Archive for the ‘News Reports’ Category

Doctors Disciplined by Their Own Hospitals Escape Action by Licensing Boards. Who’s at Fault?

Thursday, March 24th, 2011

Public Citizen logo

Public Citizen recently posted a report that revealed an extremely disturbing failure by licensing boards and/or hospitals to take appropriate disciplinary action against physicians, who have had their hospital privileges revoked, suspended or restricted.

At the heart of this revelation is the fact that when a physician does have action taken against his/her hospital privileges, the hospital is required to report such negative, adverse action to the jurisdiction’s medical licensing board. Nevertheless, as Public Citizen reports, during the time period being analyzed by Public Citizen (1990 to 2009), almost 6,000 such physicians have escaped any disciplinary action by state medical boards.

Of 10,672 physicians listed in the NPDB (National Practitioner Data Bank) for having clinical privileges revoked or restricted by hospitals, just 45 percent of them also had one or more licensing actions taken against them by state medical boards. That means 55 percent of them – 5,887 doctors – escaped any licensing action by the state. The study examined the NPDB’s Public Use File from its inception in 1990 to 2009.

For anyone familiar with how hospitals operate, it usually takes some egregious conduct for a hospital to take action against one of its privileged physicians. Threats of lawsuits by the physician against the institution are many times the first defense taken by a physician causing many hospitals to back-down from taking any disciplinary action. Often, those called upon to review the conduct of their fellow physicians are hesitant to discipline their peers too harshly for a multitude of reasons – not the least of which is the concept of “there but for the grace of God go I.”

That being said, how is it that when such an extraordinary step such as revocation, suspension or curtailment of hospital privileges does take place, these physicians escape being disciplined by their state medical boards?

Dr. Sidney Wolfe, director of Public Citizen’s Health Research Group and overseer of the study, offers these thoughts:

One of two things is happening, and either is alarming. Either state medical boards are receiving this disturbing information from hospitals but not acting upon it, or much less likely, they are not receiving the information at all. Something is broken and needs to be fixed.

While I personally don’t purport to know the “reporting requirements” for all medical licensing boards throughout the United States, let me share with you the reporting requirements and legislative mandate of two jurisdictions with which I am familiar.

In Maryland, one need only look at the Maryland Board of Physicians (this state’s regulatory body) “responsible for licensing and disciplining physicians, physician assistants, respiratory care practitioners, licensed radiation therapists, radiographers, nuclear medicine technologists, radiologist assistants, and polysomnographic technologists” Hospital Reporting Requirements FAQ to get the answer as to whether or not such hospital actions are a “reportable event.”

By law, hospitals must report to the Board – within 10 days of action – any action taken that immediately affects the privileges of a practitioner or any other health professional regulated by the Board, based on any of the grounds listed in Sections 14-404 (Physicians), 14-5A-17 (Respiratory Care), 14-5B-14 (Radiation Therapists, Radiographers, Nuclear Medicine Technologists, and Radiologist Assistants), 15-314 (Physician Assistants), and 14-5C-17 (Polysomnographic Technologists) of the Medical Practice Act. These matters generally relate to questions of competence, performance, unprofessional practices and unethical practices.

In the District of Columbia, once you work your way through the maze of online links, you eventually find that it is the Board of Medicine, “a division within the DC Department of Health, Health Regulation and Licensing Administration (HRLA), that “has the responsibility to regulate the practice of medicine in the District of Columbia.

What is interesting is that on its website, the D.C. Board of Medicine takes pride in the fact that in 2010, Public Citizen, the very source of criticism of the various licensing agencies in the most recent 2011 report being discussed here, listed D.C. as No. 16 in the nation in “living up to their obligations to protect patients from doctors who are practicing substandard medicine.” A review of the 2010 report by Public Citizen reveals that D.C. had previously been ranked No. 42 in terms of “meeting its obligations” to “protect patients from doctors…practicing substandard medicine.”

So exactly where is the proverbial ball being dropped? Is it the hospital that is failing to report its adverse action to the medical board? Is it the medical board, having been told of the adverse action, that sweeps the sins of the offending physician under the rug? Whichever it is – and it’s most likely a combination of the two to some extent but more likely the latter – those who suffer in the final analysis are patients, who unknowingly come under the care of these questionable physicians.

