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Texas Tort Reform is NOT a Model for Nationwide Health Care Reform

Mike Ferrara — Mon, 07 Sep 2009 20:24:15 GMT

Tort reformers like to talk a lot about how the threat of malpractice suits raises health care costs by forcing doctors to practice “defensive medicine”—the ordering of unnecessary tests, procedures, and prescriptions in an attempt to protect themselves against a possible negligence lawsuit.

In a 2008 AMA survey, they remind us, a majority of the doctors who responded admitted to practicing defensive medicine—a number that translates, the AMA calculated, to $1.4 billion more spent annually on health care. If our doctors weren’t threatened into doing this, we’d all save loads of money and our national health crisis would be over.

Are the tort reformers right? Well, let’s look at Texas. Several years ago, the state passed a stringent medical malpractice law that capped awards for pain and suffering at $250,000, and brought the number of malpractice lawsuits down dramatically.

So the cost of health care in Texas must also be down, you suppose, since doctors don’t face the same malpractice threats as the rest of the country. Eh, No. In fact, Texas is home to three of the top ten most expensive cities in the country to receive health care: McAllen, Harlingen and Corpus Christi. In each of these cities, every Medicare patient is costing the country more than $10,000 a year (a couple thousand more than the national average).

So if defensive medicine against the threat of malpractice suits isn’t driving up costs, what is?

Harvard Medical School surgeon Atul Gawande got a candid answer to this question from a general surgeon in McAllen, Texas:

“Come on,” the general surgeon finally said. “We all know these arguments are [BS]. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures.

The surgeon came to McAllen in the mid-nineties, and since then, he said, “the way to practice medicine has changed completely. Before, it was about how to do a good job. Now it is about ‘How much will you benefit?’ ” –Atul Gawande, The NewYorker

While tort reform like Texas' won't improve the cost of our health care, changing our charge-per-service structure just might.

Originally posted at InjuryBoard by Mike Ferrara

Just How Much do Malpractice Suits Raise Health Care Costs?

Mike Ferrara — Thu, 16 Jul 2009 22:22:45 GMT

A succinct op-ed in The New York Times earlier this week by UPenn Law School professor Tom Baker made some terrific points about medical malpractice, and the expensive malpractice insurance that everyone is always blaming for the skyrocketing costs of health care.

Eighty percent of malpractice claims involve significant disability or death, a 2006 analysis of medical malpractice claims conducted by the Harvard School of Public Health shows, and the amount of compensation patients receive strongly depends on the merits of their claims. Most people injured by medical malpractice do not bring legal claims, earlier studies by the same researchers have found.

In other words, patient claims, and accordingly, the malpractice insurance to cover them, are not that large unless patients can prove significant injury or death due to medical negligence. This means that claims are not draining our pocketbooks; medical negligence is.

On the other hand, medical liability has improved patient safety — by leading hospitals to hire risk managers, for example, and spurring anesthesiologists to improve their safety standards and practices. Even medical societies’ efforts to attack the liability system have helped, by inspiring the research that has documented the surprising extent of preventable injuries in hospitals. That research helped start the patient safety movement.

Disturbingly, findings have shown that hospitals in New Jersey, Pennsylvania, and in fact all over the country are still vastly underreporting preventable errors, even serious ones, that occur on their watch, despite state laws requiring them to do so. On the consumer level, patients have no way of knowing how well local hospitals are performing. State agencies do not release reports from individual hospitals regarding their rate of medical errors. Oftentimes, it is not until the health department cites a hospital for breaking state laws that the public even hears of the hospital’s failing.

Take away medical liability and you take away the only meaningful check and balance a patient has on the impossible monstrosity of a system that American health care has become.

As Baker notes, “there’s a better answer for doctors worried about high malpractice insurance premiums.” And this answer is:

…[m]edical providers should be required to disclose injuries, provide quicker compensation to deserving patients and — here’s the answer for doctors worried about their premiums — shift the responsibility for buying malpractice insurance to hospitals and other large medical institutions. Evidence-based liability reform would give these institutions the incentive they need to cut back on the most wasteful aspect of American health care: preventable medical injuries.

It’s so crazy it just might work.

Originally posted at InjuryBoard by Mike Ferrara

How Deadly is Your Dry Cleaning Part 2 – A Blogger Strikes Back

Camryn Hansen — Mon, 12 Jan 2009 13:12:44 GMT

After being ignored for several days, a blog I wrote last week on the dangers of the dry cleaning chemical perc caught fire this weekend, inciting comments that were not simply indignant, but personally insulting—accusing me and the Ferrara Law Firm of everything from pseudo-science to fear mongering. One email I received curtly informed me that I suffer from a “lack of education.”

