6/18/11 - Liability and Health Reform Update
ACTION ALERT - Fair Share AMENDMENT Vote Wednesday
((Editor's comments in blue italics. Please scroll to the end for more information, disclaimer, etc.))
Editor's Commentary - PLEASE CALL YOUR STATE SENATOR
Pennsylvania's doctors, hospitals and businesses support the Fair Share Act - the ORIGINAL Fair Share Act, passed by the PA House and then bottled up in the Senate.
On Wednesday, the only measure that could make it our of Sen. Stuart Greenleaf's Judiciary Committee will reach the Senate floor - but before it passes, it needs MAJOR work. So we're asking you to contact your state senator and ask him or her to vote YES on the Corman Amendment to Sen. Greenleaf's SB1131.
Without the Corman Amendment, SB1131 isn't worth passing - so you need to ask your senators to vote Yes on the Corman amendment BEFORE they vote on SB1311. After the CORMAN AMENDMENT passes and is attached to SB1311, THEN we'd like them to vote Yes on it.
Following is important information to help you get engaged in the fight - WE NEED YOUR CALLS AND EMAILS BEFORE WEDNESDAY'S VOTE.
How to contact your Pennsylvania State Senators (alphabetically):
http://www.legis.state.pa.us/cfdocs/legis/home/member_information/senators_alpha.cfm
If you don't know who represents you, use this easy tool to find out:
http://www.legis.state.pa.us/cfdocs/legis/home/findyourlegislator/#address
Do it right now, before you forget.
Thank you!
DBR
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From our friends at Cold Spark Media and Citizens to Protect PA Jobs:
Hello everyone,We need your help to score a major victory for tort reform in Pennsylvania.
The PA Senate is going to vote on SB 1131 on joint and several - but this is not the bill which will help Pennsylvania businesses like HB1, which passed the house with a huge margin, would have. This is a significantly watered-down version and needs to be amended on the Senate Floor in order to make it effective.
Senator Corman is offering an amendment to SB1131 that reforms the failed Joint and Several liability system in Pennsylvania. This is the Fair Share Act that we've been fighting for over the last many months. Your help so far has been crucial but this is not the time to let up. Please call your Senator and ask him or her to vote for CORMAN AMENDMENT to SB1131. Tell them to stand on the side of small business, hospitals, doctors, and manufacturers, and not on the side of the trial lawyers.Find your senator here:
We believe that Senators Erickson, Mary Jo White, and Gene Yaw are on the fence. Please encourage them to stand up for job creation in Pennsylvania by supporting the CORMAN AMENDMENT
Sincerely,Citizens to Protect PA Jobs
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The Legal IntelligencerTort Reform Compromise Gains in State Senate
http://www.law.com/jsp/pa/PubArticlePA.jsp?id=1202497538582&src=EMC-Email&et=editorial&bu=The%20Legal%20Intelligencer&pt=TLI%20AM%20Legal%20Alert&cn=TLI_AM20110616&kw=Tort%20Reform%20Compromise%20Gains%20in%20State%20Senate&slreturn=1&hbxlogin=1
Amaris Elliott-Engel - June 16, 2011
A proposal to abolish the common-law doctrine of joint and several liability has become law once in the last decade before being struck down by the state Supreme Court on procedural grounds. The same proposal was passed by the General Assembly in 2006, only to be vetoed by a Democratic governor.
But in 2011, the measure isn't getting past a state Senate committee chairman in its original form, despite the fact that Republicans control the governor's mansion and both houses of the state legislature.
Instead, state Sen. Stewart Greenleaf, R-Montgomery, the majority chairman of the Senate Judiciary Committee, crafted alternatives to a proposal that has been popular with lawmakers in the past and would require defendants that are apportioned responsibility for causing a plaintiff's injuries at 60 percent or less to only pay the portion for which they were found liable.
Greenleaf's latest alternative to House Bill 1/Senate Bill 2 was introduced Monday and was approved by the Judiciary Committee 13-1 Tuesday. The bill also was sponsored by State Sen. Jake Corman, R-Centre, who was one of the sponsors of SB2.
Senate Bill 1131, the latest Senate alternative to HB1/SB2, would still apply joint and several liability to economic damages and in cases "where a minor has a beneficial interest."
