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The Myth of the Tough Prosecutor as a Distraction from Health Care Corporate Executives' Impunity

The tragic case of the Boston Marathon bombing illustrates how myth making about tough law enforcement obscures the impunity enjoyed by top health care executives.<br /><br /><b>A "Tough to a Fault" Prosecutor</b><br /><br />A recent Reuters<a href="http://www.reuters.com/article/2013/04/22/us-usa-explosions-prosecutor-idUSBRE93L00X20130422"> article</a> touted the toughness of the prosecutor who will take on the case of the surviving accused Boston terrorist:<br /><br /><blockquote class="tr_bq"><span id="articleText"><span class="focusParagraph">As the top  federal law enforcer in Massachusetts, U.S. Attorney Carmen Ortiz has<i>  taken heat for being tough to a fault and coming down too hard on some  defendants.</i><br /><br /> </span><span id="midArticle_1"></span>But as she builds a possible  death penalty case against suspected Boston Marathon bomber Dzhokhar  Tsarnaev, 19, the <i>unflinching approach </i>that earned her opponents in the  past could become a legal asset for the biggest case of her career, said  attorneys who have faced off against her.<br /><span id="midArticle_2"></span><br />'The  criticism lately has been that they've<i> over-charged some people and  been overly harsh</i>,' said Peter Elikann, a Boston defense attorney.'I  don't think that's relevant for Tsarnaev because no one is going to  accuse any prosecutor of making too big a deal out of this case.'</span></blockquote><span id="articleText"></span><br /><br />Similarly, an<a href="http://www.businessweek.com/news/2013-04-23/marathon-bomb-prosecutor-seen-as-ready-for-marquee-case"> article</a> in Bloomberg included this:<br /><br /><br /><blockquote class="tr_bq">Ortiz’s former bosses insist that she’s ready for her moment on the big stage. <br /><br />'She’s<i> tough-minded</i> and exceptionally professional,' [former Massachusetts Attorney General Scott] Harshbarger said. </blockquote><br />One of the cases cited as an example of Ms Ortiz's toughness was her prosecution of electronic information freedom activist Aaron Swart.  As Rueters noted,<br /><br /><blockquote class="tr_bq"><span id="articleText">One of Ortiz's best-known cases to date was  her prosecution of Aaron Swartz on wire fraud and hacking allegations  for downloading millions of articles from an academic database.<br /><br /><span id="midArticle_10"></span>Swartz,  a 26-year-old computer prodigy, hanged himself in his Brooklyn, New  York, apartment in January, prompting friends and family to partly blame  Ortiz's prosecution for his death.</span></blockquote><br /><span id="articleText"></span><br />At the time, Ms Ortiz was criticized for being unreasonably harsh, but then as now toughness was touted as her style.<br /><br /><b>Not So Tough on Corporate Crime </b><br /><br />However, as we <a href="http://hcrenewal.blogspot.com/2013/01/the-tragic-case-of-aaron-swartz-unequal.html">pointed out then</a>, while Ms Ortiz was noted for being tough on individuals accused of various offenses, she was notably not so tough on individuals involved in alleged corporate health care wrong doing.<br /><br />In particular, as we wrote before, Ms Ortiz was involved in three settlements of notably bad behavior by large health care corporations, none of which involved prosecution of, or any penalties for the individuals at the corporations who authorized, directed or implemented the bad behavior.<br /><br /><span style="background-color: #f3f3f3;"><u>Forest Pharmaceuticals </u></span><span style="background-color: #f3f3f3;"><br />In September, 2010, how Ms Ortiz led the pursuit of a settlement with Forest Pharmaceuticals became apparent (look <a href="http://hcrenewal.blogspot.com/2010/09/forest-pharmaceuticals-pleads-guilty-to.html">here</a>).    The company was accused of promoting its anti-depressant Celexa for  use in adolescents and children.  Such drugs have since been shown to  increase the risk of suicide by such young patients, and this drug was  only approved for adults.  At the time, Ms Ortiz said, "Forest  Pharmaceuticals deliberately chose to pursue corporate profits over its  obligations to the F.D.A. and the American public."  Although the  offense may have lead to use of the drug by many adolescents and  children, and hence may have lead to some of them attempting or  committing suicide, the case was settled only with fines.  As is usual  in such legal settlements, no individual corporate executive who  authorized or lead the off-label and potentially dangerous marketing of  the drug was arrested, or accused, and none suffered any negative  consequences.</span><span style="background-color: #f3f3f3;"><br /></span><span style="background-color: #f3f3f3;"><u>GlaxoSmithKline </u></span><span style="background-color: #f3f3f3;"><br />In October, 2010, how Ms Ortiz led the pursuit of a settlement with GlaxoSmithKline became apparent (look <a href="http://hcrenewal.blogspot.com/2010/10/glaxosmithkline-subsidiary-pleads.html">here</a>.)   The company was accused of selling drugs that were not what they  appeared to be, apparently because the wrong drugs were put in labelled  containers.  Obviously, taking one drug, like Paxil, GSK's  anti-depressant which has a number of known adverse effects, including  suicide risk for adolescents and children as noted above, when a patient  is supposed to be taking a wholly different drug could lead to patient  harm.  At that time, Ms Ortiz said, "We will not tolerate corporate  attempts to profit at the expense of the  ill and needy in our society -- or those who cut corners that result in  potentially dangerous consequences to consumers."   Again, while the  settlement involved a guilty plea by a GSK subsidiary, again no  individual corporate executive who had authority over the drug  manufacturing was arrested or accused, much less suffered any negative  consequences.</span><span style="background-color: #f3f3f3;"><br /></span><span style="background-color: #f3f3f3;"><u>St Jude Medical </u></span><span style="background-color: #f3f3f3;"><br />In January, 2011, Ms Ortiz led the pursuit of a settlement with St Jude Medical (look <a href="http://hcrenewal.blogspot.com/2011/01/st-jude-medical-settles-again.html">here</a>).   The company was accused of paying kickbacks to doctors to implant its  cardiac defibrillators (ICDs) and pacemakers.  Obviously, providing  kickbacks to doctors may have lead them to plant devices in patients who  did not really need them, yet the devices and the implantation  procedures can have adverse effects.  At that time, Ms Ortiz said, "The  United States alleges that St Jude solicited physicians for the  studies in order to retain their business and/or convert their business  from a competitor's product."  Again, as is usual, the settlement did  not require any executive who authorized or directed the activities  leading to the kickbacks suffered any negative consequences.</span><br /><br /><br />Despite this, note that Bloomberg in its recent coverage of the Tsarnaev prosecution even tried to make Ms Ortiz failure to hold any individuals accountable for this health care corporate misbehavior seem like tough prosecution.<br /><br /><br /><blockquote class="tr_bq"><span id="articleText">The office has been a <i>leader in health-care fraud prosecutions</i>, securing  $4 billion in civil and health-care recoveries in 2012. Those included a  $3 billion payment from GlaxoSmithKline Plc (GSK), which pleaded guilty  to charges that it illegally promoted prescription drugs. </span></blockquote><span id="articleText"></span><br />Again, note that apparently being a "leader" in health care fraud prosecution involved pushing for big fines to be paid by the corporations involved in actions that may have harmed many patients, but no punishment for  the individuals who may have authorized, directed or implemented the bad behavior, but being "tough" on Aaron Swartz involved pushing for a long imprisonment of someone whose alleged crime was not violent, and did not result in anyone being hurt.<br /><br /><br /><b>Summary </b><br /><br />As we have noted again and again and again, leaders of large health care organizations, particularly the largest health care corporations, seem to enjoy virtual impunity.  No matter how bad the behavior of the corporations which they are supposed to be leading, and no matter whether such behavior might have harmed patients, they almost never have to face any negative consequences, especially not fines they must pay themselves, much less prison time.  We have <a href="http://hcrenewal.blogspot.com/search/label/legal%20settlements">documented many legal settlements</a> of often egregiously bad alleged behavior that did not involve any penalties for top corporate leaders. <br /><br />One way corporate leaders thus escape accountability seems to be the cultivation of myths that distract the public from what is going on.  One such urban legend seems to be the toughness of government prosecutors.  If prosecutors are believed to be uniformly tough and uncompromising, then the public may be lead to believe either that they are tough and uncompromising on corporate crime    <br /><br />As we have said repeatedly, true health care reform would require making the leaders of health care organizations accountable, especially for the effects of their actions on patients' and the public's health.<br /><br />

