Friday, December 12, 2008

Kaiser Permanente to pay $11.4 million total for retaliating against doctor who complained about patient care

I have been shocked at the unwillingness of Kaiser Permanente to make any effort to remediate problems that are brought to its attention. The people I have complained to have immediately thrown up a stone wall. Will this verdict cause Kaiser to respond differently to complaints? Will the persons responsible be fired? I doubt it.

Jury awards $7.5M more to former Kaiser doctor
Mercury News
The Associated Press

A Los Angeles jury has ordered Kaiser Permanante to pay $7.5 million in punitive damages to a radiologist who was forced to resign from one the company's hospitals in 2006 after complaining about patient care.

The jury's decision on Thursday means Kaiser owes Dr. Michael Martinucci a combined $11.4 million. The same panel on Monday awarded the doctor $3.9 million in compensatory damages.

Kaiser says it will appeal Thursday's decision, saying it was "shocked and disappointed by the verdict."

Martinucci sued Kaiser after leaving the company, claiming he was forced to quit because he complained about work standards at the Hollywood hospital.

Martinucci was hired at Kaiser in 2003 and resigned three years later after his supervisor and a human resources staffer accused him of being racist and making sexual advances toward a male technologist.

Sunday, November 23, 2008

Exercise cuts cancer risk – new study
By Sue Mueller
Nov 23, 2008

Physical inactivity or lack of exercise may dramatically increase risk of breast cancer, according to a new report published in the Dec 2008 issue of Cancer Causes and Control.

The report by Coyle Y.M at the University of Texas Southwestern Medical Center in Dallas, TX says exercise lowers estrogen levels that if high would cause a higher risk of breast cancer.

Coyle suggests that estrogen induces breast cancer by increasing breast epithelial cell proliferation, the metabolism of estrogen to genotoxic metabolites and the silencing of tumor suppressor genes (TSGS) that have been implicated in breast carcinogenesis.

According to the author, animal studies suggest that exercise slows breast tumor growth by promoting changes in cellular proliferation and apoptosis.

Human studies albeit limited also suggest that exercise produces favorable changes in estrogen metabolism which in turn reduces the risk of breast epithelial cell proliferation.

Coyle says that exercise reduces promoter hypermethylation of TSGS in breast carcinogenesis by lowering estrogen levels.

Further research is needed to clarify the mechanisms that relate to exercise as a negative modulator of breast cancer risk, the author concludes.

Many studies have suggested that regular physical activity or exercise reduces risk of cancer.

One recent study involving 5,968 women led James McClain of the National Cancer Institute and colleagues confirmed previous studies that have shown people who did physical exercise regularly were at lower risk of developing cancer.

The study reported at a meeting of the American Association for Cancer Research also found among women who were in the upper half with regard to the amount of physical activity each week, those who slept less than seven hours per night were 47 percent more likely to develop cancer than those who slept longer.

One study led by Michael F Leitzmann and colleagues at the National Cancer Institute and published in the Oct. 2008 issue of Breast Cancer Research found that postmenopausal women with body mass index lower than 25 kg/m2 who engaged in vigorous exercise were 23 percent less likely to develop breast cancer. But no such association was found in overweight and obese women.

The researchers followed up 32,000 women who enrolled in the Breast Cancer Detection Demonstration Project Follow-up Study to examine if there was an association between risk of breast cancer and physical exercise.

Another study led by Freedman DM and colleagues from National Cancer Institute and published in Oct 21, 2008 issue of Cancer Causes and Control found exercise such as walking and hiking for 10 or more hours per week rendered the greatest protection against breast cancer in women, a 43 percent reduction in the risk.

Wednesday, October 29, 2008

FDA ignores science regarding BPA

Do incidents like this mean you can't trust anything the FDA says?

Experts: FDA ignored evidence when calling BPA safe
Oct. 29, 2008
By Liz Szabo

The Food and Drug Administration ignored evidence when concluding that a chemical in plastic baby bottles is safe, according an expert panel asked to review the agency's handling of the controversial substance.

The Food and Drug Administration ignored evidence about the danger posed by a chemical in plastic baby bottles, according a report released Wednesday.

The excluded studies suggest bisphenol A, or BPA, could pose harm to children at levels at least 10 times lower than the amount the agency says is safe, according to the report written by outside scientists asked to review the agency's handling of the controversial substance.

Excluding evidence of harm "creates a false sense of security" about BPA, the panel's report says.

The scientists took the FDA to task for basing its safety decision in August on three industry-funded studies. Another government agency, the National Toxicology Program, decided many other independent studies deserved consideration. The toxicology program concluded last month there is "some concern" that BPA alters development of the brain, prostate and behavior in children and fetuses.

The expert panel also found the FDA underestimated how much BPA babies ingest on several counts. For one, the agency failed to consider the cumulative effect of being exposed to BPA from dozens of products, a fundamental error that "severely limits the usefulness" of the FDA's safety estimate.

An advocacy group, the Natural Resources Defense Council, believes BPA is too toxic to use in baby products at all. The group formally has asked the FDA to remove BPA from food and beverage containers.

The new report was written by a subcommittee of the FDA's outside science board, experts who advise the FDA on complex issues. The full science board, scheduled to meet Friday, can endorse the subcommittee's report or write its own..

Tuesday, October 7, 2008

AIG insurance executives start spending $85 billion bailout--at a luxury resort

Insurance company executives know we love them, and that we wouldn't want them to tighten their belts now that they're on the dole. After all, if we'd wanted them to suffer, we wouldn't have given them $85 billion dollars, right?

The Washington Times
AIG execs hold $440K post-bailout retreat
Sean Lengell
October 7, 2008

Top executives at the failed insurance giant AIG spent more than $440,000 at a company retreat days after the federal government bailed out the company with $85 billion in taxpayer funds.

American International Group (AIG) paid the exclusive St. Regis resort in Monarch Beach, Calif., more than $200,000 for rooms — some costing as much at $1,000 a night — as well as more than $150,000 in meals, according to released documents an testimony during a hearing of the House Committee on Oversight and Government Reform Tuesday on Capitol Hill.

"Less than one week after taxpayers rescued AIG, company executives could be found wining and dining at one of the most exclusive resorts in the nation," said committee Chairman Henry A. Waxman, California Democrat.

The invoice also included almost $25,000 in spa and salon charges for pedicures, manicures, facials, massages and other services...

Saturday, October 4, 2008

Was Dr. Nemeroff bought off by drug makers?

In the following case, I'm more disturbed about the doctor being bought by drug companies than by his failure to report income to the IRS.

Emory Psychiatrist Dr. Charles B. Nemeroff Did Not Report Drug Income
By Jenny Huntington
October 4th 2008

"Congressional investigators have revealed that Dr. Charles B. Nemeroff of Emory University, one of the nation’s leading psychiatrists, has failed to report income of more than $1.2 million, thus violating federal regulations.

"The money, which came from consulting arrangements with drug makers, has been earned by Nemeroff over a period of seven years, from 2000 to 2007. The total amount has been estimated at about $2.8 million..."