State Sen. Dominic Pileggi, R-Delaware, the Senate Republican Majority Leader, plans for the Senate to vote on the issue of joint and several liability this month, perhaps as early as next week, spokesman Erik Arneson said in an e-mail, but amendments are almost certain to be offered.
Greenleaf said that he amended SB2 because joint and several lability needs to be reformed, but still provides an important function in Pennsylvania law: ensuring that injured victims are substantially compensated for their injuries.
"Joint and several liability has always had the philosophy that we should protect the victims of wrongdoing and make sure, best as we can, that they're fully compensated and not throw them onto the taxpayer."
Greenleaf argued that SB2 would cause victims, subject to physical injuries and who cannot get fully compensated, to rely on the governmental programs of Medicaid or Medicare for their care.
Employers who cannot get compensated for workers' compensation claims from judgments also will be adversely affected, and doctor defendants in medical malpractice cases will no longer be able to turn to hospital co-defendants to supplement their share of defense verdicts, Greenleaf said.
Even though the stars might have seemed aligned for changes to Pennsylvania's tort law because Republicans control the General Assembly and the executive branch, the Pennsylvania Republican Party is not a monolith on issues that have support among Republican voters, including tort reform, school choice and whether to tax natural gas drillers, said Christopher Borick, director of the Muhlenberg College Institute of Public Opinion.
"What happens sometimes in the small body of the Senate, it only takes a few key members who have differences on the matter to really hold it up and in this case craft a version that is less intense relative to the House version," Borick said.
James Redmond, senior vice president for legislative services for The Hospital and Healthsystem Association of Pennsylvania, said that proponents of changing Pennsylvania's tort law hope that SB1131 can be amended so it ends up looking more like SB2.
The association opposes SB1131, not only because of the proposed exception of ending joint and several liability for noneconomic damages, but because making an exception for minors who have a beneficial interest in tort cases "could be interpreted as including most cases," Redmond said.
Greenleaf deserves credit for trying to bring the proponents and opponents of changing the doctrine of joint and several liability together, but the health care provider community, business community and insurance community view SB2/HB1 as non-negotiable, Redmond said.
Redmond said he believes that the majority of the Senate is supportive of SB2, but that version of tort reform is opposed by Greenleaf and will not get out of the Judiciary Committee.
Mark E. Phenicie, legislative counsel for the trial lawyer group Pennsylvania Association of Justice, said that one reason that SB2/HB1 may be less popular in the Senate than in the past is that there are 20 new senators and a totally new Senate leadership since the 60 percent standard was last passed by legislators.
Phenicie said that SB1 is a compromise between SB2 and Senate Bill 500, a prior bill introduced by Greenleaf which would abolish joint liability for any defendant whose percentage share of liability is less than the percentage share attributed to the plaintiff. The bill would bar a plaintiff from recovering damages from the defendant in excess of the defendant's percentage share.
"We think that [compromise] eminently fair," Phenicie said. "Most of the angst on tort reform has mostly come to non-economic damages. While they're very real they're hard to quantify."
Redmond said SB1131 is only being called a compromise by the state's trial lawyers.
Proponents of the Greenleaf's proposal fear that Gov. Tom Corbett will find it unacceptable, Phenicie said.
Corbett's press office did not respond to a request for comment Wednesday.
A spokesman for Republican House Majority Leader Mike Turzai, R-Allegheny, said there is nothing to comment on regarding alternatives to HB1 until the full Senate acts.
In April, the state House of Representatives approved HB1, the "Fair Share Act," on a 112-88 vote
During his budget address in March, Corbett said that he would sign legislation abrogating the doctrine of joint and several liability, arguing legal liability scares jobs away and leaves minor players stuck paying the full price of lawsuits. •
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http://www.pittsburghlive.com/x/pittsburghtrib/opinion/s_741555.html
Torts' tough track
By Brad Bumsted, TRIBUNE-REVIEW
Sunday, June 12, 2011
How much clout does a committee chairman have? Quite a lot, is the answer. But in the end, not more than a majority of his or her caucus or the will of the House or Senate.
How much clout does a committee chairman have? Quite a lot, is the answer. But in the end, not more than a majority of his or her caucus or the will of the House or Senate.
It's an issue now because Senate Judiciary Chairman Stewart Greenleaf will not allow the "Fair Share Act" to emerge from his committee for a Senate vote. It has been passed by the House and it's a top priority of Gov. Tom Corbett.
