Legal Fundamentals of Surrogate Decision Making

My article, "Legal Fundamentals of Surrogate Decision Making" has just been published in Chest.  Here is the abstract:The four previous articles in this series have traced the history of patient autonomy and have identified its ethical and legal foundations. Patient autonomy is highly valued in the United States to the extent that the patient does not lose the right of self-determination when he or she loses the capacity to make health-care decisions for him or herself. The law has devised several tools to promote “prospective autonomy.” One mechanism is the instructional advance directive or living will. But most of us do not write such...

Fist Fight and Love Triangle In Pennsylvania Costs One CEO His Job -

A job paying $4.5 million a year is not easy to come by, at least in my area of the world it’s not.  He used to have clout and now with this all over the media, I guess time will tell if it stays or goes away.  This is bizarre as his mistress as she is called moved out from her home with her husband, and then the former CEO, Melani hired a private detective to follow her.  Something must have been cooking as he showed up and the husband was there and it sounds like that’s what erupted into a fist fight.  Highmark as a company also has this battle in place with UMPC.  Hospitals and Insurance Company Competing...

Neupro Patch Gets FDA Approval for Advanced Stage Idiopathic Parkinson’s Disease and Restless Leg Syndrome

The patch is worn for a day and contains a sulfite, sodium metabisulfite that some are allergic to and you have to watch for a few other drug interactions with anything that causes drowsiness and there’s a side effect of hallucinations and that side effect is higher with those who have Parkinson’s disease.  Another side effect is an urge to behave unusually, urges to gamble or increased sexual urges.  This is right off the website with the warnings.  The drug is said to stimulate dopamine receptors that regulate movements.  BD BRUSSELS & ATLANTA--(EON: Enhanced Online News)--UCB announced today that the U.S. Food...

Express Scripts and Medco Get Federal Approval To Merger Valued at $29 Billion - Is It All About Data to sell for Bigger Profits?

This means more mail order prescriptions on the way eventually as almost all health plans today have one.  I wonder how this affects chain pharmacies like Walgreens who are still disputing contract amounts with Express Scripts.   Blue Cross members can’t get prescriptions there so now does it all switch over to Medco?  Express Scripts to buy Medco for $29 Billion–Medco 2nd Quarter Profits Were Down 4% And the Profit Algorithms Once Again Are Hard at Work To Control Costs via Acquisition   The initial announcement of Express Scripts was announced in July of 2011.  When you add in Caremark as the other large...

Over Diagnosing for Breast Cancer? Report Suggests Some Treatments Were Not Needed

This is one that I know about through my mother as we had this happen.  It turned out she did not have breast cancer and a “mass” was found.  I’ll make this brief but she was over-diagnosed when the x-ray was blown up to further investigate.  That lead to a biopsy which was also messed up and if she would have gone for treatment for this tiny miniscule mass they found with radiation, she may not be here today at age 87 and this was about 3 years ago when all this occurred.  Upon consulting with a veteran surgeon who went over everything in detail he said yes she has a mass but it was not cancer and he has done a ton of surgeries...

Oracle Buys Cloud Based Clinical Trial Application Company–ClearTrial

It was not too long ago that Oracle Larry Ellison received an award for his contributions to Health IT from the NIH.  We see the move with analytics all over healthcare today so this makes sense for Oracle to be in this business. Oracle and Clear Trial will continue to operate as separate companies and biopharmaceutical, device and diagnostic companies are under more pressure than ever today to keep things in a budget for sure.  BD   Larry Ellison Announced As Distinguished Medical Informatics Awardee for His Contributions to Health IT and the Ellison Foundation From the Friends of the National Library of Medicine...

Study Suggests that Pay for Performance Incentives for Hospitals Is Not Leading to Better Patient Outcomes

Back in January of 2011 we had another study saying the same thing so we can add one more bit of information to the theories that pay for performance are worthwhile? Does this further suggest that insurers all over are not getting their money’s worth?  If hear from their side, which if focused on reimbursements you might hear a different story but I’ll take the clinical side any day as we know all about the algorithms built for profit and it’s getting harder to do both with better clinical outcomes and at the same time apply fixes for the payments.  Sure hospitals are getting to be a lot smarter with “running the business” but...

