By Jonathan Tilove
WASHINGTON The state must
know by the fourth anniversary of Hurricane Katrina how much money it will
get from FEMA for Charity Hospital so it can move ahead with plans to replace
the critical medical facility in New
That was the word this week from Paul Rainwater, executive
director of the Louisiana Recovery Authority, as he shuttled between
testifying at House and Senate hearings and meeting with members of the Louisiana
congressional delegation and with Janet Woodka, the
coordinator of the Office of Gulf Coast Rebuilding.
In the meantime, U.S. Rep. Anh
"Joseph" Cao, R-New Orleans, will be bringing Rep. John Mica, R-Fla., the ranking Republican on
the House Transportation and Infrastructure Committee, to Charity Hospital
on June 1 for an on-site roundtable discussion of the state of recovery of
health care facilities in the 2nd Congressional District.
On April 23, Cao presented a letter to President Obama at
a White House reception in which he wrote that Charity was "completely
destroyed" by Hurricane Katrina and pressing the case that FEMA owes
Louisiana $492 million to replace it.
Under the federal Stafford Act, FEMA is obliged to pay the
full cost of replacing Charity if, as LSU contends, it was more than half
damaged in the storm. LSU runs the Charity Hospital System in the state. The
FEMA office in New Orleans
denied that claim, ultimately offering $150 million instead. The state appealed
to the FEMA regional office, which denied the appeal earlier this month.
Cao said he believes that bringing Mica, members of the Louisiana
congressional delegation and the media into Charity on June 1 will help make
his case about Charity's deplorable condition.
But, in denying LSU's claims, FEMA has insisted that much
of the deterioration in Charity's condition after Katrina was a consequence
of LSU's negligence after the storm.
As the FEMA Region 6 office wrote in denying the LSU
appeal, "It is evident that any asset protective measures completed by
the applicant during the two years following the hurricane were insufficient
in keeping the condition of the building from worsening."
LSU and state officials have until early July to decide
whether to make a second appeal to FEMA's national headquarters in Washington, where they
could augment their argument with an oral presentation. If they lose again,
they could sue FEMA, but, as Rainwater noted, that would push any final
outcome into the distant future.
The alternative is to take advantage of a new arbitration
system mandated in legislation authored by Sen. Mary Landrieu, D-La., to
break the logjam between Louisiana
and FEMA on a number of projects, of which Charity is by far the largest.
The problem is that the Department of Homeland Security,
of which FEMA is a part, is apparently still trying to figure out what the
arbitration process would look like. Until that is revealed, Louisiana officials
are left to choose between a pig and poke.
Landrieu sought to light a fire under Homeland Security
this week, saying, "FEMA must resolve how much money it owes Charity Hospital to repair Hurricane Katrina's
"The decision on federal funding for Charity must be
made with the utmost expediency," Landrieu said. "Funding disputes
like these are exactly the reason I included language to create an
arbitration panel in the Recovery Act. It is critical that we free up the
$1.4 billion caught in red tape that is preventing our region from more fully
On Friday, D.C. Delegate Eleanor Holmes Norton, chairing a
Transportation and Infrastructure subcommittee hearing, told Rainwater and
FEMA Acting Deputy Administrator David Garratt that the Charity dispute is a
"classic" conflict between Rainwater's understandable desire to get
as much out of FEMA as he can and Garratt's understandable desire to
responsibly husband federal dollars. It can only be resolved by a third
party, she said.
In his meeting with Woodka,
Rainwater discussed her ongoing efforts to explore other options for federal
financing for a new medical center in New Orleans
pursuit of the full $492 million from FEMA falls short.
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Thomas E. Nolan, M.D.
Re: "Report on Interim LSU public hospital says costs
too high, efficiency too low," Page 1, May 18.
I was surprised and dismayed by your article. Certain
statements were not reported in the manner in which they were represented in
the Alvarez & Marsal assessment. Specifically,
I take issue with your account of the report's assessment that "the
hospital does a poor job of making efficient use of its 12 operating
Until Katrina, surgical patients were serviced by two
hospitals with a total capacity of 25 operating rooms. The current operating
room configuration does have a maximum capacity of 12 rooms. However, we have
significantly increased our average cases per room every month. Before
Katrina, the hospital saw an average of 39 cases per month, per room at University Hospital and 31 at Charity. Today at
the Interim LSU Hospital,
we have an average of 47 cases per month per room.
Furthermore, as the region's only Level I Trauma Center,
we must dedicate at least one operating room to emergencies 24 hours a day.
We also dispute the way Alvarez & Marsal
calculated the efficient use of operating rooms, and will meet with them soon
to discuss the matter.
I am pleased that A&M recognized that staff members in
the peri-operative departments were "observed
to be dedicated to providing the best standard of care for the patient and
work in a patient-focused environment." The report added, "The care
delivery system works well due, in part, to the efforts of experienced and
The report contained many pages of laudatory reviews,
followed by a few paragraphs of criticism. News articles such as this have a
negative impact on morale.
Thomas E. Nolan, M.D.
Associated Dean for Clinical Affairs
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Norman C. Francis
Scott S. Cowen
Re: "House votes to shift LSU's hospital power,"
Page A4, May 19.
As presidents of our respective universities, we support
Rep. Jim Tucker's House Bill 830. Our universities have proudly served the
indigent population in the metropolitan area through Charity and University Hospitals for decades. HB 830 will
transfer the ownership of Charity and University Hospitals
to an independent Board of Trustees. The board, in turn, would authorize the
management of the Medical Center of Louisiana-New Orleans' assets by a new
non-profit entity, the University Hospital Corp.
The University Hospital Corp. board would consist of one
representative from each of the five universities originally involved in
Medical Center of Louisiana-New Orleans and four independent directors.
Independent members for either board will go through a thorough selection
process to ensure they have the professional expertise, experience and
independence to fulfill their assigned duties.
This bill creates a new transparent and accountable
structure with the appropriate board representation to ensure public funds
are properly used.
We believe the bill is in the long-term interests of the New Orleans community,
the state, and the hospital's patients.
HB 830 guarantees the new public hospital will not be
controlled by one institution but, instead, by those representing the entire
Norman C. Francis
Scott S. Cowen
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BATON ROUGE - Money issues top the agendas in the House
and Senate this week as the 2009 legislative session hits its mid-point
The Legislature can meet 45 days in a 60-day period in
this session. Since lawmakers have been meeting only four days a week since
the session began April 27, legislative leaders say they expect they will be
in session at the 6 p.m. June 25 deadline.
The House is scheduled to debate proposals to pay the cost
of running the Legislature and the court system as senators look for ways to
handle deficits in the future and how to work around this year's $1.4 billion
hole in state-generated funds.
The Senate Finance Committee is getting near wrapping up
debate on the House-passed budget in HB1 and adopting its own version of how
funds should be spent. It is searching for a way to reduce higher education
and health care cuts.
In the Appropriations Committee today:
# HB869 by Speaker of the House Jim Tucker, R-Terrytown, appropriates $68.63 million in state general
funds for the operations of the House and Senate and the Legislative Fiscal
Office, the Legislative Budgetary Control Council, and the Louisiana State
Law Institute. Of that, $28.38 goes to the House and $19.37 million to the
The legislative auditor's office is funded with $9.3
million in state general funds and $19.7 million in self-generated funds (the
Legislative Auditor Ancillary Enterprise Fund).
The Legislature's total of about $47.75 million is to pay
salaries and allowances of members, officers, and staff of the House of
Representatives and the Senate. Besides salaries, mileage and per diem, the
money pays necessary additions to the House and/or Senate chambers and other
legislative rooms; audio-visual upgrades, technological enhancements, and
technical support; printing the bills, journals, and calendars; computer
equipment and services; library services; provision of accessibility services
for persons with disabilities; and for all other expenses of the Legislature,
including legislative assistants.
# Chairman Jim Fannin,
D-Jonesboro, has HB963 which appropriates $153.86 million for the operation
The Louisiana Supreme Court gets $68.96 million; courts of
appeal $41.59 million; district courts $32.43 million; Orleans Parish
criminal court $5.37 million; juvenile and family courts $2.22 million; other
courts (required by statute) $2.66 million; and other courts (not required by
In the House Transportation Committee, Lafayette Rep.
Rickey Hardy has HB11, which calls for a special driver's license and license
plate for drug dealers. Hardy said it would let police and the public know if
a drug dealer is nearby.
