Wednesday, October 31, 2012

Trouble In Mitt Romney's Socialist Hospital Paradise

In 2010 Romney himself acknowledged the need for Obama's health care law (before he began pursuing the Republican presidential nomination):

"Look, it doesn't make a lot of sense for us to have millions and millions of people who have no health insurance and yet who can go to the emergency room and get entirely free care for which they have no responsibility, particularly if they are people who have sufficient means to pay their own way."

Trouble In Mitt Romney's Socialist Hospital Paradise
Arthur Delaney and Jamieson
Huff Post

In the early hours of May 1, D.C. bartender Mike Boone came to the aid of a young woman who was being mugged.

Boone had offered to walk her home from the bar, Trusty's on Capitol Hill, since the immediate neighborhood is not known for having the safest streets at night. A man jumped from behind some bushes and grabbed the woman's purse. Boone also grabbed it, and the two men started fighting.

"We were punching each other pretty hard," Boone recalled. It wasn't until blood gushed from his body and the woman screamed that the bartender realized what had really happened.

"He was punching me with a knife," Boone said.

Boone passed out on the sidewalk. He woke up the next day in a hospital bed, recovering from eight stab wounds and a collapsed lung.

Like nearly 50 million other Americans, Boone lacked health insurance. A pre-existing condition -- in his case, a broken back he suffered in 1993 -- prevented him from obtaining affordable coverage. President Barack Obama's health care law prohibits insurance companies from discriminating against people with pre-existing conditions, but that reform doesn't go into effect for adults until 2014.

Republican presidential nominee Mitt Romney has vowed to repeal the health care law entirely if he's elected. In America, Romney has said, we don't let people die in the street simply because they lack health insurance: Hospitals are there to care for the uninsured.

"We don't have a setting across this country where if you don't have insurance, we just say to you, 'Tough luck, you're going to die when you have your heart attack,'" Romney said in an interview with The Columbus Dispatch on Oct. 11. "No, you go to the hospital, you get treated, you get care, and it's paid for, either by charity, the government or by the hospital."

Indeed, the health care system did not let Boone bleed to death on the sidewalk. But it did bury him in life-altering debt. After four days in the hospital and two surgeries, the 39-year-old -- hailed as a hero on Capitol Hill and beyond for his actions -- is staring at $60,000 in medical bills so far. And they haven't stopped rolling in.

Well-wishers, moved by media reports of his story, have donated $17,000 to help Boone cover his expenses, and he's hoping a public fund for crime victims could defray as much as $25,000 more. But Boone, who said he expects to earn only about $15,000 this year, figures he'll still be looking at nearly $20,000 in debt, all for risking his life for a fellow human being.

His story is one that plays out with troubling regularity in the bar-and-restaurant business, where a high quotient of workers go without health coverage. Post-tragedy fundraisers are common in the industry. The events serve as vivid examples of the private sector's safety net in action.

These fundraisers can defray some of the costs of emergency care, as they have done for Boone, but often they don't provide nearly enough. Paying for health care isn't as efficient or just as Romney suggests. Instead, much of the cost is borne by health care providers and insurers and, ultimately, the insured. We all pay.

"At first, I was like, man, this is really great, this could take care of it," Boone said of the charity he has received. "And then the big bills started coming."


Douglas Zehner is the senior vice president and chief financial officer at MedStar Washington Hospital Center in northwest Washington, where Boone was treated. He said Medstar gave $22.1 million worth of care to uninsured or underinsured patients and forgave $85.1 million in debt last year. But that charity isn't free. The only way the hospital can recoup its losses, Zehner said, is by negotiating with private insurance providers for higher prices, a process known as "cost-shifting."

"I have to price my services with insurance carriers because that’s the only group I'm even in the room talking to about how much they're going to pay me for my services," Zehner said. "So the way the cost-shifting works is you basically back into how much [money] you need to run that service [for all patients] and apply it to the expected number of people that are coming in that have insurance to get that service."

The fewer people who have insurance, the greater the burden on those who do have coverage. In order to cover the costs of treating the uninsured, premiums go up. The American Hospital Association estimated that U.S. hospitals performed $39.3 billion worth of uncompensated care in 2010, the most recent year for which numbers are available. That's 5.8 percent of total expenses.

This is a problem that Obama's health care law seeks to address and one that Romney himself has acknowledged in the past, before he began pursuing the Republican presidential nomination.

"Look, it doesn't make a lot of sense for us to have millions and millions of people who have no health insurance and yet who can go to the emergency room and get entirely free care for which they have no responsibility, particularly if they are people who have sufficient means to pay their own way," he said in 2010.

In 2007, he used even starker language: "When [uninsured people] show up at the hospital, they get care. They get free care paid for by you and me. If that's not a form of socialism, I don't know what is."...

Saturday, October 20, 2012

Some drugs may remain potent long after expiration dates

Some drugs may remain potent long after expiration dates
American Council on Science and Health
October 9, 2012

When it comes to perishable food items, consumers often rely on expiration dates to determine when a product will spoil. But does the same rule of thumb hold for labeled expiration dates on medications? Not necessarily, according to a new study published in the Archives of Internal Medicine, which shows that drugs actually stay potent long after the printed expiration date.

Researchers from the California Poison Control System at the University of California San Francisco School of Pharmacy studied eight medications that had expired 28 to 40 years prior to analysis and had not been previously opened. Three tablets or capsules of each drug were analyzed, and the results showed that 12 of the 14 active ingredients in each medication tested were found in concentrations at least 90 percent of the labeled amounts, which is recognized as the minimum level of acceptable potency. The only medications tested whose efficacy had dropped below the 90 percent level were aspirin and amphetamine.

Typical drug expiration dates range from one to five years after their production, but the FDA does not require drug makers to determine how long after that date medications may remain potent. The federal Shelf-Life Extension Program does, however, check long-term stability of federal drug stockpiles and has previously extended expiration dates by more than a year. Based on these analyses and their own research, the authors support broadly extending expiration dates for many drugs.

