Wednesday, March 25, 2009

News Clipping Archives

Maryland / Regional

Medicaid crackdown can't beat industry opposition (Baltimore Sun)

Site for Catonsville District Courthouse to be determined (Catonsville Times)

City tuberculosis rate hits historic low (Baltimore Sun)

Baltimore Tuberculosis Rate Lowest In City History (WBAL-TV11 News)

Baltimore tuberculosis rate drops to lowest level in 200 years (Baltimore Sun)

Lawmaker pushes bill to study medical marijuana (Annapolis Capital)

County Still No. 2 in Md. For STDs, Official Says (Washington Post)

Groups branching out to reach uninsured  (Montgomery County Gazette)

Senate nixes false health claims bill (Daily Record)

Having Almost Become Extinct, House Calls Stage A Welcome Recovery (Washington Post)

Firefighter May Have Neglected EMS Rules (Washington Post)

Va dentist faces 60 drug-related charges (Salisbury Daily Times)

National / International

Agency Doubles Number With HIV and TB (Washington Post)

Snuff makes strange bedfellows (Baltimore Sun)

Opinion

Broader Access to Morning-After Pills (New York Times)

 

 

Maryland / Regional

 

Medicaid crackdown can't beat industry opposition

Lobbying by doctors, hospitals, drug companies fells legislation

 

By Laura Smitherman

Baltimore Sun

Wednesday, March 25, 2009

 

The Maryland Senate narrowly killed Gov. Martin O'Malley's proposal to crack down on Medicaid fraud Tuesday after doctors, hospitals and the pharmaceutical industry had intensely opposed the bill.

 

The plan to root out false claims was defeated by one vote with no debate in the Senate, after an extensive behind-the-scenes lobbying effort that aligned many of the state's most powerful health care interests.

 

The bill, modeled on laws passed in nearly half the states, would have given Maryland officials and whistle-blowers greater latitude to pursue Medicaid fraud and collect damages.

 

Opponents contended that the measure would have prompted frivolous lawsuits and would have added to administrative costs for health care providers, including physician practices and nursing homes. Those costs would then have been passed on to patients when rising medical costs have become a national crisis.

 

Senate President Thomas V. Mike Miller, who supported the bill, said board chairmen at two hospitals in his district urged him to reject the legislation. "It's a huge lobbying contingent - the doctors, the hospitals, the drug companies - all fighting vigorously to keep this from becoming law," he said after the vote.

 

O'Malley put his weight behind the legislation this year and crafted his budget proposal to include $22 million in additional collections from providers who defraud Medicaid, a state-federal program that provides health care to lower-income residents.

 

"We are obviously disappointed," said O'Malley spokesman Shaun Adamec. "In this economy, we would expect there would be more support for eliminating fraud and waste."

 

But critics said that establishing such targets would encourage prosecutors to bring marginal cases to achieve a financial goal.

 

"If we're having trouble chasing Medicaid fraud ... this is not the solution," said Jonathan Diesenhaus, an attorney representing Pharmaceutical Research and Manufacturers of America, an industry group. The Maryland proposal, he said, would "cost money and create improper incentives for prosecutors."

 

Miller said his chamber might reconsider if the governor lines up the votes needed for passage. The administration was scrambling late Tuesday to persuade several senators to switch their votes. Among those likely to be lobbied is Sen. C. Anthony Muse, a Prince George's County Democrat who voted for the bill in committee but against it on the floor.

 

Muse said he changed his mind after receiving several dozen phone calls from hospital workers in his district who raised concerns about the economic impact of the legislation. "It may be a good bill for a different day," he said. "When they are saying this could lead to massive layoffs, that's something people don't want to hear right now."

 

The House of Delegates has yet to consider the measure. A similar proposal died last year in the Senate.

 

O'Malley's administration had argued that this is the year that lawmakers should approve the proposal, considering the state's financial straits. By some estimates, 10 percent of Medicaid dollars are lost to fraud, and state officials note that since the federal government enacted similar legislation in 1986, it has recouped more than $16 billion.

 

But state officials say the federal act is limited and the government can pursue only the largest violators. They note that there is a 10-year backlog of cases. The bill would have enabled state officials to pursue smaller cases that would otherwise fall by the wayside; they point to a $650 million national settlement with Merck & Co. in a case that had languished on the federal level until it was revived by Nevada officials.

 

"States that have this have been able to put taxpayer money back into the budget as a result of unscrupulous entities taking advantage of the Medicaid program," said Thomas Russell, inspector general with the Maryland Department of Health and Mental Hygiene.

 

Under the bill, Maryland officials would have been able to collect civil penalties of up to $10,000 and triple damages; now they can penalize perpetrators only for the amount of the fraud. The bill also would have allowed whistle-blowers to file suit on behalf of the state.

 

Sen. Alex X. Mooney, a Frederick County Republican who voted against the bill, said he worried about creating an opening for disgruntled employees to file unwarranted lawsuits against doctors and hospitals.

 

Sen. John C. Astle, an Anne Arundel County Democrat, said he voted against the bill because he believes the state already has the tools to pursue Medicaid fraud. "There was a lot of lobbying," he acknowledged.

 

A number of groups lined up in opposition, including the Maryland Chamber of Commerce, the Maryland Hospital Association and MedChi, the state medical society.

 

Nancy Fiedler of the hospital association that the bill could have made it harder for hospitals to keep physicians in Maryland and would have added litigation costs to a health care system already straining financially. Sixty percent of Maryland hospitals lost money in the fourth quarter of 2008, she said.

 

Fiedler said her group doesn't believe that projected savings would have materialized.

