Paul E. Perkowski, MD,
president-elect
It has been a goal of local physicians and physician
organizations to get the political establishment to appropriate funds and
dedicate resources toward a replacement facility for the dilapidated Earl K.
Long Medical
Center. There is no
doubt in the medical community that this facility does not serve the needs of
its patients, and does not adequately represent the capital city as a
state-of-the-art flagship public university hospital. In fact, there is no
controversy as to the necessity of replacing this hospital.
Sadly, despite the extraordinary efforts of Earl K. Long’s
physicians and the facility itself in the aftermath of Hurricane Katrina,
that tragedy sidetracked any state plan to replace EKL. Since that time the
focus has been on rebuilding New
Orleans and replacing the shuttered Charity and VA
hospitals there.
Meanwhile, EKL lumbers on, serving patients, training
resident physicians and medical students the best it can. In late 2007, just
before the gubernatorial election, the Capital Area Medical Society partnered
with local physicians to urge the new governor to put a replacement hospital
for the Baton Rouge
area at the top of his priority list.
Recently LSU and Our Lady of the Lake Regional
Medical Center
have announced a partnership to take over the major residency training
programs and patient care now centered at Earl K. Long.
While we, as physicians, will look at all options on the
table with regards to this difficult problem, this announcement came as quite
a surprise to both the medical staffs of EKL and OLOL. A public/private
partnership may be a viable solution to caring for our city’s indigent and
underserved patients, but such a partnership would change drastically the way
our private physicians practice medicine at OLOL, and would simultaneously
uproot our LSU physicians and significantly change their practices.
Unfortunately, the powers that be at LSU and OLOL seemed
to have embarked on this difficult journey without consulting their most
important assets; the physicians I just mentioned. In fact, in my personal
communications, I have discovered little and tepid support for this plan
among the medical staffs.
The plan might work, but it will not work if all parties
are not on board. The Capital Area Medical Society supports graduate medical
education in the Baton Rouge
area. We are on record as supporting a flagship public teaching hospital for
the capital region. We support all efforts to increase access to care for our
underserved patient population.
We understand and hope that all these goals can be
accomplished simultaneously with a plan agreed upon after careful
consideration by all parties involved. We will not stand by, however, and
support any plan that is forced upon our patients and physicians without
consultation and consideration.
Paul E. Perkowski, MD,
president-elect
Capital Area Medical Society
Baton Rouge
http://www.2theadvocate.com/opinion/48737937.html
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A state-brokered deal to give Louisiana
State University
ownership of a proposed New Orleans
teaching hospital and to give Tulane and other local universities seats on
its governing body is a good compromise to advance the project.
The Tulane Board of Trustees ratified the deal Friday.
Their LSU counterparts are to consider it today, and they also should endorse
it.
The hospital would be run by an LSU-affiliated nonprofit
with a 12-member board appointed by LSU, Tulane, Xavier, Dillard and Southern
universities, Delgado Community College and state officials.
Accepting the agreement, which also distributes medical
residency slots between LSU and Tulane, would end the impasse between the two
schools over how to run the hospital.
The proposed governing board would be obligated by the
memorandum to do what's best for the hospital. LSU would have ownership of
the hospital, a large representation on its board and would also appoint the
board president. For its part, Tulane gets a say in the hospital's governance
and "branding," as well as the same number of residency slots as
before Katrina.
Having the two medical schools involved with the hospital
would undoubtedly make it better -- but that requires the cooperation this
agreement brings. Gov. Bobby Jindal and Health and
Hospitals Secretary Alan Levine deserve credit for their roles in the
negotiations, which also included LSU System President John Lombardi, Tulane
President Scott Cowen and board members from LSU and Tulane.
New Orleanians need a teaching
hospital, and building it should remain everyone's goal. Approving this
agreement gets this community one step closer to that objective -- and that's
why the LSU board should endorse the deal.
http://www.nola.com/news/t-p/editorials/index.ssf?/base/news-5/124564805427220.xml&coll=1
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By Bill Barrow
Capital bureau
BATON ROUGE -- Moving one step closer to ending the
health-care standoff between Tulane University and Louisiana State
University, Tulane's
board on Friday endorsed a draft governance agreement for the proposed $1.2
billion teaching hospital in lower Mid-City.
LSU's Board of Supervisors will convene Monday to discuss
the document birthed from a series of negotiations between LSU System
President John Lombardi and Tulane President Scott Cowen, with state Health
Secretary Alan Levine acting as mediator.
The memorandum of understanding would make LSU owner of
the hospital to be operated by a nonprofit corporation with board of
directors representing LSU, Tulane and other New Orleans schools.
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Tulane board members ratified the agreement during a
private teleconference, according to school officials who offered no further
comment.
It is not certain that LSU's board will follow Tulane's
lead. Dr. Fred Cerise, LSU's vice president for health affairs, said this
week that supervisors were kept in the loop as conversations progressed, but
said there are details board members had not seen before Levine unveiled the
agreement Thursday.
Killing the deal would kick the issue back to the
Legislature, which has five remaining session work days to settle the matter
in a statute rather than allow the schools to craft their own agreement.
House Speaker Jim Tucker, R-Algiers, filed House Bill 830
earlier this session to create an independent board with no representatives
from any of the schools with a stake in the hospital. Tucker said this week
that he is most interested in "getting this hospital moving" and
would shelve his bill if LSU and Tulane reach common ground.
The schools have been at odds for months over the name of
the hospital, apportionment of the board slots and the number of medical
residency slots for each school, among other issues.
Under the draft agreement, the 12-member board would
comprise seven permanent members representing the various schools and five
"nonpermanent" members with no school affiliation. LSU supervisors
would appoint four members, while Tulane and Xavier University
would have one slot each. The seventh seat would rotate every two years among
Delgado Community
College, Dillard
University and Southern
University.
The chairman of the corporation must be an LSU appointee.
The initial five nonpermanent members would be selected by
the state health secretary and the governor's commissioner of administration,
with the permanent members of the board having to approve the slate. The
permanent members would choose the nonpermanent successors using an internal
nomination and confirmation process.
The full hospital complex would be named "University Medical Center."
The main building, which would include the inpatient beds, would be named for
the Rev. Avery C. Alexander, the late civil rights leader and legislator whose
name the Legislature affixed to the old Charity Hospital
downtown several years ago.
Medical residency slots would be divided as they were at
Charity and University
Hospitals before
Katrina: 373.26 slots for LSU and 200 for Tulane.
Even if lawmakers scrap debate on Tucker's governance bill
should LSU lend its approval of the agreement, it is possible that the
Legislature eventually would have to rewrite the portion of state law that
spells out the governance of the existing Medical Center of Louisiana at New Orleans, the legal
name of Charity and University together.
http://www.nola.com/news/t-p/capital/index.ssf?/base/news-7/1245476118241890.xml&coll=1
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Advocate Capitol News Bureau
The Board of Tulane University signed off on a proposed
agreement that includes the university’s role in a proposed $1.2 billion
state academic medical center in New
Orleans.
The center would be built and operated by a nonprofit
private corporation affiliated with LSU.
Tulane would continue to house some of its physician
training programs at the medical center as it does at LSU’s hospital in New Orleans today. It would have one seat on a 12-member
corporation board.
The memorandum of understanding which Tulane’s board
endorsed was developed by officials from LSU, Tulane and the state Department
of Health and Hospitals.
The agreement defines the governance and operational
structure of the proposed new academic medical center that would replace Charity Hospital, which has been shuttered
since Hurricane Katrina.
The LSU Board of Supervisors has called a special Monday
meeting to address the proposal.
http://www.2theadvocate.com/news/48648232.html
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Associated Press
NEW ORLEANS
(AP) - The Tulane University Board of Trustees has endorsed a proposal that
would give the school a permanent seat on a board that would run a new teaching
hospital planned for lower Mid-City.
The Louisiana State University System Board of Supervisors
is scheduled to consider the proposal on Monday.
The two schools have disagreed for some time over many
aspects of the proposed 424-bed hospital.
The proposal calls for a 12-member board of directors.
LSU would appoint four, Tulane and Xavier universities one
each, and one would rotate among Delgado, Dillard and Southern universities.
Those members would vote on whether to accept executive brach
nominations for the other five seats.
They would have to be independent of all the schools, and
have relevant professional expertise.
http://www.wxvt.com/Global/story.asp?S=10567414&nav=menu1344_2
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by Michael Weiser, Guest Columnist
I own a multimillion dollar business, with thousands of
employees, headquartered in our building at 1900 Canal St. That's in the 37-acre
site that LSU has targeted for expropriation to build a $1.2 billion hospital
in Lower Mid City.
My building flooded in the aftermath of Hurricane Katrina.
I could have relocated my business anywhere and would have been welcomed with
open arms. But I chose to do the right thing -- although apparently not
necessarily the smart thing. I came back; I rebuilt. This is the building and
location I had meticulously chosen; this is where I wanted to stay.
Imagine my surprise when I opened the newspaper one day
and read that LSU and the powers-that-be had decided to take my property. I
asked myself, why did I come back here? This state, and
this city, clearly think I am disposable.
Since that shock, it has become obvious that LSU doesn't
have the money to build this $1.2 billion hospital or even a reasonable plan
to raise the money.
My worst nightmare is that the $300 million already
allocated for this project by the state will allow LSU to do the
expropriations and demolish this historic neighborhood and that the funds to
actually build the hospital are nowhere to be found in this economy. What we
will then have is a 37-acre vacant lot on Canal Street.
In the middle of this mess, House Bill 780 appeared.
It is a common-sense bill by Rep. Rick Nowlin,
R-Natchitoches, which would require LSU to have a realistic financing plan,
approved by the Legislature, showing that LSU can raise the money to build
the hospital, before spending millions of taxpayer dollars to seize the land
and destroy homes and businesses.
HB 780 breezed through the House, 94-2. It crashed and
burned in the Senate Education Committee, where it was "deferred"
by a vote of 6-1.
You have to ask -- why are LSU and the State Office of
Facility Planning so afraid of this bill? This bill should be embraced by LSU
and any reasonable and thoughtful legislator. Wouldn't having a valid,
up-to-date financing plan help speed the process? Who builds property or
opens a business without clear and present funding? That's Business 101.
I should know; I took the course at LSU.
As state Treasurer John Kennedy testified before the Senate
Committee: "All this bill does is say we won't
take anybody's land, we won't take anybody's business, until it's clear that
we're going to have the money to build a hospital."