On the Senate floor today, Sen. Joe McPherson,
D-Woodworth, has SB67, a constitutional amendment that says any salary
increase enacted for statewide elected officials, members of the Legislature
or members of the Public Service Commission will not be implemented until a
subsequent term of office.
Also to be debated are a package of bills by Senate
President Joel Chaisson, D-Destrehan, that
establish new ways of handling crises in state funding.
# SB1 is a constitutional amendment to authorize cutting
of up to 10 percent of all agencies, departments and most dedicated funds
when state funding falls short by at least 1 percent.
# SB2 would eliminate a provision in law that says
protected funds can't be cut two years in a row. Current law allows cuts up
to 5 percent but not in consecutive years.
# SB34 is the statutory version of SB1, which would allow
cutting of up to 10 percent from almost all funds if at least a 1 percent
shortfall is predicted by the Revenue Estimating Conference.
SB168 by Sen. Neil Riser, R-Columbia, also is on the
Senate calendar for debate. It would require that everyone in a vehicle - not
just those in the front seat, wear seatbelts.
Sen. Rob Marionneaux, D-Livonia,
is scheduled to bring up his SB186, an expansion of the Louisiana Smokefree Air Act, to ban smoking in bars and outside
patios at restaurants.
SB291 on the Senate agenda by Sen. Dale Erdey, R-Livington, would allow
a security officer employed by a church, synagogue, mosque or other place of
worship to carry a concealed handgun.
On Thursday, House
Speaker Tucker has scheduled for full House debate HB879, a supplemental
appropriations bill that allocates almost $203 million in state and mostly
federal funds to cover medical vendor payments in the current fiscal year.
Doctors, hospitals and other providers have been concerned that lack of
payments would jeopardize their ability to continue providing care. Also,
since Charity Hospital
in New Orleans
has been out of operation, private hospitals have been treating indigent
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BATON ROUGE - The Council for A Better Louisiana on Monday
urged state leaders to do whatever it takes to protect higher education and
health care from the full impact of proposed budget cuts.
"What we must remember is that if a state is to be a
good place to live and work, colleges and universities must be healthy enough
to play a significant role in economic diversification and helping to create
and retain knowledge-based jobs," said CABL President Barry Erwin.
"In order to play that role, our post-secondary institutions need to be
seen as a priority."
Erwin said lawmakers should "consider a variety of
revenue options to mitigate the impact the reduction of revenues would have
on post-secondary education in our state." The proposed cuts in the
executive budget "would cause serious and long-term harm to higher
education in Louisiana."
He said they should reduce the proposed $219 million cuts
in higher education by at least half.
CABL proposes a multi-step plan that includes delaying the
implementation of $340 million in income tax cuts upper-middle and
Delaying the so-called "Stelly
Tax" elimination would provide "a bridge" so higher education
would have time to prepare for less income in the future, Erwin said. The
Board of Regents could use the time to study what really is needed to meet
the workforce needs of the state and make adjustments.
"CABL clearly understands that budget cuts are
unavoidable," he said. "That means it is imperative that the cuts
to higher education that do take place are strategic and that we protect our
true priorities - the ones that will help define our future. Louisiana has spent
years digging out of a hole that crippled post-secondary education in our
state for much of the last 20 years. We cannot afford to turn back the clock
Gov. Bobby Jindal already has
said he would veto any effort to delay the income tax break in legislation
approved last year authored by Sen. B.L. "Buddy" Shaw,
R-Shreveport. He said he views any delay of tax breaks as a tax increase.
Jindal also opposes a plan to be
debated in the Senate that would delay the claiming all itemized deductions
that are in excess of what the federal government allows to be claimed on
federal income tax forms.
The Senate leadership plan would keep the current 65
percent level of deductions for three years and then allow the full deduction
to be claimed.
Sen. Sen. Robert Adley,
R-Benton, the author of the bill that authorized the claim level to rise to
100 percent, supports the delay. He said it was passed at a time when the
state had plenty of money.
The governor also opposes another idea in CABL's proposal - using one-time money, such as the
"Rainy Day Fund" and Mega-Project Fund, to offset cuts.
Senators also are weighing use of those funds as a partial
solution to the current budget problems.
The governor does support the third plank in CABL's plan - allowing colleges and universities to raise
tuition without coming to the Legislature for permission.
Erwin said CABL also is concerned about the impact the
proposed budget cuts to health care "will have on our efforts to provide
health care to citizens in need. It is estimated that the cuts will lead to
the loss of more than 4,000 private-sector jobs impacting every region of Louisiana.
"In addition," he said, "we are also
concerned that the cuts will move us in the opposite direction of many of the
reform efforts Louisiana
has proposed and implemented in the past."
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Diabetes is a major health factor in New Orleans
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Health System Leverages MedAssets to Transform Its
25, 2009 (Close-Up Media via COMTEX) -- MDAS | Quote | Chart |
News | PowerRating -- MedAssets,
Inc. has announced a long-term strategic agreement to provide
transformational revenue cycle services to New Orleans-based Ochsner Health System for the realization of continued
consulting, and accounts receivable service expertise will be utilized to
fundamentally reengineer Ochsner's revenue cycle
processes, from patient access through business office operations, to help
deliver improved net revenue and cash flow.
According to a release, MedAssets
and Ochsner currently have a relationship, with MedAssets providing spend management and revenue cycle
solutions, including group purchasing and supply chain analytics and
consulting and claims management. In recent months, Ochsner
has invested in MedAssets' revenue cycle management
technology solutions to enhance revenue capture and integrity through tools
focused on chargemaster management, price modeling,
charge capture, denial management, and supply chain and revenue cycle
Ochsner Health System is a
non-profit, academic, multi-specialty, healthcare delivery system dedicated
to patient care, research and education.
"We are proud to help support Ochsner
Health System's unwavering mission to provide Louisiana communities with the
finest healthcare by implementing best-practice revenue cycle
capabilities," said Rand Ballard, chief customer officer and chief
operating officer, MedAssets, Inc. "We believe
our proven experience in transforming revenue cycle operations through the
application of data-driven software tools and services makes MedAssets the perfect partner to help Ochsner
achieve its short and long term goals."
"Through this agreement, we are building on a
strategic relationship that already exists within our organization and
looking to realize significant benefits in our revenue cycle," said Jody
Ohlmeyer, vice president, finance, Ochsner Health System. "We look forward to improved
revenue cycle operations that will positively position Ochsner
for the future."
"Our revenue cycle services experts and technology
will work side-by-side with the Ochsner team to
implement best practice processes," said Robert Wright, president,
Revenue Cycle Services, MedAssets. "This
crucial program will create more effective financial operations and improved
net revenue capture that will be experienced throughout the health system -
from staff training to customer service."
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By NANCI HELLMICH
Overweight women who exercised one to two hours a week
lost several pounds in six months without dieting, a study shows. But those
who exercised the most -- about three hours a week - didn't lose as much as
they should have, possibly because they increased the calories they consumed.
"There is a great lesson here: People generally
overestimate the calories they are burning with exercise, and they may reward
themselves by eating more," says lead researcher Tim Church, director of
preventive-medicine research at the Pennington
Center in Baton Rouge.
If a person runs for an hour then goes out to have a large
high-calorie coffee drink and a big muffin, she likely consumed more calories
than she used, he says.
For the latest study, Church and colleagues recruited 411
overweight or obese sedentary women, average age of 57. Some of the women
were told not to change their physical activity level. The others were
divided into three groups and instructed to do different amounts each week.
They rotated walking briskly on a treadmill at a fitness center with riding a
stationary bike. Their workouts were monitored closely by the researchers.
The women were asked not to change their habits during the study.
At the end of six months, one group of exercisers was
doing an average of 72 minutes of moderate physical activity a week; another
group was doing about 136 minutes (a little more than two hours); and the
third one was doing 194 minutes (slightly more than three hours.)
The findings reported in "PLoS
ONE", a Public Library of Science online journal:
Women who did 72 minutes of physical activity a week lost
between 2 to 3 pounds in six months, which was what was expected from the
amount of exercise they were doing.
Those doing more than two hours
of activity a week lost slightly more than 4 pounds in that time, which was
what was anticipated.
Those who did three hours of activity a week only lost
about 2 to 3 pounds, but they should have lost almost 6 pounds from the
increase in physical activity.
Everyone who exercised lost dangerous belly fat. Those who
didn't lose weight dropped about an inch around the middle. Those who did
lose weight trimmed an average of 2 inches around the waist.