It's issue No. 1 for the business community but Greenleaf thinks it shortchanges victims.
The bill would prevent minor parties in lawsuits from having to pay full damages when those most responsible can't pay. Supporters say it prevents targeting "deep pocket" defendants who bear a small share of the responsibility for causing damages. It's based on the concept of "comparative responsibility."
Ultimately, Greenleaf knows he can't block it if a majority of Senate Republican Caucus members demand action. But he is trying to hold out for some modifications.
It's likely there's a majority. And a member of leadership, Senate Appropriations Chairman Jake Corman, R-Centre County, has his own bill, which is like the House bill. It's also parked in the Judiciary Committee.
The bill has been passed twice before by the General Assembly but never became law. So supporters see no need to compromise on a weaker version. The legislation was overturned by the courts and later vetoed by then-Gov. Ed Rendell, a Democrat.
It pits trial lawyers against the business and insurance communities.
Greenleaf wants to make sure victims have a fair shot and ultimately taxpayers and ratepayers aren't left holding the bag.
But supporters say taking this step is critical for reducing Pennsylvania's reputation as a haven for plaintiffs' lawyers and to improve the overall climate for business. It's the first step in "tort reform" and Corbett and House Majority Leader Mike Turzai, R-Bradford Woods, will have more to follow.
What Greenleaf is doing is no different from what numerous committee chairmen have done in the past. When Rep. Bill DeWeese, D-Greene, was House Judiciary chairman in the 1980s, he used to bottle up bills restricting abortion.
Last session, former House Appropriations Chairman Dwight Evans, D-Philadelphia, refused for the longest time to release the so-called Castle Doctrine bill. That bill expands the concept of self-defense by allowing people to shoot an assailant outside their home without retreat when their lives are in danger. Currently they can do that in their homes. But the majority of the House wanted action on the bill. Many Democrats supported it.
A "discharge resolution" was filed and then-Democrat House leaders saw the handwriting on the wall. Evans released it. It was approved by both chambers, then vetoed by Rendell.
It should soon end up on Corbett's desk. Like several other bills, it's stuck in a no-man's land with a House-passed and Senate-passed version. It's all about who gets the credit -- which legislator becomes the final sponsor.
Greenleaf says it's the business community that won't compromise. He said he offered "compromise after compromise." Businesses leaders say: Why should we if we have the votes?
Erik Arneson, a spokesman for Senate Majority Leader Dominic Pileggi, R-Delaware County, said there will be a vote this month. On what version, it remains to be seen.
As for the clout of committee chairmen, it's like most other arenas, including the private sector -- there are limits on a boss's power.
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Members of the PA Senate JUDICIARY Committee
Officers
Greenleaf, Stewart J. , Chair
19 East Wing
(717) 787-6599
sgreenleaf@pasen.gov
Senate District 12 Bucks (part) and Montgomery (part) Counties
White, Mary Jo, Vice Chair
169 Capitol Building
(717) 787-9684 mwhite@pasen.gov
Senate District 21 Butler (part), Clarion, Erie (part), Forest, Venango and Warren (part) Counties
Leach, Daylin , Minority Chair
184 Main Capitol
(717) 787-5544
http://www.senatorleach.com
Senate District 17 Delaware (part) and Montgomery (part) Counties
Scarnati, Joseph B., III, ex-officio
292 Capitol Building
(717) 787-7084
jscarnati@pasen.gov
Senate District 25 Cameron, Clearfield (part), Elk, Jefferson, Mckean, Potter, Tioga and Warren (part) Counties
Majority
Alloway, Richard L., II
187 Main Capitol
(717) 787-4651
alloway@pasen.gov
Senate District 33 Adams, Franklin and York (part) Counties
Earll, Jane M.
177 Capitol Building
(717) 787-8927 jearll@pasen.gov
Senate District 49 Erie (part) County
Gordner, John R.
351 Main Capitol
(717) 787-8928 jgordner@pasen.gov
Senate District 27 Columbia, Dauphin (part), Luzerne (part), Montour, Northumberland and Snyder Counties
Orie, Jane Clare
362 Main Capitol
(717) 787-6538
jorie@pasen.gov
Senate District 40 Allegheny (part) and Butler (part) Counties
Piccola, Jeffrey E.