 

 

The vote

 

Yes

James Brochin (D); Joan Carter Conway (D); Ulysses Currie (D); George Della Jr.(D); Roy Dyson (D); Jennie Forehand (D); Brian Frosh (D); Rob Garagiola (D); Lisa Gladden (D); David Harrington (D); Verna Jones (D); Delores Kelley (D); Nancy King (D); Kathy Klausmeier (D); Mike Lenett (D); Richard Madaleno (D); Thomas V. Mike Miller (D); Thomas "Mac" Middleton (D); Paul Pinsky (D); Jamie Raskin (D); James Robey (D); James Rosapepe (D); Norman Stone (D)

 

 

No

John Astle (D); David Brinkley (R); Richard Colburn (R); James E DeGrange Sr. (D); George Edwards (R); Nathaniel Exum (D); Barry Glassman (R); Janet Greenip (R); Larry Haines (R); Andy Harris (R); Nancy Jacobs (R); Ed Kasemeyer (D); Allan Kittleman (R); Rona Kramer (D); Nathaniel McFadden (D); Alex Mooney (R); Don Munson (R); C. Anthony Muse (D); Douglas J.J. Peters (D); E.J. Pipkin (R); Catherine Pugh (D); Bryan Simonaire (R); J. Lowell Stoltzfus (R); Bobby A. Zirkin (D)

 

Copyright 2009 Baltimore Sun.

 

Site for Catonsville District Courthouse to be determined

 

By Kevin Rector

Catonsville Times

Wednesday, March 25, 2009

 

Deal to move District Court close to done, but opposition says new location is wrong

 

A plan to relocate the Catonsville District Court on Walker Avenue to six acres of land just south of Interstate 70 near North Rolling and Johnnycake roads is on the verge of being approved after years of land solicitations and requests for the state to pay for the move, according to Maryland District Court Chief Judge Ben Clyburn.

 

Pending an allocation of $350,000 in the current budget now being discussed in Annapolis, the court system will have a total of $2.85 million to complete negotiations for the land owned by Whalen Properties, Clyburn said.

 

While that is welcome news to Clyburn and other court officials who have been angling for a new courthouse for years, community leaders near the current courthouse and those near its proposed replacement are strongly opposed to the plan.

 

For leaders in Arbutus, the current courthouse is a nearby economic anchor they don't want to lose, they said.

 

"I look around Arbutus and I see two of the four most prominent corners in Arbutus controlled by lawyers," said Terry Nolan, a lawyer and president of the Arbutus Business and Professional Association.

 

"The growth pull of a courthouse is great," he said. "And we have it and we're losing it."

 

For leaders in Westview Park, a Catonsville community adjacent to the new location, a new courthouse looms as a source of increased traffic and crime.

 

"We're just concerned that putting the district courthouse right near our community would cause a lot of cut-through traffic," said Steve Whisler, president of the Westview Park Improvement & Civic Association.

 

"And there's the issue of criminals being around," he said.

 

While Clyburn said he understands the community leaders' concerns, the courthouse must be moved, he said -- and soon.

 

He said courts are in disrepair, are too small and lack property security throughout the state's district court system.

 

If the plan for a new Catonsville District Court doesn't move forward, the $2.5 million in state funds allocated for the project in 2007 and the additional $350,000 now pending will be reallocated to other court projects in Baltimore City and Harford County, and the Catonsville courthouse will be bumped to the end of the projects line, Clyburn said.

 

"That money is not going to hang out there any longer," he said.

 

Steve Whalen, of Whalen Properties, did not return calls for comment.

 

Looking to expand since 2002

 

The drive for a new Catonsville courthouse first began in 2002, when court officials approached the state Department of General Services about constructing a larger facility away from the expanding University of Maryland, Baltimore County campus.

 

"In December 2005, DGS considered land on the Spring Grove Hospital campus as a possible site for a new Catonsville District Court. At that time, the Department of Health and Mental Hygiene indicated it was not prepared to declare any of that campus as surplus," according to a statement from Dave Humphrey, director of communications and marketing for the department.

 

"The Spring Grove site was one of several in the 21228 ZIP code being considered," according to the statement.

 

The current courthouse sits off Wilkens Avenue on land adjoining the university campus and the Spring Grove Hospital Center campus. University officials have expressed interest in the land.

 

In the courthouse building's basement, where defendants are held before court hearings, it is common to see "women handcuffed to chairs because there is no lockup for women in the building," Clyburn said.

 

There is not enough office space -- "It's probably the only court house I know of where the state's attorney does not have an office," Clyburn said -- and not enough space for lawyers and their clients to have private conversations.

 

"There's no space for alternative dispute resolution, in terms of confidentiality space. There's no space for defense attorneys or advocates against domestic violence to talk to their clients," Clyburn said. "You have everyone out in the hallway engaged in these confidential conversations."

 

Community leaders said they don't dispute the need for a new courthouse, but want it to go on vacant land at the Spring Grove campus across the street from where the court is now.

 

In January, the Arbutus Business and Professional Association approved a resolution that said the courthouse's current location "has stimulated and sustained investment in legal communities in Arbutus, Catonsville, and Lansdowne, as well as stimulating economic activities intended in part to support the courthouse personnel and patrons."

 

Moving the courthouse across the street to Spring Grove would maintain that business, the resolution said.

 

Whisler said Westview Park residents would rather see the court remain "centrally located" at Spring Grove as well.

 

Clyburn said he would "very much like to locate on Spring Grove, but we can't and we can't wait."

 

According to Humphrey, "consideration" was given to putting the courthouse at Spring Grove a few years ago.

 

But "after discussion with various parties it was determined that that would not be an appropriate location," he said.

 

David Paulson, a spokesman for the state Department of Health and Mental Hygiene, which controls the Spring Grove property, said that "there is no plan at all to sell off any portion of the property."

 

Del. Steven DeBoy, whose District 12A includes parts of Catonsville and Arbutus, said he agreed that moving the courthouse to Spring Grove would be "optimal for everyone involved," but echoed Clyburn and others in saying that is not an option.

 

State law requires that one Baltimore County district court remain in the 21228 ZIP code, Clyburn said, which makes Baltimore County "the only jurisdiction where the location of the court is actually spelt out in statute."

 

That limitation, and the unavailability of Spring Grove land, made the process of finding a viable plot of land for the new courthouse particularly arduous, Clyburn said.

 

It took years to find Whalen's property, and there are no plans to start looking again, the judge said.

 

Community leaders said they expect land at the hospital center to be deemed surplus in the near future, and court officials should wait for that to happen.

 

If the court does wait, it won't need the $2.85 million to buy land because the Spring Grove property is already state-owned, Nolan said.

 

But even if it was deemed surplus tomorrow it would still have to go through a sell-off process," Cylburn said.

 

"Under the law, (Spring Grove officials) would have to give other executive agencies the opportunity to say, 'Yeah, we want that land,' too," Clyburn said. "Even in the best case scenario, we would not be able to get that land for three, four, five years."