We are not talking here about a physician, who is otherwise a competent, skilled practitioner in his or her area of specialty, but who has a “bad day” and renders substandard care to a patient. Unfortunately, that happens with some degree of regularity across the nation every day. For a hospital to go to the point of bringing one of its own up on disciplinary charges and taking adverse action against that physician is a major step – one reflecting by necessity such a level of incompetency, a pattern of unsafe, bad care, outrageous conduct and the like that it must call into question the overall competency, integrity and character of that physician. Then, if that is the case – which it clearly must be – why are such physicians allowed to simply pull-up stakes and move on elsewhere to practice their trade? How is this in the interest of patient safety, which is precisely one of the main reasons for the very existence of medical licensing boards?

Public Citizen didn’t just report the findings of its analysis; it did something about it.

Public Citizen today sent the report to Kathleen Sebelius, Secretary of the Department of Health and Human Services, urging the agency’s Office of Inspector General to reinstitute investigations of state medical boards, something it has not done since 1993. Public Citizen also is notifying the 33 medical boards that have had the worst records in disciplining these doctors.

We commend Public Citizen for its investigation and report. While it is no doubt important that this problem comes to light, it is even more important that it be corrected – and soon. Will Secretary Sebelius take action? Will the licensing boards clean-up their act now that their misdeeds have been brought to the public’s attention? If hospitals are, in fact, not reporting their adverse actions, will there be repercussions for this failure? When will medical boards do what they are constituted to do – protect the safety and well-being of patientsnot when they feel like it, but when they are mandated to do it?

An Unpleasant Truth About Insurance Coverage For Patients With Traumatic Brain Injuries

Thursday, March 10th, 2011

traumatic brain injury

Since Arizona Rep. Gabrielle Gifford was shot in the head about three months ago, the internet was flooded with articles about her recovery and the nature of her injuries. During this time, some news sources began to explore the nationwide availability of rehabilitation resources and insurance coverage for patients with traumatic brain injury (TBI). The truth about the availability of insurance coverage for TBI rehabilitation is truly frightening.

According to an article published by ABC News, insurance coverage and rehab services are quite scarce when it comes to patients who require long-term TBI rehabilitation. It appears that private as well a publically funded insurance plans, including Medicare and Tricare, exclude many types of cognitive rehabilitation services, particularly when the patient requires long-term placement in a nursing home or rehabilitation facility. As a result, thousands of patients, including U.S. military members and veterans are left without necessary TBI rehabilitation.

The Tricare Coverage Manual, for example,  states that “[c]ognitive rehabilitation services designed to improve cognitive functioning after a brain injury are not supported by reliable scientific evidence of efficacy.” Apparently, this attitude towards cognitive rehab is not uncommon in the insurance industry. Even America’s Health Insurance Plans (AHIP) claims that cognitive rehabilitation has no benefit to patients with TBI, according to Susan Pisano, a spokesperson for AHIP.

To better understand traumatic brain injury and how rehabilitation can give a TBI victim a meaningful life, watch this video by the Research Channel.

httpv://www.youtube.com/watch?v=FgtHvBF4t-E&feature=related

This resistance from the insurance industry persists despite the fact that cognitive rehabilitation has been shown to be quite helpful. According to the Brain Injury Association of America, a number of studies have shown cognitive rehab to be very effective for patients with TBIs.  If you or a loved one were denied coverage for TBI rehabilitation, we encourage you to share your story with our readers. How did you handle the situation?  If you were ultimately successful in securing insurance coverage, how did you do it? If you found other sources of funding for TBI rehabilitation, please share your story and information so others might benefit from your experience.

New Treatment Holds Promise for Patients With Spinal Cord Injuries

Wednesday, February 23rd, 2011

According to a recent article in Medical News Today, Functional Electrical Stimulation (FES) can significantly reduce disability caused by spinal cord injuries. The study was originally posted on line in the Journal of Neurorehabilitation and Neural Repair.

