By MARSHA SHULER
Advocate Capitol
News Bureau
A Louisiana House
panel put its blessing Thursday on LSU negotiations with Our Lady of the Lake Regional
Medical Center
for a potential home for its medical education programs.
The Health and
Welfare Committee — without objection — approved Senate Concurrent Resolution
130 sponsored by state Sen. Sharon Broome, D-Baton Rouge.
LSU and the Lake
are discussing a public-private partnership which would lead to the eventual
closure of LSU’s antiquated Earl K. Long Medical Center
in north Baton Rouge.
LSU physician
training programs and patient care for the poor and uninsured would move to
the Lake — located near I-10 off Essen Lane — from
EKL.
“This is a step in
the direction of making sure that we have a quality facility that I believe
our patients certainly deserve,” said state Rep. Regina Barrow, D-Baton
Rouge.
For years, EKL’s facilities have been substandard and in need of
replacement, she said.
“With the current
finances of the state, we are looking at a cooperative endeavor” with the Lake instead of new hospital construction, Barrow said.
The resolution
also allows LSU to pursue other alternatives, she said.
Legislative
approval of the resolution is being sought to make lawmakers aware of the
potential partnership and elicit their support, said LSU System Vice
President Fred Cerise, who oversees medical education and hospitals.
Cerise said LSU
and the Lake are working on a cooperative endeavor
agreement to implement the general deal that is outlined in the resolution.
If accord is reached, the agreement would require approval of the Joint
Legislative Committee on the Budget, Cerise said.
Then, probably
another two years down the road, LSU would need legislative authority to
actually close EKL as an in-patient hospital, Cerise said. In the meantime, a
60-patient addition would have been constructed and ready to receive patients
that today go to EKL, he said.
EKL is facing
potential loss of hospital and medical education accreditation from national
groups because of conditions at the Airline
Drive facility, Barrow said.
“There needs to be
something written that there’s some progress toward a solution,” said Barrow.
Cerise said
there’s $24 million in the state construction program for hospital planning
and land acquisition.
The resolution
tells accrediting agencies “that we plan to do something different,” Cerise
said.
LSU and the Lake have signed a memorandum of understanding setting
out in general terms what is expected of all parties to the agreement.
Negotiations are
continuing that now involve Gov. Bobby Jindal’s
administration with a goal of reaching a cooperative endeavor agreement by
Sept. 30.
Before approving
SCR130, the panel stripped the measure of any reference to capital costs that
may be associated with LSU moving its operations to the Lake’s
campus.
Supporting the
measure in committee were representatives of the Catholic Health Association
and the Baton Rouge Area Chamber.
The legislation
now heads to the House floor for debate.
http://www.2theadvocate.com/news/48572607.html
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By Jan Moller
Capital bureau
BATON ROUGE -- The
$1.2 billion teaching hospital proposed for lower Mid-City would be owned by
Louisiana State University and operated by a nonprofit corporation with
representation from LSU, Tulane, Xavier and other New Orleans schools under a
draft agreement unveiled Thursday by Gov. Bobby Jindal's
administration.
The proposed
memorandum of understanding is the result of more than 30 hours of
negotiations during the past three weeks and attempts to break a lengthy
logjam between Tulane and LSU about how the 424-bed hospital should be run.
Health and
Hospitals Secretary Alan Levine said the agreement "represents the best
that we could come up with" and needs to be ratified by the schools
before planning for the hospital can continue.
"Tulane and
LSU need each other, and we need both of them," Levine said at a meeting
with reporters to present the 15-page governing blueprint.
The Tulane Board
of Trustees has scheduled a meeting today at 3:30 p.m.to
take up the matter, while the LSU Board of Supervisors will discuss the
document on Monday.
It is far from
clear whether the draft will be acceptable to the two schools, which have
bickered for months about everything from the distribution of board
appointments and residency slots to what the new hospital should be called.
Dr. Fred Cerise,
LSU's vice president for health care, declined to comment about the specifics
of the agreement until it has been presented to his board. "There are a
lot of elements in there that our board has seen before. But there's a lot
that they haven't seen," Cerise said.
Tulane University spokeswoman Debbie Grant reserved comment
until after her board meets this afternoon.
The proposal calls
for the hospital to be run by an LSU-affiliated nonprofit that would be ruled
by a 12-member board of directors, consisting of seven permanent and five
"non-permanent" members.
Four of the
permanent members would be appointed by the LSU board, while Tulane and
Xavier would each have one appointment. The seventh permanent seat would
rotate between Delgado, Dillard and Southern universities, each serving a
two-year term.
The five
"non-permanent" members would initially be selected by the
secretary of Health and Hospitals and the governor's commissioner of
administration and voted in by the permanent members. The non-permanent
members would have to be independent of any of the affiliated schools and
would have to have professional expertise relevant to running an academic
medical center, such as finance, medicine or health care law.
The medical center
would be called University
Medical Center,
and the main building would be called the Rev. Avery C. Alexander Hospital.
The agreement states the "branding" of the hospital must reflect
that the medical center is part of the LSU system and is a teaching hospital
for Tulane.
Medical residency
slots would be divided the same way as before Hurricane Katrina, with 200 for
Tulane and 373.26 slots for LSU.
Levine said it is
important that the corporation be structured at arm's length from the state,
so it can borrow money for construction of the hospital without affecting the
state's debt limit.
"You've got
to have an organization that's outside the state's debt cap," Levine
said.
If the university
boards fail to ratify the agreement, Levine said there is still time left in
the legislative session to try to pass a bill by House Speaker Jim Tucker, R-Algiers, that creates an independent board in state law.
But if the memorandum is approved, Levine said Tucker's House Bill 830 will not
be necessary.
"That
legislation becomes very important if we can't reach agreement," Levine
said.
http://www.nola.com/news/t-p/capital/index.ssf?/base/news-7/1245388827317980.xml&coll=1
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By MARSHA SHULER
Advocate Capitol
News Bureau
The state’s health
chief Thursday released a proposed “draft” agreement that would create a
private, nonprofit organization to finance and operate a planned $1.2 billion
academic medical center in New
Orleans.
The corporation
would be affiliated with LSU, but it would have an independent board of
directors.
Under the draft
agreement, LSU would own the medical center and lease it to the corporation.
The new center would replace the LSU public hospitals in New Orleans, known as the University and
Big Charity.
State Department
of Health and Hospitals Secretary Alan Levine said the proposed “memorandum
of understanding” is an attempt to settle differences between LSU and Tulane University
— both of which would have physician training programs at the New Orleans public
facilities.
“We need LSU and
Tulane working together,” said Levine.
The proposed pact
culminates some 30 hours of intense negotiations on governance issues over
the last three weeks among the state, LSU and Tulane University
officials, Levine said.
“It’s the best we
could come up with,” said Levine as he reviewed the proposal with reporters.
The proposed
agreement now must be ratified by the LSU Board of Supervisors and Tulane University board. Then the parties
would iron out a cooperative endeavor agreement that would require legislative
budget panel approval.
Still up in the
air is financing of the project, which is tied up in a dispute with the
federal government over reimbursement for damages done to Charity Hospital
during Hurricane Katrina.
Levine said the
state may end up having to go to court over the $492 million it claims it is
owed by federal government.
The medical center
would be a part of a complex that would also include a federal Veterans
Administration hospital.
The LSU Board has
called a special Monday meeting to consider the proposal.
LSU System Vice
President Fred Cerise said LSU and Tulane had agreed to withhold comment
until their boards act. Levine said he hopes those approvals will come by
Monday.
