Medicare regulation revives end-of-life planning

From the Associated Press:

 new health regulation issued this month offers Medicare recipients voluntary end-of-life planning, which Democrats dropped from the monumental health care overhaul last year.

The provision allows Medicare to pay for voluntary counseling to help beneficiaries deal with the complex and painful decisions families face when a loved one is approaching death.

But the practice was heavily criticized by former Alaska Gov. Sarah Palin and some other Republicans who have likened the counseling to “death panels.”

The “voluntary advance care planning” is included in a Medicare regulation issued Dec. 3 that covers annual checkups, known as wellness visits. It goes into effect Jan. 1.

The new regulation was first reported by The New York Times.

For years, federal laws and policies have encouraged Americans to think ahead about end-of-life decisions and make their wishes known in advance through living wills and similar legal documents. But when House Democrats proposed last year to pay doctors for end-of-life counseling, it touched off a wave of suspicion and anger.

Opponents said end-of-life planning should be left to families, while proponents said doctors’ advice was a basic element of health care.

Prominent Republicans singled it out as a glaring example of government overreach. Palin’s use of the phrase “death panels” solidified GOP opposition to the health care bill.

The Joint Commission Appoints New CMO


The Joint Commission said Wednesday it appointed Dr. Ana Pujols-McKee as its new executive vice president and chief medical officer.

McKee will work on developing policies and strategies that promote patient safety and improve quality in health care. Her responsibilities will include supporting The Joint Commission’s Patient Safety Advisory Group and offer clinical guidance for the organization’s Center for Transforming Healthcare.

“Ana has a well-deserved reputation as a dynamic leader who forms strong, effective partnerships that promote health care quality and patient safety,” Dr. Mark Chassin, the organization’s president, said in prepared remarks. “Her talents will serve The Joint Commission well as it continues to focus on helping health care organizations excel in providing the highest quality and safest care that Americans expect and deserve.”

McKee currently serves as the CMO and associate executive director for Penn Presbyterian Medical Center, University of Pennsylvania Health System. She is also an associate professor of medicine at the University of Pennsylvania School of Medicine in Philadelphia.

Obese Drivers at Higher Risk of Death in Car Crashes: Study

From US News and World Report:

Here’s another reason not to pile on too many excess pounds: A new study finds that the obese and very obese are at raised risk of death in severe car crashes.

According to the research, published in the American Journal of Emergency Medicine, a moderately obese driver is 21 percent more likely to die in a severe motor vehicle crash compared to non-obese drivers, while being severely obese hikes the risk of death by 56 percent.

However, being just slightly overweight seemed to lower the odds for death in a severe crash: these drivers were actually less likely to die than either underweight or normal-weight drivers, according to researchers at the University at Buffalo School of Medicine and Biomedical Sciences.

In the study, the researchers analyzed data from the national Fatality Analysis Reporting System involving almost 156,000 drivers in severe motor vehicle crashes occurring between 2000-2005. The researchers included all fatalities occurring within 30 days of a crash.

Docs warn some: Step away from the shovel

From the Boston Herald:

That’s heart-attack snow out there, heavy and wet, the experts say.

Docs say the best way to shovel for both your heart and your back is to pay a 16-year-old. But if you insist on moving the stuff yourself, here are some things to think about.

“A lot of people are out of shape and don’t realize how heavy the (physical) demand is,” said Assaad Sayah, chief of emergency medicine for Cambridge Health Alliance.

He said the messy, wet snow dropped around Boston overnight is exactly the kind that health-care professionals fear . . . it raises the likelihood that they’ll have some heavy lifting to do themselves in the ER today.

Couch potatoes who pick up their shovels without taking precautions account for an increase of up to 20 percent in the number of patients showing up in emergency rooms with heart attacks.

Keep a visit to the ER out of your holiday plans

Some good advice from  Top 4 ways to avoid the ER:

1.  If traveling, don’t forget your medication.

2.  Use caution if you get out the ladder.

3.  Don’t drink and drive.

4.  If it’s been a year since you’ve seen Grandma, she’s aged since you’ve seen her last.  This doesn’t necessarily mean she needs to go to the hospital.

Full story here.

Doctor’s lawsuit against medical examiner tossed

From The Des Moines Register:

Woodbury County’s medical examiner had the right to notify state regulators of his suspicions that a local surgeon’s mistakes contributed to three patient deaths, a federal judge ruled this week.

Judge Linda Reade threw out a libel lawsuit filed last year by the surgeon, Dr. Ralph Reeder, against the longtime medical examiner, Dr. Thomas Carroll.

State medical regulators had worried that the lawsuit would discourage other doctors from reporting concerns about their colleagues’ possible malpractice.

The Iowa Board of Medicine, which licenses physicians, charged Reeder with incompetence in 2008, then withdrew the charges for lack of evidence. Reeder denied the allegations. He sued Carroll after learning that the licensing board’s investigation had been sparked by a 2004 letter from the medical examiner. Carroll, who performed autopsies on two of the three patients, suggested in the letter that the surgeon’s spinal operations contributed to the deaths.

Reeder said in his lawsuit that he spent more than $200,000 defending himself against false allegations that damaged his reputation in the Sioux City area. He contended Carroll wrote the letter out of spite, partly because Reeder was a co-owner of a small South Dakota hospital that the medical examiner believed was unfairly drawing business away from Sioux City hospitals.

Chief U.S. District Judge Linda Reade dismissed Reeder’s lawsuit Tuesday. She noted that physicians are required to tell regulators if they believe a colleague has committed malpractice. State law says people who file such reports “shall not be civilly liable as a result of filing a report with the board, so long as such report is not made with malice,” she wrote.

Mark Bowden, the medical board’s executive director, said such lawsuits crop up from time to time. They always raise fears that health professionals will hesitate to tell regulators about suspected malpractice. “This decision hopefully will reduce the chilling effect,” he said.

Reeder’s lawyer, Charles Patterson, said he hadn’t decided whether to appeal the decision. He said the surgeon is an excellent doctor whose work had never been questioned before. “He is really, in every sense of the word, a victim of circumstances he couldn’t control,” Patterson said.

Doctor Arrested in Whistle-Blowing Case

From the New York Times:

Texas officials have filed criminal charges against a West Texas physician over accusations that they say he orchestrated against two nurses who had filed a complaint against him with the state medical board.

The physician, Dr. Rolando G. Arafiles Jr., who practices at Winkler County Memorial Hospital in Kermit, Tex., was charged late Tuesday by the state attorney general’s office with retaliation and misuse of official information, the latter being the same charge that was leveled against the nurses. Both of the charges against Dr. Arafiles are third-degree felonies that carry a maximum sentence of 10 years in prison and a $10,000 fine.

In a case that alarmed advocates for whistle-blower protections, the two nurses were fired by the hospital and prosecuted in 2009 after anonymously reporting Dr. Arafiles for a variety of surgical and prescribing practices. After learning of the Texas Medical Board investigation, Dr. Arafiles consulted the sheriff in Winkler County, a personal friend, who seized the nurses’ computers and found their letter to the board, which included patient case numbers. Kermit, a town of 7,000 people about 400 miles west of Dallas, is the county seat.

The arrest warrant charged that Dr. Arafiles misused official information by asking a hospital employee to provide contact information for patients whose case numbers were listed in the nurses’ complaint. He then provided that information to the sheriff, who contacted the patients as part of his investigation.