ACSH’s Dr. Josh Bloom generally agrees and points out that “most medications found in solid (pill or capsule) form remain unchanged long past their expiration date, but this is not the case with liquid medications, since they are much more likely to spoil and lose potency. One exception to this guideline is tetracycline, which can decompose even in the solid state, forming a toxic byproduct.” He continues, “This is not carte blanche to start firing down all kinds of expired pills, but given the cost of drugs, this study is a good start to identifying old medicines that are OK to take yet are being thrown away for no good reason.”

Wednesday, October 17, 2012

Lawsuit against Kaiser Permanente: doctors did not do pathology testing on growth

Lawsuit against Kaiser Permanente: doctors did not do pathology testing on growth
Courthouse News Service
October 17, 2012

SANTA ANA, Calif. (CN) - With classic signs of basal cell carcinoma, a woman was left with a growth on her eyelid for 2.5 years, her court complaint alleges, in Orange County Superior Court.

Kaiser has "policies and procedures that instructed and ordered defendant Wong and other physicians within defendant Kaiser's physician groups to refrain, for financial and/or cost cutting reasons, from sending the material removed from plaintiff's eye-lid for pathology or biopsy testing," until the third time the growth was excised, the patient alleges in her court complaint.

Five months before a correct diagnosis, along with growth removal and reconstructive surgery of the patient's eyelid, leaving her with a deformity, Kaiser's "specialist" (italics in complaint) noted that the growth showed "characteristics of being 'thick walled,' " but still did not send the matter removed from the site to a lab for testing, the woman says in her court complaint.

Monday, October 15, 2012

Non-Partisan Kaiser Foundation Says 60% Of Seniors Would Pay More For Medicare Under Romney-Ryan Voucher Plan

It's Official: Non-Partisan Kaiser Foundation Says 60% Of Seniors Would Pay More For Medicare Under Romney-Ryan Voucher Plan
Rick Ungar

A new study out today by the non-partisan Kaiser Family Foundation confirms what many have been saying for a very long time—the Romney-Ryan Medicare plan would result in six out of ten seniors paying substantially more for the same Medicare benefits they receive today.

The premium support approach to Medicare involves the government providing seniors with a set amount of money each year—pegged to the second lowest priced private health care plan available—in an effort to turn over health care for seniors to the private insurance market. While proponents of the approach believe that this will generate more competition in health care, make seniors more responsible for how they spend their health care dollars and result in less spending on seniors by the federal government, critics have argued that the sum of money the government would pay would be insufficient to cover the rising costs of health care, leaving seniors exposed to having to pay an ever growing portion of their health insurance coverage.

According to Kaiser, the premium support approach (often referred to as a voucher plan) to Medicare—the hallmark of the Paul Ryan Medicare plan that has been endorsed and adopted by Governor Romney—would mean higher premium costs for more than half of beneficiaries currently enrolled in traditional Medicare—if such a program were in place today—while raising the costs for nearly all of those who participate in a Medicare Advantage program.

The study further found that the additional costs to seniors would vary from region to region, with areas of high per-capita Medicare spending seeing a cost boost for 80 percent of Medicare recipients.

While the Obama campaign was quick to trumpet the results of the study as further proof that the Romney-Ryan plan would mean dramatically higher costs to seniors when it comes to their healthcare, the Romney campaign fired back, noting that the Kaiser report says that it is not intend to model any specific proposal of either campaign.

The Romney troops are right to a point—but they somehow failed to fully quote what the Kaiser Family Foundation had to say, no doubt an inadvertent error that we shall seek to correct here—

“The analysis does not attempt to model any specific proposal, but is generally based on an approach included in House Budget Chairman Paul Ryan’s fiscal year 2013 budget plan (emphasis added), the proposal Chairman Ryan co-sponsored with Senator Ron Wyden of Oregon, and; in the plan put forward by former Senator Pete Domenici and Dr. Alice Rivlin. In the first two proposals, people who are at least 55 years old, including current beneficiaries, would be exempt from the new system. Republican presidential nominee Gov. Mitt Romney has supported a premium-support system along these lines. (emphasis added.)”

Here are the bullet points of the study results, including how you might be affected based on where you live:

Nearly six in 10 Medicare beneficiaries nationally could face higher premiums for Medicare benefits, assuming current plan preferences, including more than half of beneficiaries enrolled in traditional Medicare and almost nine in 10 Medicare Advantage enrollees. Even if as many as one-quarter of all beneficiaries moved into a low-cost plan offered in their area, the new system would still result in more than a third of all beneficiaries facing higher premiums.

Premiums for traditional Medicare would vary widely based on geography under the proposed premium support system, with no increase for beneficiaries living in Alaska, Delaware, Hawaii, Wyoming and the District of Columbia, but an average increase of at least $100 per month in California, Florida, Michigan, New Jersey, Nevada and New York. Such variations would exist even within a state, with traditional Medicare premiums remaining unchanged in California’s San Francisco and Sacramento counties and rising by more than $200 per month in Los Angeles and Orange counties.

At least nine in 10 Medicare beneficiaries in Connecticut, Florida, Massachusetts and New Jersey would face higher premiums in their current plan. Many counties in those states have relatively high per-beneficiary Medicare spending, which would make it more costly to enroll in traditional Medicare rather than one of the low-bidding private plans in those counties. In contrast, in areas with relatively low Medicare per-capita spending, it could be more costly to enroll in a private plan.

For those who may not follow health care policy closely, the Kaiser Family Foundation is one of the few independent think tanks that neither side of the political aisle is likely to criticize for being partisan as the organization’s record for impartiality is so well established. This would explain why the Romney campaign has chosen to attempt to distinguish the report from their plan (although there little to distinguish the Romney-Ryan Medicare plan from the model studied by Kaiser) rather than attack the findings of the Kaiser Family Foundation report.

Sunday, October 14, 2012

Kaiser charged member $4,029 AFTER Kaiser hospital bill was entirely paid

Kaiser Member Upset Over Hospital Charges
Diane Lund-Muzikant
Lund Report
October 11, 2012

Susan Chaney is convinced insurance companies are some of the highest profiting companies in America at the expense of people such as herself who deserve the right to affordable healthcare.

