Saturday, November 30, 2013

Strikes at University of California hospitals statewide

Second strike in 6 months at UCLA Medical Center
Some UC Hospital Workers To Participate In 1-Day Strike Wednesday
CBS Local News
Nov 20, 2013

Hundreds of replacement workers will fill in for workers on strike. Dr. Tom Rosenthal, the chief medical officer ...


UCLA Chief Medical Officer Says Strike Is About Pensions, Not Patient Care
May 21, 2013
WESTWOOD ( — As a two-day strike began Tuesday at five of the biggest medical centers in the University of California system, medical workers say they are protesting low staffing levels and patient care, while officials contend that the strike is about pensions.

Thousands of union medical workers walked picket lines throughout the state, including at UC Irvine and the Westwood and Santa Monica campuses of UCLA Medical Center. The strike officially began at 4a.m. Tuesday morning.

The strike comes after nearly a year of stalled contract negotiations with UC administrators. Striking workers said they are protesting a range of issues, including patient care and current staffing levels.

“I am here for my patients, I’m really concerned about their safety,” said radiation therapist Jenny Takakura, who administers radiation to cancer patients.

“We’ve had three therapists that have left, and each time they’ve left they have not been replaced,” she said.

UCLA Chief Medical Officer Dr. Tom Rosenthal said there are no issues with patient care...

[Maura Larkins comment: In fact, there are issues with patient care at UCLA, but they are hushed up. UCLA achieves this by working with other medical centers. UCLA hushes up other hospitals' problems, thus making sure other hospitals aren't motivated to improve, and keeping UCLA's reputation among the best. In fact, the grading is on a curve, so laziness and greed are allowed free rein.]

"The union representing patient care and service employees at UCLA Medical Center, Santa Monica held a strike last Wednesday. Strikes took place at each of the University of California hospitals statewide on the same day."

UCLA-Santa Monica Hospital Workers Participate In Strike
Parimal M. Rohit
Santa Monica Mirror
Nov. 29, 2013

For the second time in almost six months, some workers from the Santa Monica-UCLA Medical Center participated in a one-day strike last week.

The Nov. 20 strike, coordinated by the American Federation of State, County, and Municipal Employees (AFSCME) Local 3299, took place at each of the University of California hospitals statewide, including the UCLA-run facilities both in Santa Monica and in Westwood.

All hospitals remained open, with elective surgeries directly impacted by the one-day walkout, according to news reports.

Similar to the two-day strike at Santa Monica-UCLA Medical Center and other University of California hospitals in May, elective surgeries scheduled for Nov. 20 were reportedly rescheduled.

Union officials and the workers participating in the strike made demands for increased staffing, pay raises, and updated pension plans.

According to a statement released by UCLA Health, 325 replacement workers filled in for those who joined the picket line. Some administration staff members were “redeployed” to substitute for a variety of workers ranging from housekeeping staff to respiratory therapists and nursing assistants, according to UCLA Health.

“We sincerely apologize for any inconvenience this strike may cause our patients and their families and friends,” UCLA Hospital System’s chief medical officer Dr. Tom Rosenthal said in a released statement prior to the strike. “However, every effort is being made to ensure that the hospitals and clinics that are part of the UCLA Health System remain open and continue to deliver the highest level of patient care.”

In all, 20 percent of elected surgeries scheduled during the one-day strike were rescheduled.

It was estimated the one-day strike would cost the entire UCLA Health System $2.5 million, including lost revenue and compensation for replacement workers.

AFSCME represents about 22,000 patient care and service employees. About 3,800 of those employees work for the UCLA Health System.

Despite the strike, UCLA Health said approximately 75 percent of AFSCME employees still showed up for work.

Also on the picket line alongside AFSCME Local 3299 members were representatives of other unions representing teaching assistants, lecturers, librarians, nurses, and healthcare and research employees at the University of California.

A similar strike took place May 21 and 22, when nearly 30,000 people participated in a two-day strike at University of California hospitals across the state. Members of the second labor union, University Professional and Technical Employees (UPTE), joined the two-day strike in solidarity.

At Santa Monica-UCLA Medical Center, more than 100 hospital employees lined Wilshire Boulevard and 16th Street during the two-day strike last May in an effort to increase staffing, update pension plans, and demand raises.

In September, AFSCME Local 3299 filed a complaint with the California Public Employment Relations Board (PERB) and alleged representatives on behalf of the Regents of the University of California engaged in intimidation practices against hospital workers during the two-day strike in May.