173 Capitol Building (717) 787-6801
jpiccola@pasen.gov
Senate District 15 Dauphin (part) and York (part) Counties
Rafferty, John C., Jr.
20 East Wing (717) 787-1398
jrafferty@pasen.gov
Senate District 44 Berks (part), Chester (part) and Montgomery (part) Counties
Minority
Boscola, Lisa M.
458 Capitol Building
(717) 787-4236 boscola@pasenate.com
Senate District 18 Lehigh (part), Monroe (part) and Northampton (part) Counties
Farnese, Jr., Lawrence M.
543 Main Capitol (717) 787-5662 http://www.senatorfarnese.com
Senate District 1 Philadelphia (part) County
Hughes, Vincent J.
545 Capitol Building
(717) 787-7112
hughes@pasenate.com
Senate District 7 Montgomery (part) and Philadelphia (part) Counties
Stack, Michael J.
543 Main Capitol (717) 787-9608 stack@pasenate.com
Senate District 5 Philadelphia (part) County
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Pittsburgh TRIBUNE-REVIEW
Corbett pushes limits on who would pay damage awards from lawsuits
http://www.pittsburghlive.com/x/pittsburghtrib/news/state/s_740798.html
By Brad Bumsted
Tuesday, June 7, 2011
HARRISBURG — Republican Gov. Tom Corbett wants the General Assembly to place limits on who would have to pay damage awards in civil suits before lawmakers recess for the summer, a spokesman said on Monday.
Specifically, Corbett is asking the House and Senate to approve legislation that would apportion liability based on one's degree of actual responsibility — for those parties deemed less than 60 percent responsible, said Kevin Harley, the governor's press secretary.
Currently, an award can be collected from any liable defendant. Supporters of the legislation say a company 10 percent responsible for an accident now can be required to pay 100 percent of damages if others can't pay.
The governor sees it as a major step to making Pennsylvania more business-friendly, Harley said.
A House-passed bill, and an identical Senate bill, are pending in the Senate Judiciary Committee. Chairman Stewart Greenleaf, R-Montgomery County, met with supporters and opponents yesterday from the legal, insurance and business communities in an effort to find middle ground.
Greenleaf said he proposed several compromises rejected by business leaders.
"They said they want the Legislature to decide," he said.
Greenleaf said he will continue to seek compromise on modified versions of the legislation Corbett is seeking.
Asked if he would release the House bill or a similar Senate bill from his committee, Greenleaf said, "No. Those bills are terribly unfair." ((Says Sen. Greenleaf.....))
While House leaders call the legislation the Fair Share Act. Mark Phenicie, legislative counsel for the Pennsylvania Trial Lawyers Association, which opposes the legislation, calls it the Corporate Irresponsibility Act.
"There's nothing fair about that bill," Phenicie said. ((Oh, and the guy the trial lawyers pay to make sure they keep making lots of money in PA....he says it's unfair, too.))
Gene Barr, vice president for government and public affairs for the Pennsylvania Chamber of Business and Industry, argued that "broad-based legal reform is very important in making Pennsylvania a more competitive state in terms of attracting business.
"We are one of a handful of states that has not reformed civil liability for businesses, and that's a big reason why we are viewed by CEOs as among the costliest states to do business."
Legal reform and property tax reform are on Corbett's list of "wants" from the Legislature along with a no-tax-hike budget, Harley said..
Under a law enacted five years ago, school boards are required to submit proposed property tax increases to voters if the increases exceed a so-called "education index," slightly higher than the inflation rate. But there are 10 exceptions to seeking voter approval, and they have prevented most tax increases from going to a referendum.
In five years, only 14 such referendums have appeared on the ballot. Pennsylvania has 500 school districts.
Corbett in his March budget address called for eliminating all exceptions.
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From Defense of Medicine Blog
High Quality Care Does Not Reduce Litigation Exposure
by Jonathan B. Stepanian, Esq.
http://www.defenseofmedicine.com/2011/05/high-quality-care-does-not-reduce-litigation-exposure/#more-563
Providing high quality care is not strongly associated with a reduction in litigation exposure according to a recent study published in the New England Journal of Medicine. The results of this study, while frustrating to some, reaffirm our belief that litigation has more to do with the process of care rather than the quality of care; I have written about this point in the past.
