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GOP Maverick Embraces Medicaid Expansion

Kaiser Health News - Wed, 10/15/2014 - 9:15am

The Washington Post examines the efforts by Ohio Gov. John Kasich, a Republican, to redefine the GOP. While touting party orthodoxy on economic matters, he has embraced his own version of compassionate conservatism, among other things, implementing the health law's Medicaid expansion. And he is sailing to re-election in a key battleground state.

The Washington Post: Ohio’s John Kasich Wants To Redefine The Republican Party
If Kasich were to run in 2016, he would probably face some serious obstacles, in part because he has not spent the past year getting ready to run. GOP strategists suggest he would enter as a candidate at the top of the field’s second tier, as neither a purely establishment nor purely tea party candidate. He would carry baggage among conservatives for having expanded Medicaid under the Affordable Care Act but could point to success in Ohio as a sign of how he might do in general-election battlegrounds (Balz, 10/14).

Meanwhile, the health law continues to be a hot topic in the Arkansas Senate race -

The Associated Press: Cotton, Pryor Tangle Over Health Law’s Impact
Democratic U.S. Sen. Mark Pryor accused Republican Rep. Tom Cotton of having "no answer" for Arkansans receiving coverage under the federal health overhaul, a law that Cotton called a disaster that must be repealed as the two squared off in their second televised debate Tuesday. The two candidates in the hotly contested Arkansas Senate race faced off in their only head-to-head matchup, with less than a week to go before the first votes are cast for the November election. Early voting begins Oct. 20. Pryor accused Cotton of having no solution for the nearly 200,000 Arkansans receiving coverage through the state's "private option" compromise Medicaid expansion if the federal health law is repealed. Cotton criticized Pryor for his vote for the overhaul, and said repealing it would allow for reforming the health care system and giving states control over programs such as Medicaid. "I think we have to start over on health care reform because Obamacare is a disaster," Cotton said (DeMillo, 10/14).

Categories: Health Care

FTC Cracks Down On Companies Selling Phony Health Insurance

Kaiser Health News - Wed, 10/15/2014 - 9:14am

The firms sold consumers a discount card but it offered no health insurance benefits. Also in the news, a government researcher says federal officials need to monitor billing errors and overpayments to Medicare Advantage plans.

CBS News: FTC Cracks Down On A Health Insurance Scam
Several marketing companies accused of leading people to believe they were buying health insurance when the companies were offering only a supposed discount card issued by a made-up trade association were banned from selling health care-related products, the Federal Trade Commission said on Tuesday (Lipka, 10/14).

The Center For Public Integrity: A Call For More Scrutiny Of Private Medicare Advantage Plans 
Federal officials need to do a better job ferreting out billing errors and overpayments to Medicare Advantage plans — mistakes which are estimated to cost taxpayers billions of dollars every year, a top government researcher says. Medicare pays the privately-run Advantage health insurance plans, which cover more than 15 million elderly and disabled Americans, using a complex formula called a "risk score." Sicker patients command higher rates than healthier ones, but the industry has been criticized for allegedly overstating how sick some patients are to boost Medicare revenue, a practice known as "upcoding" (Schulte, 10/15).

Categories: Health Care

Views On Ebola: Try To Keep 'An Even Keel'; Who's In Charge Of Fighting A Pandemic?

Kaiser Health News - Wed, 10/15/2014 - 9:14am

The Washington Post: Keeping An Even Keel At Home On Ebola
Understandably, the specter of such a dangerous disease in the United States has bred fear. But it is remarkable how some public figures are inflaming that fear. Commentator Rush Limbaugh took flight on Tuesday, saying on the radio that "I don’t think anybody involved with Ebola knows what they're doing. I don’t care if it’s the WHO or the Centers for Disease Control, I don’t think anybody knows what they’re doing." This was an unfounded rant that can only deepen public disquiet. ... One infected person, Ms. Pham, does not constitute an outbreak. But we think [CDC Director Thomas] Frieden and others are wise to prepare for the worst, including by making sure that hospitals across the country know what to do if a patient shows symptoms that look like Ebola and have the ability to respond rapidly and effectively (10/14). 

The Washington Post’s The Plum Line: Americans Are Terrified Of Ebola. Which Could Make It Harder To Stop Ebola.
We're scared, and getting more scared all the time. And it may be time to wonder whether the combination of fear and politics could hinder the effective decision-making needed to keep the virus from harming Americans. Yes, Ebola is a terrible infectious disease, one that kills most of the people who catch it. And in parts of west Africa, there is a genuine outbreak that has already killed thousands of people. If you were in Liberia right now, you’d have good reason to be afraid. But you’re not (Paul Waldman, 10/14).

The New York Times: Scarier Than Ebola
Do me a favor. Turn away from the ceaseless media coverage of Ebola in Texas — the interviews with the Dallas nurse's neighbors, the hand-wringing over her pooch, the instructions on protective medical gear — and answer this: Have you had your flu shot? Are you planning on one? During the 2013-2014 flu season, according to the Centers for Disease Control and Prevention, only 46 percent of Americans received vaccinations against influenza, even though it kills about 3,000 people in this country in a good year, nearly 50,000 in a bad one. These are deaths by a familiar assassin. Many of them could have been prevented. So why aren't we in a lather over that? Why fixate on remote threats that we feel we can't control when there are immediate ones that we simply don't bother to? (Frank Bruni, 10/14). 

The Washington Post: Actually, Flu Is The Virus You Should Really Be Worrying About
If you are worried about contracting Ebola, I have two suggestions. First, stop. Second, get a flu shot. On the first: If you live in the United States, your chances of getting Ebola are vanishingly small — even if you are a health-care worker, or a journalist who travels to Africa to report on the epidemic (Ruth Marcus, 10/14). 

Bloomberg: Is U.S. Ready For A Pandemic?
Although the likelihood of a large-scale outbreak of Ebola is almost immeasurably tiny, Americans have begun to ask: Who, really, is in charge of snuffing out a potential epidemic? The Centers for Disease Control? Texas Governor Rick Perry? The local alderman? In the U.S., the proper role of government in public health is an extraordinarily vexed and complicated question. As a consequence, when a killer hemorrhagic fever shows up on our shores, the dead hand of the past practically guarantees that we will dither in crafting an effective response (Stephen Mihm, 10/14).

The Wall Street Journal: How the U.S. Made The Ebola Crisis Worse
Amid discussions of quarantines, lockdowns and doomsday death scenarios about Ebola, little has been said about the exodus of Africa's health-care professionals and how it has contributed to the outbreak. For 50 years, the U.S. and other Western nations have admitted health professionals—especially doctors and nurses—from poor countries, including Liberia, Sierra Leone and Guinea, three nations at the heart of the Ebola epidemic. The loss of these men and women is now reflected in reports about severe medical-manpower shortages in these countries, an absence of local medical leadership so critical for responding to the crisis, and a collapse or near-collapse of their health-care systems (E. Fuller Torrey, 10/14). 

Reuters: Read This To Get A Better Understanding Of How Ebola Spreads
No virus that causes disease in humans has ever been known to mutate to change its mode of transmission. This means it is highly unlikely that Ebola has mutated to become airborne. It is, however, droplet-borne — and the distinction between the two is crucial (Celine Gounder, 10/13). 

Categories: Health Care

Viewpoints: Health Law Undercuts Labor Markets; The Surprising Foes On Calif. Prop 45

Kaiser Health News - Wed, 10/15/2014 - 9:14am

Bloomberg: Obamacare Is A Job-Slashing, Deficit-Deepening Disaster
A report out today from the Republican staff of the Senate Budget Committee highlights a critical point about Obamacare: The law’s negative effect on labor markets helps explain why it will increase deficits by $131 billion over the next 10 years. This finding stands in stark contrast to Democrats' repeated assertions that the law will reduce the deficit. The public dialogue on Obamacare has thus far largely focused on how the law affects premiums and limits access to certain health insurance plans or doctors. While these side-effects are troublesome, it is perhaps more significant that Obamacare has had -- and will continue to have -- a substantial impact on labor markets, jobs and the budget picture (Lanhee Chen, 10/14).