Specifically, the complaint charged the Regents of the University of California with threatening “adverse action against employees for participating in a strike,” listing three scenarios where a UC representative allegedly singled out an employee to be terminated or reprimanded if they took part in the two-day walkout in May.

The Santa Monica-UCLA Medical Center is a 267-bed facility located at 16th Street and Wilshire Boulevard.

Strike news update at UCLA
By UCLA Newsroom
November 20, 2013

An estimated 230 UCLA service employees represented by the American Federation of State, County and Municipal Employees (AFSCME) did not report to work on Wednesday. Among them are cooks and food service workers, landscaping crews and custodial staff. (Staff at UCLA Ronald Reagan Medical Center are separate.)

To minimize the impact on campus operations, supervisors prioritized tasks, performed some duties and utilized temporary replacement workers.

In dining facilities operated by Housing and Hospital Services, meals were simplified. Four facilities representing about 30 percent of the operation were closed for the day: Bruin Plate, Feast at Rieber, Hedrick Test Kitchen and Café 1919.

Custodial service in on-campus housing was prioritized around the cleaning of restrooms and removal of refuse from living areas.

Cleaning priorities for other campus buildings were focused on the highest-demand classrooms, restrooms, libraries. UCLA attempted to provide some minimum amount of service to all buildings on Wednesday.

Landscaping crews focused on trash removal and key campus areas.

Tuesday, November 26, 2013

Perks Ease Way in Health Plans for Lawmakers

Perks Ease Way in Health Plans for Lawmakers
New York Times
November 19, 2013

WASHINGTON — Members of Congress like to boast that they will have the same health care enrollment experience as constituents struggling with the balky federal website, because the law they wrote forced lawmakers to get coverage from the new insurance exchanges.

That is true. As long as their constituents have access to “in-person support sessions” like the ones being conducted at the Capitol and congressional office buildings by the local exchange and four major insurers. Or can log on to a special Blue Cross and Blue Shield website for members of Congress and use a special toll-free telephone number — a “dedicated congressional health insurance plan assistance line.”

And then there is the fact that lawmakers have a larger menu of “gold plan” insurance choices than most of their constituents have back home.

While millions of Americans have been left to fend for themselves and go through the frustrating experience of trying to navigate the federal exchange, members of Congress and their aides have all sorts of assistance to help them sort through their options and enroll.

Lawmakers and the employees who work in their “official offices” will receive coverage next year through the small-business marketplace of the local insurance exchange, known as D.C. Health Link, which has staff members close at hand for guidance.

“D.C. Health Link set up shop right here in Congress,” said Eleanor Holmes Norton, the delegate to the House from the nation’s capital.

Insurers routinely offer “member services” to enrollees. But on Capitol Hill, the phrase has special meaning, indicating concierge-type services for members of Congress.

If lawmakers have questions about Aetna plan benefits and provider networks, they can call a special phone number that provides “member services for members of Congress and staff.”

On the website run by the Obama administration for 36 states, it is notoriously difficult to see the prices, deductibles and other details of health plans.

It is much easier for members of Congress and their aides to see and compare their options on websites run by the Senate, the House and the local exchange.

Lawmakers can select from 112 options offered in the “gold tier” of the District of Columbia exchange, far more than are available to most of their constituents.

Aetna is offering eight plan options to members of Congress, and Blue Cross and Blue Shield is offering 16. Eight are available from Kaiser Permanente, and 80 are on sale from the UnitedHealth Group.

Lawmakers and their aides are not eligible for tax credit subsidies, but the government pays up to 75 percent of their premiums, contributing a maximum of $5,114 a year for individual coverage and $11,378 for family coverage. The government contribution is based on the same formula used for most other federal employees.

In debates leading up to passage of the Affordable Care Act, members of both parties suggested that all Americans should have coverage as good as what Congress had. President Obama said in 2009 that people should be able to buy insurance in a marketplace, or exchange, “the same way that federal employees do, same way that members of Congress do.”

For decades, members of Congress have received coverage through the Federal Employees Health Benefits Program. They generally like their coverage, but — like millions of Americans facing the loss of their policies next year — they cannot keep it.

In the past, if lawmakers did nothing in the open enrollment period, their coverage would automatically continue. This year, by contrast, they must affirmatively pick a plan. Their coverage under the federal employee program will end on Dec. 31. If they do not choose a plan via D.C. Health Link by Dec. 9, they will lose the government contribution to their premiums and could lose their right to retiree health benefits as well.

In addition, lawmakers who go without insurance next year may, like other Americans, be subject to tax penalties.