The New England Journal authors sought to assess “whether high-quality health care institutions are less likely to be sued for negligence than their low-performing counterparts.” Although this premise may seem logical, its validity has been questioned by many studies.
In this recent study, the authors compared 1465 nursing homes in terms of quality indicators and demands for compensation for injury. The authors chose nursing homes because quality data on those facilities is widely available and standardized. Hospital data is less available and standard. Additionally, the incidence of malpractice claims against institutions is not widely available. For this study, the authors were able to look to five of the largest nursing home chains in the United States to obtain information related to the incidence of claims against their facilities.
To define which nursing homes provided “high quality care,” the study authors selected 10 specific quality indicators to compare across facilities, such as the incidence of falls or fractures, the development of pressure ulcers, and staffing. They questioned whether those facilities with better quality indicators faced a lower incidence of malpractice claims.
Some will find their results frustrating. Although the authors found an inverse relationship between nursing home performance and litigation risk for several of the measured quality indicators, the associations were weak. The authors observed
[T]he levels of litigation were only fractionally lower for the best-performing nursing homes than for their worst-performing counterparts.
Intuitively, we like to think that increases in quality of care will lead to lower risk of litigation.
However, this recent New England Journal study does not demonstrate that this is necessarily true. Although quality care is certainly important, health care providers need to remember that the process of providing care is equally important. Refining that process of care may help to lower the risk of negligence litigation.
About the author - Jon is a partner at the McQuaide Blasko law firm whose practice is specialized in litigation, complex medical professional liability defense, health care, and providing legal counsel on numerous issues associated with day-to-day hospital operations. He has successfully tried several cases to verdict as first-chair trial counsel before juries in both state and federal court. Jon has also represented clients in appellate litigation, mediation, and in connection with administrative agency investigations. Contact Jon by email.
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((And at the federal level, kudos to Reps. Dent and Paulson for this latest entry in the medical liability reform saga...))
Press Releases - June 16, 2011
Dent and Paulsen Introduce Medical Liability Reform Bill
http://dent.house.gov/index.cfm?p=PressReleases&ContentRecord_id=6ba7c5a6-72f1-4bfb-8463-18569408470b
WASHINGTON, D.C. -- U.S. Reps. Charlie Dent (PA-15) and Erik Paulsen (MN-3) today introduced legislation (H.R. 2205) to decrease the cost of health care and improve protections for patients through comprehensive medical liability reform.
“The 2010 health care law missed a critical opportunity to enact meaningful medical liability reforms,” said Rep. Dent. “Our medical justice system is a major cost driver for health care spending and it impacts the ability of patients to receive high quality care. We expect doctors to make decisions based solely on what is best for their patients, not on what is best to defend against frivolous lawsuits. Across the United States, the lack of comprehensive reform has affected where qualified doctors practice, what fields of medicine they pursue, and the services they provide. As Congress continues to discuss ways to reform and strengthen our health care system, advancing the common-sense policies included in H.R. 2205 will help reduce health care spending and ensure access to quality care.”
“The reality is medical liability does contribute to increased healthcare costs. Healthcare professionals practice defensive medicine for fear of frivolous lawsuits and end up ordering billions of dollars in extra tests and treatments,” said Rep. Paulsen. “The current environment not only increases the cost of care for patients, but also discourages highly skilled and dedicated physicians from providing important services. Three out of four emergency rooms have reported shortages of specialists, and many orthopedic surgeons have chosen to retire early or scale back their surgical duties, because of liability concerns. These reforms are needed to protect patients, reduce healthcare costs, and ensure that this nation continues to produce the world’s greatest healthcare professionals.”
The practice of defensive medicine – when doctors order tests and treatments in order to protect themselves against frivolous lawsuits – is estimated to cost as much as $200 billion annually.
Congressional Budget Office (CBO) analyses indicate comprehensive medical liability reform would save the government $54 billion over the next decade and cut national health care spending by 0.5 percent per year.
H.R. 2205 will help end the costly practice of defensive medicine by encouraging states to adopt effective alternative medical liability laws that reduce the number of health care lawsuits initiated, reduce the average amount of time taken to resolve lawsuits and reduce the cost of malpractice insurance. The legislation will also enact nationwide reforms to stabilize compensation for injured patients, hold parties responsible for their degree of fault, ensure that meritorious claims are swiftly resolved, encourage compliance with accepted clinical practice guidelines, and guarantee that medical care is available to those who need it the most by providing protections to safety-net providers.