Initially baffled by this (I honestly don’t often get such passionate responses to my Injury Board blogs, which, counter to what some comments suggest, aren’t out to specifically target dry cleaning as the scourge of America, but vary in topic, addressing issues from big tobacco to library legislation), I googled the names of the negative commenters. While I expected some of them to have something to do with dry cleaning, I didn’t expect them all to—but they did. Every one of them owns or runs or works in a dry cleaner.

Before I delve into the meaning of this, I should first make it clear that I am not an attorney; I’m a freelance writer. I don’t get paid to bring in cases against anybody; I don’t get royalties from settlements or jury awards; I don’t get money for anything other than writing blogs, which are just that: blogs. They don’t in any way pretend to scientific authority, and don’t presume to prioritize threats to the wellbeing of Americans. Rather, they are meant to touch on issues of public health and safety with a vigorous skepticism towards products and services that have been shown to pose a level of risk that many people, when informed of such a risk, will not willingly accept.

Such is the case with dry cleaning. For my own part, after getting my clothes dry cleaned a couple of weeks ago (I usually don’t; it was a special occasion) and breaking out in an itchy rash afterward, I decided to research why this might be. Lo and behold, I immediately stumbled on the EPA’s website, which describes the dry cleaning chemical perc (also known as tetrachloroethylene) thus:

Tetrachloroethylene is widely used for dry-cleaning fabrics and metal degreasing operations. The main effects of tetrachloroethylene in humans are neurological, liver, and kidney effects following acute (short-term) and chronic (long-term) inhalation exposure. Adverse reproductive effects, such as spontaneous abortions, have been reported from occupational exposure to tetrachloroethylene; however, no definite conclusions can be made because of the limitations of the studies. Results from epidemiological studies of dry-cleaners occupationally exposed to tetrachloroethylene suggest increased risks for several types of cancer. Animal studies have reported an increased incidence of liver cancer in mice, via inhalation and gavage (experimentally placing the chemical in the stomach), and kidney and mononuclear cell leukemia in rats. In the mid-1980s, EPA considered the epidemiological and animal evidence on tetrachloroethylene as intermediate between a probable and possible human carcinogen (Group B/C). The Agency is currently reassessing its potential carcinogenicity. -EPA

While a few different comments make fun of the word “probable” in this characterization, as though it’s somehow indicative of scientific and even personal failures on the part of EPA researchers, my feeling as a consumer (not, as I said, a lawyer) is that this established probability is sufficient for me to want to avoid conventional dry cleaning for the rest of my life. Why chance it? The benefits of dry cleaning just aren’t fantastic enough for me to want probably toxic chemicals soaking into my skin—to compound, I might add, rather than exist as an alternative to, the many other environmental and food-based toxins so many commenters propagandistically cite as a lot more dangerous than perc. The probability is undoubtedly sufficient for many Americans to choose alternatives to conventional dry cleaning. Case in point, the state of California has actually banned the chemical perc and plans to phase it out completely by 2023—not to be alarmist, but to benefit public health using the best research currently available.

For those of you who charged me with personally proving that perc causes cancer, you might as well know that I’m not a scientist (nor, in fact, even a pseudo-scientist) and that I can’t prove any of it. All I can do is let consumers know what I, as a non-industry person, didn’t know two weeks ago about the suspected risks of dry cleaning chemicals, but wish someone had told me earlier.

For those of you who argued that perc is relatively safe and doesn’t cause cancer, liver or kidney disease, spontaneous abortions, and/or nervous system depression, what proof do you have? I’d be grateful to see it, for all our sakes. As I’m sure you know, simply saying that it’s safe doesn’t make it safe. It might, however, keep your customers from choosing legitimately safer alternatives—which may be a greater concern to you than the actual health of the public.

Originally posted at InjuryBoard by Camryn Hansen

Congress: the FDA Will Now Control Cigarettes

Mike Ferrara — Thu, 11 Jun 2009 21:15:36 GMT

The Senate voted today and the House is expected to vote tomorrow to pass The Family Smoking Prevention and Tobacco Control Act, a critical piece of legislation that will allow the FDA to regulate cigarettes and other forms of tobacco.

Currently, a full twenty percent of Americans smoke, and 400,000 die every year from diseases related to smoking.