Los Angeles Times: Obama: Messiah Or Mess?
The initial rollout of the Obamacare website was a managerial disaster, for which he bears responsibility, but the Affordable Care Act has already brought perhaps 10 million people into insured healthcare or Medicaid for the first time (Timothy Garton Ash, 10/14). 

Los Angeles Times: Covered California Becomes A Prime Target In Proposition 45 Debate
Proposition 45 would extend the regulatory power that Proposition 103 gave the state Insurance Commissioner over property and casualty coverage to a new branch of the insurance market: the health policies sold to individuals and small groups. So it's no surprise that the Proposition 45 campaign would turn into a reprise of 1988's battle over Proposition 103, pitting the consumer advocates at Consumer Watchdog against big insurance companies. What has been surprising is the degree to which the campaign has devolved into a fight between Consumer Watchdog and Covered California (Jon Healey, 10/14). 

The New York Times’ The Upshot: Egg Freezing As A Work Benefit? Some Women See Darker Message
Tech companies are famous for their lavish benefits, like in-office haircuts, dry cleaning and massages. Now some of those companies are setting off a debate about women and work with a new benefit — paying for women on the payroll to freeze their eggs. ... Yet by paying for women to delay pregnancy, are employers helping them achieve that balance — or avoiding policies that experts agree would greatly help solve the problem, like paid family leave, child care and flexible work arrangements? (Claire Cain Miller, 10/14).

Los Angeles Times: Supreme Court Should Put A Stop To The Relentless Attacks On Abortion
In 1973, the Supreme Court held in Roe vs. Wade that women have a fundamental, constitutional right to an abortion, as long as that right is balanced against the state's interest in protecting prenatal life and a woman's health. In 1992, a second decision held that although the government could put some reasonable restrictions on abortion, it could not place an "undue burden" on a woman's right to choose. And yet many of the 230 restrictive laws enacted in 30 states since 2011 have been specifically designed to circumvent those two rulings (10/14). 

USA Today: Health Care Cartels Limit Americans' Options
Defenders of these [certificate of need] laws claim they reduce health care costs by avoiding duplication of medical equipment and services, or that they increase charity care. The reality is that the laws "result in fewer beds and hospitals operating in the typical" metropolitan area, according to the Journal of Health Care Finance. A new study from George Mason University's Mercatus Center finds that the laws restrict access to health care while slowing the adoption of new technology. A review of the economic literature in the study shows that CON laws are likely to result in higher costs and provide no extra services for the indigent (Thomas Stratmann and Darpana M. Sheth, 10/14). 

Southtown Star/Chicago Sun Times: The Cost Of Saving On Mental Health Care
When I saw the news release about a Cook County Board hearing today to "look into mental health needs and services," I was sort of surprised. Surprised because it has been my experience that hardly anyone in this state cares very much about the needs of the mentally ill as long as such people don’t shoot them while they’re eating burgers at a McDonald’s. Since the closing of the Tinley Park Mental Health Center in 2012, Cook County Jail has become the largest facility treating mentally ill patients in Illinois. The city of Chicago shut down six of its 12 mental health clinics around the same time. Other than mental health advocates and a few medical professionals, few people noticed or cared (Phil Kadner, 10/14).

Categories: Health Care

Second Dallas Health Worker Has Ebola; CDC Announces 'More Robust' Response

Kaiser Health News - Wed, 10/15/2014 - 9:14am

Seventy-six health-care workers who helped treat Ebola patient Thomas Eric Duncan are now being monitored for potential Ebola exposure. Forty-eight others are being watched because they had contact with Duncan.

Los Angeles Times: Second Texas Healthcare Worker Tests Positive For Ebola
second female healthcare worker at a Dallas hospital has tested positive for the Ebola virus, prompting the federal Centers for Disease Control and Protection to send in a team in a bit to halt further spread of the deadly disease (Mohan and Muskal, 10/15).

The Wall Street Journal: Second Health-Care Worker In Texas Tests Positive For Ebola Virus
The U.S. Centers for Disease Control and Prevention said Tuesday that it was actively monitoring 76 health-care workers who helped treat Mr. Duncan for potential Ebola exposure after Ms. Pham had contract the virus from Mr. Duncan, though CDC director Tom Frieden said there was no reason to think any of them were infected. The 76 workers are in addition to 48 people who were already being monitored because they were in contact with Mr. Duncan, or with people who themselves had been in close contact with the Liberian man before he was admitted to the hospital Sept. 28 (Bustillo, 10/15).

The Washington Post: Dallas Hospital Learned Its Ebola Protocols While Struggling To Save Mortally Ill Patient
The hospital that treated Ebola victim Thomas Eric Duncan had to learn on the fly how to control the deadly virus, adding new layers of protective gear for workers in what became a losing battle to keep the contagion from spreading, a top official with the Centers for Disease Control and Prevention said Tuesday (Nutt, Phillip and Achenbach, 10/14).

The Associated Press: Dallas Nurses Cite Sloppy Conditions In Ebola Care
A Liberian Ebola patient was left in an open area of a Dallas emergency room for hours, and the nurses treating him worked for days without proper protective gear and faced constantly changing protocols, according to a statement released late Tuesday by the largest U.S. nurses’ union. Nurses were forced to use medical tape to secure openings in their flimsy garments, worried that their necks and heads were exposed as they cared for a patient with explosive diarrhea and projectile vomiting, said Deborah Burger of National Nurses United (Sedensky and Mendoza, 10/15).

The Washington Post: CDC Director: We Could Have Done More To Prevent Second Ebola Infection In Texas
The director of the Centers for Disease Control and Prevention said the agency regretted its initial response to the first Ebola diagnosis in the United States, acknowledging that more could have been done to combat infection at the hospital treating the patient. "We did send some expertise in infection control," Thomas Frieden said during a news conference Tuesday. "But I think we could, in retrospect, with 20/20 hindsight, have sent a more robust hospital infection control team and been more hands-on with the hospital from day one about exactly how this should be managed" (Berman, 10/14).

Stateline: Q&A: What Are States Doing to Prepare for an Ebola Outbreak?
As fears of an Ebola outbreak rise, federal agencies are taking steps to protect and inform the public. The Centers for Disease Control and Prevention in Atlanta is taking the lead on most aspects of the effort – issuing containment guidelines to hospitals and other health workers, training airport personnel on screening methods, and creating uniform lab tests to diagnose the deadly disease. But as in all public health emergencies, state and local public health departments are the nation’s first line of defense. What role do state and local health agencies play in protecting the public? (Vestal, 10,14).

Categories: Health Care

High Court Allows Texas Abortion Clinics To Stay Open

Kaiser Health News - Wed, 10/15/2014 - 9:12am

The Supreme Court's order, staying a decision of the U.S. Court of Appeals for the 5th Circuit, will allow more than a dozen clinics to resume operations at least temporarily, until a legal challenge has been settled.

The New York Times: Supreme Court Allows Texas Abortion Clinics To Stay Open
The Supreme Court on Tuesday allowed more than a dozen Texas abortion clinics to reopen, blocking a state law that had imposed strict requirements on abortion providers. Had the law been allowed to stand, it would have caused all but eight of the state’s abortion clinics to close and would have required many women to travel more than 150 miles to the nearest abortion provider (Liptak, 10/14).

The Washington Post: Supreme Court Blocks Texas Abortion Law
The court’s order, staying a decision of the U.S. Court of Appeals for the 5th Circuit that the law could go into effect, will allow more than a dozen of the clinics to resume operation, according to the group that challenged the law, the Center for Reproductive Rights. The court’s brief order did not say why it was disagreeing with the appeals court. Justices Antonin Scalia, Clarence Thomas and Samuel A. Alito Jr. would have allowed the law to go into effect while abortion providers pursued their claims that it is unconstitutional (Barnes, 10/14).

