California HMOs are slyly attacking the new patients' rights laws
touted by Gov. Gray Davis as the toughest in the nation. The
industry can't be allowed to undermine the two pillars of HMO
patients' rights it has targeted effective state regulation and legal
accountability.
In the latest assault, Kaiser Permanente convinced an
administrative law judge to rule that the state's HMO regulator
could not intervene in most patients' quality of care problems.
The dangerous reasoning grew out of Kaiser's aggressive legal
opposition to a $1.1-million fine levied against it after three
patients with ruptured abdominal aortal aneurysms died after
their access to treatment was blocked by Kaiser's unresponsive
telephone call system or its over-capacity emergency rooms.
Newly uncovered internal documents have proven the systemic
nature of Kaiser's problems, although these were not introduced
as evidence in the case. In a program Kaiser claims to have
ended, the company's telephone clerks who handled patient
calls were paid financial bonuses to limit doctor appointments,
to not transfer calls to nurses and to hang up quickly. For its part,
Kaiser has contended that its patients' quality of care is its
doctors' problem, not the HMO's.
The state medical board, which regulates doctors, says it has no
authority to address systemic quality of care and access to care
problems at HMOs or in doctor-run medical groups; the board
leaves those problems to the HMO regulator, the Department of
Managed Health Care.
Kaiser now is seeking to turn this crack in the law--the lack of
regulation of doctor-run medical groups--into a gaping loophole.
For the largest HMO in the nation to hide behind its doctors, who
work only for Kaiser, is like an auto manufacturer claiming it is
not responsible for the design of its exploding gas tanks
because its workers built them.
Fortunately, the Department of Managed Health Care rejected
the administrative law judge's decision, saying, "California's
reforms are a beacon to the nation and we will not turn back the
clock." Department Director Daniel Zingale also urged Kaiser to
reconsider its "legal strategy of arguing that limitations on patient
protection laws render this case unenforceable."
Now, Kaiser can decide whether to pursue its case in state
Superior Court, where a similar ruling could undermine the
authority of the agency created in 2000 specifically to enforce the
California HMO reform package.
Kaiser and other HMOs supported much of this reform
legislation to quell a public backlash at the time; now they must
begin to live within those laws rather than continually try to
obstruct them.
Ironically, Kaiser's litigiousness over the company's rights
contrasts starkly with HMOs' evisceration of the legal right
extended to their patients in 1999. The mandatory binding
arbitration agreements HMOs have forced their patients into as a
condition of enrolling have become a means of disemboweling
the HMOs' legal accountability to the individual.
Until the state's "right to sue" law, most patients could not
recover damages when HMOs harmed them. Effective in 2001,
the liability law gave all patients that right when their HMO
interfered with the quality of their care but did not specify in what
forum. Currently, there is no public record of any patient using
the law. Forced arbitration has prevented cases from coming
before judges, which keeps case law beneficial to patients from
developing.
Without such precedents to determine the scope of HMOs'
liability, the industry is evading accountability on yet another
front.
Legislators must focus their attention on the efforts by HMOs to
weaken the state's patients' bill of rights--even the sneak attacks.
----------------
The above op-ed was printed in The Los Angeles Times on
June 10, 2002.
Limits on Residents' Hours Worry Teaching Hospitals
June 14, 2002
By REED ABELSON , The New York Times
Many of the nation's teaching hospitals, already under
financial pressure, are raising concerns about the effect
of new rules that will limit the number of hours worked by
medical residents.
"For academic medical centers, the impact is going to be
profound," said Dr. Peter Herbert, the chief of staff for
Yale-New Haven Hospital, a teaching affiliate of the Yale
School of Medicine, who estimates that the cost for some
hospitals could run into the millions of dollars.
The rules, which are being imposed by the group that
accredits teaching hospitals, will limit the average resident�s
workweek to 80 hours and restrict a resident's continuous duty to no
more than 24 hours at a time.
Some hospitals consider residents an inexpensive source of
labor. Having significantly cut back on nurses and other
staff, hospitals rely heavily on these new doctors, who
spend several years training at a hospital after earning
their medical degrees.
In addition to caring for patients, particularly the poor
and uninsured, these doctors often handle paperwork,
transport patients and perform tasks once delegated to
others [such as PAs, Physician Assistants].
The new rules, which are aimed at reducing the risk of
dangerous errors by inexperienced doctors who are sleep
deprived, will not take effect until next July 2003.