Charles W. Dent (R-PA-15) Erik Paulsen (R-3-MN)
1009 Longworth House Office Building 127 Cannon HOB
Washington, DC 20515 Washington, D.C., 20515
Telephone: 202-226-0778 Telephone: 202-225-2871
FAX: 202-226-0778 FAX: 202-225-6351
http://dent.house.gov http://paulsen.house.gov
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From MedInnovation
http://medinnovationblog.blogspot.com/2011/06/health-reform-and-great-unmentionable.html
Monday, June 6, 2011
Health Reform and the Great Unmentionable : Lack of Patient Compliance as One Cause of Poor Outcomes
http://medinnovationblog.blogspot.com/2011/06/health-reform-and-great-unmentionable.html
Monday, June 6, 2011
Health Reform and the Great Unmentionable : Lack of Patient Compliance as One Cause of Poor Outcomes
The typical attempt to solve a social ill focuses on giving people information, or it tries to motivate people through fear. But these strategies tend to fail…The more important and deeply rooted the behavior, the less impact information has the more people close their minds to messages that scare them.
Tina Rosenberg, Join the Club: How Peer Pressure Can Transform the World, W.W. Norton and Company, 2011June 6, 2011 - U.S. health system critics and health reform zealots often close their minds to a major cause of poor outcomes – lack of patient compliance. Instead , they attribute poor outcomes to lack of universal coverage, socioeconomic distress, or the profit-seeking medical industrial complex. To say bad outcomes stems from bad behavior to cultural and peer conformity is unmentionable and therefore unspeakable because patients are sacred. Criticism of patients as a source of bad results is off-limits. It is viewed as bad politics. These are potential voters you are criticizing. Health professionals and the capitalistic system in which they practice, not patients or population factors, are said to be responsible for the bad health of the nation, even though abundant evidence exists that other things – life style, poverty, income differences, inferior education, lack of family cohesion, violence in the streets and homes, clean water, adequate energy sources, culture, and simply following the crowd – are more responsible (1, 2).The “Social Cure”In her new book, Join the Club, How Peer Pressure Can Transform the Word (3), Tina Rosenberg, a Pulitzer-prize winning author , does us a favor by reminding us that patient behavior, dictated by the culture in which they live and their desire for social acceptance by peers, plays just as great a role as most other factors combined . Rosenberg reminds us, again and again, that the “social cure” – people responding positively to peer pressure and new social norms – may be more important than health reform itself. No amount of information she asserts, or warnings from government expert or from doctors “can budge us when we refuse to be budged…We often lie to others about our bad behavior, but the more interesting and powerful excuses come when we lie to ourselves.” People do not like to be lectured to about their health. They prefer to listen to their own inner demons, no matter what the consequences, To them, it is short-term gratification, not long-term consequences, that count.Patient Non-ComplianceIn the paragraph that follows, she gives these examples of what she is talking about.“Take, for example, patient adherence – failure to carry out a doctor’s orders. Poor patient adherence is a serious problem; dozens of studies have shown this. Only a fourth of the people on blood-pressure drugs in one study took their pills correctly. Only 13 percent of diabetes patients taking certain drugs complied with their regimens for a year. Three-quarter of patients in a study did not keep follow-up appointments and 50 percent of patients with chronic illnesses dropped out of a treatment within a year.”Failure of Alternative ApproachesAlternative approaches have been tried to help patients comply – counseling, group therapy of patients with common diseases, patient information brochures, electronic beeping pillboxes, automated –reminder phone calls, DOTS (Directly Observed Treatment, Short-Course) by loved ones, a nurse, or a community worker) – may work temporarily but in the long-term none of these approaches can get people to take their pills more than half the time.Innovative "social Cure" ProgramsThe point of Rosenberg’s book is this. People do not respond to what authorities or doctors tell them to do, but to what their peers approve of or what they do. Creating innovative peer groups to respond to health problems, whether these groups be similar to alcoholics anonymous, to maverick organizations persuading teenagers it is manipulative tobacco companies not adult do-gooders that are trying to get them to stop smoking, peers telling gays and HIV-positive individuals that condom use is a good thing – creates positive social change and the “social cures.” These programs , she says, are what we ought to be concentrating upon.Summing UpIn summary, the health of society may depend more on social and peer conformity than its national health system. People will do what they want to do and what they think pleases their peers rather than following the advice or warnings of harm from health experts or doctors.References1. L. Sagan, The Health of Nations: The Cause of Sickness and Well-Being, Basic Books, 1987.2. D. Satcher, and R. Pamies, Multicultural Medicine and Health Differences, MacGraw Hill, 2006.3. T. Rosenberg, Join the Club: How Peer Pressure Can Transform the World, W, W. Norton and Company, 2011.
