FEMA dispute over Charity Hospital on my plate, Homeland Security secretary
says
by Bruce Alpert
and Jonathan Tilove, The Times-Picayune
Jennifer Zdon
/ The Times-Picayune
The fate of Charity Hospital
-- and who will pay for it -- is still undecided.
Secretary of
Homeland Security Janet Napolitano said Monday that it's her department's job
to conclude the long-running dispute over how much FEMA owes Louisiana for the damage inflicted on Charity Hospital
by Hurricane Katrina, but up to Louisianians to figure
out what happens next and how to pay for what FEMA won't.
"They have to
make choices and we're not in a position to make choices for communities, " Napolitano said in an interview with The
Times-Picayune in advance of Saturday's fourth anniversary of Katrina.
"What we are
in the business of is facilitating the recovery of the community -- breaking
through some of the bureaucratic entanglements that existed prior to January
and moving things through as quickly as possible within the confines of what
we're able to provide, " Napolitano said.
Ted Jackson / The
Times-Picayune
Secretary of Homeland Security Janet Napolitano
Napolitano's
comments on Charity track those made last week by President Barack Obama and
Vice President Joe Biden. All expect Louisiana
to use a new binding arbitration process established for resolving disputes
between the Federal Emergency Management Agency and state and local
officials.
Napolitano's
department will be issuing regulations by the end of the month describing the
arbitration process. Gov. Bobby Jindal said last
week that the state will decide then whether to take the appeal of previous
FEMA decisions on Charity and some other big-ticket projects to arbitration,
which would be decided within 60 days.
If so, Jindal hopes the arbitration panel -- comprised of three
judges from the Civilian Board of Contract Appeals of the General Services
Administration -- would agree that Charity was more than half damaged in the
storm and qualifies for the full replacement cost of $492 million. FEMA's
last offer was for $150 million.
But, he said,
"what we've heard from the federal government is that they are open to
looking for other . . . federal sources of funding to combine with FEMA
funding to allow us to proceed" with building the new teaching hospital
in Mid-City.
Honore
calls for money
Meanwhile, Retired
Lt. Gen. Russel Honore
added his voice to those calling for the federal government to help pay for a
new hospital to replace Charity, a shift in position for the man who
commanded Joint Task Force-Katrina in the wake of the 2005 storm. In May, Honore told The Times-Picayune that Charity should have
been reopened after the storm and that "the state of Louisiana needs to pay for its own damn
medical center."
"Contrary to
what I may have said in the past, the federal government needs to step up and
provide a decent grant (to replace Charity) because the storm did destroy the
hospital, " Honore
said last week.
"I think a
medical center or teaching hospital is something the city needs and I don't
think it can fit in Old Charity, " Honore said. "I do think it's time for FEMA and
Health and Human Services to step up and help the city replace what was
Charity with what could be the beginning of a world-class medical
center."
"We need one
in New Orleans
and it needs to be able to withstand a flood, "
he said. "This time the first floor needs to be a parking lot."
Chris Granger / The
Times-Picayune Ellis Lucia / The
Times-Picayune
Retired Lt. Gen. Russel Honore
Louisiana Recovery Authority chief Paul Rainwater
Bursting bottlenecks
In a wide-ranging
interview in her office, Napolitano said that when she first visited New Orleans in March,
she found that applications for rebuilding money were
"bottlenecked" within the FEMA bureaucracy, which falls under the
Department of Homeland Security.
"There was a
lot of frustration by everybody, including by the FEMA employees who felt
like they live in New Orleans,
too; they wanted to get things done, "
Napolitano said. "And so if I had to list accomplishments, one was kind
of eliminating some of the red tape and the layers of review, creating a
culture within FEMA that the goal was to get money out. I think we've done
that, I think as of today we're at about $1.2 billion, just on the public
assistance side, that is out in the last seven months."
Paul Rainwater,
head of the Louisiana Recovery Authority, said that FEMA is doing a better
job of releasing long-stalled money, but said the agency probably could
benefit from additional "decision teams" because there is still $2
billion in dispute.
"Listen,
we're always looking for ways to improve our capacity,
" Napolitano said. She said the agency is finding that once it
resolves an impasse and decides that a project either qualifies or doesn't
qualify for rebuilding money, the decision can be applied to other similar
disputes.
