Sunday, March 1, 2009

News Clipping Archives

 

Maryland / Regional

Doctors in short supply in rural Maryland (Baltimore Sun)

Washington state to allow assisted suicide (USA Today)

National / International

Confusion a part of health care plan in stimulus (Washington Post)

Ripples From Peanut Scandal Affect Companies Big and Small   (Washington Post)

Opinion

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Maryland / Regional

 

Doctors in short supply in rural Maryland

Legislators seek remedies before the situation gets even worse

 

By Stephanie Desmon

Baltimore Sun

Sunday, March 1, 2009

 

When his longtime physician retired, Southern Maryland lawmaker Thomas "Mac" Middleton faced a predicament: The senator needed a new doctor but couldn't find one who was taking new patients. "I had to go through three different doctor groups before someone would take me," he said.

 

He ran right into the critical doctor shortage facing rural Maryland - to the west of Baltimore, to the south, on the Eastern Shore.

 

There are not enough primary-care doctors setting up practice in these areas, leaving some residents without access to basic health care and leading to more costly and serious illnesses, doctors say. Those doctors - and many specialists - are reluctant to leave the city for the country, where they typically get paid less, work more and find fewer job opportunities for their spouses, who aren't always ready to give up the trappings of life near an urban area.

 

Middleton and other legislators in Annapolis are now seeking ways to recruit and retain physicians to care for people in large swaths of Maryland.

 

"We have areas where you just can't get care - you have to leave and go to another jurisdiction," said Gene Ransom III, executive director of the Maryland State Medical Society, or MedChi. "It's a real problem for people, especially for people who can't afford to do that."

 

There used to be 10 obstetrician/gynecologists in Allegany County, for example; now there are four. There is just one psychiatrist in St. Mary's County. The wait to see a new primary-care doctor on the Eastern Shore can be weeks - if that doctor is even seeing new patients.

 

Lawmakers - who worked on two task forces last year that looked at different parts of the issue - are considering both short- and long-term fixes. Solutions could include a loan forgiveness program for primary-care doctors and specialists in rural areas who agree to remain in those communities for a certain number of years. Newly qualified doctors come with as much as $200,000 in student loan debt, and earning enough to keep up with the payments can be difficult, especially in rural areas.

 

There has been a small loan forgiveness program in the state, but Sen. Rob Garagiola, a Montgomery County Democrat, called it "very inadequate."

 

He worries that in this tight economy it might be difficult to sell a plan that sends money to such a program, but he thinks that the current proposal could fly. By building a fraction, less than 10 cents per $100, into state hospital rates, a fund could be created to pay down close to $14 million in debt for doctors who agree to practice in underserved areas.

 

Rural doctors are saddled with more than school debt. They must also deal with the same high medical malpractice insurance rates and the lower-than-average reimbursements for services that all doctors in Maryland face. Another piece of legislation being championed by Garagiola would set minimum medical insurance reimbursement rates for certain procedures.

 

Another proposal would create a rural residency program so that doctors could get some or all of their training in an underserved area - with the hope that they would stay there and set up practice. About 50 percent of doctors go on to practice where they do their residency, where they have established friends and begun families.

 

"When a physician does their residency program, they tend to settle there," said Del. Adelaide C. Eckhardt, a Dorchester County Republican. Eckhardt figures if a primary-care doctor does her residency on the Eastern Shore, there's a good chance she'll set out her shingle there, too.

 

But setting up a residency program is not simple. Such a program would have to be developed in conjunction with a hospital, such as the University of Maryland, that already has a residency program, would require oversight and training, and would have to take into account many logistical issues. All of that would cost money to carry out.

 

An even longer-term solution that Eckhardt likes would model a "grow your own" program in Alabama that encourages rural children to pursue careers in medicine.

 

"The whole concept is when you've got a physician who comes from a rural community, they'll go back to that rural community," said Nancy Fiedler, spokeswoman for the Maryland Hospital Association.

 

Dr. Claudia Baquet, dean of policy and planning at the University of Maryland School of Medicine and a member of the task force that studied the rural issue, thinks that some progress can be made. "I think we stand a good chance of making some meaningful changes to address physician shortages in rural and underserved areas, despite the economic issues."

 

Added Middleton: "We should have done something yesterday."

 

Meanwhile, the shortage is only expected to worsen. A study last year by the Maryland Hospital Association and MedChi found that by 2015, 32 percent of the state's physicians are expected to retire. The state's overall population is also aging, and those Marylanders will require more medical care than they are now receiving.

 

"The need is going up, and the supply of physicians is going down," said state Health Secretary John M. Colmers.

 

In some places, the shortage is already felt every day.

 

The waiting room at Dr. Matthew Allaway's Cumberland office is always packed, with waits of up to 90 minutes. On a recent Wednesday, he started at 7 a.m., took no lunch break and saw 60 patients.