This relatively new treatment applies small electrical impulses to stimulate paralyzed muscles. The treatment has been shown to measurably improve a patient’s ability to pick up and hold objects. Dr. Popovic and his team concluded that FES should be used in conjunction with traditional physical therapy.

To see how this works, here’s an incredible demonstration by Children’s Hospital of an FES bicycle.

httpv://www.youtube.com/watch?v=27vIfWdB3wk

Here are some key facts about this study:

  • FES therapy uses low-intensity electrical pulses generated by a pocket-sized electric stimulator.
  • Unlike permanent FES systems, the one designed by Dr. Popovic and colleagues is for short-term treatment. The therapist uses the stimulator to make muscles move in a patient’s limb. The idea is that after many repetitions, the nervous system can ‘relearn’ the motion and eventually activate the muscles on its own, without the device.
  • The randomized trial, believed to be the first of its kind, involved 21 rehabilitation inpatients who could not grasp objects or perform many activities of daily living. All received conventional occupational therapy five days per week for eight weeks. However, one group (9 people) also received an hour of stimulation therapy daily, while another group (12 people) had an additional hour of conventional occupational therapy only.
  • Patients who received only occupational therapy saw a “gentle improvement” in their grasping ability, but the level of improvement achieved with stimulation therapy was at least three times greater using the Spinal Cord Independence Measure, which evaluates degree of disability in patients with spinal cord injury.
  • Based on their findings, the study’s authors recommend that stimulation therapy should be part of the therapeutic process for people with incomplete spinal cord injuries whose hand function is impaired.
  • Dr. Popovic’s team has almost completed a prototype of their stimulator, but need financial support to take it forward. Dr. Popovic thinks the device could be available to hospitals within a year of being funded.One limitation of the study is that the research team could not get all participants to take part in a six-month follow-up assessment. However, six individuals who received FES therapy were assessed six months after the study. All had better hand function after six months than on the day they were discharged from the study.
  • Dr. Popovic stresses that FES therapy should augment, and not replace, existing occupational therapy.
  • Another study, now underway, will determine whether stimulation therapy can improve grasping ability in people with chronic (long-term) incomplete spinal cord injuries.

If you or a loved one suffer from spinal cord injury, please consult with a physician about FES. In conjunction with physical therapy, this non-invasive medical procedure promises tremendous benefits to patients with spinal cord injuries. If you are aware of other studies or treatment relating to rehabilitation from spinal cord injuries, we encourage you to share your knowledge with our readers.

Baltimore Loses a True Sports Legend and a Gem of a Man – Ernie Tyler

Saturday, February 12th, 2011

Ernie Tyler - Baltimore Orioles Legend (photo by daylife.com)

Friday, on the way to the office, the news came across my car radio that Orioles Great, Ernie Tyler, had died. For those of you not from Baltimore or who don’t follow the Orioles, you might ask: “Who is Ernie Tyler? What was his ERA, or his batting average, on base percentage…?” Well, those were not statistics that were associated with this legend of Baltimore sports. You have no doubt heard about Baltimore’s Iron Man – Cal Ripken, Jr., who was drafted in the second round by the Orioles in 1978, played his final game on October 6, 2001, and set the all-time record for consecutive games played at an astounding figure of 2,632. Now you should know about Baltimore’s other Iron Man – Ernie Tyler, who put-up a bigger consecutive games number than Cal – 3,769.

Why haven’t you heard about this Iron Man? Why hasn’t he been featured by national media? Maybe because Ernie was one of those behind the scenes people, without whom the game would not be the same. The irony is, however, that Ernie really wasn’t behind the scenes; he was front and center at every Orioles game – he was the Orioles’ “umpires attendant,” who performed his job with grace, diligence and panache for over 50 years!

Sure, I saw Ernie performing his job whether I was sitting in my seat at a game or watching from my couch. I didn’t know the man personally, but every Orioles fan must have that feeling that they did know Ernie. He didn’t perform his tasks of delivering new balls to the home plate umpire with a unique flair or in some attention-grabbing outfit. When a foul ball was lying listless in the dirt behind home plate and needed to be removed so the game could play on, there he was, with what is described by former Oriole’s great, Mike Boddicker, as his “meat hooks” hands, swooping down on the ball, with his “side-to-side trot” in one graceful movement so the game could resume without delay. We all know that balls need to have the shine treated before games so that pitchers can get a better grip.

