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Old September 2nd, 2002, 19:56
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August 11 - August 17, 2002

Saturday, August 17, 2002

Unitarian Church Calls For an End to the War on Drugs

In a recent "Statement of Conscience", the Unitarian Universalist Association of Congregations called for an end to the war on drugs as a matter of conscience. Some exerpts:

* For United States taxpayers, the price tag on the drug offensive has soared from $66 million in 1968 to almost $20 billion in 2000, an increase of over 30,000 percent. In practice the drug war disproportionately targets people of color and people who are poverty-stricken. Coercive measures have not reduced drug use, but they have clogged our criminal justice system with non-violent offenders. It is time to explore alternative approaches and to end this costly war.

* The war on drugs has blurred the distinction between drug use and drug abuse...Yet many people who use both legal and illegal drugs live productive, functional lives and do no harm to society.

* Legal prohibition of drugs leads to inflated street value, which in turn incites violent turf wars among distributors. The whole pattern is reminiscent of the proliferation of organized crime at the time of alcohol prohibition in the early twentieth century. That policy also failed.

* Instead of the current war on drugs, we offer the following policies for study, debate, and implementation...Establish a legal, regulated, and taxed market for marijuana. Treat marijuana as we treat alcohol.

Comment: this is a thoughtful review of the failed US led "war on drugs." It is important in that it comes from the Unitarian Universalist Association. article ]  


Friday, August 16, 2002

Court Upholds California's Limits on 'Emotional Distress'
NewsMax.com Wires. Tuesday, Aug. 13, 2002. SAN FRANCISCO – Relatives of patients allegedly victimized in medical malpractice cases may not sue for "emotional distress" unless they witness the injury and are aware of what is going on at the time, the California Supreme Court ruled Monday.

The ruling came at a time when a number of medical organizations have warned that doctors were being forced to give up their practices because of multimillion-dollar jury awards that were catapulting malpractice insurance premiums out of their reach. In a unanimous decision, the court found that two women who were at the hospital did not have a valid claim for "negligent infliction of emotional distress," or NIED, as a result of surgery performed on their mother in 1994 that nearly ended in tragedy because they were not in the operating room when surgeons nicked a major artery, causing the elderly woman to suffer serious bleeding that triggered a frantic effort to save her life. "The plaintiffs have not shown they were aware of the transection of [the patient's] artery at the time it occurred," the court said. "Nor have they shown they were contemporaneously aware of any error in the subsequent diagnosis and treatment of that injury in the moments they saw their mother rolled through the hallway by medical personnel." Janice Bird and her sisters, Dayle Edgmon and Kim Moran, had sued three doctors on the claim they witnessed the incident in which their mother, Nita Bird, wound up in a critical-care ward after what was supposed to be a 20-minute outpatient procedure at a Los Angeles-area hospital on Nov. 30, 1994. The two daughters who were at the hospital that day, Bird and Edgmon, contended that they suffered emotional distress when, after an hour of waiting, they began hearing from hospital personnel that the procedure to implant a chemotherapy catheter had run into problems and that their mother might have suffered a stroke. Moran, the third daughter, was told of the situation by telephone. Their growing alarm was fueled by calls over the hospital loudspeaker for a thoracic surgeon to respond immediately, the sight of a doctor hurrying by carrying an armload of blood units, and the sight of their mother, her blue coloring indicating a lack of oxygen, being wheeled down a hallway into emergency surgery. The court disagreed however, and concluded that state law required a potential plaintiff to see the injury take place and to be aware that negligence was involved. In a statement that could have implications for future NIED suits, the court found that the adult daughters did not have the necessary medical knowledge to be aware that malpractice may have been involved in the code-blue crisis. "The problem with defining the injury-producing event as defendants' failure to diagnose and treat the damaged artery is that plaintiffs could not meaningfully have perceived any such failure," the decision said. "Except in the most obvious cases, a misdiagnosis is beyond the awareness of lay bystanders." The lawsuit and its potential impact on malpractice awards drew the interest of American Medical Association, which said in a June 5 amicus curiae, or friend-of-the-court brief, that a broader interpretation of who is eligible for NIED damages could have major implications in the financial survival of health care providers and the future access that family members will have to hospitalized patients undergoing treatments. "It may not be known when malpractice will occur, but it is known that, when it does occur, one or more members of a patient's family may be nearby," the brief said. "Moreover, health care professionals worried about potential bystander NIED liability can take steps to isolate the patient from his or her family." Bird's daughters said in their depositions that they knew something was amiss, but the court ruled that was not good enough and that the sisters needed to have witnessed the artery transection and known that a mishap had occurred. "Even if plaintiffs believed, as they stated in their declarations, that their mother was bleeding to death, they had no reason to know that the care she was receiving to diagnose and correct the cause of the problem was inadequate," the court said. Nita Bird survived the surgical procedures, but she died of cancer in 1996. Copyright 2002 by United Press International. All rights
reserved. Reprinted from newsmax.com [ article ]  