Some congressional aides, especially older employees who face higher premiums, are unhappy about the changes. But some who carefully compare their options on the exchange find that they can save money. Contribute to Our Reporting

Jacqueline A. Thomas, a 26-year-old legislative correspondent for Representative Debbie Wasserman Schultz, Democrat of Florida, said she was able to reduce her monthly premium to $60, from $120, by switching to a Kaiser plan from a Blue Cross and Blue Shield plan.

“I’ll be paying half as much for comparable coverage,” she said.

The congressional work force is full of young, healthy people like Ms. Thomas, precisely the type of customer insurers want to attract.

Congressional aides naturally have a few complaints. Some are confused by the large number of options. When they sign up for a plan online, they get no confirmation, so they are apprehensive. In addition, the website for the local exchange does not display the government contribution for members of Congress and their aides.

It shows, for example, that a couple with one child may pay $1,300 a month for a plan, when, in fact, their share of the premium is only $352; the government pays $948. Local exchange officials said their website had not been set up to calculate premium contributions using the formula required for lawmakers and other federal employees.

One part of the new insurance program is veiled in secrecy. Lawmakers may allow some or all of their employees to keep their current insurance by declaring that they do not work in the “official office” of a member of Congress. Members do not have to disclose such decisions, though some have voluntarily done so.

Thus, for example, a spokesman for Representative Darrell Issa, Republican of California, said the congressman had decided that all of his staff members, including those who work in his personal office, could stay in the Federal Employees Health Benefits Program and would not have to go into an exchange.

By making it easier to compare the costs and benefits of different health plans, the exchange could make it e

asier for insurers to compete with Blue Cross and Blue Shield, which has long dominated the market on Capitol Hill. For its part, Blue Cross and Blue Shield says it can best meet the needs of lawmakers and their aides because its national plans have a large network of providers, including nearly 90 percent of all doctors in the United States.

One perk is not in danger. Lawmakers can receive care from the attending physician to Congress, conveniently located in the Capitol, for an annual fee of $576. And they can get care at military hospitals.

Settlement in case of former Delaware pediatrician Earl Bradley, guilty of raping or abusing patients

The lawsuits contended Beebe could have prevented future attacks by Bradley if the staff had reported him to Delaware's medical disciplinary board, which licenses and disciplines physicians.

Del. child abuse victims notified of settlement payouts
Cris Barris
The (Wilmington, Del.) News Journal
November 25, 2013

WILMINGTON, Del. -- More than 1,400 victims of former Delaware pediatrician Earl B. Bradley have been sent letters detailing the amount of money they will receive from a $122 million settlement from a class-action lawsuit against Beebe Medical Center, the Medical Society of Delaware and a handful of doctors.

Bruce L. Hudson, a Wilmington, Del., attorney who represented about 150 former patients of the Lewes, Del., doctor who filmed himself raping about 100 children, including babies, and abused hundreds of others, said victims and their families will finally learn how much they will be compensated.

"It's been a long time coming," Hudson said of the case, which began with 17 victims suing in March 2010, a few months after Bradley was charged with multiple counts of rape. "They are finding out for the first time that they are going to be awarded money and how much."

Beebe, which once employed Bradley and cleared him of wrongdoing involving his medical treatment of young girls, was accused along with other defendants of knowing he posed a threat but failing to report him to authorities.

Besides the allegations that occurred while he was employed at Beebe in the mid-1990s, Bradley abused patients at an office in Milford, Del., and also at his Disney-themed BayBees Pediatrics from the late 1990s until his December 2009 arrest.

The settlement money, from which attorney fees are being deducted, is roughly $112 million from Beebe's insurance carriers, $7 million from Beebe and $3 million from the Medical Society and other defendants.

“It's been 14 years and it will be a good thing to able to close this chapter and not talk about it again. ” — Mother of victim, now 21

Hudson said 1,402 patients filed claims, and all will get some compensation. Victims, almost all of whom are still minors, have been divided into five different categories depending on the degree of abuse a mediator determines they suffered, and all victims in that category will get the same award.

The exact amounts of the awards for those in each category have not been made public. But a source familiar with the case said those in the highest category, entitled, "Clear and Convincing Evidence of Intercourse," will get roughly $400,000 to $500,000.

Those in the lowest category, "Child Was Likely Not Abused," will get a nominal fee of about $1,000 to $2,500. The source was not certain of the exact amounts for each category, but wanted to stress that no victim is getting anywhere near $1 million.

"Of the hundreds of victims, not all were injured equally," Hudson told The (Wilmington, Del.) News Journal last year when the parties were negotiating the settlement. "Some are horrendously scarred. Others have more minor cases. There won't be an equal distribution but there is going to be an equitable distribution."

