talks. He says he often has little or no
feeling under his neck and he has some other internal maladies.
But that's light years from six months ago.
He remembers teammate Paul Marcantel,
the Red Devils' other starting running back and the son of Pickering coach James Marcantel,
walking up to him and sticking his hand out. Veintidos
said, "Paul, I think I can't breathe and can't move."'
He was rushed to East
Beauregard Medical
Center, then Fort
Polk and, finally, LSU Health
Sciences Center
in Shreveport.
He underwent surgery Oct. 11 in Shreveport
to fuse two vertebrae and remove part of his spinal cord to reduce the
swelling in his neck.
"There was a critical period when he was on
the respirator," coach Marcantel said.
"It was touch and go."
He began improving immediately after his mother,
Zelma, and LSU Hospital
got him moved to Children's Hospital in New
Orleans. He left New Orleans on March 6.
"When he first came here, he couldn't sit up
by himself," said 51-year-old physical therapist Lori Boyter, whom Veintidos called
his "godmother."
"He had just come off the ventilator, so he
was pretty weak, but he was so determined and so courageous," Boyter said. "It is extremely difficult to walk
after such an injury.
"Initially, it took five of us to walk him 50
feet in 45 minutes. By the time he left, he could walk 500 feet, and I was
just beside him. That's a gigantic change."
Veintidos
said he "broke down" one night in Children's Hospital after trying
vainly for an hour to push a button on his television remote to change the
channel. "I kept thinking, 'Why? Why?"'
For the most part, though, he was an extraordinary
patient, going above and beyond the time required for both physical and
occupational therapy sessions, making friends with everyone and giving
nicknames to nearly everyone.
"He had every reason to be frustrated and
upset," said Boyter, "but he went out of
his way to encourage the other kids here. He was an inspiration to the staff,
the patients and the patients' families. He had a steady determination to get
back on his feet, and he did it against the odds."
Veintidos
said he couldn't have done it without the help of those at the hospital.
"I had some of the best doctors and some of
the best nurses in the world," he said.
New Orleans Saints quarterback Drew Brees and Saints coach Sean Payton, who lavished him with
memorabilia, and former LSU coach Nick Saban all
visited him there.
The day Veintidos left
Children's Hospital was bittersweet for some.
"He had a million moms here, and everybody
was so happy he could go home, but sad because we'd miss him so," Boyter said.
Veintidos
had vowed that he wouldn't leave in a wheelchair — he'd roll on the floor or
he'd walk out. Ultimately, he agreed to be wheeled to the lobby, but not out
of it.
"There were some nurses around and Jeff, my rec therapist, was beside me," Veintidos
recalled. "I had to rock myself, 1, 2, 3, and I stood up."
http://www.foxnews.com/story/0,2933,519736,00.html
[BACK TO TOP]
The Associated Press
(AP) — NEW
ORLEANS - A doctoral and medical student at LSU
Health Sciences Center New Orleans has won a national research award for
graduate students.
Jeffrey White's paper was about development of a
kind of cell needed for kidneys to filter blood.
White and his mentor, Oliver Wessely,
are working to understand the genetic control of those cells, called podocytes. He showed that without two key genes, podocytes won't form and kidney function is damaged.
The American Association of Anatomists gave him
the Langman Award at the recent experimental
biology meeting in New Orleans.
It's given for the best paper presented by a graduate student.
http://www.nola.com/newsflash/index.ssf?/base/national-13/1241863763259090.xml&storylist=louisiana
[BACK TO TOP]
Brenda Browning
After paying close attention to the wrangling
going on in the Legislature over the past few days, I have come to the
conclusion that “practice what you preach” no longer applies.
Gov. Bobby Jindal and
his administration, who so ardently pushed ethics
reform last year, have turned a blind eye to their own issues of
transparency. Three bills were brought up to make the Governor’s Office’s
records more available to the public, and three times the administration has
quashed their passage through committee.
While the governor is pressing hard to tout himself the conservative answer to the Republicans’
prayers on the national stage, he is proposing to devastate LSU’s newfound
status with severe budget cuts. I’m glad that he was afforded a good college
education. Many in Louisiana
now will not be.
While railing on about our state’s lack of revenue,
he and his administration have absolutely refused raising any taxes,
including a progressive gas tax that would help finance repairs to our
failing roads and bridges, and a cigarette tax that would bring money to
health care.
So much for ethics. When is the next election?
Brenda Browning
engineering technician
Zachary
http://www.2theadvocate.com/opinion/44679917.html
[BACK TO TOP]
ScienceDaily — Dr. Nicolas Bazan, Director of the
Neuroscience Center of Excellence, Boyd Professor, and Ernest C. and Yvette
C. Villere Chair of Retinal Degenerative Diseases
Research at LSU Health Sciences Center New Orleans, will present new research
findings showing that an omega three fatty acid in the diet protects brain
cells by preventing the misfolding of a protein
resulting from a gene mutation in neurodegenerative diseases like Parkinson's
and Huntington's.
He will present these findings for the first time
on April 19,
2009 at the Ernest
N. Morial Convention
Center, Nouvelle C Room, at the American
Society for Nutrition, Experimental Biology 2009 Annual Meeting.
With funding from the National Eye Institute of
the National Institutes of Health, Dr. Bazan and
his colleagues developed a cell model with a mutation of the Ataxin-1 gene.
The defective Ataxin-1 gene induces the misfolding
of the protein produced by the gene. These misshapened
proteins cannot be properly processed by the cell machinery, resulting in
tangled clumps of toxic protein that eventually kill the cell. Spinocerebellar Ataxia, a disabling disorder that affects
speech, eye movement, and hand coordination at early ages of life, is one
disorder resulting from the Ataxin-1 misfolding
defect. The research team led by Dr. Bazan found
that the omega three fatty acid, docosahexaenoic
acid (DHA), protects cells from this defect.
Dr. Bazan's laboratory
discovered earlier that neuroprotectin D1 (NPD1), a
naturally-occurring molecule in the human brain that is derived from DHA also
promotes brain cell survival. In this system NPD1 is capable of rescue the
dying cells with the pathological type of Ataxin-1, keeping their integrity
intact.
"These experiments provide proof of principle
that neuroprotectin D1 can be applied
therapeutically to combat various neurodegenerative diseases," says Dr. Bazan. "Furthermore, this study provides the basis
of new therapeutic approaches to manipulate retinal pigment epithelial cells
to be used as a source of NPD1 to treat patients with disorders characterized
by this mutation like Parkinson's, Retinitis Pigmentosa
and some forms of Alzheimer's Disease."
http://www.sciencedaily.com/releases/2009/04/090419133844.htm
[BACK TO TOP]
DAVID BAUDER
The Associated Press
(AP) — NEW
YORK - "Don't drop me," CNN's Dr. Sanjay
Gupta said as he hopped on the back of a motorcycle for a ride down a dusty
Mexican street. He was looking for the boy believed to be the first person
diagnosed with swine flu, armed with a picture on his Blackberry.
Gupta would not have been in La Gloria, Mexico, if he had accepted the Obama
administration's overture to be U.S. surgeon general. You get the
feeling he would have missed it.