Expiration Date - Theater on Facing Death

If you are in Minneapolis during the next week, head over to Uptown to see Expiration Date.  This was an impressive and moving theater piece about facing death.  It was under 90-minutes long.  After a nice ride along the Mississippi and a bluff-side picnic, this was a fantastic capstone to my afternoon.&nb...

New Book - "It's OK to Die"

Dr. Monica Williams-Murphy vividly recalls performing emergency chest compressions on a 100-year-old nursing home patient with advanced dementia.  Lacking a 'Do Not Resuscitate' order, Williams-Murphy was obligated to do all she could to try to save a woman that she knew was beyond saving.  "I wasn't going to bring her back to something better." That experience got the Huntsville, Alabama Hospital emergency department physician thinking about why frail elderly people often get the "full-court medical press" at the end, rather than being allowed to slip away peacefully.   The result is "It's OK to Die," a new self-published...

A Third Generation Approach to Medical Futility

In the latest issue of Health Care Ethics USA [20(1), Winter 2012], Ron Hamel and Michael Panicola contribute "Enhancing Communication and Coordination of Care: A Third Generation Approach to Medical Futility."  Hamel is Senior Director of Ethics for the Catholic Health Association.  Panicola is Director of Ethics for SSM Health Care in St. Louis.  They trace the history of approaches to futility:  (1) definitional, (2) procedural, and (3) surrogate selection.  But they found that these approaches were not adequately addressing a significant increase in futility cases at SSM acute care facilities.  Futility...

Idaho Anti-Futility Bill Passes House and Senate

Doctors and nurses in Idaho could soon face stricter limits on when they can withhold care to dying patients without the patient's consent.  The House voted 57-12 Wednesday along largely party lines to approve a measure some pro-life groups say is needed to bolster respect for people's lives - at the end of their lives.  The Senate already approved the measure, so it's headed to Gov. C.L. "Butch" Otter's desk.  House sponsor Rep. Erik Simpson of Idaho Falls said the bill remedies loopholes that could allow physicians to deny life-prolonging treatments against the wishes of patients' family members.  But Democrats including House Minority Leader John Rusche, a medical doctor, worried this measure creates potential conflicts with laws meant to protect medical...

Hospitals and Insurance Company Competing for Patients In Pittsburgh–Contracts In Question

In this case it’s Highmark and UPMC in the Pittsburg area.  It’s interesting to listen to the comments in the video and the “deals” are discussed here.  They bring up United Healthcare buying up physician’s groups and we have that big in the OC.  United Healthcare Acquisition of Monarch Healthcare HMO Already Causing Confusion and Access Problems for Blue Shield Patients in Orange County Health Insurance Contracts at the OC Corral–Lawsuits, an ACO and A Lot of Mixed Up and Confused Patients As Data Disruption and Patient Care Move Center Stage… This is really getting tough for patients and again being here in the OC I am...

Orange County Oncology Doctor Who Couldn’t Stop Defrauding Medicare Will Get His License Back After He Serves Time & House Sold for Just Under $10 Million

This was the oncologist that couldn’t help himself and made millions and on top of this the government seems to have messed up with the auctioning of his big house.  The sale of his house was supposed to pay off damages and give the government some money back but the government liens were not filed against the Justices as individuals so the trustee says they will get zero. The house by the way sold for just under $10 million so the defrauding business was good while it lasted and this was his second go around as he was slapped on the hands basically the firs time.  If there were big payments due on that house, no wonder he couldn’t...

The Wrath of Dr. Khan–ER Versus Medicine Video (Humor)

This is just too funny…only an ER doctor…and glad he has a sense of humor too.   img alt="" galleryimg="no" onload="var downlevelDiv = document.getElementById('9771e981-a59a-427c-ad42-d14c59481db7'); downlevelDiv.innerHTML = "";" src="//lh3.ggpht.com/-3aFthKrrnJY/T3QJ_-Pf6LI/AAAAAAAA6GM/CtcKl0LyqdU/videoa3b956e554b3%25255B18%25255D.jpg?imgmax=800" style="border-style: none">Wrath of Dr. Khan     We certainly need a break now and then.  BD Technorati Tags: Hunor,ER,doctor,heatlhcare,medicine,silly,Star Trek...