The Wall Street Journal: Supreme Court Blocks Some Texas Abortion Restrictions
The high court’s order covered a provision in a Texas abortion law that requires clinic facilities to meet building standards for new “ambulatory surgical centers.” It also exempted clinics in El Paso and McAllen from a part of the law that requires abortion doctors to have admitting privileges at a local hospital. The Supreme Court order reinstated an August U.S. District Court ruling that had struck down those provisions as unconstitutional. The Fifth U.S. Circuit Court of Appeals in New Orleans had allowed the regulations to take effect while the state appealed the district-court ruling. The case now goes back to the Fifth Circuit for further proceeding (Bravin, 10/14).

Houston Chronicle: U.S. Supreme Court Blocks Parts Of Texas Abortion Law
The U.S. Supreme Court Tuesday evening ordered Texas to stop enforcing part of the state's strict new abortion law until a legal challenge has been settled, at least temporarily allowing more than a dozen clinics to immediately reopen. A majority of the justices agreed that abortion facilities across the state should not yet have to meet the standards of hospital-style surgical centers and that clinics in McAllen and El Paso should, for now, be exempt from a requirement that abortion doctors obtain admitting privileges at nearby hospitals. The regulations are part of House Bill 2, a sweeping abortion measure approved last summer that had forced 75 percent of the clinics in Texas to close, leaving just eight in a state of 26 million people. Supporters have argued the law protects the safety of those seeking abortions, while opponents have said the procedure is safe and the law was designed to force clinics to close (Rosenthal, 10/14).

USA Today: Supreme Court Eases Impact Of Texas Abortion Law
The court allowed most of the law to take effect, with two major exceptions. It blocked a provision that would have required clinics to meet the same construction and nursing-staff standards as ambulatory surgical centers. And it exempted abortion providers in McAllen and El Paso — remote corners of the sprawling state — from needing admitting privileges at nearby hospitals. The compromise appeared to have been endorsed by six justices, because the other three — Justices Antonin Scalia, Clarence Thomas and Samuel Alito — said they would have let the entire law stand (Wolf, 10/14).

Politico: SCOTUS Impedes Texas Abortion Law
The court, in a 6-3 decision, said that Texas cannot immediately enforce the part of the law that requires the clinics to meet the standards of ambulatory surgical centers across the state. Texas argued that the upgrades were needed to protect women’s health. The abortion providers said that the requirements warranted costly upgrades that they felt were unnecessary and were aimed less at enhancing safety than limiting women’s access to abortion. The Court of Appeals for the 5th Circuit on Oct. 2 had said that the provision could be enforced immediately. That led to the swift closure of more than a dozen clinics across the state (Haberkorn, 10/14).

CNN: Supreme Court Allows Texas Abortion Clinics To Reopen For Now
The Supreme Court for now has ordered Texas not to enforce a law that had effectively shut down several clinics that provide abortions. The court's order means those clinics can reopen immediately. The restrictions had gone into effect in recent days, but a number of abortion rights supporters then asked the justices to intervene on an emergency basis (Mears, 10/14).

Meanwhile, a doctor who travels long distances to perform abortions is profiled -

Los Angeles Times: Doctor Goes To Great Lengths To Keep Abortion Accessible
Dr. Carol Ball was two-thirds of the way through her morning commute when she heard the news. The first leg of her journey, a scooter ride to the Twin Cities airport, had been uneventful. Not so for the second leg — a 200-mile flight to Sioux Falls — as the U.S. Supreme Court struck down a Massachusetts law keeping protesters at least 35 feet from abortion clinics. The loss of any kind of protection is a blow in Ball's line of work, and the Massachusetts case had been widely watched. But the ruling will have no direct effect on the doctor in running shoes and khakis who performs abortions far from home. Because losing protection means you have some to begin with (La Ganga, 10/14).

Categories: Health Care

Colorado University To Limit Student Work Hours -- Partly To Ease Health Law Coverage Requirements

Kaiser Health News - Wed, 10/15/2014 - 9:12am

Elsewhere, one woman's story of why getting coverage is important. 

Denver Post: CU Boulder Avoids ACA Requirement By Limiting Student Work Hours
The University of Colorado at Boulder is limiting student employee hours to 25 a week during spring and fall semesters in response to Affordable Care Act provisions, and other CU campuses are doing the same. In a newsletter to students, CU-Boulder said the act — which requires employers to provide health insurance to employees working 30 or more hours per week, or pay fines — was the catalyst for the policy change but not the sole reason. "Not only does the policy support degree attainment as the student's primary focus, it will help assist the campus in achieving chancellor (Phil) DiStefano's initiative of increasing the six-year graduation rate," the newsletter said. Spokesman Ryan Huff estimates the new policy, effective Oct. 1, will affect fewer than 10 percent of undergraduate students because most already work fewer than 25 hours a week for the university (Draper, 10/14).

Charlotte Observer: North Carolina Woman’s New ACA Coverage Leads To Early Detection Of Cancer
In March, after Kimberly Tonyan got health insurance through the Affordable Care Act exchange, she spoke at a news conference urging others to enroll. Her 11-year-old twins stood at her side in Raleigh. “You have nothing to lose,” the Cornelius woman said, “but your life.” Little did she know. A couple of months later, Tonyan (rhymes with “onion”) went to the doctor, complaining of abdominal pain. It was the start of a medical journey that led to an early cancer diagnosis and the discovery that she has Cowden syndrome, a rare genetic mutation that puts her at high risk for other cancers. It’s been a tough year. She has one surgery behind her and another ahead. For the rest of her life she’ll be closely monitored. But Tonyan wants to get the word out about the importance of getting insured and seeing a doctor. Despite the pain and anxiety, what matters most is that she has boosted her odds of seeing Caitlyn and Charlotte grow up. Because Cowden syndrome is hereditary, Tonyan’s oncologist says the diagnosis will also benefit her daughters and their descendents, who have a better chance of living long, healthy lives with proper care (Helms, 10/13).

Categories: Health Care

Political Cartoon: 'Stats, STAT!'

Kaiser Health News - Wed, 10/15/2014 - 9:11am

Kaiser Health News provides a fresh take on health policy developments with "Stats, STAT!" by Harley Schwadron.

And here's today's health policy haiku:

THE NEVER-ENDING BATTLE

A new ruling? Do
Texas abortion clinics
need revolving doors?
-Anonymous

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Categories: Health Care

Study Of 80,000 Birthing Moms Suggests Epidurals Safer Than Thought

CommonHealth (WBUR) - Wed, 10/15/2014 - 8:18am

(archibald jude via Compfight)

I subscribe to the dentistry school of birthing babies. That is, I wouldn’t want to get a tooth filled without Novocaine, and I wouldn’t want to have a baby without an epidural.

I know that opinions — strong ones — vary on this, but for those of my ilk who’d like yet another data point to support the pain-relief side, here it is: A national study, one of the biggest yet, of complications from epidurals has just been presented at the annual conference of the American Society of Anesthesiologists now under way in New Orleans. And it suggests that epidurals are even safer than previously thought, with rates of the most-feared complications well under 1 percent.

Dr. Samir Jani, a senior resident in anesthesiology at Beth Israel Deaconess Medical Center, presented the findings, gleaned from a giant national database of anesthesiology cases, the National Anesthesia Clinical Outcomes Registry.

He found that among more than 80,000 cases of anesthesia during labor and delivery, 2,223 involved complications, for an overall rate of 2.78 percent. But most of those concerned medication errors — over-dosing, under-dosing, or use of expired drugs.

The rate of the complications that many women fear most — nerve damage or an excruciating “spinal headache” — were even lower than previously estimated, Dr. Jani said: .2 percent — that’s 2/10 of one percent — for the headache; .002 percent for spinal nerve damage and .14 percent for damage to other nerves.

“So it’s well under 1 percent for the kinds of complications that I think a lot of women worry about,” he said, not the 1-2 percent that he’s been quoting his patients based on textbook teachings.