 

"The bottom line is, you have to limit what time you can spend with your patients," said Allaway, who is president of the Allegany County Medical Society.

 

Allaway, 38, is from Chicago, and his partner is from Florida. He chose Cumberland for his urology practice after training in nearby Morgantown, W.Va.

 

The inadequate number of primary-care doctors in Western Maryland is evident nearly every day in his practice. They are so overworked, he said, that routine screening tests can fall through the cracks.

 

So by the time patients are diagnosed and come to Allaway, they often have larger kidney cancers, more advanced prostate cancers - cancers that often won't respond as well to treatments and that end up being more costly to the health care system.

 

Sometimes Allaway has to pull strings to get his patients in to see primary-care doctors. He doesn't know what will happen when the county's two neurosurgeons - both in their 60s - decide to retire. And he knows women must be suffering - or at least traveling long distances to see a doctor - since the number of obstetricians in the county has been cut in half.

 

"We haven't been able to recruit," Allaway said. "Where are these women getting care, and what kind of care are they getting?"

 

Copyright © 2009, The Baltimore Sun.

 

Washington state to allow assisted suicide

 

Associated Press

USA Today

Sunday, March 1, 2009

 

OLYMPIA, Wash. (AP) — Terminally ill patients with less than six months to live will soon be able to ask their doctors to prescribe them lethal medication in Washington state.

 

But even though the "Death with Dignity" law takes effect Thursday, people who might seek the life-ending prescriptions could find their doctors conflicted or not willing to write them.

 

Many doctors are hesitant to talk publicly about where they stand on the issue, said Dr. Tom Preston, a retired cardiologist and board member of Compassion & Choices, the group that campaigned for and supports the law.

 

"There are a lot of doctors, who in principle, would approve or don't mind this, but for a lot of social or professional reasons, they don't want to be involved," he said.

 

But Preston said discussions about end-of-life issues between doctor and patient will increase because of the new law, and he thinks that as time goes on more and more doctors who don't have a religious or philosophical opposition will be open to participating.

 

"It will be a cultural shift," he said.

 

The U.S. Supreme Court ruled in 2006 that it was up to states to regulate medical practice, including assisted suicide, and Washington's Initiative 1000 was passed by nearly 60% of state voters in November.

 

It became the second state, behind Oregon, to have a voter-approved measure allowing assisted suicide.

 

In December, a Montana district judge ruled that doctor-assisted suicides are legal. That decision, which was based on an individual lawsuit, is before the Montana Supreme Court. While Montana doctors are allowed to write prescriptions pending the appeal, it's unknown whether any actually have because there's no reporting process.

 

Under the Oregon and Washington laws, physicians and pharmacists are not required to write or fill lethal prescriptions if they are opposed to the law. Some Washington hospitals are opting out of participation, which precludes their doctors from participating on hospital property.

 

Dr. Stu Farber, director of the palliative care consult service at the University of Washington Medical Center, voted against the measure and doesn't plan to prescribe lethal medication to his patients for now.

 

"I am not here to tell people how they should either live their life or the end of their life," Farber said. "There's possibly a story out there, in the future, that's so compelling that maybe I would write a prescription."

 

Farber said he would refer patients to Compassion & Choices of Washington, the state's largest aid-in-dying advocacy group, after talking about how they came to their decision.

 

The advocacy group is compiling a directory of physicians who aren't opting out of the law, as well as pharmacies willing to fill the prescriptions, said executive director Robb Miller.

 

"Physicians don't understand yet exactly how the law works," Miller said. "Whenever there's lack of understanding, there tends to be some reluctance."

 

Dr. Robert Thompson, an internist and cardiologist at Swedish Medical Center in Seattle who voted for the measure, said that in his 32 years of practice he has treated patients who would have benefited from this law.

 

"I believe for the sake of compassion, and for a person's own individual rights, that this should be an option for them," he said.

 

Washington's law is based on Oregon's measure, which took effect in late 1997. Since then, more than 340 people — mostly ailing with cancer — have used that state's measure to end their lives.

 

Under the Washington law, any patient requesting fatal medication must be at least 18 years old, declared competent and a state resident. The patient would have to make two oral requests, 15 days apart, and submit a written request witnessed by two people, one of which must not be a relative, heir, attending doctor, or connected with a health facility where the requester lives.

 

Two doctors must certify that the patient has a terminal condition and six months or less to live.

 

Some doctors who opposed the measure have argued that a six-month terminal diagnosis is never a sure thing.

 

"There is no question in my mind that, if this is too easy of a task, people will die prematurely," said Dr. Linda Wrede-Seaman, a family physician and palliative care specialist in Yakima.