His aggressive spirit covering the outbreak stood
out during the brief period that the story went into overdrive, including his
successful search for 5-year-old Edgar Hernandez near a pig farm in La Gloria
and the somewhat goofy "undercover" report from a Mexican hospital
where swine flu victims were kept behind closed doors.
He acknowledged some apprehension about going to Mexico, not
wanting to catch the disease on which he was reporting.
"As a medical reporter, in some ways these
are the hardest stories to cover," Gupta said. "Bird flu, that was
different. That had a 70 percent fatality rate-it just wasn't spreading. This
is a disease that seems to be spreading, but doesn't seem to have a high
fatality rate. Everyone is worried about a disease that has both characteristics."
By his second full day in Mexico, Gupta
said he sensed the concern easing.
The Mexico trip increased Gupta's
celebrity. The only TV network medical correspondent named one of People
magazine's "sexiest men alive" doubled his Twitter following to
20,000 people while he was there.
Gupta, who performs surgery at Grady Memorial
Hospital in Atlanta, said he learned a valuable lesson
early in his CNN career from Dr. Tim Johnson, veteran ABC News medical
correspondent. Johnson told him to talk to the camera as if it were a
patient.
Gupta, 39 and a White House fellow in the Clinton administration,
started at CNN in 2001 believing his main role would be to report on health
policy. He didn't know if he'd ever be on camera, but that changed the day a
study was released showing a link between the Vietnam War-era chemical Agent
Orange and blood disease. Gupta was asked to go on the air and talk about it.
"The culture (of journalism) is totally
different," he said. "For one thing, I didn't have any clothes. I'd
worn scrubs my whole life. I came to CNN with one suit and two ties."
ABC's Johnson said it seems Gupta has taken his
advice. "I feel like a doctor who happens to be on TV, even though
that's what I do now full time," he said. "I think he has that quality,
too. To me, it helps communicate with the audience because you're not
preaching at them, you're teaching at them."
Once he became comfortable with the camera, Gupta
carved out a different role. While Johnson is a commentator, Gupta frequently
goes to the scene of stories reporting on health issues. He's been to Iraq (where
he performed emergency brain surgery on a soldier), and to areas damaged by
the tsunami and Hurricane Katrina.
That has caused some controversy, as when he
battled filmmaker Michael Moore after questioning claims in "Sicko." His enthusiasm in finding Hernandez,
however, made for a memorable story. Gupta used his medical credentials to
ask pertinent questions and get into the hospital to illustrate how patients
were quarantined.
Gupta was called by Obama's transition team last
fall about the surgeon general's job, and took nearly two months to weighing
the possibilities. For one thing, becoming surgeon general would have
effectively ended his career as a surgeon.
Gupta performs surgery at least once a week and
would be only 43 if he completed a term as surgeon general. He didn't want to
stop practicing that young. His wife was pregnant at the time (their daughter
was born six weeks ago) and he thought he'd regret being a commuter dad with
three young children.
"It was a hard decision, and until I actually
said it publicly, I still wasn't 100 percent sure," he said. "When
I said it publicly, I felt good about it, and sometimes that's the way you
know."
http://www.nola.com/newsflash/index.ssf?/base/entertainment-1/1241975051141260.xml&storylist=health
[BACK TO TOP]
By MELINDA DESLATTE
Associated Press Writer
Cavities drilled and filled in the school library.
Teeth pulled in the school gym. Students getting teeth cleanings and dental
X-rays, then heading back to math and reading
classes.
Such mobile dental clinics have provided care to
thousands of poor Louisiana
children on school campuses. But the clinics would be forced to close if
lawmakers agree to a proposed ban on dental surgeries and other tooth work at
schools.
Supporters of the ban say they want to outlaw
"drive-by dentistry" that they consider unsanitary and unsafe for
children.
"Louisiana's
children do not deserve Third World dentistry," said Claudia Cavallino, a pediatric dentist from New Orleans.
Opponents argue the mobile clinics bring care to
poor children who otherwise might never see a dentist. They say the bill is a
bid by some dentists to get more money for themselves,
now that the state has increased reimbursement rates for dental work through
the Medicaid program for the poor.
"We are doctors going to treat children that
will never (otherwise) get it. We are regulated by the State Board of
Dentistry. How is it good for us to do free services and then all of a sudden
it's not good when we bill for them?" said Gregory Folse,
a Lafayette dentist who provides mobile dental care at schools in New
Orleans, Baton Rouge and Shreveport.
The House Health and Welfare Committee plans to
debate the bill by Rep. Kevin Pearson, R-Slidell, on Wednesday, a week after
some lawmakers on the panel called for more information before they make a
decision.
Mobile clinics have been growing in Louisiana, where a
majority of poor children lack regular access to dental care even though the
state's Medicaid program will cover the costs.
Cavallino
questioned whether the clinics can properly handle infections and emergencies
and knew enough detail about the children's medical history and drug
allergies before treating them.
"I have grave concerns about the quality of
dental care being delivered by the transient nature of school-based dental
programs," she told the House committee last week. "I also fear
that a disaster is waiting to happen when invasive, irreversible surgical
procedures are being done and anesthetics are being given to a child" in
a school library or cafeteria.
The Louisiana Dental Association is pushing the
ban on the mobile clinics, saying children need a "dental home"
with coordinated care in a permanent office that can track medical records
and follow-up appointments.
Ginger Hunt is CEO of Primary Care Providers for a
Healthy Feliciana, which has provided dental care at schools in rural East
Feliciana Parish since 2003. She said shuttering the school clinics would
harm underserved children.
"I believe this is a money issue. Ten years
ago when we knew we were in crisis in Louisiana,
and we knew we were in crisis across the nation, where was the dental
association then?" she said. "This year when the money is there, it
seems as though the service is coming. It's coming a little late."
Opponents of the bill include the Louisiana
Primary Care Association and the state chapter of the American Academy
of Pediatrics. The Federal Trade Commission questioned whether Pearson's bill
would curtail access to dental care for poor children.
Proponents and opponents of the ban disagree on
how much care would be available to children in the Medicaid program without
the school clinics.
Marty Garrett, a Baton Rouge dentist and past
president of the Louisiana Dental Association, said more than 1,100 dentists
in Louisiana have signed up to treat Medicaid-eligible children in their
offices. Garrett supports the ban on the mobile dentistry units.
But Sue Catchings said
getting an appointment can be difficult for working parents.
Catchings,
CEO of Health Care Centers in Schools, which provides dental care in Baton Rouge schools,
said parents who are paid an hourly wage often can't afford to lose money to
take their children to the dentist or don't have transportation to easily get
there.
Of a survey of 146 dental offices in the Baton Rouge area, Catchings said she found 33 who would take children on
Medicaid. But only five of those offices would take after-hours appointments
and only two would take patients on Saturdays, she said.
"They're not open when our parents can get
there," Catchings said.
It's unclear where state officials stand on the
ban.
The state Board of Elementary and Secondary
Education voted to support the bill. But Joe Salter, speaking for BESE, said
board members didn't have accurate information from bill supporters at the
time and now had concerns.
State Health and Hospitals Secretary Alan Levine
hasn't offered a position.
"The debate should be about how we get these
children dental care. We're not taking a particular side in the debate, but
our posture is that we want kids to have access, and we're willing to look at
different ways of getting to that goal," Levine said in a statement.