An awkward question: But don’t anesthesiologists tend to be pretty pro-anesthesia? Mightn’t that bias the results?

“Actually,” Dr. Jani said, “Whenever I talk to all my patients, I tell them, ‘I’m not here to sell you an epidural. it’s your ultimate decision.’ And I think that that’s the mentality that almost all of us have. We aren’t ever going to force on a patient what they don’t want. But in that informed consent process, it’s important we quote not only possible complications but the rates to the best of our knowledge. At the end of the day, it’s good to be able to tell your patient that this is a safe and efficient method to be able to control labor pain.”

And what about the common belief that getting an epidural can hinder the pushing process in labor?

The study did not look at that question, Dr. Jani said, but “in our current knowledge, we don’t believe that’s the case. If a woman is going to have dysfunctional labor, it’s going to happen with or without the epidural.”

Bottom line, he said: Most epidurals are considered elective, and patients need to be informed accurately of possible complications. “Prior to this knowledge, I’d mention that the most common risk would be a headache afterward and potential nerve damage — but now I can be more confident in saying it’s even less than we thought and it’s extremely low.”

Readers, thoughts? Experiences?

Categories: Health Care

First Edition: October 15, 2014

Kaiser Health News - Wed, 10/15/2014 - 7:09am

Today's headlines include the latest news regarding the second Dallas health worker diagnosed with Ebola and the Centers for Disease Control and Prevention's strategy to deal with the threat.

Kaiser Health News: California Prop. 46, Inspired By Tragedy, Pits Doctors Against Lawyers
KQED’s April Dembosky, working in partnership with Kaiser Health News and NPR, reports: “Prop. 46 would make it mandatory for doctors to consult the database. California would become one of nine states requiring doctors to check before prescribing painkillers to first-time patients. After passing similar laws, Tennessee and New York saw a significant reduction in the number of narcotics prescriptions written. Studies have verified the correlation, but acknowledge that drug abusers may be turning to street drugs, like heroin. Many doctors in California like the database. Some have called it ‘indispensable.’ But they don’t like being told how to practice medicine” (Dembosky, 10/14). Read the story.

Los Angeles Times: California Will Cancel Obamacare Coverage For 10,000 Over Citizenship
California's health insurance exchange is canceling Obamacare coverage for 10,474 people who failed to prove their citizenship or legal residency in the U.S. Covered California, the state-run insurance exchange, enrolled more than 1.2 million people during the rollout of the Affordable Care Act this year. For most consumers, the exchange said, it could verify citizenship or immigration status instantly with a federal data hub (Terhune, 10/14).

The New York Times: California: 10,500 Could Lose Health Care
State officials plan to cancel coverage for about 10,500 people participating in the state health insurance exchange because they could not prove that they were citizens or legal residents of the United States. Covered California, the state-run insurance exchange, sent notices to nearly 150,000 people last month asking them to submit documentation to prove their legal status. Those living in the United States illegally are not eligible for insurance through the Affordable Care Act (Medina, 10/14).

The Washington Post: Ohio’s John Kasich Wants To Redefine The Republican Party
If Kasich were to run in 2016, he would probably face some serious obstacles, in part because he has not spent the past year getting ready to run. GOP strategists suggest he would enter as a candidate at the top of the field’s second tier, as neither a purely establishment nor purely tea party candidate. He would carry baggage among conservatives for having expanded Medicaid under the Affordable Care Act but could point to success in Ohio as a sign of how he might do in general-election battlegrounds (Balz, 10/14).

The New York Times: Supreme Court Allows Texas Abortion Clinics To Stay Open
The Supreme Court on Tuesday allowed more than a dozen Texas abortion clinics to reopen, blocking a state law that had imposed strict requirements on abortion providers. Had the law been allowed to stand, it would have caused all but eight of the state’s abortion clinics to close and would have required many women to travel more than 150 miles to the nearest abortion provider (Liptak, 10/14).

The Washington Post: Supreme Court Blocks Texas Abortion Law
The court’s order, staying a decision of the U.S. Court of Appeals for the 5th Circuit that the law could go into effect, will allow more than a dozen of the clinics to resume operation, according to the group that challenged the law, the Center for Reproductive Rights. The court’s brief order did not say why it was disagreeing with the appeals court. Justices Antonin Scalia, Clarence Thomas and Samuel A. Alito Jr. would have allowed the law to go into effect while abortion providers pursued their claims that it is unconstitutional (Barnes, 10/14).

The Wall Street Journal: Supreme Court Blocks Some Texas Abortion Restrictions
The high court’s order covered a provision in a Texas abortion law that requires clinic facilities to meet building standards for new “ambulatory surgical centers.” It also exempted clinics in El Paso and McAllen from a part of the law that requires abortion doctors to have admitting privileges at a local hospital. The Supreme Court order reinstated an August U.S. District Court ruling that had struck down those provisions as unconstitutional. The Fifth U.S. Circuit Court of Appeals in New Orleans had allowed the regulations to take effect while the state appealed the district-court ruling. The case now goes back to the Fifth Circuit for further proceeding (Bravin, 10/14).

USA Today: Supreme Court Eases Impact Of Texas Abortion Law
The court allowed most of the law to take effect, with two major exceptions. It blocked a provision that would have required clinics to meet the same construction and nursing-staff standards as ambulatory surgical centers. And it exempted abortion providers in McAllen and El Paso — remote corners of the sprawling state — from needing admitting privileges at nearby hospitals. The compromise appeared to have been endorsed by six justices, because the other three — Justices Antonin Scalia, Clarence Thomas and Samuel Alito — said they would have let the entire law stand (Wolf, 10/14).

Politico: SCOTUS Impedes Texas Abortion Law
The court, in a 6-3 decision, said that Texas cannot immediately enforce the part of the law that requires the clinics to meet the standards of ambulatory surgical centers across the state. Texas argued that the upgrades were needed to protect women’s health. The abortion providers said that the requirements warranted costly upgrades that they felt were unnecessary and were aimed less at enhancing safety than limiting women’s access to abortion. The Court of Appeals for the 5th Circuit on Oct. 2 had said that the provision could be enforced immediately. That led to the swift closure of more than a dozen clinics across the state (Haberkorn, 10/14).

Los Angeles Times: Doctor Goes To Great Lengths To Keep Abortion Accessible
Dr. Carol Ball was two-thirds of the way through her morning commute when she heard the news. The first leg of her journey, a scooter ride to the Twin Cities airport, had been uneventful. Not so for the second leg — a 200-mile flight to Sioux Falls — as the U.S. Supreme Court struck down a Massachusetts law keeping protesters at least 35 feet from abortion clinics. The loss of any kind of protection is a blow in Ball's line of work, and the Massachusetts case had been widely watched. But the ruling will have no direct effect on the doctor in running shoes and khakis who performs abortions far from home. Because losing protection means you have some to begin with (La Ganga, 10/14).

Los Angeles Times: Second Texas Healthcare Worker Tests Positive For Ebola
A second healthcare worker who provided care for the first Ebola patient diagnosed in the U.S. has tested positive for the disease, public health officials announced early Wednesday (Charky, 10/15).

The Wall Street Journal: Second Health-Care Worker In Texas Tests Positive For Ebola Virus
The U.S. Centers for Disease Control and Prevention said Tuesday that it was actively monitoring 76 health-care workers who helped treat Mr. Duncan for potential Ebola exposure after Ms. Pham had contract the virus from Mr. Duncan, though CDC director Tom Frieden said there was no reason to think any of them were infected. The 76 workers are in addition to 48 people who were already being monitored because they were in contact with Mr. Duncan, or with people who themselves had been in close contact with the Liberian man before he was admitted to the hospital Sept. 28 (Bustillo, 10/15).

The Washington Post: Dallas Hospital Learned Its Ebola Protocols While Struggling To Save Mortally Ill Patient
The hospital that treated Ebola victim Thomas Eric Duncan had to learn on the fly how to control the deadly virus, adding new layers of protective gear for workers in what became a losing battle to keep the contagion from spreading, a top official with the Centers for Disease Control and Prevention said Tuesday (Nutt Phillip and Achenbach, 10/14).