She spoke out after her husband, Jerry, a diabetic, was hospitalized at Kaiser Sunnyside in January for a foot ulcer that had gone undiagnosed.

After receiving the bill, Chaney realized their deductible and co-insurance hadn’t been met. That, she said, was never the issue.

Chaney became upset when Kaiser sent paperwork known as an Explanation of Benefits indicating that its medical center had billed $20,809.45 for the surgery, medical equipment and hospital stay, while the allowed amount was $28,300.65. Kaiser paid $24,644.32 toward the bill, while the Chaney’s were left owing $4,029.92.

“How does the hospital get paid $8,000 more than the cost of care?” asked Chaney who sent a complaint to the Oregon Insurance Division. “Everyone seems to think we’re trying to get out of paying, but that’s not the case. This is one reason people can’t afford healthcare is when they have to pay more than the actual cost. We’re the lucky people; we have insurance. But this is absolutely ludicrous.”

Earlier, Chaney had contacted Congressman Earl Blumenauer’s office in Portland, speaking with his casework manager Emily Hebbron who encouraged her to file a complaint with the Insurance Division.

“I want to make sure she gets an answer,” Hebbron said. “And I comment her for looking at the hospital bill so closely. Not everyone would have done so.”

The Insurance Division did look into this issue, according to a letter sent by Dennis Kuckartz, a consumer advocate. “When the allowed amount is greater than the billed charges, the benefits are calculated on the billed charges,” he wrote. “Even if Kaiser Permanente would have only allowed the billed charges, Mr. Chaney’s liability would have been the same. The claim was processed correctly.”

That explanation doesn’t satisfy Chaney. ”I still contend that this is what’s wrong with the entire system. I do not feel that a hospital or doctor or anyone for that matter should be able to negotiate a higher payment than the cost of care. Add that to the fact that then Kaiser tried to ‘strong arm’ us into making payments of nearly $400 a month on our portion when they had already received $4,000 more than the actual cost of care is absurd. After months and many, many phone calls Kaiser did finally agree to take only $175 per month until our portion is paid.”...

A Possibly Fatal Mistake

A Possibly Fatal Mistake
Daniel Stolle
New York Times
October 12, 2012

MY wife and I attended my 30-year college reunion a couple of weekends ago, but the partying was bittersweet. My freshman roommate, Scott Androes, was in a Seattle hospital bed, a victim in part of a broken health care system. Strip away the sound and fury of campaign ads and rival spinmeisters, and what’s at stake in this presidential election is, in part, lives like Scott’s.

Scott and I were both Oregon farm boys, friends through the Future Farmers of America, when Harvard sent us thick envelopes. We were exhilarated but nervous, for neither of us had ever actually visited Harvard, and we asked to room together for moral support among all those city slickers.

We were the country bumpkins of Harvard Yard. Yet if we amused our classmates more than we intended, we had our private jokes as well. We let slip (falsely) that we kept deer rifles under our beds and smiled as our friends gave them a wide berth.

Scott was there when I limped back from the Worst Date in History (quite regularly), and he and I together worked our way onto the Crimson, the student newspaper. He had an omnivorous mind: Scott may be the only champion judge of dairy cattle who enjoyed quoting Thomas Macaulay, the 19th-century British historian. Scott topped off his erudition with a crackling wit to deflate pretentiousness (which, at Harvard, kept him busy).

By nature, Scott was even-keeled, prudent and cautious, and he always looked like the mild-mannered financial consultant that he became. He never lost his temper, never drove too fast, never got drunk, never smoked marijuana.

Well, not that I remember. I don’t want to discredit his youth.

Yet for all his innate prudence, Scott now, at age 52, is suffering from Stage 4 prostate cancer, in part because he didn’t have health insurance. President Obama’s health care reform came just a bit too late to help Scott, but it will protect others like him — unless Mitt Romney repeals it.

If you favor gutting “Obamacare,” please listen to Scott’s story. He is willing to recount his embarrassing tale in part so that readers can learn from it.

I’ll let Scott take over the narrative:

It all started in December 2003 when I quit my job as a pension consultant in a fit of midlife crisis. For the next year I did little besides read books I’d always wanted to read and play poker in the local card rooms.

I didn’t buy health insurance because I knew it would be really expensive in the individual policy market, because many of the people in this market are high risk. I would have bought insurance if there had been any kind of fair-risk pooling. In 2005 I started working seasonally for H&R Block doing tax returns.

As seasonal work it of course doesn’t provide health benefits, but then lots of full-time jobs don’t either. I knew I was taking a big risk without insurance, but I was foolish.

In 2011 I began having greater difficulty peeing. I didn’t go see the doctor because that would have been several hundred dollars out of pocket — just enough disincentive to get me to make a bad decision.

Early this year, I began seeing blood in my urine, and then I got scared. I Googled “blood in urine” and turned up several possible explanations. I remember sitting at my computer and thinking, “Well, I can afford the cost of an infection, but cancer would probably bust my bank and take everything in my I.R.A. So I’m just going to bet on this being an infection.”

I was extremely busy at work since it was peak tax season, so I figured I’d go after April 15. Then I developed a 102-degree fever and went to one of those urgent care clinics in a strip mall. (I didn’t have a regular physician and hadn’t been getting annual physicals.)

The doctor there gave me a diagnosis of prostate infection and prescribed antibiotics. That seemed to help, but by April 15 it seemed to be getting worse again. On May 3 I saw a urologist, and he drew blood for tests, but the results weren’t back yet that weekend when my health degenerated rapidly.

A friend took me to the Swedish Medical Center Emergency Room near my home. Doctors ran blood labs immediately. A normal P.S.A. test for prostate cancer is below 4, and mine was 1,100. They also did a CT scan, which turned up possible signs of cancerous bone lesions. Prostate cancer likes to spread to bones.

