Health Law

The New York Times (1/25, A16, Barringer) reported that "there is a huge gap between what researchers are discovering about environmental contaminants and what they can prove about their impact on disease."  And, because of this gap, "only a tiny fraction of workers' compensation payments are received by those who were exposed to harmful substances at work."  Rafael Metzger, a California lawyer who specializes in cases involving diseases contracted in the workplace, noted that the few people "who might think" they have an occupational disease "'are mostly not successful' in getting compensation 'because there isn't a robust body of literature to support the claim.'"  Dwight Lovan, Kentucky's commissioner of worker's compensation, stated that people "are dependent on the scientific and medical communities for the element of causality."  In some cases, however, "proof of causality has been eased or waived."  In 2008, the Veterans Affairs Department "agreed to consider any service member who served for at least 90 days eligible for disability benefits if they later contracted" Lou Gehrig's disease.  One official noted that "the agency made no link between the onset of ALS and a service member's experience."

Modern Healthcare (1/24, Zigmond) reported that the Government Accountability Office (GAO) said in a new report that the "Veterans Affairs Department's long-term strategic planning and budgeting need improvement." The GAO notes that "the VA spent about $4.1 billion, or about 12 percent of its total healthcare spending, on long-term care for veterans" in fiscal 2007, but the department "underestimated its long-term-care spending for fiscal years 2005 and 2006 due to unrealistic assumptions and projections." For 2007, the VA's "long-term strategic plan reported expected increases for some of its long-term-care workload, but...the workload information the VA provided for both nursing home and noninstitutional care was incomplete," according to the GAO. For its next long-term strategic plan, the GAO recommends the VA "include three types of workload information...planned total nursing home workload...estimated demand for noninstitutional services and the department's timeframe for meeting that demand; and a comparison of planned noninstitutional workload with recent noninstitutional workload to show the effect of the expected change."

The Washington Post (1/24, A3, Stein, Shear) reported that President Obama "lifted a ban on U.S. funding for international health groups that perform abortions, promote legalizing the procedure or provide counseling about terminating pregnancies" Friday. The Mexico City Policy, "also known as the 'global gag rule,'" was "originally instituted in 1984" by Ronald Reagan, and reversed in 1993 by President Bill Clinton. President George W. Bush later revived the rule in 2001. Obama's move "revokes Bush's order, calling the limitations on funding 'excessively broad' and adding that 'they have undermined efforts to promote safe and effective voluntary family programs in foreign nations."

        Obama also claimed that "he would work with Congress to restore financial support for the United Nations Population Fund," and he "bemoaned the 'politicization' of abortion," the New York Times (1/24, A13, Baker) added. Promising "a new dialogue about reducing unintended pregnancies," he lifted restrictions on "the United States Agency for International Development from providing money to any international nongovernment organization that 'performs or actively promotes abortion as a method of family planning' in foreign countries." Those restrictions, however, "did not apply to counseling for abortions in the case of rape, incest, or danger to the life of the pregnant woman."

        Obama's announcement Friday afternoon, "with considerably less fanfare than his earlier pronouncement about closing the U.S. military prison at Guantanamo Bay, Cuba," was seen by some as an effort to downplay his move, the Los Angeles Times (1/24, Levey) noted. Still, it "appeared to do little to shift the tone of the debate." The Wall Street Journal (1/24, Meckler), the AP (1/24, Lee, Sidoti), the Boston Globe (1/24), BBC News (1/24), Time (1/23, Sullivan), and the Washington Times (1/24, Ward) also covered the story.

CQ (1/26, Adams) reports that House Democrats have "included language in their economic stimulus bill that would expand the Medicaid program and allow its use for family planning services." The CQ portrayed the move as something of a Trojan horse, suggesting that Republicans are taking little notice as they focus on criticisms of the SCHIP expansion bill. "Republicans have spent the better part of the past decade shrinking the Medicaid program, which states complain has gotten too expensive; states pay, on average, 43 percent of the cost. Under current law, if a state wants to use Medicaid money for family planning, it must obtain a waiver from the Department of Health and Human Services."

        In a separate article, CQ (1/24, Wayne) reported that Democrats in the Senate "are proposing about $148 billion in new spending for Medicaid and Medicare, electronic health records, biomedical research and health insurance for the unemployed as part of the emerging economic stimulus package. The health measures are included in a $455 billion portion of the stimulus package that the Senate Finance Committee is expected to approve Tuesday."