The document would
settle medical center governance issues that provoked House Speaker Jim
Tucker, R-Terrytown, to file governance plan
legislation that LSU opposed, Levine said.
Levine said LSU
and Tulane both have important roles to play at the medical center in the
training of future physicians and other medical professionals and in medical
research activities.
The agreement spells
out that LSU would have 373 residency — or physician
in training — positions while Tulane would have 200 at the facility.
But a 12-member
board would be in charge of the hospital business operations, he said. It’s a
model used by other successful medical centers around the nation, he said.
Four of its
members would be appointed by LSU, one by Tulane, one by Xavier and another
on a rotating basis by Delgado, Dillard and Southern — all of whom have
training programs.
Another five board
members without any affiliation to the universities would round out the
board. They would have to be experts in finance, health care, medicine and
the like.
Originally, LSU
wanted sign-off on board members and had protested Tulane’s presence on the
board because the university has a part-ownership in a private New Orleans area
hospital.
http://www.2theadvocate.com/news/48571157.html
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LaPolitics
Weekly | 06.19.09
By John Maginnis
HealthSecretary Alan Levine, a University of Florida
alumnus, has experienced more of the LSU-Tulane rivalry than he ever wanted
to see. On Thursday, he was relieved
to announce an accord between the two schools over governance of the proposed
$1.2 billion research and teaching hospital in New Orleans. Levine estimated he negotiated through 30
hours of meetings between representatives of both boards.
At the bottom
line, Tulane will get a seat on the to-be-formed governing board for the
hospital where its residents will train, but LSU medical officials will
control the business operation. Both
university boards will meet in the coming days to consider a draft memorandum
of understanding concerning the new hospital.
The resolution
also ends legislative consideration of a bill by Speaker Jim Tucker to
transfer control of the medical center from LSU to an independent board. He has requested that his bill, seen as leverage
to nudge LSU toward an agreement, not be heard by the Senate Health Committee.
[BACK TO TOP]
By MARSHA SHULER
Advocate Capitol
News Bureau
The state’s health
chief Thursday released a proposed “draft” agreement that would create a
private, non-profit organization to finance and operate a planned $1.2
billion academic medical center in New
Orleans.
The corporation
would be affiliated with LSU but it would have an independent board of
directors.
Under the draft
agreement, LSU would own the medical center and lease it to the corporation.
The new center would replace the LSU public hospitals in New Orleans, known as the University and
Big Charity.
State Department
of Health and Hospitals Secretary Alan Levine said the proposed “memorandum
of understanding” is an attempt to settle differences between LSU and Tulane University
— both of which would have physician training programs at the New Orleans public
facilities.
“We need LSU and
Tulane working together,” said Levine.
The proposed pact
culminates some 30 hours of intense negotiations on governance issues over
the last three weeks among the state, LSU and Tulane University
officials, Levine said.
“It’s the best we
could come up with,” said Levine as he reviewed the proposal with reporters.
The proposed
agreement now must be ratified by the LSU Board of Supervisors and Tulane University board. Then the parties
would iron out a cooperative endeavor agreement that would require
legislative budget panel approval.
Still up in the
air is financing of the project, which is tied up in a dispute with the
federal government over reimbursement for damages done to Charity Hospital
during Hurricane Katrina.
Levine said the
state may end up having to go to court over the $492 million it claims is
owed by federal government.
The medical center
would be a part of a complex that would also include a federal Veterans
Administration hospital.
The LSU Board has
called a special Monday meeting to consider the proposal.
LSU System Vice
President Fred Cerise said LSU and Tulane had agreed to withhold comment
until their boards act. Levine said he hopes those approvals will come by
Monday.
The document would
settle medical center governance issues that provoked House Speaker Jim
Tucker, R-Terrytown, to file governance plan
legislation that LSU opposed, Levine said.
Levine said LSU
and Tulane both have important roles to play at the medical center in the
training of future physicians and other medical professionals and in medical
research activities.
The agreement
spells out that LSU would have 373 residency — or
physician in training — positions while Tulane would have 200 at the
facility.
But a 12-member
board would be in charge of the hospital business operations, he said. It’s a
model used by other successful medical centers around the nation, he said.
“The first
responsibility of the board is the success of the enterprise,” said Levine.
Four of its
members would be appointed by LSU, one by Tulane, one by Xavier and another
on a rotating basis by Delgado, Dillard and Southern — all of whom have
training programs.
Another five board
members without any affiliation to the universities would round out the
board. They would have to be experts in finance, health care, medicine and
the like.
Originally, LSU
wanted sign-off on board members and had protested Tulane’s presence on the
board because the university has a part-ownership in a private New Orleans area
hospital.
http://www.2theadvocate.com/news/48562592.html
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Maya Rodriguez /
Eyewitness News
WWLTV
BATON ROUGE, La. – There's a new draft agreement out on how two
major universities would play a role in running a new medical center in New Orleans.
State Health
Secretary Alan Levine announced a proposed agreement Thursday that spells out
how LSU and Tulane universities would be involved in the medical center.
The proposal lays
out several key areas of governance for the hospital. It calls for the
formation of a non-profit corporation that would be overseen by a governing
board made up of 12 people.
Just who would sit
on that board, though, has been a source of controversy between the two
universities. Tulane wanted to be able to appoint a board member, but LSU was
against that because Tulane already has a hospital.
However, the draft
agreement does call for Tulane to appoint one board member. LSU would appoint
four members, and one board member would be rotated between Xavier, Dillard
and Delgado.
Community members
not affiliated with any university would fill the rest of the slots.
However, Levine
said any work on a new medical facility cannot move forward without the two
universities on board.
"Because of
the uniqueness of what we're trying to do here, it can not be successful if
we don't have both institutions committed to this thing, not just in writing,
but in principal and I believe they are, and for the state," Levine
said.
Spokespersons for
both universities declined to comment on the draft proposal.
Tulane University's board is expected to consider the proposal
Friday. LSU’s board is scheduled to discuss it Monday.
The boards of the
two universities still have to approve this agreement before it can go into
effect.
http://www.wwltv.com/topstories/stories/wwl061809cbmedcenter.35c1df4.html
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By Caroline Moses
BATON ROUGE, LA
(WAFB) - Dire conditions at Earl K. Long Hospital have legislators
and administrators scrambling for ways to overhaul the hospital system in Baton Rouge, ranging
from private-public partnerships to taking over already existing buildings.
"It's a big
deal for us to be working on a project of this scope," said Dr. Fred
Cerise, LSU System vice president of health care. He says state-run
healthcare is not working. Representative Regina Barrow, D-Baton Rouge, says
that's especially true when it comes to Earl K. Long Hospital.
"It's been substandard for many years," she said. When you talk
about six patients in one room with one bathroom, that
is not very sanitary conditions."
As a solution, Dr.
Cerise is working on a possible merger between Earl K. Long and Our Lady of
the Lake, but mixing state facilities with
private ones is a relatively new concept for some legislators. "I
believe that there are many other alternatives out there and we, the
legislature, are asking those questions," said Barrow. She says she's
concerned that the Lake's mission statement
may exclude certain services Earl K. Long would provide, like abortion and
dealing with the prison population. "With that, we have to make sure
services currently offered are not lost and that individuals are still able
to receive those types of services," said Barrow.
A more immediate
worry is keeping EKL accredited, so that's why a House committee agreed to a
resolution. It's meant to show the state is paving a new healthcare path. It
is no longer looking to repair or rebuild EKL. "When we haven't acquired
land which we said we would do I think it's important to show we have a plan
to do something differently," said Cerise. While a partnership with the Lake remains in the equation, legislators and
administrators have also discussed moving EKL into a building the state
already owns. It's in the medical corridor at Essen Lane and Perkins Road.