The Myth of the Tough Prosecutor as a Distraction from Health Care Corporate Executives' Impunity

The tragic case of the Boston Marathon bombing illustrates how myth making about tough law enforcement obscures the impunity enjoyed by top ...

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Johns Hopkins: Thanks to EHRs, time with patients seems “squeezed out” of medical training, investigator says

Question:  Who would have thought it?  That there is yet another potentially deadly unintended consequence of <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/">bad health IT</a> and health IT <a href="http://hcrenewal.blogspot.com/2012/03/doctors-and-ehrs-reframing-modernists-v.html">hyper-enthusiasm</a>?<br /><br />Suggested answer:  anyone who truly understands the issues at the intersection of medicine, information science, information technology, and <a href="http://en.wikipedia.org/wiki/Social_informatics">Social Informatics</a> - which probably excludes 95% of the health IT "experts", pundits and opportunists.<br /><br />Which only goes to show how dense such people can be - as the medical trainees of today will be treating them, their families, and their children in the future:<br /><blockquote class="tr_bq"><br /><div class="Boxed" id="detailInteriorDate"><div class="Copy"><b>Johns Hopkins Medicine</b></div><div class="Copy"><b>Release Date: 04/23/2013     </b></div></div><b>    </b><br /><div class="Boxed" id="detailInteriorSubTitle"><div class="Copy"><b><a href="http://www.hopkinsmedicine.org/news/media/releases/doctors_in_training_spend_very_little_time_at_patient_bedside_study_finds">Time with patients seems “squeezed out” of training, investigator says </a></b></div><div class="Copy"></div></div>Medical interns spend just 12 percent of their time examining and  talking with patients, and more than 40 percent of their time behind a  computer, according to a new Johns Hopkins study that closely followed  first-year residents at Baltimore’s two large academic medical centers.  Indeed, the study found, interns spent nearly as much time walking (7  percent) as they did caring for patients at the bedside.</blockquote><br />I can honestly say much if not most of my time in training, several decades ago, was spent at the bedside.<br /><br /><blockquote class="tr_bq">Compared with similar time-tracking studies done before 2003, when  hospitals were first required to limit the number of consecutive working  hours for trainees, the researchers found that interns since then spend  significantly less time in direct contact with patients. Changes to the  2003 rules limited interns to no more than 30 consecutive hours on  duty, and further restrictions in 2011 allow them to work only 16 hours  in a row.<br /><br />“One of the most important learning opportunities in residency is direct interaction with patients,” says <a href="http://www.hopkinsmedicine.org/gim/fellowship/current_fellows.html">Lauren Block</a>, M.D., M.P.H., a clinical fellow in the <a href="http://www.hopkinsmedicine.org/gim/index.html">Division of General Internal Medicine</a> at the Johns Hopkins University School of Medicine and leader of the  study published online in the Journal of General Internal Medicine.  <b>“Spending an average of eight minutes a day with each patient just  doesn’t seem like enough time to me.”</b></blockquote><br />An understatement, as most critical information comes from the H&P and ongoing patient interaction - not from cybernetics.  Further, that's probably all the time a butcher spends processing a slab of meat...<br /><br /><blockquote class="tr_bq">“Most of us went into medicine because we love spending time with the  patients. Our systems have squeezed this out of medical training,” says <a href="http://www.hopkinsmedicine.org/doctors/results/directory/profile/0019344/leonard-feldman">Leonard Feldman</a>, M.D., the study’s senior author and a hospitalist at The Johns Hopkins Hospital (JHH).<br /><br />For the study, trained observers followed 29 internal medicine interns —  doctors in their first year out of medical school — at JHH and the  University of Maryland Medical Center for three weeks during January  2012, for a total of 873 hours. The observers used an iPod Touch app to  mark down what the interns were doing at every minute of their shifts.  If they were multi-tasking, the observers were told to count the  activity most closely related to direct patient care.<br /><br />The researchers found that interns spent 12 percent of their time  talking with and examining patients; <b>64 percent on indirect patient  care, such as placing orders, researching patient history and filling  out electronic paperwork</b>; 15 percent on educational activities, such as  medical rounds; and 9 percent on miscellaneous activities. </blockquote><br />Researching the history is made more complex by today's low-usability EHR systems, so much so that I personally know of cases (through my legal work) where trainees and even attendings did not know the patient's history.  In the past, this would have been considered a severe medical<i> faux pas</i>.<br /><br /><blockquote class="tr_bq">The  researchers acknowledge that it’s unclear what proportion of time spent  at the bedside is ideal, or whether the interns they studied in the  first year of a three-year internal medicine training program make up  the time lost with patients later in residency. <b>But 12 percent, Feldman  says, “seems shockingly low at face value. Interns spend almost four  more times as long reviewing charts than directly engaging patients.”</b></blockquote><br />Not to be critical of the Hopkins piece, it is excellent - but academics often use disclaimers and softeners in their conclusions as a custom and tradition.  At a blog I can be more direct:  12% <b>is </b>shockingly low.  No "<i>seems</i>" is actually necessary.<br /><br /><blockquote class="tr_bq">Feldman says questions raised by his study aren’t just about whether  the patients are getting enough time with their doctors, but whether the  time spent with patients is enough to give interns the experience they  need to practice excellent medicine. </blockquote><br />Personally, I would really be nervous under the care of graduates who'd only spent a tenth of their clinical hours actually seeing, speaking to and examining patients, and a majority of their time frittering around with computers.<br /><br /><blockquote class="tr_bq">With fewer hours spent in the  hospital, protocols need to be put in place to ensure that vital parts  of training aren’t lost, the researchers say.<br /><br />“As residency changes, we need to find ways to preserve the  patient-doctor relationship,” Block says. “<b>Getting to know patients  better can improve diagnoses and care and reduce medical errors</b>.” </blockquote><br />As opposed to getting to know the (needlessly complex and confusing) EHR better, which adds little. <br /><blockquote class="tr_bq"><br />The researchers say <b>better electronic medical records may help reduce  time spent combing through patient histories on the computer.</b> </blockquote><br />After several decades of the health IT industry being in business,  it's sad that an organization of the (deserved) stature of Johns Hopkins has to provide remedial education 101 to that industry in 2013.<br /><br />Perhaps that's the most important finding of all in this study.<br /><br /><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNAEBZdGCqLpgyopzxpqBtlbkLnV5mikUGkEG5suqe1In_rW838Xj0an0yDmxP3jhB9DBUYLrm8C6_gdvqyOfVSc9XS0YGgpjksJjTXbug-QzW5iCNM75DvwXUGD5qbwVHw9G-y9UyR872/s1600/wizard_of_id.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="146" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNAEBZdGCqLpgyopzxpqBtlbkLnV5mikUGkEG5suqe1In_rW838Xj0an0yDmxP3jhB9DBUYLrm8C6_gdvqyOfVSc9XS0YGgpjksJjTXbug-QzW5iCNM75DvwXUGD5qbwVHw9G-y9UyR872/s400/wizard_of_id.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">There's some wisdom in this comic strip.  Click to enlarge.</td></tr></tbody></table><br /><br />-- SS<br />

