With Hawaii physicians leaving the state and hospitals suffering a shortage of personnel, doctors have pointed to high malpractice insurance rates as a major factor in Hawaii’s medical crisis.

In spite of this, malpractice tort reform appeared to die on February 14 as Senator David Ige’s (D-Pearl City-Aiea) Senate Health Committee refused to pass bills out of committee which would have limited malpractice awards for non-economic damage.

But reform was quickly resurrected in the House with Rep. Josh Green (D-Kona) inserting tort reform language favored by Governor Linda Lingle into a house bill by Rep. Angus McKelvey (D-West Maui).

Interestingly enough, neither Representative is leading the way on the hottest health care issue of the season–proposals to allow construction of Malulani hospital on Maui.

McKelvey is an opponent of Maui’s proposed privately funded Malulani hospital calling a bill to allow Malulani’s construction, “a slap in the face to West Maui”.

Speaking to Hawaii Free Press’, Green criticizes Malulani’s application for a Certificate of Need as “substandard” claiming that Malulani’s proposal would have paid nurses and physicians less than the existing Maui Memorial Medical center –an assertion which Malulani supporters dismiss as “ridiculous”. Yet Green and McKelvey are leading the way on tort reform.

Why is reform still alive? A clue comes from Rep. Green. Asked by Hawaii Free Press what is the most important message the public needs to get about malpractice tort reform, Green indicated that the threatened closure of Oahu’s Kahuku Hospital came in large part because of the soaring cost of the hospital’s malpractice insurance. Said Green, “it went from $70,000 to $430,000.”

That is the change from 2002 to 2004, cited in The Honolulu Advertiser. In 2005, according to Pacific Business News, Kahuku’s malpractice insurance went even higher–costing $456,000.
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Tailored treatments facing long road before being norm

Genes can be powerful predictors of a person’s future health problems, but testing a patient’s genes to tailor treatment strategies remains at the cutting edge of health care and legal professions.

The promise behind personalized medicine is that genetic tests can be used to craft ways to detect, treat or delay disease. Yet using genetic tests to tailor health care strategies is rarely done. These tests are too expensive for the typical patient, and many doctors aren’t trained properly to administer, assess or use the tests for patient care.

“It is clearly the wave of the future. It’s where people are going,” said Terry Roman, a partner at Snell & Wilmer law firm in downtown Phoenix. “The challenge often is that the legal and ethical worlds have not caught up with genetic testing.”
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Doctors, lawyers and labs that offer genetic testing envision a day when genetic tests will become a routine part of clinical care, much like cholesterol screens that are regularly used to help prevent heart disease.

Many things need to happen before personalized medicine becomes routine care, though. Not all doctors are convinced that DNA triggers a disease as much as environmental or lifestyle factors. Ethical concerns persist about how data from genetic tests will be used.

Perhaps the biggest hurdle is the expense to administer the tests and whether insurers will pick up some costs as part of standard care.

Gary Marchant, executive director of the Center for the Study of Law, Science & Technology at Arizona State University, said lawsuits will force doctors to take a closer look at using genetic tests.
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Prescription Drugs | Former New England Journal of Medicine Editor Angell Criticizes Pharmaceutical Companies at Event in Tennessee

Former New England Journal of Medicine Editor Marcia Angell of Harvard Medical School in Memphis, Tenn., on Thursday “continu[ed] her public criticism” of pharmaceutical companies, the Memphis Commercial Appeal reports. Angell, author of the 2004 book “The Truth About the Drug Companies: How They Deceive Us and What To Do About It,” has accused drug companies of price gouging and conducting biased research, among other allegations. During the speech, Angell said drug companies are “involved intimately in every detail of the research” for new drugs, and “they design the research so that their drugs look better than they really are.” Angell also has called for the federal government to negotiate directly with drug companies for the Medicare prescription drug benefit and said the structure of the current program benefits companies more than beneficiaries. Ken Johnson, senior vice president of the Pharmaceutical Research and Manufacturers of America, on Thursday said, “Marcia Angell’s misguided solution is to let government bureaucrats choose medicines for patients instead of allowing patients and their doctors to determine the best course of treatment.” Johnson also criticized a recent Boston Globe opinion piece by Angell that criticized PhRMA president and CEO Billy Tauzin, who is a former member of Congress. In the opinion piece, Angell wrote that Tauzin sponsored the Medicare drug benefit, then left his position in Congress soon after the legislation passed. Angell wrote, “He was rewarded with a high-paying job as chief executive of the pharmaceutical industry’s trade association.” Johnson said Tauzin left Congress because he was diagnosed with cancer and accepted the position at PhRMA after a drug produced by a firm in the industry group helped him to overcome his disease. Johnson wrote, “This experience made him an advocate for researching and developing new medicines to fight diseases” (Connolly, Memphis Commercial Appeal, 2/23).

Handouts prompt some area health systems to impose stricter rules

Dr. Lydia R. Best prepares to take blood from Deborah McClendon at the Covenant Community Care Center in Detroit. The pharmaceutical industry defends its practices. See full image

Strict rules
Just over a year ago, a group of influential physicians proposed that the nation’s 125 university medical centers adopt strict regulations on doctors’ ties to drug makers. Writing in the Journal of the American Medical Association, the group called for seven regulations:
# All gifts, of any value, from company to doctor should be banned.
# Free drug samples should be banned and replaced with a voucher system for low-income patients.
# Doctors who have financial relationships with drug companies should be excluded from committees that select which drugs are used.
# Drug companies shouldn’t directly sponsor continuing medical education.
# Drug companies shouldn’t directly pay for doctors to travel to meetings, but travel grants through a central account are acceptable.
# Doctors shouldn’t serve on drug companies’ speaker bureaus or publish articles ghostwritten by industry employees.
# Consulting contracts and research grants from drug companies are acceptable, but they should focus on science, not marketing, and the details should be made available on a public Web site.
Source: Journal of the American Medical Association

Nancy Bentivolio has seen pharmaceutical sales representatives plenty of times in the waiting room of her doctor’s office. They come in smartly dressed, lugging briefcases and samples, and are often ushered right in while patients wait.

For Bentivolio, 72, their presence is part and parcel of the business of a doctor’s office, and one that has helped her get free samples.

“They benefited me so much,” she said of the samples that helped treat her rheumatoid arthritis when she didn’t have insurance.
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Michelle Sonnier’s triplets are finally home from Christus Schumpert Hospital. They spent several weeks in the hospital, but Michelle’s stay was much shorter, thanks in part to this technology.

A home uterine monitoring system helps moms with high-risk pregnancies stay at home longer before giving birth.

Dr. John Waterfallen is Michelle’s obsterician.

He says, “Any patient with premature labor is able to stay out of the hospital and be monitored at home. It’s especially useful with multiple pregnancies with twins or triplets because often times, they’re going to have a lot of contractions.”

Those early contractions can keep high-risk pregnant women going back and forth to the hospital for weeks or even put them in the hospital a month before they actually give birth. But this system cuts that out. The first step is to attach this monitor around your waist for an hour.

Medical personnel receive the data through the telephone line. They check the contractions and let the mom-to-be know when it’s really time to go. A device that helped Michelle stay at home longer instead of a having long stay in the hospital.
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