The Associated Press: Dallas Nurses Cite Sloppy Conditions In Ebola Care
A Liberian Ebola patient was left in an open area of a Dallas emergency room for hours, and the nurses treating him worked for days without proper protective gear and faced constantly changing protocols, according to a statement released late Tuesday by the largest U.S. nurses’ union. Nurses were forced to use medical tape to secure openings in their flimsy garments, worried that their necks and heads were exposed as they cared for a patient with explosive diarrhea and projectile vomiting, said Deborah Burger of National Nurses United (10/15).

The Washington Post: CDC Director: We Could Have Done More To Prevent Second Ebola Infection In Texas
The director of the Centers for Disease Control and Prevention said the agency regretted its initial response to the first Ebola diagnosis in the United States, acknowledging that more could have been done to combat infection at the hospital treating the patient. “We did send some expertise in infection control,” Thomas Frieden said during a news conference Tuesday. “But I think we could, in retrospect, with 20/20 hindsight, have sent a more robust hospital infection control team and been more hands-on with the hospital from day one about exactly how this should be managed” (Berman, 10/14).

The New York Times: Philadelphia Teachers Hit By Latest Cuts
Money is so short at Feltonville School of Arts and Sciences, a public middle school here, that a nurse works only three afternoons a week, leaving the principal to oversee the daily medication of 10 children, including a diabetic who needs insulin shots. On the third floor filled with 200 seventh and eighth graders, one of two restrooms remains locked because there are not enough hall monitors. And in a sixth-grade math class of 33 students with only 11 textbooks to go around, the teacher rations paper used to print out homework equations. … The latest fund-raising effort came last week when the School Reform Commission, the state-appointed board that oversees the Philadelphia schools, unilaterally and abruptly canceled the union contract for teachers and required them to pay minimum health care premiums from $25 to $67 a month for a single person. Until now, teachers have not paid for health insurance (Rich, 10/14).

Los Angeles Times: UCLA Study Offers Hope On Emergency Room Crowding
A new UCLA study has found that while people enrolled in low-cost, government-run health plans visit emergency rooms at high rates soon after becoming insured, the number falls dramatically within a year. That's good news, said study author and UCLA professor Dr. Gerald Kominski, because patients' long-neglected health problems are being "addressed during the first year, and because of that there's a drop-off." Some worry that the expansion of health coverage under the Affordable Care Act will not ease emergency room crowding as President Obama and others have predicted, but will instead encourage more people to go to the hospital (Karlamangla, 10/14).

The Washington Post: America’s Fastest-Growing Profession Is Joining A Very Public Fight For Higher Wages
Knowing what a difference higher pay can make, Reece has joined a new movement launching this week to raise wages and improve workplace protections for home health-care aides nationwide. Backed by the Service Employees International Union, the effort seeks to replicate the “Fight for 15,” a push earlier this year to raise the income of fast-food workers through high-profile strikes. On Wednesday, Reece will rally on D.C.’s Freedom Plaza to demand the same for home health-care aides. It’s part of actions in nine states aimed at putting the concerns of the nation’s fastest-growing workforce — one that’s 91 percent female, 56 percent non-white and highly dependent on public aid — on the political agenda. About 600,000 of the country’s 2.1 million home health-care aides are members of the SEIU (DePillis, 10/14).

The Wall Street Journal: Arizona Agrees To Improve Prison Conditions In Settlement With ACLU
The state Department of Corrections will take more than 100 measures to change its practices on providing prisoners with medical and mental-health care, according to terms of the deal, filed Tuesday in the U.S. District Court of Arizona. The settlement covers Arizona’s state prison system, which holds more than 33,000 inmates. The new measures, according to the agreement, will allow mentally ill prisoners who are held in isolation to have better access to treatment and 19 hours a week outside their cells; will provide more medical and dental care for the overall prison population; and will restrict the use of pepper spray to situations that jeopardize the safety of prisoners or guards or compromise prison security (Lazo, 10/14).

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Categories: Health Care

Free Public Access to Federal Materials on Guide to Law Online

In Custodia Legis - Tue, 10/14/2014 - 6:41pm

This is a guest post by Ann Hemmens, legal reference librarian at the Law Library of Congress. 

Through an agreement with the Library of Congress, the publisher William S. Hein & Co., Inc. has generously allowed the Law Library of Congress to offer free online access to historical U.S. legal materials from HeinOnline.  These titles are available through the Library’s web portal, Guide to Law Online: U.S. Federal, and include:

These collections are browseable.  For example, to locate the 1982 version of the Bankruptcy code in Title 11 of the U.S. Code you could select the year (1982) and then Title number (11) to retrieve the material.

Browse to the year and the Title number to retrieve the material.

Researchers can download PDF files of up to 20 pages per download. When you are viewing the document you need, look for the PDF icon at the top of the page to select the items for either printing or downloading.  In the example below from the Code of Federal Regulations (C.F.R.), you would click on the PDF icon at the top of the page and a “Print/Download Options” screen appears allowing you to select either the current section you are viewing or a custom page range. You can either print the pages or download them as a searchable PDF document.

Click the PDF icon at the top of the page to see print and download options.

Hein authorized the Library to provide these historical U.S. federal legal materials to the public via the Internet “…as a donation to the Library and to the American public.”  These free online resources will benefit all legal researchers whether accessing them from a home office, a local library or school, or here at the Library of Congress.

Categories: Research & Litigation

8 Things You Need To Know About Ebola

CommonHealth (WBUR) - Tue, 10/14/2014 - 5:48pm

Cpl. Zachary Wicker demonstrated the use of a germ-protective gear in Fort Bliss, Texas on Tuesday. (Juan Carlos Llorca/AP)

Ebola has been dominating the headlines lately, raising concern about the disease potentially spreading to Massachusetts. And after two recent Ebola scares in Boston, local authorities are also trying to reassure the public.

Here’s what you need to know about Ebola:

What is Ebola?

Ebola is an infectious disease caused by strains of the Ebola virus. The fatality rate has been around 50 percent, but the latest numbers from the World Health Organization (WHO) put it close to 70 percent.

There are five strains of the Ebola virus — four are known to cause the disease in humans and the fifth is known to affect other primates, according to the Centers for Disease Control (CDC). The disease was first identified in 1976 near the Ebola River in what is now the Democratic Republic of the Congo (DRC). According to the CDC, there have been sporadic outbreaks in the last 15 years in parts of the DRC, Uganda, South Sudan, and the Philippines (where a strain of the virus was detected in pigs in 2008).

How do you get Ebola?

You can only get Ebola if you have direct contact (through broken skin or mucous membranes) with:

  • The body fluids (blood, vomit, urine, feces, sweat, semen, spit, other fluids) of a person who is sick or has died from Ebola
  • Objects contaminated with the virus (needles, medical equipment)
  • Infected animals (by contact with their bloods, fluids or infected meat)

Ebola is not spread through the air, water, food or casual contact with another individual, according to the CDC. There are questions about whether the virus could mutate and become airborne.

It’s important to note that Ebola can only spread when an infected person is showing symptoms. This means if a person does not have symptoms of Ebola, they cannot spread the disease to other people.

What are the symptoms of Ebola?

Symptoms of the disease include fever, headache, stomach pain, diarrhea, vomiting, muscle pain, and unexplained bruising or bleeding. Symptoms can appear anywhere from two to 21 days after exposure.

What countries have been affected?

The WHO considers the latest outbreak the largest and most complex since it initially affected multiple countries in west Africa — specifically Guinea, Liberia, Sierra Leone, Nigeria, and Senegal. But the disease has played out differently in each country largely due to issues around infrastructure and health care resources.

The total number of cases has reached 8,914 with 4,447 deaths, according to the WHO. The most severely affected countries are Guinea, Sierra Leone and Liberia. In Nigeria and Senegal, there was just one reported case of Ebola, due to an infected traveler entering each country. According to the CDC, people who have traveled to those countries since late September are not as risk for exposure to Ebola. In fact Nigeria, Africa’s most populous country, is seen as a success story for quashing the disease.