"So, once you
answer it once, you answer it for a number of projects,
" she said.
Coordinator's office
Napolitano said
she hasn't decided whether to recommend the continuation of the Office of the
Federal Coordinator for Gulf Coast Rebuilding beyond its scheduled expiration
Sept. 30. She said she agrees with Obama that it is more important to have
the right people in place to work on rebuilding issues, than to what office
those people are assigned.
"The
president and I see this the same way, which is that the question is not so
much the names of the offices of the organizational boxes, but getting people
in who will work effectively with the community, "
Napolitano said.
Soon after she
took office, Napolitano asked Nancy Ward, the interim FEMA administrator
before Craig Fugate won Senate confirmation, to help resolve ongoing
personnel issues, including accusations of sexual harassment and
discrimination, levied at supervisors by some employees at the New Orleans
FEMA office. At the time, she replaced the New Orleans management team with veteran
FEMA administrator Tony Russell.
"I'm just not
going to comment on independent personnel actions, "
Napolitano said. "But I would say overall we obviously solved some of
the organizational issues that were in the way of going to work effectively
with the communities, with the neighborhoods and getting those assistance
claims paid."
http://www.nola.com/politics/index.ssf/2009/08/fema_dispute_over_charity_hosp.html
[BACK TO TOP]
By MARSHA SHULER
Advocate Capitol
News Bureau
ARTHUR D. LAUCK/THE ADVOCATE
U.S. Sen. David Vitter, R-La., delivers his take
Monday on federal health-care restructuring that’s dominating congressional
debate during a town-hall meeting at the West Baton Rouge
Parish Community
Center in Port Allen.
PORT ALLEN — The
“profit motive” in the health-care industry is not to blame for the problems
people face in getting and keeping coverage, Republican U.S. Sen. David
Vitter told a town-hall meeting crowd Monday.
Rather, Vitter
claims that medical liability lawsuits are causing more problems and putting
health care out of reach for many. He said “tort reform” — limiting lawsuits
— should be part of a private-sector solution. Vitter said he opposes the
recommendations advanced by President Barack Obama and Democratic
congressional leadership.
Meanwhile, Vitter
continued to criticize Democratic U.S. Rep. Charles Melancon,
of Napoleonville, a potential 2010 challenger, and threw a barb or two at
Democratic U.S. Sen. Mary Landrieu, too.
Vitter called
“frivolous” an ethics complaint filed by Democrats against him alleging
misuse of taxpayer dollars for political attacks on Melancon.
Vitter said the
complaint is a Democratic affront to “free speech.” He said he is only
pointing out how other members of the state’s congressional delegate are
voting on health care and other issues that he considers unresponsive to
constituents.
“Remember who has
town halls and who doesn’t,” said Vitter, noting that he is hosting 19 events
during the August congressional recess.
Health care
dominated questions posed by the 100 or so gathered at the 90-minute West Baton
Rouge Parish Community Center event.
Vitter said
improvements are needed in the U.S. health-care system “but I
think we should do it in specific targeted ways” instead of dismantling the
current system and replacing it with a costly government or government-backed
co-operative.
He suggested
formation of association health plans where small business and others can
pool resources across state lines to get “premium deals;” holding down cost
of prescription drugs by their re-importation and use of generics; and
limiting lawsuits.
Town hall
participant Calvin Fair, of Gonzales, said he is worried about the number of
people, including members of his family in their late 50s, who cannot afford
health insurance even though they work.
“How do we help my
family?” asked Fair. “How can we reach people like my brother and sister who
have played by all the rules? … The private insurance system is not working.”
Fair said he
understood Vitter talking about limiting lawsuits but that is responsible for
about 5 percent of the total health-care bill. “We need to cut the profit
motive out of health care,” Fair said.
Vitter said Fair
is low-balling the potential savings through ending lawsuit abuse and
underscored it again as a way to stop health-care costs from skyrocketing.
Vitter said he
does not believe there are 47 million uninsured Americans. He said “a full
quarter are illegal aliens;” others qualify for government insurance programs
and yet others can afford to purchase insurance and just don’t. He said the
“core uninsured is under 20 million.”
Vitter said the
uninsured problem that Fair notes can be fixed “without setting up a
(government) system that’s going to kick people off what they are now in.”