Friday, October 3, 2008

Why you should be a bad patient: you're likely to survive longer

It's Better to Be a Bad Patient, Actor Says
Oct. 3, 2008

You probably know Evan Handler as Harry Goldenblatt, Charlotte York's husband on HBO's "Sex and the City," or as Charlie Runkle, the agent for David Duchovny's character on "Californication." What you probably don't know is that he's a passionate patient advocate, based on his experience being treated for leukemia in the mid- and late-1980s.

In many ways, Handler is the ultimate empowered patient. "I learned that I must always remain in control, double-check everyone's work, and trust no one completely," Handler wrote of his approximately eight months in the hospital. "I must have been sheer hell to be around. But I know that my cantankerousness saved my life on several occasions."

In his books "It's Only Temporary," and "Time on Fire," Handler wrote that during his months in the hospital, he was given intravenous drugs that were supposed to go to another patient, that nurses tried to give him medications his doctors had forbidden for him and that staff members refused to follow the hospital's posted hygiene precautions for immunosuppressed patients like himself.

Handler survived when statistics said he shouldn't have. He endured round after round of chemotherapy, one infection after another and a bone marrow transplant. In this conversation with CNN Medical Correspondent Elizabeth Cohen, Handler discusses firing your doctor, tattooing medical directives on your stomach and the importance of not doing exactly what you're told.

Elizabeth Cohen: Were you a "bad" patient?

Evan Handler: The irony of "bad" patients is that they actually do better for themselves. ... There were hundreds and hundreds of instances where my being a "bad" patient saved my life.

Cohen: You write about how nurses tried to give you drugs to which you'd had "horrendous adverse reactions" even though doctors had explicitly written in your chart you shouldn't have those drugs. A friend of mine had a similar problem, and we decided maybe he should have hung a sign around his neck with a list of the drugs he wasn't supposed to get...

Cohen: You write about how you became "a criminal of sorts" by forging your doctor's signature on authorization slips so your bloodwork would be done by a lab that ran the tests more quickly. Were you afraid you'd get caught?

Handler: Nothing bad is going to happen to you if you don't do exactly as you're told. They weren't going to put me in jail. I worried about getting caught only because then I wouldn't be able to do it any more.

Cohen: You describe your first doctor as being nasty, hostile and disrespectful. He yelled at your father for calling him on the phone with a question about your care. He yelled at you when you were in the middle of chemotherapy and came to see him with a rash and a fever because the fever was only 100 degrees. Did you wait too long to fire him?

Handler: Oh, yeah. Doctors had told me that I would be endangering my care if I switched doctors, but that advice was criminal. ..

Cohen: When you were being treated for leukemia, you were very, very sick. You said sometimes you were barely conscious. How'd you keep up the stamina to keep double-checking everyone's work?

Handler: I was lucky to be able to maintain my strength and do it as long as I did, and my girlfriend at the time, Jackie, was willing to sit by my side and advocate for me, and she was very skilled at doing it. You wonder, how many people die from illnesses because the strength to keep up vigilance runs out?

Friday, September 26, 2008

Default credit swaps: insurance or financial weapon of mass destruction?

Insurance makes us safer, right? Maybe not. Here's an article from Reuters.

Buffett's "time bomb" goes off on Wall Street
Sep 18, 2008

" default swaps -- complex derivatives originally designed to protect banks from deadbeat borrowers -- are adding to the turmoil.

"This was supposedly a way to hedge risk," says Ellen Brown, the author of the book "Web of Debt."

"I'm sure their predictive models were right as far as the risk of the things they were insuring against. But what they didn't factor in was the risk that the sellers of this protection wouldn't pay ... That's what we're seeing now."

Brown is hardly alone in her criticism of the derivatives. Five years ago, billionaire investor Warren Buffett called them a "time bomb" and "financial weapons of mass destruction" and directed the insurance arm of his Berkshire Hathaway Inc (BRKa.N: Quote, Profile, Research, Stock Buzz) to exit the business...

"When the credit default market began back in the mid-1990s, the transactions were simpler, more transparent affairs. Not all the sellers were insurance companies like AIG -- most were not. But the protection buyer usually knew the protection seller..."

Wednesday, August 20, 2008

Tri-City Hospital Confiscates Delivered Papers


Tri-City Hospital Bans The Paper

Following last week’s cover story in The Paper that strongly opposed Measure A, an apparent serious First Amendment violaton occurred when Tri-City Hospital personnel took what The Paper’s editor and publisher, Lyle E. Davis, alleges was an illegal action by confiscating all copies of The Paper that had been delivered to the hospital waiting rooms.

The bond measure for which Tri-City Hospital District seeks support from the electorate would provide $589 million in funding for Tri-City Hospital...

Bob Allred, a driver for The Paper reported to Davis that while delivering papers he had been accosted by a young woman in the lobby of the hospital who told him she had been instructed to pick up all copies of The Paper and that he was not to deliver any others...

Under the law, Davis contends the hospital, being a public hospital, has no legal authority to deny distribution of The Paper, based on content, under the 1st Amendment of both the state of California constitution and the Federal Constitution...

Thursday, August 14, 2008

Patrick Fitzgerald wins in medicare fraud case against Amerigroup

2-Amerigroup to pay $225 mln Medicaid settlement
Aug 14, 2008

WASHINGTON, Aug 14 (Reuters) - Health insurer Amerigroup Corp (AGP.N: Quote, Profile, Research, Stock Buzz) will pay $225 million to settle federal and state claims of fraud in a government health insurance program, the company and the U.S. Justice Department said on Thursday.

The pact, in coordination with Illinois officials, settles allegations that the company's health plans excluded pregnant women and unhealthy patients in the Illinois Medicaid plan. Medicaid is the state-federal health plan for the poor.

"A settlement of this magnitude sends the clear message that this office takes health care fraud very seriously," said Patrick Fitzgerald, the U.S. attorney for the northern district of Illinois, in a statement...

A jury found Amerigroup liable under federal and state law in October 2006, and the court entered a $334 million judgment against Amerigroup...

Sunday, June 1, 2008

Who benefits from CASBO's "calculated risks"?

The first time I saw Lora Duzyk (on left in above picture) she had just been promoted to Assistant Superintendent of Business Services at SDCOE. I thought to myself, "She couldn't possibly know about the criminal actions in the SDCOE business office. Don Shelton, her predecessor, must have known about wrongdoing by SDCOE Joint Powers Authority, but how could this round-faced, innocent-looking blond lady with the sweet smile be involed in such goings-on?

It turns out I was wrong.

Here's what Lora Duzyk herself wrote:

"At CASBO [California Association of School Business Officials] we take actions – or calculated risks – based on our version of thoughtful data: our strategic plan...

"We’re very near adoption of our new strategic plan: ... We’re the lead agency in implementing a partnership program for SB 352 CBO training: Classes have begun in a program that took five years of CASBO advocacy to bring to fruition..."

