31 May 2011


The Center for Dieses Control and Prevention reports that so far this year the United States has had 118 cases of measles. This is the highest year to date total since 1996.
The CDC on Tuesday released the count for January 1 through May 20. Cases were seen in 23 states. None of the patients died, but about 40 percent were hospitalized.
The U.S. normally sees about 50 cases of measles in a year, thanks to vaccinations. About 90 percent of the cases this year were unvaccinated.
Measles is highly contagious and up to 90 percent of people exposed to an infected person get sick. The virus spreads easily through the air, and in closed rooms, infected droplets can linger for up to two hours.


Drug shortages have always been a part of the medical world, however the problem is growing. Hospitals and care givers are concerned that the drugs they desperately need to save lives is hard to get. There are already record cases where vital treatment has been delayed while doctors wait for the drugs they need.
The number of drugs listed in short supply has tripled over the past five years, to a record 211 medications last year. While some of those have been resolved, another 89 drug shortages have occurred in the first three months of this year, according to the University of Utah's Drug Information Service. It tracks shortages for the American Society of Health-System Pharmacists.
The vast majority involve injectable medications used mostly by medical centers in emergency rooms, ICUs and cancer wards. Particular shortages can last for weeks or for many months, and there aren't always good alternatives. Nor is it just a U.S. problem, as other countries report some of the same supply disruptions.
It's frightening for families.
At Miami Children's Hospital, doctors had to postpone for a month the last round of chemotherapy for 14-year-old girl, because of a months-long nationwide shortage of cytarabine, a drug considered key to curing a type of leukemia.
The parent commented that she is always fearful that if her child is going so long without chemo, that there may be a chance her cancer's going to come back. The mother says she'll be nervous until her daughter finishes her final treatments scheduled for this week. She can’t believe that in this day and age, we really shouldn't be having this kind of problem and putting children's lives at risk.
There are lots of causes, from recalls of contaminated vials, to trouble importing raw ingredients, to spikes in demand, to factories that temporarily shut down for quality upgrades.
Some experts pointedly note that pricier brand-name drugs seldom are in short supply. The Food and Drug Administration agrees that the overarching problem is that fewer and fewer manufacturers produce these older, cheaper generic drugs, especially the harder-to-make injectable ones. So if one company has trouble, or decides to quit making a particular drug, there are few others able to ramp up their own production to fill the gap.
The shortage that's made the most headlines is a sedative used on death row. But on the health-care front, shortages are wide-ranging, including:
-Thiotepa, used with bone marrow transplants.
-A whole list of electrolytes, injectable nutrients crucial for certain premature infants and tube-feeding of the critically ill.
-Norepinephrine injections for septic shock.
-A cystic fibrosis drug named acetylcysteine.
-Injections used in the ER for certain types of cardiac arrest.
-Certain versions of pills for ADHD, attention deficit hyperactivity disorder.
-Some leuprolide hormone injections used in fertility treatment.
No one is tracking patient harm. But last fall, the nonprofit Institute for Safe Medication Practices said it had two reports of people who died from the wrong dose of a substitute painkiller during a morphine shortage.
Every pharmacist in every hospital across the country is working to make sure those things don't happen, but shortages create the perfect storm for a medication error to happen
What can be done?
The FDA has taken an unusual step, asking some foreign companies to temporarily ship to the U.S. their own versions of some scarce drugs that aren't normally sold here. That eased shortages of propofol, a key anesthesia drug, and the transplant drug thiotepa.
Affected companies say they're working hard to eliminate backlogs. For instance, Hospira Inc., the largest maker of those injectable drugs, says it is increasing production capacity and working with FDA to address shortage situations as quickly as possible and to help prevent recurrence.
But the Generic Pharmaceutical Association says some shortages are beyond industry control, such as FDA inspections or stockpiling that can exacerbate a shortage.
Drug shortages of any kind are a complex problem that require broad-based solutions from all stakeholders
Lawmakers are getting involved. Senator Herb Kohl of Wisconsin is urging the Federal Trade Commission to consider if any pending drug-company mergers would create or exacerbate shortages.
Also, pending legislation would require manufacturers to give FDA advance notice of problems such as manufacturing delays that might trigger a shortage. The FDA cannot force a company to make a drug, but was able to prevent 38 close calls from turning into shortages last year by speeding approval of manufacturing changes or urging competing companies to get ready to meet a shortfall.
With all things considered, everyone and every company is out to provide the best drugs as needed so as to not put anyone’s life at risk. If a drug shortage is foretasted steps are being taken, and have successfully been taken, to prevent the worst from happening.