Whatever they
decide, they'll likely need legislative approval first and that's why they
want this preliminary approval now. Hospital officials say it will likely be
two years before a partnership is solidified or before another solution is
reached to treat Baton Rouge's
poor and uninsured.
http://www.wafb.com/Global/story.asp?S=10558105&nav=menu57_2
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Associated Press
NEW
ORLEANS (AP) - The
Department of Psychiatry at LSU
Health Sciences
Center's New Orleans
School of Medicine has received the 2009 Distinguished Partners in Education
Award by the state Board of Elementary and Secondary Education and the state
Department of Education.
1 of only 11
organizations statewide to receive the award, the department was nominated by
Doris Voitier, Superintendent of St. Bernard Parish
Public Schools.
The LSUHSC
Department of Psychiatry worked with Voitier, her
faculty, and St. Bernard students and their families to provide mental health
services and emotional support for the schools, which reopened in November
2005, 11 weeks after Hurricane Katrina.
http://www.wxvt.com/Global/story.asp?S=10560749&nav=menu1344_2
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LSUHSC’s
Jacob only Louisianian selected by national
fellowship program
By Leslie Capo
New Orleans, LA –
Jean T. Jacob, PhD, Professor of Ophthalmology and Director of Research
Development at LSU Health Sciences Center New Orleans School of Medicine, is
one of 53 women and the only Louisianian selected
for the 2009-10 class of fellows in the Hedwig van Ameringen
Executive Leadership in Academic Medicine (ELAM) Program for Women at Drexel
University College of Medicine. ELAM is the only national program
dedicated to preparing senior women faculty for leadership at academic health
centers. The new fellows, characterized as academic health’s most promising
women leaders, represent 49 medical, dental, and public health schools.
During their year
with ELAM,
fellows gain a broader and deeper knowledge of the challenges facing academic
health centers through meetings with national leaders in the field,
interactions with peers in the program, and interviews with a wide range of
senior officers at their own institutions. Fellows also undertake a long-term
project that addresses an institutional need or goal while providing an
opportunity for leadership and greater visibility. ELAM’s mission is to increase the number of women in senior
leadership positions, to change the culture of academic health centers to
become more inclusive of different perspectives and more responsive to
changing social agendas.
Dr. Jacob also
serves as Director of Research at the LSU Eye Center. As Professor of Ophthalmology
and Neuroscience, she has continuously secured funding from both the NIH and
private corporations to support her research projects and nine
member laboratory team. Dr. Jacob is a biomedical polymer scientist
whose research interests focus on the biocompatibility of synthetic and
bio-polymers in the eye. This involves analyzing the polymer surface and the
adjacent tissue on a submicroscopic level for chemical changes in the
polymer, protein deposits, chemical changes in the structure of cells next to
the polymer and quantitative changes in the composition of the adjacent
tissue.
Dr. Jacob’s
investigation into the biocompatibility response around implants in the eye
has led to improvements in several basic implant designs (artificial cornea,
total eye replacement devices, reinforcement membranes, and glaucoma drains).
Her work has also led to the identification of ways to alter the conformation
of the implant surface to increase cellular infiltration and improve implant
stabilization. Dr. Jacob holds six patents.
Her current
research projects include dry eye modeling and analysis of tear components,
contact lens materials/wear analysis and testing, development and testing of
biodegradable nerve guides for the enhanced regeneration of nerves after
injury, and developing methods to promote better adhesion to biomaterials.
Besides her own research, Dr. Jacob has mentored more than 66
residents, postdoctoral fellows, and medical, graduate, and senior
undergraduate students. She also mentored two Junior Principal Investigators
on Centers of Biomedical Research Excellence (COBRE) and Louisiana Biomedical
Research Network (LaBRN) center grants over the
last 4 years. Additionally, she has served as both a permanent and ad hoc
reviewer for three different study sections at the National Institutes of
Health/National Eye Institute over a17-year period. She has also chaired and
served on numerous committees at all three levels of
the Health Sciences
Center (Department, School of Medicine,
and Health Sciences Center)
including serving as the LSUHSC Faculty Senate President. Dr. Jacob is Vice President of the
International Society of Contact Lens Research and has chaired annual
international symposia for the Symposium on the Material Science and
Chemistry of Contact Lenses as well as the annual meeting of the Society for
Biomaterials. She is a member of the American Chemical Society, the
Association for Research in Vision and Ophthalmology, the Controlled Release
Society, and the Tear Film & Ocular Surface Society.
After earning her
undergraduate degree from the University
of California at Riverside,
she completed her PhD in Biomedical Polymer Science at Tulane University.
Dr. Jacob joined the faculty of LSU Health Sciences Center New Orleans in
1989.
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Shriners Hospital to hold open house
Shreveport Times| 06.19.09
By Alisa Stingley
Faced with an
uncertain future, Shriners Hospitals for Children
in Shreveport
wants the community to know more about what makes the 87-year-old institution
special.
An open house will
be from 11 a.m. to 2 p.m. Saturday. The hospital is at Kings Highway and Samford Avenue.
There will be
guided tours of the hospital, free hot dogs and snacks, and face painting, as
well as a large-scale model train display by the Ark-La-Tex Modular Club.
Also on hand will be members of the El Karubah Shriners, who will be offering rides in their mini-cars.
"Saturday's
open house simply gives us an opportunity to better show the Shreveport community the
types of programs and services offered by this historic facility," said
Kim Green, administrator.
Founded in 1922,
the Shreveport Shriners Hospital
is the world's first Shriners Hospital.
Specializing in orthopaedic conditions including
scoliosis, cerebral palsy, osteogenesis imperfecta and hip, hand and foot disorders, the Shreveport Hospital has provided care to a global
population of more than 55,000 children.
But the hospital
is among six that national Shriners officials may
close to save money. Shriners will vote on
proposals related to the hospitals during the organization's annual meeting
July 6-8 in San Antonio.
The national trustees in March agreed to put closing hospitals to a vote
because of a mounting budget shortfall.
The Shriners organization depends on an endowment to generate
money for the hospital system's $850 million a year budget. The endowment has
declined due to the stock market fall.
However, Ralph Semb,
chairman of the national hospital board of trustees, told The Times recently
there may be talks with LSU
Health Sciences
Center to keep the
hospital open. LSUHSC officials have not commented on any discussions.
The open house
also will feature a photo exhibition by Christian Berg, director of public
relations and photographer for the Shreveport
Hospital. Among the
photos included in the collection is "Sifting Sand," a photo of a
young boy playing in the hospital's playground sandbox. The photo was
selected by the National Association of Children's Hospitals and Related
Institutions for "Champions," its 2009 traveling exhibition of 50
photographs. Receiving special recognition as a top 10 photo, "Sifting
Sand" was chosen from nearly 250 photographs submitted to NACHRI by
children's hospitals across the country.
The exhibit will
travel the country and is on display this week on Capitol Hill in the rotunda
of the Russell Senate
Office Building
in Washington, D.C.
http://www.shreveporttimes.com/article/20090619/NEWS01/906190344/Shriners-Hospital-to-hold-open-house
[BACK TO TOP]
Advocate Capitol
News Bureau
Legislation to
establish a loan program to help Louisiana
health-care providers move to electronic medical records systems cleared a
House panel Thursday.
The Health and
Welfare Committee signed off on Senate Bill 246 sponsored by state Sen.
