New Rules For Hospital Dumping                                                                                                                                                                                 The Centers for Medicare and Medicaid Services recently made some changes to the Emergency Treatment and Labor Act (EMTALA) regulations. The new regulations, which took effect October 1, clarify that all hospitals, even specialty hospitals without emergency departments, must accept patient transfers from other hospitals as required by EMTALA

EMTALA was passed by Congress in 1986 in response to widespread concerns that hospitals were turning away or transferring patients who were in need of emergency medical care but unable to pay for those services. The law requires hospitals with emergency rooms to provide emergency medical services to anyone regardless of ability to pay. The law also requires hospitals to accept transfers from another hospital’s emergency department if it is within the capability of the facility. Previously, it was unclear whether specialty hospitals without emergency departments were required to accept patient transfers from other hospitals’ emergency rooms.

The new regulations also authorize nurse-midwives and other qualified personnel acting within their legally authorized scope of practice to certify false labor. Previously, the EMTALA regulations required a physician to certify that a woman was not in “true” labor. 

Doctor-Assisted Suicide Legislation Blocked in California
By Sarah Larkins
CNSNews.com Correspondent
(Update: A bill to legalize physician-assisted suicide in California was rejected by the State Senate Judiciary Committee on Tuesday. This is the fourth time an assisted suicide measure has failed to advance in California. The Los Angeles Times reported that a single senator - a Democrat -- cast the deciding vote against the measure.)

(CNSNews.com) - Legislation to legalize doctor-assisted suicide in California is headed for an important test in the state Senate Judiciary Committee, but opponents amassing on Tuesday at the state capitol said they were confident the bill would eventually be defeated even if it cleared the committee.

Californians Against Assisted Suicide (CAAS) organized disability rights advocates, hospice officials, the California League of United Latin American Citizens and others to show the diversity of the opposition to the bill.

"We're cautiously optimistic," CAAS spokesperson Tim Rosales told Cybercast News Service. "No matter what happens, we think that we have the votes to stop this in the legislature in California."

Assembly Bill 651, known as the California Compassionate Choices Act, would allow terminally ill patients to request a prescription to end their lives.

"[The bill] fundamentally changes the relationship between doctors and patients," Rosales argued. "For thousands of years, doctors have been in the position of doing no harm, of helping patients. This would, for the first time in California, really redefine that relationship and would allow doctors to prescribe a lethal dose of drugs for the only purpose of ... committing suicide."

However, Democratic Assemblywoman Patty Berg referred to the legislation as a "peace of mind" issue.

"It's an individual saying, 'I've come to the end, and I don't want to continue living in the state I'm in and going through this process,'" Berg said in June, according to the San Jose Mercury News.

Berg and fellow Democratic Assemblyman Lloyd Devine first introduced the bill in 2005. After stalling in the Assembly, provisions for physician-assisted suicide were added to another bill that was awaiting action in the Senate.

The bill previously failed to collect even half of the 40 votes needed in the Assembly, which bodes trouble for the current effort to pass it, Rosales said.

However, Robert Kenneth, communications director for the Death with Dignity National Center in Portland, Ore., disagreed.

"We're hopeful and optimistic that it will be voted out of the Judiciary Committee and move on to a full Senate vote relatively quickly," Kenneth told Cybercast News Service.

In 1997, Oregon became the first, and is still the only state to legalize physician-aided suicides. According to the Oregon Department of Human Service's eighth annual report on the law, 246 patients have taken medications to end their lives in the past eight years since the law's implementation.

Physician-assisted suicide differs from euthanasia in that it does not allow physicians to administer life-ending medication, only to prescribe it. Patients must administer the medication themselves.

California's bill, modeled after the Oregon law, would apply to patients who have been diagnosed with a terminal illness and told that they have six months or fewer to live, and who are mentally competent to make and communicate health care decisions. The attending physician and a consulting physician would determine whether these criteria were fulfilled.

"Technically speaking, physician-assisted dying is painfully specific," Kenneth said. "It's only for people who are already dying of a terminal illness, and they just want to have control over those final hours and final days. Otherwise, wracked with pain and loss of bowel and bladder control, it's just an agonizing, terrible process."

According to the bill, doctors would be able to request a psychological evaluation if they believed a patient was suffering from a psychiatric or psychological disorder caused by either depression or medication.

The bill lists other safeguards, including that a doctor must provide alternative options such as hospice care and that a patient must make both a written and an oral request, which must be reiterated within 15 days of the first oral request.

Rosales argued, however, that such safeguards do not address other troubling aspects of the legislation.