This makes sense to me. I would think it would make sense
to any business person. We already have a large, empty space in New Orleans where land
was seized, millions of dollars spent and buildings bulldozed, for a big
project that never happened. Remember the proposed expansion of the
Convention Center? Can we really afford to let this happen on Canal Street?
To top it off, I recently saw the design plans for the
proposed LSU hospital. LSU plans to seize 37 acres and tear everything down,
including my building. But the fine print reveals that the $1.2 billion only
covers building on half of the land. The rest (including where my building
now stands) will remain empty, marked for "future development".
I have to say, I am not feeling the love.
The legislative session ends June 25. I've been told
there's still time to resurrect HB 780 and get it onto the floor of the
Senate for a vote. I heard the speech by LSU System President John Lombardi
where he tells the Legislature to get out of LSU's way. The way I see it, the
Legislature is our best chance for logic, reason and caution for a project
this size.
It's simple: Don't take my property and my business until
you can, at the very least, show that you have the money to build. I don't
think that is asking too much, do you?
Ask your senator to bring back and support HB 780.
http://www.nola.com/politics/index.ssf/2009/06/point_of_view_feeling_discarde.html
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$1.2 Billion dollar teaching hospital in N. O.
BATON ROUGE, LA (AP) - The $1.2 billion teaching hospital
proposed for New Orleans would be owned by LSU
and operated by a non-profit corporation with representation from LSU,
Tulane, Xavier and other New Orleans
schools.
The draft agreement was inveiled
Thursday by Governor Bobby Jindal's administration.
The proposed memorandum of understanding is the result of
more than 30 hours of negotiations to break a lengthy log jam between Tulane
and LSU about how the 424-bed hospital should be run.
Health and Hospitals Secretary Alan Levine said the
agreement needs to be ratified by the schools before planning for the
hospital can continue.
The Tulane Board of Trustees has scheduled a meeting
Friday to take up the matter, while the LSU Board of Supervisors will discuss
the document on Monday.
http://www.ksla.com/Global/story.asp?S=10562470
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Damian Brumley
It seems Gov. Bobby Jindal in
one term will destroy what has existed since before the United States was the United States.
The Charity Hospital opened it doors at Chartres
and Bienville streets in New Orleans
on May 10, 1736.
It is the second oldest continuing public hospital in the United States.
For 273 years the poor and forgotten have depended on what is now known as
The Louisiana State University Medical Center System and people bent with
ideological zeal will now crush a sailor's dream.
Two years before the Second Continental Congress voted
unanimously to appoint George Washington head of the Continental Army, Charity Hospital was caring for the poor.
Sixteen days later on May 26 at the Battle of Ackia,
Chickasaw Indians defeat the French in what was then the Louisiana territories
still under French rule.
Oceans of time, pirates, two world wars, the Great
Depression and countless self-serving politicians have come and gone, yet
these wise men reject the wisdom of the ages.
What hubris, what arrogance, what inhumanity to man.
Damian Brumley
Montgomery
http://www.thetowntalk.com/article/20090620/OPINION03/906180321
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Louisiana
Health: Text Of Proposed Agreement For New Orleans Hospital
BayouBuzz
Staff | 06.19.09
Read the MOMORANDUM here:
http://www.bayoubuzz.com/News/Louisiana/Government/Louisiana_Health__Text_Of_Proposed_Agreement_For_New_Orleans_Hospital__9056.asp
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US
researchers found that men with prostate cancer who consumed a mix of polyphenols found in green tea experienced a significant
reduction in serum markers such as PSA, VGF and VEGF that predict the
progression of prostate cancer.
The study was the
work of Dr James A Cardelli, professor and director
of basic and translational research in the Feist-Weiller
Cancer Center, LSU Health Sciences Center in Shreveport, Louisiana, and
colleagues and is published in the 19 June issue of Cancer Prevention
Research.
Some studies have shown that green tea, the second most
popular drink in the world, has many health benefits, and can reduce the
incidence of prostate cancer, but trials in humans have been contradictory,
said Cardelli, explaining that the few trials done
so far have evaluated green tea's clinical efficacy but not its effect on
biomarkers of prostate cancer, which indicate cancer progression.
He told the press that:
"The investigational agent used in the trial, Polyphenon E (provided by Polyphenon
Pharma) may have the potential to lower the
incidence and slow the progression of prostate cancer."
"There is reasonably good evidence that many cancers
are preventable, and our studies using plant-derived substances support the
idea that plant compounds found in a healthy diet can play a role in
preventing cancer development and progression," he added.
For the trial, Cardelli and
colleagues recruited 26 men aged 41 to 72 who had been diagnosed with
prostate cancer (their biopsies had proved positive) and were scheduled to
have a radical prostatectomy.
The patients consumed four capsules of Polyphenon
E a day for an average of just over a month (ranging from about 12 to 73
days) until their operation.
Each capsule contained 1.3 g of tea polyphenols,
comprising 800 mg of (--)-epigallocatechin-3-gallate (EGCG) and lesser
amounts of (--)- epicatechin,
(--)-epigallocatechin, and
(--)-epicatechin-3-gallate.
Each patient gave a blood sample the day before they
started the drug trial and then on the day of their operation.
The researchers looked at changes in 5 biomarkers,
including: hepatocyte growth factor (HGF), vascular
endothelial growth factor (VEGF), insulin- like growth factor (IGF)-I, IGF
binding protein-3 (IGFBP-3), and prostate-specific antigen (PSA).
The results showed that over the period of the study,
levels of HGF, VEGF, PSA, IGF-I, IGFBP-3, and the
IGF-I/IGFBP-3 ratio decreased significantly, as did 5 of the liver function
tests, such as total protein, albumin, aspartate aminotransferase, alkaline phosphatase,
and amylase. Other liver function tests also decreased, but not significantly.
Thus liver function remained normal.
Some patients showed more than a 30 per cent reduction in
HGF, VEGF and PSA levels.
Cardelli and colleagues
concluded that:
"Our results show a significant reduction in serum
levels of PSA, HGF, and VEGF in men with prostate cancer after brief
treatment with EGCG (Polyphenon E), with no
elevation of liver enzymes."
This suggests there might be a place for Polyphenon E in the treatment or prevention of prostate
cancer, they said.
Researchers in Italy studying the effects of
green tea polyphenols found they reduced the risk
of developing prostate cancer in men with high-grade prostate intraepithelial
neoplasia (HGPIN), said the researchers in a
separate statement.
Cardelli said:
"These studies are just the beginning and a lot of
work remains to be done, however, we think that the use of tea polyphenols alone or in combination with other compounds
currently used for cancer therapy should be explored as an approach to
prevent cancer progression and recurrence."
Unfortunately the study was not a randomized trial so we
can't rule the possibility that some other factor, such as changes to
lifestyle, taking other supplements, improved diet, and so on, may be
responsible for the lowering of biomarkers, commented Dr William G Nelson,
professor of oncology, urology and pharmacology at the Johns Hopkins Kimmel
Cancer Center. However, he added that:
"This trial is provocative enough to consider a more
substantial randomized trial."
Cardelli and his team are doing
a similar trail with breast cancer patients and plan to carry out further
investigations to determine why Polyphenon E had a
dramatic effect in some patients and not others.
Cardelli said that controlled
clinical trials to see if other combinations of plant phenols might be even
more effective than Polyphenon E
http://www.medicalnewstoday.com/articles/154803.php
[BACK TO TOP]
By MICHELLE MILLHOLLON AND WILL SENTELL
Advocate Capitol News Bureau
A state Senate committee advanced legislation Sunday that
would increase funding for higher education, health care and the arts.
The Senate Committee on Finance made changes to House Bill
881, the supplemental budget bill, that depend on
the Legislature approving other proposals.
The objective is to minimize cuts to higher education and
other state services in the $28 billion budget for the fiscal year that
starts July 1.
Whether the changes stay intact depends on the outcome of
negotiations with the House.
Like the state Senate, the House wants to reduce the cuts
in the budget that Gov. Bobby Jindal proposed. The
chambers are divided on how to accomplish that goal.
The disagreements became vocal in House and Senate
committees meeting Sunday and on the floor in both chambers.
House Speaker Jim Tucker said he planned to meet with
Senate leadership behind closed doors to discuss the budget impasse.
He said the House and the Senate are close to an
agreement.
The Senate wants to tap into the state’s “rainy day” fund
and delay an income tax break. The House wants to use the proceeds of a
proposed tax amnesty program while also forcing the state to tighten its
belt.
State revenue is expected to drop by $1.3 billion in the
upcoming fiscal year. Like the rest of the nation, Louisiana is feeling the pinch of the
recession.
The Senate Finance Committee acknowledged that the changes
it wants to make are contingent on the tax break being delayed and the “rainy
day” fund being tapped.
The Senate wants to generate $118 million by delaying the
tax break and $86 million by withdrawing money from the “rainy day” fund.
The money would be used to reduce cuts to higher education
and health care.
Both proposals are waiting to be acted upon by the House
with less than five days left in the legislative session.
Tucker criticized the Senate committee’s actions.
“We don’t make contingency appropriations in the House of
Representatives. The last time I checked, it was unconstitutional,” Tucker
said.
How to tackle Louisiana’s
budget problems also flared Sunday during a meeting of the House
Appropriations Committee.
The House panel was discussing Senate Bill 1, which would
give the state more budget-cutting flexibility during difficult financial
times.
But House Speaker Pro Tem Karen Peterson, D-New Orleans,
complained that the committee should have been debating how much to dip into
the state’s “rainy day” fund, one of the key issues in the last five days of
the session.
The Senate has already passed Senate Concurrent Resolution
81, which would draw down $258 million to help offset budget problems. House
leaders and Jindal are unsure how much they want to
spend.
“I thought that is why we are here on Father’s Day,”
Peterson said.
But state Rep. Jim Fannin,
D-Jonesboro and chairman of the committee, said the panel would not debate
the bill, which was on the agenda, because of ongoing negotiations on budget
issues.
“We still have issues with Sen. Chaisson,”
Fannin said, a reference to Senate President Joel Chaisson II, D-Destrehan. He is sponsor of the resolution
to use “rainy day” fund dollars.
Peterson sounded miffed.
“We have people being hurt while we have money on the
table,” she said. “It’s a farce.”
Commissioner of Administration Angèle
Davis noted that the state faces several years of declining revenue, not just
this year.
Peterson asked Davis
how much Jindal wants to use in “rainy day” funds.
“It’s in negotiations,” she replied.
Peterson then asked Davis
for Jindal’s view on a Senate-passed bill that
would delay a state tax cut to generate $118 million for higher education.