        Modern Healthcare (1/24, DoBias) added that the spending includes "$87 billion for the Medicaid boost and another $17.9 billion to help providers purchase the systems necessary to effectively use electronic health records. Other provisions include a $1.1 billion investment to spur comparative-effectiveness research, $25 billion for an expansion of the COBRA health insurance program and $25 million to eliminate copayments for American Indians and Alaska Natives in Medicaid."

        Senate stimulus package summary proposes $3 billion more for health IT. The Wall Street Journal (1/25, Yoest) reports, "Proposed spending in the U.S. Senate's stimulus package includes $3 billion more for health information technology than that proposed by the U.S. House, a summary released Friday by the Senate Appropriations Committee shows." The summary's proposed $5 billion for health information technology "comes on top of roughly $18 billion in the Senate Finance Committee's portion of the bill for health technology."

        On the front of its Business Day section, the New York Times (1/26, B1, Lohr) also notes spending on health IT in the stimulus bill

        House stimulus package including health IT funding should reach floor this week. Government Health IT (1/23, Foxhall) reported, "The massive legislative stimulus package with billions of dollars for health information technology continued on a fast track through Congress on Jan. 22, passing two House committees on its route to the House floor by the middle of [this] week." The bill "will provide $20 billion, spread over several years, for infrastructure and incentives to encourage doctors and hospitals to use health information technology."

The New York Times (1/23, A15, Hartocollis) reported, "For 20 years, federal law has protected married couples from having to choose between divorcing or becoming impoverished when one spouse needs expensive nursing home care, allowing the healthier spouse to retain assets and income while the sicker one's care is covered by Medicaid." In New York, these benefits have been extended to people who receive care at home. But now, "the federal government has ruled that New York has been too generous...forcing several thousand couples to make a stark choice by March." Mark L. Kissinger, the deputy commissioner of long-term care for the state Health Department, told the Times that the federal government is "saying if you put your spouse in a nursing home, you're going to get to keep more income than if you keep your spouse out of a nursing home. ... That's completely opposite to public policy and research of the last 10 years."

The Wall Street Journal (1/24, Burton) reported, "A medical society representing U.S. spine surgeons has taken the rare step of requiring that researchers disclose not just the existence of financial ties to medical-device companies, but the dollar amounts as well." The North American Spine Society's (NASS) move comes in response to "pressure from lawmakers, prosecutors and lawsuits by companies' former employees," as "prominent surgeons doing research have been found to have significant financial relationships....with medical-device firms." NASS stated that its policy will apply to "'all relationships engaged in by all participants in all' activities of the spine society," and failure to disclose would result in penalties that may include "suspension, expulsion, or public letters of censure." The sanctions, however "wouldn't have any effect on a doctor's ability to practice." Catherine D. DeAngelis, editor in chief of the Journal of the American Medical Association, stated that although "she knows of no other such policy," she plans to discuss the move with "other top medical-journal editors...at a June meeting."

In the Wall Street Journal (1/23) Health Blog, Jacob Goldstein wrote, "Minnesota's attorney general is suing the biggest hospital system in the Twin Cities, alleging that Allina Hospitals & Clinics is violating a state law by charging patients excessive interest on unpaid bills." Attorney General Lori Swanson "wants the hospital to give a refund to patients who paid interest she says is excessive." The hospital system said it told Swanson "it had decided to lower the maximum interest rate to eight percent," and "argued that it never violated state law." Goldstein noted that "the legal debate turns on whether the hospital's debt program constitutes an 'open-ended credit plan' under state law," according to the Minneapolis Star Tribune. "The law allows such plans to charge 18 percent interest."

The Los Angeles Times (1/25, Yoshino) reported that California "parents and medical professionals are grappling with a significantly diminished network of care for the state's 10 million children." Driven "more by financial pressure than any shift in medical protocol," over "65 hospitals have either eliminated their children's units or shut down altogether." Many hospitals "have been forced to shift resources toward adults, who receive higher state and federal subsidies." This trend continues, however, "even as the number of children has grown." According to one analysis, over "800 inpatient children's beds were lost from 1998 through 2007 -- a 19 percent drop." The state currently "has about one licensed pediatric bed per 2,500 children." Meanwhile, "policy experts, nurses and many pediatricians worry that young patients are now concentrated at too few hospitals, even with more children being treated as outpatients." Moreover, the cuts are occurring "without serious, coordinated analysis of how the losses statewide could affect the quality of care." In fact, "researchers are only just beginning to study the phenomenon."