Very clever, Ms. Duzyk. CASBO trains all the school business officers, indoctrinating them into the system in which insurance companies make big profits by making sure that schools use lawyers that have been hand-picked to generate business--and soak the taxpayers--for the benefit of those in power, without regard to the needs of students.

Duzyk is clear about who CASBO benefits. Duzyk praises " members today, all of whom took calculated risks to move the association forward for their sake and for the sake of their colleagues throughout California.

How do Duzyk and her sidekick Diane Crosier benefit themselves and insurance companies? By making sure that school officers and top employees who violate the law are protected. That ensures that problems--and lawsuits--keep coming. The school officials and administrators love it--they've got great job security, no matter what they do. Chancellor Omero Suarez of Grossmont Cuyamaca Community College District and Victoria Richart of MiraCosta College are perfect examples. But their lawyers, from Stutz Artiano Shinoff & Holtz also represent the lion's share of K-12 school districts in San Diego County.

Duzyk writes, "Taking calculated risks based on thoughtful consideration of the data at hand is the hallmark of every great human achievement...Risking nothing means gaining nothing."

Duzyk and her friends have carefully calculated that it's worth the risk to break the law. And they are apparently correct.

About a month ago my few remaining illusions about sweet little Lora Duzyk were shattered when I saw a picture of her along with Don Shelton and the news that the two of them would be chosen in May 2008 as board members of Mission Federal Credit Union. I realize now that Duzyk had me completely fooled that first time I saw her. She knew the truth that night. She had simply calculated that she would be safe if she ignored it.

CASBO's motto is "Smart Business. Smart Schools."

Clearly, the "smart" in the motto isn't referring to students. The taxpayers might be paying the salaries of CASBO members, but they're not reaping the benefits.

Wednesday, April 16, 2008

Insurance company lawyers should have settled instead of continuing harrassment

Chula Vista, Calif., Goodrich Employee Wins Harassment Lawsuit.
Knight Ridder/Tribune Business News, February, 2003

By Michael Kinsman, The San Diego Union-Tribune Knight Ridder/Tribune Business News

Feb. 8--Goodrich Aerostructures in Chula Vista just took a half-million-dollar hit just because it didn't listen to one of its employees.

The aerospace manufacturer recently was on the losing end of a lawsuit filed by maintenance technician Bob Haist, who said he was slandered by his manager.

A San Diego Superior Court jury awarded Haist $165,000 for the slander and another $335,000 for malice.

Wednesday, March 26, 2008

Health care executive tries to bribe witness

Federal Jury Convicts Nat'l Century Exec


A federal jury on Wednesday convicted the founder of a failed health care company of trying to bribe a witness in an upcoming $1.9 billion fraud trial.

The jury took one day to deliver its decision against Lance Poulsen, former chief executive officer of National Century Financial Enterprises, described as the nation's largest health care financing firm before its 2002 bankruptcy.

Poulsen was accused of offering a former company executive $500,000 to give misleading testimony during Poulsen's fraud trial scheduled for August.

The executive, Sherry Gibson, told jurors that Karl Demmler, a long time friend to her and Poulsen, told her that Poulsen "wanted to make me whole."

The jury also convicted Demmler, who prosecutors had accused of acting as an intermediary for Poulsen to contact Gibson.

Poulsen said Gibson misunderstood his attempts to help her. He said he was only trying to provide her with a new attorney because he believed she'd been wrongly convicted based on bad legal advice.

Gibson pleaded guilty in 2003 for her role in the National Century fraud case in exchange for cooperating with prosecutors.

The government said the defendants could each face 35 years in prison on all counts of the four-count indictment alleging conspiracy, two counts of witness tampering and obstruction of justice. In court, U.S. District Judge Algenon Marbley referred to as many as 55 years. Actual sentences are usually much lower than the maximum penalties.

Marbley ordered Demmler taken into custody, citing comments he'd made while under investigation that he wanted to kill and dismember a federal bankruptcy judge. Poulsen has been held in a jail in Chillicothe.

Prosecutors were satisfied with the verdict. "The jury indicated that witness tampering would not take place in this courtroom or any other," said federal prosecutor Douglas Squires. "The case was a matter of money for lies."

The verdict could play a role in Poulsen's August fraud trial.

"What we proved is that the witness tampering was related to that scheduled jury trial of Lance Poulsen, and that trial is pending," Squires said.

Poulsen looked down briefly as Marbley read the guilty verdicts, while Demmler stared straight ahead. Poulsen's lawyers said they were taken aback by the verdict and would consider an appeal.

"The evidence pretty strongly demonstrated that he tried to set the record straight and encouraged the witness to tell the truth," said attorney Peter Anderson.

The government wouldn't say whether it would consider a plea deal ahead of the August trial. Poulsen's attorney said that decision would be up to Poulsen.

"Mr. Poulsen has been adamant about his innocence with regard to the allegations in that matter, and will take all the appropriate measures to try to clear his name in that case," said attorney William Terpening.

On a phone call with Demmler recorded by the government, Poulsen said Gibson should explain that her previous statements to prosecutors were based on old facts.

Poulsen said Gibson should say, "But now, there is a new set of charges and it's a new indictment and I'm not familiar with it," Poulsen said on the recording.

In other recordings, Demmler suggests to Poulsen that Gibson could "have amnesia."

Prosecutors portrayed Gibson as a repentant ex-felon who'd served her time after pleading guilty to corporate fraud.

"How can I make you understand that I just want this whole situation behind me so I can get on with my life," Gibson said in a Jan. 29 letter to Demmler quoted by prosecutors.

Poulsen wanted to pay Gibson for one reason, U.S. trial attorney Leo Wise told jurors: to help him win his fraud case.

Defense attorneys characterized Gibson as an angry woman with an ax to grind who turned on Demmler and Poulsen when they were just trying to help her.

They quoted a different part of the same letter in which Gibson suggests that figuring out a way to get back what she lost would be "something to check out."

Poulsen testified he never tried to influence Gibson. "I never asked Sherry to lie," he told jurors during testimony that stretched over several hours. "I never asked her to forget anything."

In his August trial, Poulsen faces multiple counts of wire and securities fraud and money laundering.

The government alleges Poulsen misled investors about unsecured loans his company was providing health care companies such as hospitals and nursing homes. Prosecutors accuse Poulsen and other former executives of the suburban Dublin-based company of moving money to cover up shortfalls and fabricating data. The company filed for bankruptcy following an FBI raid.

At least nine former National Century executives have been convicted of corporate fraud related to the case to date, including Gibson.

The witness tampering case began after Gibson invited Demmler to dinner at a Don Pablo's restaurant in Columbus June 19.

"Business first," Demmler said when they met that night, then proceeded to explain that Poulsen wanted to "make her whole" based on what she'd been through, prosecutors said.

Gibson testified she understood that to mean she was being offered a bribe to change her testimony. She informed the government, turned down their request to investigate the allegation, then changed her mind after Demmler contacted her about another meeting.