 

Health care providers writing a prescription or dispensing medication also must file a copy of the record with the state Department of Health, which is required to create an annual report on how the law is used.

 

The University of Washington health system and Group Health Cooperative chose not to opt out.

 

That decision was made easier by the law's clear option that physicians could opt out if they wanted to, said Dr. Larry Robinson, vice dean for clinical affairs at the UW School of Medicine.

 

"We're not forcing anyone to do anything," he said.

 

 

Copyright 2009 The Associated Press. All rights reserved.

 

National / International

 

Confusion a part of health care plan in stimulus

 

Associated Press

By Erica Werner

Washington Post

Sunday, March 1, 2009

 

WASHINGTON -- The Obama administration rushed to include a health care safety net for laid-off workers in the recently signed stimulus bill, but has not told employers exactly how to make it work.

 

As a result, tens of thousands of jobless people could wait months before getting help paying for health insurance that their employers previously had covered.

 

"Too many people are still trying to figure this out," said Heath Weems, director of human resources policy at the National Association of Manufacturers. "There is a lot of confusion."

 

At issue is the program called COBRA, the acronym for the law that allows workers to keep their company's health insurance plan for 18 months after they leave their job, if they pay the premiums.

 

The policies are so expensive that only a minority of eligible workers sign up, often those with medical conditions that demand attention. Costs for a family of four can top $1,000 per month.

 

A $25 billion provision in the stimulus bill aimed to cut COBRA's price tag, reducing its cost by 65 percent for workers laid off as far back as Sept. 1.

 

The bill gives eligible workers 60 days to apply. Then they get the reduced-cost premium for nine months.

 

But it's not going to happen right away.

 

Employers are waiting for instructions from the Labor Department and the Internal Revenue Service on how to put the program into place. Both agencies posted some information online Thursday.

 

Until employers get the guidance they need and notify potentially eligible ex-employees, most workers will not apply for the new benefit. Many probably will not know it exists.

 

Left waiting are people such as Cassandra J. Kelsey, 55. The District of Columbia resident lost her job with Verizon in January. She says she can barely pay her rent and is eating less to save money to cover the $550 a month premium to keep her health coverage under COBRA.

 

Kelsey walks with a cane and lists a litany of ailments, including degenerative arthritis and hypertension. For her, going without health insurance is unthinkable.

 

Outside a D.C. career center on a recent morning, Kelsey clutched copies of her COBRA invoice, clippings from a local newspaper about the stimulus bill and a form letter she received from the White House after writing to Obama about her troubles.

 

Kelsey knew about the reduced premium and said it would bring her COBRA costs below $200 a month. But when she called her benefits department, she was distressed to learn that she would not be able to get the reduced cost immediately, probably not until May.

 

"I can't take advantage of it now which I think is totally unfair," Kelsey said. "I don't know how I'm going to make it."

 

The stimulus bill contemplated that workers might not get the reduced premium immediately, and contains a provision that would allow them to be reimbursed later on.

 

That would be little help to Kelsey and others who need the benefit now.

 

An IRS spokesman said the agency is moving as fast as it can. A Labor Department spokeswoman responded to questions with an e-mail linking to a short agency fact sheet.

 

One question that employers are struggling with is how to go back and find employees who were laid off as far back as September.

 

Also, the legislation says only workers who were "involuntarily terminated" are eligible, but never defines that term. Does it include only people who are laid off? Or those who take buyouts offered by their employers?

 

No one knows how many people will actually seek a share of the stimulus money to pay their COBRA premiums. Congressional experts estimated 7 million, but that may be too high.

 

Advocates fear that even cut-rate COBRA could prove too little, too late for some jobless Americans.

 

"For many people it will remain unaffordable," said Ron Pollack, executive director of Families USA.

 

On the Net:

White House:http://www.whitehouse.gov/

 

COBRA:http://www.dol.gov/ebsa/COBRA.html

 

IRS:http://tinyurl.com/cozxx6

 

© 2009 The Associated Press.

 

Ripples From Peanut Scandal Affect Companies Big and Small

 

By Lyndsey Layton

Washington Post

Sunday, March 1, 2009; A05

 

Candymaker Tom Hurst didn't even recognize the name Peanut Corporation of America when he first read about the company at the heart of the salmonella outbreak.

 

But within days, the president of Heavenly Candy was calling Whole Foods stores across the country, telling them to pull his Peanut Bliss bars off the shelves, filling out unending paperwork for the Food and Drug Administration, and staring at a loss of a month's worth of products with a value of about $6,000.

 

"Peanut Bliss had been selling really well, and then this happened," said Hurst, who runs the company out of his Oregon home and has one employee -- his wife, Susan. "This was half my sales."