The Riverside (CA) Press Enterprise (1/25, Hines) reports, "Many California hospitals are struggling financially as a growing number of patients can't pay their bills or postpone non-urgent surgeries and more uninsured patients seek care in emergency departments."  A new report by the California Hospital Association shows a "73 percent increase in the number of patients who could not pay their hospital expenses."  One CEO of a local hospital "said his facility began noticing recession affects at least two months ago," telling the Press Enterprise, "We have seen some elective surgeries being postponed because people don't want to miss work or don't want to pay their out-of-pocket costs."

American Medical News (1/26, Caffarini) reports that "increasing numbers of hospitals nationwide are instituting mass layoffs as they try to stay solvent in what some administrators and consultants have called the most challenging time for the industry in at least 40 years."  Meanwhile, "some smaller hospitals have even laid off employed doctors or slashed physician pay, and consultants warn that as the economy gets worse, more hospitals will likely follow."  A number of hospital administrators point out that "a combination of factors resulting from the recession have caused an economic meltdown unlike any they've seen."

        Xtent may lay off nearly all its workers. The Wall Street Journal (1/26, Kamp) reports, "A tough financing environment caught up to development-stage medical company Xtent Inc., which has a heart stent in the works but said Friday it may lay off nearly all its workers while it looks for a strategic deal."  The company's chief executive said that "Xtent's technology -- which allows stents to be cut to size while in blood vessels -- could...work for companies interested in long stents to treat clogged leg arteries."  The company, "which went public about two years ago at $16, closed Friday at 20 cents a share," which "puts the market valuation at less than $5 million."

American Medical News (1/26, Berry) reports, "Health plans are trying to make lemonade out of the lemon of an economy that has soured their core business." In doing so, "they are turning their focus on making money in the individual health insurance market," anticipating "national reform efforts" that "could get more of the estimated 46 million uninsured signed up for individual plans." In addition, "as health plans see it, with every layoff and cutback, the number of potential individual buyers grows." According to the Kaiser Family Foundation, "for every one percent increase in the unemployment rate, an estimated 1.1 million become uninsured," while "another one million become eligible for Medicaid or State Children's Health Insurance Program."

Modern Healthcare (1/23, Zigmond) reported, "The Association of Air Medical Services, Helicopter Association International, and Air Medical Operators Association contributed to a joint position paper...in preparation for the National Transportation Safety Board's four-day meeting to discuss air emergency services." In a press statement, Sandy Kinkade, president of the Association of Air Medical Services, said "that recent studies reveal that the majority of accidents occur in low light and changing weather." Kinkade said that "it is imperative that our industry continue to adopt appropriate safety measures, particularly with regard to nighttime and changing weather conditions, and that more funds be dedicated to aviation infrastructure for helicopters." Modern Healthcare noted that last year, "there were seven air ambulance crashes that killed 28 people."

Life Sciences Law

Following a New York Times story, the Washington Post (1/24, A6, Stein) reported, "A California biotechnology company plans to launch the first government-approved clinical trial testing human embryonic stem cells on people by next summer after receiving" approval from the Food and Drug Administration (FDA) last week. The study "will mark the first authorized use of" stem cells "derived from embryos, which have been highly controversial because the embryos are destroyed in the process." The company, Geron Corp., aims to determine "the safety of the cells...but researchers also will look for any signs that the therapy restored sensation or movement" in patients "with severe spinal cord injuries."

        The trial is expected to "begin later this summer," Time (1/24, Park) noted. For the study, researchers will coax "the stem cells to develop into a type of cell known as an oligodendrocyte, which in turn gives rise to critical insulation and growth factors that can repair neurons damaged by a trauma to the spinal cord." The cell treatment, named GRNPOPC1, will be injected "at specific locations, where the cells will remain" to repair and "potentially re-establish proper connections."

        "The cell therapy is made from one of the first batches of human embryonic stem cells ever created," which was "derived using molecules from mice and cows," the Los Angeles Times (1/24, Kaplan) added. Researchers feared that these cells "could never be used to treat people," because they "might be rejected by the human immune system." Meanwhile, "newer stem cell lines that are animal-free have not been eligible for federal research funding under [a] policy set by President Bush in 2001."

        Bloomberg News (1/24, Waters, Lopatto), HealthDay (1/23, Reinberg), WebMD (1/23, DeNoon), Chicago Tribune (1/24, Japsen), the Canada's Globe and Mail (1/24, Church), and BBC News (1/23) also covered the story.

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