Daniel Poulin
Re:
"Resolving the hospital impasse," Our Opinions, June 25.
Your opinion is
just plain wrong.
What impasse? LSU
has made their decision and the last time I checked, the state of Louisiana was paying
the tab.
Advertisement
The truth is, all parties involved should not include Tulane.
LSU is this
state's flagship university, and Tulane is a private entity with its own
tuition, funding and endowments.
The proposed
project is a state-funded public hospital, and until Tulane wants to pony up
with say half a billion for its share of the new facility, then it should
take a hike.
Tulane does not
have a dog in this fight otherwise.
Daniel Poulin
Metairie
http://www.nola.com/news/t-p/letterstoeditor/index.ssf?/base/news-14/124599436292390.xml&coll=1
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By Leslie Capo
New Orleans, LA – Research lead by Dr. Nicolas Bazan, Boyd Professor and Director of the Neuroscience
Center of Excellence at LSU Health Sciences Center New Orleans, identifying
an enzyme that makes neuroprotectin D1 which
specifically and selectively protects retinal cells key for vision, will be
published in the June
26, 2009 issue of the Journal of Biological Chemistry.
Dr. Bazan’s research team
previously discovered neuroprotectin D1 (NPD1), a
naturally produced chemical messenger that protects cells from injury caused
by free radicals and other oxidative stress. Neuroprotectin
D1 is derived from the omega-3 fatty acid, DHA (docosahexaenoic
acid) which is present in both brain and retinal cells.
Retinal pigment epithelial (RPE) cells are essential for
the survival of rod and cone photoreceptor cells. RPE cells regulate the
renewal of the tips of photoreceptor cells among other functions. When RPE
cells do not function properly, photoreceptor cells are damaged and can die,
leading to decreased vision and eventual blindness as in such conditions as
retinitis pigmentosa and age-related macular
degeneration. A number of stressors, including free radicals, damage RPE
cells. Dr. Bazan’s lab has shown that RPE cells
produce NPD1 in response to oxidative stress. The focus of this research
project was to further define that process.
The LSUHSC team’s main participant was Jorgelina
Calandria, a PhD student in the LSUHSC Neuroscience
Center Graduate Program working with Dr. Bazan,
along with Pranab Mukherjee,
PhD, Research Assistant Professor. Calandria
developed a stable cell line to explore the role of an enzyme called 15-LOX-1
that they believed might play a key role in the process of converting DHA
into NPD1. They designed a series of experiments using cells with, and those
deficient in, 15-LOX-1, and measured response to oxidative stress. They found
that the cells deficient in 15-LOX-1 were more vulnerable and susceptible to
cell death and that NPD1 production in those cells was also diminished,
demonstrating that 15-LOX-1 is key to the production
of NPD1. The team also conducted
experiments where retinal cells deficient in 15-LOX-1 were treated with NPD1.
NPD1 was able to selectively and successfully rescue them, demonstrating the
protective power of NPD1 in RPE cells.
“These studies have created a new interest in RPE cells
not only due to the potential applications in the treatment of retinal
degenerative diseases, but also in neurodegenerative diseases such as
Parkinson’s disease,” notes Dr. Bazan. “This
research has helped us define NPD1 survival bioactivity in the RPE cell. It
is clinically significant because it underpins the exploration of therapeutic
interventions for diseases affecting millions.”
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by Jan Moller, The Times-Picayune
TED JACKSON / THE TIMES-PICAYUNE
Senate President Sen. Joel Chaisson
II, D-Destrehan, right, and Speaker of the House Rep. Jim Tucker, R-Algiers,
shake hands in conference committee after a contentious battle over the
budget which ended in compromise as the legislative session ended in Baton
Rouge Thursday.
BATON ROUGE -- The
Legislature wrapped up its two-month session Thursday by approving a budget
deal that plugs $210 million in one-time dollars back into health care,
higher education and other programs but still reduces spending well below
current-year levels.
The deal ends
weeks of sometimes-contentious negotiations between House and Senate leaders
and culminates a session that saw Gov. Bobby Jindal
win approval of the vast majority of his legislative agenda.
Besides the
budget, lawmakers also agreed to subsidize the sale of a north Louisiana
chicken plant, tightened the laws on sex offenders and drunken drivers, and
approved a deal to keep the Saints in New Orleans for the foreseeable future.
They also reduced state support for health care and higher education,
weakened the minimum standards for admission to high school and approved tax
breaks for movie producers, green energy initiatives, capital gains and
investors in start-up firms.
"The debate
was intense and passionate, and the results were good for the people of Louisiana, " Jindal said at a
session-ending news conference, surrounded by legislative leaders.
Jindal also played successful defense against
several tax-related measures he opposed, including two attempts to raise
tobacco taxes, a bill to delay an income-tax break that takes effect this
year, and another that would have forced the state to accept $98 million in
expanded federal unemployment benefits.
But not everything
Jindal supported went through, including a bill
that sought to give legislators more budget flexibility by allowing cuts of
up to 10 percent from specially protected funds in years when the state is
running a deficit. Senate Bill 1 by Sen. Joel Chaisson
II, D-Destrehan, sailed through most of the legislative process but ran into
trouble in the final days and died in a House-Senate conference committee.
The session also
disappointed some who were hoping that the reform agenda that dominated the
governor's first year in office would continue into his second regular
session. "I don't think education in general fared too well during this
session, " said Barry Erwin, president of the
nonprofit Council for a Better Louisiana.
The nonpartisan
group joined business lobbyists in pushing a package of bills that sought to
take away some power from local school boards. The bills went nowhere, as
lawmakers ran into a wall of opposition from school board members and quickly
backed down.
Erwin cited the
failed school board bills and the curriculum bill -- which would establish a
new "career track" high school diploma and lower the minimum
academic requirement for promotion from eighth grade -- as efforts that would
dilute the progress education has made in recent years.
But it was the
budget, which faced a $1.3 billion revenue drop because of the sluggish
economy, lower energy prices and a slew of tax breaks approved by the
Legislature in recent years, that dominated the
session.
The final deal
came together nearly two weeks after legislators sent the main $28 billion
budget bill to Jindal with $274 million in spending
that was contingent on the passage of other legislation. When the governor announced
that he would veto the contingency items, it set off a second round of debate
as lawmakers tried restoring some of that money through other bills.