In the past large corporations were targeted in health care fraud cases. Now, the executives at these corporations are being sought out with their personal reputation and futures on the line. A Michigan Medical Malpractice Lawyer states that this can be a hard pill to swallow for executives.
The new tactic is raising the anxiety level and risks for corporate honchos at drug companies, medical device manufacturers, nursing home chains and other major health care enterprises that deal with Medicare and Medicaid.
Previously, if a company got caught, its lawyers in many cases would be able to negotiate a financial settlement. The company would write the government a check for a number followed by lots of zeroes and promise not to break the rules again. Often the cost would just get passed on to customers.
Now, on top of fines paid by a company, senior executives can face criminal charges even if they weren't involved in the scheme but could have stopped it had they known. Furthermore, they can also be banned from doing business with government health programs, a career ending consequence.
Many in industry see the more aggressive strategy as government overkill, meting out radical punishment to individuals whose guilt prosecutors would be hard pressed to prove to a jury.
The feds say they got frustrated with repeat violations and decided to start using enforcement tools that were already on the books but had been allowed to languish. By some estimates, health care fraud costs taxpayers $60 billion a year, galling when Medicare faces insolvency.
When you look at the history of health care enforcement, there has been a number of Fortune 500 companies that have been caught not once, not twice, but sometimes three times violating the trust of the American people, submitting false claims, paying kickbacks to doctors, marketing drugs which have not been tested for safety and efficacy.
The inspector general of the Health and Human Services Department stated that he feels that those in high ranking positions at these companies are not getting that what is happing is wrong. If writing a check for $200 million isn't enough to have a company change its ways, then maybe the individuals who are responsible for this be held accountable. The behavior of a company starts at the top.
Lawyers who represent drug companies say the change has definitely caused a stir, but the end result is far from certain. People are alarmed, and want to know what facts and circumstances would cause the Justice Department to indict someone who hadn't even known about the misconduct. The drug companies claim they are doing all they can to achieve compliance.
Others say high-powered corporate targets won't go meekly. If the government does continue to press its campaign against individuals, we may see the limits of the government's theories tested. There is a very important open question as to whether individuals can be held criminally culpable or lose their jobs simply by virtue of their status.
Although the Obama administration has increased scrutiny of corporate America generally, this shift in health care enforcement seems to have come up from the ranks, government and corporate attorneys say.
Investigators and lawyers at the HHS inspector general's office, the Justice Department and the Food and Drug Administration started moving more or less independently toward holding executives accountable. Morris outlined the inspector general's position in congressional testimony this spring, saying his office will use its power judiciously.
A test case is playing out with an 83-year-old drug company chief executive, Howard Solomon of New York City-based Forest Laboratories. Forest makes antidepressants, blood pressure drugs and other medications. Last month, the inspector general's office notified Forest that Solomon could potentially be banned from doing business with federal programs.
The power to ban or exclude an individual rests with the inspector general. It's routinely applied to low-level violators, but rarely to people of Solomon's rank. In the industry, they call it the "death penalty."
Last year, a Forest subsidiary pleaded guilty to criminal charges as part of a settlement with the Justice Department in which the company also agreed to pay $313 million to resolve long-running investigations. Prosecutors charged that Forest deliberately ignored an FDA warning to stop distributing an unapproved thyroid drug, promoted the use of an antidepressant in treating children although it was only approved for adults and misled FDA inspectors making a quality check at a manufacturing plant.
The company said it had considered the case closed. But then came the inspector general's letter.
A statement release said no one has ever alleged that Mr. Solomon has done anything wrong and excluding him would be completely unjustified. In prior cases where a senior executive has been excluded, that individual has been accused of wrongdoing and ultimately has either been convicted of or pleaded guilty to a crime.
Forest is fighting the move to ban Solomon. The inspector general's office refused to comment on the case, and no final decision has been made. In congressional testimony, it was said that when there is evidence an executive knew or should have known about misconduct, the inspector general "will operate with a presumption in favor of exclusion of that executive."
Separate from the inspector general's power to ban, the FDA has resurrected something called the "Park Doctrine," which makes it easier for prosecutors to bring criminal charges against an executive.
The doctrine, stemming from a 1970s Supreme Court case, allows the government to charge corporate officers in the chain of command with a criminal misdemeanor. They could face up to a year in prison and fines if they had the authority and responsibility to prevent, detect or resolve misconduct affecting the public welfare but failed to do so.
Although many details concerning the laws are still being discussed, the progress may already be making an impact on the industry. CEO’s and executives may think twice before making a questionable decision. Some companies already in fear of repercussions have changed their ways and began compliance.