 

With so many problems at the courthouse now, Clyburn said, waiting that long is not an option.

 

"At this time, the DGS Office of Real Estate is drafting a contract for the purchase of land for a new District Court.

 

"Until finalized, I am not allowed to discuss details," Humphrey said in an e-mail. "Once complete and the seller and DGS agree to all terms, the contract will be presented to the Maryland Board of Public Works for approval."

 

Copyright 2009 Catonsville Times.

 
 

 

City tuberculosis rate hits historic low

Two-century record tied to TB control effort

 

By Kelly Brewington

Baltimore Sun

Wednesday, March 25, 2009

 

Baltimore has recorded the lowest rate of tuberculosis since it began keeping track of infection rates nearly two centuries ago, city officials said Tuesday.

 

Last year, the city Health Department reported 32 cases of the disease, for a rate of 5 per 100,000 people. That's down from 47 cases in 2007, a rate of 7.4 per 100,000 people.

 

"Thanks to an aggressive tuberculosis control program and effective engagement of community health care workers, the TB rates have steadily declined," Mayor Sheila Dixon said at a news conference at Johns Hopkins Bayview Medical Center, the site of a tuberculosis hospital in the late 1800s, when "consumption" was a top killer.

 

More recently, the city struggled with rates of the disease much higher than the state and national incidence. But last year's rate was nearly identical to Maryland's rate of 4.9 per 100,000 people. Nationwide, the rate was 4.2 per 100,000 people.

 

Officials credit the tuberculosis control program, a 30-year-old effort in which public health workers make house calls to ensure that those infected are taking their medicine.

 

Baltimore was among the first cities in the nation to try the approach, which is now duplicated around the world, officials said.

 

"This is an impressive accomplishment," said Dr. Jonathan Zenilman, chief of infectious diseases at Bayview. "Before this program was instituted, Baltimore consistently had among the top-three rates of TB of U.S. cities."

 

Tuberculosis is a bacterial infection spread through the air by coughing or sneezing. It can be cured with antibiotics, but the regimen is often rigorous and can consist of up to 20 pills a day for as long as a year.

 

The disease can infect anyone, but drug users, people who work or live in prisons or homeless shelters, people with HIV/AIDS and those with compromised immune systems are most at risk.

 

The latest declines are significant for a city with high rates of HIV and a large homeless population, said Dr. Joshua M. Sharfstein, Baltimore's health commissioner.

 

He said the city has continued to fund the home visits, even in times of shrinking federal grants. Federal money to fight tuberculosis decreases as rates decline, Sharfstein said.

 

In 2005, after an outbreak among the city's homeless, the city hired a tuberculosis educator to raise awareness in shelters about the disease.

 

The city's program also gives the health commissioner the right to jail infected people who do not take their medication. They remain in jail over the course of their treatment.

 

While rates are decreasing, the city must continue to work to prevent a future outbreak, Sharfstein said.

 

"It would be a big mistake to be lulled into a sense of security," he said. "It is going to require a vigilant team to prevent resurgence."

 

Copyright 2009 Baltimore Sun.

 

Baltimore Tuberculosis Rate Lowest In City History

 

Associated Press

WBALTV 11 News

Wednesday, March 25, 2009

 

BALTIMORE -- Maryland health officials said Baltimore's tuberculosis cases fell in 2008 to the lowest total in the city's history.

 

The City Health Department's TB control program reported 32 cases last year, down from 47 cases in 2007. In Baltimore County, cases also decreased from 31 cases in 2007 to 20 cases in 2008.

 

Statewide, there were 278 cases in Maryland in 2008, an increase of 18 cases from 2007. Only six Maryland municipalities saw the number of TB cases decrease.

 

Baltimore's TB control program focuses on finding those with active TB and quickly treating them and those with whom they've been in contact.

 

"I think it's very encouraging news," said Dr. Albert Polito, director of the lung center at Mercy Hospital. "I think it's a very big milestone."

 

Polito said the numbers speak volumes about the work done by the city's health department.

 

"The officials and workers for the public health department go out to the houses and go out to the shelters of individuals and make sure they are getting medications and are taking them in the right amounts and for the proper duration of time," he said.

 

The infectious respiratory bacteria spreads through the air by coughs and sneezes but is curable and preventable.

 

Copyright 2009 by wbaltv.com. The Associated Press contributed to this report. All rights reserved.

 

Baltimore tuberculosis rate drops to lowest level in 200 years

The city health department reported 32 cases in 2008

 

By Kelly Brewington

Baltimore Sun

Wednesday, March 25, 2009

 

Baltimore Mayor Sheila Dixon and Health Commissioner Dr. Joshua M. Sharfstein hold a press conference to discuss the decline of tuberculosis in the city. (Baltimore Sun photo by Monica Lopossay / March 24, 2009)

 

Baltimore has the lowest number of tuberculosis cases since it began keeping track of infection rates nearly 200 years ago, city officials said Tuesday.

 

Last year, the city health department reported 32 cases of the disease, for a rate of 5 per 100,000 people. That is down from 47 cases in 2007, a rate of 7.4.

 

"Tuberculosis is a devastating disease," said Dr. Joshua M. Sharfstein, the city's health commissioner. He credited a program in which public health workers make house calls to ensure those infected are taking their medicine.

 

Tuberculosis, a bacterial infection spread through the air by coughing or sneezing, can be controlled with medication. Rates have been on the decline over the past two decades. But officials said the latest figures are significant for a city with many risk factors, including high rates of HIV and a large homeless population.

 

Copyright 2009 Baltimore Sun.

 

Lawmaker pushes bill to study medical marijuana

 

By Kathleen Miller

Annapolis Capital

Wednesday, March 25, 2009

 

ANNAPOLIS, Md. (AP) - Maryland advocates for medical marijuana say the state is sending mixed messages about using the drug to treat debilitating illnesses.

Quit Smoking Now: Get Your Free Kit Today

They are hoping to persuade lawmakers to create a task force to study the issue.

 

In 2003, the Maryland General Assembly approved less severe fines for people convicted of marijuana possession who can prove a medical necessity for the drug in court.