Senators pushed
hard to reduce the cuts to higher education, twice passing legislation that
would have raised $118 million by delaying full implementation of a 2007
income-tax break. But the House refused to go along with an idea they viewed
as a tax increase.
The compromise
package uses $86 million from the state's Budget Stabilization Fund, or rainy-day
fund, $76 million from an expired insurance incentive fund and other one-time
revenue sources. A final piece of the revenue puzzle fell into place this
week, when legislators learned that they would receive $60 million more than
expected in federal stimulus dollars for Medicaid. Half of that money --
about $29 million -- was plugged into the 2009-10 budget,
while the rest will be used the following year.
House Speaker Jim
Tucker, R-Algiers, said the House achieved its chief goal of preserving the
rainy-day fund for use in the 2011-12 fiscal year,
when the state's revenue problems are expected to worsen significantly as
federal economic stimulus dollars disappear and the state's contributions to
the Medicaid program are projected to increase.
"We are on a
path to avoid catastrophe in year three, "
Tucker said.
The final deal
puts back $100 million in direct state support for higher education, which
was facing $219 million in cuts as the session began. Public colleges also
would benefit from $6.5 million for endowed chairs and $5 million for
needs-based scholarships. Together, the restorations allowed leaders to say
they succeeded in reducing the total cut in state support to 7 percent.
When a $30 million
tuition increase is figured into the mix, the cuts total less than 5 percent.
"Without the
push that we made I don't believe we would have achieved that restoration, " Chaisson said.
But the budget
debate still left some legislators angry that more wasn't done. "You'll
see the backlash from what we did this session in health care and higher
education, " said Rep. Juan LaFonta,
D-New Orleans.
Health care would
receive an extra $45 million under the deal -- $233 million when federal
matching funds are included -- with nearly half of that money going to nursing
homes. That still leaves the Department of Health and Hospitals with more
than $260 million in cuts, most of which would fall on private providers of
Medicaid services.
The health care
restorations include 67 positions at the New Orleans Adolescent
Hospital, the Uptown
mental hospital that Jindal had proposed to close
in a cost-saving measure. But Health and Hospitals Secretary Alan Levine said
he will ask Jindal to veto that language, as the
money for NOAH would be taken from dollars that are targeted for outpatient
mental-health services in the New
Orleans area.
http://www.nola.com/news/index.ssf/2009/06/legislators_craft_budget_deal.html
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By MARSHA SHULER
AND JORDAN BLUM
Advocate Capitol
News Bureau
Arthur D. Lauck/The Advocate
State Sen. Elbert Guillory, D-Opelousas, and
President Pro Tem Sharon Broome, D-Baton Rouge,
celebrate the end of the legislative session Thursday on the Senate floor.
Legislators say
session not ‘pretty’
Area lawmakers
agreed that tempering Gov. Bobby Jindal’s proposed
budget cuts to higher education and health care was the best thing
accomplished in the 2009 legislative session that ended Thursday.
Lawmakers
interviewed in the session’s final hours were hard-pressed to come up with
anything else significant.
“This has not been
a pretty session,” said state Sen. Rob Marionneaux,
D-Grosse Tete, chairman of the Senate’s tax-writing
committee. “Those who have said it is real easy to cut $1 billion out of the
budget realized it’s not so easy.”
The $28 billion
state budget had to take into account a $1.3 billion drop in projected state
revenue for the fiscal year that begins Wednesday. Higher education and
health care faced the brunt of cuts.
The effects of term limits with lots of new legislators on “a
learning curve” and political partisanship in the House brought problems in
dealing with thorny tax and spend issues, they said.
“I don’t think any
of us could stand another week to be honest,” said state Rep. Regina Barrow,
D-Baton Rouge.
Some said Jindal added another complicating factor to the
situation.
“I was frankly
disappointed with the lack of leadership,” said state Sen. Dan Claitor, R-Baton Rouge. “I think it’s the general
public’s perception as well.”
He quickly added:
“That doesn’t mean I don’t support the governor or want him to be
successful.”
“After delivering
the budget he kind of left us to find additional revenues,” said state Sen.
Dale Erdey, R-Livingston, who described the session
as the most “contentious” he’s faced in his 10 years as a lawmaker.
Some legislators
raised the specter of a fall special session depending on the fallout that
comes as remaining budget cuts in higher education and health care are felt.
“The
implementation will be the telling facts in all of this,” said Senate
President Pro Tem Sharon Broome, D-Baton Rouge.
“I think the
people are going to demand it,” said state Sen. Yvonne Dorsey, D-Baton Rouge,
when poor people cannot get their medicine and there are employee layoffs at
colleges that are “economic engines” in communities.
Erdey said he has heard talk about an October or
November session “that would be in reference to the budget and how our
finances are running.”
The Legislature
sent legislation to Jindal’s desk that would
provide $100 million in additional funds to offset a $219 million cut in
higher education. Lawmakers also identified $45 million to help cushion
health-care cuts.
State Rep. Bodi White, R-Central, said he is generally pleased with
the results of budget cutting.
“We did it this
year without raising taxes and by downsizing in the least painful ways we
could,” said White, noting the Legislature did not dip too heavily into the
state’s “rainy day” fund to help get higher education more funding.
State Rep. Michael
Jackson, No Party-Baton Rouge, complained that budget cuts are too heavy and
that several ideas for alleviating some of the cuts never got the chance to
be properly debated.
“The people expect
more from their representatives,” Jackson
said. “They expect more from their government … and the only answers they
hear are ‘No, no, no’. I think the people start looking for direction.”
Marionneaux said no real steps were taken to alleviate
projected future year budget woes. “We just pushed it off,” he said.
Broome said a
proposed constitutional amendment which died in the rush of final day
activities could lessen the impact of budget cuts on higher education and
health care in the future.
While happy that
higher education got some of its funding restored, Claitor
said the current year budget battle should serve as “a wake-up call for
higher education to focus on eliminating duplication before we have to come
do it.”
http://www.2theadvocate.com/news/49151082.html
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By MICHELLE MILLHOLLON
Advocate Capitol
News Bureau
With less than an
hour left in the legislative session, lawmakers agreed to a state budget
compromise Thursday after days of discord.
The agreement
decreases the budget cuts that Gov. Bobby Jindal
originally proposed for higher education, health care, the arts and other
state services.
