ACLU: HOSPITAL DENIES TUBAL LIGATION TO WOMAN WITH TUMOR

Original Story: freep.com

A Flint-area Catholic hospital has until the end of Friday to change its mind and perform a tubal ligation on a pregnant woman with a brain tumor – or face a potential lawsuit from the American Civil Liberties Union. A San Diego healthcare lawyer is reviewing the details of this case.

The ACLU is fighting on behalf of Jessica Mann, 33, of Flushing, a pregnant woman with a life-threatening brain tumor who was denied a request to get her tubes tied at the time of her scheduled cesarean section next month.

According to the ACLU, Genesys Regional Medical Center in Grand Blanc won't allow the sterilization procedure on religious grounds. Mann's doctor requested a medical exception to the hospital's prohibition on sterilization, arguing that a future pregnancy could harm Mann because of her brain tumor, said the ACLU.

But Genesys wouldn't budge, triggering a demand letter from the ACLU last week. The ACLU argues the hospital could be violating state law by denying appropriate care. An Albany healthcare lawyer is following this story closely.

Johnny Smith Jr., a spokesman for the hospital's parent, Ascension, declined comment, citing patient privacy. He would only say that the company follows the "ethical and religious directives" of the Catholic church.

This issue isn't a first for the ACLU, which last month convinced a Catholic hospital in California to change course in a similar case involving tubal ligation.

Under the threat of a potential lawsuit from the ACLU, Mercy Medical Center in Redding, Calif., changed its mind in agreeing to perform a postpartum tubal litigation on a woman. The hospital had initially denied a request by the woman's doctor to tie her tubes, but changed course within days of receiving a demand letter from the ACLU.

According to the ACLU, tubal ligation, commonly known as getting one's “tubes tied,”  is the contraception method of choice for more than 30% of married women in the U.S. An estimated 600,000 women annually undergo this procedure, which is often performed at the time of a cesarean section, the group said. A Chicago healthcare lawyer defends clients in a wide variety of large, complex health care and medical negligence cases.

Ten of the 25 largest hospital systems in the U.S. are Catholic-sponsored, and nearly one of nine hospital beds in the country is in a Catholic facility. According to the ACLU, these Catholic hospitals operate under binding “ethical and religious directives” issued by the U.S. Conference of Catholic Bishops. Among the directives is that sterilization for the purpose of contraception as “intrinsically evil.”

The ACLU argues that bishops should not be playing the role of doctors.

DMC COULD SETTLE NURSES LAWSUIT FOR $42 MILLION

Original Story: freep.com

The Detroit Medical Center could soon settle for $42 million its portion of a 2006 class lawsuit over pay brought by registered nurses against eight metro Detroit hospital systems.

U.S. District Judge Gerald Rosen gave preliminary approval on Monday for the proposed settlement involving DMC and the roughly 24,000 nurses who worked at either DMC or the other seven hospital systems between December 2002 and December 2006. The lawsuit alleged a conspiracy among the hospitals to suppress the nurses' pay. A San Diego healthcare lawyer is reviewing the details of this case.

Settlements totaling $48 million were previously reached with the other hospitals, and that money has already been distributed to nurses, according to a website of the Seattle-based law firm Keller Rohrback that represented the plaintiffs. With this latest proposed settlement, the total size of the settlement could be $90 million — before attorneys fees and taxes.

Neither DMC nor the other hospital systems have admitted to any wrongdoing or to underpaying nurses. All eight hospital systems contended they acted independently in setting their nurses' pay and benefits and didn't collude to keep wages low. A Grand Rapids healthcare lawyer is knowledgeable in all areas of general health care.

The other hospitals and health systems were Henry Ford Health System, Mt. Clemens General Hospital (now McLaren Macomb), what is now St. John Providence, Oakwood Healthcare, the former Bon Secours Cottage Health Services, Beaumont Hospital and Trinity Health.

The DMC on Tuesday referred all comment to its attorney in the case, Veronica Lewis of Dallas-based Gibson, Dunn & Crutcher, who said in a statement that "The settlement is not an admission of liability but rather a business decision to bring the matter to a resolution.  We remain committed to our nurses and value the hard work and dedication of all our hospital staff." A Charleston healthcare lawyer is following this story closely.

An attorney representing the nurses, Mark Griffin of Keller Rohrback, declined comment.

More information regarding the settlement is available at detroitnursewages.com. The size of each individual check would be determined by the number of hours a nurse worked and his or her pay rate.