Victims and their families have until the end of the year to appeal their classification and once those appeals are finalized, attorneys said they expect to distribute the money early in 2014.

The handful of adults who filed claims will receive the money, but awards for minors will be overseen by Chancery Court and guardians assigned to each child. Families wishing to make withdrawals for expenses for health, education or other reasons must get permission from the court, Hudson said.

Bradley, who was convicted in August 2011 of raping or abusing 86 patients whose attacks he videotaped, was sentenced to 14 life terms plus 164 years in prison.

He often used promises of toys or candy or ice cream to convince parents to let him take their children to others parts of his office, which were equipped with video cameras, where he would rape or molest babies and toddlers. The average age of his victims was 3, prosecutors said.

“It's been a long time coming. They are finding out for the first time that they are going to be awarded money and how much.” — Bruce L. Hudson, attorney representing about 150 former patients

The mother of one victim who was 7 when she said she watched Bradley inappropriately penetrate her during a 1999 exam and screamed at him said she has not yet received her award but is satisfied the case is finally being resolved.

The woman, whose daughter is 21, said she expects her daughter to be in one of the top two categories and receive a six-figure settlement.

"It's been 14 years and it will be a good thing to able to close this chapter and not talk about it again," said the woman, who is not being identified in keeping with The News Journal's policy not to identify victims of sexual abuse.

The money will help pay educational expenses for the daughter, who is in college and considering graduate school and perhaps a down payment on a home. "She won't have to start at the bottom like most kids do when they get out of school," the mother said.

In the lawsuits, patients accused Beebe of negligence and dereliction of duty. Hospital officials investigated Bradley in 1996 after a nurse reported inappropriate vaginal exams -- specifically that he catheterized many of the girls he examined.

The lawsuits contended Beebe could have prevented future attacks by Bradley if the staff had reported him to Delaware's medical disciplinary board, which licenses and disciplines physicians...

Wednesday, November 20, 2013

Why are American doctors paid so damn much?

Chart: Why are there so few doctors in the US?

Because the medical establishment has intentionally limited the number of doctors in this country--so doctors could make more money by serving more patients. Of course, this has resulted in poorer medical care.

"This is yet another reason not to shed too many tears for doctors. They've basically brought this on themselves. If the market were allowed to produce as many doctors as there's demand for, they'd already be getting paid less. Right now they're enjoying the substantial rents that come from squeezing their own supply, and they've fought like lemmings for decades to keep it that way." -- Kevin Drum

Why Are American Doctors Paid So Damn Much?
By Kevin Drum
Mother Jones
Nov. 20, 2013

Conservatives have picked up today on a Kaiser Health News piece reporting on doctor complaints that insurers plan to pay them less for Obamacare patients than for other patients:

Insurance officials acknowledge they have reduced rates in some plans, saying they are under enormous pressure to keep premiums affordable. They say physicians will make up for the lower pay by seeing more patients, since the plans tend to have smaller networks of doctors. But many primary care doctors say they barely have time to take care of the patients they have now.

Matt Yglesias is unsympathetic. He says American doctors are very well paid and should quit griping: "If we ever reach the point where American doctors have been squeezed so badly that they start fleeing north of the border to get higher pay in Canada, then we've squeezed too hard. Until that happens, forget about it."

That's pretty cold. But if you really want to know what's going on, take a gander at the chart... [above]. It's from the OECD, so it includes all of the world's relatively rich countries:

That's damn peculiar, isn't it? If Econ 101 is to be believed, higher pay should produce more doctors. And yet, even though the United States pays doctors far more than any other country on the globe, we're in the bottom third. We have more doctors per capita than poorish countries like Mexico and Poland, but far fewer than Belgium and Britain and Germany—all of which pay doctors considerably less than we do here. So what's going on?

As Matt says, the basic answer is that U.S. doctors operate as a cartel. They artificially limit their own ranks, which drives up their compensation.

What we really ought to be doing is working to further pressure the incomes of doctors through supply-side reforms. That means letting nurse-practitioners treat patients without kicking a slice upstairs to an M.D., letting more doctors immigrate to the United States, and it means opening more medical schools. Common sense says that since the population both grows and ages over time, there should be more people admitted to medical school today than were thirty years ago. But that's not the case. Instead we produce roughly the same number of new doctors, admissions standards have gotten tougher, and doctors have become scarcer.