Thursday, August 15, 2002

Australian medical association calls for medical litigation rules overhaul
After a key medical insurer, St. Paul, stopped providing medical malpractice insurance in Australia, a medical liability crisis has been unleased in Australia. Liquidators were called in to help cover medical liability costs, but they can only guarantee coverage until the end of 2002. [ The Lancet Volume 360, Number 9331 10 August 2002 ]  


Wednesday, August 14, 2002

How to Keep Health Care From Being Sued out of Existence
Dave Eberhart, NewsMax.com, Tuesday, Aug. 13, 2002. The soaring cost of medical lawsuits is leaving some parts of America without health care. One state has a successful solution that could ease the problem nationwide, but powerful interest groups are ready to fight.


In one recent skirmish in the battle over tort reform, President Bush blasted, "What we want is quality health care, not rich trial lawyers.” Sen. John Edwards, D-N.C, a trial attorney whose lawsuits against doctors and insurance companies helped make him a multimillionaire, claimed that medical lawsuits were not driving up health care costs.


Circling the fray and playing a role perhaps best described as Florence Nightingale meets "M*A*S*H" is the American Medical Association. Like the TV sitcom, which fought the Korean War for a decade, AMA has been lobbying for years to persuade Congress to put a tourniquet on overzealous jury awards in malpractice cases.


Recently AMA brought reinforcements to the front by announcing a $15 million campaign to capture the minds and hearts of Congress and the American public. The professional association has identified a dozen states it says are in a medical malpractice ‘‘crisis.’’ The prescription: Have Congress impose a $250,000 cap on non-economic damages as well as limits on attorneys’ fees in malpractice case.


‘‘This is something that isn’t just affecting the economics of medical practices. In certain areas, it’s affecting the very existence of medical practices,’’ said Richard Corlin, M.D., past president of AMA.


Meanwhile, opposing forces such as Association of Trial Lawyers fight back with their own message. ‘‘[T]hey are wrong to think that the solution is to penalize people who have had their wrong leg cut off or the wrong side of their brain operated on or their breast cancer misdiagnosed, which is exactly what their proposal would do. It punishes the victim,’’ said Carlton Carl, spokesman for ATLA.


But many commentators suggest that the issue is more complex than the slogans suggest.


One theory is that embattled doctors are paying for the laissez-faire pricing of medical-malpractice insurance.


In the 1990s, medical-malpractice insurers began cutting their rates to attract customers and capital to invest in the then-lucrative financial markets. High returns on investments subsidized the doctors’ premiums.


Without regulation, however, premiums sank to a point as to be unable to cover the bills when the financial boom fizzled.


An article in the Wall Street Journal explained the origin of today’s insurance crisis as owing to a "price war” in which "shortsighted price slashing led to industry losses of nearly $3 billion last year.”


One example cited by the Journal: St. Paul Cos. stopped selling medical-malpractice coverage after suffering a $980 million loss. The company had insured more than half of Nevada’s 240 obstetricians. In Las Vegas, 90 obstetricians simply stopped taking new patients.


So What Is the Cure?


California prides itself on its handling of the dilemma.


In recent Capitol Hill testimony, Danielle Walters, executive vice president of Californians Allied for Patient Protection, described the medical liability insurance crisis that gripped California in the early 1970s.


"Liability premiums soared more than 300 percent, numerous medical liability carriers left the state completely and many physicians – particularly high-risk specialties such as obstetrics and neurosurgery – were forced to close their doors because they were either unable to get insurance or unable to afford the inflated rates.”


Then came the state’s Medical Injury Compensation Reform Act of 1975, which included such provisions as:


  • A $250,000 limit on non-economic damages.


  • Ensuring compensation for economic damages such as medical bills, lost wages, future earning, custodial care and rehabilitation.


  • Providing a statute of limitations on claims.


  • Ensuring the bulk of the award goes to the plaintiff by limiting attorney contingency fees on a sliding scale.


  • Requiring advance notice of a claim.


  • Allowing for binding arbitration of disputes.


  • Providing for periodic payment for future damages.