Other participants
wanted to know whether the health-care revamp in the Democratic-sponsored
bills in Congress allow funding of abortions and coverage for illegal aliens
and whether there is any sentiment to add “tort reform” to proposals.
Vitter said
abortions and illegal aliens are not addressed, but said he is worried about
the potential for administrative rules covering both.
A majority in
Congress do not want “medical legal reform,” he said, because trial lawyers
who oppose it are the largest Democratic campaign donors.
Near the end of
the question-and-answer session, Hillary Poucey
sought Vitter’s support on legislation that would require health insurance
policies to provide autism coverage. Vitter said he was unfamiliar with the
legislation and would have to look at it.
“He has short-term
memory loss,” Poucey said later. She said the
legislation has been discussed with Vitter and one of his aides in recent
months. “He said ‘I don’t know enough about it.’ That’s a load of crap,” said
Poucey, accompanied to the meeting by her
8-year-old autistic son, Jonah.
In response to
other questions, Vitter said he:
* Would look at the formula set in law
that’s used to determine Social Security cost of living increases in the
light of an announcement there would be none forthcoming.
* Attempt to ban U.S. Department of
Commerce use of the politically active group ACORN to help with the 2010
census because of their implication in “systematic voter fraud.”
http://www.2theadvocate.com/news/54649862.html
[BACK TO TOP]
Adam Duvernay
Senior Staff
Writer
Uncertainty
surrounding proposed health care reforms has many of President Barack Obama’s
political opponents seeking ways to curtail the effects of government-run
medicine.
A proposed
amendment to the Constitution of the State of Louisiana would do just that — shield
state residents and businesses from being forced to accept national health
care changes.
Article XII,
Section 8.2 would prohibit laws which compel persons, employers and health
care providers to participate in any health care system.
The amendment’s
author, Kirk Talbot, R-River Ridge, said his proposal was designed to
preserve personal choice and allow Louisiana
residents to refuse to accept a government option to health care.
“Liberal Democrats
don’t want people to have a choice,” Talbot said. “They want to tell people
what to do and fine them if they don’t.”
The drafting of
this amendment puts Louisiana into a group
of other states, including Arizona and Florida, which have
written similar legislation to disregard mandatory health care reforms.
Arizona’s legislature passed a similar amendment
earlier this year and is waiting on a vote from the general public in 2010.
Louisiana would require a favorable 2/3 vote in both
the state House of Representatives and the Senate before the amendment would
go to a popular vote.
The state’s
congress will reconvene on March 29, 2010.
Though the
amendment would not keep Louisiana
residents from using the government-provided health care plan, it would
shield people and employers from the penalties of not meeting the minimal
federal level of coverage.
Under Part VIII,
subpart A, section 59B of the current health care bill, individuals without
the acceptable level of health care coverage will be fined 2.5 percent of the
excess of the taxpayer’s modified adjusted gross income.
Employers who do
not meet the established level of health care coverage for their employees
would likewise be fined 8 percent of their total payroll.
For some opponents
of national health care reform, the problem is a 10th Amendment issue,
because health care is not a power expressly given to the federal government
by the constitution.
“In my opinion,
health care is not one of those things the federal government has the right
to impose on states,” Talbot said.
Texas Governor
Rick Perry said in April he would evoke the 10th Amendment if federal health
care reforms pass.
Talbot said his
Republican colleagues and some conservative Democrats in Louisiana supported his amendment and
reacted positively to its message.
Rep. Juan Lafonta, D-New Orleans, said it was to
early to block such an important piece of legislation.
“It will adversely
impact all the Medicare and Medicaid dollars we get
from the federal government, so any funding we have for seniors, for disabled
folks, for the elderly, a lot of folks are not going to receive those funds,”
Lafonta told WWLTV.
Talbot said he
understands the need for major health care reform in the United States, but pointed to
failures in Medicare, Medicaid and Social Security as reasons to avoid a
government solution.
“I don’t have all
the answers,” Talbot said. “But, there are a lot of things we can do before
we just socialize medicine.”
Talbot said
lowering taxes on medical costs and allowing health care providers to compete
across state lines were two options.
Though Talbot said
he was confident his amendment would pass both the House and the Senate, he
said he believed the matter would be taken to federal court.
Talbot said if
that happened, he wasn’t sure how his amendment would fair or whether it
would survive the judicial process.