Jindal is opposed to that.
“The governor has made his position quite clear,” Davis told Peterson. “We
don’t have to debate that again.”
The panel later approved SB 1, which next faces action on
the House floor.
The Senate Finance Committee also advanced:
n House Bill 2, the state
construction budget, after making some changes. The committee added cash for
the LSU Health
Sciences Center
in Shreveport, the Port of South Louisiana
and other projects.
The bill also contains $85 million to renovate the
Louisiana Superdome for the New Orleans Saints football team. The renovations
are part of a state incentive package for the NFL franchise.
House Bill 869 to fund the operations of the House, the
Senate, the Legislative Auditor’s Office, the
Legislative Fiscal Office, the Legislative Budgetary Control Council and the
Louisiana State Law Institute.
House Bill 667 to provide for the supporting expenses of
state government such as accident claims, aircraft, law enforcement training
and telephone usage.
http://www.2theadvocate.com/news/48740312.html
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By Stephen Largen
Leaders of area health-care groups for the developmentally
disabled and elderly will join with colleagues on the steps of the State
Capitol on Monday afternoon to urge the Legislature and Gov. Bobby Jindal to restore deep cuts in next year's budget.
Such groups are facing a cut of more than 10 percent in
reimbursements for care they deliver through the state's Medicaid health
insurance program. It's a cut that providers say will force clients into
costlier state-run facilities or to go without care altogether.
"We can't have the most vulnerable people in our
state going without their needs being met," said Roma Kidd, executive
director of ARCO, a Monroe-based provider that serves about 100
developmentally-disabled adults. "A huge number of those we support
don't have families to back them."
Kidd said legislators and the governor are making a huge
mistake if they pass the slated cut because public facilities must pay much
higher reimbursements than private providers like ARCO.
"The reimbursement for public providers is about $500
per day, while the reimbursement for private providers is around $180 dollars
per day," she said.
The cuts to health care are coming because of an expected
$1.3 billion state revenue shortfall for the fiscal year that starts July 1.
Health care and higher education, the major sources of
state spending, are also the most vulnerable to budget cuts during times of
budget shortfall because they are not constitutionally protected.
Mike Reynolds, CEO of Community Bridges West, a
Ruston-based organization that cares for developmentally-disabled clients,
will join a small group of health-care leaders in a private meeting with Jindal before the afternoon event.
"We'll see where he stands as support," Reynolds
said. "He's been supportive in the past so I'm hopeful that some of the
cuts will be restored."
The proposed budget in House Bill 1 that was sent to the
governor plugged much of the funding gap, but Jindal
said he will veto everything that relies on Senate proposals to increase
revenue.
Reynolds said the slated cuts would have a "very
significant" impact on the services that Community Bridges provides.
"Unlike some other programs, the Medicaid
reimbursements are really the sole income for these organizations," he
said.
Reynolds and Kidd said they want the state Constitution
changed so that health care and higher education are not the only areas of
spending to go under the gun during lean budget years.
"I'm not happy that we're always competing with
higher ed for the same funding," Kidd said.
"No one is really talking about health-care cuts."
http://www.thenewsstar.com/article/20090622/NEWS01/906220312
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By Jeff Matthews
BUNKIE -- For years, Dr. Don Hines had a dream to bring
the best of big-city health care to the smallest of rural hospitals.
It's not a dream anymore.
On Friday, Hines led a telemedicine demonstration at Bunkie General Hospital, showing off the equipment
and techniques that he hopes will spread and move rural hospitals throughout
the state toward the cutting edge of treatment.
"I think it's real
good," said Hines, the former longtime state senator. "It gives
patients in this area access to specialist care without having to leave the
community."
"We are in the top 20 percent of hospitals in the
country as far as Internet technology," said Bunkie General CEO Linda
Deville. "We're ahead of 80 percent. So this is huge for us. The state of
Louisiana,
can you believe, is ahead of the nation."
Hines is executive director of the Louisiana Rural Health
Information Exchange, an organization dedicated to improving patient care at
the state's rural hospitals.
As part of its plan, LARHIX is helping Louisiana's hospitals hook up to an
electronic records network to assist doctors in accessing patient records and
keep them from duplicating expensive tests and other services, and starting
an internal medicine residency program with a focus on rural medicine to help
attract doctors to rural areas.
The third part of the plan, the one that was demonstrated
Friday, is telemedicine, or treatment via videoconferencing.
In Friday's demonstration, Deville played the part of a
patient at Bunkie General being treated by Hines. Hines, needing a consult
from a specialist, videoconferenced with a doctor
at the LSU Health
Sciences Center
in Shreveport.
Hines was able to share test results, give an overview of
the patient's symptons and perform an on-camera
exam in a matter of minutes. The fictional patient was then scheduled for a
test in Shreveport.
Without the video consult, that patient would have had to
travel to Shreveport
and perhaps be subjected to some of the same tests she had in Bunkie before
she was scheduled for the follow-up test. She would then have to go back for
that test and follow-up exams, which thanks to the videoconferencing, can now
be done in Bunkie.
"That just saved her two or three trips to Shreveport," Hines
said. "Many that we see are disabled. They lack transport or they have
to borrow money for gas. This solves the problem. It gives our patients
access to specialists in Shreveport."
"It means our patients will have access to
specialists," Deville said. "It means less travel time, and some of
our patients can't travel."
LARHIX was born in the aftermath of Hurricane Katrina,
when LSUHSC-New Orleans was devastated along with much of the city. That
resulted in many more patients being referred to the hospital in Shreveport, which had a
hard time dealing with the overflow.
The telemedicine and electronic records programs, it is
hoped, will save money and time that can be spent on improving other medical
programs. Hines said 15 hospitals currently have the telemedicine
capabilities, and he hopes to expand to 23 hospitals in the north and central
parts of the state.
"This is very impressive," said Dr. Robert Barish, chancellor at LSUHSC-Shreveport. "This is
the future of medicine. This is how we need to deliver medicine going
forward."
http://www.thetowntalk.com/article/20090620/NEWS01/906200346
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By Mike Hasten
BATON ROUGE — House and Senate leaders say they are
getting closer to reaching an agreement on settling differences on spending
state dollars.
A Senate-passed resolution calling for tapping the Budget
Stabilization Fund is in the House Appropriations Committee. Since it is a
resolution, it is not subject to the 6 p.m. Monday deadline for passing bills
and is not subject to veto by the governor.
Speaker of the House Jim Tucker said Sunday that the House
is beginning to lean toward agreeing with Senate President Joel Chaisson's idea of utilizing the "rainy day
fund."
"We're still talking. We're all getting closer"
to reaching an agreement on how to handle the issue, Tucker said.
Tucker said he and Chaisson
would meet to work on a settlement.
"At least we're still talking," Sen. Mike Walsworth, R-West Monroe, said.
Senate Concurrent Resolution 81 by Chaisson
calls for drawing the one-third of the "rainy day" money that's
eligible to be claimed this year — $256 million — and spreading its use over
three years. That plan would allot $86 million for each of the next three
years.
"We're primarily concerned about the year-three
problem," Tucker said, referring to the year when the federal stimulus
dollars run out.
He said he's looking at taking out funds this year with
the caveat that the issue must be re-addressed.
If the Legislature withdraws money this year, the rainy
day funds could not be used for two more years.
Jindal has said he opposes using
the funds because the state is required by law to begin replacing the fund
"almost immediately."
Chaisson's resolution includes
language spreading out the payback over several years, which Jindal indicated could be a solution.
Tucker said he believes a compromise has been reached on
how to restore higher education so it has a cut of less than 10 percent, and
now he is "focused more on health care."
Higher education is facing cuts of $218 million, and
health care almost $200 million.
http://www.thenewsstar.com/article/20090622/NEWS01/906220323
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By MICHELLE MILLHOLLON
Advocate Capitol News Bureau
With five days left in the legislative session, lawmakers
have a pile of work in front of them that would make the most overachieving
college student cringe.
The biggest issue facing lawmakers when they reconvene
this afternoon is how to resolve the state’s budget problems, especially for
public colleges and universities.
The state is facing a $1.3 billion drop in revenue,
causing lawmakers to scramble to find additional dollars for the $28 billion
budget for the fiscal year that starts July 1
The options include:
* Generating
dollars by delaying an income tax break for a few years. The idea is popular
in the state Senate but iffy in the Louisiana House.
* Using a
proposed — but as yet uncreated — tax amnesty program to soften the blow to
higher education. House leaders are promoting the proposal, which has not yet
been approved by the Legislature. Senate leaders contend constraints on using
one-time money make it an impossible solution.
* Tapping the
state’s “rainy day” fund. The idea originated in the Senate and has
supporters in the House.
Gov. Bobby Jindal said Friday he
is fine with using the “rainy day” fund as long as the fund still can be used
in a few years and if lawmakers pay attention to replenishing it.
The “rainy day” fund, formally known as the Budget
Stabilization Fund, was set up to financially tide the state over during a
budget deficit.
The state’s financial problems are expected to continue
for several more years. The Legislature cannot take more than one-third of
the “rainy day” fund balance — or about $258 million in the upcoming fiscal
year.
However, the Jindal
administration contends the “rainy day” fund is flawed. Taking money out of
the fund would result in money being taken out of the state general fund to
replenish it, the administration claims.
Jindal said $50 million could be
used from the tax amnesty program to replenish the “rainy day” fund.
“We are in discussions with the House and the Senate,” the
governor said. “We don’t have a consensus yet.”
Talks are ongoing among the House, the Senate and the Jindal administration.
The general fund is money generated by the state. Law
requires state government balance its spending on services and projects with
the revenues collected from sources such as taxes and royalties.
It is the state general fund that lawmakers are trying to
bolster.
The main budget legislation, House Bill 1, already is on
the governor’s desk.
But HB1, the state’s operating budget, relies on some
revenue sources that have not yet been approved by both chambers of the state
Legislature. There are other appropriations bills that lawmakers can use to
diminish the cuts in HB1.
At the center of negotiations is on which combination of
spending cuts and revenue increases both House and Senate leaders can agree.
Higher education is facing $219 million in cuts, or a 15
percent cut in state funding.
Agriculture, health care and arts programs also are in
line for deep reductions.
House Speaker Jim Tucker, R-Terrytown,
did not return three calls for comment Friday.
Senate President Joel Chaisson
II, D-Destrehan, said Friday he wants to limit higher education’s cuts to
about $100 million, which he would prefer primarily come from increasing
revenues rather than choosing deeper cuts in other programs.
“The Senate wants to put far more back in higher ed than the House,” he said.