This confirms other research that physical activity alone
can contribute to some weight loss. Another recent study showed that women
who increased their activity level by an additional 3,500 steps a day lost 5
pounds during the year. Men who added that many steps lost 8 pounds in a
Another study showed that when obese women improved their
eating habits and walked briskly for an additional 50 minutes to an hour a
day, they lost about 10 percent of their body weight in six months.
Church says that there is a growing body of evidence that
physical activity decreases dangerous abdominal fat.
"Exercise without weight loss has a benefit to your
waist, but exercise with weight loss has even more benefit to your
waist," he says. This study did not include men, but he says other
research he has conducted shows the same phenomenon in men.
The loss of belly fat through exercise is important
because excess abdominal fat is considered a risk factor for many chronic
diseases including heart disease, diabetes, stroke and some types of cancer,
Experts believe the fat cells deep in the abdomen are
harmful because they secrete chemicals that play a role in a number of
diseases. The cells produce about three times more bad chemicals than
subcutaneous fat, the stuff you can pinch right under your skin, Church says.
"Plus, the plumbing of visceral fat drains directly to the liver,
allowing the bad chemicals to directly interfere with the liver's ability to
metabolize blood sugar and cholesterol."
[BACK TO TOP]
by Ramon Antonio Vargas, The Times-Picayune
When his 17-month-old daughter fell ill to a severe ear
infection one night two months ago, eastern New Orleans
resident Gregory Davis faced two unappealing choices: drive her to a hospital
downtown or one in Slidell,
both far away.
Davis took her downtown and
decided he never wanted another eastern New
Orleans resident to go through the same thing. So he
built a 1,600-square-foot primary health care clinic from scratch at 9890 Lake Forest Blvd.
It opens Tuesday.
The Champion Medical Center,
which stands literally in the shadow of the shuttered Pendleton Memorial
has an internal medicine specialist, a family practice doctor, a nurse
practitioner and a medical assistant on staff to handle routine check-ups and
a host of basic medical ailments.
It boasts three examination rooms, a doctor's office, a
waiting room lobby and a small triage area for patients with diabetes, high
blood pressure, coughs, colds, the common flu, stomach aches and minor cuts,
said Cynthia Kudji, the staff nurse practitioner.
The clinic also will perform Pap smears, breast exams, childhood
immunizations and school and employee physicals, she said.
The clinic will handle up to 40 patients a day, Kudji said. It is open on Monday and Wednesday from 8
a.m. to 5 p.m. and on Tuesday, Thursday and Friday from 8 a.m. to 8 p.m.
The Champion Medical Center
addresses the shortage of medical care that has plagued the neighborhood
since Hurricane Katrina, said Davis, a boxer who was born in Chicago and moved to
Eastover when he was 9.
With Methodist Hospital shuttered since the flooding after
Hurricane Katrina devastated eastern New Orleans,
residents have had to travel downtown or cross Lake Pontchartrain to Slidell to receive
routine but urgent treatment. Other than a large mobile medical unit and the
Tulane Community Health Center New Orleans East on Alcee Fortier Boulevard, both of which
opened last year, there have been few medical options in the neighborhood.
After his daughter's ailment, Davis gathered $250,000 of the money he has
earned from boxing purses to independently acquire and renovate the building,
a former laboratory testing facility. He then sought staff medical providers
through ads and e-mail and convinced them to move their individual practices
to the Champion Medical Center,
boxing name "True Champ."
"You won't be another Medicaid or insurance card
said Saturday, minutes before a ribbon-cutting ceremony. "We will care
about you here. You won't be made to feel in the way."
State Reps. Ann Duplessis and
Austin Badon, both New Orleans Democrats, visited Davis before the
"This young man has taken his own resources and
enhanced the entire area's resources," Duplessis
said. "It speaks loud to the interest in reinvesting viable
businesses" in post-Katrina eastern New Orleans.
Badon said routine and emergency
health care is too far away for some in eastern New Orleans. "Affordable, available
health care is needed, and I applaud (Davis)"
for addressing that need, he said.
Meanwhile, Mayor Ray Nagin's
administration has been working to buy Methodist Hospital
since 2007, but the city and the hospital owners haven't agreed on a price.
Both Nagin and outgoing recovery czar Ed Blakely
have said a deal between the city and the hospital's handlers is close,
though no one has predicted an exact date.
Pointing at Methodist's building from outside his clinic
on Saturday, Davis
said: "There wasn't time to wait for all that. We needed something
[BACK TO TOP]
Maya Rodriguez / Eyewitness News
- It is an area long-underserved when it comes to health care: New Orleans
East has struggled to regain a hospital since Hurricane Katrina.
Video: Watch the Story
In the shadow of the closed Methodist
Hospital, the staff at the Champion Medical Center
clinic celebrated their grand opening Saturday.
"The best thing with being a smaller facility: you
can work with the community and that's what I'm willing to do and I'm going
to do," said Gregory Davis, who owns the clinic.
The former boxer got into the medical field, after his
young daughter had a health emergency at the New Orleans East home, miles
away from the closest hospital.
"It was a scary experience and I don't wish that on
no one else, so that's one of the reasons I put this together," Davis said.
The clinic is just a few blocks away from the shuttered Methodist Hospital. Some state lawmakers
believe, this year, the legislature may finally be on track to fund the
re-opening of a hospital in the East.
"I am hopeful that if we can get in this legislative
session the money that's needed, we have been told it could take less than 18
months," said Sen. Ann Duplessis, D-New
Orleans East. "We have hospital district that has been formed, which has
its own board and that board will actually hire someone to come in and run
The money needed: $30 million, which has been requested by
the city. The money would be used to re-open the hospital in phases, starting
with the emergency room.
"We do think that it's smart to bring the hospital
back in phases, the most important piece is emergency care and perhaps a very
small triage, to overnight stabilization and then we build on that," Sen.
Representative Austin Badon said
he's surprised at how much time it's taken just to get to this point.
"I never thought it would take this long," he
However, Badon remains
optimistic that even amidst a state budget shortfall the money for the
hospital can be found.
"I think it's very possible that we could find the
money. I mean, we have a strong Orleans
delegation and we have a strong delegation in the eastern part of the
city," Rep. Badon said. "And we are
fighting hard to make sure that we get this money and we are able to bring
this money back to open up this hospital."
In the meantime, the Champion Medical
Center will formally
begin taking patients on Tuesday. Also on Tuesday, Sen. Duplessis
said she will be meeting with members of the Governor Bobby Jindal's administration to discuss funding for the
hospital in New Orleans East.
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New Orleans CityBusiness | 05.25.09
by Richard A. Webster
She’s known as Big Momma.
And when the police responded to a 911 emergency call at
New Orleans Glassworks on May 8, they asked her to make it easy on everybody.
“Just calm down and come with us, Big Momma,” they said.
But she refused and sprawled her sizable body out on the
floor. The first officers on the scene tried to remove her but she wouldn’t
budge. They called for backup. Two more officers arrived, but their combined
might could not shake her loose.
As more and more officers piled into the shop, Glassworks
owner Geriod Baronne
tried to keep the chaos from affecting her business.
“We have a school and I didn’t want the parents and other
people to see this going on,” she said. “I had students coming in and out, and this large woman on the floor surrounded by
Big Momma is known throughout the law enforcement and
health care communities and is beginning to make a name for herself in the
business community. She is a schizophrenic, who has been in and out of University Hospital “millions of times,” said
Cecile Tebo, crisis unit administrator for the New
Orleans Police Department.
The officers on the scene told Baronne
that Big Momma has a notorious reputation, and if she ever sees her again to
call for help immediately.
“The police said we were very lucky she didn’t defecate on
the floors like she does in the lobbies of hotels,” said Baronne,
who describes Big Momma as a 400-pound white woman, neatly dressed, carrying
an umbrella and a bag from Whole Foods. “With her size, the police said she
has done a lot of damage to other businesses and could have caused some real
damage in our glass gallery.”
The scary thing, said Tebo, is
that there are hundreds more just like Big Momma roaming the streets of New Orleans.
“We have more and more mentally ill people going into
businesses creating a public safety issue, and that’s because the inpatient
psychiatric bed situation is a total disaster,” Tebo
said. “There’s just no place to put people.”
Despite the desperate need for mental health beds in the
city, Gov. Bobby Jindal is moving forward with
plans to shut down the New Orleans Adolescent Hospital
and transfer its 35 mental health beds to Southeast Louisiana
Hospital in Mandeville.