“I have no idea
how it will do,” Talbot said. “If you ask 10 lawyers, you’ll get 10 different
opinions.”
http://www.lsureveille.com/news/state-rep-proposes-bill-to-block-health-care-reform-1.1820172
[BACK TO TOP]
By LAURA LANDRO
When 18-month-old Kaelyn Sosa
suffered a bump on the head in a fall at home, her mother took her to the
emergency room to make sure it wasn't serious. While Kaelyn
was under sedation in an MRI machine, her breathing tube was dislodged,
cutting off her oxygen and causing a crippling brain injury.
Kaelyn Sosa, 6, was crippled as
a toddler by a medical error. Her mother, Sandy, now helps the hospital protect other
patients from such accidents.
As often happens after medical accidents, the facility,
Baptist Children's Hospital in Miami,
settled with the Sosa family for an undisclosed sum. But the hospital went
further. Administrators analyzed the chain of events that led to the tragedy.
They put in place new measures aimed at preventing the mistakes that injured Kaelyn from recurring and to better respond when
something does go wrong. The hospital then engaged the child's parents in
educational efforts to underline to medical staff the critical importance of
patient safety.
Now Sandy Sosa, Kaelyn's mother,
serves as a community liaison on the hospital's quality-and-patient-safety
committee. "We wanted something good to come out of what happened to our
daughter," she says.
Medical errors kill as many as 98,000 Americans each year,
according to the Institute
of Medicine, a
government advisory group. In an effort to improve this record, some
hospitals like Baptist Children's are taking steps to admit grievous mistakes
and to learn from them in order to overhaul flawed procedures. That
represents a sharp departure from hospitals' traditional response when
something goes terribly wrong—retreating behind a wall of silence to guard against
potential lawsuits.
Now, some hospitals are hoping to stem the tide of
lawsuits by being more open with aggrieved patients and their families. While
some experts warn that disclosure will lead to an increase in litigation and
costs, there are some indications that patients are less likely to sue if
they receive full disclosure and an apology, along with an offer of
compensation. But longer term, some administrators say the solution is to
improve hospital safety records.
"Sorry alone doesn't work unless we learn from our
mistakes," says Timothy McDonald, a pediatric anesthesiologist and chief
safety officer at the University of Illinois Medical Center in Chicago. "We have
to also make promises that this won't happen again and get patients and
families engaged in the effort to improve our performance."
The University
of Illinois center set
up a specialized service in 2004 to help staff communicate with patients and
families after harm occurs. Since 2006, the center has had a policy of fully
disclosing medical errors, apologizing when they occur, and swiftly offering
a financial settlement. And patient-family members sit alongside staff on a
board charged with overseeing plans to prevent errors.
Dr. McDonald says that over the past four years, the
number of lawsuits against the center is down 40% compared to the period
between 1999 and 2004, even though the number of procedures increased 23%.
While it can't say for certain that the disclosure program was responsible
for the decreases, "we can certainly say that it has not caused an
increase in lawsuits or payouts," he says.
Among safety measures adopted: After a surgical patient
developed a blood clot and died, the University of Illinois center began
requiring doctors to assess the risk of a clot before writing any orders for
patients who had been in the hospital for more than eight hours.
And after a sponge was left in a surgical patient, despite
the fact that a manual count showed that all the sponges had been accounted
for, the hospital began requiring an X-ray of patients at risk of retained
objects, such as emergency abdominal or chest surgery, or morbidly obese
patients. In the past three years, the X-rays have found eight objects left
in patients after surgery, even though the manual count had shown that
everything was accounted for, Dr. McDonald says.
Despite such efforts, the federal Agency for Healthcare
Research and Quality reported in May that the rate of adverse events—a key
measure of patient safety defined as unintended harm during medical care—has
risen by about 1% in each of the past six years, in part because of a rise in
hospital infections. The old and the young are especially vulnerable: One in
seven hospitalized Medicare patients experience one or more adverse events,
and one in 15 hospitalized children are harmed by medication errors, other
studies show.
A hospital crash cart is color coded to prevent errors.
A number of patient-advocacy groups are calling for the
creation of a federal patient-safety agency as part of the current effort to
reshape the nation's health-care system. Among the proposals is to grant such
a body the powers to use publicly available data to identify serious
recurring errors, recommend preventive actions, and create regulations such
as requiring that look-alike medications be kept separately and that medical
staff follow checklists to prevent certain infections.