The new legislation, which President Obama is expected to sign as soon as it reaches his desk (he co-sponsored the bill when he was in the Senate), will allow the FDA to regulate the chemicals in cigarette smoke, ban cigarette flavorings (which are said to entice children and teens into the deadly habit), and look into banning menthol (which has links to higher rates of lung cancer). There are about 60 cancer-causing chemicals and 4000 poisonous chemicals in cigarette smoke: these would all be reduced under the auspices of the FDA.

However, though the FDA may also be able to reduce the amount of addictive nicotine in cigarettes, this legislation expressly forbids the agency to ban it altogether. Researchers have suggested that doing so might force addicts to turn to the black market for their nic fixes.

The law would also further restrict marketing and advertising of tobacco products. Colorful advertising and store displays will be replaced by black-and-white-only text as part of restrictions aimed at reducing the appeal to youth to try smoking. Cigarette makers will be required to stop using terms like “light” and “low tar” by next year and to place large and graphic health warnings on their packages by 2012.

“This long-overdue grant of authority to F.D.A. to regulate tobacco products means that the agency can finally take the actions needed to protect our people from the most deadly of all consumer products,” Edward M. Kennedy, the Massachusetts Democrat who was chief sponsor of the legislation in the Senate, said in a statement from home, where he is receiving treatment for a brain tumor. -The New York Times

The wholly bipartisan legislation passed in the Senate by a 3:1 ratio; it has equally bipartisan support in the House.

Originally posted at InjuryBoard by Mike Ferrara

Minnesota Teens Charged with Nursing Home Abuse While Friends Looked On

Mike Ferrara — Wed, 03 Dec 2008 20:02:29 GMT

According to a criminal complaint filed Monday, several female high school students who worked together as part-time aides at Albert Lea, Minnesota’s Good Samaritan nursing home have been accused of abusing the residents they were hired to care for.

Reported abuses include taunting seven different residents, spitting on them and in their mouths, and poking and rubbing their genitals.

Two of the young women, Brianna Marie Broitzman, 19, and Ashton Michelle Larson, 18, were old enough at the time of the alleged abuse to be charged as adults—Broitzman for 11 counts and Larson for 10. The six others involved were all 17 at the time, and have thus only been identified by birthdates and initials. Two of these young women will be tried as juveniles for abusing the residents; the other four have been charged in juvenile court for failing to report the maltreatment they witnessed.

Monday, Broitzman and Larson were charged with fifth-degree assault, abuse of a vulnerable adult with sexual contact, abuse of a vulnerable adult by a caregiver, disorderly conduct, and failing to report suspected maltreatment—all gross misdemeanors, with a maximum penalty of one year in jail and a $3,000 fine per count.

If found guilty, "they most likely will face suspended jail sentences and probation, so they'd have the threat of jail hanging over them if they get in more trouble," said Freeborn County Attorney Craig Nelson, who filed the charges Monday.

Since summer, Nelson has said that prosecuting the aides could prove difficult because the evidence is largely based on their own statements and those made by another aide who blew the whistle to the home's administrators while she was being fired for swearing in front of a resident. That aide was among those charged as a juvenile. –Warren Wolfe, Minneapolis Star Tribune

Allegations against the teens first went public in August, after state health department inspectors found that four of them had abused over a dozen residents in efforts to make “work fun.”

The abusive acts allegedly occurred between Jan. 1 and May 1, 2008. When the Good Samaritan learned of the health department’s allegations in May, it fired the four accused aides.

Originally posted at InjuryBoard by Mike Ferrara

Before You Vaccinate with Gardasil, Know the Serious Risks

Mike Ferrara — Sat, 26 Sep 2009 12:57:20 GMT

If you are considering vaccinating your daughter with the increasingly popular Merck vaccine Gardasil, designed to protect against cervical cancer by preventing the sexually transmitted virus HPV, consider the following first:

Merck’s marketing for this vaccine has been one of the most aggressive in pharmaceutical marketing history, targeting not only the consumer population but doctors, researchers and even politicians. For the overwhelming success of its Gardasil campaign, Merck took home all of the 2008 Pharmaceutical Advertising and Marketing Excellence awards, and Pharmaceutical Executive Magazine named Gardasil its Brand of the Year.

The FDA was suspiciously eager to approve and recommend Gardasil. Unlike other vaccines, which usually take three years to be FDA-approved after the conclusion of clinical testing, Gardasil sped through the system in a mere six months. With similar alacrity, only a few weeks after FDA approval, the CDC recommended Gardasil for universal use among girls. Typically, it takes vaccines from 5 to 10 years to achieve this kind of universal status.