This is yet another reason not to shed too many tears for doctors. They've basically brought this on themselves. If the market were allowed to produce as many doctors as there's demand for, they'd already be getting paid less. Right now they're enjoying the substantial rents that come from squeezing their own supply, and they've fought like lemmings for decades to keep it that way. You can hardly blame them for that, but there's no reason the rest of us should put up with it. It's time to fight back.

Thursday, November 14, 2013

Former Quebec doctor in custody on murder warrant in fatal stabbing of his kids

People don't want to believe that some doctors are evil. In fact, just because a doctor is a cardiologist doesn't mean he has a heart.

What was the first judge in this case thinking? How can a blackout that occurred AFTER the killings make a man not criminally responsible??? Is the judge really confused, or did he have some motivation to exonerate a rich, important person?

Former Quebec doctor in custody on murder warrant in fatal stabbing of his kids
By Andy Blatchford
The Canadian Press
November 13, 2013

Former Quebec doctor in custody on murder warrant in fatal stabbing of his kids

MONTREAL - A former Quebec doctor ordered to face a new trial in the fatal stabbings of his children is in custody again.

Police in Quebec say Guy Turcotte surrendered Wednesday just hours after Quebec's top court ordered a new trial in the case.

The Crown said it intended to charge Turcotte, once again, with two counts of first-degree murder.

Police said Turcotte was to be arraigned on Thursday.

Turcotte is the former cardiologist who was charged after his children were repeatedly stabbed one night in February 2009.

He was found not criminally responsible at his 2011 murder trial, when a jury accepted his argument he could not recall the events and had experienced blackouts.

The case made Turcotte a household name in Quebec and the verdict provoked a torrent of outrage.

His case was one of several infamous court decisions that helped spur new federal legislation aimed at making it harder for those found not criminally responsible to gain their freedom.

Turcotte's first trial heard that his young son and daughter were stabbed 46 times.

He was freed after 46 months of detention in a prison and, eventually, a mental institution.

"An arrest warrant was issued today for Guy Turcotte so that he would appear before the courts to answer two charges of premeditated murder," Crown spokesman Jean-Pascal Boucher told reporters.

Boucher said only a Superior Court judge would be authorized to grant any request by Turcotte to be released pending his new trial.

He did not know when the case will be heard, but he insisted prosecutors would work to hold the trial as soon as possible.

The Crown welcomed the decision earlier in the day by Quebec's Court of Appeal with "satisfaction," Boucher said.

The court ruled that legal errors were committed in Turcotte's original trial — including by the Superior Court justice who presided over it.

In the 2011 trial, the jury heard Turcotte drank washer fluid later in the evening of the killings in what he said was an attempt to end his own life. The Crown said a not-criminally-responsible verdict should be reserved only for cases of mental illness, not ones where a suicide attempt might have triggered an after-the-fact blackout.

The appeals court verdict sided with such critics.

"The burden of proof was on the accused to show that he was suffering from an incapacitating mental illness — distinct from the intoxication symptoms — and it was the jury's job to decide," said Wednesday's ruling.

"But the judge did not remind jurors of that distinction."

The appeals court conceded that the judge had a difficult role, and wasn't helped by the fact that the Crown argued its points in a way that was "sometimes confused."

That being said, according to the appeals court, "his instructions (to the jury) were deficient, which necessarily had a major impact on the verdict."

The defence argued during the appeal process that the Crown had plenty of time to raise objections before the jury went into deliberations.

Attorney Pierre Poupart told the court in September that both sides agreed to the parameters of the trial and the Crown knew what was at stake when the not-criminally-responsible defence was introduced.

Poupart argued that the jury came to a reasonable verdict and he stressed it was important for the appeals court to avoid being used as an unofficial 13th juror.

The mother of the two children, Turcotte's ex-wife, told the French-language CBC TV network that she welcomed the appeals court decision to order a new trial as a "necessary evil."

Isabelle Gaston, who has become an outspoken advocate for justice reform, had been bracing herself for the possibility of living through another trial, proceedings that would once again hear the gory details of the killings.

Gaston, who gave the interview before the Crown announced it had issued an arrest warrant for Turcotte, said Wednesday's court decision took her by surprise, at a time when she had finally found inner peace for the first time since the deaths of her young children.

Turcotte's case has already prompted reaction from Ottawa.

Earlier this year, the federal government tabled the Not Criminally Responsible Act. The bill, C-54, would give the court fresh powers to create a new high-risk category that would hold mentally ill offenders longer, without a formal review, and make it far more difficult for them to leave psychiatric facilities.

It would also keep victims' families informed about the status of such individuals and alert them when they are released.