After Kaelyn's injury in 2004,
her mother says Baptist Children's candor helped her to move past the initial
shock. The hospital's parent, Baptist Health South Florida, with six
hospitals and a number of outpatient facilities, had earlier adopted a
"full-disclosure" policy on errors, and explained to the Sosa
family what had happened as soon as the details emerged.
When Kaelyn first arrived in the
emergency department, she appeared to have had a seizure. Medical staff
sedated the child and inserted into her trachea a flexible tube connected to
a ventilator. A CT
scan turned up an abnormal finding, and an emergency MRI was ordered.
As Kaelyn was being moved from
the MRI room, an ER nurse noticed that her chest wasn't moving. The breathing
tube had become dislodged, cutting off oxygen to the brain, and no one had
noticed it until it was too late. At first, it looked as if Kaelyn might not survive. But once she was stabilized, it
became clear that Kaelyn would have serious mental
and physical disabilities.
"This wasn't just an error caused by one
person," says Thinh Tran, chief quality
officer at Baptist Health. "We identified additional gaps in care that
weren't related to this specific incident."
For starters, the hospital had had only a nurse present to
directly monitor pediatric patients on breathing machines during emergency
scans; it now requires a nurse anesthetist or anesthesiologist to be present
in the MRI room when a patient has a breathing tube inserted. ER nurses also
now carry an emergency kit filled with tools needed to maintain the flow of
air whenever they move a young patient to another area of the hospital. And
although there was a nearby pediatric crash cart, which contains child-size
equipment needed for resuscitation and other emergencies, no one on the staff
was familiar with it or knew where it was. The cart is now prominently
accessible in the MRI area.
The Sosas say that when they
later brought Kaelyn in for another MRI, they
immediately noticed these and other improvements. "It was a whole new
procedure," Ms. Sosa says.
The Sosas didn't sue Baptist
Children's. But as part of the mediated settlement, the hospital agreed to
provide free medical care for life for Kaelyn, who
is now 6 years old. In addition to physical therapy provided through Baptist,
her mother works with the girl on skills such as reading, and says she is
"cognitively smart as a whip." But Kaelyn
can't yet speak or walk independently and has difficulty with motor skills.
The Sosas agreed to recount
their story for "Forever Changed," a 15-minute video that is being
used internally to educate Baptist Children's staff about the events that led
to Kaelyn's injury.
The video includes interviews with both parents about the
pain and despair they felt and with the nurse who discovered that the
breathing tube had become disconnected and still thinks of it years later.
Ozzie Sosa, Kaelyn's father,
says the hospital's dedication to fixing the problems that led to his
daughter's injury helped the family form a bond with staff and forgive the
unintentional harm.
"No one woke up that morning and said we are going to
mess up your little girl," Mr. Sosa says. "We decided we have to
keep our emotions in check, get beyond this and help make sure that this
doesn't happen to anyone else."
http://online.wsj.com/article/SB10001424052970204884404574363043088675838.html
[BACK TO TOP]
By JONATHAN WEISMAN
WASHINGTON -- In the rhetorical battle over health care,
the forces backing President Barack Obama's overhaul have spent years polling
and using focus groups to find the precise language that would win over
voters -- an effort that doesn't at the moment appear to be working.
When Mr. Obama told grass-roots organizers last week that
the mandatory purchase of health insurance would "be affordable, based
on a sliding scale," the phrasing precisely mirrored language that had
been poll-tested and put before batteries of focus groups by Democratic
consultants over the past few years.
The words had been carefully chosen in an effort to take
away the rhetorical targets of health-overhaul foes and replace them with
terminology that would bring ordinary Americans on board. But under steady
attack from opponents using more-emotional language, some of the president's
allies are rethinking the linguistic strategy.
What are the semantics of health care reform? The Herndon
Alliance, a center-left coalition, was formed to frame reform in rational
terms but its appeals may be losing ground to emotionally-fraught phrases
from the right, Jonathan Weisman reports.
"There are emotions on both sides, and some of these
recommendations really avoid connecting to emotion in a way that we hoped
would bring the temperature down and disarm opponents," said John Rother, executive vice president for policy and strategy
at AARP, the giant seniors lobby. "I don't want to second-guess them,
but the research is very much a product of where the debate was at the time.