Typically, the grace period between the time a vaccine enters the market and the time it is universally adopted allows for adverse reactions, side-effects and other problems to be found before they have an impact on a huge population. Gardasil has not had this grace period. As of June 1, 2009, 25 million doses of the vaccine have been distributed in the United States. As of this date, there have also been 14,072 official reports of adverse events occurring after Gardasil vaccination in the United States. Ninety three percent were not serious, and ranged from arm pain to fainting, but seven percent were extremely serious, and included paralysis, blood clots, and more than 40 deaths (26 of which have been confirmed).

The worst reactions, as well as any and all long-term complications, may be still to come. Because the duration of Gardasil clinical trials was only five years, it is also not clear how long the vaccine offers protection against some strains of HPV. (It only offers 70% protection against HPV at full strength to begin with.) Some of Merck’s own clinical trials suggested that HPV protection wears off in some girls as early as three years after receiving Gardasil…which will probably translate into the need for girls and women to get booster shots every few years, ad infinitum.

The available information on this vaccine’s adverse effects strongly suggests that the FDA and CDC need to curb this frightening Gardasil free-for-all and re-evaluate its safety, both in the short term and in the long term.

Readers, if you have had any personal experiences with Gardasil’s negative effects, please share them here! People have to know about this vaccine’s risks before exposing their children to it.

Originally posted at InjuryBoard by Mike Ferrara

How Deadly is Your Dry Cleaning?

Camryn Hansen — Sat, 03 Jan 2009 23:39:12 GMT

Don’t let the “clean” in dry cleaning mislead you. Eighty five percent of dry cleaners across the country use a dangerous solvent called perchloroethylene, or “perc” for short, to remove the dirt and grime from your clothes.

Classified by the EPA as a health and environmental hazard, perc is a toxic chemical known to depress the nervous system, causing dizziness, headaches, confusion, nausea, trouble with speaking and walking, and at high concentrations, unconsciousness and even death. In studies on animals, it’s also caused kidney and liver damage. The International Agency for Research on Cancer classifies perc as a Group 2A carcinogen, meaning that it is probably cancer-causing to humans as well.

When you take your clothes home from the cleaners, the chemical perc outgases and spreads throughout your house. It also enters your body through your skin when you wear dry cleaned clothes. With repeated skin contact, it can start to dissolve the natural oils in your skin, resulting in severe skin irritation.

This is not what we should consider clean. Before you flip out, though, know that alternatives to toxic dry cleaning exist. More and more popular these days are “green” or “organic” dry cleaners, which don’t use perc, but a process called wet cleaning, in which a smart-machine applies a very small amount of water and detergent to your clothes, adapting to the specific needs of each garment. Often, hand washing also works well on even clothes that are labeled “dry clean only”—if you use some special techniques.

California has passed a law to phase out the use of perc completely by 2023. Clearly, the rest of us should follow suit.

Originally posted at InjuryBoard by Camryn Hansen

Obama Transition Team Seeks Americans’ Input on Health Care Future - Make Your Voices Heard!

Camryn Hansen — Sat, 06 Dec 2008 23:04:32 GMT

This got me excited. On Friday, Senator Tom Daschle announced that Obama’s transition team is seeking input from Americans about how to improve the national healthcare system. He asked that we volunteer to hold meetings in our homes and communities to discuss options for reform, and then offer our best ideas to the transition team. Daschle’s even promised to make a guest appearance at one of the meetings. If you sign up on the transition website to host a meeting, they’ll send you a moderator kit with all you need to effectively lead it, and turn in your notes to the people in charge of the country. They might even send Tom Daschle himself.

Were I to host a meeting (and I just might), I would make it a point to talk about the rarely discussed option of co-op community health insurance. I was fortunate enough to live in Ithaca, NY at a time when the community was organizing a co-op health fund, the purpose of which was to provide emergency and backup health insurance coverage to the uninsured and under-insured. When I joined the Ithaca Health Alliance in 2002, the cost of membership was $100 per year, and health services covered were limited to broken bones and ambulance rides. It seemed like not so much coverage at the time, but I took what I could get, since my employer wasn’t offering a nickel’s worth of mainstream coverage.

Six years later, Ithaca Health Alliance, running on the $100 a year per adult/$175 per couple/$50 per child it still charges, has opened its own Free Clinic, which provides 100% free health services to any member of the community who is uninsured. The Ithaca Health Fund also provides up to $4000 of health coverage per year for any of its members. After just a few years of accumulating community funds under the auspices of the local Ithaca community, it’s a completely workable health insurance organization that’s universally affordable, and doesn’t discriminate. Anyone in New York State can join, for the same nominal fee.