Pearson's bill would allow certain limited types
of dental care at schools, including dental cleanings and fluoride treatments
if they are free.
http://www.nola.com/newsflash/index.ssf?/base/national-14/1242031771293680.xml&storylist=louisiana
[BACK TO TOP]
By Sarah Carr
Staff writer
Tulane
University will open its first
school-based health clinic at New Orleans' Cohen High School this week, offering
services ranging from physical exams to health education and therapy.
Although Tulane has supported several other school
clinics, this is the first one that it will take on more independently. An
opening event is set for Tuesday.
"We are really hoping to be involved in an
integral way with school-based health," said Dr. Sue Ellen Abdalian, who will be the center's medical director.
Several school clinics have opened recently in the
New Orleans
region under the banner of the School Health Connection, organized by the
Louisiana Public Health Institute. The Cohen clinic, located at 3520 Dryades St.,
will be separate from that effort, although much of its financing comes from
the same source, the Public Health Institute's Primary Care Access and
Stabilization Grant program.
Abdalian
said the center will be free to all students from Cohen and surrounding
schools, whether or not they have health insurance. It also will serve
faculty and staff, although Abdalian said the focus
will be on students.
Next year, the clinic might expand to serve the
broader community surrounding Cohen, particularly the siblings of the high
school's students. For now, the clinic has one full-time nurse, a part-time
physician, a full-time social worker and a medical office assistant. Next
year, it also will have a nurse practitioner.
Emphasis will be given to preventive care, Abdalian said. "We want to catch things before they
get to be problems or big problems," she said.
Cohen, which is operated by the Recovery School District,
specializes in health careers. The school hopes to use the center as a
resource for students, who might learn how to take blood pressure, for
instance. But Abdalian said learning will be
limited by confidentiality laws, which would prevent students from spending
much time volunteering or studying in a clinic where their peers will be the
patients.
The clinic will be open Monday through Friday from
8 a.m. to 4 p.m. Summer hours will coincide with summer school.
http://www.nola.com/news/t-p/metro/index.ssf?/base/news-34/124201927254830.xml&coll=1
[BACK TO TOP]
PHILIP ELLIOTT
The Associated Press
(AP) — WASHINGTON
- When President Bill Clinton took on health care reform, industry leaders
fought back, killing the White House proposal before it could gain any
traction.
Now those industry leaders are trying to help
President Barack Obama find a solution to the problem of uninsured Americans,
offering $2 trillion in spending reductions over 10 years.
Hospitals, insurance companies, drug makers and
doctors planned to tell Obama on Monday they'll voluntarily slow their rate increases
in coming years in a move that government economists say would create
breathing room to help provide health insurance to an estimated 50 million
Americans who now go without it.
Although the offer from the industry groups
doesn't resolve thorny details of a new health care system, it does offer the
prospect of freeing a large chunk of money to help pay for coverage. And it
puts the private-sector groups in a good position to influence the bill
Congress is writing.
Six major groups plan to deliver a letter to Obama
and pledge to cut the growth rate for health care by 1.5 percentage points
each year, senior administration officials said Sunday. They spoke on the
condition of anonymity in order to sketch the offer before full details are
revealed at a White House event scheduled for Monday.
The industry groups are trying to get on the
administration bandwagon for expanded coverage now in the hope they can steer
Congress away from legislation that would restrict their profitability in
future years.
Insurers, for example, want to avoid the creation
of a government health plan that would directly compete with them to enroll
middle-class workers and their families. Drug makers worry that in the
future, new medications might have to pass a cost-benefit test before they
can win approval. And hospitals and doctors are concerned the government
could dictate what they get paid to care for any patient, not only the
elderly and the poor.
Obama has courted industry and provider groups,
inviting their representatives to the White House. There's a sense among some
of the groups that now may be the best time to act before public opinion,
fueled by anger over costs, turns against them.
It's unclear whether the proposed savings will
prove decisive in pushing a health care overhaul through Congress. There's no
detail on how the savings pledge would be enforced. And, critically, the
promised savings in private health care costs would accrue to society as a
whole, not just the federal government. That's a crucial distinction because
specific federal savings are needed to help pay for the cost of expanding
coverage.
Costs have emerged as the most serious obstacle to
Obama's plan. The estimated federal costs range from $1.2 trillion to $1.5
trillion over 10 years, and so far Obama has only spelled out how to get
about half of that.
http://www.nola.com/newsflash/index.ssf?/base/national-2/1241997081280540.xml&storylist=health
[BACK TO TOP]
By LAURAN NEERGAARD
AP medical writer
WASHINGTON
— The most pivotal moments in the swine flu saga are yet to come.
Will it sweep through impoverished Southern
Hemisphere countries in the next few months? Will it roar back in the rest of
the world in the fall? And who will be vaccinated if it does?
In the weeks since swine flu grabbed international
attention, and even years before that, some important actions have helped
shape the course of this outbreak and the ways the world will handle future
epidemics.
It’s not clear if this new swine flu strain is a
brush fire, sparking up around the globe only to fizzle, or if it will worsen
when the regular influenza season hits.
No matter how this story ends, at the very least
it has offered a real-world drill to find gaps in the playbook.
“We’ve been given an opportunity to take a look at
this before it really got bad, and we need to,” said Dr. Michael Osterholm of the University of Minnesota,
a prominent pandemic flu specialist. “We better damn well do it now because
one day we are going to really be in it for more than a week. If it’s not
this virus, there will still be another one.”
For this virus, the coming months will bring a
series of big decisions: Do manufacturers start brewing millions of swine flu
vaccine doses? Will they be stockpiled unless the new flu returns or given
along with or soon after regular flu shots? Will rich countries share enough
with the developing world? Who gets in line first — the younger people that
this strain so far seems to target or the elderly who usually are flu’s most
vulnerable?
“You may only have one chance to get out ahead of
it,” Dr. Richard Besser, acting chief of the
Centers for Disease Control and Prevention, said. “It’s important for people
to understand that all of these decisions will need to be made with
incomplete science.”
The first turning point
A different virus was the world’s wake-up call.
SARS (severe acute respiratory syndrome) started in China, and
once it broke out of the mainland in early 2003, it took just weeks to infect
more than 8,000 people from 37 countries. The virus killed more than 770
people before it disappeared.
Governments started scrambling to put together
plans to handle the next global disease threat.
Soon after, bird flu hit Asia,
reinforcing the need.
Had the new swine flu hit sooner, before all that
pandemic planning, it almost certainly would have spread faster. Even if it
proves no more dangerous than garden-variety flu, that’s deadly enough; a
pandemic is more about geography than super-lethality. By the World Health
Organization’s tally, between 250,000 and 500,000 people worldwide die each
year because of regular winter flu.
Uncovering this threat
As early as February, people in the Mexican hamlet
of La Gloria were suffering unusually strong flu symptoms. When officials
arrived to investigate in mid-March, nearly half the 3,000 villagers came out
seeking medical help. About 450 were diagnosed with acute respiratory
infections and given antibiotics. Mexico was investigating, but not until
April 12 would the outside world — the CDC and Pan American Health
Organization — start getting official word of the unexplained illness that
eventually would be blamed for dozens of deaths throughout Mexico.
By then CDC already was on the trail of swine flu
in California.
The virus had spread before anyone knew it existed.