Poulsen said the phrase had a different meaning.

"I felt she had been shafted royally," Poulsen told jurors. "I wanted to make her whole."

Tuesday, March 4, 2008

Oregon Holds Health Insurance Lottery

Oregon Holds Health Insurance Lottery
Posted: 2008-03-04 08:02:32
PORTLAND, Ore. (AP) - Oregon is conducting a one-of-a-kind lottery, and the prize is health insurance.

The state will start drawing names this week for the chance to enroll in a health care program designed for people not poor enough for Medicaid but too cash-strapped to buy their own insurance.

More than 80,000 people have s insurance plan and with too little income to buy her own.

"I'm worried about it. I know it's a death sentence," Krueger said.

An estimated 600,000 people in Oregon are uninsured, according to the Oregon Department of Human Services.

Those selected in the lottery will be eligible for a standard benefit program, which was once a heralded highlight of the Oregon Health Plan.

At its peak in 1995, the program covered 132,000 Oregonians. State budget cuts forced the program to close to newcomers by 2004, but it now has several thousand openings.

The program covers their most basic health services, medications and limited dental, hospital and vision services at little or no cost.

The health insurance lottery winners will be chosen in a series of drawings that could take a few months.

"This is such a wonderful opportunity," said Ellen Pinney, director of the Oregon Health Action Campaign. "We've heard absolutely no complaints, just a lot of hope that they are the ones who will be selected."

Advocates for the uninsured say the demand for the program underscores the state's need for health coverage.

"We have pretty much returned as a state, in terms the percentage of uninsured, to where we were in the late '80s when we created (the Oregon Health Plan standard benefit)," said Barney Speight, director of the Oregon Health Fund Board.

The board is supposed to come up with a plan to address health care access and coverage for Oregonians for consideration in the 2009 legislative session.

Gov. Ted Kulongoski considers the Oregon Health Plan a basis to build on, said Anna Richter Taylor, a spokeswoman for his office. The plan has been able to maintain its benefit package for people who are aged, blind, disabled, under 19, pregnant or receiving Temporary Assistance for Needy Families benefits.

But providing coverage for a larger population is a goal that could take much longer to reach.

"It's a huge challenge for one session - it's probably going to be a sequential process," Richter Taylor said.

Thursday, February 28, 2008

Hair analysis reveals breast cancer

Hair sample may provide breast cancer diagnosis
Fri Feb 15, 2008 2:25pm EST Email | Print | Share| Reprints | Single Page| Recommend (2) [-] Text [+]
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powered by Sphere
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Trade with personal dealer service.NEW YORK (Reuters Health) - Hair from women with breast cancer can be distinguished from hair obtained from women without the disease, researchers in Australia report.

When hair is exposed to X-rays, the radiation is diffracted in a distinctive pattern by the alpha-keratin that forms hair, the researchers explain in the International Journal of Cancer. Dr. Gary L. Corino and Dr. Peter W. French, based at Fermiscan Ltd in Sydney, used the technique to look at samples of hair from 13 patients diagnosed with breast cancer and 20 healthy subjects.

Hair was cut as close to the skin as possible to obtain samples of the most recent hair growth. The investigators "successfully and consistently generated the basic alpha-keratin X-ray diffraction pattern in every hair sample."

Hair from the breast cancer patients produced the same features "with the only difference being the superimposition of a new feature." This was a distinctive low-intensity ring.

This ring sign was fairly accurate in identifying breast cancer. It missed one of the breast cancer patients, and showed up as a false-positive in three of the healthy subject.

The researchers went on to study a length of hair representing 6 months' growth from a breast cancer patient whose hair fell out following chemotherapy. X-ray diffraction at three points along the hair showed clear evidence of the ring at the position furthest from the hair root, a fainter ring at the middle point, and complete absence of the ring close to the root.

"This progressive reduction in the intensity of the ring appears to correlate with the patient's course of treatment and possibly indicates the eradication of the cancer as a result of that treatment," Corino and French suggest.

As for the reason for the ring pattern, they suggest it may represent "incorporation of extraneous lipid material into the fiber as a result of the presence of a tumor." It may also be that the disease affects hair follicles in some way.

Further testing is needed to establish the accuracy of this methodology as a diagnostic test for breast cancer, they conclude.

SOURCE: International Journal of Cancer, February 15, 2008.

Saturday, February 23, 2008

Health Net ordered to pay $9 million for canceling coverage during cancer treatment

The punitive damage award is the first of its kind and has prompted the giant medical insurer to scrap practices that have recently come under fire.

By Lisa Girion
Los Angeles Times
February 23, 2008

One of California's largest for-profit insurers stopped a controversial practice of canceling sick policyholders Friday after a judge ordered Health Net Inc. to pay more than $9 million to a breast cancer patient it dropped in the middle of chemotherapy.

The ruling by a private arbitration judge was the first of its kind and the most powerful rebuke to the state's major insurers whose cancellation practices are under fire from the courts, state regulators and elected officials.

Calling Woodland Hills-based Health Net's actions "egregious," Judge Sam Cianchetti, a retired Los Angeles County Superior Court judge, ruled that the company broke state laws and acted in bad faith.

"Health Net was primarily concerned with and considered its own financial interests and gave little, if any, consideration and concern for the interests of the insured," Cianchetti wrote in a 21-page ruling.

Patsy Bates, a 52-year-old grandmother, was at work at the Gardena hair salon she owns when her lawyer William Shernoff called with the news. Bates said she screamed and thanked the lawyer.

Then, "I thanked God," she said. "I praised the Lord."

Bates called the arbitration judge "an angel . . . a real stand-up kind of judge."

When Health Net dropped her in January 2004, Bates was stuck with more than $129,000 in medical bills and was forced to stop chemotherapy for several months until she found a charity to pay for it.

Health Net Chief Executive Jay Gellert ordered an immediate halt to cancellations and told The Times that the company would be changing its coverage applications and retraining its sales force.

"I felt bad about what happened to her," he said. "I feel bad about the whole situation."

Gellert said he would move quickly to "give people the confidence that they can count on their policy." Specifically, he pledged to stop all cancellations until an external review process could be established to approve all cancellations.

Other insurers were considering changing their own practices. A spokeswoman for WellPoint Inc., which operates Blue Cross of California, the state's largest for-profit insurer, said the company was in favor of such an idea. Blue Shield of California declined to comment.

Until Friday, the companies had uniformly defended cancellations, saying they were necessary to hold down costs by weeding out people who may have failed to disclose pre-existing conditions on applications for coverage. They say cancellations happen infrequently.

The judge's strong denunciation of the way Health Net carried out Bates' cancellation and big money award stunned and pleased regulators and patient advocates.

State Insurance Commissioner Steve Poizner applauded the judge, saying "health insurers simply cannot hold out the promise of insurance for their consumers and then snatch it away just when people need it most. That is illegal, immoral and will not be tolerated."

Earlier, Health Net had defended its actions, saying it never would have issued Bates a policy in the first place if she had disclosed her true weight and a preexisting heart condition on her application.