Ernie Tyler mudding-up the ball (photo by The Daily Record)

Well, it’s estimated that Ernie mudded-up over 350,000 balls for the games he oversaw. But stats are not what Ernie was all about. They belonged to the man, but he belonged to the fans of the Baltimore Orioles.

The “other Iron Man” breaks his streak for “the Iron Man”

If you want to get a glimpse of what this man was like and why he is revered by Baltimore fans, just ask yourself: how and why did Ernie’s consecutive games streak end? The answer: when Cal Ripken, Jr. was inducted into the Hall of Fame, he asked Ernie to attend. Having faithfully performed his duties from 1960 to 2007, without missing a game over that span of time, Ernie elected to break “the streak” and attend the celebration in Cooperstown, N.Y. Once the festivities were over, he dutifully returned to his place near the Orioles dugout and continued to do “his thing” for the next few years. Ernie was still snatching foul balls and replenishing the umpire’s supply of fresh balls, he had mudded-up well into his 80’s.

Loved by so many and now to be missed by all who knew him

The stories of Ernie and his love of the game, the Orioles, its players, its fans, the city of Baltimore and most of all his family are chronicled in today’s edition of the Baltimore Sun and need not be repeated here. For those of us who only “knew” Ernie from afar, he nevertheless left an indelible mark on our lives. He touched us – and I simply cannot be alone in this feeling – in a very special way. His passing brings to mind stories my father used to share with me as a boy of his growing up in Brooklyn and living next to players from the Brooklyn Dodgers. Time spent on the porch and sharing stories of the Bums, who walked the streets and worked the same jobs as many of their adoring fans. Ernie reminds me of a man of that era – a real baseball man, who lived and breathed the game and brought a smile to the faces of countless baseball fans. A legend among the gods of baseball – in his own special way.

Many have left the game with grace; some with not so graceful an exit. Many have touched the souls of countless fans of America’s sport. Those plaudits are usually reserved for the men who play between the lines from April to October each year. But when a man such as Ernie Tyler passes, a very special word of praise and thanks is in order. So – thank you, Ernie!  We’ll miss you dearly. You are a sports legend of a special kind; the kind of legend that permits the game to pass from generation to generation with grace and charm.

Related Stories

Tyler was the real Mr. Oriole…

Late Orioles umpires attendant Ernie Tyler was like family…(Peter Schmuck)

New Microchip Promises to Make Life Much Easier for Paraplegic Patients

Friday, February 11th, 2011

Hope for those with paraplegia?

Researchers in the U.K. have developed a revolutionary microchip muscle stimulator that will enable patients with paraplegia to exercise multiple muscles at the same time. According to the Engineering and Physical Sciences Research Council (EPSRC), the microchip developed by Professor Andreas Demosthenous from University College of London and his team is truly unique.

The microchip chip is small enough (approximately the size of a child’s fingernail) that it can be implanted directly into the spinal canal. Unlike previous models, the new implant incorporates the muscle stimulator and the electrodes into a singular unit.  The unit is properly sealed to protect against moisture, which could lead to corrosion of the electrodes.

The creation of the implant has been made possible by new laser processing technology, which enabled researchers to micro-pack all components into one unit. With this new laser technology, researchers were able to cut much tinier electrodes from platinum. The electrodes are then folded into a 3D shape that resembles pages in a book. Each electrode can be wrapped around a nerve root. The electrode is then welded to the microchip located in the spinal cavity.

Because the implant comes with multiple electrodes, which can be connected to multiple nerve roots, it is capable of controlling entire muscle groups. In patients with paraplegia, the devise can be used to stimulate or trigger multiple paralyzed muscles at the same time. Researchers also claim that the new device will also be used in patients with bladder or bowel incontinence.  Because the device has multiple electrodes, some electrodes can be connected to nerve roots that control bladder muscles or nerves that control bowel capacity.