Alan Levine, head of the Louisiana Department of Health and Hospitals, said
it will not have a negative impact on New
Orleans, and anybody who needs help can easily go
across the lake.
But Greg Rusovich, chairman of
the New Orleans Business Council, called the proposal a “bad mistake” that
will lower the quality of life in the city and scare away old and new
“This is some of the most bizarre logic I’ve heard in
awhile, and that’s scary considering how easy it is to find bizarre logic
around here,” Rusovich said. “If you’re not
protected from flooding, businesses won’t return. And if you don’t have a
safe environment to work and raise a family, businesses won’t stay here. Our
mental health care needs to be expanded, not contracted.”
Big Momma wandered into Glassworks to watch the
glassblowing exhibitions as many homeless people do, said Baronne,
who has taken in and tried to help numerous mentally ill people during her 20
years in business.
“She looked like a ‘he’ because she had gray crew cut
hair,” Baronne said. “But for someone off the
streets she was nicely dressed. She looked like she had just showered and was
out to have lunch.”
Big Momma sat quietly for some time without causing a
disturbance as she watched the artists work. But suddenly she stood up,
walked into the glass gallery, took several fragile objects off the shelves
and tried to walk out. When confronted, she snatched Baronne’s
glasses off her face.
That’s when Baronne called 911
and Big Momma hit the floor, refusing to move.
“Nine policeman couldn’t lift
her,” Baronne said. “They had to drag her out the
door to the steps near a gurney. And then I heard them say, ‘One, two, three,
heave ho.’ And then clunk. And there she was.”
What was remarkable to Baronne
was the familiarity between the police and Big Momma who, even in her
disturbed state, did not become angry as they tried to remove her.
They joked with her and she joked back. They engaged in
what Baronne described as “interesting and pleasant
After the police had Big Momma safely in custody and made
their way to the nearest emergency room, Baronne
wrote a letter to the Magazine Street Merchants Association informing them of
Sadly, she wrote, it would not be the last time a business
owner would be forced to call the police on this woman so desperately in need
“We just wanted to alert you that when this woman gets out
of the hospital the police said that she will be on the street again. She is
a mental patient and there are not enough facilities to take care of these
people. Be aware, as you do not want her to destroy your gallery or store.”
[BACK TO TOP]
Paul E. Miller, M.D.
Electronic health records penalties for not utilizing
electronic health records are upon us.
Privacy, control, ownership, expense, compliance, support,
interoperability, sustainability and other particulars are on everyone’s lips
when discussing implementation of a statewide system that ensures secure
communication with each health provider along the continuum-of-health model
for each patient.
There is a mad rush for which entity will handle the
millions coming from American Recovery and Reinvestment Act legislation for
establishing HIT (health information technology) in the state.
How many millions were spent in the past two years on
studying HIT in the state?
Would it be better to pool resources this time and have a
university system, such as UL of Lafayette, in affiliation with NIMSAT
(National Incident Management System for Advanced Technologies), coordinate
the design, development and strategy for a long-term sustainable electronic health
record system with open-source software, than to continue to utilize
Pooling resources in a protected trust foundation that can
continue to provide future funding for upgrades and support will surely be
better than paying one-time funds … leaving the providers holding the bag for
Will Louisiana Secretary of Health Mr. Alan Levine
consider DHH as a host repository for supporting a patient centered
electronic health records system that providers could utilize by Web portal
entry as an option for all patients, but as a requirement for each Medicaid
Would the providers in the state consider a patient
portfolio type of electronic health record system housed by Louisiana DHH as
an alternative to purchasing expensive office HIT, or consider it in addition
to their proprietary systems in place as an information exchange system?
Would UL of Lafayette and NIMSAT consider this challenge,
or would someone else be willing to bid on this project?
How could a central system such as this be more practical
and efficient in regard to payment requests for services rendered; tracking
of health-care needs, services and costs; state epidemiological trending;
quality-of-care monitoring; safety-of-care delivery; overall care along the
timeline to health for clients?
Could it help improve patient health literacy and client
responsibility with real-time access to their own records; reduce the burden
of costs for providing care by preventing redundant services with real-time
health encounter recording; be the simple solution that no one wants to
discuss because it takes the money out of the many different programs and
focuses it on a single source of accountability?
Would patients go for it?
This proposal is a statewide health information exchange
and repository and is an option worth legislative investigation if Mr. Alan
Levine does not consider it immediately.
Paul E. Miller, M.D.
[BACK TO TOP]
By MARK BALLARD
Advocate Capitol News Bureau
For fans of irony, the best moment of Zen for this general
session of the Louisiana Legislature — fast reaching its midpoint — came last
week when House Speaker Jim Tucker backed an amendment, then turned to an
aide and asked “What does the amendment do?”
The amendment, added by state Rep. Avon Honey, D-Baton
Rouge, basically defied Gov. Bobby Jindal, an
action most members of the Louisiana House have been avoiding at all costs
during this session. But House members didn’t read the amendment, they didn’t
ask any questions and many now say they unwittingly jaoined
the 99-0 vote to add defiance to the administration’s House Bill 841.
One of Jindal’s advisers
discovered the infraction, sending Jindal’s minions
into the halls looking for Republicans to criticize Honey for following the
rules: properly presenting an amendment, awaiting questions, asking for and
then receiving their votes.
The next day, state Rep. Erich Ponti,
the Republican who represents much of the southeastern portion of Baton Rouge, took the podium and denounced his north Baton Rouge colleague.
Somewhat less petulantly, a more-veteran state Rep. Bodi White, the Republican whose district takes in parts
of Baker, much of Central and northern Livingston Parish, rolled his eyes and
explained during an interview that the governor had sent a card saying he
approved of HB841. While the amendment was available on the computer, it
hadn’t been printed, so White said he just assumed Jindal
also wanted the change and cast his vote without reading it first.
“He followed the rules,” White said of Honey,
acknowledging that representatives holding minority views need to do what is
necessary to further their position. “It’s what you do in that situation,
it’s what I would have done,” White said with a shrug.
Honey is just one example of a handful of legislators who,
to quote the popular song, “just keep chasing pavements, even if they lead
State Rep. Juan LaFonta, the New
Orleans Democrat who engineered a late-Friday-afternoon vote that temporarily
denied the governor’s ability to seek loans to fund construction projects,
said this tilting at windmills is born of frustration at his colleagues’
willingness to do whatever Jindal wants.
For instance, Jindal is giving
millions of taxpayer dollars to a Texas
billionaire and to a California
chicken company, even as he slashes state dollars from services for the poor,
forces state parks to shut and threatens layoffs at institutions of higher
learning. The tactics draw the attention of regular people who would become
angry once they realize that Jindal’s economic
policies mean taxpayers only benefit from what trickles down from favored
special interests, LaFonta argues.
LaFonta and his colleagues say
they learned their guerilla techniques from “Che”
Tucker, who mastered the rules and set off little bombs as leader of the
loyal opposition when state legislators kowtowed to then-Gov. Kathleen
Tucker chuckled as he acknowledged the accuracy of LaFonta’s comparison.
“When we were in the minority and we disagreed, we did
everything we could under the rules to make it work for our favor and that’s
part of the process,” Tucker said. “You have to know how work the rules to
Tucker admits a little surprise that the majority of
lawmakers haven’t pushed back more. But he says this session the Jindal administration’s lobbying efforts have been much
better. Many of the problems legislators have with bills are worked out
behind closed doors long before the issues are taken public, Tucker said.
LaFonta disagrees, saying Jindal’s policies are breezing through because many
lawmakers are afraid of the governor. LaFonta says
the minority is preparing more Gandhi-like protests aimed at shaking up
colleagues, though he refuses to say where and when they’ll be launched.
“It wouldn’t be a guerrilla movement if I told what trees
we’re in,” LaFonta said.
Mark Ballard is editor of The Advocate’s Capitol news
[BACK TO TOP]
New Orleans CityBusiness |
by The Associated Press
BATON ROUGE — Tax breaks are
stalled. Budget cuts are under negotiation. And bans on smoking in bars,
hand-held cell phone use while driving and dental work at schools are
awaiting their fate.
Very little is decided as the Legislature's regular
session nears its halfway mark Tuesday.
Only one bill has made its way to the governor's desk so
far, a measure that rewrote the rules of an economic development fund so Gov.
Bobby Jindal could use $50 million from the fund
for his deal to reopen a chicken plant in north Louisiana.