Times have changed. Temperatures have gone up."
An Obama spokesman said at least one member of the
administration had met with the group crafting the health-care language, but
declined to comment on whether the research had affected Mr. Obama's own
language in discussing health care.
The effort began four years ago, when a center-left
coalition of advocacy groups, union leaders and health-care experts teamed up
to try to change the language of the health-care debate. The Herndon
Alliance, named after the northern Virginia
suburb where proponents first met, included the AARP, Service Employees
International Union, the American Cancer Society and the liberal health-policy
group Families USA, among others.
The alliance, now based in Seattle,
hired the Democratic polling outfit Lake
Research and California market-research firm American Environics.
The idea was to take a page from the Republican playbook,
said Robert Crittenden, a physician and founder of the Herndon Alliance.
Republicans had become adept at using words to seize issues, turning the
estate tax into the "death tax," for instance.
"We always had the facts on our side," Dr.
Crittenden said. "But our language hasn't connected with what the
general public actually cared about."
The first polling began in the fall of 2005 and continues
today. In 2007, American Environics met with senior
members of the Obama campaign staff, according to people familiar with the
meeting. Alliance
representatives met with Neera Tanden,
a top Obama administration official involved in the overhaul effort.
Herndon participants aren't saying they dictated the language
the president is using. An administration official acknowledged Ms. Tanden's meetings, and said she appreciates the work done
on behalf of a health-care overhaul. But Herndon members do say they have
influenced the lexicon of overhaul advocates.
"When you've gotten the groups speaking with a
similar voice and you've got data to show one phrase works well and one
doesn't, that gets into circulation," said Ron Pollack, executive
director of Families USA.
The results are echoed in the words of Mr. Obama and
others. Out is talk of "universal" health-care coverage, a
"government" health-insurance option or "health care for
all." In are such phrases as "quality affordable health care,"
a "public" option and a "choice of private and public
plans."
But Republican aides with their own lexicon argue that in
the end, voters will see little difference between a "public
option" and a "government plan."
The alliance and its pollsters planned responses to the
charge of "government-run health care" and "socialized medicine,"
and thought through how to neutralize fear that expanding health-insurance
coverage would help illegal immigrants and what to say to small businesses.
But Dr. Crittenden said no one anticipated the charges
that the Obama program would include "death panels" or advocate
euthanasia. Perhaps more important, said Lake
Research head Celinda Lake, no one foresaw the intensity of
protests at town-hall meetings.
"To the extent that we're getting our message out,
it's been very influenced by Herndon work. Our biggest problem is it's not
getting out," Ms. Lake said.
http://online.wsj.com/article/SB125116239112455575.html
[BACK TO TOP]
The New York Times | 08.24.09
By ABIGAIL ZUGER,
M.D.
Members of the
healing professions who write (generally about themselves) are easy to
distinguish from writers who make a living in the healing professions. From
the first group comes an endless stream of memoir, self-conscious, well
intentioned and predictable. From the second comes
all kinds of other verbiage, good and bad, distinguished from the general run
of other writing only in that the medical details are correct.
And then there is
Frank Huyler, a poet and emergency room doctor in New Mexico, who resists
classification. His 1999 pitch-perfect book of short essays, “The Blood of
Strangers,” was certainly cast in the autobiographical mold, but the voice
was so unusual, the touch so light and sure, you could have walked along with
him forever. His new novel, “Right of Thirst,” easily holds its own with the
best contemporary fiction, and yet it hails from deep within medicine and
seeks to illuminate the profession as surely as ordinary memoirs do.
Charles Anderson
is a middle-age cardiologist, the type who ties a perky little bow tie every
morning and strides through the hospital trailing residents, enjoying their
sycophantic attentions even as he recognizes — for he is more self-aware than
the tie might suggest — the game of admiration and self-promotion for what it
is.
The premature
death of his wife explodes his world. He cannot put the pieces back together
and blindly casts around for somewhere else to be. Anywhere will do: with no
particular interest in geopolitics, international health, suffering humanity
or, really, even himself, Charles impulsively signs
on with a relief agency to man a station for earthquake victims high in the
mountains of an unnamed Himalayan country.