A Helping Handbook - When a Loved One is Critically Ill

A FREE 50-page resource for caregivers, patients and families facing terminal illness.What do you say to someone who is critically ill? How can you provide comfort and honesty? How do you handle your fear, sadness and anger? How can you effectively deal with busy doctors? What do you say to yourself when you're alone? A HELPING HANDBOOK--WHEN A LOVED ONE IS CRITICALLY ILL provides a private place to explore and express conflicting feelings, paving the way with inspirational poetry.&nb...

Idaho Anti-Futility Bill Proceeds to Second Chamber

Idaho S.B.1348, which has already been passed by the Idaho Senate, was today cleared by the House State Affairs Committee.  (Spokesman Revi...

BATS Stock Exchange IPO Rogue Algos–Attack of the Killer Algorithms Chapter 25–See How Other Killer Algorithms Occur in Every Day Life With Healthcare & Credit

If you haven’t figured this one out yet, it’s about computer code and “rogue” algorithms and this can happen at any time, any place and so forth.  Most all in tech know that even the best engineers cannot predict when and where but they do happen and you can reflect back on the big Amazon cloud disruption that took place last year.  We don’t like it of course but it’s something we have to live with and the folks at BATS were smart in shutting it down immediately and not seeing a a self heal function would take place.  In addition, the circuit breaking “code” algorithms kicked in, which is a good thing.  Smart engineers made...

Discussion on Supreme Court Hearing on Healthcare Reform–How Will This Play Out With Current Day Algorithms of Commerce And Unintended Consequences-Video

Do we think that they are immune from politics is one of the questions discussed here.  Granted there are changes to be made and amendments but to throw out Healthcare revision totally is not wise. When you stop and think of all the unintended consequences that will arise, it’s scary.  Again I go back to reviewing how it will play out with IT infrastructure as that’s what’s running the country anyway once it is put in place.  You do have to admit as complicated as things are today you have to do your best to look at each portion and what changes would take place.  The business and banking areas are prepared as they always...

US Chamber of Commerce Working on Full Scale Mission With Seeking Life Sciences Opportunities in Israel

You can see some of the major companies included in this area and when you think of it a lot of the Intel technologies for chips has come from Israel for a long time; however in this instance the focus is Life Sciences.  Biotech conventions in Israel are also very hot and I do website that features interviews with many of the CEOs of Israeli companies and you can view a collection here.   Another example is the Mayor of Akron who attended the ILSI BioMed Conference last year, getting educated and seeing what biotech interests he could bring back to hospitals in his city.  BD  video platformvideo managementvideo solutionsvideo...

Poet Sheila Black considers pain, disability, selfhood and ‘the problem of normal’

Interesting blog posting by Robin Amer about how poet Sheila Black has been inspired by the depictions of pain and selfhood evident in the work of Freida Kah...

Decision Making for the Unbefriended Patient

The first of my two-part series with Tanya Sellers on decision-making for the unbefriended patient has been published in The Journal of Clinical Ethics 23(...

"Expiration Date" - Minneapolis Theater on Confronting Death

I just bought my tickets for this theater work called Expiration Date.  A Health Care Directive workshop will be offered free to the community following the Sunday, April 1 matinee performance. This workshop is made possible through a partnership with Honoring Choices Minnesota, an effort of the Twin Cities Medical Society and its Foundation to encourage families and communities to have discussions regarding end-of-life care choices. Here is a description of the play:EXPIRATION DATE is a new multidisciplinary, solo theater work created and performed by Candy Simmons. What would you do if you had six months to live? For some...