Preparation had paid off. In its pandemic
planning, the U.S.
starting in 2005 put money into researching better influenza detection.
Studies of new methods found two unrelated children in San Diego with a strain of Type A influenza that turned out to be a never-before-seen type
of swine flu. Puzzled, CDC announced the cases and started hunting more. On
April 23, the agency confirmed five more illnesses in California
and Texas
and put all states on alert.
“At what point does unusual become concerning and
at what point does concern lead to action?” Besser
said. “We had to make that call.”
That same day, CDC and a Canadian lab that Mexico had consulted delivered the bad news:
The new flu was in Mexico,
too.
Could Mexico have signaled a problem
sooner? The Pan American Health Organization dismisses the question as one
for historians.
“We would have done everything the same if we had
it to do over again,” said Hugo Lopez-Gatell
Ramirez, deputy director of Mexico’s
Intelligence Unit for Health Emergencies.
Aggressive action
With the diagnosis, Mexico’s
government immediately ordered the closure of all schools, museums, libraries
and theaters in Mexico City.
The following days brought increasingly drastic actions.
Schools nationwide and other businesses shut down,
streets mostly emptied and soldiers handed out millions of face masks.
With a handful of known illnesses at first, the U.S. raced antiflu drugs from a government stockpile — enough for 11
million people — out to every state. After a large outbreak at a New York City school, apparently spread by students who
vacationed in Mexico, U.S. schools
started closing. Ultimately about 468,000 students around the country were
affected before the CDC decided that schools should reopen because the virus
was mild.
Overall, “what happened was not overreaction. It
was a prudent response,” said Michael Leavitt, the Bush administration health
secretary who led development of the U.S. pandemic flu plan and
advised other governments on theirs. “If imminent information about terrorism
is known to authorities, they need to react. A pandemic is sort of nature’s
terrorist.”
Young children tend to be initial spreaders of
regular winter flu, taking it home to family and friends, which is one reason
that school closings are included in pandemic plans. But in this case,
travelers were early spreaders.
“I’m not saying that was the right approach or the
wrong approach, but what we’ve learned is we need to be proportionate in our
response with what the risk is in our community,” said flu specialist Osterholm.
Pandemic or not
The World Health Organization, following its
post-SARS guidelines, declared an international emergency the day after Mexico’s
outbreak made headlines, to spur countries to check where else the new flu
had spread — eventually to two dozen countries and counting.
Days later, the WHO issued an unprecedented
warning: The world was close to a full-fledged pandemic. Sustained spread in
regions beyond North America, rather than
smallish outbreaks, would tip the scale.
For years, the U.S. had run drills. What would
it do if bird flu started rapidly spreading in Asia?
Close the borders to buy a little time. Reality brought a surprise.
The new swine flu started in North
America, too late to close any borders. While the U.S. joined
other countries in discouraging travel to hardest-hit Mexico, and some
nations discouraged travel to the U.S. and Canada, too, once flu starts
spreading in numerous places, such actions have little effect.
Asia
remained largely untouched. China,
no doubt recalling the harrowing days of SARS, tried to keep it that way by
quarantining dozens of Mexicans for days.
Still to come
What happens to all those antiflu
medicines that were shipped to U.S. states but not used? They’re
waiting, under guard, in case they’re needed come fall. Leavitt, the former
health secretary, said that’s the next weakness. Flying in drugs is easy;
getting them to the sick is hard.
“The further into a pandemic you get, the more
spontaneity that’s required and the more lack of preparation reveals itself,”
he said.
Then there’s the vaccine dilemma.
Makers could be told to start brewing doses in a
few weeks. But that will take months and require testing, led by the U.S., of
initial shots to see if they induce immunity, with one dose or two, and seem
safe. The last mass vaccination against a different swine flu, in the U.S. in 1976,
was marred by reports of a paralyzing side effect — and that time the flu
didn’t return.
“One of the lessons of the ’76 experience is to
take account of the uncertainty,” said Institute of Medicine
President Harvey Fineberg.
“Be able to take account of new information to modify your course.”
If vaccine is ordered, would developing countries
get a fair share? The WHO is calling vaccine makers together in late May to
push for fair access. Regardless, any shots will come too late for the
Southern Hemisphere, where influenza season is about to start.
World authorities will closely track the new swine
flu there, for help deciding whether to order vaccinations for the rest of
the world starting in the fall. The big worry is that the virus will mutate,
becoming more severe.
“The thing that’s keeping me up at night right now
is that feeling of dodging the bullet, in the sense that people are taking a
sigh of relief too soon,” the CDC’s Besser told the
AP.
http://www.2theadvocate.com/news/44651572.html
[BACK TO TOP]
Advocate staff report
State health officials said Friday the Centers for
Disease Control and Prevention confirmed two more Louisiana cases of H1N1, or swine flu,
bringing the total of confirmed cases in the state to nine.
The two confirmed cases were students from
Cathedral Carmel School in Lafayette, the first school to close after
officials with the state’s Department of Health and Hospitals believed there
was a cluster outbreak there, according to a DHH news release.
The nine confirmed cases include seven from Lafayette, one from
Ascension Parish and one from Orleans Parish.
The state is still waiting for test results from
the 33 samples sent to the CDC for testing, according to the news release.
All of those with confirmed cases have either
recovered or are recovering at home, the release says. No one in the state
has been hospitalized with the disease.
http://www.2theadvocate.com/news/44629682.html
[BACK TO TOP]
Boston Globe | 05.11.09
By J.M. Lawrence, Globe Correspondent | May 11, 2009
Brendan Maher, a Harvard psychology professor,
took the study of mental illness out of the doctor's offices of the mid-20th
century and into the lab, laying the groundwork for current genetic studies.
"He taught the field to count rather than
simply rate or describe," said Mark F. Lenzenweger,
a psychology professor at the State University of New York at Binghamton.
"Although straightforward, this was a paradigm shift, a transformational
moment for clinical psychology."
Dr. Maher, who lived in Weston for many years and
was dean of the faculty at Brandeis University in the 1960s and later dean of the
Graduate School of Arts and Sciences at Harvard
University, died March 17 of
prostate cancer at his home in Durham,
N.C. He was 84.
"He was a wonderful mentor to students, and
he particularly liked to work on studies that had practical
application," said Courtenay Harding, a Boston University
psychology professor and director of BU's Institute for the Study of Human
Resiliency. She is a former student of Dr. Maher.
Born in Lancashire,
England, Dr.
Maher was a World War II veteran. He joined the Royal Navy in 1942 just
before he turned 18.
In his 1996 memoir, "Passage to Sword Beach,"
he described working as the navigation officer aboard the lead minesweeper
forging the Royal Navy's D-day attack on Sword
Beach in Normandy. The book grew from Mr. Maher's
efforts to transcribe his war diaries for his children.
"He got three pages typed, and I said 'I'll
do it,' " said his wife, Barbara (Wood). "The
book grew with my questions and his memories."
In June 1945, Dr. Maher was wounded while sweeping
mines in Holland
and spent a year in the hospital recovering from an explosion that ravaged
his face and jaw. Plastic surgery saved his appearance, his wife said.
They met after the war at Ohio
State University
in Columbus.
