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Warning patients about the dangers of food allergies, Don't use this code for nursing home patients
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I read with concern "A $10 million allergy case: Could it happen to you?" [June 7], the story of how two doctorsa pediatrician and an allergistwere found liable for the severe brain damage suffered by their patient, a child with a known allergy to peanuts who ate some peanut-filled candy. The jury found that the physicians had failed to adequately warn the child's parents about the dangers of anaphylactic shock. But where does the chain of liability stop?
Must a pediatrician tell the parents of every patient with a food allergy that their child can die? Do we hand out epinephrine kits at the first suspicion of an allergy? Should every kid with a rash be injected? Do we need cardiac consultations about the potential harm from epinephrine?
These questions rise from the new standard of care set by this case, created by physician expert witnesses willing (for a fee) to distort the accepted standard to the point where reason disappears and the problems of one individual become everyone else's responsibility.
Obviously, a parent can't be with his child every minute. So, if a playmate or classmate unknowingly shares forbidden food, who is to blame? The classmate? The teacher? The school system that failed to confiscate every contraband peanut butter and jelly sandwich brought for lunch? Perhaps the parents, who failed to take measures to protect their child from food allergies when he was away from their side? Can the court appoint a guardian so the child can sue his parents for negligence?
Where will it end?
James Lewis Griffith Sr., JD
As former chairperson of the Adverse Reactions to Foods Committee of the Academy of Allergy, Asthma and Immunology, I would like to commend Medical Economics for the timely article on the seriousness of food allergies. However, I disagree with allergist James Rosen who testified that referring patients with a food allergy to an allergist was proper, "but not essential."
The nature of food allergies demands a referral to a board certified allergist who has an interest in food allergy. Diagnosis can be difficult and patient histories are often inaccurate. Appropriate diagnostic tests must be utilized and interpreted correctly. The patient must be given specific education on avoiding the allergen and procedures to be followed in case of accidental exposure. Follow-up treatment is essential since food allergies may change over time, particularly in children.
As this case demonstrates, the inadequate treatment of food allergy can have a catastrophic outcome. Referral to an allergy specialist is essential.
Brett V. Kettelhut, MD
In your April 12 "Practice Management Questions & Answers," I was excited to see an item about a code for Medicare payment of "health plan oversight" for a patient at a nursing home. I had always been under the impression that these codes were for the review of home health services and hospice care, not care at a skilled nursing facility. Please explain.
Editor's note: You are correct. Code G0181 may not be used for reviewing care at a skilled nursing home. We apologize for the error. For more information, see our Coding Consult column "Homing in on nursing home codes" [Aug. 9].
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Letters to the Editors. Medical Economics 2002;18:6.