Johns Hopkins: Thanks to EHRs, time with patients seems “squeezed out” of medical training, investigator says

Question: Who would have thought it? That there is yet another potentially deadly unintended consequence of bad health IT and health IT h...

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WellPoint's Former Manager-Queen Got $20.6 Million and Its Nobility Got Millions

Score another for our new would be royalty, that is, for the hired managers who run big corporations.  Early this month a few scattered reports came out showing just how much even apparently failed executives of big health care organizations can make on their way out the door. <br /><br /><b>A New Fortune for the Abdicating Queen of WellPoint </b><br /><br />Last year we <a href="http://hcrenewal.blogspot.com/2012/08/duchess-of-wellpoint-abdicates-likely.html">discussed</a> the abdication of Angela Braly, the former queen of giant insurance company WellPoint.  We then speculated about how much she might abscond with.  Now the Associated Press has <a href="http://bigstory.ap.org/article/outgoing-wellpoint-ceo-made-over-20m-last-year">reported</a>:<br /><br /><blockquote class="tr_bq"> The compensation paid to outgoing Wellpoint Inc. CEO Angela Braly  last year <i>rose 56 percent</i>, even as the company's <i>shares slid </i>on lower  enrollment in its Blue Cross Blue Shield health plans.<br /><br /><i>Braly, who resigned in August, received 2012 compensation valued at <b>$20.6 million</b>,</i> according to an Associated Press analysis of the  company's annual proxy statement. Most of the increase came from stock  options.<br /><br /> Braly, 51, became CEO in 2007. She received a<i> $1.2 million salary</i>  last year, up slightly from $1.1 million in 2011. Her compensation  included a <i>performance-related bonus of nearly $1.4 million.</i> More than  85 percent of Braly's compensation came from <i>stock options and awards,  which totaled $17.8 million.</i> That total was up from about $10 million  the year before.<br /><br /> She also received <i>$179,618 in other compensation, including $3,700  spent on security measures for her and her family due to concerns about  her safety 'as a result of the national health care debate,'</i> according  to the proxy, which was filed Tuesday with the Securities and Exchange  Commission.</blockquote><br /><b>Despite Bad Financial Performance and Investors' Losses </b><br /><br />Remember, though, that Braly was asked to leave:<br /><br /><blockquote class="tr_bq"> investors had grown frustrated with the company's performance, leading Braly to resign last August. </blockquote><br />In particular, in terms of financial performance<br /><br /><blockquote class="tr_bq"><i>shares fell 8 percent last year</i> to close 2012 at $60.92, while the Standard & Poor's 500 index rose more than 13 percent. <br /><br />WellPoint's 2012 <i>earnings were nearly flat </i>compared to 2011. The  insurer earned $2.65 billion, or $8.18 per share, last year, as total  revenue climbed 1.6 percent to $61.71 billion.</blockquote><br />A slightly different <a href="http://www.ibj.com/wellpoint-brass-given-doule-digit-pay-bumps-while-stock-price-falls/PARAMS/article/40583">analysis</a> by the Indianapolis Business Journal came up with similar results,<br /><br /><blockquote class="tr_bq"> WellPoint’s membership growth came mainly from its acquisition <a href="http://www.ibj.com/wellpoint-buying-1-800-contacts-for-about--900m/PARAMS/article/34779" target="_blank"><span style="color: blue;"></span></a>of  Virginia-based Amerigroup Corp., which operates Medicaid                               managed care plans for states. The rest of  WellPoint’s existing business lost customers during 2012.<br />                               <br />                               And while WellPoint has boosted earnings  per share by continuing to buy back shares, overall profit was unchanged  last year                               compared with about $2.6 billion in 2011.<br />                               <br />                               WellPoint raised its dividend in 2012 and  acquired 1-800-Contacts Inc. But its stock price fell 8 percent to  close the year                               at $60.92 per share.<i> Even taking into  account dividends, WellPoint shares<b> lost 6.3 percent of their value</b>  during the year.</i></blockquote><br />So while the nominal owners of the company, the investors, lost money on their investments, the CEO who presided over this loss left with a huge pile of cash.<br /><br /><b>The Royal Court of WellPoint Also Prospered </b><br /><br />Incidentally, the Indianapolis Business Journal also showed that WellPoint executives who did not leave generally got big increases in their compensation, again while the company owners to whom they ostensibly report lost money,<br /><br /><br /><blockquote class="tr_bq">                               <i>WellPoint Inc.’s top brass all enjoyed  double-digit bumps in 2012 compensation</i>, according to a proxy released  April                               2, even though the stock price fell and  the company admittedly did not meet its financial goals.<br />                               <br />                               The Indianapolis-based health insurer’s  board of directors approved higher salaries and larger potential stock  awards                               heading into 2012 after most of its top  executives saw their pay hold steady or decline in 2011.<br />                               <br />                               The company’s performance merited its  executives receiving only 83 percent of their target stock awards. But  because                               the board had already established larger  pools of stock to award to executives, the value of those awards still  rose over                               previous years. Bonus amounts fell in 2012  compared with the previous year.<br /><br />                                                               The extra cash and stock <i>drove up Chief  Financial Officer Wayne DeVeydt's overall pay 11.9 percent to nearly  <b>$4.4 million</b>.</i><br />                               <br />                               Ken Goulet, executive vice president of  WellPoint's commercial insurance business, saw <i>his total compensation  rise 18.2                               percent to nearly <b>$4.4 million</b>.</i><br />                               <br />                               And Lori Beer, executive vice president  of information technology, enjoyed <i>a 17.9-percent boost. She earned <b>$3.2  million</b>,                               </i>although that was still below the nearly  $4.5 million she received in 2010.<br />                               <br />                               John Cannon, the general counsel, saw his  <i>compensation more than double to nearly <b>$6.5 million</b></i>. But that was  partly because                               WellPoint hiked his salary by $350,000 and  gave him a $500,000 bonus for agreeing to serve as interim CEO after  the August                               resignation of former CEO Angela Braly.</blockquote><br /><b>Despite Angry Policy-Holders and Ethical Missteps </b><br /><br />So the compensation given the outgoing CEO and some of the remaining top hired managers seemed wildly out of proportion to the company's financial results.  Could the generosity they received be based on how well the company performed in other dimensions?  