“We’ve got a
reasonable, sensible budget,” Jindal said at his
end-of-the-session news conference.
The state’s rainy
day fund, a dormant insurance fund and a rising unemployment rate contributed
to the compromise.
Lawmakers put an
additional $100 million toward higher education, reducing the $219 million in
cuts that Jindal proposed amid state budget
problems.
They also found
money for projects in their districts, firefighter training at LSU, the state
agricultural department and judgments in lawsuits against the state.
Higher education
and health care still will endure cuts in the $28 billion budget for the
fiscal year that starts Wednesday.
State Commissioner
of Higher Education Sally Clausen said the reductions are very close to what
she asked for when she requested that the $219 million in proposed cuts be
halved.
“We’re very
appreciative,” Clausen said. “We now focus not on obstacles, but on
opportunities.”
The reductions in
cuts allow colleges to avoid drastic layoffs and program eliminations in the
immediate future so they can better prepare for a downsized future, she said.
Louisiana is feeling the pinch of the recession.
State revenue is expected to drop $1.3 billion in the upcoming fiscal year.
The state’s financial problems are expected to continue for several years.
House Speaker Jim
Tucker, R-Terrytown, said legislators eased the
state’s budget problems without borrowing money or raising taxes.
“We’re on a path
to avoid a catastrophe … by slowly working our way down to a smaller, more
efficient government,” he said.
Senate leaders
were less enchanted with the agreement.
“Certainly we
didn’t get everything we wanted in the bill … but it’s a compromise,” said
state Sen. Mike Michot, R-Lafayette and chairman of
the Senate Finance Committee.
The battle over
the budget dominated the final weeks of the legislative session.
Legislators sent Jindal the main budget legislation, House Bill 1, earlier
in the session.
They used other
measures — namely House Bill 881 — to appropriate additional dollars for
state services.
The House and the
Senate disagreed on how to minimize the budget cuts.
The Senate made
two proposals:
Take more than
$200 million from the state’s $775 million “rainy day” fund. The Senate
suggested using $86 million for the upcoming fiscal year and setting aside
the rest for future years.
Generate $118
million for public colleges and universities by delaying an income tax break.
The House flatly
rejected the idea of delaying the income tax break.
The two chambers
then began debating how much to take from the “rainy day” fund. The House
wanted to limit the withdrawal to $86 million. The Senate wanted to take $204
million.
In the end,
lawmakers settled on taking $86 million from the “rainy day” fund, which was
set up to tide the state over during a budget deficit.
Tucker said an
unexpected windfall also was gained by the federal government sending more
health-care dollars than anticipated because the state’s unemployment rate
rose.
Senate President
Joel Chaisson II, D-Destrehan, dismissed the notion
that the budget talks were contentious.
“We were all
passionate about achieving what we were trying to achieve,” he said.
State Rep. Sam
Jones, D-Franklin, received some booing whistles from legislators when he complained
about receiving the budget compromise at a late hour on the final day of the
legislative session.
“We’re having to swallow this like it’s coming out of a
fire hydrant,” Jones said. “This process is flawed, it’s bad.”
In the Senate,
state Sen. Joe McPherson, D-Woodworth, also griped about a lack of time to
absorb 55 pages of budget amendments.
“This is a hell of
a way to do business,” he said.
State Rep. Jane
Smith, R-Bossier
City, said the fiscal
legislative session is too busy to end up with a quality product.
“When you have
huge budget cuts and you’re basically out of money, people get very
frustrated,” Smith said. “But we usually do compromise. Some are unhappy.
Some are happy. But none are thrilled.”
Jordan Blum of the
Capitol news bureau contributed to this report
http://www.2theadvocate.com/news/49151102.html
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Susan Edwards /
Eyewitness News
BATON ROUGE, La. – Louisiana
legislators have wrapped up a two-month session, sending forward a $28
billion budget.
The budget
includes over $200 million in cuts to healthcare, higher education and other
programs.
The final gavel
came down for a nine-week legislative session with both House and Senate
members pleased with their outcome, agreeing to a final compromise on a $28
billion budget while lessening the blow to higher education and healthcare
cuts.
Afterwards, Gov.
Bobby Jindal praised both sides.
“This budget
absolutely does more with less. That’s what we said we needed to accomplish
when we opened this session. I told you that families and businesses have to
do that all the time,” Jindal said. “Unlike D.C.,
we don’t’ get to print money. We’re not going to just borrow money. We’re not
just going to raise taxes.”
One of the
sticking points was a compromise on how much should come out of the state's
rainy-day fund. The Senate wanted $206 million, while House members felt $86
million should be the most removed.
“Common sense
tells me that the reason you create a rainy day fund is so that you can
support those times when you are having somewhat of a financial crises,” said
state Sen. Ann Duplessis, D-New Orleans. “And if we
are not in a financial crisis today, I don’t think we’ll ever be.”
“We believe that’s
what we’ll be able to repay next year out of the amnesty money after we’ve
fulfilled our obligations with the surplus fund and maybe some additional oil
and gas revenues in this year that are not currently in the forecast,” said
House Speaker Jim Tucker, R-Algiers.
With less than two
hours before the end of session, both House and Senate members agreed to the
$86 million figure.
At the end of
session, legislators ultimately restored nearly $115 million to the proposed
$219 million in cuts to higher education, and, including federal funds,
almost $243 million was restored to healthcare.
“The budget that
has been passed doesn't represent democratic solution or republican
solutions,” Jindal said. “You already heard me say
this on the opening day. These are Louisiana
solutions. And that is exactly what we said we would accomplish during this
session.
“The budget
identifies efficiencies, cost savings across government that is all a part of
our effort to tighten our belt on state government while living within our means,
same thing Louisiana
businesses and families have to do every day.”
http://www.wwltv.com/topstories/stories/wwl062509cblegislative.8ff2bac.html
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Kim Kennedy
I am saddened by
the state administration, which is proposing rate cuts to private providers
of services to individuals with disabilities.
I believe this
sends a message to these citizens that “in home” services for them are not a
priority, and that quality services are not important.
Private provider
rate cuts are not necessary. The new opportunities waiver will reduce the
cost of providing in-home services by approximately $100 million during the
next three years through resource allocation. The elderly and disabled adult
waiver is expected to cut the cost of services by approximately $10,000 per
slot through a different resource allocation method. Also, the rate cut will
save $17 million in state general funds, but will cost the state $68 million
in matching federal funds.