The cost of two to three physician assistants [PAs] can run as
high as $200,000 a year, compared with $50,000 to pay a
medical resident, Dr. Cohen said. "No one knows where that
money is going to come from," he said.
In New York, the cost of adopting the law limiting
residents' hours was estimated by the state at $220 million
a year, some of which the hospitals recovered through
higher reimbursements.
The New York law took effect in 1989, and a study done in
the late 1990's suggested that many hospitals, particularly
in New York City, were still asking residents to work much
longer hours than the non-enforced law required. In recent years,
however, enforcement of the law has been increased, and
many hospitals have made more significant changes in their
staffing.
New York hospitals are not likely to feel much impact from
the new rules, said Kenneth Raske, the president of the
Greater New York Hospital Association.
While some hospitals will hire senior nurses or physician
assistants, others may rely more on other doctors and may
curtail some of the areas where residents provide care, Mr.
Bentley said.
But hiring nurses or physician assistants may not add
significantly to costs, others say. "The financial impact
won't be catastrophic," said Mark V. Pauly, a professor of
health care at the Wharton School at the University of
Pennsylvania.
At the University of Chicago hospitals many residents work 36 or
38 hours at a time without any sleep [they can barely tie their shoelaces after 18 hour shifts without sleep, much less take someone�s temperature], to be able, presumably, to provide follow-up care and
attend educational programs, said Dr. Holly Humphrey, who
oversees the residents in internal medicine.
The 24-hour limit, even with a possible additional six hours for
handing off patients or attending lectures, "is a big, big
change," Dr. Humphrey said.
Maine at Front Line in Fight Over the High Cost of Drugs
May 11, 2002
By ROBIN TONER
The anxiety, the sense of grievance and most of all the
anger fill the meeting room at a residence for the elderly
in Augusta, Me. It is another day on the barricades in
Maine, where the political rebellion against the soaring
cost of prescription drugs, now brewing around the country,
may be at its peak.
Norman Quirion, a 70-year-old retired police officer, says
it is just not right that he has to make "a drug run" to
Canada, where prices are far lower, to afford the medicines
he and his wife so badly need.
He chokes up when he talks about a neighbor's solution to
the problem: one month, the husband gets his medications,
the next month, the wife gets hers.
Dorothy Merrick, a 78-year-old retired social worker, says
she fumes when she watches the drug companies' television
commercials - "they're so elaborate, like Flo Ziegfeld" -
and thinks about how much they add to the price of drugs.
Around the country, the cost of prescription drugs has
become the issue that will not go away.
Spending on medications was up 17.1 percent last year, 18.8
percent the year before. This month, Congress will embark
on what has become a pre-election ritual: trying to pass a
law that provides relief to older Americans. The chances of
actually succeeding this year are considered slim, but the
pressure for action is so strong that lawmakers dare not
ignore it.
Nowhere is the political debate over the drug industry more
intense than in Maine, with its easy access to Canada,
where prices are regulated and the cost differences are
often achingly apparent. Support for expanding drug
benefits, regulating prices and allowing imports from
Canada runs across party lines here.
Groups periodically organize buying trips across the
border. Organizers of one such trip said their last run
saved 25 people $18,000.
Most significant, the state has approved two groundbreaking
programs to lower drug prices for the elderly and the
uninsured, measures fought hard by the industry.
Now, the state has a Democratic candidate for the United
States Senate, Chellie Pingree, who is building her
campaign on the issue.
"Gigi" Bush Eviscerates Patients' Rights
March 22, 2002
By ROBERT PEAR
WASHINGTON, March 21 - The Bush administration today
proposed dropping a requirement at the heart of federal
rules that protect the privacy of medical records. It said
doctors and hospitals should not have to obtain consent
from patients before using or disclosing medical
information for the purpose of treatment or reimbursement.
The proposal, favored by the health care industry, was
announced by Tommy G. Thompson, the secretary of health and
human services, who said the process of obtaining consent
could have "serious unintended consequences" and could
impair access to quality health care.
The sweeping privacy rules were issued by President Bill
Clinton in December 2000. When Mr. Bush allowed them to
take effect last April, consumer advocates cheered, while
much of the health care industry expressed dismay.