He said leaders in the two chambers are talking behind
closed doors.
State Sen. Mike Michot,
R-Lafayette and chairman of the Senate budget committee, said the talks are
going well.
“We’re still negotiating. There’s movement on both sides.
It’s all part of forging a compromise,” he said.
Michot said taking money from
the “rainy day” fund for higher education is a workable solution.
He said the Legislature could pull $258 million from the
fund and spread it over three years as the state grapples with the effects of
the recession.
Michot said the tax amnesty
program proceeds could be used to partially replenish the “rainy day” fund.
State Sen. Sherri Cheek, R-Shreveport, a member of the
Senate Finance Committee, said she is disappointed that negotiators are
focusing so much on higher education at the expense of proposed cuts for
health care.
The Medicaid program that treats the poor and uninsured is
facing $242 million in reductions. Roughly one in every four Louisiana residents are covered by Medicaid.
“It has to be resolved. This is a point in time when you
have to stop and focus on your goal,” she said.
Cheek said if the proposed cuts to health care programs
remain, then many services, such as those that help lower infant mortality,
will be harmed.
Cheek said community hospitals could lose more than 3,000
jobs.
“You are faced with some critical decisions that will have
an impact for the next decade,” Cheek said.
http://www.2theadvocate.com/news/48722472.html
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Cliff Doescher
Among all of the concern about potential state budget cuts
(New Orleans Adolescent
Hospital, higher education, etc.)
one group of Louisiana's
most vulnerable citizens seems to have been forgotten -- again.
I am referring to those children and adults with
intellectual and related disabilities and their families. Not only is this
group of people too often not recognized as our fellow citizens, now they are
at further risk of having their already limited services reduced, in many
cases to unsafe levels.
And what's worse is that there are solid means by which to
remedy the situation. Both the Louisiana House of Representatives and the
Senate recognized this and without debate fully restored the funding
reductions included in Gov. Jindal's budget. Now we
hear threats from the governor's office that these restorations will be
vetoed.
To everyone who is a neighbor, friend, relative or just a
concerned citizen who knows right from wrong, I urge you to first thank your
legislators for attempting to restore these most important funds, and then to
contact the governor directly to ask for his support.
On Father's Day ask him to fulfill his role as the leader
of Louisiana,
and to not veto the Medicaid funds that are necessary to simply maintain what
is already a system of support that by no means leads the nation.
Cliff Doescher
Executive Director,
Arc of Greater New
Orleans
New Orleans
http://www.nola.com/news/t-p/letterstoeditor/index.ssf?/base/news-14/124556229855260.xml&coll=1
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By J.Anfenson-Comeau
LSU Eunice is preparing its budget for the fiscal 2009-10
year with a 15.5 percent reduction in state funding, Chancellor William
“Bill” Nunez said Friday.
This is on the direction of LSU System President John
Lombardi, who last week issued a statement saying that the LSU system can no
longer wait on the Legislature to prepare a budget, but must work now to
prepare for the upcoming fiscal year.
“The LSU system has already moved ahead,” Nunez said. “as far as we’re concerned, we’re moving ahead and making
our plans, and we’re going to make it very clear the consequences of going
ahead with those plans.”
The cuts to LSUE amount to approximately $1.7 million, a
20.1 percent reduction in state funding compared to the school’s budget at
this time last year, due to a 4.6 percent mid-year cut which took effect in
December.
Nunez said that while no full-time faculty and staff will
be laid off, 15 positions currently unfilled will be cut, the operational
budget will be cut 20 percent, the library materials and acquisitions budget
will be cut 50 percent, classes and programs will be cut, departmental
divisions will be realigned, and there will be no money for repairs or
capital outlay.
Student scholarships, however, will remain unaffected,
Nunez said.
“What we have to do is look at how to maintain the mission
of our college, and do the least harm with the cuts we have at hand,” Nunez
said.
LSUE athletics are funded through student fees, and thus
will remain unaffected, Nunez added.
In addition, the college will let go much of its adjunct
faculty, resulting in fewer classes offered to students and more and larger
classes for full-time faculty.
Even letting go of adjuncts is difficult, Nunez said.
“Some of our adjuncts have been with us for years; these are like employees
to us.” Adjunct instructors are not permanent employees.
Should cuts turn out to be less than 15.5 percent, Nunez
said the college may
be able to bring back more of its
adjunct faculty.
“Being able to restore some of that support will enable us
to have a better chance of guaranteeing that students will be successful,”
Nunez said.
The budget has been a political hot potato this year, with
a $1.2 billion budget shortfall, most of which is falling on the backs of
health care and higher education.
Louisiana
higher ed is looking at a total of $219 million in
cuts, resulting in approximately 15 percent across the board cuts.
Governor Bobby Jindal recently
pledged to keep cuts to higher education under 10 percent after former
governors Buddy Roemer, Dave Treen, Mike Foster and
Kathleen Blanco held a press conference to urge the sitting governor to show
leniency towards higher ed.
However, after two months, the House budget bill, HB 1,
has made little progress, as the House and Senate have failed to reconcile
their versions of the budget while the June 25 deadline for submission of a
balanced budget approaches.
While the LSU system has been approved to increase tuition
by 3 percent, Nunez said that amount is a drop in the bucket compared to
state funding losses, and ultimately self-defeating.
“As you keep increasing tuition, you’re going to make it
harder and harder for poor families to access,” Nunez said.
Nunez said that the current budget cuts will make it
increasingly difficult to retain good faculty, particularly faculty
originating from out-of-state.
“In spite of the national recession, there are states that
are now drawing these people away,” Nunez said.
That, Nunez said, will inhibit Louisiana colleges’ ability to provide
quality education and retain students.
“We already have a problem with kids leaving the state
after they graduate. What we’re going to have now is kids leaving before they
graduate, because they’re going to be looking for higher quality,” Nunez
said. “The future is going to look pretty grim.”
http://www.eunicetoday.com/content/lsu-eunice-trims-budget-17-million
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By KATHERINE MANGAN
As lawmakers in the U.S. Senate and House of
Representatives continue this week to try to hammer out an effective and
affordable overhaul of the nation's health-care system, medical-education
lobbyists will be doing their best to slip in provisions that could benefit
graduate medical education.
One of their key priorities is getting the cap on the
number of residency positions Medicare finances at teaching hospitals lifted
so that the growing number of medical-school graduates will have enough
places to train in their specialties.
Once physicians graduate from medical school, they still
have to finish three to seven years of on-the-job training before they are
ready to independently practice medicine. Most residency programs take place
in teaching hospitals whose extra costs are reimbursed by Medicare.
Lobbyists are also asking for debt relief for
medical-school graduates who now, on average, owe $155,000 in student loans.
And they want to remove restrictions that make it hard for doctors in
training to work in nonhospital settings such as community health centers and
private doctors' offices.
“State and local governments are spending a lot of money
trying to create an adequate health-care work force, but the federal
government has dropped the ball in terms of maintaining its commitment” to
help pay for it, says Atul Grover, chief advocacy
officer of the Association of American Medical Colleges.
While the lobbyists are pushing for changes that would
expand Medicare coverage for medical education, they are also worried about
the possibility that Medicare funds to teaching hospitals could be slashed.
President Obama this month proposed cutting subsidies to
hospitals that treat large numbers of uninsured patients, in order to help
pay for his health-care overhaul.
The president says the hospitals wouldn’t need the money
because fewer people would be uninsured under his plan. But administrators at
teaching hospitals, which provide nearly three quarters of the care for
uninsured patients, say that many of the uninsured people who flock to their
hospitals are undocumented immigrants who would probably be ineligible for
health insurance.
“Teaching hospitals train just about every health
professional out there,” says Dr. Grover. Cutting Medicare payments to
hospitals that serve as safety nets “could jeopardize our ability to help
produce an adequate work force.”
The debate over changes in the health-care system has
bogged down, particularly in the Senate, largely because of worries over the
cost of the leading proposals. Estimates now start at about $1 trillion.
In the Senate, two committees are working on separate
versions. The Committee on Health, Education, Labor, and Pensions is moving
ahead with a broad overhaul that so far has gained support mostly from
Democrats.
The Senate Finance Committee, which has been struggling to
achieve bipartisan consensus on its bill, last week delayed action on its
plan so it could look for ways to trim the cost. The committee is not
expected to vote on a bill until after Congress's July 4th break.
'Drop in the Bucket'
Meanwhile, three House committees that have been
collaborating on a health-care proposal released a draft of their plan on
Friday.
It would create an additional 1,000 to 1,500 residency
slots by allowing unused training positions to be reassigned for additional
primary-care slots. But Dr. Grover says the number is "a drop in the
bucket" compared with the number of new residency positions the country
needs. He adds that many primary-care residencies already go unfilled, so
there is a good chance the additional slots would, as well.
He is encouraged, however, that the House bill facilitates
training in nonhospital settings, he says. That provision, in fact, seems
likely to be approved since it is included in both House and Senate versions
of the legislation.
The American Medical Association and the medical-colleges’
association posted links on their Web sites to generate letters of support
for including the basic principles of legislation known as the Resident
Physician Shortage Reduction Act of 2009 in any final health-care
legislation. Although the American Medical Association has resisted one of
the major components of health reform—the creation of a government-sponsored
insurance plan—it agrees with the medical-colleges’ association on the need
to create more training slots for doctors.
The more expensive physician-shortage bill is proving to
be a tougher sell at a time when lawmakers are under pressure to cut costs.
The bill, which would cost about $12-billion over the next
10 years, would increase by 15 percent, or 15,000, the number of residency
slots that are paid for by Medicare. A third of the slots would go to
teaching hospitals that have already exceeded the Medicare cap. The rest
would be distributed among all teaching hospitals on a competitive basis.
Priority would be given to programs in primary care and general surgery, as
well as those that train residents in nonhospital, community-based settings.
Because each residency position lasts three to seven
years, the legislation would provide support for about 3,600 more physicians
each year—just about enough to accommodate the growth in the number of
medical students graduating from medical schools in the United States, says
Dr. Grover, of the medical colleges' association.
Fears of a Bottleneck
Lawrence M. Shuer, associate
dean for graduate medical education at Stanford University School of
Medicine, says lifting the Medicare cap is at the top of his wish list for
the health-care bill. Since the Institute
of Medicine recommended
restricting residents' workweeks to 80 hours, many of Stanford's residency
programs have needed more residents but can't hire them because of the cap.