Wednesday, November 13, 2013

Experts Reshape Treatment Guide for Cholesterol

Experts Reshape Treatment Guide for Cholesterol
New York Times
November 12, 2013

The nation’s leading heart organizations released new guidelines on Tuesday that will fundamentally reshape the use of cholesterol-lowering statin medicines, which are now prescribed for a quarter of Americans over 40. Patients on statins will no longer need to lower their cholesterol levels to specific numerical targets monitored by regular blood tests, as has been recommended for decades. Simply taking the right dose of a statin will be sufficient, the guidelines say.

The new approach divides people needing treatment into two broad risk categories. Those at high risk because, for example, they have diabetes or have had a heart attack should take a statin except in rare cases. People with extremely high levels of the harmful cholesterol known as LDL — 190 or higher — should also be prescribed statins. In the past, people in these categories would also have been told to get their LDL down to 70, something no longer required.

Everyone else should be considered for a statin if his or her risk of a heart attack or stroke in the next 10 years is at least 7.5 percent. Doctors are advised to use a new risk calculator that factors in blood pressure, age and total cholesterol levels, among other things.

“Now one in four Americans over 40 will be saying, ‘Should I be taking this anymore?' ” said Dr. Harlan M. Krumholz, a cardiologist and professor of medicine at Yale who was not on the guidelines committee...

Sunday, November 10, 2013

Utah doctor Martin MacNeill guilty of killing wife, leaving her in tub

How many doctors are secret sociopaths? Is it possible that lack of ethics is an advantage for doctors in administrative positions? How much did Martin MacNeill care about his patients?

Utah doctor Martin MacNeill guilty of killing wife, leaving her in tub
A jury only took hours to convict a Provo, Utah doctor and former Mormon Church official in connection with his wife's 2007 death. NBC's Mike Taibbi reports.
By Paul Foy
The Associated Press
Nov. 8, 2013

PROVO, Utah - A jury convicted a doctor of murder early Saturday in the death of his wife six years ago, bringing an end to a trial that became the nation's latest true-crime cable TV obsession with its tales of jailhouse snitches, forced plastic surgery, philandering and betrayal.

Martin MacNeill was accused of knocking out Michele MacNeill with drugs after cosmetic surgery, then leaving her to die in a tub like one that was displayed during the trial.

...MacNeill was medical director of the Utah State Development Center, a residential center for people with cognitive disorders, who moonlighted in other medical jobs, once consulting for a laser hair removal clinic. He had a law degree but wasn't known to practice law and has since surrendered his law and medical licenses.

The highlight of the three-week trial was a mistress who MacNeill introduced as a nanny within weeks of his wife's death. His older daughters quickly recognized Gypsy Willis as his secret lover and said her mother had been arguing with her husband over the affair.

The daughters went to work uncovering what they call their father's secret life. They abandoned him while dogging authorities to open a murder investigation. It wasn't until MacNeill's release in July 2012 from a federal prison in Texas on charges of fraud that Utah prosecutors moved to file charges of murder and obstruction of justice.

Willis also served a federal sentence for using the identity of one of MacNeill's adopted daughters to escape a debt-heavy history. That daughter had been sent back to Ukraine, supposedly only for a summer.

For a time, MacNeill's only family defender was his only son. Damian, a 24-year-old law student, committed suicide in January 2010, according to his sisters, who have said he was haunted by their mother's death.

Prosecutors said MacNeill might have gotten away with a perfect murder, but his erratic behavior the day of his wife's death and shortly afterward was "dripping with motive."

They reminded jurors about testimony that MacNeill stood in the bathroom yelling what prosecutors called phony grief, "Why did you do this? All because of a stupid surgery," as paramedics tried to revive his wife.

Family testimony suggested it was MacNeill who insisted his 50-year-old wife, a former local beauty queen in her California hometown, get the surgery. Prosecutors said he used it as an excuse to mix painkillers, Valium and sleeping pills for her supposed recovery.

"Make no mistake, the defendant's fingerprints, if you will, are all over Michele's death," Grunander said.

Prosecutors say MacNeill contrived a medical condition in the weeks leading up to his wife's death, telling many around him he was dying of cancer or multiple sclerosis to absolve him of any motive in the death. He also made use of a cane and could be seen limping at times.

Investigators who subpoenaed MacNeill's own medical records found he was in good health. And they discovered something else: MacNeill had been collecting veteran benefits for decades, saying in an application he had bipolar or anti-social disorders.

MacNeill's arrest warrant contains a former girlfriend's explosive allegation — not used at the trial — that MacNeill killed a brother and tried to kill his mother long ago.