Although all of this may sound a bit scifi, the implant will be available for pilot studies sometime this year. If you or someone you know is paraplegic, this research is worth following. It clearly promises to offer life-chaining benefits to patients with paraplegia. If you know of other research on similar devices, we’d love for you to share that information with our readers. We’ll try to keep an eye on the progress and implementation of this device from the UK and keep you posted if and when developments occur.

Baltimore Abortion Ordinance Declared Unconstitutional – How Did We Get Here and Why?

Saturday, February 5th, 2011

Pro-Life and Pro-Choice Advocates

Last April, we posted a blog regarding a Baltimore City ordinance, which required local crisis pregnancy centers to post signs in their clinics disclosing that they did not offer abortion or birth control services if, they in fact, did not offer such services. Because of this requirement, many clinics chose to post separate notices informing the public about clinics that offered abortion services. Consequently, the Archdiocese of Baltimore, filed a lawsuit in the Federal District Court, seeking to have the ordinance declared unconstitutional.  One of its arguments was that the City should be prohibited from compelling speech by requiring the clinics to post signs.

On January 28th, 2011, District Court Judge, Marvin Garbis, ruled that the ordinance violates the First Amendment of the U.S. Constitution and, as such, is unenforceable. In his opinion, Judge Garbis wrote: “Whether a provider of pregnancy-related services is ‘pro-life’ or ‘prochoice,’ it is for the provider — not the Government — to decide when and how to discuss abortion and birth-control methods.” According to the opinion, “[t]he Government cannot, consistent with the First Amendment, require a ‘pro-life’ pregnancy-related service center to post a sign as would be required by the Ordinance.”

The dynamic of this litigation is fascinating, revealing nonsensical and unpredictable aspects of the abortion debate.  One could argue that the original passing of the ordinance was fueled by an underlying “pro-life” attitude.  After all, why would the City require clinics that don’t offer abortion services to publically state that they don’t offer abortion services? My personal opinion is two-fold: 1) to discourage individuals in need of abortion services from seeking abortion services, and 2) to reveal to the public the number of clinics that don’t offer abortion services in order to paint a picture that the public is generally pro-life (this is particularly true because the ordinance did not require clinics offering abortion services to post notices that they offered such services).

Interestingly, the ordinance backfired. Some of the clinics required to disclose that they did not offer abortion services chose to inform the public about other clinics where abortion services are available. There is nothing wrong with that, right? Well, apparently the Archdiocese did not think so, and, in my personal opinion, here is the real reason why: As soon as it became apparent that many of the clinics could simply choose to post notices about other clinics, which offered abortion services, it also became apparent that the ordinance was de facto prompting free advertising for abortion services all over the city.

I can’t imagine that the Archdiocese was too thrilled about that. Hence, the litigation ensued and the opponents of the ordinance prevailed on an argument, which is commonly and usually made by the “pro-choice” side of the abortion debate. At the heart of Judge Garbis’ opinion is the notion that the government should not legislate morality or religion. On January 28th, the Archdiocese and other “pro-life” groups prevailed on an argument, which has undermined and discredited the “pro-life” position for decades. How ironic!

Have you have been following this litigation in Baltimore City? What are your thoughts? Was Baltimore’s ordinance misguided or spot-on? Will Judge Garbis’ decision be reversed or upheld on appeal?

Photo from foxnews.com

CT Scans – Are You Being Properly Protected Against Radiation?

Thursday, December 2nd, 2010

According to new research presented at the annual meeting of the Radiological Society of North America, breast shields should be used for men and women undergoing CT scans of the chest/lungs. According to Terry Healey, M.D., Director of thoracic radiation at Alpert Medical School of Brown University, the breast shield is capable of reducing the level of radiation by about 30%.  This is significant considering that radiation can cause or contribute to the development of various malignancies (e.g. breast cancer, lung cancer, esophageal cancer).

Although some physicians argue that the use of breast shields may impact the quality of the CT scan (i.e., by producing artifacts such as streaks or lines making the interpretation of the study more difficult), this new research suggests that the use of breast shields does not impact the diagnostic quality of the CT scan. A breast shield is nothing more than a thin piece of heavy metal placed in front of the chest during the CT scan procedure.

