MEDICAL MALPRACTICE

Emergency Room Standards

Arizona Gov. Janet Napolitano vetoed a bill aimed at retaining emergency room physicians by making it more difficult for patients to collect damages in lawsuits. The bill (H2315) would have required that plaintiffs provide “clear and convincing evidence” that malpractice was committed, rather than the weaker “preponderance of evidence” that was previously required, reported the Arizona Capitol Times. Supporters of the measure said the threat of costly lawsuits has led to fewer doctors, particularly specialists such as surgeons, practicing in emergency rooms. But opponents of the bill said it went too far and left the public at risk of not being able to receive compensation for injuries caused by negligence. Napolitano wrote in her veto letter that there is no evidence that the bill would have alleviated a shortage of emergency room doctors. She also said that five judges wrote to her expressing concern that the bill may have been unconstitutional. But Dr. Todd Taylor of the American College of Emergency Physicians noted that other states are passing tort reforms and advertising them in an effort to recruit emergency personnel. A Georgia law is even tougher than Arizona’s legislation because it requires clear and convincing evidence of “gross negligence,” he said. “That’s what we’re competing against.”

SUBSTANCE ABUSE

Mexican Law Could Affect U.S.

A controversial new measure in Mexico decriminalizes the possession of small amounts of marijuana, cocaine, heroin and other drugs. Passed by the Mexican Legislature in late April, the legislation is intended to keep small-time addicts from crowding prisons and allow police and prosecutors to focus on large-scale trafficking, according to the AP. “No charges will be brought against…addicts or consumers who are found in possession of any narcotic for personal use,” the legislation states. “We can’t close our eyes to this reality,” Sen. Jorge Zemeno of President Vincente Fox’s conservative National Action Party told the AP. “We cannot continue to fill our jails with people who have addictions.” But a U.S. diplomat said the law could complicate drug war cooperation between the two countries, and give parents of U.S. students on spring break in Cancun one more thing to worry about. A Dutch student visiting Mexico said the law would help tourists avoid harassment by bribe-hungry police. But Jesus Almaguer, president of Cancun’s Hotel Association, said the law would not do much to lessen street-corner sales. “Those who consume drugs and visit our city already know how to obtain them.” There are questions about how the law would work; some officials say police could still detain small-scale drug users and send them to treatment centers without facing criminal charges. President Fox has said he will not sign the bill, but lawmakers have responded that they’ll override his veto.

Hospitalizations for Alcohol Abuse Cost $2 Billion Annually

Community hospitals treated nearly 210,000 patients for alcohol abuse in 2003, resulting in costs of nearly $2 billion, according to the Agency for Healthcare Research and Quality.  In a report released May 2006, alcohol abuse was listed as a related cause in 1.1 million hospital stays. About 75 percent of those hospitalized were men, which ranks alcohol abuse among the top 25 most common reasons for hospitalization of men. Abuse was most prominent in men aged 35-44, where it was ranked as the 4^th leading cause for hospitalization. Alcohol abuse was also a significant problem among the uninsured, accounting for 25.3 out of every 1,000 hospitalizations, making it the 4^th most common reason. Out of all hospital stays for alcohol abuse, 65 percent involved a co-occurring substance use disorder, 34.4 percent were also linked to mood disorders and 23 percent involved hypertension. Other related conditions included liver disease, anxiety disorders and chronic obstructive pulmonary disease.

SCHIP

Funds Distributed

The Centers for Medicare & Medicaid Services are distributing $456 million in federal funds to 12 states (Illinois, Iowa, Maryland, Massachusetts, Minnesota, Mississippi, Missouri, Nebraska, New Jersey, North Carolina, Rhode Island and South Dakota) and five territories (American Samoa, Guam, Puerto Rico, Northern Mariana Islands and Virgin Islands) for their State Children’s Health Insurance Programs. The amount includes $173 million in FY 2003 funds that were unspent at the end of FY 2005, as well as $283 million that were provided by Congress last February. States have three years in which to spend each year’s SCHIP allotment. At the end of that three-year period, many states have unspent funds, which are then redistributed to states that have exhausted their allotments. The $173 million of reallocated funds available this year was far short of the $456 million that was needed to keep every SCHIP program running. The Deficit Reduction Act enacted by Congress last winter, added enough funds for the remainder. Currently, more than 6.1 million children are enrolled in SCHIP.

STATE MEDICAL BOARDS

Report Ranks Boards

Public Citizen’s recent annual ranking of state medical boards found that Mississippi took the fewest disciplinary actions against doctors in 2003-2005, and Kentucky the most. The Washington, D.C. nonprofit compiles data from the Federation of State Medical Boards on the rate of serious disciplinary actions (revocations, surrenders, suspensions and probation/restrictions) per 1,000 doctors in a state. In 2005, there were 3,255 serious disciplinary actions taken by state medical boards, down 1.2 percent from the 3,296 such actions taken in 2004. The three-year state disciplinary rates ranged from 1.62 actions per 1,000 physicians in Mississippi, to 9.08 actions per 1,000 in Kentucky. The watchdog organization says boards are likely to do a better job of disciplining physicians if they have adequate staffing and funding (which could include channeling all money from licensing fees into board activities instead of into the state general revenue fund); undertake investigations rather than just responding to complaints; are independent from state medical societies; and have a “reasonable” framework in place for disciplining doctors – such as using a “preponderance of the evidence” rather than “beyond reasonable doubt” or “clear and convincing evidence” as the legal standard for discipline.