Sherri Cheek, R-Keithville, and shipped it to the House floor for final
legislative passage.
Bunkie physician
Don Hines, the former state Senate president, told the panel that the
proposed state budget contains $5 million to help expand medical records
technology into hospitals, physicians offices and
health clinics.
The $5 million
would be used as seed money to start a loan program that will allow state
health-care providers to get a head start on the technology upgrade before it
is mandated, said Hines, who is working on technology upgrades for rural
hospitals.
http://www.2theadvocate.com/news/48572542.html
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Louisiana has long lagged behind the rest of the
nation in measurements of population health and health-care provision.
I had hoped that
term limits and recent elections would bring us a new crop of state leaders
with innovative ideas to help us improve in these critical areas. Sadly, it
has become clear that this is not what has happened.
At a time when our
state is facing a budget crisis, health care is one of the areas targeted for
heavy cuts. While some, like Rep. Karen Carter Peterson, have proposed
fiscally responsible ways to protect health care programs, other legislators
and our governor have offered only resistance.
They have no new
ideas and no answers, just a lot of "no." Certainly, some budget
cuts are necessary, but harsh cuts can destroy worthwhile and effective
health programs. Without creative thinking and fresh approaches that can keep
these programs alive, Louisiana
citizens will continue to suffer and the state will continue to languish at
the bottom of almost every national, quality-of-life ranking.
During a session
in which innovative thinking has been sorely lacking, Rep. Peterson has
presented not one, but two bills that would improve public health and create
new funding for health programs by raising the price of tobacco products.
Unfortunately, one was defeated last month and the other has been stalled.
Countless studies have shown that raising tobacco prices has a significant
impact on tobacco use. In addition, a recent poll of Louisiana residents shows that a vast
majority - 72 percent of Republicans and 72 percent of Democrats - support
such a price increase.
Why are these
legislators against smart policies to improve public health in our state and
save taxpayers' money? Why are they fighting the will of the people?
Chelsie Rachal
LSUA student
http://www.thetowntalk.com/article/20090619/OPINION/906180319
[BACK TO TOP]
Paul Murphy /
Eyewitness News
NEW
ORLEANS – A peace
accord is in the works in the ongoing budget war between the state House and
Senate in Baton Rouge.
Video: Watch the
Story
Negotiators from
both chambers spent much of the day working on a compromise that would
restore some, but not all, of the devastating cuts to higher education and
health care.
The budget battles
have been waged and fought. Now it's time to meet in the middle.
That won't be easy
when the two chambers have taken two very different approaches to plugging a
$1 billion budget hole.
“The House would
like to restore fewer cuts. The Senate would like to restore more. They've
gone about different ways and gone back and forth to try and have their will
put upon each other, but it just hasn't happened yet,” said Barry Erwin, with
the Council For A Better Louisiana.
Major cuts to both
higher education and health care hang in the balance as lawmakers try to
reach a compromise, but after weeks of feuding, leaders of the two chambers
are now back at the table.
“I think they've
stopped their sword rattling,” said state Sen. John Alario,
D-Westwego. “At least they're talking to each other and working on some
compromises. In the end, higher education won't get what it really wants, but
they won't be as bad as they started off. Health care will have some
additional funds allocated to them to minimize those cuts.”
UNO Chancellor Tim
Ryan was at the capitol for some last-minute lobbying.
“There seems to be
a commitment to restore $100 plus million of the $219 million dollar cut in
the governor's budget. That will still be damaging cuts to UNO and other
state universities,” Ryan said.
Ryan said UNO is
still looking at layoffs and more than $9 million in budget reductions.
“We're going to
have a lean, mean athletic department. We're going to have a lean, mean
university,” Ryan said. “But it's going to do its job, which is to educate
the people and students of the New
Orleans area.”
Alario said lawmakers plan to work through the
weekend looking for money to plug the holes.
“The Senate had a
plan to put more money into it. It looks like the House is not going to go
along with that. We now have to work backward from there and try to figure
out what we can do to make thinks work best for the state,” Alario said.
Lawmakers have
already given final approval to next year's $28 billion spending plan. The
bills that fuel the budget are still on the table.
While budget
negotiations continue, lawmakers can all agree on one thing. With one week
left in the session, they don't have a lot of time to work out their
differences.
http://www.wwltv.com/local/stories/wwl061809cbmakingpeace.30314df.html#
[BACK TO TOP]
By MARSHA SILLS
Advocate Acadiana bureau
LAFAYETTE — In the past school year, 6,000 children were monitored by one university research center as part
of a study to combat childhood obesity.
Now, a donation of
$400,000 will enable a statewide study of public schoolchildren’s health.
The donation to
the University of Louisiana at Lafayette’s Cecil J. Picard Center
for Child Development and Lifelong Learning was made by the Special
Children’s Foundation.
This past school
year, the Picard
Center oversaw the implementation
of Fitnessgram, a software program that enables
individualized monitoring of students physical activity and health. The
program was piloted with 6,000 students in 12 parishes: Caddo, DeSoto, Lincoln, Ouachita,
Sabine, Natchitoches, Morehouse, West
Feliciana, Orleans, St. Mary, St. Martin and Lafayette.
The data from the
pilot program is still under review, but reports of preliminary findings have
been passed on to participating school districts, said Billy Stokes, Picard
Center’s director.
Senate Bill 309,
which would expand the Fitnessgram program to all
public school districts, is pending in the Legislature. Texas has already implemented the program
statewide, said Stokes said.
“If Texas can implement it
to 2.8 million children, I think we can implement it to 700,000 children in
the public school system in the state,” Stokes said.
The $400,000
donation is the final installment of the foundation’s $1 million
contribution to the center and will assist with the longitudinal study as
well as enable the center to help those districts which may need assistance
with the program implementation.
The foundation,
founded by Baton Rouge
philanthropist Loyd Rockhold,
has been a partner in the center’s efforts and also contributed $2 million to
the construction of a permanent building for the center.
Stokes said the
donation will also help support an endowed chair in children’s health created
with the foundation’s assistance.
Rockhold, his wife, and his daughter, Sharon
Holder, the foundation’s president, presented an oversized display check to
Stokes, ULL President Joseph Savoie and university officials Thursday.
The center’s
research on children’s health builds upon the vision of the late Picard to
improve the lives of Louisiana’s
school children, said his son, Tyron Picard.
Given the national
epidemic of childhood obesity, the new research “will put our university and
the work done here on the cutting edge,” Tyron Picard said.
http://www.2theadvocate.com/news/48571087.html.
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by Amber
Sandoval-Griffin, The Times-Picayune
More than 30
people, including sheriffs from Orleans, St. Bernard and Plaquemines
parishes, gathered at the gates of the New Orleans Adolescent Hospital on
State Street this morning to rally support for keeping the psychiatric
hospital on the south shore.
To cope with the
budget shortfall, Gov. Bobby Jindal has proposed
closing the 35-bed hospital, moving its in-patient services to Southeast Lousiana Hospital
in Mandeville and dispersing outpatient services throughout New Orleans.
Among those
gathered Thursday were Orleans Parish Civil Sheriff Paul Valteau
Jr., New Orleans Police Department Mobile Crisis Unit Commander Cecile Tebo and NOAH President Pat Roy. All said the proposal to
move NOAH's services would make access to the hospital
for those on the south shore
of Lake Pontchartrain
more difficult.
Lawmakers in Baton Rouge have
successfully restored money for NOAH to the budget that now is on the
governor's desk. But the $9.12 million line item is part of the
"contingency" money that Jindal has
promised to veto. That means for NOAH to remain open, the money would have to
be plugged into another spending bill moving through the process.