With under five weeks left to go,
all the big money matters remain to be decided — following the trend of
regular sessions year after year. But while this session was designed largely
to deal with financial matters, lawmakers also are grappling with an array of
controversial proposals that go far beyond the budget and taxes.
Battles are under way between lawmakers and the Jindal administration over stimulus money, budget cuts,
tax break delays and access to the governor's records.
The centerpiece of the session is the $27.9 billion state
budget proposed for the new year that begins July 1. The proposal contains
deep cuts to public colleges and health services and slashes more than 3,500
state government jobs.
Lawmakers are trying to balance the budget with the loss
of $1.3 billion in state general fund revenue.
But the budget debate is part of a larger chess game at
the Capitol. Legislation awaiting decisions could either drain more dollars
from state coffers or raise the amount of revenue available to offset cuts.
Lawmakers have proposed tax breaks with hefty price tags,
but none of significant cost have gotten out of the tax committees — House
Ways and Means and Senate Revenue and Fiscal Affairs. Both panels have heard
hours of testimony but not acted on many bills.
"The picture is not very bright at this point,"
Rep. Hunter Greene, R-Baton Rouge and chairman of the Ways and Means
Committee, said of the state's financial situation. "We have to be
House Speaker Jim Tucker, R-Terrytown,
said he expects a package of tax breaks to move forward in the House, but he
said they will have small, manageable price tags.
"The mega ones of 200, 300 and 400 million dollars
aren't coming out," Tucker said.
Instead, what has gained traction in the Senate is a
proposal to delay a planned tax cut for middle- and upper-income taxpayers
who itemize charitable donations, home mortgage interest and certain medical
costs on their state tax forms.
The full Senate will debate the measure, which has the
backing of Senate President Joel Chaisson,
D-Destrehan, and a bipartisan group of Senate leaders. The senators want to
use the $118 million generated by stalling the tax break to stop cuts planned
for higher education.
"For the state's immediate and long-term future, it
is clear that we cannot allow budget cuts that will do irreparable harm to
our colleges and universities, institutions that are the engine that powers
the creation of jobs and businesses in Louisiana," Senate Finance
Committee Chairman Mike Michot, R-Lafayette, said
in a statement.
The bill faces steep opposition from Jindal,
who has threatened to veto it. Tucker also said he thinks it would be
difficult to get House backing for the plan.
Other ideas to offset budget cuts have had little luck. A
cigarette tax hike proposed by Rep. Karen Carter Peterson, D-New Orleans,
remains stuck in committee, and attempts to raid the economic development
"mega-fund" also haven't gone anywhere, amid opposition from the
Jindal's also fighting attempts
to override his rejection of $98 million in federal stimulus money to expand
The House passed the override, though most House members
said they didn't realize what they were approving because the language had
been quietly slipped into a bill by Rep. Avon Honey, D-Baton Rouge.
Now, Jindal wants the Senate to
kill the proposal, saying it would make businesses pay higher unemployment
taxes. The governor said he'll veto the bill if it reaches his desk.
Beyond financial matters, a recurring dispute for Jindal involves the broad public records exemption his
office has to shield records from the public. The exemption for Louisiana's governor,
which has existed for decades, is more sweeping than the records exemption
for nearly any other governor in the nation, and lawmakers want to change it.
"I told the governor we need to pass a bill. Status
quo is not an option," Chaisson said.
Jindal, who campaigned on
transparency in government, has proposed a measure that would open more of
his documents to scrutiny. But it doesn't go nearly as far as several
lawmakers want, and two Republican legislators complain it actually could
allow other state government agencies to shield documents from public view
with a protection they don't have today.
Other non-fiscal disputes this session:
— Superintendent of Education Paul Pastorek's
push to overhaul local school board laws faced trouble even before Rep. Steve
Carter, R-Baton Rouge, filed the bills. Only one has escaped committee, a
measure to get school boards out of hiring and firing decisions. Its future
remains unclear amid staunch opposition from the boards.
— Rep. Ernest Wooton, R-Belle
Chasse, returned with his proposal to allow concealed weapons on college
campuses. It awaits debate on the House floor, but faces resistance from
higher education leaders who successfully defeated it last year.
— Both the House and Senate have passed proposals to ease
standardized testing requirements for struggling middle school students.
Supporters say it would allow failing students to receive technical training
and could keep students from becoming dropouts. Critics say it would give
diplomas to students who aren't getting the basic reading, writing and math
skills they should.
Meanwhile, lawmakers also are considering bills that would
outlaw smoking in bars and casinos and prohibit talking on a hand-held cell
phone while driving. A new dispute arising this session involves a bill by
Rep. Kevin Pearson, R-Slidell, that would ban most
mobile dental clinics at public schools.
[BACK TO TOP]
School Spinoff Conducts New Herpes Keratitis Drug Study
NanoViricides, Inc. announced
that it has signed a pre-clinical study agreement for the evaluation of NanoViricides drug candidate for herpes keratitis of the eye.
The study will be conducted by Thevac,
LLC, a spin-off of the Louisiana State University (LSU), Baton Rouge, LA.
It will be performed in collaboration with the Division of Biotechnology and
Molecular Medicine at the LSU School of Veterinary Medicine, which
administers the LSU-Tulane Center for Experimental Infectious Disease
Research (Director, K. G. Kousoulas, PhD) (see also
Herpes keratitis (herpes virus
infection of the cornea) is a serious, potentially blinding disease of the
eye. It is the leading infectious cause of blindness in developed countries
and the most common infectious corneal disease in the United States. It can often
necessitate corneal transplantation.
Herpes virus infections and adenoviral infections of the
cornea together constitute most of the viral disease of the external eye.
At present, there is no satisfactory treatment that works
for both adenoviral and herpesvirus keratitis/conjunctivitis. The potential domestic market
for a drug effective against all or most viral infections of the external eye
is variously estimated to be from $500M to billions of dollars.
We are very pleased to have a recognized expert like Dr. Kousoulas associated with this study, said Eugene
Seymour, MD, MPH, Chief Executive Officer of NanoViricides,
Inc., adding, This will provide us with independent results for the nanoviricide drug candidates against viral diseases of
the external eye. Separate studies are expected to begin shortly in
collaboration with a pharmaceutical company.
The NanoViricides technology
appears to be very promising for treating a variety of viral diseases
including influenza, says Dr. Kousoulas. About
THEVAC, LLC THEVAC, LLC is a LSU spin-of company, which has been formed to
produce valuable reagents and provide sophisticated services to industry in
collaboration with LSU Baton Rouge. About NanoViricides:
NanoViricides, Inc. (www.nanoviricides.com) is a
development stage company that is creating special purpose nanomaterials for viral therapy.
The Company's novel nanoviricide
class of drug candidates are designed to
specifically attack enveloped virus particles and to dismantle them. The
Company is developing drugs against a number of viral diseases including H5N1
bird flu, seasonal Influenza, HIV, EKC, Hepatitis C, Rabies, Dengue fever,
and Ebola virus, among others.
[BACK TO TOP]
Meg Farris / Eyewitness News
Smoking is dangerous and deadly for all people, but a new
study finds that women may be more in danger. Doctors found that women
younger than 60 and those who were lighter smokers had worse lung function
and more severe illness than men.
Video: Watch the Story
And a smoking warning for teens: The Centers for Disease
Control found that high school students who try to quit smoking cigarettes
often fail. Doctors find that even though teens haven't been smoking for a
long time, they are already dependent on nicotine. Ninth graders had a little
bit easier time quitting than older high school students, possibly because
they hadn't smoked as long.
And there is also a warning for parents who smoke.
Children who are exposed to regular tobacco smoke are more likely to get
early emphysema later in life. Even if they never smoke when they get older,
doctors think that maybe their lungs never recover fully.
There is another study finding that opposites attract. A
Brazilian study finds that people are more likely to pick a mate whose genes
are very different than their own. Married couples are more likely to have
differences in the DNA that is linked to the immune system. Doctors say this
is an evolutionary advantage when it comes to having healthy children.
Doctors think maybe a person's body smell or the face structure
subconsciously signals a potential mate.
Researchers in Finland believe they have found
why some people have more of those warm and fuzzy sentimental feelings. Those
people have a higher concentration of brain tissue in two areas of the brain,
the same areas important for the basic biological drives of sex and food.
[BACK TO TOP]
The New York Times | 05.25.09
By DENISE GRADY
Armed Forces Medical Examiner System
After reading CT scans and X-rays, radiologists often
make notes of injuries to show pathologists where to look for bullets or
shrapnel during autopsies
Within an hour after the bodies arrive in their
flag-draped coffins at Dover Air Force Base, they go through a process that
has never been used on the dead from any other war.