Dr. Maher had earned his undergraduate degree in 1950 from Manchester University
and won a Fulbright Scholarship to study in America.
"They asked him where would
you like to study. He said 'Princeton, Yale, or in Colorado,'
" said his wife, who earned her doctorate in
psychology at Ohio
State. "He had to
look up where Columbus
was."
They were married for 56 years.
"Bren had a great capacity for enjoying life
and enjoying what he did," his wife said. "He was always balanced
by a wonderful sense of humor. He was very witty. He was very light-hearted
but serious at the same time."
As newlyweds, the Mahers
lived in England,
where Dr. Maher worked in the prison system.
Dr. Maher also did research at Northwestern
University, Louisiana State
University, the University of Wisconsin, and the University of Copenhagen.
He pioneered studies on schizophrenia, probing the
nature of disorganized thinking and how delusions form. His 1966 book,
"The Principles of Psychopathology: An Experimental Approach,"
became a landmark text in the field.
He worked at Harvard as a lecturer beginning in
1960 and later took a post at Brandeis. He enjoyed talking about his days as
the Irish dean at a Jewish-founded university, his friends said. It was a
good fit, he told them.
In 1972, he returned to Harvard, where he spent
the rest of his career in the psychology department. He twice served as
chairman of the department and taught undergraduates through stories
sometimes laced with Celtic wisdom.
At Harvard, he was known as "a statesman of
first rank," Lenzenweger said. "Those
faced with the thorny and sometimes fractious complexities of academic life
often sought out Brendan for guidance and wisdom."
In addition to his wife, Barbara, Dr. Maher leaves
his daughter, Rebecca of Durham; four sons, Thomas of Chapel Hill, N.C.,
Nicholas of Atlanta, Liam of Amsterdam, and Niall of New York City; and five
grandchildren.
A memorial service is planned for 2 p.m. Sept. 25
in The Memorial Church at Harvard.
http://www.boston.com/bostonglobe/obituaries/articles/2009/05/11/brendan_maher_84_mental_health_pioneer/
[BACK TO TOP]
The New York Times | 05.10.09
By KEVIN SACK
Thanks to patients who still value their health in
hard times, the recession has barely slowed the growth of concierge medical
practices, which charge hefty membership fees for highly personalized care
and around-the-clock access.
From Seattle, where
the movement began in 1996, to South Florida,
where its largest concern is now based, physicians with boutique practices
say they are losing far fewer patients for financial reasons than they had
expected. While some new practices are not filling as quickly as they might,
they continue to attract a steady flow of patients willing to pay thousands
of dollars for the privilege.
The practices typically charge at least $1,500 a
year, with the most elite services asking $25,000 or more per family. The
fees cover a thorough physical exam and enable physicians to limit the number
of patients they see so they can provide premier service.
Doctors give patients their cellphone
numbers and schedule leisurely same-day appointments with no waiting. Some
make house calls, though patients still need health insurance to pay for
hospitalizations and specialists.
Most of the 20 physicians and executives
interviewed said that a small number of patients had decided not to re-enroll
in recent months, citing lost jobs or devalued portfolios. They tend to be
like Susan Schwartzman, a book publicist from Yonkers who said she had given up her
concierge doctor because of declining income, but only after first canceling
her gym membership and swearing off restaurants.
For the most part, however, boutique practices
have shown resiliency. Doctors said the recession seemed to have reaffirmed
the importance of health care to their patients. With jobs scarce and stress
at a peak, many may see a link between continued health and continued
employment. And with savings depleted, they recognize that assiduous
preventive care may help them avoid costly chronic conditions and
hospitalizations.
“It’s the old penny-wise, pound-foolish thing,”
said Dr. C. Scott Molden, who practices internal
medicine in St. Louis
with MDVIP, the largest consortium of fee-based doctors. “I tell people, ‘You
cannot afford to not be in my practice. You cannot afford to be sick, even
with insurance.’ What I’m offering is to keep people out of hospitals.”
Ted McCallum of Newtown,
Conn., said that after losing his job as a
hotel manager in June, he decided to stick with his MDVIP doctor, Robert L. Ruxin of Ridgefield,
because their 20-year relationship provided stability in unsettling times.
“It did involve forgoing some of the luxuries I’ve
gotten used to,” Mr. McCallum, 57, said about losing his job. “But I wasn’t
willing to forgo this one.”
“As the saying goes, If you have your health,
you’re a rich man,” he added.
Similarly, Janet K. Yerta,
an 82-year-old retiree in Atlanta,
has remained with her MDVIP physician, Dr. T. Kirkland Garner, despite
watching her investment income wither. “I’m not one of those people that’s running over with money,” she said. “But there are
two things I value: my salvation and my health.”
Critics of concierge medicine consider it elitist
and say it has widened the already significant class disparities in American
medicine. They also say it has exacerbated the shortage of primary care
physicians by leaving more patients to be treated by a shrinking pool of
doctors.
But advocates counter that the concierge movement
reflects deep exasperation with the two-hour waits and 10-minute appointments
of conventional primary care. Given the burnout among physicians who must see
more than two dozen patients a day, they say the concierge model may sustain
doctors who would otherwise hang up their stethoscopes.
Dr. Thomas W. LaGrelius
of Torrance, Calif.,
who leads the Society for Innovative Medical Practice Design, a professional
association of concierge physicians, estimated that there were 5,000 such
doctors in the United
States, out of an estimated 240,000
internal medicine physicians and related subspecialists.
MDVIP, which started in Boca Raton, Fla.,
in 2000, expects to add more than 80 doctors to its network of 300 this year,
said Darin Engelhardt, the firm’s president. The
company is privately held and does not release detailed membership data, but
Mr. Engelhardt said that renewal rates among its
100,000 patients had remained at its usual level of 93 percent a year during
the recession. Each MDVIP doctor is limited to 600 patients, who each pay
$1,500 to $1,800 a year.
“I’m happily able to report that we have not seen
any adverse impact from the economy,” Mr. Engelhardt
said. “What we’ve been told by patients is that during difficult times like
this, they are reassessing their priorities and that their health care needs
come to the forefront.”
Dr. Dragan Djordjevic, a Chicago
physician who affiliated with MDVIP two years ago, said he had expected a lot
of dropouts. “Every day, patients would come in and talk about how the
economy was killing them,” he said. “So naturally, I’d go home thinking they
were going to cancel.”
But Dr. Djordjevic said
that he had lost perhaps only five patients from 600 since the beginning of
the year, and that they had been easily replaced from a waiting list of more
than 100.
Peter W. Hoedemaker, the
chief executive of MD², a concierge medical provider based near Seattle, said the company had been pleasantly surprised
by patient enrollments at its new office in Chicago. The five MD² practices, each with
two doctors, charge $25,000 per family and limit each doctor to 50 families.
About a dozen openings remain in Chicago, Mr. Hoedemaker said, far fewer than projected, and the group
is looking to expand to New York
City.
As the economy crumbled last fall, Dr. Cynthia L.
Williams of Torrance
worried about the unfortunate timing when she sent letters in November
informing her 2,200 patients that she would be converting to a $2,000-a-year
concierge practice. Nonetheless, she said, she had signed up 315 patients and
was adding one a week. “On my busiest day I’m seeing 14 patients, but on a
lot it’s eight,” she said. “In the old practice, I was booked about one
patient every 12 minutes, about 25 to 30 a day. I love it, and I think my
patients love it.”