 

Seriously ill people can still be arrested, however, and fined up to $100 if convicted of possession or use of marijuana or related paraphernalia, even if they prove in court they have a medical necessity. Otherwise, violators are subject to fines of up to $1,000 and can face up to a year in jail for simple possession or use of the drug.

 

Delegate Henry Heller, D-Montgomery, said the 2003 law was "well-intentioned," but gives people a "false sense of security."

 

Heller, who says he doesn't use medical marijuana himself, said he is sponsoring legislation to study the issue after some his neighbors in a Silver Spring senior community told him they wanted to use marijuana to treat severe illnesses but were afraid of running afoul of the law.

 

Heller's proposal is to have a task force staffed by the Department of Health and Mental Hygiene study legal and feasibility issues related to the research, use and procurement of medical marijuana. The group would have to issue a recommendation to repeal or maintain the state's current policy for medical marijuana.

 

Thirteen states have removed criminal penalties for patients who use and possess marijuana with their doctor's approval or certification, according to a Maryland Department of Legislative Services analysis. The task force would require additional general fund expenditures, however, to research and produce the report.

 

A number of medical marijuana advocates told the House Judiciary Committee Tuesday that Maryland is sending mixed messages about using marijuana to provide relief from debilitating illnesses such as cancer or HIV.

 

Howard County resident Suzi Rank told lawmakers she has used marijuana to battle the nausea that accompanied chemotherapy and steroid treatment for cancer and a blood disease.

 

Rank said she tried eight different anti-nausea medications from her doctor and was hospitalized twice for dehydration before she tried marijuana and "it helped like nothing else had."

 

"I have been a law-abiding citizen my whole life except for using marijuana," Rank said. "I feel like I am a typical medical marijuana patient, we are not out dealing drugs, we are your average person. I feel like I had to choose between my life, losing my life and breaking the law."

 

On the Net:

Read House Bill 1339: http://mlis.state.md.us/2009rs/fnotes/bil_0009/hb1339.pdf

 

Copyright 2009 Annapolis Capital.

 

County Still No. 2 in Md. For STDs, Official Says

 

By Ovetta Wiggins

Washington Post

Wednesday, March 25, 2009; B02

 

Prince George's County continues to have the second-highest rate of sexually transmitted diseases in Maryland and the second-highest number of reported AIDS and HIV cases, according to the county's top health official. Prince George's trails only Baltimore in both categories.

 

The county had 5,240 reported AIDS and HIV cases in 2007, the most recent data available, County Health Officer Donald Shell told the County Council yesterday.

 

Shell said proximity to the District has continued to affect the county. Last week, District health officials reported that 3 percent of city residents have HIV or AIDS. "There is no border line," Shell said. "Our proximity puts us at greater risk."

 

He said another major problem in Prince George's is lack of access to health care. About 151,000 residents do not have health coverage, and about 102,000 are on Medicaid, Shell said.

 

Shell also reported a "resurgence" of syphilis in the county. In 1998, there were 6.6 cases per 100,000 residents, compared with 11.2 cases per 100,000 in 2007. Shell reported infection rates for several STDs, but his department did not provide data to support his conclusion that the county has the state's second-highest overall rate.

 

He attributed the alarming rates of HIV and syphilis in part to disregard of health experts' advice about practicing safe sex, mainly among heterosexuals. Shell said he has gone to local college campuses to speak and was somewhat surprised by the response.

 

"They don't care about condom usage or about their partners," he said. "There is a blatant disregard that anything is going to happen to them."

 

Copyright 2009 Washington Post.

 

Groups branching out to reach uninsured

Montgomery Cares expects to serve more patients this year

 

By Dan Gross

Montgomery County Gazette

Wednesday, March 25, 2009

 

Martin Stone gets a free blood pressure check from Esther Murana, an intern working with wellness and prevention at Shady Grove Adventist Hospital. Sitting in the back is Son Phan, also a Shady Grove intern. Stone went to the MobileMed Upcounty Primary Care Clinic to get some information about the clinic.

 

More than a year ago, the 51-year-old Germantown resident lost her job and health insurance as a medical receptionist. She now volunteers and is a patient at the MobileMed Upcounty Primary Care Clinic.

 

'I became a volunteer because I didn't have money, but I had time,' she said. 'They squeezed me in as a patient on the same day I called, and I thought that was astounding. I thought there was no help out there.'

 

She joins county health officials who are empowering residents with the message that they can receive assistance, even in the midst of an unstable economy.

 

And assistance programs such as Montgomery Cares, which funds Mobile Medical Care and other nonprofit clinics, are bracing for an increase in those seeking help.

 

This fiscal year, officials expect to serve about 21,000 residents by June 30, an increase of 33 percent from last year, said Rebecca Smith, acting senior administrator for the program.

 

Next year, the program is expected to serve about 22,500 patients, with an ultimate goal of 40,000.

 

'The need is greater than what we have,' Smith said, referring to limited financial resources for the program. 'But we're trying to increase service every year.'

 

Across the county, hospitals are experiencing a high demand for services for the uninsured.

 

In February, Holy Cross Hospital opened a primary care health clinic in Gaithersburg. Given the county's estimated 80,000 to 120,000 uninsured residents, the office remains busy.

 

'The need was already there, and is probably growing. Given the economy, I don't expect it to decrease,' said Dr. Elise Riley, the hospital's medical director. 'I don't have numbers, but my sense is that we're seeing a few more people who recently became unemployed and lost their insurance.'

 

As part of the national Cover the Uninsured Week, Adventist is hosting registration events and counseling sessions, including the one in Germantown on Tuesday, to help uninsured residents enroll in programs such as Medicaid, the Children's Health Insurance Program and other services. Cover the Uninsured is an initiative of the Robert Wood Johnson Foundation, a New Jersey-based independent philanthropy seeking to improve health policy.

 

'Folks without insurance wait so long to get care, and when they do, it may be too late.'

 

said Judy Lichty, regional director of health and wellness for Adventist HealthCare.

 

Many residents were hesitant to discuss their personal stories Tuesday, but said they realized the need to protect their health by getting a variety of health screenings, testing everything from blood pressure to carbon monoxide.

 

'One of the saddest things for me is seeing someone with a chronic condition, like high blood pressure or diabetes, having control over their symptoms, losing their insurance and then having something worse, like a stroke, happen to them,' Riley said.