Utah investigators confirmed the brother, Rufus Roy MacNeill, was found dead in a bathtub in New Jersey. They determined MacNeill was never charged and found no indication he was ever under investigation for it.

Lowering urates reduces kidney disease

Urate-Lowering Cuts Complications From Gout
Alice Goodman
November 08, 2013

SAN DIEGO — Patients with gout who remain on urate-lowering therapy are less likely to develop kidney damage leading to chronic kidney disease than untreated patients, according to results from a large study.

There was an economic incentive to conduct this study, said lead investigator Gerald Levy, MD, a rheumatologist from Kaiser Permanente Medical Group in Downey, California. "Gout has increased dramatically over the past 20 years. With it, associated costs — including office visits, urgent care, emergency department visits, and hospitalizations — have gone up to about $1 billion per year."

Kaiser Permanente of Southern California covers 3.6 million people. "This is a big pile of patients," Dr. Levy told reporters attending a news conference here at the American College of Rheumatology (ACR) 2013 Annual Meeting.

"A number of studies show that people with renal disease can develop hyperuricemia, and some will also develop gout. We wanted to see if reversing uricemia would have an impact on renal disease," he explained.

Investigators identified 111,992 patients with serum uric acid levels above 7 mg/dL in the Kaiser Permanente database.

Of these, 16,186 had been tested for serum uric acid levels and glomerular filtration rates at least once in the 6 months prior to study entry and at least once during the follow-up period.

All of these patients were followed for 36 months from the first documented high serum uric acid level. Patients were grouped into categories: never treated with urate-lowering therapy (n = 11,192), on urate-lowering therapy less than 80% of the time (n = 3902), and on urate-lowering therapy more than 80% of the time (n = 1092).

Almost all of the patients receiving treatment were also on allopurinol (98.3%).

"Achieving serum uric acid below 6 mg/dL — as per ACR guidelines — was protective and associated with a 37% improvement in renal outcomes," Dr. Levy said. "These patients represent the real world."

Table. Effect of Urate-Lowering Therapy on Serum Uric Acid

Treatment Hazard Ratio 95% Confidence Interval P Value
Less than 80% of the time 1.27 1.05–1.55 .01
More than 80% of the time 1.08 0.76–1.52 .68
Serum uric acid at goal 0.63 0.50–0.78 <.0001

Patients taking urate-lowering therapy more than 80% of the time were older, sicker, and more likely to have a diagnosis of gout. They also initiated therapy earlier than patients in the other 2 groups.

Worse outcome was associated with age, being female, hypertension, diabetes, congestive heart failure, previous hospitalizations, higher serum uric acid level at entry, and rheumatoid arthritis. There was no difference in the number of deaths in the 3 groups.

A limitation of this study is that it was observational and retrospective, and some data points were missing, noted Dr. Levy.

"The next group of studies will assess whether we can actually improve renal function by lowering serum urate levels. We need to demonstrate this and see how long it takes to show improvement," he said. "We found changes in 36 months, and we believe these changes take place early. If we can prevent progression to chronic kidney disease and dialysis, this would have tremendous cost savings."

News conference moderator, Christie Bartels, MD, from the University of Wisconsin in Madison, noted that "the data for urate-lowering therapy in hyperuricemia are compelling, but we still need a prospective randomized controlled trial. The study findings are a plug for ACR guidelines for gout therapy, because many patients do not get to goal," she said.

Rheumatologists need to give patients a reason to stay on medications, Dr. Bartels added, and the fact that urate-lowering therapy might prevent a gout attack and preserve the kidneys could be that reason. " This is especially important in gout patients who present with kidney problems initially," she noted.

Dr. Levy and Dr. Bartels have disclosed no relevant financial relationships.

ACR 2013 Annual Meeting: Abstract 857. Presented October 27, 2013.

Saturday, November 2, 2013

Do doctors help medical students by allowing them to practice on patients who are not considered important? CA issues fines against hospitals

The California Department of Public Health usually relies on self-reporting by doctors and hospitals, which happens rarely, I have observed.

Adverse Events Draw $775K in Fines at 9 CA Hospitals
Cheryl Clark
HealthLeaders Media
October 28, 2013

The most recent round of administrative penalties for hospital deficiencies constituting immediate jeopardy includes two patient falls resulting in deaths, a wrong-site surgery, and a retained surgical object.

>>>Slideshow: CA hospitals penalized for medical errors

At Sharp Memorial Hospital in San Diego, a surgical team took out a man's healthy left kidney instead of his cancerous right one because the hospital didn't make imaging studies viewable in the operating room and because the surgeon "forgot" how to log-in to see them before cutting into the patient.