Many of the doctors boasted of their ability to
keep patients out of emergency rooms by intervening by phone for conditions
like diverticulitis or an abnormal heart rhythm. They said their deep
knowledge of their patients helped them detect subtle changes and danger
signs.
“A close personal relationship with a physician is
not something that’s easy to find anymore,” said Dr. David L. Elliott, an
MDVIP physician in Phoenix.
“People find it valuable.”
http://www.nytimes.com/2009/05/11/health/policy/11concierge.html?_r=1&ref=health
[BACK TO TOP]
The New York Times | 05.10.09
By ROBERT PEAR
WASHINGTON
— Doctors, hospitals, drug makers and insurance companies will join President
Obama on Monday in announcing their commitment to a sharp reduction in the
growth of national health spending, White House officials said Sunday.
The officials said the plan could save $2,500 a
year for a family of four in the fifth year and a total of $2 trillion for
the nation over 10 years. That could make it less expensive for Congress to
enact comprehensive health insurance coverage, a daunting challenge facing
the Obama administration.
At this point, administration officials said, they
do not have a way to enforce the commitment, other than by publicizing the
performance of health care providers to hold them accountable.
By offering to hold down costs voluntarily,
providers said, they hope to stave off new government price constraints that
might be imposed by Congress or a National Health Board of the kind favored
by many Democrats.
In remarks prepared for delivery to health care
providers on Monday, Mr. Obama says: “These groups are voluntarily coming
together to make an unprecedented commitment. Over the next 10 years, from
2010 to 2019, they are pledging to cut the growth rate of national health
care spending by 1.5 percentage points each year — an amount that’s equal to
over $2 trillion.”
“Reform is not a luxury that can be postponed, but
a necessity that cannot wait,” Mr. Obama says.
In a letter addressed to Mr. Obama, six leaders of
the health care industry say: “We will do our part to achieve your
administration’s goal of decreasing by 1.5 percentage points the annual
health care spending growth rate, saving $2 trillion or more. This represents
more than a 20 percent reduction in the projected rate of growth.”
The letter was signed by executives of the
Advanced Medical Technology Association, a lobby for medical device
manufacturers; the American Hospital Association; the American Medical
Association; America’s
Health Insurance Plans, a trade group for insurers; the Pharmaceutical
Research and Manufacturers of America; and the Service Employees
International Union.
Signers of the letter said that large amounts
could be saved by aggressive efforts to prevent obesity, coordinate care,
manage chronic illnesses and curtail unnecessary tests and procedures; by
standardizing insurance claim forms; and by increasing the use of information
technology, like electronic medical records.
Administration officials said private insurers and
government programs could also save money by paying for entire episodes of
care, rather than for each service separately.
An administration official, speaking in a conference
call on Sunday, said, “The savings are crucially dependent on getting health
care reform done this year.” The administration insisted that the official
not be identified.
Some of the savings could be achieved by voluntary
action in the private sector. But most of the savings in Medicare and
Medicaid could not be achieved without changes in federal law and
regulations.
In the abstract, slowing the growth of health
spending is a goal on which consumers and health care providers agree. But
experience shows that specific proposals touch off fierce battles among
interest groups fighting to expand their share of health care money.
In a relatively rosy forecast, the White House
said Sunday that the savings from a more efficient health care system would far
exceed the costs of achieving universal health coverage, with federal
subsidies for people who could not afford insurance on their own.
The Department of Health and Human Services
estimates that health spending will grow an average of 6.2 percent a year in
the coming decade, to $4.4 trillion in 2018 from $2.4 trillion last year.
Health care now accounts for about 17 percent of
the overall economy and, with no change in existing law, the share will grow
to 21 percent in 2019, administration officials said. The commitments made by
health care providers would hold down the share to 18 percent of the economy,
and that difference is equivalent to savings of nearly $700 billion in 2019
alone, the officials said.
The goal set forth in the letter resembles a proposal
made in December by America’s
Health Insurance Plans, the lobby for insurers like Aetna,
Humana, UnitedHealth and WellPoint. Administration officials said the idea
was broached to them by Dennis Rivera, coordinator of the health care
campaign of the Service Employees International Union.
In a report being sent to Congress on Monday, two
research and advocacy groups, the Center for American Progress and the
Democratic Leadership Council, say that productivity growth in health care
has lagged behind that of other industries.
The government could save nearly $600 billion over
the next decade if the health care industry increased its productivity growth
by 1.5 to 2 percentage points a year, said the report, by David M. Cutler, a
Harvard economist.
http://www.nytimes.com/2009/05/11/health/policy/11drug.html?ref=health
[BACK TO TOP]
The New York Times | 05.09.09
By GARDINER HARRIS and LAWRENCE K. ALTMAN
There have been few more dramatic moments at the
World Health Organization than the late-night gathering on April 29 when Dr.
Margaret Chan, its powerful director general, declared that the human race
was in peril.
“After all, it really is all of humanity that is
under threat during a pandemic,” Dr. Chan said to the world’s gathered news
media.
In the days since her announcement, concerns about
the swine flu outbreak have eased around the globe. The Centers for Disease
Control and Prevention has advised that schools reopen. And coverage of the
flu outbreak no longer dominates cable news shows.
But Dr. Chan has yet to relax the alert level of
the organization, the public health arm of the United Nations. That is
because the warning system is based on how far the virus has spread, not its
lethality. While most praise the actions of Dr. Chan and the W.H.O. in the
current outbreak, some have said that the organization needs to adjust its
warning system to reflect what is known about the severity of the spreading
illness.
“The W.H.O. needs a mechanism to dial down the
anxiety levels while educating us about the extent of the transmission,” said
Dr. William Schaffner, chairman of the preventive
medicine department at Vanderbilt
University.
In an interview, Dr. Chan said she had been guided
in her recent decisions by her experiences during the 2003 outbreak of severe
acute respiratory syndrome, or SARS, in Hong Kong,
where she led the Health Department.
“That helped me to understand that managing a high
pressure crisis that affects life and suffering of so many people, I need to
approach it with a sense of urgency,” she said.
Rules adopted in 2005 by the W.H.O., based in Geneva, have made Dr.
Chan perhaps the most powerful international public health official in
history. She no longer must beg for cooperation from national authorities but
can demand information about threats to global health.
All of this authority is packed into a diminutive
woman with large glasses who does not drive, type or cook, is fond of sharp
suits and silver pins, and may be among the most qualified people in the
world to lead the global response to the threat of a pandemic flu.
“She is superbly qualified to deal with
emergencies like the one we have been living through,” said Dr. Julio Frenk, dean of the Harvard School of Public Health who
was Dr. Chan’s chief rival when she won the top W.H.O. post in 2006.
And it all started because her boyfriend decided
to move to Canada.
Born in 1947, Dr. Chan grew up in Hong Kong and became a teacher. When David Chan, who
would become her husband, left Hong Kong for college in Canada in
1969, she worried that the separation would end their relationship. So she
consulted her mother, who told her to follow her heart to Canada.
Then, when he decided to become a doctor, she
worried that his medical studies would leave him no time for her. So she
decided to become a doctor with him. But first, she had to win over a dean at
the University
of Western Ontario who,
in her admissions interview, told her that she should become a homemaker, not
a doctor.