The current state
budget includes $77 million in raises for state workers. Private providers
will be laying people off while the state gives raises to its workers. Is this
right?
Additionally,
these rate cuts severely impact some programs and will have a negative effect
on the state’s economy. The elderly and disabled adult program will be
decimated by the proposed rate cuts. Few providers, if any, can provide
services reimbursed at $8.95 per hour when minimum wage is $7.25.
Also, a rate cut
to private providers will cause some to go out of business and many others to
lay off workers. This means more Louisiana
citizens on unemployment, food stamps and Medicaid.
The most important
reasons, though, are how the rate cuts eventually could impact our citizens
with disabilities. Some may no longer be able to remain “at home” in the
community because the resources to support them will be greatly limited as
providers close their doors.
This leaves them
the option of living in group homes, state institutions or nursing homes, or
receiving no services at all. Individuals who are lucky enough to remain in
their homes will be served by agencies that will struggle to pay a decent wage
to their workers.
There are about
3,900 individuals on the elderly and disabled adult waiver program. Nursing
homes should not be the only option for services to these individuals because
of unnecessary provider rate cuts.
Gov. Bobby Jindal says he has the job he wants. We need him to do
the job he has, making this a better Louisiana
for all citizens by restoring the cuts to home and community-based services
for individuals with disabilities.
Kim Kennedy
private provider,
social services
Baton Rouge
http://www.2theadvocate.com/opinion/49148222.html
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AP
A friend of mine
had a house guest recently who, while sipping a cup of tea at her kitchen
table late at night, broke out into nasty-looking hives all over his back. A
quick inspection found that a tick had burrowed its way into his skin. After
removing it with a pair of tweezers, she whisked him to the emergency room.
“I was really
worried,“ she told me. “Ticks can cause allergic
reactions. I wanted him to be seen by a doctor immediately.“
But when they
arrived at the ER, they were told there would be a three-hour wait. Thinking
fast, my friend remembered reading the name of the hospital’s president;
we’ll call him John Smith. “I lightheartedly said, ‘I wonder what would
happen if I called John Smith and woke him up? Would that get him seen any
faster?‘ “
Her houseguest was
seen by a doctor immediately.
Was my friend
being really smart—or really obnoxious?
Both, said the
emergency room doctors I talked to. As waits continue to grow longer in the
emergency room, patients need to think about what to do if they feel that
they’re not getting the attention they need in an already overtaxed ER.
According to a
report out this week, the average total waiting time in a U.S. emergency room in 2008 was
four hours and three minutes, a 27-minute increase in nationwide average wait
times since 2002.
The report by
Press Ganey Associates analyzed the experiences of
nearly 1.4 million patients treated at more than 1,700 emergency departments
nationwide.
The recession is
one chief reason for the increase, according to the American College
of Emergency Physicians. In a survey in January of more than 1,700 emergency
doctors, 66 percent said they’d seen an increase in the number of patients in
their emergency rooms over the preceding six months. Most of the
physicians—83 percent—reported seeing patients who’d lost their jobs and
health insurance and delayed medical care.
“Some of these
people come to the ER because they’ve been turned away by their primary care
physician, because they’ve lost their insurance,“
said Dr. Angela Gardner, incoming president of the physicians group.
“Sometimes they’ve delayed care because they have no insurance and end up
with a much more serious condition.“
Gardner, who works
in the ER at Parkland Hospital in Dallas,
Texas, said these newly
uninsured people are taxing an overburdened system.
“We’re overwhelmed
and swamped,“ she said.
Given this
situation, I asked four ER doctors what they would do if their spouse had a
life-threatening emergency and they felt as if they weren’t getting the
attention they needed in the emergency room. Although they all pointed out
that emergency rooms do an excellent job of triaging patients, and you might
have to wait while others who are sicker than you get seen by the doctor,
there are some steps you can take if you truly fear that you or your loved
one is not getting the care you need.
Dr. Assaad Sayah, chief of
emergency medicine, Cambridge Health Alliance, Massachusetts:
“I would start by
saying to the triage nurse, ‘I know that you are busy, and I need one minute
of your time. My wife has been waiting for a long time, and her condition has
gotten worse since we arrived.‘ Describe her
worsening condition and say, ‘I would really appreciate it if you could take
a minute and look at her again.‘
“This would work
most of the time. If I got a hostile answer, I would ask to speak with the
charge nurse or charge physician. If I felt like I was not getting anywhere,
I would ask to speak with the administrator on call. The last resort is to
call the hospital operator (dial 0 from the emergency department waiting room
phone) and ask to page the patient advocate and hospital administrator. ... I
would not use inappropriate or threatening language.“
Dr. Jesse Pines,
assistant professor of emergency medicine, Hospital of the University of Pennsylvania:
“You could say,
‘She’s not acting right. This is not normal for her.‘
... As your friend did, you can always try to drop a big name, like say
you’re friends with the president of the hospital. In general, if they think
you’re a VIP (even if you’re not), you’ll definitely get seen more quickly.
... Obnoxious real VIPs get the fastest service, while obnoxious wannabe VIP
liars get the slowest service.
“A basic principle
of medical care is that ‘the squeaky wheel gets the grease.‘
I would recommend advocating on behalf of your spouse. It’s uncomfortable
that it has to be this way, but it works the same in any service business.
The more you complain, the faster the service. But it’s a fine line.
Complaining can piss off the staff, so it’s important not to go over the top.
Family members who are too vocal are sometimes escorted out by security.“
Dr. Joseph Guarisco, chief of emergency services at Ochsner Health System, Louisiana:
“I would ask to
speak with the Emergency Department director. If they weren’t there, I would
ask to speak with the charge nurse or shift supervisor. ... I would advise
them that you think the patient has an ‘emergency medical condition that
should be evaluated right away.‘ Most of us in
emergency medicine define the urgency in those terms and should be
responsive.