Researchers studied 50 patients, who needed CT scans of the chest. Most of the patients were undergoing the study to rule-out lung cancer.  For some patient the shield was placed directly on the chest. For other patients, the shield was slightly elevated from the chest surface. Overall, some artifact was present in about 2/3 of the cases. However, in the opinion of the researchers, there were no instances where the artifact interfered with the diagnostic quality of the radiographic study.

According to Judy Yee, M.D., vice chair of radiology at the University of California: ”[T]here’s no good reason not to use breast shields. The cost is relatively low and the benefit large.”

Perhaps a larger patient population is needed for the results of this research to be more widely accepted by the radiology community. We’d appreciate anyone who has experience in this field to share their thoughts on this topic. Do such shields cause artifact that makes the study less accurate and potentially dangerous to a patient? Does the accuracy of the scan, when a shield is used, depend on which type of scanner is used or which generation of scanner is being used? Are there other techniques that can be used to protect a patient yet not run the risk of artifact “mis-read”? We’re not physicians or radiology technicians, so we welcome any insights those who are might have on this topic.

If you are concerned about excessive radiation and need to undergo a chest CT, ask your radiologist if a protective shield can be used during your CT scan. Discuss the issue and – as we always stress – take charge of your own medical care. Be an informed patient and be responsible for your own health and safety. Know what the issues, risks and benefits are and discuss it with your doctor. Then – and only then – make an informed decision.

Image from emedicine.medscape.com

DARVON AND DARVOCET WITHDRAWN FROM U.S. MARKET – WHAT SHOULD YOU DO IF YOU ARE TAKING THESE MEDICATIONS?

Tuesday, November 23rd, 2010

Last week, the manufacturer of Darvon and Darvocet, Xanodyne Pharmaceuticals, agreed to withdraw these drugs from the market in response to FDA requests.  The FDA has also requested that generic drug manufacturers also stop marketing propoxyphene-based pain killers like Darvon and Darvocet. These drugs were withdrawn from the U.K. market almost six years ago. About a year and a half ago, the European drug agency also placed a ban on propoxyphene-based pain killers. An estimated 10 million Americans are taking propoxyphene-based drugs.

Although propoxyphene was always associated with a number of complications, the FDA’s request was prompted by new studies revealing the drug’s serious cardiovascular side-effects. The FDA was petitioned on a number of occasions to pull propoxyphene off the market. The latest petition came from the public interest group Public Citizen in 2006.  The FDA submitted the petition to an expert advisory committee that voted in favor of withdrawing the medication in 2009 (14 to 12 ).

The FDA did not request that the medication be removed from  the U.S. market in 2009. Instead, it requested that the manufacturer of the drug, Xanodyne Pharmaceuticals, Inc., conduct research to study the effects of the drug on the heart. This new research revealed that people taking propoxyphene (Darvon, Darvocet and  the like) can develop abnormal or fatal heart rhythm.  These findings prompted the FDA to request the withdrawal of the medication. Propoxyphene is also associated with the following cardiovascular complications:

  • Tachycardia
  • Cardiac/respiratory arrest
  • Congestive heart failure
  • Myocardial infarction
  • Hypotension

Some other side effects include:

  • Drug overdose/toxicity
  • Drug dependence/withdrawal
  • Anxiety
  • Nausea
  • Vomiting
  • Drowsiness/ dizziness
  • Hives
  • Difficulty breathing
  • Chest tightness
  • Swelling of the face, mouth, lips or tongue

The Public Citizen group has claimed that about 2000 people in the U.S. have died as a result of propoxyphene in the last six years. The good news for those taking Darvon, Darvocet or a similar drug is that the cardiovascular side effects of these drugs are not cumulative. Therefore,  the risk of developing cardiovascular problems should go away once the drug is stopped.

If you are taking Darvon or Darvocet, DO NOT stop taking the drug until you talk to your doctor. Sudden interruption of the medication can lead to serious withdrawal symptoms.  If you are taking propoxyphene-based medications, contact your doctor immediately so that you may be transitioned to a safer pain killer.

Photo: pharmer.org

Should You Be Concerned About Cancer If You Have Lupus?

Tuesday, November 16th, 2010

Did you know that people with lupus are more likely to develop cancer?  According to a recent study presented at the American College of Rheumatology Annual Scientific Meeting, patients with lupus are 15 % more likely to develop cancer when compared with the general population.