I also had a blood disorder called disseminated intravascular coagulation, which is sometimes brought on by prostate cancer. It basically causes you to destroy your own blood cells, and it’s abbreviated as D.I.C. Medical students joke that it stands for “death is close.”... •

Thursday, October 11, 2012

In meningitis scare, charges firm misled U.S. regulators

Corruption seems to be at the heart of so many of our health care problems.

In meningitis scare, charges firm misled U.S. regulators
By Tim Ghianni
Oct 11, 2012

The deadly meningitis outbreak that has claimed a dozen lives is prompting calls for increased oversight of the nation's custom-made pharmaceutical industry, amid charges that the company at the center of the scare may have misled U.S. regulators.

On Wednesday, Idaho became the 11th state to report a case of the rare illness, which has been linked to tainted steroids produced by a specialty pharmacy in Massachusetts.

The U.S. Food and Drug Administration, whose role in the outbreak has come under criticism, said it was planning an afternoon media briefing on Thursday.

In all, 138 people have contracted meningitis as a result of the now-recalled drugs, according to the latest tally from the U.S. Centers of Disease Control and officials in 11 states where the outbreak has spread. The case in Idaho is the first discovered in the western United States.

Lawmakers have come under pressure to close what critics see as a loophole in oversight that left the New England Compounding Company (NECC), the Massachusetts pharmacy linked to the tainted steroids, largely exempt from federal regulation.

The FDA regulates only the ingredients and their suppliers, not the little-known corner of the drug world known as "compounding," which is subject to a patchwork of state oversight.

State and federal officials are now investigating NECC, which distributed thousands of vials of a contaminated steroid made at a shabby brick complex next to a waste and recycling operation in a western suburb of Boston.

The pharmacies are owned by Gregory Conigliaro, an engineer, and his brother-in-law, Barry Cadden, a pharmacist who was in charge of pharmacy operations at NECC. The waste and recycling facility is another of Conigliaro's business interests.

Compounding pharmacies such as NECC are permitted to make medications based on specific prescriptions for individual patients.

State and federal regulators are investigating why NECC shipped thousands of vials of preservative-free methylprednisolone acetate steroid to healthcare facilities in multiple states.

"It does seem like the agencies, both at the state and the federal level, may have been misled by some of the information we were given," Massachusetts Governor Deval Patrick told reporters on Wednesday.

The number of cases has grown rapidly as health practitioners contacted about 13,000 people who received injections from a potentially tainted supply of steroid medication shipped to 23 states.

In five states - Tennessee, Michigan, Maryland, Virginia, and Florida - the outbreak has claimed lives, with the latest victim a 70-year-old man in Florida.

Thousands of people received the injections to relieve back pain and other complaints and are at risk of infection...

(Writing by James B. Kelleher; Editing By Greg McCune; Desking by Vicki Allen)

Read more: In meningitis scare, charges firm misled U.S. regulators

Wednesday, October 10, 2012

Meningitis warning for those who've had spinal injections of steroids since May 21, 2012

Doctors have been having problems recognizing fungal meningitis.

Doctors Are Off Balance as Patients Show Atypical Meningitis Reactions
Wall Street Journal
October 10, 2012

The rare fungal meningitis behind a deadly national outbreak is difficult to diagnose because it can cause strokes and other reactions unlike those typically seen with the more common type of the illness.

Meningitis, a swelling of the protective membranes of the brain and spinal cord, is typically caused by bacteria that can be treated with antibiotics, or by a virus, for which there is no treatment.

Fungal meningitis, on the other hand, needs to be treated with antifungal drugs. The length of treatment isn't known but the federal Centers for Disease Control and Prevention is telling doctors that patients may need treatment for months.

Bacterial meningitis tends to attack quickly with a fever, a headache that grows worse, a stiff neck and eventually a loss of consciousness.

However, some patients who contracted fungal meningitis in the current outbreak have had just a mild headache and no fever, and "for the most part symptoms occur in a more gradual fashion," said William Schaffner, an infectious disease expert and chairman of the department of preventive medicine at Vanderbilt University School of Medicine in Nashville, which has treated four patients with fungal meningitis.

Dr. Schaffner said fungal meningitis is invading blood vessels and causing strokes in some patients affected by the current outbreak. But doctors don't typically test for meningitis when patients go to the emergency room with signs of stroke, such as weakness or loss of movement on one side of their bodies, slurred speech or sudden vision changes.

"Nobody is totally sure what these patients look like," said Trish Perl, senior hospital epidemiologist at the Johns Hopkins Health System in Baltimore, who is advising doctors about patients who might have the disease.

Because the fungal-meningitis symptoms have been so varied among patients, federal health officials have urged doctors to set a low bar in deciding whether to test patients who received a steroid injection in their backs. The test requires a spinal tap, which involves a needle inserted in the spinal column to collect spinal fluid.

The CDC has said as many as 13,000 people in 23 states have been exposed to the potentially contaminated steroid injections made by the New England Compounding Center before the products were recalled Sept. 26.
Compounding pharmacies create blends of medicines, including liquid forms of pills.

The agency said patients who have had an epidural steroid injection since May 21, 2012, and are experiencing symptoms such as headache, fever, sensitivity to light, slurred speech or numbness, should contact their doctors as soon as possible.

Officials are most concerned about spinal injections. Those given in other places, such as the knees or hips, are highly unlikely to cause meningitis, though there is the possibility of a local joint infection...

Friday, October 5, 2012

Woman self-diagnoses rare disease

I have known many people whose doctors failed to diagnose serious problems--particularly at Kaiser Permanente. It's wise to do some research oneself. Often doctors are too busy to think about unusual conditions. They rely on the sets of symptoms that they're familiar with. In fact, at Kaiser, doctors are expected to rely on fixed lists of symptoms, and to ignore everything else. This way, Kaiser is able to correctly treat a large percentage of people, while improperly diagnosing an unfortunate minority. It's medicine based on percentages, not the Hippocratic oath or professional standards.

Woman self-diagnoses rare disease
October 03, 2012
For the North County Times

To look at Chondra Hungerford today, you would never think she had ever been anything but strikingly beautiful.

And yet, last year at this time, she was gaining a pound a week, thick hair had started to sprout on her back, her skin was broken out in adult acne, and a lump of fat had started to form between her shoulders at the base of her neck.