That, of course, seems equally improbable. <br /><br />The Los Angeles Times <a href="http://www.latimes.com/business/money/la-fi-mo-wellpoint-ceo-pay-20130403,0,6503087.story">noted</a>,<br /><br /><blockquote class="tr_bq"> <i>Braly had also caught the ire of consumers and even President Obama</i><a class="taxInlineTagLink" href="http://www.latimes.com/topic/politics/government/barack-obama-PEPLT007408.topic" id="PEPLT007408" title="Barack Obama"></a> in 2010 for trying to raise rates by up to 39% in California. The  national outrage that ensued helped Obama win approval for his  healthcare overhaul in Congress.</blockquote><br />Furthermore, as we have discussed again and again, most recently <a href="http://hcrenewal.blogspot.com/2012/08/duchess-of-wellpoint-abdicates-likely.html">here</a>, WellPoint has a very sorry record of ethical misadventures.   (The updated list is at the end of this post.)  So one could certainly not justify the huge payments given WellPoint hired managers by their upstanding ethical leadership.<br /><br /><b>Summary</b><br /><br />In a new book just published by Robert A G Monks, entitled <a href="http://www.governmentcapture.com/citizens-disunited/"><i>Citizens Disunited</i></a>, the author describes one of the biggest problems affecting the US economy and society as the rise of "manager-kings."  Clearly, Angela Braly could be called the former "manager-queen" of WellPoint.  The company seemed to be run primarily for the benefit of the queen and her court, while its investors lost money, its customers became outraged, and it stumbled from one ethical quandary to another.<br /><br />In the eighteenth century, British colonial subjects in North America succeeded in a revolution that lead them out from under the rule of a British King.  How many examples do we have to have before there is action to repudiate the rule of our new manager-kings and queens?  And to turn health care back into a calling meant to put patients' and the public's health first, rather than a feudal society meant to benefit its nobility?<br /><br />As we have said again, again, again,...<br /><br />True health care reform would decrease the size and scope of health care  organizations, and make their leaders accountable to ownership, when  appropriate, and to the community at large for patients' and the public  health.  <br /><br /><br /><br /><strong>Appendix: WellPoint's Ethical Misadventures</strong><br /><br /><ul><li><em>settled a RICO (racketeer influenced corrupt organization) law-suit</em> in California over its alleged systematic attempts to withhold payments from physicians (see 2005 post <a href="http://hcrenewal.blogspot.com/2005/07/wellpoint-settles-rico-law-suit.html">here</a>).</li><li>subsidiary New York Empire Blue Cross and Blue Shield<em> misplaced a computer disc containing confidential information </em>on 75,000 policy-holders (see 2007 story <a href="http://www.nytimes.com/2007/03/14/business/14insure.html">here</a>).</li><li>California Anthem Blue Cross subsidiary <em>cancelled individual insurance policies after their owners made large claims</em> (a practices sometimes called rescission).  The company was ordered to  pay a million dollar fine in early 2007 for this (see post <a href="http://hcrenewal.blogspot.com/2007/03/wellpoint-fined-1-million-for-canceling.html">here</a>).  A state agency charged that some of these cancellations by another WellPoint subsidiary were improper (see post <a href="http://hcrenewal.blogspot.com/2007/07/more-than-half-of-wellpoints-policy.html">here</a>).   WellPoint was alleged to have pushed physicians to look for patients'  medical problems that would allow rescission (see post <a href="http://hcrenewal.blogspot.com/2008/02/wellpoint-halts-attempts-to-have.html">here</a>).   It turned out that California never collected the 2007 fine noted  above, allegedly because the state agency feared that WellPoint had  become too powerful to take on (see post <a href="http://hcrenewal.blogspot.com/2008/07/wellpoint-settles-but-has-it-become-too.html">here</a>). But in 2008, WellPoint agreed to pay more fines for its rescission practices (see post <a href="http://hcrenewal.blogspot.com/2008/07/fines-re-statements-and-more-fines-just.html">here</a>).   In 2009, WellPoint executives were defiant about their continued  intention to make rescission in hearings before the US congress (see  post <a href="http://hcrenewal.blogspot.com/2009/06/managed-care-executives-will-not-limit.html">here</a>).</li><li>California Blue Cross subsidiary allegedly attempted to <em>get physicians to sign contracts whose confidentiality provisions would have prevented them from consulting lawyers</em> about the contracts (see 2007 post <a href="http://hcrenewal.blogspot.com/2007/11/physicians-and-contracts-cautionary.html">here</a>).</li><li>formerly acclaimed <em>CFO was fired</em> for unclear reasons, and then <em>allegations from numerous women of what now might be called Tiger Woods-like activities surfaced</em> (see post <a href="http://hcrenewal.blogspot.com/2008/01/more-managed-care-management-mumbo.html">here</a>).</li><li>announced that its <em>investment portfolio was hardly immune from the losses</em> prevalent in late 2008 (see post <a href="http://hcrenewal.blogspot.com/2008/10/if-this-is-how-wellpoint-has-managed.html">here</a>).</li><li>was sanctioned by the US government in early 2009 for <em>erroneously denying coverage</em> to senior patients who subscribed to its Medicare drug plans (see 2009 post <a href="http://hcrenewal.blogspot.com/2009/01/wellpoint-sanctioned.html">here</a>).</li><li><em>settled charges that it had used a questionable data-base</em>  (built by Ingenix, a subsidiary of ostensible WellPoint competitor  UnitedHealth) to determine fees paid to physicians for out-of-network  care (see 2009 post <a href="http://hcrenewal.blogspot.com/2009/02/wellpoint-settles.html">here</a>).  </li><li><em>violated state law more than 700 times over a three-year period</em> by failing to pay medical claims on time and misrepresenting policy  provisions to customers, according to the California health insurance  commissioner (see 2010 post <a href="http://hcrenewal.blogspot.com/2010/02/argument-over-insurance-rate-hikes.html">here</a>). </li><li><em>exposed confidential data from about 470,000 patients</em> (see 2010 post <a href="http://hcrenewal.blogspot.com/2010/06/wellpoint-dont-know-much-about-computer.html">here</a>) and settled the resulting lawsuit in 2011 (see post <a href="http://hcrenewal.blogspot.com/2011/10/still-more-ehr-chaos-pandemonium-bedlam.html">here</a>).</li><li><em>fired a top executive who publicly apologized for the company's excessively high charges</em> (see 2010 post <em>here</em>).</li><li>California Anthem subsidiary was fined for <em>systematically failing to make fair and timely payments</em> to doctors and hospitals (see 2010 post <a href="http://hcrenewal.blogspot.com/2010/12/health-insurers-sanctioned-fined.html">here</a>).</li><li>management was accused of <em>hiding the company's political contributions from the company's own stock-holders</em> (see 2012 posts <a href="http://hcrenewal.blogspot.com/2012/04/some-of-wellpoints-owners-stockholders.html">here</a> and <a href="http://hcrenewal.blogspot.com/2012/05/wall-street-journal-defends-hired.html">here</a>).</li><li>settled charges that its Anthem subsidiary <em>cheated former policy-holders</em> out of money owed when that company was converted from a mutual insurance company (see 2012 post <a href="http://hcrenewal.blogspot.com/2012/06/huge-insurance-company-wellpoint.html">here</a>)</li></ul><br /><br />