Posted by Richard L. Reece, MD at 6:30 AM
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Some Programs OK’d By Health Law Lacking Funding
By Phil Galewitz
KHN Staff Writer
Jun 09, 2011
http://www.kaiserhealthnews.org/Stories/2011/June/09/unfunded-appropriations-health-law.aspx
Posted by Richard L. Reece, MD at 6:30 AM
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Some Programs OK’d By Health Law Lacking Funding
By Phil Galewitz
KHN Staff Writer
Jun 09, 2011
http://www.kaiserhealthnews.org/Stories/2011/June/09/unfunded-appropriations-health-law.aspx
((The administration promised medical liability reform as a carrot to get the AMA to endorse the PPACA and threw $25 million at states for "demonstration projects." Then, this year, they promised more....but, not surprisingly, the money just isn't there....))
While the health care law has survived Republican efforts to repeal it, some of its individual initiatives are in limbo or limping along because of funding problems. The law authorized the new efforts but didn’t provide appropriations for them. That has to occur separately – and given current deficit woes, as well as wrangling between Democrats and Republicans, the programs might never get off the ground, some experts say. “Since the law was passed, the budgetary picture in Congress has changed dramatically," said Bruce Vladeck, former Medicare administrator in the Clinton administration and now a New York health care consultant. "So stuff (Obama administration officials) were interested in doing when health reform passed, they now have a realistic sense that …they are never going to get an appropriation to do it.”
One of the higher-profile initiatives that has not received any funding is a $50 million program to help states test alternatives to resolve medical malpractice disputes.
The American Medical Association, which backed the health law, is upset. “Congress should fully fund medical liability demonstration and pilot programs in the health reform law,” said Dr. Cecil Wilson, president of the AMA. “Everyone pays for the increasingly irrational medical liability system in this country.” ((That's what happens when you accept promises from politicians....))
A separate program that is providing $25 million in grants to test malpractice reforms to improve patient safety hasn’t been affected. The White House approved those grants six months before the health care law was enacted.
Other initiatives in the health law slated for this year that haven't started or been fully funded include:
--A $24 million program to help test regional systems for delivering emergency care. The effort would help hospitals work together to assure adequate physician staffing in the ERs. No money has been proposed.
--A program to have health clinics run by nurse practitioners. The program has received $15 million instead of the $50 million called for in the law.
--A project to monitor for-profit nursing home chains and a program to increase use of information technology such as electronic health records in nursing homes. No money has been proposed.
Although these programs were authorized under the health law, funding was not mandated.
Administration officials say, given the budget squeeze, they’ve had to set priorities on funding.
“While recognizing the importance of restraining federal spending, the administration has proposed funding for some activities authorized by the Affordable Care Act, such as nurse-managed health centers and many workforce programs,” said Jessica Santillo, a spokeswoman for the Health and Human Services Department.
Some lobbying groups aren’t satisfied. For example, emergency room physicians worry they may lost an opportunity to improve care. “We’ve been very disappointed at the lack of federal funding to implement the regionalized systems of emergency care pilot projects that were created under the Affordable Care Act,” said Dr. Sandra Schneider, president of the American College of Emergency Physicians. She said numerous studies have proven that “regionalized, coordinated and accountable emergency care systems would not only improve patient outcomes, but do so at less cost.”
Another program from the law that has not been funded is a $60 million program to test alternative dental providers such as hygienists or dental aides who would extract teeth and fill cavities in rural areas where dentists are scarce. The program, which is supposed to start by March 2012 was strongly supported by the Battle Creek, Mich.-based W.K. Kellogg Foundation which has been funding a similar program in Alaska. The federal money would be awarded to colleges, community health centers and Indian health clinics.