Bates said a broker filled out the application while she was styling a client's hair on a busy day in her shop. She said she answered his questions as best she could.

Bates said she already had insurance and wasn't in the market until the broker came by and told her that he thought he could get her a lower monthly premium if she switched to Health Net.

At the arbitration hearing, internal company documents were disclosed showing that Health Net had paid employee bonuses for meeting a cancellation quota and for the amount of money saved.

"It's difficult to imagine a policy more reprehensible than tying bonuses to encourage the rescission of health insurance that keeps the public well and alive," the judge wrote.,1,2680255.story

Universal Health Care cost 1.1% in Taiwan

Experts call for health cover in U.S., cite study
Wed Feb 20, 2008 8

HONG KONG (Reuters) -
Experts called for universal health insurance in the United States, citing a study in Taiwan that showed it increased life expectancy and closed the gap between those who were most healthy and least healthy.

In a commentary published in the Annals of Internal Medicine, the experts said Taiwan's experience lent "credence to the argument that the United States should join other industrialized nations in ensuring universal health insurance coverage".

"Our failure to introduce national health insurance undermines access to care for millions and is a major factor in health outcome disparities and highly preventable deaths in the United States," wrote Karen Davis, of The Commonwealth Fund, and Andrew Huang, of Duke University Medical Centre.

Their call accompanied an article in the same journal on a 10-year study in Taiwan that showed that universal health insurance raised life expectancy.

However, the Taiwan researchers considered the improvements to be modest and called for more aggressive disease prevention programs to reduce lifestyle-related illnesses, such as cancer.

"Two risk behaviors among men in Taiwan, smoking and betel quid chewing, remained high after the introduction of national health insurance," the Taiwan researchers wrote.

"Every second middle-aged man is a smoker and every fourth is a chewer ... which could account for the large increases in lung and oral cancer in the lower socioeconomic groups and the relatively small reduction in health disparities."

Taiwan introduced universal health insurance in 1995, which extended insurance coverage from 57 percent of the population to everyone. Co-payments are required, however: 10 percent for inpatient and 20 percent for outpatient care, although these are waived for the very poor, veterans and indigenous groups.

National health expenditure rose modestly, from 5.1 percent of gross national product before 1995 to 6.2 percent in 2005.

Visits to the doctor and use of medication increased substantially after 1995, especially among the elderly and poor.

The most obvious positive correlation was life expectancy for men, which increased to 74.22 years from 71.83 years after universal health insurance.

There was a reduction in deaths from cardiovascular and infectious diseases, and from accidents, but deaths from cancer and diabetes rose.

(Reporting by Tan Ee Lyn; Editing by Alex Richardson)

Music improves stroke recovery

Music hits right note for stroke patients
Tue Feb 19, 2008
21 Feb 2008

LONDON (Reuters) - A little Beethoven is good for the brain, according to a Finnish study published on Wednesday showing that music helps people recover more quickly from strokes.

And patients who listened to a few hours of music each day soon after a stroke also improved their verbal memory and were in a better mood compared to patients who did not listen to music or used audio books, the researchers said.

Music therapy has long been used in a range of treatments but the study published in the journal Brain is the first to show the effect in people, they added.

"These findings demonstrate for the first time that music listening during the early post-stroke stage can enhance cognitive recovery and prevent negative mood," the researchers wrote...

Hospitals slow on cardiac arrest treatment at night

Cardiac arrest: avoid nights, weekend, study says
Wed Feb 20, 2008
Daytime dozing may be warning sign of stroke

CHICAGO (Reuters) - People who have a cardiac arrest in the hospital at night or on the weekend are far less likely to survive than those who suffer one during the day, U.S. researchers said on Tuesday.

Studies suggest this may be at least partly because of inadequate staffing at off-peak hours.

The researchers found only 14.7 percent of people whose hearts stop pumping during the night survive, compared with nearly 20 percent of people during the day.

Those who had a cardiac arrest at around 3 p.m. had the survival rate, Dr. Mary Ann Peberdy of Virginia Commonwealth University in Richmond and colleagues reported in the Journal of the American Medical Association.

The only part of the hospital with difference in survival day or night was the emergency department. "That survival difference by time of day was there regardless of where we looked, except in the emergency department," Peberdy said...

Tuesday, January 22, 2008

How much do you have to lose before it's not frivolous?

Patients asked to sign contracts: company offers plans to curb frivolous lawsuits
May 1, 2004
by Jennifer Silverman

International Medical News Group
Gale Group

Click HERE for original article.

Patients asked to sign contracts: company offers plans to curb frivolous lawsuits
OB/GYN News, May 1, 2004 by Jennifer Silverman

Physicians across the country are taking a new aggressive stance to protect themselves against malpractice lawsuits: They're asking their patients to sign on the dotted line, specifying that they won't sue for any "frivolous" reason.

If it is a meritorious case, the patient "has to use a board-certified expert witness who follows the code of ethics for that particular professional society," said Dr. Jeff Segal, a nonpracticing neurosurgeon and founder of Medical Justice Corp., a company based in Greensboro, S.C., that provides these types of contracts as well as services designed to keep physicians from getting sued for so-called frivolous reasons.

In Dr. Segal's view, the term "frivolous" means the expert testimony against the physician was not compatible with what would be delivered by a majority of specialists, or at least a respectable minority.

In one example of a frivolous case, a urologist performed a vasectomy, performed postoperative semen counts at 1 week and at 1 month, and 1 year later got sued because the patient's wife became pregnant. "As it turns out, it wasn't his baby. I think that's a frivolous case," said Dr. Segal, who himself was sued while he practiced medicine.

Medical malpractice insurance pays for defending against a lawsuit and for the payment of a settlement or judgment. In contrast, Medical Justice plans are designed to help deter frivolous lawsuits and provide purchasers with assistance if they are sued. Also, Medical Justice will assist plan owners should they choose to countersue.

About 500 physicians from various specialties in 30 states have purchased plans from Medical Justice. It has grown most dramatically in the last several months, said Dr. Segal, whose clients pay from $625 to $1,800 a year, depending on the specialty's level of risk, for a plan. A neurosurgeon, for example, is going to pay a higher fee than a family doctor, he said.

These physicians' patients are asked to sign a contract that contains the clauses on lawsuits along with other standard provisions.

The language in the agreement is reciprocal, meaning that the physician agrees to the same stipulations as the patient. "Each side must use a board-certified expert witness in the same or similar specialty, who follows code of ethics for that specialty society," Dr. Segal said.

If a malpractice complaint is raised, "we send a letter to plaintiff's counsel telling them who we are, in the hopes that [the letter] will be enough to make a frivolous case go away," Dr. Segal said. If it doesn't, the next step is to examine the expert testimony on the plaintiff's side.

"Expert witnesses can make or break a case. We have our own panel of experts to determine whether there's a lie or hyperbole in expert testimony." If the expert's testimony is deemed fraudulent, the expert is reported to his or her professional society.