WellPoint's Former Manager-Queen Got $20.6 Million and Its Nobility Got Millions

Score another for our new would be royalty, that is, for the hired managers who run big corporations. Early this month a few scattered repo...

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SILVERSTEIN v. ABINGTON MEMORIAL HOSPITAL: MOTION TO PROHIBIT COMMENTARY ABOUT THIS LITIGATION TO ANY PUBLIC CONTEXT: Do computers have more rights than patients?

Herein is an issue of potential <a href="http://en.wikipedia.org/wiki/Internet_censorship">Internet censorship</a> and/or attempted <a href="http://en.wikipedia.org/wiki/Prior_restraint">prior restraint</a> of the rights of a citizen to express him/herself freely:<br /><br />At my post "<a href="http://hcrenewal.blogspot.com/2013/04/hospital-defense-maliciousness-aided.html">Hospital  defense maliciousness, aided and abetted by attorneys who ignore the  ABA and Pennsylvania's Ethical Rules of Conduct Regarding "Candor  Towards the Tribunal</a>" I wrote about how a defense attorney in a case I unfortunately am substitute plaintiff in, that involving EHRs and the injury and the death of my mother, violated the requirement under the Code of Conduct of lawyers to exhibit candor before the tribunal, and perhaps <b>18 Pa.C.S. §4904 relating to unsworn falsification to authorities</b> as well.<br /><br />As also mentioned, the lawfirm was displeased, but did not respond to my offer to consider amending any factually erroneous assertions at that post.<br /><br />Now here is their response:<br /><br /><table border="1" cellspacing="0" class="ChamaeleonGrid" rules="all"><tbody><tr class="AlternatingGridItem"><td>4/19/2013</td><td>Motion</td><td>BY  ABINGTON MEMORIAL HOSPITAL MOTION TO PROHIBIT COMMENTARY ABOUT THIS  LITIGATION TO ANY PUBLIC CONTEXT WITH MEMORANDUM OF LAW WITH SERVICE ON  04/19/2013</td></tr></tbody></table><b><br /></b>The Motion text is <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/Silverstein%20-%20Def%27s%20Motion%20to%20Prohibit%20Commentary%20about%20this%20Litigation%20%2800262678%29.pdf">here</a> in PDF (it is a public document available to anyone on the Montgomery County, PA Prothonotary website).<br /><br />The court has yet to rule on this new motion and Substitute Plaintiff's (me) replies.<br /><br />I will, of course, abide by the Court's decision.<br /><br />First: I note that I have been writing about issues of <i><b>court </b><b>process</b></i>, not the substance of the case's actual issues.   I think citizens have a right to know about process in their courtrooms.  I am also Joe Public, exercising my rights to freedom of expression; I am not an attorney breaking some rule of case publicity.  I am not even the suit's initiator.  What rule(s) am I breaking, exactly, I'd like to know from the Defense.<br /><br />Further, in my opinion, considering that multiple authorities including the <b>Institute of Medicine of the National Academies</b> (<a href="http://hcrenewal.blogspot.com/2011/11/iom-report-on-health-it-safety-nix-fda.html">link</a>), <b>FDA</b> (<a href="http://hcrenewal.blogspot.com/2010/08/smoking-gun-internal-fda-memorandum-of.html">link</a>), <b>Joint Commission</b> (<a href="http://hcrenewal.blogspot.com/2008/12/joint-commission-sentinel-events-alert.html">link</a>), <b>ECRI Institute</b> (<a href="http://hcrenewal.blogspot.com/2013/02/peering-underneath-icebergs-water-level.html">link</a>), <b>National Institute of Standards and Technology</b> (<a href="http://hcrenewal.blogspot.com/2011/10/nist-on-ehr-mission-hostile-user.html">link</a>), <b>AHRQ-Agency for Healthcare Research and Quality at HHS itself </b>(<a href="http://healthit.ahrq.gov/HealthITHazardManagerFinalReport">link</a>) and others have written about risks of health IT to patients and the need for far more study and data on the issue, in my view there is a compelling public interest in being informed about the progress of this lawsuit.<br /><br />We have not reached the day yet, I hope, when computers have more rights than patients.<br /><br />I note that if the involved lawfirm, Marshall Dennehey Warner Coleman Goggin, would stick to the Rules of Conduct for attorneys, it would seem they have nothing to fear.<br /><br />I note the remarkable statement about "<i>unjustified and malicious personal attacks against Moving Defendant and defense counsel</i>", i.e., pointing out exactly what they did.  Namely, fail to provide <b>the required Candor towards the Tribunal </b>regarding the undisclosed 2008 <u>Stroud v. AMH</u> decision on COM's, known to them (same hospital, same counsel) at the time multiple, frivolous contrary claims about COM's to harm my mother's case were made to the courts from 2010 to just recently in 2013.  <br /><br />In fact, that statement itself may be an example of legal misconduct - rendering false charges and certifying them in writing to a court as true.  