She studied pediatrics and joined the Hong Kong
Health Department in its maternal and child health group in 1978. She rose
quickly to become the department’s leader and faced a terrible decision in
1997 when an outbreak of avian influenza threatened the population. Fresh
poultry is a Hong Kong staple, but Dr. Chan
ordered the region’s population of 1.4 million chickens and ducks
slaughtered. The outbreak ended.
Public health experts who witnessed her handling
of SARS gave her high marks.
“When I saw her then, she’d been getting three to
four hours of sleep a night for weeks,” said Dr. Jeffrey P. Koplan, a former director of the C.D.C. “They did what
they needed to do.”
Dr. Chan was later criticized by some in Hong Kong for failing to respond quickly enough to the
2003 SARS epidemic, although a panel of experts supported her leadership. Her
rapid and urgent response to an infectious threat from Mexico last
month grew out of that experience, several who knew her said.
In 2005, rules adopted by the W.H.O. gave the
director general complete authority to change the global pandemic alert
level.
“She is the first director general who has been
able to wield these new powers,” said Dr. David L. Heymann,
who recently left the organization to become chairman of the Health
Protection Agency in Britain.
“She has the most powerful mandate ever.”
In her announcement on April 29, Dr. Chan made it
clear that she alone had decided to raise the pandemic alert. In an
interview, she said there would always be uncertainty about new disease
threats.
“With any new disease, it’s difficult to
understand the full picture,” she said. “One has to be modest to understand
that we are competing against an enemy, the virus. And trying to understand
it and reduce the anxiety of the world and reduce the suffering of people,
that’s not easy.”
The W.H.O. will analyze its own response to the
swine flu outbreak and adjust its system, Dr. Frenk
said. Many predicted that the organization would find some way to reflect the
severity, and not just the geographic reach, of a new threat.
“They need that other dimension,” said Dr. Harvey
V. Fineberg, president of the Institute of Medicine.
But the health organization and Dr. Chan in particular
performed well, nearly a dozen flu experts said. After all, initial reports
from Mexico
suggested that swine flu was both lethal and highly infectious. Only when the
disease spread to the United
States did it become clearer that it was
not as dangerous as feared.
“The world’s response in a 10-day period was
remarkable,” said Dr. Michael T. Osterholm,
director of the Center for Infectious Disease Research and Policy at the University of Minnesota, “and W.H.O. deserves credit
for being a big part of it.”
http://www.nytimes.com/2009/05/10/health/10chan.html?ref=health
[BACK TO TOP]
The New York Times | 05.08.09
By DONALD G. McNEIL Jr.
Underlying conditions like asthma, diabetes, heart
disease or tuberculosis appear to put swine flu victims at greater risk of
hospitalization or death, doctors from the World Health Organization and the
Centers for Disease Control and Prevention said Friday.
Health officials emphasized that the observations
were preliminary and based on discussion of only about 40 deaths in Mexico and half of the 57 hospitalizations in
the United States.
But a few trends have begun to emerge.
Some of the serious cases involve healthy young
people, and the reasons for that are still unexplained. Many of the patients
went into rapid decline and died of viral pneumonia, not bacterial pneumonia,
said Dr. Sylvie Briand, a W.H.O. flu expert. Viral pneumonia may be a result
of the “cytokine storm,” in which the body’s own immune reaction to a new
virus floods the lungs with fluid. It can progress faster and be harder to
treat than bacterial pneumonia.
Dr. Richard E. Besser,
the acting director of the C.D.C., said most of the hospitalized Americans
had an additional health problem. In seven cases it was asthma, which is
worrying because asthma has become quite common in the United States.
So has diabetes, which is linked to America’s epidemic of obesity, he
said. Seasonal flu has always been dangerous for those with cardiovascular
problems, which are unusual among the young.
Active tuberculosis is much less common in the United States
than in poor countries.
The W.H.O. said it was aware of more than 2,500
laboratory-confirmed cases of the new swine flu in 25 countries. The C.D.C.
said there were 1,639 confirmed cases in 42 states and 850 cases that state
officials considered probable. Many mild cases are presumed to be going
untested.
Canada
reported its first death linked to swine flu on Friday.
The victim, a woman from a remote part of Alberta, was in her
30s and had an additional medical problem, which officials did not identify.
She died April 28, and her tissues were tested for the virus only because an
elderly relative who lived with her had tested positive for it this week.
“It is not clear to what extent H1N1 may or may
not have contributed to her death,” Dr. André
Corriveau, Alberta’s
chief medical officer, said, using another name for the virus.
The swine flu has made many Americans more careful
about washing their hands and using sanitizers, the Harvard School of Public
Health reported Friday as it released a poll it took at the behest of the
Centers for Disease Control.
Two-thirds of those polled said they had been cleaning
their hands more often, as the C.D.C. suggests, and 55 percent said they had
made preparations for keeping sick family members home. The poll, which
involved telephone interviews with 1,013 people last Tuesday and Wednesday,
has a margin of sampling error of plus or minus four percentage points.
Asked about actions not endorsed by the Centers
for Disease Control, one-quarter of the respondents said they avoided air
travel or large public gatherings, 16 percent said they avoided people who
had recently visited Mexico,
and 13 percent said they avoided Mexican restaurants or stores.
While 61 percent said they were not worried that
they or a family member would get the flu in the next year, 77 percent said
they were closely following news reports about the outbreak. Half the parents
polled complained that their children’s schools had not given them enough
information. Officials got high marks: 88 percent of those polled said they
were very or somewhat satisfied with information given by public health officials.
Dr. Besser seemed less
satisfied with the lessons gleaned from that information. He was worried, he
said at a news conference, that the public had “a sense of having dodged a
bullet, a sense that this is over.”
Flu takes months to spread, he noted. “And while
we’ve seen a lot of encouraging news in terms of severity,” he said, “we
continue to see hundreds and hundreds of new cases each day.”
Ian Austen contributed reporting from Ottawa.
http://www.nytimes.com/2009/05/09/health/09flu.html?ref=health
[BACK TO TOP]
The New York Times | 05.08.09
By RONI CARYN RABIN
Even as the U.S. Labor Department released figures
showing that the economy lost more than half a million jobs in April,
researchers on Friday made public a large study with an unsettling finding:
Losing your job may make you sick.
A researcher at the Harvard School of Public
analyzed detailed employment and health data from 8,125 individuals surveyed
in 1999, 2001 and 2003 by the U.S. Panel Study of Income Dynamics.
Workers who lost a job through no fault of their
own, she found, were twice as likely to report developing a new ailment like
high blood pressure, diabetes or heart disease over the next year and a half,
compared to people who were continuously employed.
Interestingly, the risk was just as high for those
who found new jobs quickly as it was for those who remained unemployed.
Though it’s long been known that poor health and
unemployment often go together, questions have lingered about whether
unemployment triggers illness, or whether people in ill health are more
likely to leave a job, be fired or laid off.
In an attempt to sort out this chicken-or-egg
problem, the new study looked specifically at people who lost their jobs
through no fault of their own — for example, because of a plant or business
closure.