At Antelope Valley Hospital in Lancaster, a patient returned to the emergency department three times before doctors realized they had forgotten to remove a 9 x 6-inch surgical device. According to state officials, the device was not included in the instrument count.

And at Community Regional Medical Center in Fresno, a surgeon left the OR after instructing a physician's assistant to finish the surgery, which the assistant was not trained to complete. The patient suffered major blood loss, cardiac arrest, and loss of oxygen to the brain. At the completion of a state investigation, the patient remained on life support.

These major adverse events in California hospitals are among 10 detailed in state documents accompanying $775,000 in administrative penalties to these hospitals, which state officials announced last week. The fines are assessed once state investigators determine that lapses in regulatory compliance caused or likely caused serious injury or death to a patient.

Since these penalties began in 2007, the state had issued 295 penalties to more than 155 of the state's 400 acute care facilities, according to a statement issued Thursday by the California Department of Public Health.

Including the latest round of penalties, the state has assessed $13.3 million in fines and has collected $10.1 million. Most of the $3.2 million not yet collected is under appeal by the hospitals that dispute the state's findings.

The funds are to be used for programs to improve healthcare safety.

In a phone interview Thursday, Debby Rogers, deputy director for the state Department of Public Health's Center for Healthcare Quality, refused to comment on any particular hospital's harmful event, but acknowledged that some incidents are more serious than others.

New regulations due to take effect by the end of the year, will allow the state to consider how much patient harm was done "and how widespread inside the hospital a particularly deficiency is."

"We feel strongly that publicizing these deficiencies helps hold these facilities accountable but it also empowers consumers to speak to their providers to put protections in place so something like this doesn't happen," Rogers said.

...At Community Regional Medical Center, Fresno, Fresno County, a patient admitted for ascending aortic aneurysm repair suffered massive blood loss, cardiac arrest, and loss of oxygen to the brain after the heart surgeon left the operating room prior to the closure of the patient's chest during open heart surgery.

The surgeon instead directed a physician's assistant "to be left in charge,
an individual not qualified to be left in charge of the cardiovascular surgery."

State investigators said the patient's loss of blood "required reopening the chest and manual massage of the heart." The patient was subsequently placed on life support.

Asked for an explanation, the surgeon said he had allowed the physician's assistant "to practice above her privilege card as 'she was preparing for an advanced quality practice exam and for that, she needed so many cases with opening and closing the chest and to cannulate the heart." The surgeon said he had always been there when she did this procedure "until this time."

State investigators wrote that the incident was reported through "an anonymous complaint," suggesting that the hospital may not have properly reported the incident as required by law.

The penalty is $75,000. This is the hospital's second administrative penalty...

10 California hospitals fined a total of $675,000
August 15, 2013
By Ari Bloomekatz
Los Angeles Times

Ten California hospitals, including Ronald Reagan UCLA Medical Center and Hollywood Presbyterian Medical Center, were slapped with fines Thursday totaling $675,000 because they failed to follow certain licensing requirements that "caused, or was likely to cause, serious injury or death to patients."

The fines ranged from $50,000 to $100,000, according to a news release from the California Department of Public Health.

St. Jude Medical Center in Fullerton, for example, was fined $100,000 for its fifth administrative penalty, according to the release.

"Based on observation, interview and record review, the hospital failed to follow their policy and procedure to have relevant images and results properly labeled and displayed prior to a patient's surgery," according to documents provided by the public health department. "This failure resulted in the removal of the wrong kidney."

The penalty against UCLA's hospital was for not following the proper surgical policies and procedures that led to "a patient having to undergo a second surgery to remove a retained foreign object." The hospital was fined $50,000...

Cheryl Clark seems to be working for a magazine, Health Leaders, that is genuinely interested in improving the practice of medicine

Cheryl Clark seems to be working for a magazine, Health Leaders, that is genuinely interested in improving the practice of medicine.

Cheryl Clark
Health Leaders
Nov. 2, 2013

Are you a journalist interested in how doctors practice medicine?

A position is opening up at the company I work for that I would seriously consider applying for. You'd write for hospital providers and physicians about issues in service lines, ethics, physician culture and behavior, relationships with hospital administrators, care appropriateness, medical training and certification, fraud, regulatory changes that are pivoting doctor pay toward outcomes measurement for the whole patient and away from the "pay per visit" and lots of other stuff.

You'd write 50 weekly columns a year and 1,700 (or so) -word articles for our monthly print magazine, HealthLeaders.