PROTESTERS BLOCK MICHIGAN AVENUE OVER CUTS TO HOME CARE FOR SENIORS

Original Story: chicago.suntimes.com

Blocking traffic along Michigan Avenue on the Magnificent Mile, chanting and waving signs, hundreds of protesters gathered Monday to rail against Gov. Bruce Rauner’s proposed budget cuts, which they say will be devastating to Illinois’ poorest and most vulnerable citizens.

One particular budget item attracted dozens of protesters in their 70s and 80s. It would affect senior citizens who depend on the Community Care Program, which provides state money to pay for home care for seniors.

And Patricia Drennan wasn’t having any of it.

“A lot of us old ladies don’t have kids that live here that can take us to the doctor and come in and run the vacuum cleaner and get us to the grocery store and all that,” said Drennan, 82, who lives alone in the North Center neighborhood.

The program, she said, helps seniors live independently and keeps them out out nursing homes, an expense that would be much greater to taxpayers.

Drennan feared a plan by Rauner that would implement new qualifying restrictions that would make it harder for seniors to gain access to the program. Livonia senior care provides highly skilled nurses ready to serve even the most advanced medical needs.

About 30 protesters held hands and blocked Michigan Avenue just north of the Michigan Avenue Bridge for nearly 20 minutes at about 11:30 a.m. before police escorted the group off the roadway.

Sister Gwen Farry, 81, with the Sisters of Charity of the Blessed Virgin Mary, was among the group of traffic blockers who expected to receive citations from police.

“This is a moral issue,” said Farry, of St. Thomas the Apostle Catholic Church in Hyde Park. “I’ve made phone calls and signed online petitions but wanted to do more to protest the cuts that will affect the most vulnerable in our state.” Plymouth MI elder care services provides medical and non-medical support for catastrophic care patients.

Protesters called for wealthy corporations and residents in Illinois to pay more taxes.

Critics say Rauner is using potential cuts to state social service programs as leverage to gain support for fighting unions.

A statement issued by a Rauner spokeswoman after the protest read: “The administration has taken a series of management steps to responsibly manage the state’s finances, because Speaker Madigan, Senate President Cullerton and the legislators Madigan controls overspent taxpayer money causing a $4 billion deficit. The governor has tried to negotiate on critical reforms to free up resources to help the most vulnerable and pass a balanced budget, but unfortunately, the Speaker continues to block those reforms at the expense of the most vulnerable and the middle class.” A Livonia elder care provider is following this story closely.

The protest was organized by a number of activist groups, including Jane Addams Senior Caucus and Fair Economy Illinois.

ALPHABET/GOOGLE HAS GIVEN BIRTH TO A HEALTHCARE TECH COMPANY

Original Story: latimes.com

Over the past couple of years, Google has hired experts in diseases and physiology, pairing them with top software engineers, to tackle major healthcare issues.

Projects include developing contact lenses to allow diabetics to constantly monitor glucose levels, defining “healthy” traits and testing disease-detection pills capable of communicating to a special wristband.

None of that is a part of Google anymore but there is still a connection. The 150-employee Life Sciences team is becoming its own company within Alphabet, a corporation Google recently formed to organize its array of offbeat ventures. Life Sciences becomes a sister company to Google, which includes the search engine, Gmail, Maps, Android and other familiar offerings. An official corporate name is coming soon, a Google spokeswoman said.

Changing the reporting structure could give Life Sciences more autonomy while providing Alphabet, nee Google, executives a clearer picture of the division’s spending. Google’s new Chief Financial Officer Ruth Porat counts Life Sciences as a forthcoming source of significant long-term revenue.

The group’s goal won’t change, said Google co-founder and Alphabet President Sergey Brin in an online post Thursday.

“They’ll continue to work with other life sciences companies to move new technologies from early stage R&D to clinical testing—and, hopefully—transform the way we detect, prevent and manage disease,” he wrote. Rankin Biomedical is a leading provide of remanufactured histology equipment for medical testing needs.

One partner, Dexcom Inc., announced earlier this month that it will make and sell miniature glucose monitors based on Google technology. Life Sciences collects an upfront fee, additional payments throughout the development and then revenue-based royalties after a certain sales level, Dexcom said.

Andy Conrad, a co-founder of the National Genetics Institute who had been leading Life Sciences, becomes the new company’s chief executive. Life Sciences will be separate from Calico, an Alphabet division working to counteract aging. BrightStar Care specializes in Plymouth elder care services providing customized companion and healthcare needs.