But the refugees
(the local ones, that is) are slow to arrive, and Charles is left alone in
the poorly supplied medical tent with his own thoughts — exactly the company
he wanted to avoid. The other relief worker, a young German woman working on
a Ph.D. in population genetics, ignores him. The local facilitator on loan
from the army is an impassive cipher. Charles can focus only on the impending
patients.
The three wait in
the camp for the healing to begin — a triad of doctor, nurse and
administrator as potent as any other human triangle. It is almost “Waiting
for Godot,” the medical version, but eventually the
stalemate ends when a border skirmish upends their makeshift little world.
A lesser writer
would have piled on the medical color — health care in the developing world
is full of attention-gripping pus and gore. Dr. Huyler
indulges only a little: the reader winds up learning more about guns than
scalpels. Yet the story never abandons the big medical themes: doctor and
patient, illness and health are, after all, border zones in a state of
permanent skirmish. There is also the timeless, ugly question of how and why
a fistful of cash can transform what doctors like to call the natural history
of disease. Dr. Huyler’s writing is quiet, precise,
spellbinding from beginning to end.
He is the one
casting the spell, so I suppose he is entitled to break it himself, as he
does with a thud after the story ends. In an afterword, readers will find a
request that they do their part for health care in inaccessible mountain
ranges by donating a few dollars to a Bolivian charity on whose board of
directors Dr. Huyler’s brother serves.
You didn’t catch
Sartre taking up a collection for the homeless. Poet though Dr. Huyler may be, there is clearly enough physician left in
him for this kind of pragmatic hat-passing — one more interesting facet of
this strikingly multilayered writer.
That doctors and
their work now routinely populate all forms of popular American culture is a
historical aberration. Bert Hansen, a professor of medical history at Baruch College of the City University of New
York, begins his illustrated account of the start of this phenomenon with the
observation that until late in the 19th century, no one really wanted any
more contact with doctors than was necessary — certainly not in publications
intended to entertain.
When a doctor’s
image did appear, he was generally depicted as a ponderous, bearded creature,
with the depressed mien of an utterly useless man. A cartoon run in the
satirical weekly Puck in 1884 lambastes a Philadelphia medical school as a “physician
factory,” sucking up hapless local youth through a chute and disgorging an
army of saw-wielding, frock-coated maniacs.
Louis Pasteur
changed all that. In 1885 the success of his rabies vaccine gripped the
public’s attention, and the media rushed to glorify and sanctify him and his
suddenly attractive profession. Forget the inconvenient detail that Pasteur
was actually not a medical doctor at all: cue the white coat, the pristine
glassware stacked on the laboratory bench, the heroic demeanor and, of
course, the grateful patients. As scientific triumphs accumulated, the
hagiography of the doctor spread throughout the media, from print
advertisements to radio spots, from comic books to adoring photo essays in
Life magazine.
While various
slipups in the years since this golden era have made it pretty clear that
Ronald Colman, Paul Muni and Edward G. Robinson no longer set professional
standards, it is still nice to see them all again in Dr. Hansen’s book,
superheroes fighting the good fight.
http://www.nytimes.com/2009/08/25/health/25book.html?ref=health
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The New York Times | 08.24.09
By RONI CARYN
RABIN
Physicians are
allowed to use drugs in ways that are not specifically approved by the Food
and Drug Administration, a practice called off-label prescribing. There is
usually less scientific evidence to support nonapproved
uses, and a new survey of physicians has found that many might not even know
when they are prescribing off label.
The average
physician in the survey identified the F.D.A. approval status correctly for
only about half the drugs on a list provided by the researchers, according to
a study in Pharmacoepidemiology and Drug Safety.
Confusion was
greatest with psychiatric drugs, the survey of some 600 doctors found. Nearly
one in five who prescribed Seroquel (quetiapine) in the previous year thought it was approved
for patients with dementia and agitation, even though it was never approved
for this use and even carried a “black box” warning that it was dangerous for
elderly patients with dementia. And one in three doctors who used lorazepam (often marketed as Ativan)
to treat chronic anxiety thought it had been approved for this use; in fact,
the F.D.A. warning advises against using it for this purpose.
The study’s senior
author, Dr. G. Caleb Alexander, assistant professor of medicine at the University of Chicago, said a concern was that
off-label uses often did not have the same level of scientific scrutiny as
F.D.A.-approved uses.
http://www.nytimes.com/2009/08/25/health/research/25disp.html?ref=health
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