Of course, some Americans need more health care than $4000 can pay for in a year. But isn’t this a fantastic start? Wouldn’t you like to see organizations like this crop up in every community, making health care fully accessible to everyone who wants it?

I would. And as a matter of fact, we almost had one here in Pennsylvania. The founder of the Ithaca Health Alliance, Paul Glover, a former Ithacan who now teaches at Temple University, began organizing a similar health co-op a few years ago, when he moved to Philadelphia. (He called it PhilaHealthia.) When the Philadelphia Insurance Department was asked to endorse it, however, not only did it refuse, but it ordered Glover to “cease and desist”—making it illegal to continue the program, despite its demonstrated success in New York State, and despite guarantees of full transparency and accountability. Uninsured Philadelphians everywhere (by recent estimates there are more than 135,000 in the city; 900,000 in the state) have written desperate, pleading letters to the Insurance Department to approve the program, but it won’t budge.

I, for one, am asking the Obama transition team to consider federal intervention into state health insurance departments like Pennsylvania’s, such that community-run programs which offer concrete and practical solutions to the American health care/health insurance crisis cannot be indiscriminately prohibited by insurance company-dominated state regimes. If you have innovative thoughts on solving the health care crisis, I encourage you to take a moment to offer them to all of us, as well.

Originally posted at InjuryBoard by Camryn Hansen

Allstate is Cooking the Books.

Mike Ferrara — Sun, 08 Feb 2009 22:42:07 GMT

Allstate is already well known for collecting exorbitant premiums and simultaneously refusing to pay reasonable claims to customers, forcing them instead to either endure years of litigation while their bills go unpaid, or settle for a fraction of the claims they deserve.

Evidence in Allstate company reports shows that the American insurance giant has also been fudging its numbers to appear financially stronger in the crumbling economy than it actually is.

According to The Washington Post, Allstate has made at least two “account changes” adding erroneous funds to their assets: one for $347 million and another for $365 million.

In the economic crunch, Allstate and other insurers have been asking insurance regulators to either let them operate with less of a financial cushion than before, or simply approve “account changes” that make the cushion they have just look larger. The regulators have been more or less amenable.

Allstate's home regulator in Illinois approved one of the company's accounting changes during the fourth quarter of last year, retroactive to Sept. 30, Allstate reported.

The company made the other change anticipating that the National Association of Insurance Commissioners would later endorse the approach, Allstate spokeswoman Maryellen Thielen said. Instead, the NAIC executive committee rejected the proposal on Jan. 29, leaving the question for individual states to resolve, Thielen said in an e-mail.

In a Jan. 29 conference call with investment analysts, Allstate executives said they already had regulators' blessing.

“They look at it favorably because it's indicative of the strength of the company,” Allstate Controller Samuel Pilch said when an analyst asked about the approximately $700 million of capital the company generated through accounting changes. – David S. Hilzenrath, The Washington Post

The blatant refusal on the part of regulators to responsibly regulate Allstate or any other insurer means that individual states will be given the power to approve or reject insurance companies’ accounting practices, determining how successful each company appears to the public and in turn, how the public chooses insurers. Companies will soon be reporting their financial standing differently from state to state, and the already confusing process of choosing and keeping an insurance company will become virtually impossible from the standpoint of a company’s financial health—and accordingly, its likelihood of actually covering you in the event of an accident.

Originally posted at InjuryBoard by Mike Ferrara

Nutro Recalls its Dry Cat Food – Cat Owners Be Vigilant

Camryn Hansen — Sun, 24 May 2009 18:46:19 GMT

On Thursday, Nutro Products, one of the nation’s most popular pet food manufacturers, announced a voluntary recall of almost all its dry cat food products.

Unlike many recent pet food recalls, this one is not due to contamination, but to incorrect levels of zinc and potassium, two essential nutrients for cats that if consumed at improper levels, can cause illness.

The recalled cat food is sold under the brand names Nutro Natural Choice Complete Care and Nutro Max dry cat foods with "Best If Used By” dates between May 12, 2010 and August 22, 2010. No dry dog food or canned dog or cat food has been affected.

Nutro is advising consumers who have purchased these products to immediately stop feeding them to their cats, and switch to another food containing a balanced nutritional profile.

The company has not yet received complaints in connection with the nutrient imbalance, but asks that cat owners consult their vets immediately if their cats exhibit symptoms such as loss of appetite or refusal of food, weight loss, vomiting or diarrhea.

Customers may return any unused portion of recalled Nutro cat food to the store for a full refund or exchange.

Read the full press release here.

Originally posted at InjuryBoard by Camryn Hansen