 

Get help

 

Learn more about assistance available to county residents 9 a.m. to 3 p.m. today and Thursday at Mary's Center, 8709 Flower Ave., Silver Spring. In Germantown, get help 10 a.m. to 4 p.m. Friday at MobileMed Upcounty Primary Care Clinic, 19735 Germantown Road.

 

BY the numbers

 

Estimated number of uninsured residents:

 

Montgomery County: 80,000 to 120,000

 

Maryland: 760,000

 

United States: 46 million

 

Source: University of Minnesota's State Health Access Data Assistance Center and Montgomery County

 

Copyright 2009 Montgomery County Gazette.

 

Senate nixes false health claims bill

 

Associated Press

Daily Record

Wednesday, March 25, 2009

 

ANNAPOLIS — The Maryland Senate on Tuesday narrowly rejected a bill proposed by Gov. Martin O'Malley that would create civil penalties for making a false health claim.

 

The 23-24 vote also dealt a further blow to the state's troubled budget, which assumes about $22 million in help from the bill's passage.

 

The measure was designed to strengthen anti-fraud laws relating to Medicaid money. But Senate President Thomas V. Mike Miller, who voted for the bill, said an “intense lobbying” effort against the measure from doctors' associations, hospitals and drug companies helped sway enough senators to vote against it.

 

“For whatever reason, the hospitals and the doctors want to avoid having people find out about false claims and people being billed for duplicative services,” Miller, D-Calvert, told reporters.

 

The state currently can pursue criminal fraud cases involving misuse of Medicaid money, causing some opponents to argue that state law already has provisions to go after fraud. Opponents also expressed concerns about frivolous lawsuits.

 

Sen. Alex Mooney, R-Frederick, said he thought the bill would pave the way for disgruntled employees in doctors' offices and hospitals to sue employers out of spite.

 

“They could just make stuff up or they could interpret stuff differently than how it occurred,” Mooney said.

 

The federal government has created incentives for states to enact their own anti-fraud laws to fight false health claims in a manner modeled after the Federal Claims Act, which provides whistle-blower protection and entitles whistle blowers to a share of recovered damages.

 

In Maryland, the bill has considerable financial implications, because O'Malley assumed $22 million in the fiscal year 2010 budget based on the bill's passage. An estimated $11 million would come from an enhanced federal Medicaid match for enacting anti-fraud legislation, and an additional estimated $11 million would from damages collected by the state, if the law is enacted.

 

“The governor certainly would have hoped there would have been more support in the Senate, particularly in these difficult economic times, to eliminate waste, fraud and abuse in our hospital system,” said Shaun Adamec, an O'Malley spokesman.

 

Adamec said the administration would push to find a couple of votes to reconsider the measure — and bring it to another vote.

 

Miller said it's going to be up to O'Malley to find them.

 

“I think he can if he wants to, but he's going to have tough sledding in the House as well,” Miller said.

 

Currently, 22 states and the District of Columbia have enacted false claims acts with whistle-blower provisions, according to an analysis by the state's nonpartisan Department of Legislative Services.

 

Copyright 2009 Daily Record.

 

Having Almost Become Extinct, House Calls Stage A Welcome Recovery

 

By Ranit Mishori
Washington Post
Tuesday, March 24, 2009; HE01

 

When George Taler meets with a patient, he does all the usual things: He measures blood pressure, listens to the heart and lungs, takes a look in the mouth and ears, and updates the medical chart. But then he does something unusual: He checks out medicine containers in the bathroom, food in the refrigerator and the general condition of the patient's environment.

 

Taler, a physician at Washington Hospital Center, does house calls.

 

He is part of a small but growing tribe of doctors, nurses, physician assistants and nurse practitioners who are reviving this once-common practice for keeping Americans healthy and in touch with their doctors. Having virtually disappeared from medical practice by the 1980s, the house call has been making somewhat of a comeback, thanks primarily to Medicare changes that make house calls more easily billable. Advocates say revival of the house call could help reduce health-care costs substantially and enhance quality of care for many elderly and chronically ill patients.

 

For generations, the home visit was an institution, something a doctor, black bag in hand, just did. In 1930, house calls made up about 40 percent of physician encounters with patients in the United States, according to a recent article in the journal Clinics in Geriatric Medicine.

By 1950, that number had dropped to 10 percent. And by 1980, home visits accounted for a mere 1 percent.

 

Why did the house call fade away? In part, technology was to blame. As new diagnostic tools and advanced treatments became available in hospitals and clinics, that's where people wanted to go. As the article in Clinics puts it, both doctors and patients came to associate " 'good medicine' with hospitals and clinics. House calls became old fashioned."

 

Financial incentives also worked against house calls, according to the article. More doctors chose specialized fields that relied on the technology of hospitals, while those who chose primary care could see easily twice as many patients in offices and clinics as they could traveling from home to home.

 

And then there's the fact that private insurance has rarely fully covered such visits. (A few "concierge" medical practices will perform house calls for those patients willing to pay a substantial annual fee, or a trip fee, that is not covered by insurance.)

 

Similar constraints and disincentives have not been at work in other countries, including Canada, Denmark, France and the Netherlands, where home visits have continued to be a part of medical practice.

 

According to the Clinics article, in Britain, which has a strong tradition of primary care medicine and a national system of subsidized health care, doctors make 10 times as many house calls per 1,000 patients each year as do U.S. doctors.

 

In 1998, Medicare modified its billing procedures, making it easier for practitioners to receive payment for home visits to the elderly and chronically ill and increasing payments by 50 percent. Since then, Medicare statistics show a large bump in physician house calls, from 1.5 million in 2000 to almost 2.2 million in 2007.

 

Although house calls still account for fewer than 1 percent of all outpatient visits, "there is certainly a growing interest," says Constance Row, executive director of the American Academy of Home Care Physicians. According to the Clinics article, "increasing numbers of physicians have chosen full-time house call practice as their preferred professional role." Row backs efforts to increase the use of house calls as a "win-win situation for everyone. It is one of those things that patients want, that their families and caregivers want and also something that would actually save money."