Since 2004, every service man and woman killed in Iraq or Afghanistan
has been given a CT scan, and since 2001, when the fighting began in Afghanistan,
all have had autopsies, performed by pathologists in the Armed Forces Medical
Examiner System. In previous wars, autopsies on people killed in combat were
uncommon, and scans were never done.
The combined procedures have yielded a wealth of details
about injuries from bullets, blasts, shrapnel and burns — information that
has revealed deficiencies in body armor and vehicle shielding and led to
improvements in helmets and medical equipment used on the battlefield.
The military world initially doubted the usefulness of
scanning corpses but now eagerly seeks data from the scans, medical examiners
say, noting that on a single day in April, they received six requests for
information from the Defense Department and its contractors.
“We’ve created a huge database that’s never existed before,”
said Capt. Craig T. Mallak, 48, a Navy pathologist
and lawyer who is chief of the Armed Forces Medical Examiner System, a
division of the Armed Forces Institute of Pathology.
The medical examiners have scanned about 3,000 corpses,
more than any other institution in the world, creating a minutely detailed
and permanent three-dimensional record of combat injuries. Although the scans
are sometimes called “virtual autopsies,” they do not replace old-fashioned
autopsies. Rather, they add information and can help guide autopsies and
speed them by showing pathologists where to look for bullets or shrapnel, and
by revealing fractures and tissue damage so clearly that the need for lengthy
dissection is sometimes eliminated. The examiners try to remove as many metal
fragments as possible, because the pieces can yield information about enemy
One discovery led to an important change in the medical
gear used to stabilize injured troops on the battlefield.
Col. Howard T. Harcke, a
71-year-old Marine Corps radiologist who delayed retirement to read CT scans
noticed something peculiar in late 2005. The emergency treatment for a
collapsed lung involves inserting a needle and tube into the chest cavity to
relieve pressure and allow the lung to reinflate.
But in one case, Colonel Harcke could see from a
scan that the tube was too short to reach the chest cavity. Then he saw
another case, and another, and half a dozen more.
In an interview, Colonel Harcke
said it was impossible to tell whether anyone had died because the tubes were
too short; all had other severe injuries. But a collapsed lung can be
life-threatening, so proper treatment is essential.
Colonel Harcke pulled 100 scans
from the archives and used them to calculate the average thickness of the
chest wall in American troops; he found that the standard tubing, five
centimeters long, was too short for 50 percent of the troops. If the tubing
was lengthened to eight centimeters, it would be long enough for 99 percent.
“Soldiers are bigger and stronger now,” Colonel Harcke said.
The findings were presented to the Army Surgeon General,
who in August 2006 ordered that the kits given to combat medics be changed to
include only the longer tubing.
“I was thrilled,” Colonel Harcke
The medical examiners also discovered that troops were
dying from wounds to the upper body that could have been prevented by body
armor that covered more of the torso and shoulders. The information, which
became public in 2006, led the military to scramble to ship more armor plates
It was Captain Mallak who
decided that autopsies should be performed on all troops killed in Afghanistan or Iraq. Federal law gives him that
“Families want a full accounting,” he said. During World
War II and the Vietnam War, he explained, families were told simply that
their loved one had died in service of their country.
“Personally, I felt that families would no longer just
accept that,” Captain Mallak said.
The examiner’s office has not publicized the autopsy policy
and has not often discussed it. Families are informed that autopsies are
being performed and that they can request a copy of the report. Occasionally,
families object, but the autopsy is done anyway. About 85 percent to 90
percent of families request the reports, and 10 percent also ask for
photographs from the autopsy, said Paul Stone, a spokesman for the medical
examiner system. Relatives are also told they can call or e-mail the medical
examiners with questions.
“Every day, families come back for more information,”
Captain Mallak said. “The No. 1 question they want
to know is, ‘Did my loved one suffer?’ If we can say, ‘No, it was
instantaneous, he or she never knew what happened,’ they do get a great sense
of relief out of that. But we don’t lie.”
Indeed, the reports are sent with cover letters urging the
families not to read them alone.
The possibility that a relative burned to death is a
particular source of anguish for families, and one area in which CT can
outperform an autopsy. In a body damaged by flames, CT can help pathologists
figure out whether the burns occurred before or after death. The scans can
also tell whether a person found in water died from drowning. Families who
request the autopsy reports often put off reading them, said Ami Neiberger-Miller, a spokeswoman for the Tragedy
Assistance Program for Survivors, a nonprofit group for people who have lost
relatives in war.
“I think people feel, ‘We should request it; we may not
want to read it today, but we may want to read it 10 years from now,’ ” Ms. Neiberger-Miller said. Her brother was killed in Baghdad in 2007, she
said, and her family has never opened his autopsy report.
Liz Sweet, whose 23-year-old son, T. J., committed suicide
in 2003, requested his autopsy report and read it.
“For our family, we needed it,” Mrs. Sweet said. “I just
felt better knowing I had that report.” T. J. Sweet’s coffin was closed, so
Mrs. Sweet asked Captain Mallak for a photograph
taken before the autopsy, to prove to herself that
it really was her son who had died.
“He was one of the most compassionate people throughout
this whole process that I dealt with from the Department of Defense,” Mrs.
Sweet said of Captain Mallak.
The scans and autopsies are done in a 70,000-square-foot
facility at the Dover
base that is both a pathology laboratory and a mortuary. Journalists are not
allowed inside. The CT scanning began in 2004, when it was suggested and paid
for by the Defense Advanced Research Projects Agency, or Darpa,
part of the Defense Department. Darpa got the idea
of using CT scanners to perform virtual autopsies from Switzerland, where it started
about 10 years ago.
Now the idea of virtual autopsies has begun to catch on
with medical examiners in this country, who are
eager to use it in murder cases but also to learn the cause of death in
people from religious groups that forbid traditional autopsies. Scans can
also help pathologists plan limited autopsies if a family finds a complete
one too invasive.
John Getz, the program manager for the Armed Forces
medical examiners, said mobile CT scanners could also be used to screen mass
casualties during disasters like Hurricane Katrina, to help with
identification and also to determine if any of the dead were the victims of
crimes rather than accidents.
Forces CT scanner, specially designed to scan
entire corpses one after another, is the envy of medical examiners and crime
laboratories around the country, and several states have asked Captain Mallak and his colleagues for advice on setting up
Colonel Harcke said he hoped the
technology would help to increase the autopsy rates at civilian hospitals,
which now perform them only 5 percent to 10 percent of the time.
“We hope to return to a time where we were 50 years ago,”
he said, “when autopsies were an important part of the medical model, and we
continued to learn after death.”
[BACK TO TOP]
The New York Times | 05.25.09
By ABIGAIL ZUGER, M.D.
Greenwich Printing Office
You have probably had your fill by now of swine flu, bird
flu, flu of all descriptions; you have turned off your television, tossed the
front section of this newspaper into the trash, and called for not one more
word about the flu or any of the other dire infections breaking news around
Sad news: you are out of luck. There will unquestionably
be more words — many more — and you will probably wind up reading them. An
insatiable fascination with contagious illness is hard-wired into all of us,
as two new books make clear.
From Philip Alcabes, an
epidemiologist and a professor at Hunter
College in New York, comes “Dread,” a sober analysis
of why exactly this should be so. What is it that distinguishes epidemic
infection from all other diseases, the ones that fail to generate breathless
headlines and have failed to inspire the gigantic body of literature and
commentary that trail behind history’s epidemics?
The answer is logical enough: epidemics hit us right at
the nexus of self-interest and altruism, that exquisitely uncomfortable spot
where our brother’s misfortune nudges us just enough that we need to examine
it and distance ourselves from it (and, in more highly evolved civilizations,
take care of it before it takes care of us).
The history of epidemic infection is actually somewhat less
about disease and treatment than the various ways humans have found to create
a nice thick wall between the ill and the well, the “us” and the “them.” Only
quite recently has the radical notion of reaching through the wall and
protecting the well by treating the ill gained much support.
Dr. Alcabes takes a methodical
tour of the terrain, from the leprosy of biblical times through the bubonic
plague outbreaks of medieval and Renaissance Europe, cholera and tuberculosis
in the 19th century, AIDS in the 20th. Politics, religion and economic
concerns shaped the public response to each, with feeble medical intervention
generally trailing far behind.