Today's proposal would repeal a provision widely viewed as
the core of the Clinton rules: a requirement that doctors,
hospitals and other health care providers obtain written
consent from patients before using or disclosing medical
information for treatment, the payment of claims or any of
a long list of "health care operations," like setting
insurance premiums and measuring the competence of doctors.
"HMOS Amputate Senior Citizens from HealthCare"
[excerpts from Robert Pear's article in THE NEW YORK TIMES]
"The federal policy of increasing payments to health maintenance organizations in the hope of persuading them to stay in the Medicare program has largely been a failure, federal investigators said today."
"[...] John D. Dingell, Democrat of Michigan, said: "Congress continues to pour money into the coffers of Medicare H.M.O.'s in hopes of providing better care to America's seniors. But the H.M.O.'s keep stranding hundreds of thousands of beneficiaries annually by either leaving the program or reducing benefits. It is foolish even to consider throwing more money at this failed system."
On Jan. 1, 536,000 elderly people are to be dropped from health maintenance organizations that are curtailing their participation in Medicare. Those actions are being taken after three years in which health plans dropped more than 1.6 million Medicare beneficiaries, 933,600 this year, 327,000 at the start of last year and 407,000 in 1999."
MARATHON MAN, President G.W. Bush, completes his contribution to the summer end Marathon Congressional Hearings:
"Gigi" G.W. Bush, using Dr. Charlie Norwood's dental instruments [R-GA], practicing 'sensible' oral surgery to extract the full linguistic meaning from our 'Patients Bill of Rights'. President 'Gigi' is the essence of our loftiest national medical program reforms, ... as he repeatedly asks us, one and all, the rhetorical question:
Is it safe?
Classical Story: HMO Patient Suffers Sub-clavicular Bleeding Under Current Patients' Bill of Rights
from today's Reuters, excerpts from article by Adam Entous
"The Senate voted in June to expand those rights [Patients' Bill of Rights] in state and federal court despite objections from Bush and business. Norwood and Dingell were poised to follow suit in the House -- that is, until Norwood reached his own Oval Office agreement.
Under the compromise he reached with Bush, which Republicans will offer as an amendment to the original Norwood-Dingell patients' bill of rights, patients would be able to file suit against HMOs and insurance companies in state court. But the proceedings would be governed by new federal standards which have yet to be spelled out. Bush had previously sought to limit all lawsuits to federal court.
The agreement would also set $1.5 million caps for both pain-and-suffering and punitive damages -- higher than the $500,000 caps Bush initially proposed, but far less the $5 million limits approved by the Senate and backed by Dingell and other House Democrats.
In a victory for business, Norwood and Bush would steer lawsuits against large U.S. employers that administer their own health plans to federal court rather than state court, where juries are more likely to return large verdicts in favor of plaintiffs. The agreement also bars class action lawsuits in both federal and state courts."
Some history on Congressman Charlie Norwood (R-GA):
Good ole Congressman Charlie! He has his hand at the nuclear till, like it's a honeypot! First, with the Savannah River Site (SRS), homesite of our thousands of tons of Cold War nuclear sludge and metal oxide salts, with a half-life radioactive toxicity of a billion years. And, he is one of the favored recipients of PAC dollars and contributions, from the Radiology Political Action Committee (RADPAC), a lobby PAC mobilized to ensure that mammograms are billed at over a hundred bucks, and that there are no restrictions on insider referrals, between radiologists and the lucrative labs they select as their "honey".
Immediate actions are necessary to manage nuclear materials at the Savannah River Site (SRS), Aiken, South Carolina, until decisions on their ultimate disposition are made and implemented, in many ways contingent upon decisions executed by Congressman Charlie Norwood.
The actions evaluated in our EIS would stabilize SRS materials that represent environment, safety and health vulnerabilities in their current storage condition or which may represent a vulnerability within the next 10 years. These vulnerabilities are the result of the suspension of nuclear materials production and processing operations which accompanied the end of the Cold War.
The U.S. Atomic Energy Commission, a predecessor agency of the Department of Energy (DOE), established the Savannah River Site in the early 1950's. The SRS occupies approximately 800 square kilometers (300 square miles) adjacent to the Savannah River, mostly in Aiken and Barnwell Counties of South Carolina, about 40 kilometers (25 miles) southeast of Augusta, Georgia, and about 32 kilometers (20 miles) south of Aiken, South Carolina. The SRS mission for the past 40 years has been the production of special radioactive isotopes to support national programs.