"I don't
think the Governor really knew much about the decision (to move the hospital ) he was making. I'd like to think he is smarter
than that," said Cecile Tebo, director of the
New Orleans Police Crisis Unit.
"We all work
together as a united front in taking care of these people," said Pat
Roy, president of NOAH. "They (the patients) don't know one day from the
next and they need mental health professionals."
"We have
overwhelming support to keep this organization here," Roy said. "The only people that aren't
in support are the New Orleans
hospitals and the governor as far as I know of."
State health
department officials maintain that the move would save the state money and
improve services.
http://www.nola.com/news/index.ssf/2009/06/noah_supporters_rally_to_keep.html
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U.S. senators begin amending health care bill
New Orleans CityBusiness | 06.18.09
by The Associated
Press
WASHINGTON — Initial congressional work on the
historic health care overhaul pushed by President Barack Obama is going so
slowly that Sen. Christopher Dodd told colleagues "I never suggested
this was going to be warp speed."
Senators pushed
ahead anyhow today on what were supposed to be the easy parts of sweeping
health care legislation. But they quickly found out that almost nothing about
revamping the system is uncontroversial.
First up for the
Senate Health, Education, Labor and Pensions Committee, which Dodd is heading
in Sen. Edward M. Kennedy's absence, were amendments to improve quality and
efficiency. But the debate quickly shifted to more contentious issues including
the overall cost of enacting President Barack Obama's top domestic priority
of reshaping the nation's health care system to bring down costs and extend
insurance to 50 million Americans who lack it.
"You could
end up with a bill that's easily headed to a $2 trillion price tag,"
complained Sen. Judd Gregg, R-N.H., as he offered an amendment that would
require proof that various quality measures such as training and identifying
best practices would actually save money.
The committee
rejected his amendment, as Sen. Barbara Mikulski, D-Md.,
contended it would be "throwing sand in the gears."
An amendment by
Sen. Orrin Hatch, R-Utah, would have limited the use of research comparing
the effectiveness of various medical procedures — a hot-button issue for Republicans
because they say it could lead to health care rationing. It, too, was
rejected on a 13-10 party-line vote.
The committee was
on its second day of work on a 600-plus-page bill, but the first day of real
work after Wednesday's session was entirely given over to speechmaking. Dodd,
a Connecticut Democrat, is leading the committee while Kennedy receives
treatment for cancer.
Elsewhere in the
Capitol senators on the key Finance Committee delayed their own voting
session as they struggled to slash costs to under $1 trillion over 10 years.
Members of the
Finance Committee, considered Congress' best hope of producing a bipartisan
bill, were meeting behind closed doors today for further negotiations.
In the House joint
draft legislation was expected as early as Friday from the three committees
with health care jurisdiction — Ways and Means, Energy and Commerce, and
Education and Labor — with hearings to begin next week. The committees are
writing legislation that would require all Americans to have health care
coverage, and establish a new public insurance plan to compete with the
private market.
"I have every
confidence we will have a public option coming out of the House of
Representatives. It will be a level playing field. For us to have substantial
health care reform, this has to be part of it," House Speaker Nancy
Pelosi, D-Calif., said today.
The public plan
option, supported by Obama, could have a much tougher ride in the Senate
where minority Republicans hold more sway and believe it could drive private
companies out of business.
The Finance
Committee, struggling with the public plan among other issues, was supposed
to release draft legislation Wednesday and begin voting on it next week. But
the committee announced that votes would wait, possibly until after July 4,
as senators sought to retool their proposals to cut the cost by more than
one-third, from an initial $1.6 trillion to less than $1 trillion.
Senators on the
health committee were considering a lengthy bill plus 388 amendments, but with
the most contentious issues — the public plan question and whether to require
employers to cover their workers — still unwritten.
The legislation
would create a new insurance marketplace where people could shop for coverage
plans with help from government subsidies.
As written, it
would cost some $1 trillion but still leave 37 million people uninsured, and
Republicans are deeply skeptical. The health committee is scheduled to meet
daily and was supposed to finalize the bill by the end of next week, but
after Wednesday's session Dodd backed away from that deadline, saying he
wasn't tied to it.
http://www.neworleanscitybusiness.com/uptotheminute.cfm?recid=25341
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The New York Times | 06.18.09
By KEVIN SACK
In their heart of
hearts, few in the Obama administration would have predicted late last year
that they would be this well positioned by June to achieve a major victory on
health care. As the economy faltered, and attention focused on Wall Street
and Detroit,
it seemed unthinkable that Congress would be ready to devote the summer of
2009 to the costly proposition of providing health coverage for all, a goal
that has eluded presidents since Theodore Roosevelt.
But five months
after the inauguration, health care dominates the domestic agenda on both
ends of Pennsylvania Avenue.
Any package that emerges will preserve the country’s private insurance
system, at least for now. It could nonetheless bring sweeping changes,
requiring that everyone be insured, creating a government health plan to
compete with commercial carriers and perhaps taxing employer-provided health
benefits.
One Senate
committee began the formal drafting of its overhaul plan in a contentious
session this week, while a second — the influential Finance Committee —
delayed the release of its proposal until after the Fourth of July because of
emerging concerns about its cost. In the House, hearings on a draft proposal
are scheduled for next week. Both chambers are striving to vote on bills
before the August recess so that a conference committee can negotiate a
compromise and send it to President Obama by October.
Mr. Obama now
rarely lets a day pass without pushing the case for broad-based change. His
cool-headed analysis is increasingly sprinkled with impassioned rhetoric. “If
we do not fix our health care system,” he told the American Medical
Association on Monday, “America
may go the way of G.M.”
That politics and
economics have converged to spark such momentum “is remarkable,” said Peter
R. Orszag, the White House budget director. “You
have industry groups that are cognizant of the need to make changes, members
of Congress who have been preparing for this moment and a president quite
committed to doing it. It is a rare alignment of forces.”
And yet, students
of history in the White House and Congress realize they are only now entering
the riskiest phase, when real details begin to generate real opposition. To
date, a fragile coalition of stakeholders has been kept at the table by
presidential leadership and fiscal realpolitik. But
it may not take much for the guiding principle of “shared responsibility” to
fracture into shards of self-interest.
On Monday, the American
Hospital Association expressed deep disappointment in Mr. Obama’s weekend
proposal to help pay for expanded coverage by cutting Medicare payments to
hospitals. The next day, the United States Chamber of Commerce announced it
would oppose a bill that included any one of three central elements: a new
government insurance option, a requirement that businesses provide health
coverage to workers or pay a fine, and the creation of a federal board to set
insurance benefits. By midweek, the release of higher-than-expected cost
estimates by the Congressional Budget Office had emboldened Republicans to
step up their criticism, and forced the Senate Finance Committee back to the
drawing board.
Kathleen Sebelius, the secretary of health and human services,
said the administration was prepared for the undulations of the legislative
process. “There will be a lot of times when it appears that everything is
falling apart,” Ms. Sebelius said. “Anytime
specific legislative language is crafted, there’s something to hate about
it.”
But Ms. Sebelius said she had been impressed by the dedication of
Congressional leaders, and by Mr. Obama’s “absolute focus on the fact that
this is a moment — we’re not going to lose this moment.”
The moment arises
from a confluence of factors: Democratic control of the White House and
Congress; the exasperation of big business and consumers with uncontrollable
health costs; heightened economic insecurity during the recession; the
Massachusetts model for achieving near universal coverage; Mr. Obama’s
determination that health care is central to economic recovery; the presence
of health care enthusiasts at the helm of key Congressional committees; and
even Senator Edward M. Kennedy’s battle against brain cancer.
