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Teaching Hospital Update May 16-20, 2011


Email Alert

May 20, 2011

By Amy Kaufman and Leah Voigt*

AAMC Statement on Cuts to HRSA's Children's Hospital Graduate Medical Education Funding

The Association of American Medical Colleges (AAMC) president and chief executive officer issued the following statement today about cuts to the Children's Hospital Graduate Medical Education (CHGME) Payment Program in the 2011 Health Resources and Services Administration (HRSA) operating plan:

"The AAMC is deeply concerned about the $48.5 million in cuts to CHGME funding. At a time when the nation faces a critical doctor shortage and more Americans are about to enter the health insurance system, any cuts to funding that supports physician training will have serious repercussions for America's health.

Our nation will face a serious shortage of both primary care and specialist physicians by 2020, including pediatricians and pediatric specialists. The Expert Work Group on Pediatric Subspecialties describes the 'crisis' in pediatric subspecialty care as one caused by an insufficient number of specialists, an increasing demand for services, and not enough funding for medical education. The lack of available care harms children and families and produces economic inefficiencies in the healthcare system as a whole.

AAMC Statement on Cuts to HRSA's Children's Hospital Graduate Medical Education Funding, Med. News Today (May 19, 2011).

Teens Respond to Anti-Smoking Advice from Docs

Healthcare professionals may have a key role in smoking prevention, reduction, and cessation in teens, researchers found. A retrospective observational study of urban students in the mid-south showed that intervention from a healthcare professional was associated with healthier smoking attitudes, accurate understanding of damages related to smoking, and, in smokers, increased number of quit attempts, researchers reported in Pediatrics.

Smokers who received and recalled counsel from a healthcare professional were also generally more likely to have fewer intentions to smoke after five years, said researchers from the University of Memphis. The study measured responses on a range of smoking behaviors and benefits of physician advice for smokers and nonsmokers in a pool of 5,154 eleventh grade students, 46% of whom had ever smoked.

Data came from the Memphis Health Project, a longitudinal study of urban adolescents; 82.9% were African American and about 23% came from low-income neighborhoods.

Students were grouped into the following categories: screened and advised; only screened; only advised; and neither intervention.

Students were also grouped based on their smoking status ranging from "never" to "smoke at least one cigarette a day." Measures of knowledge of health risks, intentions to smoke, and social benefit associated with smoking were also taken. Smokers were evaluated for history of and plans for smoking cessation (categorized by pre-contemplation, contemplation, and action or maintenance), intention to quit, number of quit attempts, and relapse status.

Cole Petrochko, Teens Respond to Anti-Smoking Advice from Docs, MedPage Today (May 17, 2011).

Johnson & Johnson Failed to Warn Parents About Motrin Risks, Lawyer Argues

Johnson & Johnson (J&J) failed to warn parents that its Children's Motrin and Children's Tylenol pain relievers can cause allergic reactions that leave kids blinded and burned, said a lawyer for the family of a girl allegedly injured by the drugs.

J&J officials had studies linking the pain relievers to a drug reaction that can cause skin burns and eye damage and didn't provide warnings on the medicines' labels, an attorney for the family of Brianna Maya, told a Philadelphia jury. Maya was left blind in one eye and suffered burns over 84% of her body after taking Motrin and Tylenol in 2000 when she was three and a half years old, Jensen said. She's now thirteen years old.

J&J, the world's largest health-products maker, and its McNeil unit have faced at least two other jury trials over claims the companies hid the pain relievers' links to Stevens-Johnson Syndrome, an allergic drug reaction that can leave patients with damaged eyes, a blistered mouth, and burned skin.

A California jury cleared the companies of liability in 2008 for injuries suffered by an eleven-year-old girl who took the pain relievers and developed the syndrome. Her family had sought $1 billion in damages. Two years later, a federal jury in Illinois awarded a woman who took Children's Motrin and suffered similar injuries $3.5 million in damages. A judge threw that award out on procedural grounds.