The Balanced Budget Act of 1997 limited the number of
resident physicians each teaching hospital can claim for reimbursement under
Medicare to the levels that were in place in 1996. Some teaching hospitals
have exceeded the Medicare-financed cap by paying for additional slots on
their own, but Dr. Grover says institutions don't have enough money to be
able to continue to do this for much longer.
Meanwhile, medical groups have been sounding the alarm in
recent years about a potential shortage of physicians, especially in primary
care, as the U.S.
population ages and baby-boomer doctors retire. The medical-colleges’
association predicted in November that the nation could face a shortage of at
least 124,000 physicians by 2025.
While new medical schools are opening and existing ones
are expanding to help fill that need, the number of practicing physicians
won’t budge as long as the Medicare cap remains in place, medical educators
say.
Allopathic medical schools graduate about 16,000 doctors a
year, and osteopathic schools turn out about 3,000 doctors of their own.
About half of the osteopathic doctors enter residencies sponsored by the
Accreditation Council for Graduate Medical Education. That means about 17,500
new doctors enter the residency match, a process in which medical-school
graduates are assigned to training programs each year.
Some graduates of medical schools in other countries also
participate in the process, and a total of about 22,400 first-year positions
were offered in the match in March.
Beyond Hospitals
Medical educators are also seeking more flexibility for
residents to train in nonhospital settings. Strict government accounting
requirements make it difficult, and potentially costly, for residency
programs to send trainees to off-hospital sites, where more and more patients
are being treated.
"Urban academic medical centers such as the
University of Chicago would be in a much better position to develop programs
that extend into the community if they could send residents to community
hospitals without sustaining a financial penalty because of the [graduate
medical education] caps," says Holly J. Humphrey, dean for medical
education at the University of Chicago Pritzker
School of Medicine.
A bill pending before the Senate Finance Committee would
eliminate some of those restrictions. It would also allow payments for
medical residents, which are now given to the hospital rather than the
resident, to shift to another facility when a teaching hospital closes.
Residency-program directors in Louisiana
faced headaches after flooding caused by Hurricane Katrina forced several New Orleans teaching
hospitals to close. Officials at Charles
R. Drew
University of Medicine
& Science had to struggle to find training spots for their residents, and
the money to pay for them, after the school’s troubled teaching hospital was
shut down.
Medical educators have also been lobbying for more tuition
assistance and loan forgiveness for medical-school graduates. Crushing debts
have kept many young physicians from pursuing relatively low-paying positions
in primary care or rural health care, they say. At least one bill introduced
in both the House and Senate includes financial breaks for primary-care
trainees.
“Specialty selections are going to continue to be skewed
as long as students are facing debt levels that high,” says David G. Nichols,
vice dean for education at the Johns Hopkins University School of Medicine,
who counts debt relief as one of his top priorities for a health-care package.
http://chronicle.com/daily/2009/06/20374n.htm?rss
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Indianapolis Star | 06.21.09
John Hay Jr.
As Congress tackles the urgent issue of reforming our
nation's broken health-care system, Christian pastors and faith-based
organizers are not letting corporate lobbyists or insurance companies set the
agenda.
I have joined my fellow Christian pastors across the
country taking part in media and grassroots advocacy to encourage members of
Congress to make quality health care affordable for all families. In radio
ads airing in Indiana, Arkansas,
Colorado, Louisiana,
Florida, Missouri
and Nebraska
-- states where members of Congress will likely determine the fate of
health-care reform -- pastors are reminding elected officials that health
care is a profound moral issue because every human life is sacred.
In the coming months, people of faith across the country
will take action to encourage lawmakers to build a health-care system that
serves the common good. Nearly 600 clergy in 42 states have agreed to preach
about health care from the pulpit. Faith leaders will be traveling to Washington every month
to meet with public officials and build support for reform. Churches will be
hosting "Health Care Sundays" to help connect the values of
compassion and healing central to our religious traditions with the need for
quality health care. These inspiring efforts represent an unprecedented
collaboration among pastors, national religious groups and faith-based
community organizing networks.
It's a moral outrage and a political failure that 46
million Americans lack health insurance in the world's richest nation.
According to a Families USA report released in March, 1.6 million residents
of the Hoosier state are uninsured, including a staggering 53 percent of
Hispanics and 42 percent of African-Americans. But statistics fail to tell
the heartbreaking human stories of suffering that I witness in my church
every day. A report can't reveal the anguish of a mother unable to afford a
doctor's visit for a sick child, or the pain of a husband ignoring a
debilitating injury because missing work means losing his job.
Ministering to ailing families, I'm reminded more than
ever that our health-care debate is about fundamental values. Nothing less is
at stake here than whether or not we are going to live up to our highest
ideals as a country.
In the face of a devastating economic and health-care
crisis leaving so many families behind, Republicans and Democrats must
recognize that providing affordable health care transcends narrow partisan
agendas or the tired ideological battles of the past. Let's end the divisive
fear-mongering over "socialized medicine," reject false choices and
find common ground to create a health-care system worthy of a great nation.
We need bold actions, political will and the moral urgency to pass
comprehensive health-care reform now. The guardians of the status quo will
surely make this a tough fight. But inspired by faith and hope, together we
can make whole that which is broken. The spirit of change is on the move.
http://www.indystar.com/article/20090620/OPINION01/906200403/1002/OPINION/People+of+faith+respond+to++outrage++of+uninsured
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New Orleans CityBusiness |
06.19.09
by The Associated Press
WASHINGTON — Democrats got a sobering glimpse of what it
would look like if their ambitious health care overhaul ran into a wall — and
quickly pulled back to regroup and get moving again.
Trying to regain the initiative, House Democrats today
unveiled draft legislation they said would cover virtually all of the
nation's nearly 50 million uninsured as President Barack Obama has promised.
However, they offered few details on how to pay for it.
The president welcomed their action as "a major step
toward our goal of fixing what is broken about health care while building on
what works."
But in the Senate, two committees were getting bogged
down, struggling to cope with a trillion-dollar-plus price tag over 10 years.
Their House colleagues simply steered away from costs and focused on the
promised benefits of the legislation.
Republicans weren't cutting them any slack and sharpened
their criticism. "I fear this plan will force tens of millions of
Americans to lose their current health care coverage," said Rep. David
Camp, R-Mich., one the top GOP lawmakers on health.
The Obama White House played down the turmoil as nothing
more than inside-Washington drama.
"We continue to put one foot in front of the other in
the march toward health care reform," press secretary Robert Gibbs said.
Major provisions of the 850-page House bill would impose
new responsibilities on both individuals and employers to get coverage, end
insurance company practices that deny coverage to the sick and create a new
government-sponsored plan to compete with private companies.
The insurance industry said it had major problems with the
proposal for a government plan but stopped short of declaring outright
opposition to the overhaul.
House Democrats say they won't reveal how they intend to
pay for their plan until later. Higher taxes on upper-income households
appear likely, but broad levies — even a federal sales tax — are also under
discussion. Democrats say spending more now to revamp health care will save
money later.
"Is this going to bring down the cost of health
insurance? You bet your sweet life," said Rep. Charles Rangel, D-N.Y.,
chairman of the Ways and Means Committee, one of three panels working on the
House bill.
The House leaders' news conference capped a week in which
the health care overhaul effort seemed to stumble at the starting line.
A $1.6-trillion cost estimate forced the Senate Finance
Committee to delay introduction of its bill as members sought ways to scale
it back. The Senate Health, Education, Labor and Pensions Committee made
little progress as it considered amendments to an incomplete bill.
The whole enterprise is "basically a gridlock,"
said John McCain, R-Ariz.
"This is not reform," added McCain, Obama's
opponent in last year's presidential election. "This is why we should
start over."
Democrats had a more positive description of the scene
playing out across the Capitol.
"This is just tedious hard work," said Sen. Kent
Conrad, D-N.D. "It's just slogging through options."
Despite the heightened anxiety, the shape of the debate
was growing clearer.
On one side is the House Democrats' sweeping health care
bill. It would require all individuals to obtain health insurance and force
employers to offer coverage to their workers, with exemptions for small
businesses. A new public health insurance plan, strongly opposed by
Republicans, would compete with private companies within a new health care
purchasing "exchange" where people could shop for coverage.
Government subsidies would help the poor buy care, and
seniors in the Medicare program would pay less for their prescription drugs.
To pay for it all, House Democrats are considering
everything from taxing soda to raising income taxes on people earning more
than $200,000 to imposing a federal sales tax.
On the other side is the House Republican plan, which
would focus on trying to help small businesses and self-employed people find
private coverage.
Searching for the elusive middle ground are a small group
of senators on the Senate Finance Committee, which had to scale back its own
initial plan when cost estimates topped $1.6 trillion.
The end result may be a bill that's more affordable but
covers fewer of the millions of uninsured.
The earlier Finance Committee draft would have helped
provide coverage for people making up to four times the federal poverty
level, or about $88,000 for a family of four. The new plan would limit
insurance subsidies to those making up to $66,000.
The Finance panel also is looking at leaving a new public
insurance plan out of its bill, instead creating nonprofit co-ops to offer
insurance in competition with private companies, according to an outline
obtained by The Associated Press. The co-ops could accept federal loans for
startup operations but would have to repay the money.
http://www.neworleanscitybusiness.com/uptotheminute.cfm?recid=25375
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Jefferson
school member not in favor of mobile dental clinics
by Barri Bronston,
The Times-Picayune
The Times-PicayuneJefferson
Parish School Board member Glenn Hayes Jr.
As state legislators continue to debate the pros and cons
of allowing school children to receive dental care through mobile clinics, a
Jefferson Parish School Board member is urging the board to go a different
route.
Board member Glenn Hayes said this week there are dozens
of dentists in Jefferson Parish willing to take on poor children and provide
them with the "proper, safe and sterilized dental care they require."
He said the state Department of Health and Human Services
will provide $21 a child to help pay the cost of transportation.
"I am not going to accept convenience as an excuse to
treat students in school, especially where that treatment falls short of
ideal and better alternatives are out there," Hayes said.
Last year, more than 200 Jefferson Parish public school
children received dental care through ReachOut
Healthcare America of Phoenix, which serves uninsured children throughout the
United States, including
St. Bernard, St. Charles
and Plaquemines parishes.
Schools Superintendent Diane Roussel
had signed a "memorandum of understanding" with the company, which
sets up mobile clinics to provide comprehensive dental care such as
cleanings, fillings and sealants.
The service is free to the school system, with the company
making its money through partial Medicaid reimbursement.
The board terminated the agreement after a debate similar
to the one taking place in the Legislature. Proponents say mobile dentistry
is the only option for some children, who otherwise might not get to a
dentist at all; opponents question the quality of such care and say children
would be better served in a dental office.