The society can make its own judgment of that expert witness, Dr. Segal said. In some cases, the expert can be expelled if the case is made that their testimony was tainted or untrue.

Dr. Compton Girdharry, an ob.gyn. in Alliance, Ohio, who retired in 2003, bought a plan from Medical Justice after his malpractice insurer went out of business and he couldn't afford the $250,000 tail coverage that would have covered him for an additional year. Medical Justice will offer assistance to him in any lawsuits that may come up from the time he was a practicing physician.

"The majority of suits in my profession are frivolous in my opinion," said Dr. Girdharry in an interview. He was involved in 10 lawsuits during his career. While most were either settled or dropped, two went to jury trial, including one he called "totally frivolous."

The patient had sued Dr. Girdharry, the anesthesiologist, and the hospital for experiencing pain during a repeat C-section and tubal ligation. "We stopped the procedure when she said she was in pain, and the anesthesiologist gave her some nitrous oxide so we could finish the procedure." According to Dr. Girdharry, the patient was fine for the rest of operation, and records showed no signs of complications.

To him, it made sense to call Medical Justice, even though he won both of the two jury trials in which he had been involved. Even as the winner, "I'd still seek compensation from the other party, because it costs money to defend myself."

Dr. Girdharry may go back into practice part-time for a federal clinic that's offering him malpractice insurance. In the meantime, he's keeping his insurance with Medical Justice, which in his opinion has already paid for itself. "We're living in a time when people have a higher expectation from physicians--that until proven otherwise, it's the doctor's fault."

Medical Justice is only 2 years old, yet, it's already had an impact, Dr. Segal said. A study conducted by SG Risk, an actuarial firm based in New Jersey, estimated that Medical Justice clients have a 2% chance of being sued per year.

Not everyone agrees with this concept. Joanne Doroshow, executive director of the nonprofit Center for Justice & Democracy in New York, argues that malpractice cases by their own merit are rarely frivolous, mainly because it's so expensive to line up the experts and develop the case. One of the obvious problems is that no doctor ever believes a lawsuit against him is anything less than frivolous, Ms. Doroshow said.

Kathy Olsen, of San Diego County, Calif., whose teenage son suffered permanent blindness as a result of an untreated cranial abscess, said she was "appalled" that insurance such as that offered by Medical Justice even exists. "How much do you have to lose before it's not frivolous?" Mrs. Olsen said. "As parents, we are assuming that physicians are going to take care of us."

Mrs. Olsen said the physicians treating her then-2-year-old son had written down "cranial abscess" as a possible reason for his symptoms, but never informed her of this possibility. "Instead, they told us he had some form of meningitis, and didn't scan him." As a result, the abscess herniated his brain and he had to spend 5 months in the hospital. "The physicians involved in his care should have done something about it and reported back to our pediatrician. A brain abscess, if detected in time, can be removed," said Mrs. Olsen, who won her case in court.

To Barry Furrow, director of the Health Law Institute at Widener University School of Law in Wilmington. Del., Medical Justice's approaches "are just scare tactics." In an interview, Mr. Furrow said he doubted that the courts would be very sympathetic to such vague agreements. "It is also not clear that a pure waiver of liability, as Florida doctors are now demanding, would hold up in state courts. But this is a highly politicized issue, and judges have sometimes been fooled by the arguments."

The board-certified expert witness requirement is an odd idea, he continued. "I've been an expert in several cases, and I certainly have no board certification. I think, however, that some medical societies are beginning to use this idea of certifying experts, as a way of scaring away doctors from testifying."

Dr. Segal says 99% of patients have signed the contracts provided by Medical Justice clients. "Most people believe that they wouldn't sue for a frivolous reason anyway."

Arrangements of this type do exist elsewhere, Arthur Levin, director of the Center for Medical Consumers in New York, said in an interview. Kaiser Permanente, for example, "requires enrollees to sign a 'willingness to arbitrate' agreement. That's one example where a health plan is saying it would rather resolve through arbitration than go through the courts."

In addition, some states have procedures that require some sort of affidavit from a medical expert that a case has merit, he said.

What Mr. Levin finds disturbing about Medical Justice is that a very ill person could walk into a physician's office, refuse to sign the consent form, and not get treated. "There's something very off-putting about telling patients that you won't treat them unless they sign an agreement."

No one is happy that physicians are paying for such high malpractice premiums, Mr. Levin said. "Does it unfairly punish physicians? Yes. However, the answer to the medical liability crisis isn't to create an atmosphere where the physician will only take care of sick people if they agree to his or her terms. It doesn't speak well to the profession."

Ms. Doroshow said it's unfair to force a patient who has no legal or medical training to sign this type of form. "It's intimidating, because they don't understand what kind of sanctions can be brought against them. It also hurts the doctor-patient relationship. Only the legal system and courts can decide if something is frivolous. That's what it's there for."


Associate Editor, Practice Trends

Wednesday, January 9, 2008

The Myth Of Tort Reform: Taking away David's sling

CASD strongly opposes arbitrary attempts to limit tort remedies or consumers' access to the courts -- misleadingly labeled "tort reform". A person or industry which does something wrong should be held accountable for those actions.

The term "tort reform" is used for the proposition that there are too many lawsuits filed by consumers for the wrongs (torts) done by others which caused them injury. Using inflammatory and misleading terms like "jackpot justice" and "shakedown lawsuits," insurance companies and other big businesses spend millions of dollars on propaganda to convince the public there are too many lawsuits and that they are driving up the cost of medical care, increasing the price of products and insurance, clogging up the courts and creating a drag on the economy. These "tort reformers" want to protect the wrongdoers from responsibility for the harm they cause.

The greatest myth of all is that consumer lawsuits are tying up our courts and huge verdicts are hurting the economy. Most civil court filings involve family law disputes. The non-partisan Center for State Courts reports that tort claims account for only between 5 and 7% of all lawsuits in state courts. Tort law is good for consumers and leads to better business practices -- it provides consumers with the right to be financially reimbursed for injury or death caused by dangerous products or below-standard services. We must be able to hold wrongdoers, individual or corporate, accountable for the injuries they cause. The civil justice system is the only way to achieve this goal.

CASD, not CALA, fights lawsuit abuse

CASD Position Statements

Who We Are:
Consumer Attorneys of San Diego ("CASD") is an organization of San Diego trial lawyers who represent consumers, working families, individual workers and others who are injured and need access to the civil justice system. Consumer attorneys protect the rights of individuals by obtaining remedies for injuries caused by the negligence or carelessness of others, and, in the process, achieving safer products, a safe workplace, a clean environment and quality health care. CASD is devoted to preserving the constitutional right to trial by jury, providing access to a fair and impartial court and enforcing the rule of law. CASD also seeks to strengthen the civil justice system through educating the public as to the right to public health and safety and the rights guaranteed by our cherished Bill of Rights.

Arbitration Clauses:
Taking Away Big Rights with Small Print

CASD strongly opposes attempts to limit an individual's right to a jury trial by imposing mandatory arbitration clauses on consumers. Mandatory arbitration strips consumers of their fundamental rights, many times without their knowledge.

