Articles Posted in Ethics

Donald_Trump-1-225x300A GOP assault on American health care has been turned aside, for now. But major questions have been exposed that will need answering if we as a country are ever to come together over health care. Do we recognize that health care—comprising 17.5 percent of the Gross Domestic Product and trillions of dollars in spending annually— has become so costly, complicated, and critical that each of us, at some point in our lives, must have some assistance from all the rest of the collective us?

In short: Do we believe that health care is a right?

All other civilized countries answered that question long ago in the affirmative and have implemented systems that guarantee everyone living within their borders (or even visitors from places like the USA) a basic package of health care.  But we here in the United States still struggle with the world’s most expensive health care system that delivers care to a smaller percentage of its residents than anywhere else and that gets worse outcomes than most other advanced countries.

doc-sleep-300x225Must doctors be absolutely impervious to common sense improvements in the way they train their own? Their bullheadedness has reemerged with the revisited decision by a major academic credentialing group to allow medical residents yet again to work 24-hour shifts.

The Accreditation Council for Graduate Medical Education clearly was on the defensive when it issued its memo on residents’ learning and working hours, guidance that academic medical centers and hospitals nationwide will rely on in setting workplace standards for the young doctors in whose hands so many patients will put their lives. The council noted that it had established a high-level task force to reconsider criticisms of residents’ stress and overwork and how this might imperil patient care, responding to an early rollback of shift hours:

“… The Task Force has determined that the hypothesized benefits associated with the changes made to first-year resident scheduled hours in 2011 have not been realized, and the disruption of team-based care and supervisory systems has had a significant negative impact on the professional education of the first-year resident, and effectiveness of care delivery of the team as a whole. It is important to note that 24 hours is a ceiling, not a floor. Residents in many specialties may never experience a 24-hour clinical work period. Individual specialties have the flexibility to modify these requirements to make them more restrictive as appropriate, and in fact, some already do. As in the past, it is expected that emergency medicine and internal medicine will make individual requirements more restrictive.”

consent-300x170Modern medicine has become so complex, bureaucratic, and forbidding that it’s little wonder that patients—already ailing—don’t grasp the risks and consequences of treatments they prescribe. Overwhelmed patients also don’t demand that doctors fully brief them.

And shame on physicians for failing to help patients more in this critical area of caregiving, two doctors have written in an excellent New York Times Op-Ed column. The doctors—Mikkael Sekeres, director of the leukemia program at the Cleveland Clinic, and Timothy Gilligan, director of coaching, Center for Excellence in Healthcare Communication, at the Cleveland Clinic—deserve credit for calling out colleagues while describing the vital health care concept of informed consent.

My firm has detailed information on this important patient right in health care (click here to see).

elder-abuse-awareness-300x210It’s one of the more disturbing, revolting, and painful health care investigations put out by a news organization in recent times. It’s disheartening but it also demands action: So, what steps will federal, state, and local authorities take now that CNN has reported that thousands of sick, disabled, and defenseless patients, most of them women, have been sexually abused and assaulted in nursing homes in the last decade?

The broadcast network said that data, collected by the U.S. Health and Human Services Department’s Administration for Community Living, show 16,000 sexual abuse complaints have been filed since 2000 over conditions at long-term care facilities (both nursing homes and assisted living facilities). Experts say there may have been more cases because sexual assault and abuse, due to stigmatization, often is un- or under-reported.

CNN, which turned up more than 380 sexual assault allegations in Illinois and more than 250 in Texas between 2013 and 2016, said it had analyzed U.S data in the same period, finding that “the federal government has cited more than 1,000 nursing homes for mishandling or failing to prevent alleged cases of rape, sexual assault and sexual abuse at their facilities … And nearly 100 of these facilities have been cited multiple times during the same period.”

PrecisionHealth-300x108It’s a $50-million business with a roster of blue-chip consultants who would be an envied faculty at most any major university. But look closely at the activities of Precision Health Economics because this firm’s esteemed academic economists, for big bucks, are boosting Big Pharma’s efforts to justify some of its sky-high prices for its products to policy-makers, regulators, and lawmakers.

