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...

CVS/Caremark Sends Letters to Tufts Members Containing Personal Information Like Medical Conditions/Meds Info to Wrong Patients–Attack of the Killer Algorithms Chapter 24

This is chapter 24 addressing flawed data this time.  The article said that CVS would not discuss this, well if you are in technology you know what happened, it was a rogue algorithm, in other words a programming error and this is what “The Attack of the Killer Algorithms” is all about.  This time it was private information sent to the wrong people but what’s it going to be next time.  If you read my series on the “Attacks” there’s tons more like this.  This why we need not rush the programming that takes place with developers.  Companies who put rushed deadlines on developers of software and push for releases before...

Conversations on End-of-Life Care with Ira Byock (Free Podcast)

What's the best way for a physician to talk with a patient? What are appropriate boundaries when it comes to patient care? How do palliative care and hospice work together? What's right - and wrong - about our approach to end-of-life care in the United States?The answers to these and other questions posed by Hospice Foundation of America's Hank Willner, M.D., are contained in an audio interview with Ira Byock, M.D., a national leader in end-of-life care. Their interview marks the debut of HFA's audio program, Professionally Speaking, available at no charge on HFA's website to listen online or downlo...

Small Businesses Question Health Insurance Tax Being Affordable–Economics Have Changed Since Law Was Written-Tax “Millionaire Data Sellers” Instead - Much Bigger Pot To Make Up for Lost Budget Funds

If you read here often enough you may have stumbled across my little campaign to tax the profits that banks, corporations, high frequency traders, drugs store chains and so on make getting “data for nothing and the profits for free”.  The potential is huge if Walgreens made just under $800 million on their SEC statement in 2010 and I would almost guess they could have broke a billion in 2011.  Why should the big conglomerates profit so heavily and the “algorithmically generated profits” be so high?  There’s no incentive to set up factories and hire people when a company can grab a couple programmers, write the web mining algos...

Alaska Senator Defends Ban of Unilateral DNR Orders

Alaska Senator Fred Dyson has an op-ed in the Alaska Dispatch defending his proposed SB 172.  He writes:  "In a recent meeting with the Providence Executive Leadership Team, I was told that the doctor always has the last word on a DNR order, regardless of patient consent. Providence maintained this was true even if the patient had full capacity to make all their own health care decisions and understood the risks and benefits of an attempt at CPR."  Dyson continues:  "The question is whether current law gives a patient, with capacity, the right to make a DNR order ineffective. I maintain it does, and SB 172 seeks to clarify...

Roche Cutting the Price of 2 Cancer Drugs in India To Potentially Avoid Compulsory Law Provisions That Allows Generic Drugs When Cost Is Not Affordable

It was just last week that India took the very first step to make cancer drugs more affordable with Bayer and it looks like Roche might see some writing on the wall.  We all know how expensive cancer drugs are and how unaffordable they can be for the patients who need them most. India Authorizes Local Drug Manufacturer to Make and Sell Generic Copy of Patented Bayer Cancer Drug To Make It Affordable By jumping ahead of the game and making the drugs affordable up front they could stand to remain outside of the laws in India and again hopefully they will be affordable.  The two drugs Herceptin and Mabthera will also be renamed to market...

Worried If your ACO Is Going to Be Too Costly? HCP Offering Accountable Care Reinsurance–Once You Figure Out What Your ACO Model Is…

It didn’t take long for this to pop up especially with so many unknown factors that are out there today as even the best laid plans with analytics are in a model, technology can show up tomorrow and throw a left hook at any time.  We have a lot of created and non-created disruptions in healthcare and some good and some not so good. ACO Stop Loss Reinsurance is the actual name and there premiums paid and it can be spread over a number of payments.  Many managed care organizations have purchased re-insurance policies as well and sells malpractice insurance to doctors as a primary business.  Last year in the Cayman Islands, Aetna...

IBM Watson Going to Work at Memorial Sloan-Kettering Cancer Center–Data Loading and Training To Begin

This is actually very good to compile cancer data and we can certainly learn from it.  The process will take a while as the data has to be fed in.  When used for diagnosis knowledge, patient input, drugs, and so forth this is great.  Even big data has the same issues though as what we have used for years and that is being assured of what data you load as it’s still a machine.  At the end of 2011 it was also announced that on the west coast that Cedar Sinai was going to explore the system for the same or similar purposes.  Wellpoint to Bankroll Use of IBM Watson at Cedar Sinai Medical Center to Research Cancer Data/Information...