The study also revealed that patients with lupus are three times more likely to develop lymphoma (cancer of the white blood cells) and that woman are less likely to develop estrogen-sensitive cancers if they have Lupus (breast cancer – 30% decreased risk, endometrium – 51% decreased risk,  ovary – 44% decreased risk).

With respect to other carcenomas, the following correlations were established:

  • 3.4 times more likely to develop non-Hodgkin’s lymphoma
  • 3.2 times more likely to develop any lymphoma
  • 2.8 times more likely to develop vulvo-vaginal cancers
  • 2. 2 times more likely to develop liver cancer
  • 1.7 times more likely to develop leukemia
  • 1.7 times more likely to develop cervical cancer
  • 1.2 times more likely to develop lung cancer

Systemic lupus (systemic lupus erythematosus or SLE) is an autoimmune disease, whereby the body’s immune system is unable to distinguish between harmful or foreign substances/tissue and normal/healthy tissue. As a result, the immune system ends up fighting healthy tissue as if it were diseased. Some of the symptoms associated with lupus include:

  • Arthritis
  • Fatigue
  • Fever
  • General discomfort, uneasiness or ill feeling (malaise)
  • Joint pain and swelling
  • Muscle aches
  • Nausea and vomiting
  • Pleural effusions
  • Pleurisy (causes chest pain)
  • Psychosis
  • Seizures
  • Sensitivity to sunlight
  • Skin rash — a “butterfly” rash over the cheeks and bridge of the nose affects about half of those with SLE. The rash gets worse when in sunlight. The rash may also be widespread.
  • Swollen glands

If you have lupus, you must appreciate your risk for developing cancer. The key to successful cancer treatment is early detection and treatment. Make sure that your doctor is aware of your lupus condition and that your risk for developing cancer is properly and systematically assessed.

Photo: from http://articles.elitefts.com

Are Your HIPPA Privacy Rights Really Being Protected? New Study Suggests They Are Not!

Monday, November 15th, 2010

Anyone who has been to a healthcare provider in the last five years has become familiar with a HIPAA Release form. As a patient, you are required to sign the form giving the provider permission to release confidential medical records to your insurance company. Along with the form you may have been given a summary of the law describing your rights. I usually get a shrug and an apology from the registration staff for having to repeatedly ask me to sign the same form. However, it has always seemed to me healthcare workers were taking the law seriously and complying with its regulations.

I was surprised to learn recently hospitals are not shoring up their responsibility under the federal law to protect the unwarranted release or loss of my data. Individual physician office practices are scoring even lower in their protection of confidential patient data. Ponemon Institute released a benchmark study this past week on hospital compliance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996. While I was not able to access the full report, their press release was compelling enough.

Federal and cival penalties for HIPAA privacy and security breaches were significantly increased as part of the HITECH Section of the American Recovery and Reinvestment Act which took effect on February 17, 2010.  Along with billions of dollars for investment into creating electronic health records (EHR), additional funding was allocated to ensure breaches in confidentiality would be investigated and violators successfully penalized. Key provisions of the HITECH regulations now include:

BEWARE THE UNAWARE

  • Fines will be imposed even when a violator unknowingly violates the act. The minimum penalty is $100 with an annual maximum for repeat minimal violations of $25,000.  If the violation is severe, irregardless of the circumstances, a provider can be fined up to $50,000 per violation with an annual maximum fine of $1.5 million. No penalty will be imposed if the violation is corrected in 30 days.

BEWARE THE AWARE BUT FOOLISH

  • This penalty is reserved for the provider, who is aware of the act and willfully, but not neglectfully, accesses medical data without patient consent. Such infractions could occur during the course of patient transfer to another facility when a provider might want to learn the clinical outcome of a prior patient. Fines in this category range from $1,000 to a maximum of $100,000 for repeated violations.