“If you don’t get
a response, advise the individual in charge dispassionately and without
confrontation, ‘I understand you are busy, but I feel the patient will have a
bad outcome if not seen right away.‘ If the person
in charge was a nurse, ask to speak with the physician and repeat the same
thing. If there’s no response, further advise the individual in charge, ‘I
feel strongly about this and must call the administrator on call.‘ If no response, I would call the hospital administrator
on call and advise him or her of those same concerns. And yes, name-dropping
the administrator’s name always helps. It should not. But if you truly feel
the patient may suffer harm by not being seen right away, do it.“
Dr. David Beiser, assistant professor of medicine, University of Chicago:
“If you are
concerned that a family member or friend is getting sicker while awaiting
treatment in the Emergency Department, it’s always reasonable to request that
the triage nurse do a quick re-assessment of the patient. As far as invoking
the threat of a letter to the CEO, that can trigger the ‘VIP Care’ response,
which may save time, but also may expose the patient to increased risk by
changing practice patterns. VIP treatment subverts the normal way we practice
medicine and in my experience usually leads to medical errors. I have made my
worst mistakes while treating friends, colleagues, and other VIPs. ...
Belligerence, histrionics or requests for VIP treatment usually end up
working against the doctor-patient relationship.“
In case you were
wondering, my friend’s houseguest was indeed having an allergic reaction to a
tick. He received an antihistamine and antibiotics to prevent infection and
is fine and very happy with the care he received in the emergency room.
http://www.counton2.com/cbd/lifestyles/health_med_fitness/article/how_to_get_help_in_a_hurry_in_the_er/37912/
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USA TODAY | 06.26.09
By Richard Wolf, USA
TODAY
WASHINGTON — The type of advertising war that helped
doom the last effort to overhaul the nation's health care system is heating
up.
Business groups
opposed to health care bills floated by House and Senate Democrats launched
print ads this week. The Republican National Committee ran its own TV ad as
well.
Until now, ads for
and against President Obama's proposed health care overhaul have been run by
lesser-known groups. Interested groups are stepping up their efforts during
Congress' July Fourth recess.
"It's
probably the starting gun," says Evan Tracey of Campaign Media Analysis
Group, which tracks political advertising.
The boost in
negative ads comes as Congress begins to move on Democratic legislation. Of
concern to employers is a provision that would force them to offer insurance
or pay fees. Health insurers don't want to compete with a public insurance
plan funded at least in part by tax dollars.
Whether the
advertising reaches the level of 1994 remains to be seen. Then, the health
insurance industry ran a series of TV ads featuring a couple, Harry and Louise, that helped to bring down President Clinton's
complex plan.
This week's
entries have been the most pointed so far this year. The U.S. Chamber of
Commerce ran a full-page ad in Roll Call, a Capitol Hill newspaper, opposing
the employer mandate and public insurance plan. "Health care reform that
punishes employers would be bad for the economy and jobs," the ad
warned.
The National
Federation of Independent Business ran an ad in The Hill, a similar
publication, and plans an Internet ad next week. "We need to make it
really clear that a mandate will kill jobs," spokeswoman Stephanie Cathcart said.
The GOP ad ran
Wednesday on cable TV as ABC aired a town-hall-style meeting on health care
from the White House. "When he says 'government option,' that means
putting government bureaucrats in charge," the ad intoned.
So far, insurers
have kept their money on the sidelines. "It's still early in the
process," says Robert Zirkelbach of America's
Health Insurance Plans. "We haven't taken anything off the table."
A group called
Conservatives for Patients' Rights, headed by former Columbia/HCA Healthcare
executive Richard Scott, is launching a round of 30-second cable TV ads in 11
states next week. The ads target 14 senators who could help decide the fate
of Obama's public option. Scott's group has spent more than $1 million a
month since March, much of it his own money.
Last month, a
group called Patients United Now joined the ad wars in opposition. It's
backed by Americans for Prosperity, a conservative group headed by political
strategist Tim Phillips that claims more than 22,000 donors. One of its
founders was David Koch of Koch Industries; two of its current directors are
Art Pope, a North Carolina
conservative activist and businessman, and James Miller, former budget
director in the Reagan administration.
On the other side
of the issue, Health Care for America Now, a coalition created last year,
made its first media buy of more than $1 million
this month. Much of the money for TV ads in 10 states comes from the group's
steering committee, including labor unions and civil rights groups.
"As the health
care debate is heating up, we're spending more on advertising," said Jacki Schechner, the
coalition's spokeswoman.
MoveOn.org, a
political action committee that claims 5 million members and an average
donation under $100, launched an ad Thursday targeting Sen. Dianne Feinstein,
D-Calif., for "dragging her heels" on
Obama's effort. Feinstein recently said on CNN that Obama doesn't have the
votes to pass his bill now.
http://www.usatoday.com/news/washington/2009-06-26-health-care-ads_N.htm
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John C. Saunders
Jr.
Re: "Health
care standoff," Other Opinions, June 23.
Paul Krugman really is insufferable. In his column on health
care and a public insurance option, he speaks with a truly forked tongue. On
the one hand he says (with no proof) that voters overwhelmingly favor this
public option. Yet, on the other, he says this option will be undermined by
centrists in Congress, and then defines the centrists' position as that
"held by most Americans."
I happen to be one
of those in that great center, who recognizes the burning need for health
care reform, but I do not favor the public option under any circumstance. And
from what I can tell from many around me, neither do they.
I think Krugman hit the nail on the head when he said the
centrists represent most Americans. But he is so far to the left that to him,
that majority appears to be coming from "right field" -- a jab at
conservatism.
It's not
Republican conservatism -- it is exactly what Krugman
called it -- centrists who are fighting desperately to prevent liberals like
him from ascending to power, while also rejecting heavy-handed conservatism.
No one proposes
unfair protection of the insurance companies, and they will surely fail if
they do not rein in their excesses. But the creation of a government
"competitor" who has endlessly deep pockets and can write any check
it wants to "force" private insurers to kowtow is totally opposite
to everything the country stands for. That's a government monopoly.
The conservatives
and the liberals are pulling this country apart with a sardonic glee, ever
blaming the other, while the majority of us suffer in the responsible and
logical center. I can only hope Krugman and his
liberal ilk fail.
And I don't mean
President Obama personally, just all the liberal policies espoused. I
personally am grateful for the many Democratic legislators who are willing to
take a centrist stand and act for the benefit of the people rather than their
party's planks.
John C. Saunders
Jr.
New Orleans
http://www.nola.com/news/t-p/letterstoeditor/index.ssf?/base/news-14/124599431692390.xml&coll=1
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Los Angeles Times | 06.25.09
By Thomas H. Maugh II
Eitan Abramovich /
AFP/Getty Images
Employees of Guatemala’s
National Congress take precautions against the swine flu virus in Guatemala City. Health
officials have confirmed that the H1N1 flu has killed its first victim in Guatemala
— a 35-year-old man.