Hayes is proposing that the board "opt for a solution
that is endorsed by the Louisiana Dental Association," which says dental
care should be provided in dental offices. The board will consider his
measure July 8 at 3 p.m. at Bonnabel Magnet
Academy High
School.
Because of an increase in Medicaid reimbursement -- up to
70 percent of typical fees -- more dentists are willing to take on children
who can't afford to pay, he said.
He said in Jefferson Parish, 97 dentists have registered
with the Department of Health and Human Services to treat Medicaid children.
With the department providing $21 a child for transportation, school
officials should be able to work out an arrangement to get eligible children
to a dental office near their school, he said.
"It would create a dental home and safe hygienic
environment," Hayes said. "We have to protect our students and make
sure the (Medicaid) reimbursements are used properly."
A bill making its way through the state Legislature would
have banned in-school dentistry altogether. But opponents of House Bill 687
by Rep. Kevin Person, R-Slidell, including the Federal Trade Commission, have
said the clinics have generated no complaints and serve a vital role in the
lives of poor children.
The bill is now in the Senate, but with directions to the
Louisiana Board of Dentistry to draw up detailed regulations governing mobile
clinics in schools, including standards of care, sanitation and parental
involvement.
http://www.nola.com/news/index.ssf/2009/06/jefferson_school_members_not_i.html
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Health care reform advocates are changing up their tactics
this week as they target lawmakers, particularly ones in the South, who have
been opposing President Barack Obama's proposal for a public insurance
option.
Health Care for America Now, a coalition of more than
1,000 health care groups advocating for public health insurance, have
launched a 10-day $1.1 million television ad campaign targeting senators in
10 states, including Arkansas, Florida, Louisiana, and North Carolina.
The ads, entitled "What If," support Obama's
proposal for a public insurance option in his plans to overhaul health care.
As Facing South reported earlier this week, conservative-leaning Democrats in
Congress -- including Southern lawmakers - have been facing criticism for
their opposition to public health insurance.
Urging viewers to call their Senators, the ads asks,"What
if we stripped away the $13 billion insurance company profits? The $119
million CEO bonuses?" You can view the ads here:
Other health care reform groups are also using ads to
target lawmakers who oppose the public insurance option. As the Wall Street
Journal blog reported:
[T]he Democratic-leaning MoveOn.Org is targeting Louisiana
Democratic Sen. Mary Landrieu who has voiced opposition to a public insurance
option. A 60-second radio ad running in Orleans
parish through Wednesday suggests the senator is in the pocket of the health
care industry. The ad focuses on financial contributions she has received
stating that Landrieu has received "$1.6 million in campaign
contributions from the health care industry - the same industry that's now
spending millions to stop the president's plan."
Over the past week the Senate has been struggling to find
agreement over a public insurance plan. But on Friday House Democrats
released a health care reform draft outline that they say will bring down
spiraling costs and insure about 95% of Americans. The plan, which would
include a public insurance option, would require employers to provide
coverage to employees or pay a penalty equal to 8 percent of their payroll.
The Associated Press reported:
Major provisions of the draft bill would impose new
responsibilities on individuals and employers to get coverage, end insurance
company practices that deny coverage to the sick and create a new
government-sponsored plan to compete with private companies.
http://news.google.com/news?pz=1&ned=us&hl=en&q=~health-care+OR+%22healthcare%22+%22OR+%22health+care%22+%2Blouisiana+OR+%2B%22new+orleans%22&cf=all&scoring=n
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Sec'y Sebelius argues US health care too expensive
The Associated Press
(AP) — WASHINGTON
- Health and Human Services Secretary Kathleen Sebelius
says the country has no choice but to revamp its health care program because
current costs are "crushing families and businesses."
Sebelius acknowledged in a
nationally broadcast interview that getting legislation overhauling the
system enacted won't be easy and won't happen quickly and without many policy
debates.
Sebelius, interviewed on ABC's
"Good Morning America" Monday, said that people can must also bear
more responsibility for holding costs down by taking better care of themselves. Health care adviser Melody Barnes said the administration's
plan would redirect money "so that you are efficiently and effectively
using it."
House Republican Whip Eric Cantor said a
government-administered plan "will increase costs. It will reduce
choices and essentially it will not allow you to keep what you have."
http://www.nola.com/newsflash/index.ssf?/base/national-27/124567298164230.xml&storylist=health
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Obama To Formally Announce Medicare Drug Cuts Today
The pharmaceutical industry agreed Saturday to reduce Medicare
drug costs as part of health overhaul in an apparent effort to stave off
potentially more-burdensome givebacks under the Democrats' health-overhaul
plan. Today, President Barack Obama will make a formal announcement about the
deal.
The Wall Street Journal reports: "Drug makers on
Saturday outlined a proposal to forgo $80 billion in revenue over a decade,
largely by covering more of the cost of brand-name prescription drugs under
the federal government program for seniors. It would make up part of the $313
billion in government health-spending cuts that President Barack Obama has
proposed over a decade to help pay for the overhaul plan. ... The agreement
is the latest in a series of cost-cutting deals the government has made with
insurance companies, doctors, hospitals and medical-device manufacturers as
it seeks to find ways to pay for proposed changes to the health-care system,
including expanding insurance coverage to 46 million uninsured
Americans."
The deal seeks to help seniors who fall in Medicare's
"doughnut hole." The Wall Street Journal reports: "Under the
pharmaceutical deal, drug companies would pay half of the cost of a
prescription when it isn't covered under a gap in the Medicare Part D
prescription benefit. In the current system, Medicare beneficiaries are
responsible for paying drugs' full price once they exceed $2,700 and up to
$6,154 per year."
The Journal also reports that "Drug companies have
been raising the prices of many drugs this year in advance of the expected
health-system changes, analysts say. Pharmaceutical companies say the
increases are fair and necessary as drugs mature, but analysts say the
companies are trying to eke out as much revenue from the treatments as they
can before patents expire and health-care changes drive down prices" (Adamy and Rockoff, 6/22).
The Associated Press/Wall Street Journal reports on how
the deal marked a major triumph for Sen. Max Baucus, D-Mont., chairman of the
Senate Finance Committee, as well as the Obama administration. The AP reports
that President Barack Obama said: "The agreement by pharmaceutical
companies to contribute to the health reform effort comes on the heels of the
landmark pledge many health industry leaders made to me last month, when they
offered to do their part to reduce health spending $2 trillion over the next
decade. We are at a turning point in America's journey toward health
care reform."
The AP reports: "Sen. Baucus's
announcement said drug companies would pay half of the cost of brand-name
drugs for seniors in the so-called doughnut hole -- a gap in coverage that is
a feature of many of the plans providing prescription coverage under
Medicare. Other officials said wealthier Medicare beneficiaries would not
receive the same break, but there was no mention of that in the statement. In
addition, the entire cost of the drug would count toward a patient's
out-of-pocket costs, meaning their insurance coverage would cover more of
their expenses than otherwise."
"While none of the changes in the prescription drug
program would directly lower government costs, several officials also said
the industry agreed to measures that would give the Treasury more money under
federal health programs. In particular, officials said drug companies would
likely wind up paying pay higher rebates for certain drugs under Medicaid,
the program that provides health care for the poor. Those funds would be used
to help pay for legislation expanding health insurance for millions who now
lack it" (6/21).
The Washington Post reports that "Barry Rand, chief
executive of AARP, will join President Obama at the White House to announce
the endorsement of an organization that boasts 40 million highly engaged,
politically active members. The unusual offer by the Pharmaceutical Research
and Manufacturers of America (PhRMA) is part of its
effort to convince skeptical lawmakers that it backs major health care
legislation. Though the agreement represents a fraction of the total cost of
health-care reform, it has been managed for maximum public relations
exposure" (Connolly, 6/22).
Meanwhile, the Washington Post’s Daily Dose notes:
"The pharmaceutical industry is aggressively lobbying for a
comprehensive health bill that would lock in insurance coverage for up to 50
million new customers. The real question however is whether the Senate
Finance Committee will be able to reach consensus this week on a bill that
costs no more than $1 trillion over the next decade, guarantees basic health
coverage to the majority of Americans and raises the quality of care
nationwide. Several senators hit the Sunday talk show circuit to deliberate
whether to include a new government-run insurance program in reform
legislation" (Connolly, 6/22).
http://www.kaiserhealthnews.org/Daily-Reports/2009/June/22/Drug-Costs.aspx
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USA TODAY | 06.21.09
By Mary Brophy Marcus, USA
TODAY
When you're 8 years old, it can be darn hard not eating a
cupcake when everyone else is having one. But that's the way life is for Nyla Wright, a Philadelphia-area second-grader who was
diagnosed with type 2 diabetes last year. She still
gets treats now and then, but overall has to watch what she pops into her
mouth.
An increasing number of children are being diagnosed with
type 2 diabetes, a condition medical experts blame
on a culture steeped in junk food and inactivity that has led to more obese
kids. Aggressive early treatment and lifestyle changes can help, and even
snuff out disease symptoms, but more sweeping health care system changes,
including better health insurance for older teens and people in their 20s,
are required for young diabetics to age into healthy older adults, experts
say.
TEENS: Not defined by their diabetes
"It's really stunning how the percentages for type 2
diabetes are going up in younger and younger Americans. Clearly, diabetes is
following obesity, and both have huge ramifications on long-term
health," says Siri Atma
Greeley, a pediatric endocrinologist at the University of Chicago Medical
Center.
About 150,000 children in the USA have been diagnosed with
diabetes, most with type 1, according to the Centers for Disease Control and
Prevention. But the number of children with type 2 diabetes has been rising
steadily in the past decade, says Ann Albright with the CDC. About 3,700 youth
were newly diagnosed with type 2 diabetes from 2002 to 2003
— that's about five in every 100,000 children, according to the CDC. Type 2
is especially affecting Hispanic, African American and American Indian youth.
Possible 'genetic mutations' in children
In type 1 diabetes, the body's pancreas does not make any
or enough of the special cells that produce insulin. Insulin helps the body
turn food into energy. In type 2 diabetes, the pancreas makes insulin, but
the cells in the body aren't able to use it properly. Over time, the disease
can cause serious health problems.
There are various theories about why type 2 diabetes is
appearing in greater numbers in the young now, says Melinda Sothern,
professor of public health at Louisiana
State University
Health Sciences
Center in New Orleans.