Jef Feeley and Chris Yasiejko, Johnson & Johnson Failed to Warn Parents about Motrin Risks, Lawyer Argues, Bloomberg News (May 18, 2011).

Study Finds Sleepy Surgeons Match Well-Rested Ones

Cardiac surgeons with less than six hours of sleep performed as well as those who had more than six hours of sleep, according to a six-year prospective study in a high-volume Canadian center.

Of the 4,047 consecutive surgical procedures, the mortality rates were 3.6%, 2.8%, and 3.4%, respectively, for surgeons with fewer than three hours of sleep, three to six hours, and more than six hours, researchers from the London Health Sciences Centre in Ontario, Canada, reported.

The researchers found no significant interaction between surgeon age, hours of sleep, and occurrence of death or any of ten major complications monitored, according to the study published online in Archives of Surgery. The London Health Sciences Centre performs 1,300-1,400 cardiac surgical procedures per year. Six of the eight consulting surgeons consented to participate in the study; four were younger than forty-five years old, and two were fifty to fifty-five years old.

The investigators said that previous studies using laparoscopic simulators that showed a correlation between lack of sleep and complications may not be applicable to cardiac operations. They also noted that no good studies exist that evaluate "the effects of sleep deprivation on the fine motor skills required to perform coronary artery bypass grafting (CABG), valve, or aortic operations." The operations observed in the study included CABG, valve, combined valve-CABG, or aortic surgery between January 2004 and December 2009.

The ten major complications monitored were the use of postoperative intra-aortic balloon pump, stroke or delirium, reoperation for bleeding, arrest or permanent pacemaker, new renal failure, septicemia, mediastinitis, sternal dehiscence, respiratory failure, and postoperative myocardial infarction.

Chris Kaiser, Sleepy Surgeons Match Well Rested Ones, MedPage Today (May 19, 2011).

Rebound Continues for Health Insurers: Gains Due in Part to Patients Delaying Care Because of Cost

Four major Massachusetts health insurance companies yesterday posted strong financial gains for the first three months of 2011, a year after reporting steep first-quarter losses that they blamed on that state administration's decision to cap premium increases. The gains, which continued a rebound that started mid-way through last year, reflected factors also at play in the national health insurance market, including cost-conscious patients who are delaying medical care, a boost in investment income, and lower administrative spending.

A key driver of the companies' improved fortunes was a decline in the number of insurance claims as more Massachusetts residents cut back on imaging tests, chose generic drugs, or postponed elective procedures such as knee replacements. That's because employers are shifting more of the price of insurance to workers, resulting in higher copayments and deductibles.

"We've seen more people making very deliberate decisions on discretionary medical services,'' said the chief financial officer at Harvard Pilgrim Health Care in Wellesley. "Almost 80 percent of our lower than anticipated cost trend is due to less utilization.'' Combined, the four nonprofit health insurers reaped nearly $70 million for the three months ending March 31, compared with total losses topping $150 million for the same period last year. The numbers mirrored a significant income increase reported Friday by Partners HealthCare System Inc., the state's largest hospital group.

The health plans' quarterly results also coincided with a state legislative committee hearing on Governor Deval Patrick's bill to ease the insurance burden by changing the way medical care is paid for, and attracted the attention of those who say insurers and healthcare providers have not done enough to lower medical costs.

Robert Weisman, Rebound Continues for Health Insurers, BOSTON GLOBE (May 17, 2011).

AHLA Teaching Hospital Updates are intended to provide quick summaries of cutting-edge issues of interest to teaching hospitals and their counsel. Additional information and more in-depth coverage on these topics may be available from AHLA Health Lawyers weekly and appropriate AHLA Practice Groups.

*We would like to thank Amy Kaufman, Esquire (Nashville, TN), and Leah Voigt, Esquire (Spectrum Health Hospitals, Grand Rapids, MI), for providing this week's update

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