Large institutions are increasingly imposing mandatory arbitration clauses on consumers and small businesses in everything from car sales contracts and credit card applications to insurance agreements and health care treatment release forms. A consumer must agree to these arbitration clauses as a condition of receiving a service or buying a product. Even before any dispute over services or goods arises, these clauses mandate that buyers give up their right to a jury trial in court and force them to pay arbitration companies to hear their claims. Mandatory arbitration clauses take away a consumer's fundamental right to trial by jury and other rights - often without his or her even knowing these rights have been eliminated -- and can cost consumers thousands of dollars more than it would cost them to go to court. Sometimes these institutions have "sweetheart deals" with the arbitration providers, which further tilts the tables against consumers and small businesses.

CASD strongly opposes the use and enforcement of unilaterally-imposed mandatory arbitration. CASD promotes fair resolutions of civil disputes and the right of individuals to have their grievances heard by a fair and impartial court and a jury of their peers, but also recognizes that some claims may benefit when arbitration is voluntarily selected by both parties.

Caps on Damages Limit Justice

CASD opposes any arbitrary limit on the amount of damages a jury can award. CASD believes the citizens who serve as jurors in our civil justice system are the people best able to determine what is just and fair after having listened to all of the evidence.

"Damages" is the term used to describe the amount of money it will take to compensate for the harm done to an injured party, so the person is returned, as nearly as possible, to the life he or she would have had absent the injury. Damages are intended to fix what can be fixed (such as reimbursement of out-of-pocket expenses like medical bills and lost wages), and to compensate for what cannot be fixed, for example, pain, physical impairment, loss of enjoyment of life, impaired activities of daily living and disfigurement.

Some corporations, insurance companies, and politicians often claim we need to limit damages a jury can award under the guise that such limits will lower insurance rates and reduce the cost of doing business. This approach protects wrongdoers from the consequences of their negligent and careless actions, shifts the losses caused by the wrongful conduct to the innocent injured person, and fosters unsafe environments, products, and medical practices.

CASD believes in the jury system. Juries are capable of making a fair decision as to damages just as they are capable of deciding whether a defendant should be held responsible for its wrongful conduct - an issue which must be decided before ever reaching the issues of damages. Juries are well aware of the impact a damage award will have on a defendant. However, juries also recognize it is only fair that wrongdoers pay for their careless conduct and that holding them responsible for the harm they cause is an effective deterrent which benefits the public at large.

Class Actions:
Giving Power to the Little Guy

CASD supports class action lawsuits as an economic and judicially efficient way to permit consumers to hold large and powerful defendants accountable for widespread wrongful conduct.

Class actions occur when judges approve a petition to combine many similar claims into one legal action. This type of suit is often brought against large corporate defendants that cheat thousands or even millions of consumers, but usually each in a small way. Combining the cases saves courts the costs and inconvenience of hearing thousands of small cases one at a time, thereby promoting efficiency and consistency. Class actions are often the only way to "level the playing field" for the little guy and hold powerful defendants accountable for widespread wrongful conduct and unsafe practices because the claims are too small for an individual consumer to afford to prosecute on his or her own. When the plaintiffs win a class action lawsuit, the defendant's wrongly-obtained money is returned to consumers away which will hopefully deter other defendants from the same wrongful and fraudulent behavior. In addition, any fees paid to the attorney must be approved by the court. These fees are often paid by the defendant in addition to the recovery to the class members.

Because class action lawsuits benefit large numbers of people, foster judicial efficiency, promote safety and protect our health and the environment, CASD strongly supports the responsible use of this mechanism to hold large and powerful defendants accountable for their unfair and unlawful conduct and practices.

Contingency Fees:
Making Justice Available to All

CASD strongly supports a client's right to enter into a contingency fee agreement with an attorney as part of our commitment to ensure access to the courts for all.

A contingency fee arrangement, frequently called "the poor man's key to the courthouse", allows the client to pay a percentage of whatever compensation is received to the attorney as payment in full for his or her services, regardless of how much time and money the attorney has put into the case. If no compensation is recovered, the attorney is paid nothing. Contingency fee agreements are "rooted in our commitment to equal justice for both those of moderate means and the wealthy." Many individuals would not be able to pursue their claims if they could not have an attorney represent them on a contingency fee basis. If they had to pay the attorney an hourly fee and advance all the costs for the experts required to prove their cases, they would simply have to abandon their claims. This is particularly true for the typical tort claim in which the person has been injured and has lost wages.

Many large corporations, insurance companies and even politicians insist that contingency fees should be limited or eliminated altogether. They are not interested in justice or protecting the consumer. Their goal is to eliminate responsibility for their wrongful conduct by making sure consumers cannot afford to hire attorneys. Limits on contingency fees limit access to justice and help the wrongdoers and their insurers keep the money that should be used to compensate the injured people. Corporations and insurance companies, on the other hand, have no limit on the number of attorneys and law firms they can hire to defend them or on how much they pay these attorneys.

CASD supports a client's right to make a contingency fee agreement with his or her attorney as part of our commitment to ensure access to the courts for all.

Judicial Independence

Consumer Attorneys of San Diego hereby expresses our solidarity in support of the independence of our Nation's judges, juries and courts. While the Constitution guarantees the right of every American citizen to disagree with a decision of a jury or judge, personal threats, demeaning words or creating an atmosphere of contempt are never acceptable. We all need to fear a day when our legal rights are determined by public opinion. The right to be judged by an independent judge or jury must be protected.

Medical Malpractice:
The Remedy When Doctor Doesn't Know Best

CASD is committed to supporting injured patients through the challenges of medical malpractice litigation and obtaining a fair recovery to compensate them for the harm caused by their physician or other health care provider.

Medical malpractice lawsuits permit patients to receive compensation for injuries caused by a negligent health care provider (such as a hospital, doctor or dentist). Medical malpractice lawsuits are costly and difficult to prove, and in many states, recovery is limited by damage caps. To prevail, the patient must have a meritorious claim, gather all relevant records and evidence, then locate a physician willing to review the materials and testify that the defendant health care provider acted negligently and caused the patient harm. Locating a physician willing to take time away from his or her busy practice and testify against "one of their own" can be an extremely difficult task for a patient. Moreover, the fees associated with having these experts testify can be prohibitive to a badly injured patient. Many states already have a "cap" or limit on how much money a patient can recover for the pain, loss of enjoyment of life, impairment, and dramatic change in lifestyle caused by a health care provider's negligence. Thus injured patients and their families are not permitted to recover all of their losses. For example, in California, a patient's recovery for such damages is limited to $250,000, no matter how severe the injuries or how many family members survive a decedent who died as a result of the negligent care or treatment.

Punitive Damages:
A Powerful Deterrent to Malicious Corporate Behavior

CASD opposes limits on a jury's right to award punitive damages as a deterrent to despicable conduct such as fraud, oppression and malice.