"We have a new generation of children who are
metabolically different. We think there's been a series of genetic mutations
— linked to environmental and lifestyle changes — over the last few
generations that have led to this," says Sothern, who presented research
earlier this month on the topic at the American Diabetes Association's annual
meeting in New Orleans.
Why a child's body stops using insulin properly — called
insulin sensitivity — isn't clear, but Sothern says her government-funded
study suggests a child's current body fat is the strongest predictor of poor
insulin sensitivity.
While the majority of chubby kids don't get diabetes, if a
child has a family history, or a mother who had gestational diabetes was
obese while pregnant or did not breast-feed, they can be at risk, Sothern
says.
You top that with high-calorie, high-fat eating habits and
a lack of exercise, and you can push an at-risk individual over the edge and
into diabetes earlier in life, says Rebecca Lipton, associate professor in
pediatric endocrinology at the University
of Chicago.
In Nyla's case, her father has
diabetes, and Nyla is 25 pounds overweight, says
Martha Zeger, Nyla's
pediatric endocrinologist at Thomas Jefferson University
Hospital in Philadelphia.
Nyla takes metformin
to lower blood sugar, and the family's health habits have been upgraded, says
mom Stephanie. Macaroni and cheese has been replaced by whole grains, veggies
and proteins. Nyla swims competitively, too.
Ongoing support from a team of health experts, including a
nutritionist, helps, but parents make the biggest difference, Zeger says.
A chilling prognosis for type 2 kids
Still, larger efforts, such as large-scale government
programs at the preschool level, are needed to reverse the habits of a
junk-food nation and curb the disease, Sothern says.
Anxiety runs high for what aging children with diabetes
will be up against in the years ahead.
"The health insurance system is just horrible for
these kids as they age. They get kicked out of their cozy pediatric health
care systems, knocked off their parents' health plans, then stop care and
suffer the consequences," Lipton says.
Long-term complications of untreated diabetes that
previously affected adults in their 60s — blindness, kidney failure,
amputations and cardiovascular disease — will appear sooner.
"We are already seeing some 20- and 25-year-old kids
now on dialysis for kidney failure. It's chilling," Lipton says.
"We're still on the front wave of this
epidemic," says Larry Deeb, a Tallahassee pediatric
endocrinologist and past president of the American Diabetes Association.
"It's a long ways from 17 to 80."
Nyla swims, watches her diet and
takes medication.
http://www.usatoday.com/news/health/2009-06-21-kids-diabetes_N.htm
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At V.A. Hospital, a Rogue Cancer Unit
The New York Times | 06.20.09
By WALT BOGDANICH
For patients with prostate cancer, it is a common surgical
procedure: a doctor implants dozens of radioactive seeds to attack the
disease. But when Dr. Gary D. Kao treated one patient at the veterans’
hospital in Philadelphia,
his aim was more than a little off.
Most of the seeds, 40 in all, landed in the patient’s
healthy bladder, not the prostate.
It was a serious mistake, and under federal rules,
regulators investigated. But Dr. Kao, with their consent, made his mistake
all but disappear.
He simply rewrote his surgical plan to match the number of
seeds in the prostate, investigators said.
The revision may have made Dr. Kao look better, but it did
nothing for the patient, who had to undergo a second implant. It failed, too,
resulting in an unintended dose to the rectum. Regulators knew nothing of
this second mistake because no one reported it.
Two years later, in 2005, Dr. Kao rewrote another surgical
plan after putting half the seeds in the wrong organ. Once again, regulators
did not object.
Had the government responded more aggressively, it might
have uncovered a rogue cancer unit at the hospital, one that operated with
virtually no outside scrutiny and botched 92 of 116 cancer treatments over a
span of more than six years — and then kept quiet about it, according to
interviews with investigators, government officials and public records.
The team continued implants for a year even though the
equipment that measured whether patients received the proper radiation dose
was broken. The radiation safety committee at the Veterans Affairs hospital
knew of this problem but took no action, records show.
One patient was the Rev. Ricardo Flippin,
a 21-year veteran of the Air Force. “I couldn’t walk and I couldn’t stand,”
he said, citing rectal pain so severe that he had to remain in bed for six
months, losing his church job and his income.
Pastor Flippin first learned of
what his doctors called a radiation injury not from the V.A., but from an Ohio hospital where he
underwent rectal surgery in 2006 to treat the damage. “There are times when I
don’t have control over my bowels,” he said one recent Sunday, after excusing
himself during a service at a church in West Virginia where he now preaches.
The 92 implant errors resulted from a systemwide
failure in which none of the safeguards that were supposed to protect
veterans from poor medical care worked, an examination by The New York Times
has found.
Peer review, a staple of every good hospital, in which
colleagues examine one another’s work, did not exist in the unit. The V.A.’s
radiation safety program; the Nuclear Regulatory Commission, which regulates
the use of all nuclear materials; and the Joint Commission, a group that
accredited the hospital, all failed to intervene; either their inspections
had been limited or they had not acted decisively upon finding problems.
Over all, the implant program lacked a “safety culture,”
the nuclear commission found. Dr. Kao and other members of his team, the commission said, were not properly supervised or trained
in what constitutes a substandard implant and the need to report it. Dr. Kao
declined to comment for this article.
Virtually none of the substandard implants in Philadelphia were
reported to the nuclear commission, meaning errors went uninvestigated for
weeks, months and sometimes years. During that time, many patients did not
know that their cancer treatments were flawed.
Federal investigators are continuing to look into the
flawed implants as well as those at other V.A. hospitals. The Philadelphia prostate
unit was closed after problems began to surface in mid-2008, and it has yet
to reopen. The V.A. has also suspended the implants, known as brachytherapy, at hospitals in Jackson,
Miss., and Cincinnati,
though neither had problems on a scale of Philadelphia’s.
The V.A. has yet to fully account for how these
substandard implants affected veterans, though no one is believed to have
died from them. No patient names have been made public. Veterans
officials said Dr. Kao was no longer at the Philadelphia hospital and would not be
allowed to return. The officials acknowledged that they had failed to
supervise the unit.
A lawyer for Dr. Kao, Jack L. Gruenstein,
said The Times’s account of the doctor’s role was
“false,” but he declined to elaborate.
A nuclear commission consultant, Dr. Ronald E. Goans, reviewed about a quarter of the substandard implants
and reported that “erratic seed placement caused a number of cases to have
elevated doses to the rectum, bladder or perineum.” After learning of the
problems, the V.A. flew seven patients treated in Philadelphia
to its most experienced brachytherapy program in Seattle for additional
implants.
“I’m not easily shaken,” Dr. Leon S. Malmud,
chairman of a nuclear commission advisory committee, said last month after
investigators briefed the panel on their findings in Philadelphia. “But this is a very anxiety-provoking
story.”
Clues That All Is Not Right
The brachytherapy program at the
Philadelphia V.A. hospital began in early 2002, giving veterans an option for
treating prostate cancer without major surgery. In this procedure, metal
seeds the size of a grain of rice are permanently
inserted into the prostate through needles.
“The idea is to create a radioactive cloud that conforms
to and treats the prostate,” said Dr. Louis Potters, department chairman of
radiation medicine at North Shore Long Island Jewish Health System.
By using ultrasound in the operating room, Dr. Potters can
assess how well radiation is being distributed. “So at the completion of the
case,” he said, “I can go out and tell that patient’s wife or significant
other that we did a very good implant.”
And good implants were what the Philadelphia V.A. expected
when it staffed the new unit with outside contractors from an Ivy League
institution, the University of Pennsylvania School of Medicine.
One contractor was Dr. Kao. In addition to his work as a
cancer researcher, he had a medical degree from Johns Hopkins and a Ph.D.
from Penn.
He is also on a team from Penn that won a contract this year from a
NASA-financed consortium to study radiation in space.
Although Dr. Kao was board certified in radiation
oncology, he had limited experience in brachytherapy,
according to the nuclear commission. Even so, the unit had no peer review.
“In every facility that I’ve ever practiced and seen,
there is some form of peer review going on,” said Dr. James Welsh, a
radiation oncologist and member of the nuclear commission’s advisory board.
It was not long before problems began to surface. In the
first year, nine implants were substandard, including two on the same day,
records show.
In early 2003, the V.A. and the nuclear commission got
their first solid clue that all was not right in the cancer unit.
On Feb. 3, Dr. Kao mistakenly implanted more than half the
seeds in a patient’s bladder. With the patient still under anesthesia, a urologist had to thread a small tube through the man’s
penis to retrieve the 40 errant seeds. Because they were bloody and
contaminated with urine, the seeds could not be reused, and no more were
available.
As a carcinogen that can burn healthy tissue as well as
kill cancerous cells, radiation is supposed to be closely monitored. The
hospital’s radiation safety committee handles regulatory issues. The V.A.’s
National Health Physics Program oversees radiation use in all veteran
facilities.
But the chief regulator is the Nuclear Regulatory
Commission. Serious accidents involving radioactive materials must be
reported to that agency, which has the power to investigate and levy fines.
Congress receives an annual list of those accidents.
After learning of Dr. Kao’s error, V.A. officials thought
that because he had revised his surgical plan while still in the operating
room, the mistake did not exist. The nuclear commission agreed, on the ground
that doctors needed freedom to revise their surgical plan depending on what
they found during surgery.
Yet this case did not involve a new diagnostic
interpretation: it was an implant mistake, causing the patient to return for
another procedure.
Dr. Charles M. Anderson, who heads the V.A.’s national
radiation safety committee, said it was “not good medical practice” to have
to redo surgery.
Asked whether Dr. Kao was trying to cover up a mistake,
Dr. Anderson said, “I’m not going to look into this guy’s soul.”
The Nuclear Regulatory Commission lacked the authority to
challenge Dr. Kao’s revisions, said Steven A. Reynolds, director of nuclear
materials safety for the commission. “The N.R.C. isn’t in the business of
practicing medicine,” Mr. Reynolds said.
The two incidents in Philadelphia
have prompted the N.R.C. staff to propose allowing revisions to surgical
plans only before an implant is done.
One Patient’s Case
When Pastor Flippin arrived for
his implant in May 2005, he was unaware that brachytherapy
errors at the Philadelphia V.A. were piling up.
He had traveled to Philadelphia
from West Virginia
to care for his elderly mother. “I felt I had been neglectful in my
relationship with my mother,” said Pastor Flippin,
68. Now he wanted to make things right. “The best way to do that was to go
back and be with her,” he said.
After learning that he had prostate cancer, Pastor Flippin picked brachytherapy
rather than external beam radiation or surgery. The doctor’s words were
especially comforting, he said.