    No one can dispute Walters’ testimony that today California has a healthy and competitive medical liability insurance market and some of the lowest malpractice premiums in the United States. "When you compare California to other large, diverse states, physicians in California pay one-half to one-third of what their colleagues pay for the same liability coverage,” she told Congress.


    Why Not Copy This Success?


    So, if it is as easy as that, why haven’t all the states – never mind the feds – copied the California formula?


    It goes without saying that the special interests work to keep that from happening, but according to National Underwriter Co., simply copying the MICRA statutes would get a well-intentioned state legislature only halfway home.


    "The other half of the explanation [of the California success] lies in the dozens of court cases decided by the California Courts of Appeal and Supreme Court during the 27 years since MICRA was enacted – court cases that have fleshed out the all-important details of MICRA.”


    Attorney Victor E. Schwartz of Partner Shook, Hardy & Bacon agrees. In testimony on Capitol Hill he summed up the legal minefield waiting to vaporize legislation. "[W]hen States have passed balanced medical malpractice reforms, they have been nullified by state courts under obscure portions of very lengthy and prolix State Constitutions.”


    Perhaps the best solution: a revised version of MICRA in which the all-important details are addressed in the text of the statutes and not left to the interpretation of the courts.


    But even this apparently fail-safe plan is flawed, say tort reform’s glib opponents, such as Sen. Edwards. These perennial doomsayers profess over and over that lawmakers who enact tort reform should not expect insurance rates to drop.


    Joanne Doroshow of Center for Justice & Democracy, a group that opposes tort reform, cites a study, "Premium Deceit – the Failure of Tort Reform to Cut Insurance Prices.” At the heart of the paper is this announcement: "[T]he insurance industry never promised that tort reform would achieve specific premium savings.”


    "We would like to thank the insurance industry for finally admitting what is already obvious: that they have not cut, and have no plans to cut, insurance premiums for doctors, hospitals or other businesses as a consequence of ‘tort reform’ – restrictions on consumers’ rights to sue wrongdoers in court,” said Doroshow.


    Even if true, would insurance premiums not rise even more without tort reform?


    How One American Industry Was Saved From lawyers

    Despite such fighting words, experts point out that tort reforms can work and history proves it.


    The California success story aside, there is the case of the General Aviation Revitalization Act, signed by then-President Bill Clinton in 1994.


    In recent Hill testimony, attorney Victor E. Schwartz of Shook, Hardy & Bacon described how tort litigation was driving the general aviation industry out of business. Key players such as Piper and Cessna simply stopped producing planes.


    With tort reform stability came back to the industry, according to Schwartz. "Those companies are now back in business. Over 25,000 jobs have been created,” he pointed out.


    But what if commercial insurers were to reap and hold profits that arose from tort reform? One answer: The Federal Risk Retention Act would provide a vehicle to cut the windfall grabbers off at the pass. Under the long proposed legislation, doctors’ groups form their own insurance pool or insurance purchasing groups to shop among commercial insurers for a better price.


    At the end of the day, most internecine battles feature more intransigence than rationality and can wreak significant collateral damage.


    Lawyers Have One Party in Their Pocket


    Case in point: Though Republicans and Democrats agree on the need for a terrorism-insurance law, Republicans want to tack on limits on tort lawsuits. However, the powerful trial lawyer bloc opposes them, and it has plenty of allies in the Democrat-controlled Senate.


    It is raw testimony to the nettlesome nature of the issue that key "wartime” legislation that should have been a slam-dunk is in fact stalled.

    [ article ]  



  • Tuesday, August 13, 2002

    Book Review: You've Been Had!
    This book by epidemiologist Melvin Benarde makes the case that the media and environmentalists have turned American into a nation of hypochondriacs. [ BMJ 2002;325:343 ( 10 August ) ]  


    Preventing Falls in the Elderly
    This study of 1090 Australians over 70 years old found that group based exercise was the best way to decrease falls at home. The exercise seemed to cause improved balance. Group exercise was more effective than home hazard management and vision improvement. Comment: this adds weight to another study that showed that Tai Chi exercising reduced falls. [ BMJ 2002;325:128 ( 20 July )]  


    Monday, August 12, 2002

    Hand Lacerations < 2 cm Long Don't Need Suturing
    This study of 154 patients found that full-thickness uncomplicated hand lacerations less than 2 cm in length don't need suturing. Cosmetic outcome was the same whether or not the laceration was sutured. [ BMJ 2002;325:299 ( 10 August ) ]  
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