She endured a menstrual period every two weeks, her skin bruised at the slightest touch and people stopped to ask her whether she was pregnant.

After having been a fitness model and personal trainer all of her adult life, such a body transformation was torture for Hungerford, 28. "I was training really hard, eating only fish and vegetables and nothing was working," the mother of two from Vista recalled. "I was turning into a monster."

And though she saw doctors for these and other complaints since being diagnosed with hypertension at age 19, Hungerford's primary-care physician seemed unable to correctly diagnose her condition.

That was until one day early last year, after seeing photographs of her shockingly round face, Hungerford said, "It all came together for me ... I went in to the doctor (the next week) and told him that he needed to order a cortisol lab (test). I knew I had Cushing's."

Hungerford said her doctor remained skeptical that she had the rare endocrine disease, which strikes only two or three people in a million. "I tell him 'I have Cushing's disease,' and he says to me, ‘I hope you do, because everyone who comes in her swears they do and you'd be the very first one (who did).'"

Named for the American neurosurgeon Harvey Cushing, Cushing's disease is caused by a tumor of the pituitary gland, which is located at the base of the brain. People with the disease have too much adrenocorticotropic hormone or ACTH, which in turn stimulates the production and release of cortisol.

Cortisol, the body's fight-or-flight hormone, helps maintain blood pressure, reduces the immune system's response and controls the body's use of carbohydrates, protein and fats. But in excess, it can cause upper body obesity, a full or moon face, acne, unusual purple stretch marks called striae, bone pain, weak muscles and irregular menstrual cycles...

"Chondra is a remarkable young woman," said UC San Diego endocrinologist Joseph Witztum, who recommended Hungerford for surgery. "Being aware of what is going on with you, carefully noting all the changes and using the Web in an intelligent way allowed her to make the diagnosis of a rare disease. She essentially had her doctor collect the needed laboratory data and presented an endocrinologist with the diagnosis and the supporting data. I can only imagine how surprised he was!"

...In April 2012, UC San Diego neurosurgeon Hoi U performed Hungerford's hour-long surgery to remove a 1-millimeter tumor from her pituitary gland.

...Cortisol (like cortisone) has the effect of reducing pain. Having lived with such high cortisol levels and then going to almost none, she started feeling general pain sensations almost for the first time.

Dr. U said that after the tumor is removed, it takes some adjustment for the body to return to producing normal levels of cortisol. "It can be like cold turkey for the patient," he said. "You have to give the patient some cortisone at first to achieve a soft landing. But everybody's (pain threshold) is different as you taper it down," he said with a smile. "That is like being a Chinese chef ... too much soy sauce? Not enough?"

...Indeed, this month Hungerford gave a presentation to a combined medicine/endocrinology conference at UC San Diego at which she presented, in a half-hour "mystery" narrative, the story of her illness.

Many of the young doctors were not able to diagnose Hungerford's disease until the end,
and her presentation did highlight some of the fragmentation of our current medical system, said Witztum, adding, "It was an amazing performance and I encouraged her to go into some type of medical-related profession, even consider going to medical school."

How UCLA's Millionaire Doctor/public employee David Feinberg got $1.3 million amid tuition hikes, budget cuts and a recession

Dr. David Feinberg

[Maura Larkins comment: Both Dr. Feinberg and Chancellor Gene Block are psychiatry professors. A lawsuit has been filed against yet another professor of psychiatry at UCLA. Dr. Alexander Bystritsky is accused of causing the wrongful death of a woman by giving her dangerous medications in order to make her feel happy and to believe she was cured of her illness, causing her to give a large donation to UCLA.

What kind of ethics does Dr. David Feinberg have? What's he going to do with all this money? I'm guessing it's not all going to scholarships for students who can't pay tuition at UCLA.]

UCLA's Millionaire Doctor David Feinberg
How Feinberg got $1.3 million amid tuition hikes, budget cuts and a recession
By Beth Barrett
LA Weekly
Mar 31 2011

Last year, when Stanford Hospital & Clinics was considering poaching Dr. David Feinberg from UCLA, where he is the associate vice chancellor and CEO of its public hospital system, the university brass and the powerful UC Board of Regents decided to do whatever was required to keep their golden administrator.

Things were bad at UCLA when the feverish bid to retain Feinberg broke out. It had just been slammed with $60 million in academic program cuts by the deficit-riddled state of California, and faces another $96 million bite on July 1. In a series of recent hikes, the university raised average student tuition 40 percent from about $7,000 to more than $11,000.

More tuition hikes were coming, and the university owed its employees $21.5 billion in future pension payments that it had no clear-cut way to pay.

But the vast Ronald Reagan UCLA Medical Center, a public nonprofit, had experienced a financially robust previous year under Feinberg, and the facility in 2009 enjoyed high patient-satisfaction rankings as usual. Despite California's stubborn recession, UCLA Chancellor Gene Block — like Feinberg, a psychiatry professor at the School of Medicine — decided to make his colleague a staggering offer: He would nearly double Feinberg's $739,695 base salary to $1.33 million.

That included a 22 percent pay raise of $160,300 and an annual "retention bonus" of $250,000 paid every year that Feinberg does not leave for another job. Block also decided to continue Feinberg's "incentive bonus," which had hit $210,739 in the previous fiscal year.

There was nothing else quite like Block's offer elsewhere in California's university medical schools. The next highest paid is UC San Francisco's CEO Mark Laret. San Francisco, like UCLA, is a top facility, ranked seventh in the nation by U.S. News & World Report, close behind No. 5 UCLA.

In 2010, Laret's $739,700 pay was reduced as a result of the systemwide pay cuts. But with an "incentive" bonus of $176,912 and a car allowance of $8,916, he earned $876,215. Now, suddenly Feinberg was in line to earn nearly half a million dollars more than Laret.

On June 30, Feinberg will begin getting his annual quarter-million-dollar bonus simply for not leaving for another job.

Feinberg's juicy pay package led to uncomfortable headlines for UCLA on Sept. 17, the day after the Board of Regents approved it.

