Practice Beat

Joan R. Rose

Elder Abuse: A treatment mistake—or a criminal act? States keep blurring the lines

A Michigan physician has been charged with three counts of second-degree "vulnerable-adult abuse." He's the latest in a growing number of doctors who find themselves facing criminal charges for medical treatment decisions gone awry.

Michigan Attorney General Jennifer M. Granholm alleges that the Ann Arbor physician improperly treated three nursing home patients' bedsores, causing them additional pain and suffering. The AG's medical expert has determined that none of the wounds should have been treated with a sharp debridement. Moreover, she contends, the doctor should have "considered more basic procedures, such as ordering a splint or additional lab tests, before undertaking the surgical debridements."

Under Michigan law, vulnerable-adult abuse in the second degree is a felony. If convicted, the physician could face four years in prison and/or a $5,000 fine on each count.

Abortion Providers: Facing a bigger threat—and going after an old foe

While anthrax threats aren't new to abortion providers, the volume of threats is increasing. Since Sept. 11, several hundred clinics nationwide have received letters filled with a white powdery substance and claiming to contain anthrax, according to Planned Parenthood Federation of America.

On the West Coast, meanwhile, physicians will get another chance to shut down an Internet site they say threatens their safety. The US Court of Appeals for the Ninth Circuit has agreed to reconsider its decision in a suit against a group that created "The Nuremberg Files" Web site and "wanted" posters listing the names and addresses of abortion providers, with photos. A jury, finding they were "deadly threats" against physicians, awarded the doctors $107 million. But a three-judge appellate panel overturned the verdict, finding that the content of both was protected under the First Amendment right of free speech.

The American Medical Association joined Planned Parenthood in asking the court to rehear the case.

Patient Safety: Uncle Sam digs deepto improve quality

The US Department of Health and Human Services will fund 94 new research grants, contracts, and other projects to reduce medical errors and improve patient safety. The $50 million initiative—the first phase of a multiyear effort—will address how errors occur and provide science-based information on what patients, clinicians, and others can do to make the health care system safer. The research will include eight projects to examine how working conditions that produce fatigue, stress, and lack of sleep lead to medical errors.

Earlier this year, HHS Secretary Tommy Thompson created the Patient Safety Task Force to coordinate and strengthen government systems for collecting data in concert with the states and the private sector.

Online Drug Ads: Direct-to-consumer advertising touts free samples

Novartis Pharmaceuticals, in conjunction with MedManage Systems, recently became the first manufacturer to offer vouchers for free drug samples directly from the Internet. In addition to simplifying sample accountability, MedManage says, the approach reduces physician liability by ensuring that no patient receives expired medication.

Patients visiting the Famvir Web site (www.famvir.com/gh_index.asp ) can print out a voucher for a five-day trial of the medication. The vouchers must be signed by a physician and accompanied by a prescription. Patients then redeem them at any of the more than 55,000 participating pharmacies nationwide. Only one voucher per patient may be redeemed.

MedManage has similar programs pending with several other major pharmaceutical companies.

Patients' Rights: High court upholds the right of Medicare patients to sue their HMOs

The US Supreme Court has declined to hear an appeal of a California Supreme Court ruling that Medicare patients may sue their HMOs in state court for denying needed care.

The plaintiff, now deceased, suffered from progressive lung disease. In the lawsuit, continued by his estate, he claimed that the defendants (PacifiCare of California, his physician, and the doctor's medical group) repeatedly refused to refer him to a specialist for a lung transplant, ultimately forcing him to leave the plan in order to get on a transplant list. He contended that the HMO had denied the care for its own financial gain.

A trial court dismissed the case on grounds that it was precluded by Medicare law, which allows beneficiaries to sue only in federal court—and then only for reimbursement of the actual value of the denied services. But the appellate court disagreed, pointing out that the primary causes of action are based on claims that don't involve reimbursement issues. "Removal of the right to sue the private Medicare provider for its torts would result in an inequitable and substantial dilution of the rights of patients," the court said.

The author is a Contributing Writer.

 

Joan Rose. Practice Beat. Medical Economics Dec. 3, 2001;78:14.