The language itself, Dr. Alcabes
argues, can sometimes transform the facts: once you call a disease an
“epidemic,” for instance, you immediately imply that it has a story line,
with a beginning and an end, a certain moral tenor and a narrative flow that
regular old illness lacks.
And so, he asks provocatively, is obesity is really the
newest modern epidemic? Or is the word being used cannily by public health
officials, with the intent of inspiring a specific public reaction — creating
an “us” and a “them” (“they” have bad habits and have made poor choices) and
implying that someday it will be “over”?
This is fascinating stuff, or at least it should be.
Unfortunately, Dr. Alcabes writes with the
trademark mumble of the social scientist, and he has successfully gutted most
of the human interest from his story. The facts are there, but the color has
bled far away.
For living color, turn to “The Lassa Ward,” which
effortlessly transmits both the facts and the fascination of a bad infectious
outbreak. Dr. Ross Donaldson spent two months in Sierra Leone as a medical student
in 2003. Malaria, tuberculosis, yellow fever and AIDS were rampant, but Dr.
Donaldson, for reasons clear perhaps only to the invulnerable post-adolescent
he was at the time, decided to spend his time with Lassa fever patients.
This rat-borne illness is one of Africa’s
dire viral hemorrhagic fevers; like Ebola, it can reduce a human body to a
bruised, bloated corpse in days. It is terrifying — the secretions of
infected patients easily spread the disease — but it is also treatable, and
in the best cases patients get well and go home.
Dr. Donaldson had trailed the elderly Lassa specialist Dr.
Conteh for only a few weeks when, to his horror, he
was left alone in charge of the Lassa isolation ward. “No matter how low a
cotton tree falls, it is still taller than grass,” the old doctor said as he
left to teach in another town. In other words, the inexperienced Dr.
Donaldson, with three years of medical school, had more formal education than
anyone else around.
With patients who were sicker than sick, and little in the
way of tests or treatments, Dr. Donaldson clung to the usual life preservers:
the advice of a couple of experienced nurses and his own common sense. At the
end of two weeks, he writes, “I hardly recognized the person I had become.”
He was a Lassa expert, veteran of the old education-by-immersion process that
terrifies medical students no matter where they are.
His take on epidemic infection is dead-on, down to the
bizarre stubbornness that often permeates stricken communities and prevents
the very changes that might save lives. (For Lassa, a key preventive measure
was to stop eating rats, but rat meat tasted far too good for that advice to
be taken seriously.)
Dr. Donaldson shows how life can be strangely orderly at
the deep center of an epidemic: meals are eaten, drugs are dispensed,
patients die but others recover, and a little girl lying bloated and moribund
in the hospital makes it home to play in a rat-infested yard. She may be
immune to Lassa now, but her playmates are not. This is the portrait of
contagion at the highest possible magnification, and all the abstruse details
of policy, prevention and financing are right there, if you look hard enough.
[BACK TO TOP]
The New York Times | 05.25.09
By SANDEEP JAUHAR, M.D.
I was chatting recently with a doctor friend who was
depressed because he thought he had lost a referral source.
“This internist was sending me patients,” he told me, as I
recall. “Then last month he sent me only one patient. And this month only one
I nodded hesitantly, unsure what he was driving at.
“So I understand something must have happened,” he said.
“Like what?” I asked.
He threw up his hands, exasperated by my obliviousness.
“He met someone else! He developed a relationship with another cardiologist.”
I smiled at the overwrought response, with its
connotations of a romantic breakup. But to my friend, this was no joke. Like
most specialists, his livelihood depends on referrals. And like most, he will
go to great lengths to preserve his referral sources.
Physician-to-physician referrals are the currency of
day-to-day transactions in medicine, but as with any currency, they can be
Logic says that a referral should depend only on a
patient’s needs and the reputation and skill of the physician to which the
patient is referred. But medicine is a business too, so that isn’t how it
always works in practice.
The talk springs up in every doctors’
lounge: “Dr. X is opening shop — let’s give him some business.” When my wife
told me she wanted to start an endocrinology practice, I reassured her that I
would send patients to her, and that so would my brother, also a doctor, and
his friends. As far as I can tell, there are no restrictions on such a
Studies suggest that physicians receive up to 45 percent
of new patients by referral, usually from other physicians. Referral rates to
specialists in the United States
are estimated to be at least twice as high as in Great Britain.
The rates reflect several aspects of American medicine:
increasing specialization, the lack of time for any doctor to give to complex
cases, and fear of lawsuits over not consulting an expert. At the same time,
referrals are a way for cash-strapped doctors to generate business.
When I was in training, simple referrals from internists,
like patients with only mild hypertension, bothered me as a waste of time.
Now that I am in practice, I welcome them. I haven’t changed my mind that
these referrals are probably unnecessary, and there is plenty of evidence
that wasteful expert consultation is adding to health costs and creating
redundant care. But as a full-fledged doctor, I appreciate the business. It
is hard not to view a referral as an overture from another physician, and it
is equally hard not to return the favor.
A sort of paradox is at work. Specialists are better paid
than primary care physicians, but they are also less autonomous because,
unlike primary care physicians, they depend on other doctors for referrals.
There is pressure on specialists to keep referral sources happy, especially
in doctor-saturated metropolitan areas like New York City.
There are limits, of course, on the autonomy of referring
physicians, too. For instance, by federal law a doctor cannot refer patients
to himself or to a business in which he has a significant financial stake,
like a laboratory or imaging center, and he cannot be paid for a referral.
The reasoning is that such behavior can interfere with clinical judgment,
decrease quality and increase costs.
In 2006, Tenet Healthcare Corp., based in Dallas,
agreed to pay $21 million to settle a whistleblower lawsuit asserting that a
hospital it owned in San Diego
had paid kickbacks to physicians for referrals. (Tenet did not admit
wrongdoing.) That same year, a New
Jersey teaching hospital was investigated for
giving sham salaries to community doctors in a reported attempt to increase
the number of referrals to its cardiac surgery program. Two cardiologists
pleaded guilty to federal fraud charges.
But there are gray areas in practice. The Office of the
Inspector General in the Department of Health and Human Services has
investigated office space rentals, for example. Across the country, mobile
medical imaging companies have made arrangements with internists to perform,
in their offices, cardiac ultrasounds, which the companies send to
cardiologists for interpretation. Insurance companies that cover the imaging
pay the companies, and the companies pay rent to the internists. By law,
these rent payments must reflect fair market value and be unrelated to the
volume of patients referred by the internists for imaging. But according to
doctors familiar with these agreements, that isn’t always the case.
“Obviously you get more rent if you provide 50 patients
than if you provide 5,” an internist on Long Island,
who did not want his name used, told me.
When I asked whether it wasn’t just a form of a kickback,
“When the companies take more time, they have to pay more
rent,” he said. “You don’t say it is per patient; you say per hour. But
patients equal time.”
Though he no longer participates in these contracts, he
was open about the payments — about $100 per patient — and he saw nothing
wrong with them. “As internists, we don’t bill for procedures, so we have to
figure out another way to make money,” he said. “Every little bit helps.”
Whether the rent payments amount to indirect kickbacks is
an open question still being investigated by the inspector general. The real
issue, I think, is not the rentals but a referral system that is too easily
corrupted. There is so much pressure to generate referrals that lines become
Our health care system needs a different approach, one in
which patients are not treated as commodities.
One possibility is what Gail Wilensky,
a health policy expert, argued for this year in The New England Journal of
Medicine: a single payment that would cover all physician services and
hospital care for any one patient. A major driver of referral proliferation
is that doctors are paid piecework. There is less of an incentive to increase
volume if payments are bundled rather than discrete for every service.
A bundled-payments system is already in place for
hospitals, dialysis centers and nursing homes. Extending such a strategy to
individual doctors’ payments seems to be the logical next step.
is a cardiologist on Long Island and the
author of the recent memoir “Intern: A Doctor’s Initiation.”
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The New York Times | 05.25.09
By JANE E. BRODY
Edward Ferguson, a civil engineer living in Vancouver, Wash.,
retired at age 65 from a job handling multimillion-dollar contracts. Five
years later he could not balance a checkbook, walk without falling, drive a
car, control his bladder or recognize his granddaughter.
Instead of the active retirement he had anticipated, Mr.