Then, in late December, Feinberg earned UCLA another round of unwanted media attention. The San Francisco Chronicle obtained a private Dec. 9 letter in which Feinberg and 35 other executives in the UC system lashed out at the Board of Regents. The highly compensated group weren't demanding help for academic programs and students. They were threatening to sue the struggling California universities if the regents didn't boost the executives' long-standing $245,000 salary caps used to calculate their pensions.

The change would create a sizable pension boost, costing the universities $5.1 million per year — for just 36 government employees. In addition, the 36 executives insisted the new pension deal be retroactive to 2007, taking from the universities an additional bite of $51 million.

In the letter, Feinberg and the others wrote that it was "the University's legal, moral and ethical obligation" to hand over the pension boosts. They also threatened, "Failure to do so will likely result in a costly and unsuccessful legal confrontation," and emphasized that they were writing "URGENTLY."

The letter, which proved to be deeply embarrassing to UC officials and the regents, was widely assumed to have been leaked by a UC university system insider disgusted by the demands.

The demands from the 36 were a direct political challenge to UC President Mark Yudof, who had publicly opposed bigger pensions for university executives. The University of California system owes $21.6 billion in future pension payments to all its retirees — but it hasn't got the money, and doesn't know where it's going to get it. Yudof is pursuing fiscal reforms to raise the missing billions, including upping the retirement age for future employees from age 60 to 65 for maximum pension benefits — and, once again, raising student tuition and fees.

The leaked letter enraged students, critics of cushy government pensions and salaries and incoming Gov. Jerry Brown, who is a nonvoting member of the Board of Regents.

Brown opined in the Chronicle in December: "These executives seem very out of touch at a time when the state is contemplating billions of dollars in reductions that will affect people who are far less advantaged."

In early January, under a media spotlight, Block opposed the pension boosts, and the demand was not approved by the regents.

But three weeks later, without a formal vote, the regents — who include such notables as investment banker Richard C. Blum, husband of Sen. Dianne Feinstein, and Sherry L. Lansing, former chair/CEO of Paramount Pictures — found a way to give Feinberg and other UC system medical center executives statewide a different costly reward: "incentive" bonuses totaling $2.6 million that had been deferred from 2009.

Feinberg topped the bonus recipient list, raking in $218,728.

The popular doctor now has critics aplenty. Students, facing further tuition hikes as Gov. Brown struggles with a massive deficit, are flabbergasted at the Wall Street–like disparity between how the UC system treats its highfliers versus its students.

Student Matt Margolis, president of the Bruin Democrats, says thousands of UC, California State University and community college students "have to take quarters off, drop classes, get kicked out of their housing." For UC leaders "to respond to the need to scale back by cutting the budget and raising tuition — I don't see how that sits well with the CEO of the medical center having his salary doubled...

UCLA hospitals to pay $865,500 for breaches of celebrities' privacy

UCLA hospitals to pay $865,500 for breaches of celebrities' privacy
July 08, 2011
By Molly Hennessy-Fiske
Los Angeles Times

UCLA Health System has agreed to pay $865,500 as part of a settlement with federal regulators announced Thursday after two celebrity patients alleged that hospital employees broke the law and reviewed their medical records without authorization.

Federal and hospital officials declined to identify the celebrities involved. The complaints cover 2005 to 2009, a time during which hospital employees were repeatedly caught and fired for peeping at the medical records of dozens of celebrities, including Britney Spears, Farrah Fawcett and then-California First Lady Maria Shriver.

Violations allegedly occurred at all three UCLA Health System hospitals — Ronald Reagan UCLA Medical Center, Santa Monica UCLA Medical Center and Orthopaedic Hospital and Resnick Neuropsychiatric Hospital, according to UCLA spokeswoman Dale Tate.

The security breaches were first reported in The Times in 2008.

The violations led state legislators to pass a law imposing escalating fines on hospitals for patient privacy lapses.

After the law took effect on Jan. 1, 2009, state regulators fined Ronald Reagan UCLA Medical Center $95,000 in connection with privacy breaches that year that sources said involved the medical records of Michael Jackson, who was taken to the hospital after his death in June 2009.

The same month, the U.S. Department of Health and Human Services' Office for Civil Rights began investigating alleged violations of the federal Health Insurance Portability and Accountability Act at the hospitals, according to the settlement agreement.

Investigators found that UCLA employees examined private electronic records "repeatedly and without a permissible reason" in 2005 and 2008, including an employee in the nursing director's office, according to the agreement reached Wednesday.

The employee was not named in the agreement, and the hospital spokeswoman declined to identify who it was. But the timing and description of the alleged violations cited in the agreement suggest that it may have been Lawanda Jackson, an administrative specialist at Ronald Reagan UCLA Medical Center who was fired in 2007 after she was caught accessing Farrah Fawcett's medical records and allegedly selling information to the National Enquirer.

Jackson later pleaded guilty to a felony charge of violating federal medical privacy laws for commercial purposes but died of cancer before she could be sentenced. Fawcett died of cancer in 2009.

Federal investigators faulted the hospital system for failing to remedy the problems, discipline or retrain staff.

"Employees must clearly understand that casual review for personal interest of patients' protected health information is unacceptable and against the law," Georgina Verdugo, director of the Office for Civil Rights, said in a statement Thursday, adding that healthcare facilities "will be held accountable for employees who access protected health information to satisfy their own personal curiosity."

As a condition of the settlement, UCLA Health System was required to submit a plan to federal regulators detailing how officials would prevent future breaches. They agreed to retrain staff on privacy protections, formulate privacy policies, appoint a monitor to oversee improvements and report to regulators for the next three years.

UCLA Health System released a statement Thursday noting that, "Over the past three years, we have worked diligently to strengthen our staff training, implement enhanced data security systems and increase our auditing capabilities."

"Our patients' health, privacy and well-being are of paramount importance to us," said Dr. David T. Feinberg, chief executive of the UCLA Hospital System. "We appreciate the involvement and recommendations made by OCR in this matter and will fully comply with the plan of correction it has formulated. We remain vigilant and proactive to ensure that our patients' rights continue to be protected at all times."