Pro Publica, the Pulitzer Prize-winning online investigative site, deserves credit for raising questions about yet another area in which ordinary Americans may be outgunned by special-interest money. Big Pharma already has earned notoriety for seeking to advance its causes by paying physicians, underwriting patient advocacy groups—and now retaining high-powered economists.

Economists play a key role in providing expert views on drugs, their prices, and markets, all of which are increasingly controversial issues as Americans struggle to afford medications that can cost $1,000 a day or tens of thousands of dollars for treatment regimens lasting for a few months.

HouseGregoryHouse-276x300Doctors, nurses, and hospitals should stop ignoring colleagues who act like jerks because obnoxious physicians—think of  Dr. Gregory House, the TV internist—may hurt patients, especially in surgery.

Researchers, who published a study in the JAMA Surgery, looked at two years of quality care data from seven medical centers, involving 800 surgeons and 32,000 adult patients. They also had information on physicians with “unsolicited patient observations,” meaning complaints from those undergoing care and their friends and families.

Stat, the online health information site, summarizes what the researchers found:

nhlDo the leaders of professional hockey need to spend some time in the penalty box? It might seem so based on a report in the New York Times that the National Hockey League, as it battles its own players in court over the harms caused by repetitive head injuries, is adopting the dubious legal playbook used by pro football, Big Tobacco and Big Sugar.

The $4-billion-a-year NHL, it seems, has taken off its mitts, thrown them on the ice, and is throwing blows to challenge the ever-mounting, evidence-based research that finds that concussions are detrimental to brain health and can lead to the disease known as chronic traumatic encephalopathy or CTE.

The National Football League, after years of CTE denial, including efforts to undercut its medical science and to attack its researchers, conceded that repeated head trauma harmed its players, and pro football settled with them for more than $1 billion.

thomas-price-225Republicans jammed through their health policy guru in the middle of the night, and they and their new HHS Secretary are still trying to figure out what to do with the Affordable Care Act, aka Obamacare. Insurance markets are on the brink of chaos, and the mess is angering increasing number of Americans who may soon see their costs rise, their medical care decline, and their health imperiled.

The president and the speaker of the house continue to be at odds as to the timing of the GOP’s long-promised pledge to repeal and replace Obamacare, with the timeline stretching to the year’s end or beyond before the public gets to see the outlines or details of Republicans’ Trumpcare.

Proposals for ACA ‘repair’

price-245x300We’re dizzily trying  to keep track of all the ways that the new administration is defying the best hopes that it will pursue a health care policy that is fair, open, responsive, and based in evidence, research, and scientific expertise — not partisanship and knee-jerk. Compounding the confusion is that as soon as many of these missteps occur, they then are reversed, or maybe re-reversed. Is this the way to build the public’s confidence in any new course on health care?

A prospective leader with big ethical challenges

  • Yes, every president deserves the privilege of selecting his Cabinet officers, and the U.S. Senate, while advising and consenting, must to a degree defer to presidential picks. But Tom Price, the nominee to head the trillion-dollar Health and Human Services Department, even if confirmed, has launched poorly into his prospective top position. He did say he supports vaccinations and does not believe the debunked theory that shots cause autism or diseases. But he has offered a woeful lack of information about the administration’s plans on the much-publicized GOP repeal and replacement of Obamacare. He’s been equally blank about what’s ahead for Medicaid and Medicare, as well as how vigorously he might protect the public from bad drugs or dangerous medical devices.

sen-collins-288x300Bill_Cassidy_headshot-237x300Will the partisans who promised and now can’t deliver on a blitzkrieg to repeal and replace the Affordable Care Act, aka Obamacare, end up deeply dividing the country in even more disturbing ways?

GOP leaders, after conceding that they cannot legislate their hoped-for Obamacare replacement until much later this year (reversing their pledge to do so on Day One of the new Administration), huddled in Philadelphia, nervously, to develop strategies and tactics. As they develop “Trumpcare,” they’re confronting growing and significant restiveness about the potential destructiveness of their current course, including the possibility their repeal may cost 43,000 American lives annually.

Meantime, the health care policy proposals that have floated up, including the Patient Freedom Act of 2017 from Republican senators Susan Collins of Maine and Bill Cassidy of Louisiana, raise as many questions as they offer, including:

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