At least 16 Ebola patients are being treated outside West Africa, according to The New York Times. Three of those cases were diagnosed outside of West Africa – one in Spain and two in the U.S.  In the U.S., a 42-year-old Texas man died last week after being diagnosed with Ebola. Thomas Eric Duncan had arrived in Dallas after a trip to Liberia and became ill within days. On Sunday, a nurse who cared for Duncan also tested positive for Ebola.

Am I at risk of getting Ebola?

Again, Ebola is only spread through direct contact with the disease (a sick person’s body fluids, an infected animal or a contaminated object). That is why health care workers face a higher risk of infection, since they are often in close contact with infected patients. Such transmissions often occur when the proper safety precautions were not strictly practiced, according to the WHO. In addition to health care workers, those most at risk are family members of an infected person, and those in direct contact with the body of a person who has died from Ebola (for instance, during a burial ceremony).

It’s unknown how Texas nurse Nina Pham contracted Ebola, but that case has raised questions about hospital protocol. Officials at the Texas hospital where she works said she wore protective gear while caring for Duncan. The head of the CDC has said the diagnosis shows a clear breach in safety protocol, but a specific breach that may have led to her infection has not been identified.

Are there any cases of Ebola in Boston?

No. In a press conference Tuesday, state and local officials tried to ease fears about Ebola, emphasizing that there have been no confirmed cases of the disease anywhere in the state.

“We have zero cases of Ebola in Massachusetts and that means zero cases in Boston,” Mayor Marty Walsh said.

Walsh also said people should not be concerned about riding the MBTA or attending large events such as the Head of the Charles. “Simply going on the train, you’re not going to catch Ebola,” Walsh said.

Dr. Anita Barry, the director of the infectious disease bureau of the Boston Public Health Commission, said all possible cases of Ebola turned out to be other illnesses.

“We have actually had no recent cases that even meet the definition for CDC’s person under investigation,” Barry said.

There were two Ebola scares this past weekend. On Sunday, a man who had traveled to Liberia reported feeling ill and was transported from a Braintree clinic to Beth Israel Deaconess Medical Center. On Monday, a team in protective clothing boarded an Emirates flight from Dubai that landed at Logan Airport after five passengers exhibited flu-like symptoms. In both cases, officials said there was no Ebola.

What are local hospitals doing to deal with potential Ebola cases?

Local hospitals are following the CDC’s guidelines for hospitals and health care workers, which include everything from basic hand washing to wearing protective gear (gloves, gown, eye protection, face mask). Other guidelines include safe injection practices, limiting the use of needles, disinfecting equipment, and monitoring exposed personnel.

State Department of Public Health Commissioner Cheryl Bartlett said local hospitals are also stepping up their patient screening procedures. When a patient calls, they will be asked about their travel history and whether they have been in contact with anyone who is sick and has traveled to West Africa, in addition to routine questions about symptoms.

Is there a cure for Ebola?

There is currently no licensed vaccine or medicine available for Ebola. According to the WHO, there are two potential vaccines being tested and a range of treatments are also being evaluated. Treatment of specific symptoms and supportive care-rehydration with oral or intravenous fluids can improve survival. According to the CDC, recovering from Ebola depends on a person’s immune response and good clinical care.

Here are five other stories to check out for more insight into Ebola:

Categories: Health Care

Report Shows Stark Care Disparities, More Amputations Among Black Diabetics

CommonHealth (WBUR) - Tue, 10/14/2014 - 5:20pm

Dartmouth Atlas Project

Consider this alarming statistic: The rate of diabetes-related amputations is nearly three times higher among blacks compared to other Medicare beneficiaries.

This, according to a new report from the Dartmouth Atlas Project, located at the Dartmouth Institute of Health Care Policy and Clinical Practice. This is the influential consortium that issues eye-popping reports detailing often painfully unfair regional and ethnic variations in medical care. Here are some of the findings from the report, “Variation in the Care of Surgical Conditions: Diabetes and Peripheral Arterial Disease” released today:

•Amputation rates vary fivefold across U.S. regions among all Medicare patients with diabetes and peripheral artery disease.

•Amputation rates in the rural Southeast, particularly among black patients, are significantly higher than other regions of the country. (Think Mississippi.)

•The amputation rate for black patients is seven times higher in some regions than others

•There is an eightfold difference across regions among blacks in the likelihood that they undergo invasive surgery to increase circulation in the lower legs. In a news conference announcing the report, Marshall Chin, MD, a leading expert on racial and ethnic disparities in health care and a professor at the University of Chicago called these types of diabetes-related amputations “entirely preventable.” “In some ways,” Chin said, “these disparities are hidden unless we look for them.” And here’s more from the Dartmouth news release:

There are significant racial and regional disparities in the care of patients with diabetes. According to a new report from the Dartmouth Atlas Project, blacks are less likely to get routine preventive care than other patients and three times more likely to lose a leg to amputation, a devastating complication of diabetes and circulatory problems…

Amputation rates vary fivefold across U.S. regions among all Medicare patients with diabetes and peripheral artery disease (PAD), the report found. Amputation rates in the rural Southeast, particularly among black patients, are significantly higher than other regions of the country. Furthermore, the amputation rate for black patients is seven times higher in some regions than others and there is an eightfold difference across regions among blacks in the likelihood that they undergo invasive surgery to increase circulation in the lower legs.

“This report leaves little doubt where the focus of amputation prevention needs to be directed,” said Philip Goodney, M.D., M.S., director of the Center for the Evaluation of Surgical Care at Dartmouth Hitchcock Medical Center who co-authored the report along with David Goodman, M.D., M.S. principal investigator of the Dartmouth Atlas, and other colleagues. “While a comprehensive approach is necessary, focusing on black patients in poor, rural regions of the United States is likely to be the best place to start. We must look for opportunities to expand education and preventative care for all patients at risk for amputation. However, initiating broader efforts in these high-risk communities will be essential to have the greatest impact…”

The report draws on Medicare claims from 2007-2011 and divides the country into 306 regional markets defined by hospital use. The Medicare data sort patients as either black or non-black (including white, Hispanic, Asian, and others), limiting additional ethnic or racial analysis.

Caring for individuals with diabetes and PAD can be extremely complex and multi-faceted.

Amputation in patients with severe diabetes and PAD is often caused by wounds on the feet and poor circulation, so preventive measures and surgical remedies focus on issues such as foot exams, cholesterol levels and blood sugar control. Tests for blood sugar control and cholesterol levels are inexpensive and universally available. However, the report found that use of these preventative measures varied regionally and racially – for example, only 75.2 percent of black diabetic patients received a blood lipids test in 2010, compared to 81.5 percent of non-black patients.

After the preventive strategies have been optimized, patients with diabetes, PAD, and wounds or ulcerations generally improve most rapidly if blood flow to their feet is restored. Surgery to improve circulation includes endovascular treatments such as balloons or stents and open surgical procedures such as bypass surgery.

The rate of endovascular treatments varied more than sixfold across regions, from fewer than 4.8 procedures per 1,000 patients in Columbus, Georgia to 33.5 in Petoskey, Michigan.

The national average rate among black patients (19.7 per 1,000) was nearly 50 percent higher than the rate among non-black patients (13.3). Rates among black patients also varied dramatically, from 4.8 procedures per 1,000 in Columbus, Georgia to 41.7 in Amarillo, Texas and Hattiesburg, Mississippi.

Amputation is a treatment of last resort. In almost all cases, when comparing black and non- black patients, the lowest risk black patients have a higher risk of amputation than nearly all non- black patients.

The national average rate of leg amputation from 2007-2011 was 2.4 per 1,000 Medicare beneficiaries with diabetes and PAD. The rate varied more than fivefold across regions, from 1.2 per 1,000 patients in Royal Oak, Michigan and Sarasota, Florida to 6.2 per 1,000 patients in Tupelo, Mississippi.