"The safeguards ... do nothing to prevent doctor shopping, so even if they get turned down by one doctor they can shop until they find a doctor that will prescribe," he said. "Whether you are a doctor of dermatology or a doctor of oncology, you can prescribe this. In cases like Oregon, you have doctors who have done this without even seeing a patient one time ... There are many loopholes."

In a May 2006 Gallup poll, 69 percent of Americans polled said they supported the concept of doctor-assisted suicide.

"Generally speaking, polls continue to show, quarter after quarter, year after year, that the majority of Americans want to have control at the end of life when they're facing a terminal illness," Kenneth said.

Polls such as this are not an accurate predictor of the bill's fate, however, Rosales said.

"Depending upon how the question is asked, Americans have generally said that they're supportive of this kind of thing," he said. "However ... [the issue] always fails. It failed last year in California ... it has failed in states like Vermont, Hawaii, [and] Arizona."

This issue will prove to be an important one that cuts across political lines, Kenneth said.

"We all face this issue, either with loved ones, parents, grandparents, or when we face it ourselves. This is an issue that touches every human being," he said. "It's basically a common sense issue for people to make up their own minds."

   

Celebrity Doctor lost license 

Patients' new approach to high cost of Medical care

The 46-year-old woman, who has been identified only by her initials AM, slipped out of her hospital bed following the surgery and disappeared.

Doctors at the clinic in Rome say that apart from the unpaid bill they are also concerned for her health as she requires close monitoring following the surgery.

Dr Jamal Salhi said: "She told me that she needed the surgery because she worked in a hostess bar and that clients preferred big chested women.

"She went from a size four to a size eight which is the largest you can get in Italy. When she came to my surgery she said: "I want the biggest chest possible."

"'It has since emerged that she gave false information when she arrived at the clinic and apart from running off without paying, as with any surgery she needs to be monitored afterwards."

Dr Salhi then revealed it was not the first time he had been the victim of a fraudster. He said: "This has happened to me several times before, the most recent was last December.

"A man had a penis enlargement and disappeared without paying. We still have to be paid for that operation."

Police spokesman Adriano Lauro said: "We have issued a warrant for the woman's arrest and also one for her husband following the complaint from the clinic."

Fertility Doctor Disciplined

The Medical Board of California has revoked the license of a fertility doctor who implanted the wrong embryos in a woman and didn't tell her for 18 months.

The license of Doctor Steven Katz was pulled after the medical board concluded he engaged in what board members termed -- "some of the most serious physician misconduct imaginable."

Katz, who operates Fertility Associates of the Bay Area, has admitted that he did not tell Susan Buchweitz of Campbell he had mistakenly implanted embryos in her womb that were intended for another woman.

Katz finally revealed his mistake to Buchweitz and the other woman about the same time the medical board was about to reveal the mix-up.

By then, the baby Buchweitz had given birth to was ten months old.

Katz has until April 27th to appeal the decision in Superior Court. He can also seek a stay that would allow him to continue operating his practice.

Meanwhile, Buchweitz and the other woman are involved in an ongoing custody dispute.

Kaiser Permanente Doctor as AMA President

Michael Sexton, M.D., took the helm of the association, which represents many, but far from all of the state's physicians, at the conclusion of the group's annual House of Delegates. Sexton, 58, is board certified in emergency medicine and has been a member of Kaiser's Permanente Medical Group for 30 years.

Jack Lewin, M.D., its longtime CEO, continues to run the organization, which represents about 35,000 California physicians, on a day-to-day basis.

An emergency physician on the medical staff at the Kaiser Foundation Hospital in San Rafael, Sexton is the first Permanente physician elected to head the CMA, which in an earlier era looked down on Kaiser doctors as advocates of "socialized medicine" or worse. But those days are long gone, and Kaiser physicians now make up 11.4 percent of its membership.

Sexton headed the emergency department at Kaiser San Rafael from 1977 to 1983 and presided over its medical staff from 1979 to 1981. He has been active in local, state and national medical societies for more than 30 years, serving as chair and vice chair of the CMA's Board of Trustees and as president of the Marin Medical Society. He has been a member of the CMA board for 11 years.

In a March 20 address to the House of Delegates' 700 members, Sexton called on the CMA to take an aggressive role in championing health-care reform in California, CMA officials said, arguing that "crushing economic pressures, confusion surrounding quality and the crippling numbers of the uninsured demand that the physicians of the CMA lead California to a better place for our patients."

Still to be seen: How much actual clout Sexton will have in his new role, which has often been more ceremonial than not.

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