Punitive damages deter corporations from engaging in despicable conduct that kills, injures or steals from consumers. Punitive damages are separate and in addition to the compensatory damages awarded to a plaintiff in a lawsuit. In order to obtain punitive damages, a plaintiff must prove by clear and convincing evidence that the defendant acted with "fraud, oppression or malice".

Effective August 16, 2004, a new California law (Civil Code §3294.5) requires that 75% of any punitive damage award in a civil case be paid to California's Public Benefit Trust Fund which uses the money for the benefit of the public. The remaining 25% is payable to the plaintiff. CASD supports the use of punitive damages to deter malicious corporate behavior.

Right to a Jury Trial
Disputes Decided by the People

CASD believes the right to trial by jury is a fundamental constitutional right which should not be limited or abrogated. CASD believes the citizens who serve as jurors in our civil justice system are conscientious and diligent in determining what is fair, just and reasonable based on the evidence and the law.

The right to have a panel of citizens from the community make decisions about legal disputes is one of our most important rights. It is guaranteed in the Sixth and Seventh Amendments to our Constitution. We cherish the right to be judged by our neighbors and not by the government.

In the more than 200 years since the right to a jury trial was guaranteed to the people, there have been increasing efforts to limit this right by arbitrarily precluding a jury trial in certain types of cases or by preventing a jury from deciding certain issues in a case. Some have even advocated doing away with jury trials in civil cases altogether. However, as Thomas Jefferson said, "I consider trial by jury as the only anchor ever yet imagined by man, by which a government can be held to the principles of its Constitution."

A jury applies the collective common sense and experience garnered over the years to the case before it and protects the litigants from the potential of bias, prejudice or lack of experience of a single jurist deciding their cases. CASD strongly believes in defending the jury system.

Wednesday, January 2, 2008

Hospitals Often Move Too Slow On Restarting Hearts

Wall Street Journal

Hospitals Often Move Too Slow On Restarting Hearts, Study Says
January 2, 2008 5:02 p.m.

American hospitals frequently take too long to restart stopped hearts after cardiac arrest, a new study found.

About half a million patients suffer cardiac arrest inside a U.S. hospital each year. Less than a third survive. In many cases, a medical device called a defibrillator can restart a stopped heart by delivering an electrical shock, but only if it's used quickly.

Since 1991, the American Heart Association has recommended that hospitals be ready to shock a stopped heart within two minutes after detecting cardiac arrest. But the study, published in Thursday's edition of the New England Journal of Medicine, found that in 30% of cardiac-arrest episodes, hospitals waited longer than two minutes, leading to more deaths.

The study, led by Dr. Paul Chan, of the University of Michigan, analyzed data from 369 hospitals that participated in a voluntary Heart Association program that tracked defibrillator usage.

The study found that between 2000 and 2005, only 70% of patients received a shock within the recommended two minutes. For those patients, the chances of leaving the hospital alive were 39%.

About 17% of the patients were shocked in the third through the fifth minute. For them, the survival rate was 28%. And when hospitals took longer than five minutes to shock a patient, the survival rate fell to 15%...

Delayed defibrillation in one third of in-hospital cardiac arrests

Delayed defibrillation in one third of in-hospital cardiac arrests

January 2, 2008 Michael O'Riordan

Kansas City, MO - Delays in the time to defibrillation are common in hospitalized patients with cardiac arrest, with more than 30% of patients with cardiac arrest due to ventricular arrhythmia undergoing defibrillation more than two minutes after the initial recognition of arrest, a new study has shown [1]. Patients who received delayed defibrillation were less likely to survive to hospital discharge and more likely to have worsened neurologic and functional status upon discharge, report investigators.

"We need to start looking at this issue seriously and creatively, and to have the will to implement the processes of care that will reduce the amount of time it takes to defibrillate a patient undergoing cardiac arrest in the hospital setting," said lead investigator Dr Paul Chan (St Luke's Mid America Heart Institute, Kansas City, MO). "Time to defibrillation should be a measure of care," he added, "much in the same way that door-to-balloon time is now a marker of quality of hospital care."

The results of the study are published in the January 2, 2008 issue of the New England Journal of Medicine.

Little known about in-hospital cardiac arrest defibrillation times
The current recommendations for hospitalized patients with ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) state that the patient should be shocked within two minutes of the recognition of cardiac arrest. Speaking with heartwire, Chan said little is currently known about in-hospital defibrillation times or the factors that might result in delays to defibrillation because much of the data are based on out-of-hospital cardiac arrest. As a result, there are minimal data about the processes of care needed to reduce in-hospital delays.

With that in mind, Chan and colleagues, including Drs Harlan Krumholz (Yale University School of Medicine, New Haven, CT), Graham Nichol (University of Washington, Seattle), and Brahmajee Nallamothu (University of Michigan, Ann Arbor), obtained data from the American Heart Association National Registry of Cardiopulmonary Resuscitation (NRCPR), an analysis that included 369 acute-care hospitals participating in the NRCPR and 6789 patients who had cardiac arrest due to VF or pulseless VT. The investigators examined the association between delayed defibrillation and survival to discharge in patients with cardiac arrest in intensive care units (ICUs) or inpatient beds.

Of the patients included in the registry, delayed defibrillation occurred in 30.1%. Because this number only includes patients in hospitals participating in the NRCPR, and likely includes hospitals with systems of care in place, Chan said the prevalence of delay is probably even higher.

The investigators also showed that delays in defibrillation resulted in a lower likelihood of survival to discharge and being less likely to be discharged without neurologic complications compared with those who were shocked within the guideline-recommended two minutes. Increasing time to defibrillation also led to lower rates of survival with each minute of delay. The investigators noted several different characteristics associated with the delay. Among them are black race, a noncardiac admitting diagnosis, and the occurrence of cardiac arrest in a small hospital, after hours, or in an unmonitored hospital bed.

Factors associated with delayed time to defibrillation in multivariable analysis

Adjusted odds ratio (95% CI)

After-hours cardiac arrest
1.18 (1.05-1.33)

Type of hospital bed

Inpatient, unmonitored

Intensive care unit
0.39 (0.33-0.46)

Inpatient, monitored by telemetry
0.47 (0.41-0.53)

Hospital size

>500 beds

<250 beds
1.27 (1.08-1.47)

250-499 beds
1.02 (0.90-1.17)

Admitting diagnosis


Medical, cardiac
0.67 (0.55-0.82)

Surgical, cardiac
0.67 (0.51-0.86)

Chan said the reasons for the delays in defibrillation are complex and the investigators can only speculate why such delays occur. Outside the ICU setting or in smaller hospitals, upon the recognition of cardiac arrest, there might be delays locating the "crash cart," or delays as nurses and other staff wait for the doctor. In that situation, making it easier to perform defibrillation, through device modifications to replicate public automated external defibrillators (AEDs), would allow first responders to shock the patient. Rapid-response teams that respond only to the code alerts and work with nurses and doctors to identify high-risk cardiac arrest patients might also work.