“I was looking at situations in which people lost
their job for reasons that...shouldn’t have had anything to do with their
health,” said author Kate W. Strully, an assistant
professor of sociology at State University of New York in Albany, who did the
research as a Robert Wood Johnson Foundation scholar at the Harvard School of
Public Health. “What happens isn’t reflecting a prior condition.”
Only 6 percent of people with steady jobs
developed a new health condition during each survey period of about a year
and a half, compared with 10 percent of those who had lost a job during the
same period. It didn’t matter whether the laid off workers had found new
employment; they still had a one in 10 chance of developing a new health
condition, Dr. Strully found.
David Williams, a professor at the Harvard School
of Public Health who was not involved in the research, said the study is a
reminder that job loss and other life stressors have a tremendous impact on
both mental and physical health and contribute to the development of chronic
conditions.
"We know that stress affects health,"
said Dr. Williams, formerly director of the Robert Wood Johnson Foundation
Commission to Build a Healthier America. "It causes changes in
physiological function in multiple ways, and it can lead to alterations in
health behavior. People no longer exercise, they eat more, they
drink more. People who smoke, smoke more on high
stress days.”
“There is a lot of focus on the economic downturn,
but there is not much attention being paid to the health consequences of the
downturn,” he added. “This study shows that it does not take a long sustained
period of unemployment to see health effects.”
http://www.nytimes.com/2009/05/09/health/09sick.html?ref=health
[BACK TO TOP]
The New York Times | 05.08.09
By REED ABELSON
It is one of the biggest avoidable costs on the
nation’s medical bill.
Millions of patients each year leave the hospital
only to return within weeks or months for lack of proper follow-up care. One
in five Medicare patients, for example, returns to the hospital within 30
days. Over all, readmissions cost the federal government an estimated $17
billion a year.
But even when hospitals find ways to greatly
reduce the return trips, saving money for Medicare and other insurers, their
efforts go unrewarded. In fact, because insurers typically pay hospitals to
treat patients — not to keep them away by keeping them healthy — hospitals
can actually lose money by providing better care. Empty beds mean lost
revenue.
As Congress debates health care, some policy
experts say no meaningful improvement can be made without changing the
payment system so medical centers have more financial incentive to help
people stay out of the hospital.
“The hospitals who say they are penalized for
doing the right thing are absolutely right,” said
Dr. Robert Berenson, a policy specialist at the Urban Institute, an economic
and social policy research center in Washington.
“If we can’t do this, we can’t do much of anything in health reform.”
Attuned to the issue, two Senate leaders of the
effort to overhaul health care, Max Baucus, Democrat of Montana, and the
Charles E. Grassley, Republican of Iowa, recently announced their support for
changing the way hospitals are paid, to reward them — instead of punishing
them — for reducing the number of patients requiring readmission.
Medical providers all too familiar with the
financial double bind include Park Nicollet Health Services, a hospital and
clinic system based in St. Louis Park, Minn. Park Nicollet started tackling
the readmission problem four years ago, spending as much as $750,000 annually
on more nurses and on sophisticated software to track heart failure patients
after they left the hospital. It reduced readmissions for such patients to
only 1 in 25, down from nearly 1 in 6.
But the reduction has been a losing proposition.
Although the effort saved Medicare roughly $5 million a year, Park Nicollet
is not paid to provide the follow-up care. Meanwhile, fewer returning
hospital patients mean lower revenue for Park Nicollet.
“We’ve kept it up out of a sense of moral
obligation to these patients, but we’re getting killed,” said David K. Wessner, chief executive of Park Nicollet. “We will
totally run out of gas.”
Another hospital system, Catholic Healthcare Partners
in Cincinnati,
has dropped a similarly successful follow-up program. The hospital said it
did so because it could not afford the additional expense of keeping heart
failure patients out of the hospital. Medicare officials argue that hospitals
and doctors should already be doing what is best for patients. And they say
some simple steps could be adopted at little expense, such as making sure
patients get a list of the medications they should take after leaving the
hospital. But Medicare, the Obama administration and some members of Congress
now at work on health care legislation have acknowledged the need to change
the payment system.
“Ultimately, we have a reimbursement system for
health care that is not aligned all the time with providing high-quality
care,” said Dr. Barry M. Straube, the chief medical
officer for Medicare. “Unequivocally, there has to be payment reform.”
At Park Nicollet, the key to reducing readmissions
is an early-warning system that signals when heart failure patients’ symptoms
are starting to worsen.
All the heart patients in the program weigh
themselves daily at home and answer a few simple questions, like whether they
are short of breath. They punch this information into their telephone
keypads. If the data indicate a possible decline in a patient’s condition,
the software system alerts a nurse, who follows up with the patient.
Patients include Adeline Patyk,
85, and her husband, Chester,
83. If they begin to retain fluid, causing their weight to spike, or if they
report that their ankles are beginning to swell, they can get help before
their symptoms reach the point that they must go to the hospital. The nurse
might suggest an adjustment to their medications, for example, or send them
to a doctor.
“We don’t have to go to the hospital so often,”
Mrs. Patyk said. “That means a lot.”
Judy Ryan, a nurse who helps oversee the program,
says that it works. “We can really abort that terrible experience of the
emergency room, ultimately the I.C.U.,” Ms. Ryan said.
As part of a Medicare experiment to reduce
readmissions, Park Nicollet earned a bonus of $247,000 in 2008 — but that
payment equaled only about a third of the cost of running the program that
year. Park Nicollet, which a few years ago had 640 patients enrolled in the
program, has reduced enrollment to 380 — the patients at highest risk of
being readmitted.
Other hospitals have had similar success. With the
help of a federal grant, from 2002 to 2006, Catholic Healthcare Partners
hired six nurses to oversee the care of its high-risk heart failure patients.
Return visits dropped sharply. But when that grant
ended, officials at the hospital said, they could not persuade insurers to
pay for the program, so they eventually ended it.
Pressed by the growing need to care for patients
who cannot pay their bills, Michael D. Connelly, chief executive of Catholic
Healthcare, said his organization had little choice. He says insurers need to
develop new ways of paying hospitals, like bundling payments so a patient’s
hospital stay includes follow-up care. “One of my frustrations is it’s taking so long to do this,” he said.
The problem with the current insurance system,
some experts say, is that there is no payoff for hospitals and doctors who
invest in new ways of providing care.
“The payer reaps the entire benefit,” said Harold
D. Miller, the executive director for the Center for Healthcare Quality and
Payment Reform, a nonprofit group in Pittsburgh.
Mr. Miller says there are payment models in which
hospitals could share in the savings from better care, or could be paid more
by providing some sort of warranty on their care — as the Geisinger
Health System in Pennsylvania
has tried to do with heart operations.
The Obama administration has already discussed
reducing Medicare payments to hospitals with the highest readmission rates,
and the Senate is discussing bundling payments.
Something has to change, said Mr. Wessner at Park Nicollet. He says he understands that
health systems like his may eventually have to learn to live with more empty
beds. But he says hospitals also need to be rewarded for investing in
programs that keep patients out of the hospital — instead of pouring more
money into new facilities meant to bring in more patients.
“There’s got to be a business case and a return on
investment in new patterns of care,” Mr. Wessner
said.
http://www.nytimes.com/2009/05/09/business/09relapse.html?ref=health
[BACK TO TOP]