I note that I didn't write the <b><a href="http://www.pacode.com/secure/data/204/chapter81/s81.4.html">Rules of Professional Conduct for attorneys</a></b>; attorneys did, including <b>Rule 3.3: "Candor before the Tribunal" </b>whose obvious violation and my pointing it out is certainly not an "u<i>njustified and malicious personal attack."</i><br /><br />As far as "fair trials" go - their stated concern in this latest filing - the defense should have thought about that before breaking the aforementioned Rule of Professional Conduct, causing numerous delays.  (I wonder how many med mal cases with proper paperwork are stalled more than 2 years before Discovery even begins - the case was filed 7/16/2010.)<br /><br />It seems to me that my mother deserved to be alive at the time of her fair trial ("<a href="http://en.wikipedia.org/wiki/Justice_delayed_is_justice_denied"><i>Justice delayed is justice denied</i></a>.")  I would certainly like to know if the Defense thinks otherwise.<i><br /></i><br /><br />-- SS<br /><br /><b>Apr. 19, 2013 Addendum: </b><br /><br />As noted at Wikipedia regarding what appears to be a <a href="http://en.wikipedia.org/wiki/Prior_restraint">Motion for Prior Restraint</a>:<br /><br /><blockquote class="tr_bq"><b>Prior restraint</b> is often considered a particularly oppressive form of <a href="http://en.wikipedia.org/wiki/Censorship" title="Censorship">censorship</a> in Anglo-American jurisprudence because it prevents the restricted  material from being heard or distributed at all. Other forms of  restrictions on expression (such as actions for <a class="mw-redirect" href="http://en.wikipedia.org/wiki/Libel" title="Libel">libel</a> or <a class="mw-redirect" href="http://en.wikipedia.org/wiki/Slander_and_libel#Criminal_libel" title="Slander and libel">criminal libel</a>, <a class="mw-redirect" href="http://en.wikipedia.org/wiki/Slander" title="Slander">slander</a>, <a href="http://en.wikipedia.org/wiki/Defamation" title="Defamation">defamation</a>, and <a href="http://en.wikipedia.org/wiki/Contempt_of_court" title="Contempt of court">contempt of court</a>)  implement criminal or civil sanctions only after the offending material  has been published. While such sanctions might lead to a <a class="mw-redirect" href="http://en.wikipedia.org/wiki/Chilling_effect_%28term%29" title="Chilling effect (term)">chilling effect</a>, legal commentators argue that at least such actions do not <i>directly</i> impoverish the <a href="http://en.wikipedia.org/wiki/Marketplace_of_ideas" title="Marketplace of ideas">marketplace of ideas</a>.  <b>Prior restraint, on the other hand, takes an idea or material  completely out of the marketplace. Thus it is often considered to be the  most extreme form of censorship.</b> The <a class="mw-redirect" href="http://en.wikipedia.org/wiki/United_States_Supreme_Court" title="United States Supreme Court">United States Supreme Court</a> expressed this view in <i><a class="mw-redirect" href="http://en.wikipedia.org/wiki/Nebraska_Press_Assn._v._Stuart" title="Nebraska Press Assn. v. Stuart">Nebraska Press Assn. v. Stuart</a></i> by noting:</blockquote><br /><blockquote class="tr_bq"><blockquote class="templatequote"><div class="Bug6200">The thread running through all these cases is that  prior restraints on speech and publication <b>are the most serious and the  least tolerable infringement on First Amendment rights</b>. A criminal  penalty or a judgment in a defamation case is subject to the whole  panoply of protections afforded by deferring the impact of the judgment  until all avenues of appellate review have been exhausted. Only after  judgment has become final, correct or otherwise, does the law's sanction  become fully operative.</div></blockquote><blockquote class="templatequote"><div class="Bug6200"><b>A prior restraint, by contrast and by definition,  has an immediate and irreversible sanction. </b>If it can be said that a  threat of criminal or civil sanctions after publication 'chills' speech,  prior restraint 'freezes' it at least for the time.</div></blockquote></blockquote><br /><blockquote class="tr_bq">Also, most of the early struggles for <a href="http://en.wikipedia.org/wiki/Freedom_of_the_press" title="Freedom of the press">freedom of the press</a> were against forms of prior restraint. Thus prior restraint came to be  looked upon with a particular horror, and Anglo-American courts became  particularly unwilling to approve it, when they might approve other  forms of press restriction.</blockquote><br />-- SS

SILVERSTEIN v. ABINGTON MEMORIAL HOSPITAL: MOTION TO PROHIBIT COMMENTARY ABOUT THIS LITIGATION TO ANY PUBLIC CONTEXT: Do computers have more rights than patients?

Herein is an issue of potential Internet censorship and/or attempted prior restraint of the rights of a citizen to express him/herself fre...

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Healthcare computing 'glitch' time again: 15 patients possibly given wrong antibiotic after lab error at Regina General Hospital