 

Hurst's supplier, which had purchased roasted salted jumbo Virginia peanuts from Peanut Corporation, is reimbursing Hurst for the cost of his recalled candy but not the lost profits. That makes Hurst luckier than some.

 

After government officials closed two of Peanut Corporation's three peanut plants, few were surprised when the company filed for bankruptcy protection on Feb. 13. But hundreds of companies that unknowingly bought its tainted products now face serious financial troubles of their own, and the fallout is affecting businesses as tiny as Heavenly Candy and as large as Kellogg.

 

Federal officials say 666 illnesses and nine deaths in 45 states and Canada have been linked to the contaminated peanut products, and the outbreak is ongoing, although the pace has slowed. Investigators say the company's president, Stewart Parnell, knowingly distributed tainted peanut products. The company is the target of a federal criminal investigation as well as a growing number of civil claims from victims of salmonella illness.

 

Forward Foods of Minden, Nev., which makes Detour protein bars, popular among bodybuilders, filed for bankruptcy protection Feb. 17. In court filings, the company explained that it had to recall 75 percent of its product line because it was made from spiced roasted peanuts from Peanut Corporation.

 

"A significant value of inventory must be condemned," Forward Foods chief executive J. Patrick Muldoon wrote in an affidavit filed in U.S. Bankruptcy Court in Nevada. "And to the extent customers are appropriately destroying or returning unsold recalled product, the ability to collect outstanding receivables is very much at risk."

 

The company, which has about 50 permanent employees and 25 temporary workers, is seeking court approval of a $4 million line of credit to enable it to keep producing the protein bars and regain its footing.

 

"One of the tragedies is that it hits other small companies that were users of this product but didn't have a lot of other products to carry them," said Jean Kinsey, an economics professor at the University of Minnesota and co-director of its Food Industry Center.

 

Large national firms are taking a hit as well.

 

Scotts, the lawn fertilizer giant, sold wild bird seed that contained peanut meal from Peanut Corporation. Bird seed contaminated with salmonella is not considered a significant threat to animals, but it does endanger humans who handle it.

 

At the outset of the salmonella illness, Scotts executives said they contacted their supplier, which reassured them that the bird seed did not contain products from Peanut Corporation. Now Scotts is suing the supplier, claiming it lied about the origins of the peanut meal.

 

Scotts executives say they learned that their wild bird seed included possibly contaminated peanut meal only after it had been shipped to distributors and retailers.

 

In filings in U.S. District Court in Ohio, Scotts wrote that its recall of five varieties of bird seed has caused the company "substantial damages," although it did not specify the amount, and resulted in "significant" injury to its brand name. A spokeswoman for the company declined to discuss the matter.

 

Kellogg, which recalled products from its Austin, Keebler, Famous Amos and Special K lines, spent $34 million on the recall last year, and executives have said they expect the total to reach $70 million.

 

The widespread reverberations from the peanut scandal are a result of the way the U.S. food industry is organized, Kinsey said.

 

Peanut Corporation made just 1 percent of the country's peanut butter supply, for institutions and private labels. But it also produced various peanut products, including meal and granules, that were purchased by hundreds of manufacturers to make items including cookies, crackers and ice cream. More than 2,200 products have been recalled, many carrying well-known labels such as Martha Stewart, Famous Amos and Little Debbie. An updated list is available at http://www.fda.gov.

 

"We've got concentrated manufacturing that then sells to a large number of other people," Kinsey said. "Everyone trusts it to be safe. And, by and large, it is and has been and probably will be in the future. But you get a couple of errant operators in the supply chain, and because that product is used by so many different people and places, it has multiple tentacles and it becomes very difficult to trace it. It's so insidious."

 

Although major brands of peanut butter were not part of the salmonella scandal, the entire $800 million industry has suffered as worried consumers shied away from peanut products. Sales of peanut butter were down 24 percent in the four weeks that ended Jan. 25 compared with to the same period last year, according to Information Resources, a Chicago market research firm. February data, which might show whether consumers are returning to peanut butter, are not yet available.

 

J.M. Smucker, maker of Jif, and ConAgra Foods, which makes Peter Pan, have run newspaper ads pointing out that their peanut butter was not made with Peanut Corporation products. The ads included coupons to bring customers back.

 

"That type of advertising is mightily resisted by the food industry," Kinsey said. "They don't ever want to imply that there are food safety problems at all. But they got pushed to the wall on this."

 

Meanwhile, Peanut Corporation of America is being sued by its insurer, Hartford Casualty Insurance, which is challenging the amount it must pay out to those with legal claims against the company. In court filings, the insurer said it and Peanut Corporation are in a dispute about whether the circumstances of the salmonella contamination voids the liability coverage.

 

Staff researcher Julie Tate contributed to this report.

 

Copyright 2009 Washington Post.

 

Opinion

 

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