 

Ironically, although technology undermined the old practice of house calls, technology has now made the house call a reasonable alternative to office or hospital visits for certain patients. Doctors still rely on the black bag basics (stethoscope, otoscope, blood pressure cuff, blood-drawing equipment), but now they also come equipped with laptops with electronic medical records and wireless capabilities, portable EKG machines, even bedside X-ray and ultrasound devices that were once found only at a hospital, according to Ernest Brown of Unity Health Care, which mainly serves poor people in the District.

 

Point-of-care testing (where blood, urine and other tests are done at the bedside, with results available in minutes) has become so easy that home-care practitioners can operate very efficiently, with "very little overhead, in some cases working exclusively out of your own car," said Brown, a family physician who does house calls.

 

For Eleanor Moss, 81, having a doctor who performs house calls has been a blessing. A District native, she suffers from several chronic conditions, including multiple sclerosis, which makes it hard for her to move around, let alone leave her apartment near Howard University to see doctors. She can zip around her small home in a motorized scooter she controls with a joystick, but going much beyond that is onerous and "just wears me out . . . getting my clothes on and whatnot . . . everything," she says.

 

She seems delighted when Taler, co-director of Washington Hospital Center's medical house call program, shows up on a recent day, black bag in hand. His visits, she says, "save me. . . . I'm telling you . . . it really saves me."

 

Indeed, it is people like Moss -- elderly, with multiple conditions and limited mobility -- who represent the biggest clientele for house calls. They are what Row calls the "home-limited elderly," people who don't see a doctor routinely because getting out is so difficult. This "forgotten population," Row says, is "getting much lower-quality care than they should have."

 

When something goes wrong, they end up in emergency rooms or hospitalized, being treated in a crisis rather than routinely with an eye toward prevention. According to the Clinics article, studies have suggested that house calls may keep people in their homes longer and reduce mortality, particularly in the frail elderly population. That is probably due in part to physicians' being able to identify new or worsening medical problems that, left untreated, could contribute to further disability and even death.

 

There may also be some significant cost savings. Although homebound patients represent only 5 percent of the Medicare population, they consume more than 43 percent of the budget, according to a congressional analysis. An ER visit can be more than 10 times the cost of a typical house call, which Row pegs at $100 to $150.

 

But in one of those strange twists of how America pays for health care, the cost-saving benefit of house calls might actually hurt the medical centers that provide them. Institutions such as Washington Hospital Center, which sponsors and financially supports Taler's large house call program, depend on revenue from ER visits and hospital admissions. An analysis by Taler and his colleagues found that seeing patients at home results in a 60 percent savings to the health-care system in general, but the reduction in ER visits and hospital admissions means less money for the hospital and its programs, including Taler's.

 

"A failure of health-care policy" is what he calls the conundrum.

 

Still, Taler's service is growing and includes 600 patients -- tended to by four doctors, three nurse practitioners, three social workers, one office nurse and four support staffers -- in what he fondly calls "the largest nursing home without walls in the District." It is a 24-7 operation, able to take calls and arrange short-notice visits even outside regular business hours. "These are our friends, and we don't want to abandon them to an emergency department," Taler says.

 

Taler, who acknowledges that he is a "zealot" for house calls, argues for what he calls "slow medicine": an unhurried encounter in the patient's known and non-threatening environment, also known as home. Departing Moss's home the other day, he summed it up emphatically, and a little wistfully: "That's what I went into medicine for."

 

Or as Ernest Brown puts it, by doing house calls he is not only given the opportunity to be a good doctor, but he also gets to play the part of "psychiatrist, social worker, advocate and, in some cases, 'family.' I give a lot -- and get even more in return."

 

Ranit Mishori is a family physician and faculty member in the Department of Family Medicine at Georgetown University School of Medicine. Comments:    “mailto: health@washpost.com”.

 

Copyright 2009 Washington Post.

 

Firefighter May Have Neglected EMS Rules

 

By Elissa Silverman

Washington Post

Wednesday, March 25, 2009; B01

 

Internal D.C. fire department documents show that a paramedic might not have followed procedures in responding to a man complaining of chest pain who did not go to a hospital and died hours later of a heart attack in December.

 

Edward L. Givens, 39, of Northeast Washington signed a release form refusing further treatment, but family members said the paramedic in charge convinced them that he had acid reflux and just needed an antacid.

 

Givens said he played basketball, smoked marijuana and ate a hamburger before he felt chest pain and had trouble breathing, said his brother, Anthony Givens, who was at the home during the 911 call. Anthony Givens said he told the paramedic that both his parents had heart attacks, but routine treatment for chest pain was not administered. Instead, according to the documents, the paramedic judged his brother's problem was stomach-related, despite an abnormal result from a cardiac monitor. But EMS personnel are not trained to provide diagnoses, Medical Director James Augustine said in a report.

 

The choices made in response to that call again raise questions about the medical training of firefighters and whether the city's plan to integrate firefighting and emergency medical services is producing the best care possible. Mayor Adrian M. Fenty (D) promised the city would improve emergency services as part of a settlement with the family of David E. Rosenbaum, a retired New York Times reporter who was assaulted in 2006 but assessed as drunk by responders. He died two days later.

 

D.C. fire and EMS officials would not discuss the documents, which include an operational review, a two-page medical quality review and an event chronology, referring questions to D.C. Attorney General Peter Nickles. The operational review and the medical review differ in certain conclusions. The operational review raised concerns about the thoroughness of the evaluation; the medical review said that an "adequate patient history was obtained" and that documentation was "acceptable."

 

Nickles acknowledged that the two reviews might disagree on some operational points but said that the medical review was more informed because it included information from the autopsy. "Given the tragedy that occurred, it would be easy to conclude there could have been more of an effort," but it might not have made a difference, he said.

 

Fire Chief Dennis L. Rubin has referred the case to the District's inspector general.

 

Training remains a concern, according to the documents. The paramedic who attended to Givens was a firefighter with paramedic certification. He was taken off the streets for three months and sent to the training academy for remedial instruction. The documents show a three-lead electrocardiogram for Givens produced "some ST-segment elevation," which a top EMS official said "should have generated a higher index of suspicion" of a heart problem.