At least 1 million
Americans have now contracted the novel H1N1 influenza, according to
mathematical models prepared by the Centers for Disease Control and
Prevention, while data from the field indicates that the virus is continuing
to spread even though the normal flu season is over and that an increasing proportion
of victims are being hospitalized.
Meanwhile, the
virus is continuing its rapid spread through the Southern Hemisphere,
infecting increasing numbers of people and at least one pig.
Nearly 28,000
laboratory-confirmed U.S.
cases of the virus, also known as swine flu, have been reported to the CDC,
almost half of the more than 56,000 cases globally reported to the World
Health Organization.
But Lyn Finelli, a flu surveillance official with CDC, told a
vaccine advisory committee meeting in Atlanta today that standard models of viral
spread indicate that many times that number have been infected.
Although 1 million seems like a high number, between 15 million and 60
million Americans are infected by the influenza virus during a normal flu
season.
At least 3,065 of
those infected in this country have been hospitalized and 127 have died. The
very young are most likely to be infected, Finelli
said, but older patients seem to suffer more. The average age of swine flu
victims is 12, the average age of hospitalized patients is 20 and the average
age of those who have died is 37, she said.
The normal
seasonal flu virus has virtually disappeared from this country, as would be
expected. But the novel H1N1 virus is continuing to spread, and now accounts
for 98% of all cases.
"So far, it
doesn't look like transmission is declining at all," Finelli
said.
The spread is
highest in New England and the Northeast,
and it is beginning to take its toll. Dr. Andrew Doniger,
director of public health for Monroe County, N.Y., which includes the city of Rochester, said hospitals, emergency rooms
and laboratories in the county are being overwhelmed by "very high
volumes" of patients. He called on those who have mild symptoms to
self-medicate at home.
In the Southern
Hemisphere, which is one month into its flu season, several countries,
particularly Chile, Argentina and Australia, are already feeling
the effects of the new virus. Chile
has had more than 4,000 laboratory-confirmed cases and seven deaths, Argentina more than 1,200 cases and 17 deaths,
and Australia
3,200 cases and three deaths.
In Argentina, the virus is spreading particularly
rapidly in the conurbano, the densely populated
working-class suburbs and slums that ring Buenos Aires. Hospitals in the area are
postponing elective surgeries to have more beds available for flu patients,
and the government is sending mobile clinics into many of the neighborhoods.
In Chile,
emergency room visits have tripled and waiting times in public hospitals are
seven hours or more.
Epidemiologists
fear that the novel H1N1 virus may exchange genetic information with other
flu viruses while it is working its way through the Southern Hemisphere and
develop a greater pathogenicity when it returns to
the north this fall, but so far that is not happening, said WHO
director-general Dr. Margaret Chan. In a news conference in Moscow today, she said that "the virus
is still very stable. . . . But we all know the influenza virus is highly
unpredictable and has great potential for mutation."
One surprising
victim of the virus is a pig in Argentina. Jorge Amaya, director of the animal health and sanitation
service there, said that the animal had recovered and that other pigs were
being tested for the virus. He said he thinks the pig caught it from a human.
That was the
initial theory when researchers found the virus in a Canadian herd early in
the pandemic, but subsequent tests of the virus showed that it was different
from the one that had infected their caretaker. As of now, no one knows how the
pigs became infected.
The U.S.
Department of Agriculture has been monitoring pigs throughout this country
for signs of the virus, but so far has reported no infections.
Some help for the
upcoming winter flu season is on the way. The French pharmaceutical company Sanofi-Aventis said today that it had begun large-scale
production of a vaccine against the novel H1N1 virus. The company did not say
how many doses it was preparing, and noted that it was still producing
seasonal flu vaccine for the Northern and Southern Hemispheres.
The company has
the capacity to make 270 million doses of vaccine per year at its three
plants, two in the United States
and one in France.
The novel H1N1 vaccine has to be tested before it can be used.
http://www.latimes.com/news/science/la-sci-swineflu26-2009jun26,0,7526407.story
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By: Dr Cary Presant MD
We are undergoing
fundamental and profound changes in healthcare in the United States. In order to make
the care within a hospital more efficient, and discharge patients in a
shorter length of time, many hospitals have changed the physicians who are
responsible for the care of the patient while in the hospital. A group of
physicians trained to give inpatient care, but not outpatient care, has developed and they are called “hospitalists.”
As a result of
hospitalist care, the length of stays of individuals has shortened dramatically.
The tests performed and care given for patients with the usual complaints or
problems have been standardized and streamlined so that any necessary tests
are not forgotten, and care is given according to guidelines so that no
necessary treatment is omitted. With shorter hospital stays, hospitals are
able to avoid losing money and being threatened with bankruptcy or closure.
Patients benefit by earlier discharge, with fewer complications and less
chance that some mistake will be made in their care.
But in the past,
your own family physician or your own specialist had been in charge of your
care. One of the major advantages of having your own physician responsible
for your care in the hospital, rather than a hospitalist physician whom you
have never known, is that there is a continuity of care from home and office
into the hospital, familiarity with past history and problems while you are
in the hospital, and a knowledge of all the aspects of your inpatient care
that continues into the outpatient setting.
Continuity of care
is important whether it be from the hospital to a nursing home, the nursing
home to a patient’s actual home, or from the hospital to the patient’s home.
Increased continuity is associated with improved patient satisfaction, an increased
use of appropriate preventive health services, a greater likelihood that the
appropriate medication will be taken by the patient, less likelihood that the
patient will be readmitted to the hospital, and a lower cost of care once the
patient is discharged from the hospital.
A recent article
has examined what is happening in America to hospitalized older
adults. Dr. G. Sharma and his associates from the University of Texas Medical
Center and the Medical College of Wisconsin (JAMA, Volume 301, page 1671-1680,
2009) examined the characteristics of hospital care in 1996 and in 2006. They
reviewed over 3 million hospital admissions Medicare records, and all
patients were older than 66 years of age. They then evaluated whether
patients were seen by any physician whom they had visited in the year before
hospitalization, including their primary care physician.
In 1996, 50
percent of hospitalized patients were seen by at least one physician that
they had seen in an outpatient setting in the prior year. Over 44 percent
were seen by the patient’s primary care physician from the community.