The primary mission was the production of strategic isotopes (plutonium-239 and tritium) used in the development and production of nuclear weapons for national defense. The Site produced other special isotopes (e.g., californium-252, plutonium-238, americium-241) to support research in nuclear medicine, space exploration, and commercial applications. To produce the isotopes, DOE fabricated selected materials into metal targets and irradiated them in the SRS nuclear reactors. After irradiation and cooling, the targets and reactor fuel were dissolved in acid and the special isotopes were chemically separated and converted to a solid form, either an oxide powder or a metal. The oxide or metal was fabricated into a usable form at the SRS or at other DOE sites. The final form of the material depended on the application (nuclear weapon component, encapsulated medical source, power source, etc.).
Due to the large scale chemical separation capabilities at the SRS, materials containing significant quantities of plutonium-239, uranium- 235, and other special isotopes were shipped to the Site for processing and recovery. The materials were in a wide variety of physical shapes and forms, including (1) small encapsulated plutonium sources returned after use by national laboratories and domestic universities; (2) cans or drums of scrap metals and oxides from weapons manufacturing operations at other DOE sites; (3) irradiated metal fuel rods, tubes, plates, or assemblies from experimental DOE reactors, university research reactors, and foreign research reactors; and (4) cans, bottles, or drums containing residues or samples used in laboratory experiments at other DOE sites.
Re: the Radiology Political Action Committee (RADPAC):
Our mission, to generate funds to donate to campaign funds of legislators the administrative branch of RADPAC, RAA (radiology advocacy alliance) feels will support legislation that allows us to practice quality radiology. The ACR is a non-profit organization and cannot be directly involved with a Political action Committee (PAC). The Radiology Advocacy Committee is the administrative arm of RADPAC and radiologists can join this for $24. After joining RAA radiologists can contribute $100 to $1000 to RADPAC which will be used for political contributions.
BATTLES
Bill Thomas(R-CA) is leading a strong effort with backing from many medical groups to repeal the Stark II Bill that limits self-referral by physicians to facilities they have a financial interest in.
The ACR has strongly opposes this because it creates a conflict of interest for physicians.
New Federal legislation is pending that would allow nurse practitioners to order and interpret x-rays. The ACR is asking congress to look again at this law and its potential to decrease the quality of health care.
Health and Human Services Secretary Tommy G. Thompson employs more than 60,000 personnel and has a fiscal year 2001 budget of $429 billion. The 2002 Pentagon Budget is pegged at $310 billion, even when including the expectation of add-ons. Tommy controls more money than the entire DoD and military industrial complex. We might see a few hundred or so insurance policies for the poor and underemployed, if he spends this money wisely! He will make Hillary Clinton eat her hat when he exhibits to the entire nation the wisdom of his medical and health-related government programs. What could Hillary do with only $429 billion?! By 2002, that would scarcely cover a few hundred medical insurance policies, as they are currently written.
Tommygun engineered the Wisconsin Welfare-to-Work legislation, which served as a national model for harsh welfare reform. The program required participants to work, or go without food, aid, and shelter benefits.
Secretary Thompson has received numerous awards for his public service, including the [ADL] Anti-Defamation League's Distinguished Public Service Award. The ADL is battling several lawsuits charging them with spying on citizens with malicious intent and impunity from all laws (i.e., "above the law").
"Tommy" is also Chairman of the Amtrak Board of Directors, a train system world-renowned for its extensive network of smooth running rails and trains that cut down on excessive automobile dependency .
He also created BadgerCare, which effectively closes the gap for those who make too much money to be eligible for Medicaid, but aren�t provided health coverage by their employers [in a 15 to 25 hour-a-week temporary job]. Gov. Thompson�s Pathways to Independence is the nation�s first program to allow the disabled to have legitimate fears about losing their benefits because his program has become a national model which provides a coordinated system of Medicaid and Medicare and HUD waivers.
Gov. Thompson also created Family Care, which will allow the elderly to receive care in their homes via obscure waivers that would allow Medicaid to cover above all the highly commercial and profitable home-based services � most of them supplied by temporary agencies, beholden to no one. Secretary Thompson favors this financial strategy over nursing homes funded directly through accountable tax dollars voted by the public to serve this purpose.
Gov. Thompson is one of the nation�s leading advocates of organ donation, and as former governor of Wisconsin he built the most powerful organ procurement program in the nation, a virtual Fort Knox of human organs and body parts.