The amputation rate among black patients — 5.6 per 1,000 — was nearly three times higher than the rate among other beneficiaries (2.0). The amputation rate varied by a factor of more than seven among black patients, from 2.1 per 1,000 in San Diego to 16.1 in Tupelo, Mississippi. Among non-black patients, the amputation rate was less than 1 per 1,000 in Takoma Park, Maryland.

Some of the widest racial disparities were seen in Mississippi. There were 14.2 amputations per 1,000 beneficiaries for black patients in Meridian and 16.1 in Tupelo, compared to 3.8 and 4.7 respectively for non-black patients.

Categories: Health Care

California Prop. 46, Inspired By Tragedy, Pits Doctors Against Lawyers

Kaiser Health News - Tue, 10/14/2014 - 5:16pm

Troy and Alana Pack had spent the day at their neighborhood Halloween party in Danville. Ten-year-old Troy went as a baseball player, and 7-year-old Alana was a good witch. In the afternoon, they changed out of their costumes and set out for a walk with their mother. Destination: Baskin Robbins 31 Flavors.

“Alana, she liked anything with chocolate,” says their father, Bob Pack. “Troy, for sure, bubble gum ice cream, ’cause he liked counting the bubble gums that he would get.”

Bob and Carmen Pack with their children Troy and Alana, who were killed by an impaired driver. Bob has been pushing for California's Prop 46 to be passed.

Bob Pack stayed home. His family made it only half a mile down the road before his phone rang: “I received a call from a neighbor screaming there’d been an accident. And I raced down there.”

An impaired driver had veered off the road and hit Troy and Alana head-on. Pack was doing CPR on Troy when the paramedics arrived.

“I remember telling them I love them, and hang on. Just praying that they could hang on,” he says

Troy and Alana were pronounced dead at the hospital. In the months after their death, Pack’s wife, Carmen, retreated into her Catholic faith. Bob Pack was angry.

“I think, for me to get through, I needed action,” he says, “and I needed to take action for justice for Troy and Alana, and also for doing something that I thought maybe I could change to benefit others in the future.”

That was nearly 11 years ago. Pack quit his tech job to become an advocate. Over the last decade, he has helped write seven bills in California’s legislature. None of his efforts have been bigger than the one he’s working on for the November election: Proposition 46, the patient safety initiative. It’s complex and has three distinct proposals.

Requires Doctors to Check Prescription Database

The first proposal, aimed at addressing “doctor shopping,” came about because investigators found the driver who killed his kids was abusing prescription narcotics.

“She had gone to numerous doctors, saying that she was under different pain -- neck pain, back pain, leg pain, elbow pain,” Pack says. “They, in my view, recklessly wrote prescriptions for her, for thousands of pills.”

Pack set out to help the state build a database where doctors can see how many times a patient has been prescribed serious narcotics, like Vicodin or OxyContin. The result is the CURES database, or the Controlled Substance Utilization Review and Evaluation System.

Prop. 46 would make it mandatory for doctors to consult the database. California would become one of nine states requiring doctors to check before prescribing painkillers to first-time patients.

After passing similar laws, Tennessee and New York saw a significant reduction in the number of narcotics prescriptions written. Studies have verified the correlation, but acknowledge that drug abusers may be turning to street drugs, like heroin.

Many doctors in California like the database. Some have called it “indispensable.” But they don’t like being told how to practice medicine.

“The problem with the current way the ballot measure is written is it makes it mandatory, to have that database checked,” says Dr. Richard Thorp, president of the California Medical Association, adding technical glitches have made the database unreliable.

Lifts Cap on Malpractice Awards

Doctors are also unhappy about another big piece of Prop. 46: the proposed change to the cap on “pain and suffering” awards in medical malpractice lawsuits.

After his kids died, Bob Pack wanted to sue the doctors who prescribed drugs to the driver.

“I set out and talked to about eight lawyers,” he says.

They all turned him down. They told him a 1975 state law limited the malpractice award he could get to $250,000. That meant puny attorneys’ fees. The case wouldn’t be worth the lawyers’ time.

“My reaction was ‘What?!’ That’s not democratic. That’s not America,” Pack says. “We all have the right to the court system.”

The law that set the cap is called MICRA, the Medical Injury Compensation Reform Act of 1975, passed with the intention of keeping medical liability insurance costs low. Several other states followed suit. California’s law caps only non-economic damages, or pain and suffering awards. Economic damages –- for medical expenses or lost wages –- are not capped.

But economic damages were no help for Pack. Children have no jobs, no lost wages. And his children, sadly, had no ongoing medical bills.

 “So the victim gets victimized a second time,” Pack says, “they get no accountability or justice through the legal system.”

Some states have ruled such caps on pain and suffering awards unconstitutional.

Pack thinks California’s non-economic malpractice award should at least be adjusted for inflation. Prop. 46 would raise the cap from $250,000 to $1.1 million and provide an annual adjustment for inflation going forward.

But the CMA’s Richard Thorp sees a big problem. “That will encourage additional lawsuits in the system.” He argues more lawsuits will cause malpractice insurance premiums to go up, and those costs could drive doctors out of California.

“You’ll start to see it become more difficult to recruit doctors to California,” he says.

In a review of studies from the 1970s to the early 2000s, researchers writing for the Milbank Quarterly found that damage caps do reduce malpractice insurance premiums, with study results ranging from 6 to 25 percent.

Doctors Oppose Mandatory Substance Abuse Testing

A proposal to require drug and alcohol testing for doctors has been the centerpiece of the “Yes on Prop. 46″ campaign, inspiring campy ads of airline pilots and police officers dancing through the stalls of a public restroom.

Adding doctors to that list seemed like an easy sell. Early polls indicated voters strongly favored the idea -– many thought it was already law. In fact, if Prop. 46 passes, California would be the first state in the country to require drug testing of doctors.

Prop. 46 would give the Medical Board of California a year to set up a system to test doctors for drug and alcohol use, both randomly and within 12 hours after an unexpected patient death or serious injury at the hospital.

Doctors groups say that goes too far.

“This approach is too heavy-handed and too inappropriate,” says CMA’s Thorp. He says hospitals already have systems in place to suspend doctors who show up to work intoxicated.

The two campaigns have fought back and forth over just how much of a problem there is with impaired doctors. Regardless, Prop. 46 author Pack says, not enough is being done.

“The medical board has no authority and no mandate to be able to find out who these guys are, and weed them out or get them help,” he says.

But the focus groups revealing voter support for the idea of doctor drug testing were convincing. That has opponents calling the provision nothing more than a political gimmick.

“The only reason that was added to the proposition is because it polled well with voters,” says Thorp. “They’re just hiding the fact that they’re trying to increase the cap on non-economic damages so that the payouts to trial attorneys can increase.”

Doctors and insurance companies have amassed $57 million to fight Prop. 46, making this the most expensive campaign of the fall election. They’re outspending lawyers 10 to 1 on ads aimed at swaying voters toward a no vote. None of them even mentions doctor drug testing.

Early polls showed strong support for the measure – 58 percent. But that support is waning rapidly, dropping to 34 percent support in mid-September. Twenty-nine percent of voters said they hadn’t yet decided.

This story is part of a reporting partnership between NPR, KQED and Kaiser Health News.

Categories: Health Care

Mass. Officials Try To Quell Ebola Fear

CommonHealth (WBUR) - Tue, 10/14/2014 - 12:23pm

A Braintree cop places police tape around a Harvard Vanguard Medical Associates sign on Sunday. A patient there complained of Ebola-like symptoms, briefly closing the center. (Steven Senne/AP)

At this moment, in Massachusetts, the fear of Ebola may be more troubling than preparing for the possible cases.

Gov. Deval Patrick and Boston Mayor Marty Walsh pulled their top health, police, fire and transportation leaders into a briefing Tuesday morning and then addressed the public from Logan Airport. Their message: We’re ready, don’t worry.