Thursday, October 4, 2012

UCLA Radiology Department--Who's in charge of losing my X-rays?

I'm trying to figure out how--or why--ALL my digital X-rays got "lost" at UCLA.

[Update October 20, 2012: It seems that UCLA wants to protect Kaiser from having to answer questions about this problem at Kaiser Permanente's new Garfield Specialty Center in San Diego. My UCLA primary care doctor explained it to me, saying, "You need to forget about Kaiser." She was worried that I might "have a case against Kaiser."]

It appears that I have these people to thank for my X-rays being unavailable:


Dieter R. Enzmann, M.D.
"Leo G. Rigler" Chair and Professor (What's up with that Cheshire Cat smile? He looks like he might have swallowed my X-rays.)
Brenda Izzi, R.N., M.B.A.
Chief Administrative Officer and head of Radiology Image Library
(310) 481-7516 (310) 794-8056
(From the look on her face, I think she knows where those X-rays are.)

Brenda Jones, Director of Radiology Image Library


The head of the Medical Records Department won't even let employees give out his or her name. Perhaps the Los Angeles Times article at the bottom of this post explains the desire for anonymity.

Katherine Mair, special project manager (Her existence might be just a rumor, but I suspect she's simply too important to deal with missing X-rays.)

Erik Lozano--contractor (He had his door closed, and later was in a meeting.)

Pazzette McCray, contractor, manager 310 825 9381 (She ignored all my messages.)

Erika, contractor (She was the only one who would talk to me, but I don't think she was authorized to say much. I'm sure that's difficult for her. As far as I know, she's the only one earning her pay.)

See more information HERE.

UPDATE October 5, 2012

I got the following email this morning, but I'll believe that Ms. Izzi is sincere when I have the digital images in my possession. Erika Lee told me that the images can be burned to a CD within a day. That means they could also be sent in an email within a day. Anyone want to bet that I don't get all the digital images today? (Note to UCLA: it doesn't count if you print out an image, then scan it. You remove a huge amount of detail when you do that.)

Dear Ms. Larkins,
I am happy to look into any imaging provided by Radiology and ensure you can obtain copies of those studies. I have asked my Director of the Image Library to research your concern.
I will let you know what we uncover.
Brenda M. Izzi, RN, MBA
Chief Administrative Officer
UCLA Radiology


Dear Ms. Izzi:

It is ridiculous for your department to claim that X-rays might have gotten misplaced inside Dr. Raz's office. The Chair of the Radiology Department, Dr. Enzmann, states "the Department of Radiological Sciences is completely digital." The digital images are available on your computers, and it's simply false to say that they aren't there.

Also, please don't print out a few images, then scan them, and then call them the original digital images. You remove a huge amount of detail when you do that. By law you must provide all the videos and all the original still images. Your department has been in violation of the law for almost two weeks.

It is also shameful for your department to claim that my September 18, 2012 Request for Images was not received. I have a FAX transmission report with a photocopy of the Request to prove that you received my Request on Sept. 18.

I assume you are talking about Brenda Jones when you refer to your Director. Surely she has been researching this matter for the past three days, since Erika Lee sent a FAX on October 2, 2012 asking that my request be prioritized? Isn't Brenda Jones the person who told her subordinates to tell me that no images were available? I suggest you look into this matter yourself, Ms. Izzi.

Maura Larkins


Apparently Brenda Izzi and Katherine Mair and the mysterious head of Medical Records decided that the best response to the situation was to make up a bizarre story in which they would claim that images don't exist, and if they did, they wouldn't be able to release them.

So why would UCLA, a public entity, pay all these people in Medical Records and the Radiology Image Library to do nothing? Well, they don't exactly do nothing. They actually work very hard. It can't be easy to conduct phone calls like the following one.


On Oct. 5, 2012 at 4:50 p.m. I became part of a conference call with Ms. P. M. and the elusive Mr. E. L. of UCLA’s Medical Records office.

When I had called the office on October 2, 2012, a receptionist had gone to ask E. L. to talk to me, but then she came back and told me that his door was closed.

P. M. had ignored my messages for several days, but when I called earlier today, she had picked up the phone and talked to me.

Only P. M. spoke in the beginning of our conference call, and I began to wonder if E. L. was actually on the line. "Are you there, E.?" I asked. Then I heard his voice for the first time.

From all this I concluded that E. L. must actually be P. M.'s superior, rather than her subordinate, as I had assumed when told that P. M. was the "manager." I figure the higher-ups tell their subordinates what to say, but they don't like to actually talk to patients themselves.

In fact, I suspect that there may have been others on the line during the call who never said anything. I think B. J. was probably on the line, since she called me back just minutes after the following call. I also think that the people who were calling the shots did not speak to me at all. I think E. L., P. M. and B. J. are all following orders.

Here's my transcript of the call:

P. M.: ...I called the physician [Dr. Raz] and was told that they don't make videos in that office.

[Maura Larkins comment: I knew this statement was false. I saw the videos myself on the computer monitor as they were being taken.]

P. M.: The X-rays are the physician's product to release. We're not experts and we're not able to release it. He's a private physician.

[Maura Larkins comment: I knew that all these claims were false, too. It says on the UCLA website that the Radiology Image Library releases images on CD for free, and that it does so within 5 days of the request--because this is what is required by California law. All X-rays at UCLA are digitized, and the Radiology Image Library has access to all X-rays. In further proof, Dr. Raz's office had given me the phone number of the Radiology Image Library and told me to call that number to get copies of my images.

Also, UCLA doctors are public employees, hired by the Regents of the University of California, NOT private doctors.]

Maura: No one in your department knows California law regarding medical records?

McCray: We can not provide patient information. Erika (Lee) was being kind in trying to help you out.

Maura: (repeating the unanswered question) No one in your department knows what California law is regarding medical records?

P. M.: We know the law.

Maura: Why are you disobeying the law?

P. M.: Miss Larkins, we do not release information from a private physician.

Maura: I didn't get everything you said written down in my notes here. P. M., you said you spoke to Dr. Raz?