The Law of Unwanted Resuscitation

Much of my blogging (and much of my scholarship) focuses on the situation in which healthcare providers want to refuse patient- or surrogate-requested life-sustaining treatment.  But an equally or even more common situation is one in which clinicians provide life-sustaining treatment that the patient does not want.  For example, the patient might be resuscitated contrary to her living will, advance directive, DNR order, or POLST.  I started collecting these sorts of cases here.  I am preparing a comprehensive summary and assessment of legal liability for unwanted resuscitation in much the same manner that I did here for medical futility.  I would greatly appreciate referral to relevant court cases, administrative sanctions, or other...

Physicians and Safe Harbor Legal Immunity

My law review article, "Physicians and Safe Harbor Legal Immunity" has been published in 21(2) ANNALS OF HEALTH LAW 121-135.  The draft version is available here but will be replaced shortly with the as-published version.  Here is the abstract:Professor Sandra Johnson has identified what she calls physician’s “bad law” claims. In some circumstances, physicians perceive that there is significant legal risk in doing what they think is clinically appropriate. In response, physicians sometimes take a medically inappropriate course of action, because it appears safer. For example, physicians might feel intimidated by aggressively enforced drug control laws. In response, they may under-treat patients’ pain to avoid perceived (and real) threats of investigation, discipline,...

“Remote Area Medical–California” Begins Four Day Free Medical Clinic in Oakland–Volunteers Needed

Folks are traveling all the way from Napa to get care at the free medical clinic.  RAM does good work and thank goodness they are here and this is a reminder of the failing healthcare system in the US for sure. The same problem exists in California as they have had at other free clinics and that is getting enough volunteers.  RAM was just in Sacramento and Oakland last year and has done a lot in California.  RAM has grown to have it’s own California branch so again what does that tell you about people needing medical care and having to go to the Coliseum to get it.  Remote Area Medical Wraps Up Free Medical Care Clinic...

Wells Fargo Bank Files Suit Against Medical Development Intl Over Loan Defaults And Asked Judge to Appoint Receiver–Business Analytics Tactics and Algorithms Questioned

With $55.3 million in assets and $74.9 million in liabilities the money analytics are alive and running.  Medical Development according to the article here says that Well Fargo became a “corporate raider” to divert company assets.  Part of their business is in the Healthcare Analytics area with consulting for provider solutions.  The site states they have been a government contractor for years and has built healthcare networks and has a contract with the VA and also offers solutions for self funded employers.  From the website below: “MDI works along with healthcare payers to provide custom care networks, efficient administration...

FDA Considering Digitally Driven Kiosks for Self Diagnosis With Specific Conditions Via Algorithmic Processes

If you have heard or read the news of late it has been all over that the FDA is considering making certain drugs available over the counter that are now prescription only.  With that thought they are also investigating to see if a Kiosk would be able to assist with helping patients find the correct medications along with doing a self diagnosis.  We have seen the kiosks that tele connect but these would be without the pharmacist and all done by the machine.  You can see what they have done in the UK with tele-pharmacists at the link below. MedCentre Prescription Kiosk ATM-Like Machines May Give Pharmacies Some Competition in the...

More Intervenors in Cuthbertson v. Rasouli

Ten days ago, I observed it was good news that more parties were intervening in the important Cuthbertson v. Rasouli case pending before the Supreme Court of Canada.  It now appears there are even more intervenors.  The complete list now includes:Consent and Capacity Board      Euthanasia Prevention Coalition               Canadian Critical Care Society    Canadian Association of Critical Care Nurses       Advocacy Centre for the Elderly and ARCH Disability Law Centre               Mental Health Legal Committee and HIV & AIDS Legal Clinic Onta...

Minnesota to Host Public National Healthcare Decisions Day Events

Organizations throughout the state are collaborating to lead a massive effort highlighting the importance of advance care planning —an initiative that has culminated into naming April 16 National Healthcare Decisions Day (NHDD). In recognition of NHDD, a community-wide open-house will be held on Sunday April 15, from 1:30PM to 5:00PM at the Hilton Minneapolis/St. Paul Airport – Mall of America hotel in the Riverside Room, located at 3800 American Blvd. East, Bloomington, MN. This event is supported by Greater Twin Cities United Way. Community members are encouraged to come and get answers to their healthcare directive questions, complete an advance care directive and to help set a World Record for completing the most healthcare directives in one day! The FREE event will feature a panel...