Sometime Sunday afternoon, as word spread that a Braintree patient was being screened for Ebola, the fear factor in Boston spiked. Could this virus that’s killed 4,447 people as of early Tuesday in West Africa be in our midst? I heard from moms who were disinfecting playground equipment, from colleagues whose parents called with worry, and Walsh says his phone was ringing off the hook.

“I know this weekend was very fearful for a lot of people,” Walsh said, “but in the case of an Ebola case, we were prepared for it.”

Ebola has been ruled out in all of the scares this weekend — that Braintree patient and the five sick travelers who landed at Logan Airport from Dubai. Patrick says there have been several dozen cases in Massachusetts where doctors or nurses suspected Ebola and took precautions.

“I want to make clear that there have been no confirmed cases of Ebola in Massachusetts,” he said. “Each of the individuals that I referred to have been examined and Ebola has been ruled out.”

If you’ve called your doctor’s office or gone to a clinic or emergency room recently, you should have been asked about your travel history and whether you’ve been in contact with anyone who’s been to West Africa and is sick. State Department of Public Health Commissioner Cheryl Bartlett says all hospitals, clinics and large physician practices are using these questions to step up screening.

“[Also,] we’re asking them to do a risk assessment so that we understand if someone has low, moderate or high risk of Ebola virus disease, and that we can isolate them right away in the event they are at risk and keep them out of waiting rooms and causing exposure to other individuals,” she said.

The screening may be flagging people who do not have Ebola because the early symptoms — headache, fever, muscle aches — could be the flu or other illnesses. But Ebola is nowhere near as contagious as the flu, which kills, on average, more than 23,000 Americans every year.

Boston Public Health Interim Commissioner Huy Nguyen says with Ebola, you have to be within three feet of someone who has symptoms to be at risk.

“You cannot get Ebola through the air or water,” Nguyen said. “If you have not touched the blood or body fluids of a patient, an individual who has Ebola, if you have not touched the blood, the vomit, the feces, the semen, the sweat of an individual with Ebola, sick with Ebola, you are not at risk for contracting Ebola virus disease.”

Patrick emphasized that point about close proximity, gesturing toward Commissioner Bartlett.

“If I had Ebola, the commissioner standing right here would be at minimal risk of catching it,” Patrick said. “This is hard to catch.”

The state continues training local police, fire and other municipal health workers who might be the first to encounter Ebola. The daily conference calls, updates and outreach will likely go on for some months.

In the meantime, a growing number of Boston area medical workers are preparing to head into this public health emergency in West Africa. The World Health Organization reports a thousand new cases this week and said the rate of deaths among those who contract Ebola is climbing.

This post was updated at 4 p.m. with the All Things Considered feature report.

Earlier:

Categories: Health Care

Egypt: Legal Framework for Arbitration

Law Library of Congress: Research Reports - Tue, 10/14/2014 - 10:00am
The Law Library of Congress is proud to present a new report, Egypt: Legal Framework for Arbitration.

Arbitration is becoming an increasingly important means of settling investment and commercial disputes in Egypt. The promulgation of Arbitration Law No. 27 of 1994 was a milestone in providing a comprehensive framework for the arbitration process in the country. The Law provides for the rules governing the formation and validity of arbitration agreements, arbitrability of legal disputes, composition of the arbitral tribunal, arbitral proceedings, and enforcement of an arbitral award. Judicial precedents of the Supreme Constitutional Court and the Court of Cassation have played an important role in supplementing the provisions of the Arbitration Law.

Although the Arbitration Law is the primary source for regulating the extrajudicial dispute resolution mechanism, the country's unrest over the past three years spurred the introduction of other quicker and more flexible mechanisms for the settlement of investment disputes. Egypt has also acceded to several international conventions governing the arbitral process, the provisions of which have been incorporated into the country’s national legal system.

Visit http://www.loc.gov/law/help/arbitration/egypt.php to read the entire report.

This report is one of many prepared by the Law Library of Congress available at http://www.loc.gov/law/help/current-topics.php. The Law Library of Congress produces reports for members of Congress and others. Learn more at http://blogs.loc.gov/law/2013/05/law-library-provides-global-legal-research/. Throughout this week there will be highlights of recent and newly published reports. Follow along and share your favorites using the hashtag ‪#‎LawLibraryReport‬.
Categories: Research & Litigation

Revamped Healthcare.gov Will Deal With A New Complications

Kaiser Health News - Tue, 10/14/2014 - 9:55am

The Associated Press reports on how the updated website, which has been overhauled in anticipation of the upcoming second enrollment season, compares with last year's version. Meanwhile, investigations continue regarding Covered California's no-bid contracts.

The Associated Press: How The New Healthcare.Gov Stacks Up With The Old
HealthCare.gov, the website for health insurance under President Barack Obama’s health care law, has been revamped as its second enrollment season approaches. But things are still complicated, since other major provisions of the Affordable Care Act are taking effect for the first time (10/14).

Sacramento Bee: Consumer Watchdog Calls For Investigation Of Covered California’s No-Bid Contracts
The group backing a health insurance rate-control measure on next month’s ballot called on Attorney General Kamala Harris on Monday to investigate millions of dollars in no-bid contracts by Covered California and reported links between the health exchange’s executives and the insurance industry. The demand by Consumer Watchdog, a main supporter of Proposition 45, came after The Associated Press reported that Covered California had awarded $184 million in contracts without competitive bidding. The total included millions of dollars in contracts to firms or people that had professional ties to Covered California executive director Peter Lee, according to the report (Miller, 10/14).

Categories: Health Care

Medicaid Expansion Plans, Debates Continue To Roil GOP Officials, Cause Concern For Hospital Execs

Kaiser Health News - Tue, 10/14/2014 - 9:54am

News outlets offer updates regarding Medicaid expansion efforts in Indiana and Ohio.  

Chicago Sun-Times: Fate Of Indiana's Medicaid Expansion Proposal Still Uncertain
Indiana Gov. Mike Pence and federal officials have struggled to come to agreement on the state’s Medicaid expansion proposal — HIP 2.0 — since it was submitted in July. Advocates and stakeholders are worried that drawn-out negotiations could negatively impact 350,000 uninsured Hoosiers. Like many Republican governors and legislators, Pence initially refused to expand Medicaid, but the state would have left $17 billion in federal funds on the table and an increasing number Indiana residents were facing no coverage. HIP 2.0 proposes to replace both traditional Medicaid in Indiana and expand it for non-disabled residents making up 138 percent of poverty level — $16,000 for individuals and $33,000 for families of four. An estimated 350,000 Indiana residents would gain coverage through the expansion (Lazerus, 10/13).

Kaiser Health News: Ohio Medicaid Expansion Faces 2015 Political Hurdle
University Hospitals Chief Executive Tom Zenty warned a Cleveland audience that the state’s Medicaid expansion may not be permanent. “In July of next year, if there is no intervention, Medicaid expansion in the state of Ohio disappears,” Zenty said, during a recent panel discussion. Following the Supreme Court decision about the Affordable Care Act in 2012, states could choose whether they wanted to expand Medicaid (Tribble, 10/14).

In other news related to Medicaid and the health law -

World-Herald News Service: Medicaid Eligibility Expanded In Nebraska For Former Foster Children
A larger group of Nebraskans than originally estimated may benefit from a provision of the Affordable Care Act that grants Medicaid to young adults who had been in foster care. The State of Nebraska conceded last month that it had interpreted the provision too narrowly, and that more former foster individuals should benefit from the health coverage. The uncertainty came about because Nebraska’s age of majority — basically, the age at which a person officially becomes an adult — is 19, not 18, as it is in most states, including Iowa. In question was whether people who left foster care at age 18 in Nebraska would get Medicaid under Obamacare, or if they would have to have exited foster care at age 19. The provision of the law that took effect at the start of this year gives young adults who had been in foster care consideration similar to that of young people who are allowed to remain covered by their parents’ health insurance until 26 years of age (Ruggles, 10/13). 

Categories: Health Care

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