Just another computer "<a href="http://hcrenewal.blogspot.com/search/label/glitch">glitch</a>", that innocuous euphemism for a catastrophe-promoting IT defect, this time causing patients to receive the wrong antibiotics:<br /><br /><blockquote class="tr_bq">Regina Leader-Post<br />April 17, 2013 <br /><br /><b><a href="http://www.leaderpost.com/patients+possibly+given+wrong+antibiotic+after+error+Regina+General+Hospital/8252890/story.html#ixzz2QsfL7BoJ">15 patients possibly given wrong antibiotic after lab error at Regina General Hospital</a> </b><br /><br />Fifteen patients in southern Saskatchewan were potentially treated  with the wrong antibiotic stemming from a lab error at Regina General  Hospital, the Regina Qu'Appelle Health Region announced Tuesday.<br /><br />According  to the RQHR, lab reports between late January and late March  erroneously deemed Clindamycin would effectively treat the patients'  infections <b>when those bugs were actually resistant to the drug.  <span style="color: red;"><i>[The biological bugs, not the cybernetic bugs, that is - ed.]</i></span></b><br /><br />Only  one of the 15 patients suffered adverse effects. The 15th patient, an  adult male, experienced short-term negative effects but has since been  switched to another antibiotic. Citing patient confidentiality, the  health region would not elaborate on the man's condition.<br /><br />Dr. Jessica  Minion, a medical microbiologist in the General Hospital's laboratory,  said a <b>computer glitch </b>caused the faulty reports between Jan. 23 and  March 28. </blockquote><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"></div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"><br />Need I add that this "glitch" could very easily have killed people?<br /><br /><blockquote class="tr_bq">Minion added she and other medical staff will now cross-check  lab reports against lab tests after a change has been made within the  computer system.</blockquote><br />Wait - if the "glitch" is fixed, why is cross-checking still needed?  Doesn't sound like there's much confidence in this computing system...<br /><br /><blockquote class="tr_bq">The lab became aware of the problem on March 28  when the doctor treating the man who experienced problems notified the  hospital, Minion said. Lab staff then sifted through records and  determined a total of 15 people had been prescribed Clindamycin since  the erroneous reports began Jan. 23. </blockquote><br />Clindamycin itself is not an innocuous drug, with many potential serious <a href="http://www.drugs.com/sfx/clindamycin-side-effects.html">side effects</a>.<br /><br /><blockquote class="tr_bq">"It  was a very identifiable mistake that was being made in the computer  system, and there is a very clear trail of who exactly it affected," she  said. <b>"So we are quite confident that we have identified everybody that  would have been affected."</b></blockquote><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"><br />Only by the grace of God, none of those affected are six feet (2 meters) under, either due to their primary infections or drug adverse events from a drug they should never have been given.<br /><br />At least this time the oft-heard refrain "<a href="http://hcrenewal.blogspot.com/search/label/Patient%20care%20has%20not%20been%20compromised">but patient safety was not compromised</a>" was not proffered. </div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"><br /></div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">-- SS</div></div>

Healthcare computing 'glitch' time again: 15 patients possibly given wrong antibiotic after lab error at Regina General Hospital

Just another computer " glitch ", that innocuous euphemism for a catastrophe-promoting IT defect, this time causing patients to re...

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Guest Post: the Slow Grind of Justice

<br /> <br /><div class="MsoNormal"> <i><span style="background-color: white; color: blue; font-size: xx-small;">Health  Care Renewal presents a guest blog by Steve Lucas, a retired  businessman who formerly worked in real estate and construction who has a  long standing interest in business ethics, and has long observed the  health care scene.</span></i></div><div class="MsoNormal"><br /></div><div class="MsoNormal">The March 14, 2013 Akron Beacon Journal print edition highlights what I am sure Mercy  Medical Center hopes is the end of a long legal battle with Aultman Health Foundation. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">Cheryl Powell <a href="http://www.ohio.com/business/ohio-supreme-court-throws-out-aultman-s-appeal-in-battle-with-rival-mercy-hospital-1.380889">writes</a> in <i style="mso-bidi-font-style: normal;">"High court throws out appeal by Aultman"</i> highlights the Ohio Supreme Courts dismissal of Aultman’s suit brought in regards to a 2010 court ruling that Aultman pay Mercy $6.1 million for unfair business practices.  </div><div class="MsoNormal">A review of that legal action can be found on <a href="http://hcrenewal.blogspot.com/2010/06/guest-post-hospital-passing-that-low.html">this Health Care Renewal post</a>.</div><div class="MsoNormal"><br /></div><br /><blockquote class="tr_bq"><div class="MsoNormal">The legal battle centers on 'secret ´bonuses paid to select brokers for switching employers from other insurance plans to Aultman’s insurance company, AultCare.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Aultman Hospital is AultCare’s only in-network hospital in Canton.'</div></blockquote><br /><div class="MsoNormal"><br /></div><div class="MsoNormal">It is important to remember that AultCare is an aggressive for-profit insurance company.</div><div class="MsoNormal"><br /></div><br /><blockquote class="tr_bq"><div class="MsoNormal">At the end of the two-month trial in Stark County Common Please Court, jurors decided Aultman should pay Mercy more than $6.1 million in damages for engaging n a pattern of corrupt activity by influencing brokers with money.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">'Evidence during the trial showed that for a period of time, brokers weren’t allowed to disclose the payments to anyone, even the clients they represented.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Aultman officials have said the confidentiality requirement was dropped in 2004, well before Mercy filed its lawsuit.</div></blockquote><br /><div class="MsoNormal"><br /></div><div class="MsoNormal">We see an all too familiar behavior pattern: someone sensing that he or she is about to be caught drops an activity and then feigns innocence for our past transgressions. How often have we seen a drug company sign a consent agreement only then to return to court to sigh another consent agreement? How often are we told that an activity was committed by a low level sales person and that person is no longer with the company?</div><div class="MsoNormal"><br /></div><br /><blockquote class="tr_bq"><div class="MsoNormal">Aultman has continued to criticize the case Mercy filed, calling it a waste of resource for the non-profit health-care organizations.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">'We have always felt that this case was not positive for our community, that resources were shifted in a way that was not beneficial to the community' [the attorney representing Aultman, Allen] Schulman said. 'I don’t think that it serves the community well.'</div><div class="MsoNormal"><br /></div><div class="MsoNormal">[ Mercy President and Chief Executive Thomas] Cecconi said Mercy felt an obligation to fight Aultman’s business practices for the community’s sake.</div></blockquote><br /><div class="MsoNormal"><br /></div><div class="MsoNormal"><b>Conclusion</b></div><div class="MsoNormal"><br /></div><div class="MsoNormal">Once again we find the use of the legal system perverted by one party in an effort to gain a business advantage over another entity.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Aultman has used its non-profit status to shield the activities of a for-profit insurance subsidiary.  Perhaps someone thought that no one would sue a large non-profit hospital for the actions of the subsidiary.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Aultman used the tired old refrain that “we don’t do that anymore” as a defense for past business practices that garnered questionable profits. This after the fact admission does not absolve them of responsibility for those actions.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">When all else fails Aultman uses the appeal that it reflects badly on the community. It really does not matter that they were the ones who engaged in this activity. Additionally they make the claim this will result in a decline in resources available when they profited from the original activity.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">These are old concepts to HCR readers. The use of the legal system, from law suits being filed against those who would blow the whistle, to grinding out appeals to bleed a person or organization dry, all in an effort to protect a questionable or even illegal activity. In this case there is still the issue of Mercy’s legal fees involved in Aultman’s appeal.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Smaller markets are seeing a consolidation of hospitals and medical practices. The opportunity for one party to take advantage of this is growing as patients and doctors are presented with limited opportunities to seek appropriate medical care. When the hospital owns the insurance company, and your care will be dictated by the policy available through only one company, the opportunity for abuse has to be acknowledged. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">Mercy has begun to grow again by offering the community a less corporate medical experience. Interestingly, Mercy and Aultman have collaborated on securing scarce oncology drugs. It appears some doctors still feel it is about caring for the patient, and less about loyalty to a corporate logo.</div><div class="MsoNormal"><br /></div><div class="MsoNormal"></div><div class="MsoNormal">Steve Lucas</div><div class="MsoNormal"><br /></div>

Guest Post: the Slow Grind of Justice

Health Care Renewal presents a guest blog by Steve Lucas, a retired businessman who formerly worked in real estate and construction who...