However, by 2006
the percentage of patients who were seen by their own physician had reduced
to 39.8 percent; only 31.9 percent were seen by their own primary care
physician. This was even more striking in patients admitted on weekends and
those in large cities. Interestingly, patients in New
England were much less likely, compared to patients in other
parts of the country, to have been seen by their own doctors when in the hospital.
They then looked
at the likelihood that patients would be seen by any of their familiar
physicians in different types of hospitals. In larger hospitals, patients
were 15 percent less likely to be seen by their own physician compared to
smaller hospitals. In public hospitals, there was a 22 percent reduced
likelihood of being seen by their own physician. Surprisingly, hospitals with
a major medical school affiliation showed a 42 percent reduced likelihood of
a patient being seen by their own physician during the course of the
hospitalization.
The conclusions
are important for all individuals may ever need hospitalization. Since the
satisfaction with care and efficiency of care when a patient is discharged
from the hospital depends upon having a patient’s own physician see the
patient while they are in the hospital, patients considering elective
hospitalization (for a surgery or an evaluation) should ask their physicians
whether they will see them while they are in the hospital. If the physician
says that they will not see the patient, the patient should ask how
continuity of care will be provided, since you want the best quality of care.
If the answers are unsatisfactory, consider seeing another doctor who will be
able to provide some continuity of care from the in-patient setting to the
out-patient setting so that medication is more appropriately used, tests and
treatments are given to prevent illness, and so that there is less overall
expense to the patient in receiving care.
But also remember
that hospital care is more efficient with a hospitalist. If you are admitted
to a hospital in an emergency and receive hospitalist care, ask to have your
own primary care physician or specialist called in to consult on your other
medical conditions while the hospitalist cares for the emergency problem. In
this way, your care will be fast and effective and continuity of care when
you return to the office will be optimal.
http://www.healthnews.com/blogs/cary-presant/family-health/hopitalization-continuity-care-3354.html
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The New York Times | 06.25.09
By ROBERT PEAR
WASHINGTON —
Senate Democrats said Thursday that they had found ways to pare the cost of a
health care bill by more than a third — to $1 trillion over 10 years — while
still covering nearly all Americans.
One of the
Democrats, Senator Max Baucus of Montana,
the chairman of the Finance Committee, said the new policy options provided a
feasible route toward enactment of the legislation, which is President
Obama’s top domestic priority.
But as senators
leave town for a weeklong Fourth of July break, Democrats are nowhere near
where they had hoped to be.
The Democrats had
hoped that two Senate committees would approve the legislation by the end of
this week. The measure could affect nearly every family, employer and health
care provider in the country.
Still, Mr. Baucus
was upbeat. After a meeting of his committee on Thursday, he said, “The
Congressional Budget Office now tells us we have options that would enable us
to write a $1 trillion bill, fully paid for.”
While senators
haggled over the intricacies of policy, thousands of people held a rally in a
park nearby demanding “health care reform now.” The crowd included doctors,
nurses, labor union leaders and people without insurance. Many urged Congress
to create a public health insurance plan, as a possible alternative to private
insurance.
Mr. Baucus’s bill is likely to include a new tax on some
employer-provided health benefits and a requirement for employers to help pay
the cost of insurance for some of their low-income workers — those who enroll
in Medicaid or get federal subsidies to help them buy insurance.
Medicare cutbacks
would provide a third major source of money to help finance coverage of the
uninsured. Senators expect to trim Medicare payments to hospitals and many
other health care providers.
Senator Kent
Conrad, Democrat of North Dakota, said the overall cost of the bill had been
reduced mainly by limiting eligibility for various subsidies. Assistance
would originally have been available to people with incomes up to 400 percent
of the poverty level ($88,200 for a family of four). Democrats have lowered
the ceiling to 300 percent of the poverty level ($66,150 for a family of
four).
Senators said the
cost of the bill might also be reduced by dropping or scaling back a plan to
give tax credits to small businesses, to help them buy insurance. Mr. Baucus,
like House Democrats, wants to expand Medicaid to cover millions more people.
But to save money, he and other Senate Democrats may delay the start of the
expansion for three years, to 2013.
A bipartisan group
of seven senators, including Mr. Baucus and Charles E. Grassley of Iowa, the senior
Republican on the Finance Committee, had been hoping to announce a deal on
Thursday. With no agreement, they issued a statement in which they promised
to keep working.
“Over the past
several months, we’ve made progress toward workable solutions,” the group
said. “We are committed to continuing our work toward a bipartisan bill that
will lower costs and ensure quality, affordable care for every American.”
The statement was
a status report, but also a political document, meant to buck up the spirits
of advocates of major health care legislation, who insist that public opinion
is on their side, despite setbacks on Capitol Hill.
Mr. Conrad said
the Finance Committee had made “remarkable progress” in whittling down the
bill’s initial price tag of $1.6 trillion.
“Think of where we
started this week,” Mr. Conrad said. “We were $600 billion away from having a
package that added up. Now we have a number of options that all add up. We
know we can have a bill that’s completely paid for, at $1 trillion.”
Senator Olympia J.
Snowe, Republican of Maine, one of the core group of seven striving for an agreement, emphasized that
“we have not made a deal.” But she added, “there will be no hiatus during the
recess,” as senators and their aides push ahead.
http://www.nytimes.com/2009/06/26/health/policy/26health.html?_r=1&ref=health
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The New York Times | 06.25.09
By PAULINE W.
CHEN, M.D.
From the time I
was in grade school until just a few years ago, my parents owned a series of
small neighborhood businesses. The first was a corner convenience store in an
Italian neighborhood; eventually they traded up to three small clothing shops
situated in neighborhood malls. Whether posted above the register or
acknowledged during conversations, the message behind each transaction in
every one of these stores was this: you were getting the best service and
quality my parents could muster or you would get your money back.
Few people ever
asked. My parents understood the power of warranties and developed a small
army of loyal customers with relationships based not on money but on trust.
So I was more than
intrigued last week when I read about the possibility of offering warranties
to patients.
In the policy
journal Health Affairs, Francois de Brantes, a
nationally known advocate of health care quality,
and his co-authors propose a new health care reimbursement model that comes
with a warranty. Developed with the support of the Commonwealth Fund and the
Robert Wood Johnson Foundation, this model, called Prometheus Payment, first
offers set fees to providers. The fees cover all recommended services,
treatments and procedures for specific conditions but are also
“risk-adjusted” for patients who may be older or frail.