Mr. Obama, among
others, has observed that if a deal is not concluded this year, when his
popularity is high and lawmakers are not running for re-election, it is not
likely to happen at all.
What separates
this year’s initiative from past health care expansions is that it would try
to address the system’s shortcomings in cost, access and quality all at once.
It would do so with intricately interlocking components intended to make
health care affordable, end discriminatory insurance practices and redirect
treatment toward prevention.
Whether any
individual piece will produce its intended savings or improvements is
impossible to tell; when judging how they might work in concert, the
uncertainty is compounded.
Seeking broad
popular support, the president and Congressional leaders have played between
the 40-yard lines of the health policy spectrum. Those who favor a
single-payer, government-run insurance system have been marginalized, along
with those who would unleash the system to the free market.
Mr. Obama and the
Democrats began by using the stimulus package to direct new money toward the
computerization of health records and research on the effectiveness of
medical procedures. In the legislation now being considered, there is broad
Democratic consensus on mandating that almost all Americans have coverage,
expanding eligibility for Medicaid, subsidizing insurance for the working
poor, establishing an insurance marketing exchange and requiring insurers to
cover those with pre-existing conditions.
But there are
profound disagreements on other proposals, including the Medicare cuts, tax
increases to pay for the subsidies, and the public-plan option, which
insurers regard as a threat to their existence. The chairman of the Senate
Finance Committee, Max Baucus, Democrat of Montana, has been searching for a
compromise that might attract Republican support.
Although the
Democrats may be able to pass bills without Republican votes, bipartisanship
is important to Mr. Obama because it would set the tone for the rest of his
term. The essential tension of the coming few weeks will revolve around
whether the Democrats can maintain momentum while working to satisfy
Republican concerns. Mr. Obama is leaving the details to Congress while
pronouncing that he is “open to” particular compromises, like substituting
member-owned insurance cooperatives for the public plan.
At a comparable
stage of the Clinton
health care push of 1993, “it seemed that health care reform was
unstoppable,” former Senator Tom Daschle has written. The Clinton administration’s subsequent
tactical failures have become the antimatter of Mr. Obama’s strategy,
persuading him to move quickly, stay out of the weeds and share ownership
with Congress.
In addressing the
doctors this week, Mr. Obama argued that whatever the cost of revamping the
system, “the cost of inaction is greater.” But he also made clear that he
understood the most enduring lesson from past efforts.
“As clear as it is
that our system badly needs reform,” he said, “reform is not inevitable.”
http://www.nytimes.com/2009/06/19/us/politics/19reform.html?_r=1&ref=health
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The New York Times | 06.18.09
By ROBERT PEAR
WASHINGTON — The high cost of securing health
insurance for all Americans, the top domestic priority of President Obama,
has Congressional Democrats scrambling to scale back their proposals or find
ways to trim tens of billions of dollars a year from existing health programs.
According to
slides presented at a closed-door meeting this week, members of the Senate
Finance Committee are debating several new ideas, including “an automatic
mechanism” to reduce the growth of Medicare under an expedited procedure like
the one used to close military bases.
The documents
displayed in the slides show that the committee is also considering a
proposal that would require some employers to contribute to the cost of
Medicaid or private health insurance for low-wage workers. One purpose is to
discourage employers from foisting the cost of employee health benefits onto
the federal government, a maneuver that would push up the cost of revamping
the health system.
Mr. Obama
suggested earlier this week that the total cost to overhaul the health care
system would be “on the order of $1 trillion over the next 10 years.” But
initial estimates by the Congressional Budget Office, the official
scorekeeper on the cost of legislation, have come in much higher, leaving
many lawmakers with sticker shock and casting about for alternatives.
As the Senate
health committee continued drafting a companion bill on Thursday, one of its
Democratic members, Barbara A. Mikulski of Maryland, said, “Obviously this is not
going to go as fast as we thought.”
The Finance
Committee has wrestled all week with the three biggest issues in the health
care legislation: how to pay for coverage of the uninsured, whether to create
a new public insurance plan and whether to impose new obligations on
employers.
But it is the cost
of the legislation that seems to bedevil lawmakers the most. A budget office
estimate of $1.6 trillion as the cost of an earlier Finance Committee draft
sent members hunting for ways to pare the expense. Peppered with questions
about the legislation, the committee’s chairman, Senator Max Baucus, Democrat
of Montana, has postponed a drafting session that was to have begun early
next week.
Still, Mr. Baucus
was upbeat on Thursday. “We are getting closer and closer and closer,” he
said after a two-hour meeting of a half-dozen senators — three Democrats and
three Republicans. “There’s no doubt in my mind that we will have a
bipartisan bill.”
Other Democrats
said the cost estimate and the resulting delays were a temporary setback, not
a deal-killer.
Indeed, Speaker
Nancy Pelosi of California
said they were evidence of a vibrant democratic process.
“The give and
take, the back and forth of different ideas — you may call them snags, we
call them the legislative process,” Ms. Pelosi said. “This is a situation where
everybody wants to hear everyone’s ideas, put it all on the table, see what
it does for the American people. What is it that we can afford?”
Three House
committees have been working for months to develop a single big proposal of
their own and expect to unveil it on Friday.
Under new
cost-saving ideas being considered by the Senate Finance Committee, there
would be a goal for Medicare spending that “ensures continued sustainability
and bends the Medicare cost curve.” If the goal was not met, “an automatic
mechanism would be triggered to achieve those spending reductions.”
An existing
federal panel, the Medicare Payment Advisory Commission, would make
recommendations to Congress on how to achieve the savings, and Congress would
take an up-or-down vote on the recommendations, which could cut payments to
hospitals, managed care plans and other health care providers.
The White House
has said Mr. Obama is open to the idea of giving more power to the Medicare
commission. To help pay for health care legislation, he has proposed more
than $600 billion of Medicare and Medicaid savings, about a third of it from
hospitals, over the next 10 years.
Senator Pat
Roberts, Republican of Kansas, urged his colleagues to consider the possible
harm to hospitals and clinics. “More cuts to Medicare?” he said. “Let’s not
do that right now, please.”
Democrats are also
considering changes in a proposal that would require employers to provide
health benefits for their workers or contribute to the cost of such coverage.
Under the new option, employers would not have to provide coverage, but would
have to pay “50 percent of the national average Medicaid costs for workers
enrolled in Medicaid,” the program for low-income people.
Democrats plan to
offer federal subsidies or tax credits to help people with low or moderate
incomes buy insurance on their own. Senator Kent Conrad of North Dakota said Democrats were looking
for ways to limit the subsidies, a major cost. Under the latest option
floated by Mr. Baucus, employers would be required to pay “100 percent of the
cost of the tax credit for workers receiving the tax credit.”
Senator Orrin G.
Hatch, Republican of Utah, said these proposals were misguided because they
would create a disincentive for employers to hire low-income people.
“This means that
small-business people won’t hire anybody who’s on Medicaid,” Mr. Hatch said.
“They won’t hire any low-income workers. They get penalized for doing it.”
Some Democrats
share that concern.
Finance Committee
documents also flesh out proposals to tax employer-provided health benefits
in excess of a certain value — say, $6,200 for individuals and $15,700 for
families, which the documents project as the value of the standard Blue Cross
plan for federal employees in 2013.
The documents say
such a tax could raise $418 billion over 10 years. But the revenue would drop
sharply, to $162 billion, if the tax applied only to more affluent people:
individuals with incomes over $100,000 and families over $200,000.