P. M.: E. L. called Dr. Raz's office. The number he called was 310 794 0206.

Maura: E. L., did you speak to Dr. Raz? Did he say they don't make videos in his office?

E. L.: His office said that they don't make videos.

Maura: Who was it who said that?

E. L.: I don't have her name written down. A woman said they don't make videos. If they do make videos, we don't have access.

[Maura Larkins comment: I can't believe that anyone in Dr. Raz's office would claim that they don't make videos. But it does appear that for some reason Dr. Raz's office didn't want the videos released, and Medical Records came up with this cover story. Why wouldn't a doctor want a video of abdominal X-rays released? This is all very bizarre.]

Maura: E. L., are you a contractor?

E. L.: Yes.

Maura: P. M., are you a contractor?

McCray: Yes.


UCLA hospitals to pay $865,500 for breaches of celebrities' privacy
July 08, 2011
By Molly Hennessy-Fiske
Los Angeles Times

UCLA Health System has agreed to pay $865,500 as part of a settlement with federal regulators announced Thursday after two celebrity patients alleged that hospital employees broke the law and reviewed their medical records without authorization.

...Violations allegedly occurred at all three UCLA Health System hospitals — Ronald Reagan UCLA Medical Center, Santa Monica UCLA Medical Center and Orthopaedic Hospital and Resnick Neuropsychiatric Hospital, according to UCLA spokeswoman Dale Tate...The same month, the U.S. Department of Health and Human Services' Office for Civil Rights began investigating alleged violations of the federal Health Insurance Portability and Accountability Act at the hospitals, according to the settlement agreement.

Investigators found that UCLA employees examined private electronic records "repeatedly and without a permissible reason" in 2005 and 2008, including an employee in the nursing director's office, according to the agreement reached Wednesday.

..."Our patients' health, privacy and well-being are of paramount importance to us," said Dr. David T. Feinberg, chief executive of the UCLA Hospital System. "...We remain vigilant and proactive to ensure that our patients' rights continue to be protected at all times."

Wednesday, October 3, 2012

Can you tag your doctor a 'tool' online?

Can you tag your doctor a 'tool' online?
Star Tribune
Maura Lerner
September 4, 2012

A state Supreme Court case is testing the boundaries of website reviews. Is it defamatory to call a doctor a "real tool?"

Or to claim that a nurse described a doctor that way?

The Minnesota Supreme Court wrestled with those questions on Tuesday, as the justices heard arguments in a case about what is or isn't fair game on the Internet.

Two years ago, a Duluth neurologist, Dr. David McKee, sued the son of an elderly patient for defamation over some negative comments that were posted on rate-your-doctor websites.

On Tuesday, the state's top court was asked to decide whether the lawsuit should finally go to trial, after the case was thrown out by a lower court and reinstated on appeal. The lawsuit is one of a growing number of legal battles testing the limits of free speech on the Internet.

A good portion of the oral arguments were devoted to the meaning of the words that Dennis Laurion, 65, used to describe his family's encounter with McKee in April, 2010, when Laurion's father, Kenneth, then 84, was hospitalized with a stroke.

After McKee examined his father, Laurion complained about the doctor's bedside manner on several websites. "When I mentioned Dr. McKee's name to a friend who is a nurse, she said, 'Dr. McKee is a real tool!'" he wrote.

John Kelly, Laurion's attorney, noted that Internet sites are a "free for all" for people to share opinions and that his client's comments were perfectly appropriate. "We have a word, the word 'tool,'" Kelly told the justices. "When you look at the word, you have to ask: Is it defamatory?" He argued that the phrase, while "it clearly is not a compliment," is no worse than "calling someone an idiot or a fool."

During questioning, some of the justices seemed to agree. "Saying someone's a 'real tool' sounds more like an opinion than a statement of fact," Justice Christopher Dietzen said.

Chief Justice Lorie Skjerven Gildea had a similar reaction. "The point of the post is, 'This doctor did not treat my father well,'" she said. "I can't grasp why that wouldn't be protected opinion."

But McKee's lawyer, Marshall Tanick, argued that Laurion had gone beyond opinion, "making up" statements that were untrue. He noted that Laurion had never been able to identify the nurse who allegedly called McKee a tool. "There was no nurse," Tanick said. "He made it up." He also accused Laurion of putting words in McKee's mouth that made him look "insensitive and uncaring."

See the whole article:

See the comments.

Tuesday, October 2, 2012

Access to Doctors' Notes Aids Patients' Treatment

Access to Doctors' Notes Aids Patients' Treatment
Wall Street Journal
October 1, 2012

Patients who have access to doctor's notes in their medical records are more likely to understand their health issues, recall what the doctor told them and take their medications as prescribed, according to a study published Monday.

The study, published online in the Annals of Internal Medicine, is the culmination of an experiment known as OpenNotes, an effort to improve doctor-patient communication by letting patients know everything their doctor has to say about them, including after a visit.

Beth Israel Deaconess Medical Center in Boston, Geisinger Health System in Danville, Pa., and Harborview Medical Center in Seattle took part in the trial, which included 105 primary-care doctors and 13,564 of their patients who had at least one note available to them during the voluntary program.

While patients legally have the right to see their entire medical record, including doctor's notes, the notes aren't automatically included in requests for records and doctors don't make it easy for patients to see them, says Tom Delbanco, a primary-care doctor at Beth Israel who is co-lead author of the study and a professor at Harvard Medical School. Some doctors were initially resistant to the idea of sharing notes, he says. According to the study, doctors who declined to participate expressed concerns that their workflow might be disrupted and that they might scare or offend patients.

But the study, based on surveys of doctors and patients taken in fall 2011 after 12 to 19 months of participation, found most fears weren't realized, and patients were enthusiastic about accessing the notes.

Close to 11,800 patients opened at least one note contained in their electronic medical record. Of 5,391 patients who opened at least one note and returned online surveys, 77% to 87% across the three sites reported that OpenNotes made them feel more in control of their care and more adherent to medications...