24 May 2011


The Detroit Medical Center was among one of the first hospitals nationally to apply for federal incentive dollars. The money, if received will go towards paying for an expensive Michigan emr system, also known as electronic medical records.
The Detroit Medical Center said they have sent proof to the Centers for Medicare & Medicaid Services (CMS) that they have achieved "meaningful use" of several electronic health record objectives that qualifies them for the aid.
The DMC will get an estimated $16 million to $17 million this year, helping to cover some of the $35 million it spent in 2006 and 2007 to upgrade its computerized physician order entry and nursing documentation systems. The DMC expects to receive a total of $40 million in incentives.
The federal funding is aimed at expediting the conversion of paper medical records to electronic systems that can move with patients, which experts say could drive down health care costs.
Many hospitals nationwide haven't installed much electronic record technology and are looking for meaningful use consultation. About 1.6 percent of hospitals surveyed in January by the American Hospital Association said they meet "meaningful use" requirements and have certified electronic health record technology.
The DMC is ahead of some competitors in using electronic record systems. The DMC hospitals are rated six out of seven for using the technology by the Healthcare Information Management Systems (a seven is paperless).
Hospitals will use the federal money, made available through 2009's American Recovery and Reinvestment Act, to help pay for the transition from paper records to electronic systems that cost some health systems upwards of $100 million to deploy. Physicians also can apply for funding through CMS, which began taking applications in the middle of April.
Electronic medical records help reduce medical errors and lower health care costs by reducing duplication of tests and unnecessary procedures, eliminate transcription costs and can reduce a patient's stay. Electronic records also help assure patients that there won't be problems misreading handwriting or paperwork being lost or unseen.
CMS hasn't made any incentive payments yet to hospitals nationwide, but expects before the end of May to release information on incentive payments.
The state of Michigan has yet to issue any Medicaid incentive payments to the 13 hospitals that have applied because it is reviewing paperwork.
Medicare's first phase required compliance with 15 core measures and five of 10 other objectives. Goals included having at least 30 percent of patients get a computerized order entry for medications. Hospitals that don't achieve CMS goals by 2015 will be subject to significant financial penalties by Medicare.
Some Detroit hospital systems such as the University of Michigan Health System are working to upgrade electronic medical record systems before they apply. U-M has a more than $100 million upgrade under way, while Dearborn-based Oakwood Healthcare Inc. also is spending $60 million on a new system and plans to apply for its first incentive in 2013.
Botsford Hospital in Farmington Hills will apply for the Medicare incentive early next year after it deploys an $8 million electronic medical record system hospital wide this fall.
Other area hospital systems say they plan to apply for incentives later, including the Henry Ford Health System and St. John Providence Health System. Novi-based Trinity Health, which owns the Saint Joseph Mercy Health System in southeast Michigan, plans in July to apply for incentives at 20 sites, including hospitals in the Saint Joseph system.
The federal aid would definitely keep the DMC and other Michigan hospitals moving forward to inprove customer service, satisfaction, and care all while streamlining internal systems and saving a considerable amount of time and money.


Baby boomers are more active than past generations at this age. This activity has put extra strain on hips, knees, and shoulder joints, causing many to look into joint replacement surgery such as hip arthroscopy.
Those receiving a knee replacement surgery has doubled over the last decade and more than tripled in the 45-to-64 age group, new research shows. Hips are trending that way, too.
In the past replacement surgeries had a lot to do with obesity. Ironically, trying to stay fit and avoid extra pounds is taking a toll on a generation that expects bad joints can be replaced routinely.
Joint replacements have enabled millions of people to lead better lives by reducing joint pain, and surgeons are increasingly offering them to younger people. The problem is that no one really knows how well these implants will perform in the active baby boomers getting them now. Most studies were done on older people whose expectations were to be able to go watch a grandchild's soccer game - not play the sport themselves.
A 55-year-old retiree in San Diego plans to have a hip replacement surgery in September. She can't exercise the way she wants to. She has to go slow, which she finds really aggravating. She claims she is not worried about how she is going to feel when she is 75.
Being active is viewed as the closest thing to the fountain of youth, however, most people need to modify their exercise habits because they're overdoing one sport, not stretching, or doing something else that puts their joints at risk.
Experts recommend:
Cross training. Multiple activities prevent overuse.
Balance your routines to build strength, flexibility, core muscles and cardiovascular health.
Lose weight. Every extra pound you carry registers as 5 extra pounds on your knees.
Spend more time warming up.
Let muscles and joints recover, and rest between workouts.
If you've had a joint replacement, take part in the rehabilitation services that's recommended.