For decades,
employer-provided health benefits have not been counted in workers’ taxable
income. Mr. Baucus and many economists say the tax break is inequitable
because its benefits go disproportionately to people with higher incomes.
http://www.nytimes.com/2009/06/19/us/19health.html?ref=health
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The New York Times | 06.18.09
By PAULINE W.
CHEN, M.D.
Over the next two
weeks in hospitals and medical centers across the country, new medical school
graduates will begin their internship. Among their many worries — moving to a
new city,
meeting new colleagues, adjusting to medical training — is a more profound,
existential concern that had once plagued me.
Do I have to lose
my self in order to become the doctor I want to be?
I learned the
answer to that question partway through my internship. Not in the hospital
but in the checkout line of a local grocery store.
The customer in
front of me was an older woman — she wore a faux camel-hair coat and had hair
dyed a matching color. I remember that she had wanted her groceries bagged in
a particular fashion, but the sales clerk, a young woman with impossibly long
pink acrylics, was perplexed by the woman’s demands.
I felt as if I had
stepped into an avant-garde theatre production. Each time the young woman
bagged the groceries, the older woman admonished her
and asked her to go through the process yet again. The muscles of my jaw
tightened with each round of bagging, and even though I was off for the day,
all I could think was: I’ve got sick patients to take care of, I can’t wait
for this!
Unable to bear it
any longer, I stepped forward and bagged the woman’s groceries myself,
shoving the plastic bags into her arms while resisting the urge to push her
on her way. I imagined steam rising from my head as I ranted. But a part of
me was as shocked as the people still standing in line. I had never lost my
temper in a store, and I had never raised my voice in public. Now, a few
months into internship and with a three-minute provocation, I had the
capacity to act like a grizzly bear sprung loose from a trap.
I walked out of
the store horrified. That night thinking back on the event, I grew more
ashamed of my behavior. But I also realized that it was not the first time I
had snapped. Over the previous months, I had thrown myself into my work and
shunned everything I once enjoyed and nearly everyone I loved. I believed I
needed to do so in order to become a surgeon.
But I had lost my
self in the process, and the stress made me irritable. I was no longer the nonconfrontational person I once was.
I had, for
example, raised my voice a couple of days earlier at a receptionist in the
radiology department when she couldn’t schedule my patient for a CT scan. I
had scolded a nurse who had had the misfortune of being the fifth person to
page me as I scrambled to finish a procedure. And only a week prior, I had
squabbled with my family after my mother innocently asked, "Why do you
have to work so hard?"
According to a
study from the Johns Hopkins University School of Medicine in Baltimore, I am far from
the only doctor who has behaved this way. The researchers interviewed
residents, or doctors in training, from seven different specialties and found
that they set themselves up for burnout by accepting, even embracing, what
they believed would be a temporary imbalance between the personal and
professional aspects of their lives. While the young doctors interviewed
defined well-being as a balance between all those parts, many felt that their
medical training was so central to their ultimate sense of fulfillment that
they were willing to live with whatever personal sacrifice was required, even
if it meant a temporary loss of a sense of self.
I spoke to the
lead author, Dr. Neda Ratanawongsa,
who now practices general internal medicine at San
Francisco General Hospital
and is an assistant professor at the University
of California, San Francisco.
“It’s partly a
coping mechanism,” Dr. Ratanawongsa said. “We tell
ourselves that we can do everything but not at the same time, so we are going
to put off the thing that defines us as a person — time with children,
running a marathon, painting, playing music — in order to get trained because
being a doctor is also rewarding.”
That delayed
gratification works well initially because residents believe it is only
temporary. “A lot of what matters to residents at this time is the sense that
they are learning to care for patients well and growing as doctors. They feel
that what they are doing is going to be worth it.”
But when the
imbalance persists for longer than initially expected, professional growth is
not enough to sustain most young doctors. “The ones who are happier,” Dr. Ratanawongsa observed, "are the ones who have held
on to one or two things and have said, ‘I’m not just another resident. I play
the guitar, I run races, or I go home to family.’ They don’t do these things
to the same extent as they did before residency, but they do them enough to maintain
a sense of self.”
Residents who
don’t find this balance are at risk of burnout, clinical depression or, more
commonly, subtle forms of stress. “These residents may feel that even if they
can give excellent care most of the time, there are times when they snap at a
patient or don’t order a test fast enough because they are so burnt
out."
Although her study
focused on doctors in training, Dr. Ratanawongsa
sees the same challenges among doctors who have finished and are currently
practicing. “There is always this expectation that at some point things will
turn around. The interns say, ‘When I finish internship and become a
second-year resident, things will get better.’ The residents say, ‘When I
finish training, I will finally have balance again.’ And doctors in practice
may believe that they will find more balance once they have retired.”
The danger is that
physicians may end up leaving the work force or will become less effective
caregivers. Dr. Ratanawongsa suggests that doctors
learn how to create a better sense of balance in their lives from the moment
they begin training. “We are taught to put our patients before ourselves;
it’s in our charter of professionalism. I agree with that, but I also think
there has to be some sense that I matter, too, at some point. If something
important is going on with our loved ones or with ourselves, we need to be
able to advocate for ourselves. And we need time to reflect on who we are and
where we are going.”
In the months
after that incident at the grocery store, I continued to devote my life to my
training — there was no other way to become the surgeon I wanted to be — but
I also learned to find time for myself. Even 18 years later, I can still
remember those moments away from work well — late morning breakfasts with the
Sunday Times in hand at the greasy diner down the street from the hospital,
glorious springtime drives in a friend’s used convertible, afternoons running
on a boardwalk and walking along the beach. I lost a few extra hours of sleep
each time I did something for myself; but in the end I, and my patients,
would gain much more.
“My belief,” Dr. Ratanawongsa said, “is that doctors will have a greater
capacity to know their patient as a person if they know themselves. That kind
of knowledge requires a sense of balance and an understanding of why they
chose to become a doctor. It comes down to their capacity to be an empathic,
caring and compassionate provider; and it comes not from their medical
knowledge but from their soul.”
“This is something
we should never sacrifice, even temporarily.”
http://www.nytimes.com/2009/06/18/health/18chen.html?ref=health
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BATON ROUGE – LSU
Stephenson Disaster Management Institute Assistant Professor Jude Egan, in
studying a potential unanticipated vulnerability in the pandemic/public
health response system regarding the H1N1 Flu for Catholic Charities and the
Center for Disease Control, focused on the challenge posed by the illegal
immigrant community. Egan’s guidance suggested the federal government should
cease enforcement of immigration laws in favor of treatment and testing for
H1NI, in addition to other preventative measures.
“My point was not
to make a political argument,” Egan said “Rather it was to look at the ways
in which the service sector's reliance on undocumented labor has created a
critical part of our nation's food infrastructure and the way that previous
research and anecdotes suggest that undocumented immigrants do not seek
health care or services during a disaster for fear of deportation and laws
that deny all but emergency care to undocumented immigrants.”
The result,
according to Egan, is a class of resident in the United States that is both a
critical component of the food infrastructure and yet does not receive care
during an emergency. In a public health crisis, such as H1N1, treatment of
all potential vectors of disease, whether teens returning
from spring break or undocumented immigrants, is the key to limiting
spread.
Egan, whose
research focuses on spotting organizational vulnerabilities, especially those
that result from unanticipated consequences of the law, suggested that
Catholic Charities and the CDC “respond to the presence of undocumented
immigrants in the United States” and to “think of how law and organizational
protocols can facilitate operations rather than engaging in the political
questions behind the question of whether that presence is good or bad.”