 

Last month, the department began mandatory training for paramedics on responding to cardiac patients, including proficiency testing with the 12-lead ECG, which looks at the heart's electrical activity from 12 angles instead of three. Chest pain treatment in the District calls for paramedics to "consider" a 12-lead ECG, along with giving the patient aspirin, oxygen and nitroglycerin. Many jurisdictions make the 12-lead ECG routine.

 

"The three-lead is not reliable" to detect a heart attack, said Terry Jodrie, a regional medical director for the agency overseeing Maryland's emergency medical services.

 

The Givens case is instructive because the District is moving toward a system that relies more on firefighters with advanced life support or paramedic certification, phasing out single-role medics.

 

About four out of every five fire department 911 calls are medical.

 

Twenty of the District's 33 firehouses have what are called paramedic engine companies. The logic is that a firetruck with a trained paramedic will get an advanced life support responder to emergencies quickly. Unlike ambulances, which can get stuck at emergency rooms and end up far from their home bases, firetrucks generally stay in their assigned neighborhoods.

 

The department's improved response times with the system have attracted national attention.

 

But "playing 'beat the clock' is only one requirement of a complex series of performance metrics," said Paul Maniscalco, a senior research scientist specializing in EMS with George Washington University.

 

The documents show paramedic engine 30 and ambulance 30 were dispatched Dec. 2 at 11:42 p.m. to the Givens home in the 700 block of Division Avenue NE.

 

Within three minutes of arriving, the paramedic engine activated a cardiac monitor, and blood pressure, heart rate and a three-lead ECG were recorded.

 

Nine minutes later, engine 30 sent the signal that it was leaving the scene.

 

"You can't do a proper assessment in 12 minutes," said Kenneth Lyons, president of the union that represents single-role medics in the department.

 

Family members have said Givens did not go to a hospital because a paramedic convinced them that he had heartburn and his vital signs were normal. Anthony Givens said his brother signed the patient release without explanation or questions.

 

The 13-page operational review by Acting Assistant Fire Chief for EMS Rafael Sa'adah said responders made "multiple attempts" to take Givens to the hospital, and a signature believed to be Givens's is on an electronic patient care form.

 

But the report also said: "It does not appear that extensive discussion of risks and possible consequences of not seeking medical care and treatment took place."

 

Sa'adah stated in the report that the elevated reading in the ECG should have raised more questions about whether Givens had a heart problem. Sa'adah also noted that the paramedic did not document the call properly.

 

Augustine, the medical director, completed the medical review, which found a cardiac rhythm strip was "correctly interpreted as normal sinus rhythm" and "no other specific findings" could be determined from the ECG.

 

Toward the end of the report, Augustine wrote: "EMS personnel are not trained to provide diagnoses, nor have sufficient tools or protocols to differentiate acute coronary syndromes from other causes of chest discomfort."

 

Copyright 2009 Washington Post.

 

Va dentist faces 60 drug-related charges

 

Associated Press

Salisbury Daily Times

Wednesday, March 25, 2009

 

HARRISONBURG, Va. (AP) — A Harrisonburg dentist faces 60 drug-related charges after a state police investigation determined that she wrote prescriptions to a former employee, who would then give the pills to her.

 

Jennifer Schools Moore is charged with obtaining a prescription by fraud and drug possession, both felonies, among other counts. She was arrested earlier this month and remains free on $10,000 bond, and is not allowed to practice while the case is pending.

 

An arrest warrant indicates that Moore wrote prescriptions for oxycodone -- a narcotic pain reliever -- to the ex-employee, who passed Moore the pills.

 

A receptionist at Moore's dental office said Moore was unavailable for comment. No attorney is listed for Moore in court records.

 

Copyright 2009 The Associated Press. All rights reserved.

 

National / International

 

Agency Doubles Number With HIV and TB

2007 Estimates Reflect Improvements in Reporting Over 2006, WHO Says

 

By David Brown

Washington Post

Wednesday, March 25, 2009; A12

 

The number of people worldwide infected with both HIV and tuberculosis is twice what experts had thought, although the incidence of TB worldwide is slowly falling.

 

That was the bad news -- and the good -- in the World Health Organization's annual report on tuberculosis released yesterday.

 

Simultaneous infection with the AIDS virus and the tuberculosis bacterium is potentially both a personal and public health catastrophe. HIV greatly accelerates the progress of TB, and greater prevalence of TB -- and especially of inadequately treated cases that promote drug-resistant strains of the germ -- is a threat to everyone.

 

There were 9.27 million new cases of TB in 2007, with about half occurring in five countries: India, China, Indonesia, Nigeria and South Africa. Only about two-thirds of the cases were diagnosed. About 5.3 million new cases -- or 57 percent of the total -- were being treated, which generally requires that a person take a combination of drugs for six months.

 

The incidence of tuberculosis in 2007 was 139 new infections per 100,000 people, a decline from 142 in 2004. Because of the growth in the world's population, the number of new cases in 2007 was slightly higher than in the few years prior.

 

About 1.3 million tuberculosis patients who were not infected with HIV, and about 456,000 who were, died of the disease in 2007. TB is the leading cause of death in AIDS patients and accounted for about one-quarter of the 2 million AIDS deaths worldwide.

 

The recent push to bring HIV testing and treatment to sub-Saharan Africa, combined with improvements in disease surveillance overall, is revealing for the first time the extent of "co-infection." The number of countries reporting the proportion of their TB patients who are also HIV-positive has risen from 15 to 64 in the last three years.

 

In 2006, WHO epidemiologists estimated that 700,000 people with the AIDS virus developed active tuberculosis. For 2007, the estimate jumped to about 1.4 million -- an increase that reflected better case-finding and reporting, not an actual doubling of infections.

 

"Many programs have been insisting in countries, especially in Africa, that every single case of HIV should be tested for TB," said Mario Raviglione, head of the Stop TB department at WHO.

 

Treatment of both infections is usually required to restore someone to health.

 

Once someone whose immune system has been damaged by HIV becomes ill with tuberculosis, "without treatment, the likelihood of death is essentially 100 percent within six months," said Richard Chaisson, director of the Johns Hopkins Center for Tuberculosis Research. "The problem in Africa is HIV patients are not being diagnosed early enough. They die and they die quickly."

 

TB patients can be checked for HIV with a blood or saliva test, but it is more difficult to test HIV patients for TB. That requires them to cough up a sample of phlegm, which is then either examined under a microscope or cultured for the TB bacterium. Someone with symptoms suspicious for TB -- which principally but not exclusively infects the lungs -- also needs to get a chest X-ray.