Ferguson, now 74, thought he would spend the rest of his life in a
wheelchair, incontinent and struggling with dementia. Ten doctors were unable
to tell him what was wrong, but an Internet search by his daughter found a
condition that seemed to match his symptoms: normal pressure hydrocephalus,
The disorder involves a build-up of spinal fluid in the
ventricles of the brain, causing pressure on nerves that control the legs,
balance, bladder and cognitive function. “It’s as if the brain has reverted
to babyhood,” Dr. Michael Kaplitt, a neurosurgeon
at NewYork-Presbyterian Hospital/Weill Cornell
Medical Center, said in an interview. “Like babies, people with N.P.H. walk
slowly with feet wide apart, they are incontinent and have no memory.”
Dr. Kaplitt calls it “a classic
triad of symptoms” that should alert doctors to the possibility of N.P.H.
Yet the condition is frequently misdiagnosed as dementia,
Alzheimer’s disease, Parkinson’s disease or a spinal problem. Or it is
attributed to age — nearly all who are affected are over 55.
Living With Uncertainty
“I was the most frustrated person in the world because at
no time did a doctor give us a real diagnosis,” said Mr. Ferguson’s wife,
Elva. The suspicions of Mr. Ferguson’s daughter eventually led to an accurate
diagnosis through an M.R.I. and neurological tests. The Fergusons also found
Dr. Jeffrey Chen, the director of neurotrauma for
the Legacy Health System in Portland,
Ore., who is skilled at
treating this often-reversible condition.
Two days after surgery to install a programmable shunt
that relieved the pressure on the frontal lobes of his brain, Mr. Ferguson
walked across a room for the first time in a year. He was able to think and
write clearly, and his incontinence improved.
The Fergusons are now looking forward to their 56th
anniversary. Mr. Ferguson, who had contemplated suicide, considers himself to
have a second chance at life. “At one point I saw no light at the end of the
tunnel,” he said, “and now it is just so beautiful there.”
A Correctable Problem
No one knows how often N.P.H. occurs because it is so
often missed or misdiagnosed. Estimates range from 50,000 to 375,000 people
in the United States,
with the higher figure more likely to be correct, said Dr. Mark Luciano, a neurosurgeon at the Cleveland Clinic.
“There are a lot of people out there with a correctable
problem that is attributed to old age,” Dr. Luciano
said. “When the problem is fixed, it’s like rescuing them from oblivion. A
small percentage of people with dementia — maybe 10 or 15 percent — really
The disorder was recognized and named in 1965. But most
doctors who treat older people are unaware of it or fail to think of it when
treating patients with classic, albeit confusing, symptoms.
In most cases, the cause of N.P.H. is unknown. Some
patients had suffered a severe head injury, stroke, meningitis or a brain
tumor, perhaps decades earlier, which may have caused scarring or
inflammation that gradually interfered with drainage of spinal fluid.
Dr. Kaplitt explained that each
day the brain normally produces “about two soda cans’ worth of spinal fluid.”
This fluid protects the brain’s soft tissue, which floats in the skull. Made
deep in the brain, spinal fluid flows through a series of channels to the
brain’s four ventricles and finally exits to outside the brain and spinal
Each day the same amount of spinal fluid that is produced
must be reabsorbed into the bloodstream. But if something slows or blocks its
path, it builds up in the ventricles, which expand and press on nerves in the
Diagnosis and Treatment
Normal pressure hydrocephalus is best diagnosed by a team
that includes a radiologist, neuropsychologist and neurologist or
neurosurgeon experienced in distinguishing this condition.
The best clue often comes from a careful medical history,
since N.P.H. typically starts with gait problems, Dr. Luciano
and his colleague, Dr. Ronan Factora, a
geriatrician at the Cleveland Clinic, reported last year in the journal
Cognitive impairment typically does not precede gait
problems, they said, but when it does, or when dementia has become severe,
the response to treatment is lessened. Incontinence, which starts out as
urinary urgency, can occur at any point in the disease, and is often worsened
by problems with walking or dementia.
Although there is no one route to diagnosis, if N.P.H. is
suspected, a CT scan or M.R.I. of the brain can reveal one or more enlarged
ventricles, an essential feature of the condition. On an M.R.I., Dr. Kaplitt said, the spinal fluid often is cloudy or
Treating N.P.H. involves inserting a shunt into the brain
to drain off accumulating spinal fluid and divert it to the abdomen, where it
can be reabsorbed into the bloodstream. The ideal shunt has a valve and can
be reprogrammed to regulate the drainage. Repeat surgery is a possibility if
the shunt drains off too much or too little spinal fluid. While the shunt is
not a cure for N.P.H., in the 70 to 80 percent of patients who benefit from
it, it may give them a decade or more of near-normal life, the experts said.
To locate support groups and centers that can diagnose and
treat N.P.H., you might check the Web site established by Codman, the maker
of a programmable shunt, www.lifenph.com.
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The New York Times | 05.25.09
By NICHOLAS BAKALAR
Reducing childhood obesity may have yet another benefit:
lowering the incidence of food allergies.
Researchers studying more than 4,000 children ages 2 to 19
enrolled in a larger survey of childhood health found a significant
association of overweight and obesity with allergic reactions to eggs,
peanuts and other common allergens. For example, overweight and obese
children were over 50 percent more likely than those of normal weight to be
allergic to milk. Over all, the obese and overweight children were about 25
percent more likely to have one or more food allergies.
“While there’s nothing conclusive about our findings,”
said Cindy M. Visness, the lead author, “this is
one more motivation to try to prevent obesity in children.” Dr. Visness is an epidemiologist with Rho Inc., a company
that provides research and statistical services for clinical trials.
The scientists also found an association between being
overweight and levels of C-reactive protein, a marker of inflammation, which
suggests that systemic inflammation may also play a role in the development
of allergies. The authors acknowledge that their study, published in the May
issue of The Journal of Allergy and Clinical Immunology, does not prove that
obesity causes allergies, and that other explanations for the association are
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Parasites: Giving a Deworming Drug to Girls Could Cut H.I.V.
Transmission in Africa
The New York Times | 05.25.09
By DONALD G. McNEIL Jr.
Giving an inexpensive deworming
drug to millions of girls in rural Africa
could substantially reduce transmission of the virus that causes AIDS,
The drug praziquantel, which
costs only 32 cents per child, would prevent schistosomiasis,
a worm disease that starts as a urinary tract infection but, untreated, can
lead to female genital sores that make it easier for H.I.V. to enter. Once
lesions appear, the drug can kill the worms but not cure the sores, so girls
must be protected before they reach sexual maturity.
The study, by researchers from the Sabin Vaccine
Institute, Imperial College London and Oslo University
Hospital, appears in PLoS Neglected Tropical Diseases.
There are 207 million cases of schistosomiasis
in the world, 90 percent of them in Africa.
In Africa, humans typically get it from
wading into snail-infested water to swim or wash clothes. The worms leave the
snails and burrow into the skin; the first symptom is bloody urine.
The success of a pilot program in Burkina Faso suggested that all the 70 million
toddlers and school-age children who are infected in Africa
could be treated for $22 million; repeating that every two years for a decade
would cost $112 million.
“For this relatively small investment, the reproductive
health of young women would be improved,” the authors wrote, “and there is a
reasonable chance that H.I.V./AIDS transmission can be reduced.”
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The New York Times | 05.25.09
By ANAHAD O’CONNOR
For almost a century, eye exercises have been promoted as
a way to strengthen vision and ease nearsightedness and astigmatism,
much like exercise for the body trims fat and improves health.
Some of the most popular techniques include eye-hand
coordination drills, eye movement routines and focusing on blinking lights.
The techniques are widely promoted online and advocated by various companies,
some even claiming that they can reduce the need for glasses and ease
learning disabilities. But several studies have concluded that many of these
do-it-yourself techniques are baseless.
One of the latest studies, published in 2009, found little
evidence in support of vision exercises that supposedly slow or reduce
myopia, ease dyslexia and correct conditions caused by physiological
problems, like blurred vision. A similar conclusion had been reached in a
2005 report that reviewed 43 previous studies, finding “no clear scientific
evidence” for most of the methods reviewed.
But there are some areas of vision therapy that have been
scientifically validated, including one called orthoptics.
In this therapy, eye doctors prescribe exercises that can relieve double
vision, focus problems and conditions like strabismus, also known as crossed
eyes. Orthoptics can treat convergence
insufficiency, in which the eyes have trouble working together. It affects as
many as 1 in 5 people, but with the right exercises it can be all but cured,
THE BOTTOM LINE
Eye exercises are useful for some problems, but they do
not seem to relieve myopia or dyslexia.
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