“This is
essentially the same type of organizational and legal question that we can
ask about rail safety, supply chain management or continuity of business
operations,” Egan said. “How can legal and organizational structures
facilitate operational performance? In
what unanticipated ways do institutional structures hinder performance and
what changes could be made to change this?”
In addition to the
suspension of immigration laws, Egan also suggested the federal government
develop mobile public health centers for testing and treatment of
undocumented immigrants, make public health information available in multiple
languages and encourage employers to give employees time off work if they or
a family member are sick.
“I use a systems
based method of analysis that focuses on how institutional and organizational
level variables impact results at the operations level—thus, reversing
traditional ‘fault tree’ analysis that moves from the particular accident, or
near-miss, backward toward root causes and instead starting at the general
and anticipating future vulnerabilities,” Egan said. “Because I am also
trained as a lawyer, I often use law as a starting point, such as a
forthcoming article co-authored with Lloyd Burton at CU-Denver about how
federal rail legislation has, in effect, decreased rail safety and in part
contributed to the Metrolink rail disaster.”
The Stephenson
Disaster Management Institute, an integral part of LSU’s E. J. Ourso College of Business, was established to help save
the lives of people and animals by continuously improving disaster response
management through research and education. Vision and a generous donation by LSU
alumni Emmet and Toni Stephenson were responsible for the creation of the
institute in 2007. For more information, visit http://www.bus.lsu.edu/sdmi
or call 225-578-0238.
http://www.bus.lsu.edu/students/news/stories/2009.06.17_Illegal_Swine.asp
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The New York Times | 06.15.09
By JANE E. BRODY
In the popular
1999 movie “Girl, Interrupted,” Winona Ryder portrays a young woman who tries
to commit suicide, then spends nearly a year in a psychiatric hospital with a
diagnosis of borderline personality disorder.
The film, based on
a 1993 memoir by Susanna Kaysen, was gripping. But
experts say it oversimplified this common yet poorly understood mood
disorder.
Georges Han, a
recovered patient now studying at the University of Minnesota
for a Ph.D. in psychology, describes borderline personality disorder as “a
serious psychiatric disorder involving a pervasive sense of emptiness,
impulsivity, difficulty with emotions, transient stress-induced psychosis and
frequent suicidal thoughts or attempts.”
Moods can change
quickly and unpredictably, behaviors can be impulsive (including abuse of
alcohol or drugs, reckless driving, overspending or disordered eating), and
relationships with others are often unstable. Many patients injure themselves
and threaten or attempt suicide to relieve their emotional pain.
People with the
disorder are said to have a thin emotional skin and often behave like
2-year-olds, throwing tantrums when some innocent word, gesture, facial
expression or action by others sets off an emotional storm they cannot
control. The attacks can be brutal, pushing away those they care most about.
Then, when the storm subsides, they typically revert to being “sweet and
wonderful,” as one family member put it.
In an effort to
maintain calm, families often struggle to avoid situations that can set off
another outburst. They walk on eggshells, a doomed effort because it is not
possible to predict what will prompt an outburst. Living with a borderline
person is like traversing a minefield; you never know when an explosion will
occur.
A Misleading
Label
The name of the
disorder was coined in the 1930s, in a misleading reference to the border
between neurosis and psychosis. Experts say it has nothing to do with either
condition.
Rather, affected
individuals seem to be born with a quick and unduly sensitive emotional
trigger. The condition appears to have both genetic and environmental
underpinnings. Brain studies have indicated that the emotional center of the
nervous system — the amygdala — may be overly
reactive, while the part that reins in emotional reactions may be
underactive.
As children,
people who will develop the disorder are often “hyperreactive,
hypervigilant and supersensitive,” Valerie Porr, a therapist in New York, said in an interview. Typically
they receive a host of misdiagnoses and treatments that are inappropriate and
ineffective.
“Some children
need more than others in learning to regulate their emotions,” said Marsha M.
Linehan, a psychologist at the University of Washington
who devised the leading treatment for borderline disorder.
“These kids
require a lot of effort to keep themselves emotionally regulated,” Dr. Linehan said in an interview. “They do best with
stability. If the family situation is chaotic or the family is very uptight,
teaching children to grin and bear it, that tough kids don’t cry, these
children will have a lot of trouble.”
Even in a normal
family, such children need extra help. Dr. Linehan
told of one mother who said: “I was an ordinary mother, and my child needed a
special mother. I took training and became the special mother he needed.”
Borderline
personality disorder afflicts about 2 percent of the general population,
according to the Diagnostic and Statistical Manual, and it is twice as common
as a much better-known disorder, schizophrenia. (Other studies suggest the
prevalence is as high as 6 percent.) Many borderline patients hurt
themselves, and 10 percent die by suicide.
Yet as common and
serious a problem as it is, Dr. Linehan said that
patients often have difficulty getting the help they need — partly because
therapists tend to regard borderline patients as manipulative and demanding
of an inordinate amount of time and attention.
Ms. Porr, a social worker who specializes in helping families
of borderline patients, said therapists with traditional analytic training
often provide ineffective treatment, then experience
feelings of failure and frustration. Psychotherapeutic drugs have not been
effective in controlling the disorder. As a result, 70 percent of these
patients drop out of traditional treatments, Ms. Porr
said.
Ms. Porr tries to help families learn to handle the problem
and not make it worse. She said in an interview that families need to
understand why borderline patients act and react the way they do, then respond in ways that validate the patients’ feelings
and help them regain and maintain emotional control.
Treatments That
Can Help
Experts say that
even suicidal patients are unlikely to benefit from the kind of extended
hospitalization depicted in “Girl, Interrupted.” More often, a few days in
the hospital should be followed by psychotherapy directed at helping them
learn to live more effectively with their cognitive misinterpretations and
emotional instability.
Dr. Linehan practices dialectical behavior therapy, the only
therapy that has been demonstrated to be effective in a number of randomized
clinical trials. She said two other approaches, called mentalization
and Stepp, were also likely to be helpful.
Dialectical
behavior therapy, a derivative of cognitive behavior therapy, helps patients
identify thoughts, beliefs and assumptions that make their lives challenging
and then learn different ways of thinking and reacting.
In effect, Dr. Linehan tells patients, “Your problem is that you don’t
know how to regulate yourself, and I can teach you how.” She said thousands
of therapists have been trained in dialectical behavior therapy, and many
others practice it without special training.
But the value of
the therapy can be thwarted if patients return to an environment that
misunderstands them. Thus, Dr. Linehan said, it is
important for others to recognize that people with borderline personality
disorder are genuinely suffering. “They are in excruciating pain that is
almost always discounted by others and attributed to bad motives,” she said.
The idea is “to
validate the person’s emotional reactions, to say, ‘I understand how you
feel,’ to pay attention, not to the situation, but to the emotion behind it,”
Dr. Linehan said.
Alan E. Fruzzetti, a psychologist at the University of Nevada,
said that families have to learn how to “soothe themselves, to realize that
though the situation is awful, not to blame or be judgmental of the person
but to see the person as also suffering.”
Reacting in a nonloving way magnifies the trauma tenfold, he said in an
interview, adding: “You may have to leave a bad situation, but you must come
back in a loving way, maybe say something like, ‘That blowout yesterday, I
really want to understand your experience.’ ”
Therapists trained
in dialectical behavior therapy can be located through the Web site
www.behavioraltech.org.
http://www.nytimes.com/2009/06/16/health/16brod.html?em
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