 

Diagnosing both infections is important because it also allows medical practitioners to protect others from the disease. An outbreak of drug-resistant TB that killed more than 50 people in South Africa several years ago turned out to have spread mostly in a hospital and its clinic.

 

About 500,000 of the 9.27 million new TB cases were resistant to two or more of the standard drugs used to treat TB. Being infected with a "multi-drug resistant" strain makes treatment longer and more expensive, and a cure less likely.

 

WHO estimates that $3.2 billion is needed for TB diagnosis and treatment this year, and $1.6 billion is available. About 80 percent of the money for TB control around the world comes from domestic governments and the rest from foreign aid, the World Bank, and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

 

"The total figure [for TB control] keeps increasing, and at the same time, the gap keeps increasing, too," Raviglione said.

 

Copyright 2009 Washington Times.

 

Snuff makes strange bedfellows

Proposal to change taxes puts cancer society, R.J. Reynolds on same side

 

By Gadi Dechter

Baltimore Sun

Wednesday, March 25, 2009

 

Leaders in both houses of the General Assembly are backing a tax change on a product known as moist snuff that is being pushed by tobacco giant Philip Morris - and opposed by an unusual coalition of other tobacco interests and health advocates.

 

Lobbyist Bruce Bereano, representing the Maryland Association of Tobacco & Candy Distributors, grinned Tuesday at finding himself on the same side as the American Cancer Society.

 

"In the 36 years I've been lobbying for the tobacco industry, this is a first," Bereano said. "It's music to my ears."

 

So why is an arcane tax change luring cigarette distributors and R.J. Reynolds into an alliance with the cancer society and the Maryland Lung Association?

 

Because it's a classic "redheaded Eskimo," said Eric Gally, a lobbyist for public health advocates, using a term for legislation carefully written to benefit a small constituency.

 

Sponsored by Sen. Ulysses Currie and Del. Sheila Hixson, who head the tax committees in their respective chambers, the bill could give a competitive advantage to Philip Morris affiliate U.S. Smokeless Tobacco Co., manufacturer of brands Skoal and Copenhagen. The bill is also backed by Del. Kumar P. Barve, a Montgomery County Democrat and majority leader in the House, and Del. Justin D. Ross, the chief deputy majority whip from Prince George's County.

 

The measure would change the way the tins of moist snuff are taxed, from a 15 percent levy on the package's wholesale price to a 75 cent tax per ounce of tobacco. The state health department says that adjustment would benefit producers of higher-priced or "premium" snuff such as Skoal, while increasing the tax on "value" brands such as Grizzly, manufactured by Conwood Co., a subsidiary of Reynolds American Inc.

 

"Philip Morris has a 75 percent monopolistic market share with moist snuff," Ed Roberson, a former Conwood president, told the House Economic Matters Committee at Tuesday's hearing. "And they want you, the legislature, to protect that market share."

 

Nonsense, said the bill's proponents, who argued that the law would create an "even playing field" for producers of higher-quality products and would bring the taxing structure for moist snuff in line with excise taxes on cigarettes and other products.

 

The law would also increase tax revenues, at least in the near term, according to a legislative analysis. Sponsoring lawmakers say that's what attracted them to the bill.

 

Robert Shepherd, a former New York deputy tax commissioner and consultant for Philip Morris' smokeless-products subsidiary, told lawmakers that the bill fixes a "broken system" that effectively gives a "tax subsidy" to cheap products. Gally predicted a "very close" battle on the bill, which has failed in recent years. He said the fight was mostly between Philip Morris and R.J. Reynolds, who are "going at it almost like I've never seen anybody go at it."

 

But for some advocates, siding with a tobacco company is awkward. "We're not on the same side," said Bonita M. Pennino, a lobbyist for the American Cancer Society, in an interview. "We're advocating to improve public health. They're advocating to improve their bottom line."

 

Copyright 2009 Baltimore Sun.

 

Opinion

 

Broader Access to Morning-After Pills

 

New York Times Editorial

Wednesday, March 25, 2009

 

A federal judge in New York has added his weight to contentions that the Bush administration delayed easy, nonprescription access to the morning-after pill for political and ideological reasons, not from a desire to protect the public’s health. Judge Edward R. Korman wisely ordered the Food and Drug Administration to make the pill available without prescription to women as young as 17 and to consider approving it for girls of any age, as major medical groups have long advocated.

 

The morning-after pill, actually two pills taken in sequence, can block a pregnancy if taken soon after intercourse. It works best if taken within 24 hours but is effective up to 72 hours after intercourse. Prompt access is imperative; any delay in reaching a doctor to get a prescription can render the drug useless.

 

Judge Korman lays out in detail the continuous efforts by the Bush administration to prevent easy access to the pill by requiring a prescription, contrary to prevailing medical opinion. The World Health Organization and a slew of American health groups had urged that the pill be made available without prescription and without age restrictions, and virtually all major industrialized nations did so years ago. The drug has no serious long-term side effects, just mild short-term effects like nausea or abdominal pain in some users. The health benefits of preventing unplanned pregnancies or abortions far outweigh any likely downside.

 

Yet the Bush administration, through the Food and Drug Administration, found excuse after excuse for delaying a decision and narrowing its ultimate scope, presumably to placate Mr. Bush’s base of social and religious conservatives. At various stages, the agency’s leadership, sometimes after consulting the White House, dictated decisions that ran counter to what its scientists and advisory groups were recommending. It was only after the Senate threatened to hold up confirmation of a new F.D.A. commissioner in 2006 that the agency finally approved sales without prescription to women 18 and over, provided the drugs were kept behind the counter.

 

We called that decision “an acceptable compromise” because it finally made the drug more accessible. But Judge Korman notes that there is “overwhelming evidence” in F.D.A. files that 17-year-olds can use the drug safely without medical supervision.

 

The harder question is whether to remove all age and other restrictions, potentially allowing children as young as 11 or 12 to take the drug without medical supervision. The judge sensibly left that issue to the F.D.A., which can presumably be trusted to make a fair assessment now that it will be under new leadership.

 

Copyright 2009 The New York Times Company.

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