BEWARE THE AWARE WHO FAIL TO SECURE

  • Willful neglect will cost a provider anywhere from a minimum of $10,000 to a maximum of $250,000 per violation. Maximum penalties for repeat offenses remain up to $50,000 to $1.5 million. Lesser penalties will be imposed if the provider corrects the violation within 30 days. Maximum penalties for corrections not remedied in 30 days. Examples of violations might be an unsecured server; exposed passwords; and/or data leaving secured provisions for analysis purposes.

BEWARE THE CRIMINAL

  • Individuals who knowingly release health information and/or medical record data may be criminally prosecuted and spend 1 year in jail in addition to fines of up to $50,000. A violation using a false pretense basis is more serious. Such offenses can land individuals up to 5 years in jail in addition to fines up to $100,000. Selling or maliciously using health information for personal or financial gain comes with a 10 year prison sentence and fines up to $250,000.

With the above looming penalties, providers have been required to report all breaches involving 500 unencrypted medical records or more since September 2009. Some states have enacted even tougher laws. Earlier in 2010, Connecticut’s Attorney General, Richard Blumenthal, sued Health Net of Connecticut for misplacing security data for nearly 450,000 enrolled patients along with failing to timely notify them. The lost data included social security numbers, bank account information, and medical health information. The data was lost for 6 months before authorities and patients were notified.

California is one of the states with tough laws supporting patient confidentiality.  During 2010 the state imposed stiff penalties totaling $675,000 against 6 hospitals.

  • $250,000 for one unauthorized employee who was able to access 204 patient medical records.
  • $130,000 for unauthorized access of one patient medical record by 7 employees.
  • $100,000 for unauthorized access of 33 patient medical records by 17 employees.
  • $95,000 for unauthorized access of one patient record by 4 employees.
  • $75,000 for unauthorized access of three patient records by 1 employee.
  • $25,000 for unauthorized access of three patient records by 2 employees.

The Ponemon Institute, a research organization sponsored by ID Experts, conducted a two year study at 65 healthcare organizations and interviewed 211 senior-level managers. Data loss and theft experiences were included in the research. Poneman reported the following:

Breaches are costing the healthcare industry nearly $6 billion annually.

The average organization had 2.4 data breach incidents over the last 2 years.

Major breaches were unintentional employee action, lost or stolen computing devices, and 3rd party error.

Ponemon went on to report that 58% of the participating organizations have little to no confidence in their ability to protect electronic health records. A staggering 71% have inadequate resources allocated to data security, and 69% would be unable to quickly identify and detect a data theft. Sadly, a majority of the organizations had less than two staff dedicated to data protection management. Reportedly, there were a significant number of undetected data breaches not reported to state and federal authorities. Most interviewed did not feel the HITECH regulations have been an impetus to do a better job.

Ponemon Institute is holding a FREE WEBINAR entitled Benchmark Study on Patient Privacy and Data Security on Tuesday, November 16, 2010 at 1:00pm ET for those interested. ID Experts are reported in Fiercehealthcare.com to be the leader in data breach solutions for government, financial, universities, corporations, and healthcare organizations. While this is clearly a marketing effort, if the research process and what was revealed is solid which I suspect it is, then the results are staggering and healthcare executives need to tune in.

Another issue looming in the confidential healthcare data world was revealed in the November 14 Baltimore Sun newspaper. Med Chi, a physician medical society representing 22,000 Maryland physicians, is concerned electronic health records can also be altered by drug companies and insurance companies. They are the first medical society in the nation to pass a resolution calling for state legislation to ensure doctors retain the right to control the treatment plan and keep patient records neutral without imposed financial parameters. This resolution follows Maryland legislation last year encouraging physicians to adopt electronic medical records. It seems physicians are fearing daily access and interaction by 3rd party payors and drug companies into what was once a confidential treatment process conducted solely by health professionals.

It seems hackers, thieves, harassers, and paparrazzi have an open market at this time. Government regulations and penalties are not making much of an impact. More legislation and regulation is coming, but will my and YOUR data be any safer in the end? What will it take to get the attention and priority agenda of heathcare executives to use the experiences and systems of other industries and get data safeguarded?

Comment from Brian Nash: We will soon be posting a White Paper providing instructions on how to report a HIPAA violation as well as important links to federal and state agencies responsible for the protection of a patient’s rights under HIPAA.

Photo: hipaacomplianceguide.com