“I remember him telling me that it was a relatively safe
procedure that he had done — and I was impressed with this — he had done over
600 seed implants, that there was nothing to worry about,” Pastor Flippin said in an interview last month.
Pastor Flippin’s medical records
show that he was counseled by the other doctor in the unit, Dr. Richard
Whittington, then chief of radiation oncology at the Philadelphia V.A. and
now a professor at Penn’s medical school, a V.A. official said.
But Dr. Kao did the implant, the records show.
Investigators say he is responsible for all but a handful of the 92
substandard implants at the Philadelphia V.A. Dr. Whittington declined to be
interviewed.
At first, Pastor Flippin’s
implant seemed fine. But 10 months later, he said, he began experiencing
bowel pain that worsened with time. Now back in West
Virginia, Pastor Flippin sought
treatment at a V.A. hospital in Huntington.
Doctors there suspected constipation, hemorrhoids or gas.
“They gave me suppositories, they gave me flushings, they gave me a rinse where you sit in and
everything else,” Pastor Flippin said. “I’m saying
none of this is working.”
Doctors then prescribed narcotics. “It was just a
succession of painkiller after painkiller after painkiller, and it got to the
point where I said, ‘I don’t want any more morphine,’ ” Pastor Flippin said. His weight dropped to 109 pounds, a 20
percent loss. He had to quit his job coordinating after-school programs for a
coalition of churches in Charleston,
W.Va.
“This is not working,” he told his doctors. “I’m barely
alive, I’m wasting away and you all are not doing anything.”
Increasingly desperate, Pastor Flippin
sought help from the Ohio
State University
Medical Center,
where a doctor finally made a diagnosis: “Radiation injury to anal canal,” he
wrote. Surgery was performed to cover the damaged area with a tissue flap.
It would be another year and a half before a letter from
the V.A. arrived, informing Pastor Flippin in August 2008 that he had received a flawed
implant. “The treatment you received did not meet V.A.’s high standard of
care,” the letter said.
At this point, it hardly mattered that the V.A. rendered
Pastor Flippin’s first name wrong, calling him
Richard, rather than Ricardo.
A Discovery Leads to Others
The substandard implants might never have been discovered
were it not for a clerical error.
In the spring of 2008, a radiation safety official at the
V.A. mistakenly ordered seeds of lower strength, and they were implanted.
After the error was discovered, according to the nuclear
commission, the V.A.’s national radiation safety unit asked the hospital to
examine 10 to 20 more cases to see if the problem had occurred before.
It had not. But investigators found something more
troubling: four instances where seeds were implanted in the wrong places. As
more cases were examined, more mistakes were found.
“Every once in a while you’re going to have a medical
event because the seed will migrate, but when you see more than one or two at
one place, we’re like: ‘What’s going on? Is this a pervasive problem?’ ” said
Mr. Reynolds, the nuclear commission official.
The hospital suspended the brachytherapy
program on June 11 last year. By then, 45 substandard implants had been
found.
Two days later, the Joint Commission, which helps set
standards in the hospital industry, surveyed the Philadelphia V.A. and on the
next day accredited the hospital. “This organization is in full compliance
with applicable standards,” the Joint Commission said.
The commission said that it had no indications of the
problems in the brachytherapy program when it
arrived at the hospital and that its surveys are not detailed enough to have
uncovered the flawed implants.
Soon after, the N.R.C. sent its own inspectors to Philadelphia. And the
more the inspectors looked, the more they found. All told, 57 of the implants
delivered too little radiation to the prostate, either because the seeds
missed the prostate or were not distributed properly inside the prostate.
Thirty-five other cases involved overdoses to other parts of the body. An
unspecified number of patients were both underdosed
in the prostate and overdosed elsewhere.
From December 2006 to November 2007, the nuclear
commission found, 16 patients received seed implants in Philadelphia even though computer interface
problems prevented medical personnel from determining whether those
treatments had been successful. The V.A.’s radiation officials knew of the
problem but took no action, the nuclear commission charges.
Investigators said they did not know how the unit made so
many mistakes or why Dr. Kao decided to rewrite only two surgical plans. The
doctors, according to the nuclear commission, believed “that since the
patients were not having complications, the implant quality must be
acceptable.”
The V.A. put too much trust in the contractors, said
Darrell G. Wiedeman, a senior health physicist for
the nuclear commission. “They claim they hired experts, the best that money
could buy from the local university, so therefore they didn’t require a lot
of training and oversight,” Mr. Wiedeman said at a
recent meeting of the nuclear commission’s advisory board.
Susan Phillips, a senior executive at Penn’s medical
school and health system, said Dr. Kao had voluntarily given up his clinical
privileges there, though he continues to do research on campus. Dr. Kao did
an unspecified number of brachytherapy procedures
at the campus hospital with no apparent problems. A check of state and
federal records over the last decade in Pennsylvania turned up no malpractice or
disciplinary actions against Dr. Kao.
Back in West
Virginia, Pastor Flippin
said he continued to try to build up his small church while dealing with the
side effects of his implant. After 21 years of serving his country, he had
hoped for a better ending.
“It’s not fair,” he said. “Any veteran should expect more
than what we’re getting.”
Andrew W. Lehren and Kristina Rebelo contributed reporting.
http://www.nytimes.com/2009/06/21/health/21radiation.html?_r=1&ref=health
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The New York Times | 06.20.09
By KEVIN SACK and MARJORIE CONNELLY
Americans overwhelmingly support substantial changes to
the health care system and are strongly behind one of the most contentious
proposals Congress is considering, a government-run insurance plan to compete
with private insurers, according to the latest New York Times/CBS News poll.
The poll found that most Americans would be willing to pay
higher taxes so everyone could have health insurance and that they said the
government could do a better job of holding down health-care costs than the
private sector.
Yet the survey also revealed considerable unease about the
impact of heightened government involvement, on both the economy and the
quality of the respondents’ own medical care. While 85 percent of respondents
said the health care system needed to be fundamentally changed or completely
rebuilt, 77 percent said they were very or somewhat satisfied with the
quality of their own care.
That paradox was skillfully exploited by opponents of the
last failed attempt at overhauling the health system, during former President
Bill Clinton’s first term. Sixteen years later, it underscores the tricky
task facing lawmakers and President Obama as they try to address the health
system’s substantial problems without igniting fears that people could lose
what they like.
Across a number of questions, the poll detected
substantial support for a greater government role in health care, a position
generally identified with the Democratic Party. When asked which party was
more likely to improve health care, only 18 percent of respondents said the
Republicans, compared with 57 percent who picked the Democrats. Even one of
four Republicans said the Democrats would do better.
The national telephone survey, which was conducted from
June 12 to 16, found that 72 percent of those questioned supported a
government-administered insurance plan — something like Medicare for those
under 65 — that would compete for customers with private insurers. Twenty
percent said they were opposed.
Republicans in Congress have fiercely criticized the
proposal as an unneeded expansion of government that might evolve into a
system of nationalized health coverage and lead to the rationing of care.
But in the poll, the proposal received broad bipartisan
backing, with half of those who call themselves Republicans saying they would
support a public plan, along with nearly three-fourths of independents and
almost nine in 10 Democrats.
The poll, of 895 adults, has a margin of sampling error of
plus or minus three percentage points.
Mr. Obama and many Democrats have argued that a public
plan would be essential, in the president’s words, to “keep insurance
companies honest.” But Mr. Obama has also signaled a willingness to
compromise for Republican support, perhaps by establishing member-owned
insurance cooperatives instead.
It is not clear how fully the public understands the
complexities of the government plan proposal, and the poll results indicate
that those who said they were following the debate were somewhat less
supportive.
But they clearly indicate growing confidence in the
government’s ability to manage health care. Half of those questioned said
they thought government would be better at providing medical coverage than
private insurers, up from 30 percent in polls conducted in 2007. Nearly 60
percent said Washington
would have more success in holding down costs, up from 47 percent.
Sixty-four percent said they thought the federal
government should guarantee coverage, a figure that has stayed steady all
decade. Nearly 6 in 10 said they would be willing to pay higher taxes to make
sure that all were insured, with 4 in 10 willing to pay as much as $500 more
a year.
And a plurality, 48 percent, said they supported a
requirement that all Americans have health insurance so long as public
subsidies were offered to those who could not afford it. Thirty-eight percent
said they were opposed.
In a follow-up interview, Matt Flurkey,
56, a public plan supporter from Plymouth,
Minn., said he could accept
that the quality of his care might diminish if coverage was universal. “Even
though it might not be quite as good as what we get now,” he said, “I think
the government should run health care. Far too many people are being denied
now, and costs would be lower.”
While the survey results depict a nation desperate for
change, it also reveals a deep wariness of the possible consequences. Half to
two-thirds of respondents said they worried that if the government guaranteed
health coverage, they would see declines in the quality of their own care and
in their ability to choose doctors and get needed treatment.
“It is the responsibility of the government to guarantee
insurance for all,” said Juanita Lomaz, a
65-year-old office worker from Bakersfield, Calif. “But my care will get
worse because they’ll have to limit care in order to cover everyone.”
When asked their opinion of specific changes being
considered in Washington,
three-fourths of those surveyed said they favored requiring health insurers
to cover anyone, regardless of pre-existing medical conditions. Only a fifth
supported taxing employer-provided health benefits to help pay the cost of
coverage for the uninsured. And there was deep uncertainty about whether
employers should be required to either help insure their workers or pay into
a fund for covering the uninsured.
Three of four people questioned said unnecessary medical
tests and treatments had become a serious problem, suggesting that they would
support calls by health researchers for a payment system that would better
reward appropriate care. But an even higher number, 87 percent, said the
inability of people to have the needed tests and treatments was a serious
problem. One in four said that in the last 12 months they or someone in their
household had cut back on medications because of the expense, and one in five
said someone had skipped a recommended test or treatment.
The poll found that Americans were far less satisfied with
the cost of health care than with the quality of it. Mr. Obama, who has
emphasized the need to reduce costs, has found an audience for his argument
that health care legislation is vital to economic recovery. Eighty-six
percent of those polled said rising costs posed a serious economic threat.
Yet only a fifth of those with insurance said the cost of
their own medical care posed a hardship. And only a fourth said that keeping
health costs down was a more urgent need than providing coverage for the
country’s nearly 50 million uninsured. That was a notable change from a
Times/CBS poll taken in early April, when 40 percent said that controlling
costs was more pressing.
Marina Stefan and Dalia Sussman
contributed reporting.
http://www.nytimes.com/2009/06/21/health/policy/21poll.html?ref=health
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