The warranty is
based on the costs incurred by avoidable complications. In current
fee-for-service plans, all costs from these complications are covered by the
third party payer, regardless. But in the Prometheus Payment model, half of
the costs from avoidable complications must be paid for by the providers
themselves.
The result, Mr. de
Brantes and his co-authors write, is a payment
system that offers patients a health care warranty, since “providers win or
lose financially based on their actual performance in reducing the incidence
of avoidable complications.”
I spoke recently
with Mr. de Brantes and asked him about the Prometheus
Plan, the feasibility of a warranty in the imperfect endeavor called “health
care,” and the potential impact such a plan might have on the patient-doctor
relationship.
Q. Why a health
care warranty?
A. There are no
warranties in health care today because everything is paid fee-for-service.
And that is the underlying problem with escalating costs.
A warranty means
that you are going to think in terms of the customer’s experience and
perceptions. In health care, you would need to start thinking about the care
patients have when they need it, not in terms of an artificial payment
construct or a third party payer system.
One example of
health care with a warranty is orthodontic braces. You don’t pay for every
visit but for the entire period of care. And if the teeth don’t come out
right, the orthodontist will take care of you. The focus is on the patient,
the consumer, and that is what Prometheus Payment is trying to create for the
rest of the health care world.
The industry
pushback, however, has been that patients are not widgets, so there is no way
we can guarantee an error-free world. But that hypothesis has been debunked
by health care organizations that have already successfully offered care
similar to the Prometheus model, organizations like the Geisinger
Health System in Pennsylvania.
Q. You write about
separating different types of risk in the Prometheus Payment model. Could you
explain?
A. In health care
currently, all risks have been mixed together in a gigantic pot. But we know
that part of the total cost incurred is because of patients (inherent risk
factors, biological risk factors), and another part of the cost is because of
health care providers (how that patient is managed).
Take, for example,
a patient with breast cancer who ends up with multiple biopsies because the
laboratories don’t read her pathology correctly. There are a whole series of
costs not because the patient has cancer but because she has had bad care.
In splitting those
risks apart, you can offer this patient a warranty. If you can quantify each
of those problems and their costs, it becomes a lot easier to create
responsibility for each part. And we’ve done this for six of the biggest
chronic conditions and several procedures.
Q. A warranty
presupposes a certain degree of perfection, or “zero defects,” but both
patients and providers are susceptible to human error. Is that a problem?
A. While I agree
that aiming for zero defects will be incredibly difficult or impossible to
achieve, right now over 70 percent of patients have at least one insurance
claim that is attributable to an avoidable complication.
What we’re saying
is let’s try to cut that in half to at least 50 percent, and let’s give
health care providers incentives to reduce these avoidable complications.
Q. Will this type
of payment model encourage providers to refuse or skimp on testing in order
to save money?
A. Our message is
not to withhold tests but to give your patients the care that they need.
The likelihood,
too, is that the care they need won’t be just the amount you were planning to
give. For example, what we see in our data is that there are not enough
office visits for patients with diabetes, high blood pressure or congestive
heart failure. As a result these patients end up in the hospital. Our payment
plan would want you to spend more time with them in order to reduce the
number of hospitalizations.
The warranty is
based on reducing the costs associated with avoidable complications. That is
a very different message from one that asks providers to reduce all costs.
Q. Will a health
care warranty change the relationship between patients and doctors?
A. This type of
payment model will create more of a team not only between doctors and
patients but also between doctors, patients and payers.
Right now you have
hundreds of thousands of dedicated and devoted professionals who want nothing
else but to apply their knowledge and skills for the betterment of their
fellow human being; yet every day they go to work and the entire system
militates against their desires of doing the best for their patients. Right
now you have 50 to 80 percent of diabetic patients with an encounter that is
caused by an avoidable complication; yet it is not because clinicians aren’t
trying their best. The odds are simply stacked against them.
What we are
proposing is a system that makes it profitable to do the right thing for
patients systematically. Our system is not that complicated, but it will
require a significant amount of effort on the parts of everyone.
Q. Do you need to
be part of a large health care organization in order to offer this kind of
warranty?
A. I fundamentally
don’t believe you need large integrated systems to make this model work. It
doesn’t have to be bigger to be better. In this country we already have so
many examples of small and large physician practices and hospitals that
deliver very close to defect-free care. Our job collectively, particularly on
the payer side, is to pay them so it reinforces that behavior every day.
http://www.nytimes.com/2009/06/25/health/25chen.html?ref=health
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The New York Times | 06.25.09
By RONI CARYN
RABIN
Being overweight
won’t kill you — it may even help you live longer. That’s the latest from a
study that analyzed data on 11,326 Canadian adults, ages 25 and older, who were followed over a 12-year period.
The report,
published online last week in the journal Obesity, found that overall, people
who were overweight but not obese — defined as a body mass index of 25 to
29.9 — were actually less likely to die than people of normal weight, defined
as a B.M.I. of 18.5 to 24.9.
By contrast,
people who were underweight, with a B.M.I. under 18.5, were more likely to
die than those of average weight. Their risk of dying was 73 percent higher
than that of normal weight people, while the risk of dying for those who were
overweight was 17 percent lower than for people of normal weight.
The finding adds
to a simmering scientific controversy over the optimal weight for adults. In
2007, scientists at the Centers for Disease Control and Prevention and the
National Cancer Institute reported that overweight adults were less likely
than normal weight adults to die from a variety of diseases, including
infections and lung disease.
“Overweight may
not be the problem we thought it was,” said Dr. David H. Feeny,
a senior investigator at Kaiser Permanente Center for Health Research in
Portland, Ore., and one of the authors of the study. “Overweight was
protective.”
He said the
finding may be due to the fact that a little excess weight is protective for
the elderly, who are at greatest risk for dying, or because many health
conditions associated with being overweight, like high blood pressure, are
being treated with medication.
The study took
into account smoking status, physical activity, age,
gender and alcohol consumption. It included a separate analysis excluding
those who died early in the 12-year period, in order to weed out participants
who might have been thin because they were smokers or had an underlying
disease, like cancer.
http://www.nytimes.com/2009/06/26/health/26weight.html?ref=health
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