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Fred Schulte: "GOP senators call for overhaul of electronic health records program"

Fred Schulte, investigative reporter at the Center for Public Integrity (<a href="http://www.publicintegrity.org/authors/fred-schulte">link to bio</a>), has authored a new article worth reading in its entirety:<br /><br /><blockquote class="tr_bq"><a href="http://www.publicintegrity.org/2013/04/16/12508/gop-senators-call-overhaul-electronic-health-records-program">GOP senators call for overhaul of electronic health records program</a><br />Lawmakers say Obama's $35 billion initiative pushing health information technology isn't working.<br /><br />Six U.S. Senators are calling for an overhaul of the federal  government’s $35 billion plan for doctors and hospitals to switch from  paper to electronic medical records, <b>citing concerns from patient  privacy to possible Medicare billing fraud.</b><br /><br />The <a href="http://www.thune.senate.gov/public/index.cfm/files/serve?File_id=0cf0490e-76af-4934-b534-83f5613c7370">report</a> issued Tuesday by the half-dozen Republicans concedes that many  lawmakers and medical experts believe the digital systems can reduce  health care costs and improve the quality of care by reducing  duplicative testing and cutting down on medical errors.  <span style="color: red;"><i><b>[Eventually, and with great effort the details of which many in the field lacking appropriate education and expertise are painfully unaware - ed.]</b></i></span><br /><br />But the report asserts that the Obama administration’s push to use  billions of dollars in stimulus money helping doctors and hospitals buy  digital systems <b>needs to be “recalibrated.”</b><br /><br />“Now, nearly four years after the enactment…and after hundreds of  pages of regulations implementing the program,” the document says, “we  see evidence that the program is at risk of not achieving its goals and  that $35 billion in taxpayer money is being spent ineffectively in the  process.”</blockquote><br />I've been calling for a "recalibration" (i.e., a cessation of putting the cart before the horse) and slowing down, for years.  See for instance my July 2010 post "<b>Meaningful Use Final Rule: Have the Administration and ONC Put the Cart Before the Horse on Health IT?</b>" and its hyperlinks at <a href="http://hcrenewal.blogspot.com/2010/07/meaningful-use-final-rule-have.html">http://hcrenewal.blogspot.com/2010/07/meaningful-use-final-rule-have.html</a>.<br /><br /><blockquote class="tr_bq">Among the report’s conclusions:<br /><ul><li>Despite expectations of cost savings, the digital systems may be increasing unnecessary medical tests and billings to Medicare.</li><li>The government has not demanded that the various digital systems be  able to share medical information, a critical element to their success.</li><li>Few controls exist to prevent fraud and abuse. Many doctors and  hospitals are receiving money by simply attesting that they are meeting  required standards.</li><li>Procedures to protect the privacy of patient records are <b>“</b>lax and may jeopardize sensitive patient data.”</li><li>It remains unclear whether doctors and hospitals that have accepted  stimulus funding will be able to maintain the systems without  government money.</li></ul></blockquote><br />I have as an even larger concern the quality and fitness (and hence safety) of today's health IT systems.  In what may be the first robust study, the findings as I have pointed out on this blog are of great concern:<br /><br /><blockquote class="tr_bq">Health Leaders Media<br />April 5, 2013<br /><a href="http://www.healthleadersmedia.com/print/TEC-290834/HIT-Errors-Tip-of-the-Iceberg-Says-ECRI" target="_blank">HIT Errors 'Tip of the Iceberg,' Says ECRI </a><br /><br /><b>Healthcare systems' transitions from paper records to electronic ones  are causing harm and in so many serious ways, providers are only now  beginning to understand the scope.</b> <span style="color: red;"><i><b> [I understood the scope years ago as reflected in my writings - ed.]</b></i></span><br /><br />Computer programs truncated dosage fields, leading to morphine-caused  respiratory arrest; lab test and transplant surgery records didn't talk  to each other, leading to organ rejection and patient death; and an  electronic systems' misinterpretation of the time "midnight" meant an  infant received antibiotics one dangerous day too late.<br /><br />These are among the 171 health information technology malfunctions and  disconnects that caused or could have caused patient harm in a report to  the ECRI Institute's Patient Safety Organization. <b>Thirty-six  participating hospitals</b> reported the data under a special voluntary  program conducted last year.<br /><br />Karen Zimmer, MD, medical director of the institute, says the reports of  so many types of errors and harm got the staff's attention in part <b>because the program captured so many serious errors within just a nine-week project last spring.  <i><span style="color: red;">[Including 8 injures and 3 possible deaths in just 9 weeks as I wrote at </span></i></b><i><span style="color: red;"><span style="color: black;">"</span></span></i><span style="color: red;"><i>Peering Underneath the Iceberg's Water Level:  AMNews on the New ECRI Deep Dive Study of Health IT Events</i><i>"</i></span><b><i> <a href="http://hcrenewal.blogspot.com/2013/02/peering-underneath-icebergs-water-level.html">here</a> <span style="color: red;">- ed.]</span></i></b><br /><br />The volume of errors in the voluntary reports was she says, "an awareness raiser."<br /><br />"If we're seeing this much under a voluntary reporting program, <b>we know this is just the tip of the iceberg; we know these events are very much underreported."</b><br /><br />... ECRI is currently evaluating a similar, and much larger list of  reports from many of the 800 hospitals that contract with ECRI's PSO  services. </blockquote><br />The fact that only GOP Senators so far have made this call is perhaps somewhat surprising, considering the abuse that side of the aisle often takes for being pro-business and anti-citizen rights. <br /><br />On the other hand, hospital accidents are a truly non-partisan issue.  A Democrat or Republican (or member of any other poitical party), and their loved ones, are all in the same boat.<br /><br />As this point in time, I recommend any patient have a strong advocate following everything done, not done, supposed to be done, not supposed to be done, med and allergy lists and fulfillment, action on lab and imaging reports, etc. -- importantly, <i><b>not depending on IT-dependent clinicians to do so.</b></i><br /><br />-- SS

Fred Schulte: "GOP senators call for overhaul of electronic health records program"

Fred Schulte, investigative reporter at the Center for Public Integrity ( link to bio ), has authored a new article worth reading in its ent...

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