“We were excited to see the inclusion of the oral health provision in the bill,” said Alice Warner, program officer at the Kellogg Foundation. “We thought it was forward thinking.”
The American Dental Association, which opposes the idea of letting anyone but trained dentists extract teeth and fill cavities, applauded the lack of funding in Obama’s 2012 budget request. “We didn’t want this concept to get a foot in the door,” said an ADA spokesman.
pgalewitz@kff.org
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From the Washington Examiner
http://washingtonexaminer.com/opinion/2011/06/texas-makes-losers-pay-bringing-frivolous-lawsuits
Texas makes losers pay for bringing frivolous lawsuits
By: Examiner Editorial 06/04/11 8:05 PM
((Sigh......TEXAS......))
It's no wonder that Texas Gov. Rick Perry has recently been the focus of speculation about whether he might run for president in 2012. Texas has been on an economic roll since 2001, creating far more new jobs than any other state in the nation even as its population swelled to 25 million. Love him or hate him, Perry is in his fourth term in Austin and thus deserves a big chunk of the credit for many of the good things happening in the Lone Star State. Texas also has implemented some of the most significant state-level reforms in the country aimed at reducing or eliminating lawsuit abuse.
pgalewitz@kff.org
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From the Washington Examiner
http://washingtonexaminer.com/opinion/2011/06/texas-makes-losers-pay-bringing-frivolous-lawsuits
Texas makes losers pay for bringing frivolous lawsuits
By: Examiner Editorial 06/04/11 8:05 PM
((Sigh......TEXAS......))
It's no wonder that Texas Gov. Rick Perry has recently been the focus of speculation about whether he might run for president in 2012. Texas has been on an economic roll since 2001, creating far more new jobs than any other state in the nation even as its population swelled to 25 million. Love him or hate him, Perry is in his fourth term in Austin and thus deserves a big chunk of the credit for many of the good things happening in the Lone Star State. Texas also has implemented some of the most significant state-level reforms in the country aimed at reducing or eliminating lawsuit abuse.
The latest of these is a "loser-pays" provision requiring plaintiffs to pay the winners' legal costs in civil suits seeking punitive damages. The provision is included in the 2011 Omnibus Tort Reform Act Perry signed May 30. In addition to the loser-pays provision, the new law:
• Allows a trial judge to send a question of law directly to the appellate court without requiring all parties to agree if a ruling by a court of appeals could decide the case.
• Allows plaintiffs seeking less than $100,000 in damages to request an expedited civil action.
• Allows a trial court to dismiss a frivolous lawsuit immediately if there is no basis in law or fact for the lawsuit.
((Along with the caps on non-economic damages passed in 2003, it's no wonder there's a backlog of thousands of doctors seeking licenses to practice medicine in Texas.))
Because such litigation is controlled at the state level, the United States is unique among the industrialized nations in not having a national loser-pays law. That fact is likely among the key reasons why the American media so frequently report new examples of people suing for the most outrageous of reasons. Take, for example, Mark S. Gold, a Miami traffic court lawyer who got drunk at a local strip club last November, then woke up the next morning with a tab of nearly $19,000. He promptly sued the strip club's corporate owner, claiming he should not be held responsible for the huge bill because the bar "continuously served plaintiff alcoholic beverages to the extent that he was rendered intoxicated, partially or temporarily unconscious, and further to the extent that he had a complete loss of judgment, rational thought, or ability to enter into lawful contracts or agreements."
Odds are Gold will walk away with most, if not all, of his bar tab forgiven since the defendants know they could lose big-time if he convinces a jury to award him punitive damages. As things now stand, plaintiffs like Gold have nothing to lose and everything to gain by clogging the courts with frivolous litigation. How many such suits would be filed if losing plaintiffs everywhere knew that they would have to pay the defendants' legal fees? The absence of loser-pays provisions in the vast majority of states helps explain why class-action plaintiff litigation cost more than $248 billion last year, according to the Towers Watson (formerly Towers Perrin) 2010 Update on U.S. Tort Cost Trends. That's $808 for every man, woman and child in the country. It also makes the U.S. legal system twice as expensive, measured as a percentage of gross domestic product, as those of other industrialized nations, according to the Institute for Legal Reform
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