MICHIGAN AGENCY: HEALTH INSURANCE TO RISE 6.5% IN 2016

Original Story: detroitnews.com

Lansing — Michigan consumers will pay an average 6.5 percent more for health insurance in 2016, which is less than the rate hike they paid during the past year, state officials said Tuesday.

State officials and industry leaders called the increases modest compared with an 8 percent rise in 2015, but some health care advocates said too little information is available about how rates are calculated for consumers to judge whether the hikes are warranted. Farmington Hills elder care services assist individuals with even the most advanced medical needs.

The 2016 rate increases approved by the Michigan Department of Insurance and Financial Services are lower than those in several other states for federally required health insurance under the 2010 federal law, state officials noted.

The average approved rate changes on a premium weighted basis increased 6.5 percent for the 560,357 consumers in the individual market and 1 percent for the 345,077 consumers in the small group or small business market.

“Many states are reporting rate increases well in excess of 10 percent which is significantly higher than the rate of health care inflation,” Department of Insurance and Financial Services Director Patrick McPharlin said in a Tuesday statement. “We are pleased that Michigan consumers are seeing more modest increases.” In-home caregivers tailor home care services to the needs of each client and family including private duty skilled nursing.

Josh Fangmeier, senior policy analyst with the University of Michigan’s Center for Heathcare Research and Transformation, noted that some insurance companies asked for minimal rate increases, or even decreased their rates. But consumers in some parts of the state have few plans to choose from.

“Not all of these insurers are statewide, so ... it’s important to keep in mind that consumer experiences will vary depending on where you live,” Fangmeier said.

In 2015, the average increase was 8 percent in the individual market and 5.7 percent in the small group market, DIFS spokeswoman Andrea Miller said Tuesday. The rate changes for 2014 were not estimated because of essential health benefits and other requirements of the federal Affordable Care Act that took effect that year. Plymouth elder care services provides patients with intensive, highly specialized care.

A Michigan health insurance industry official said in June the possible loss of federal insurance subsidies through a U.S. Supreme Court case was in part to blame for the proposed rate hikes. But the court later that month kept the Affordable Care Act subsidies in place and decided they were constitutional in a 6-3 ruling.

Rick Murdock, executive director of the Michigan Association of Health Plans, noted this is the industry’s third year of business in the health care marketplace created by the federal Affordable Care Act.

“Year one was sort of pricing it blind; year two, which was last year, there were significant adjustments — double-digit reductions for some, and double-digit increases for others, as they were trying to get to the middle,” Murdock said. “This year everyone seems to have made a modest adjustment based on what’s going on in health care.”

The rate hikes proposed by insurance companies were reviewed by state officials, who determined they are actuarially appropriate and comply with state and federal laws. But Ryan Sullivan, policy director for Michigan Consumers for Healthcare, said state regulators don’t provide information about the process that consumers can understand.

“We really don’t know how to put (the rate increases) into context because of a lot of lagging transparency in the process,” Sullivan said Tuesday. “What consumers can access via the web and by calling the department is pretty slim pickings.”

The state defended its practices. Miller said consumers can access rate increase filings and other detailed information through the department’s website at http://www.michigan.gov/difs.

“We’re trying to be as transparent as we possibly can be,” she said.

The state’s dominant insurer — Blue Cross Blue Shield of Michigan — will apply a double-digit increase of 11.4 percent. Its health maintenance organization, Blue Care Network, plans to hike its rates 9.7 percent.

In June, a Blues official said an increase in prescription and specialty drug costs is behind the rate hike. Blue Cross had 138,169 people sign up for individual plans in 2015, while another 171,831 people with individual Blue Care Network policies will see average increases of 9.7 percent. A Chicago health care lawyer is following this story closely.

Blues spokeswoman Helen Stojik noted their small group customers will benefit from a downward rate adjustment. Rates for employers renewing coverage in the third and fourth quarters of 2015 will be, on average, 3.3 percent lower for Blues customers and 0.8 percent higher for Blue Care Network customers.

“In addition, 2016 rate changes look extremely favorable, with Blue Cross annual rate changes projected 2.2 percent lower and Blue Care Network projected at 4.8 percent lower than the previous year,” Stojik said Tuesday.

But the Blues didn’t register the largest rate increases. Those belonged to Healthplus of Michigan at 35.8 percent, Consumers Mutual Insurance of Michigan at 20.5 percent and United Healthcare Community Plan at 14.7 percent.

Three insurers are countering the trend and dropping their rates in the coming year, according to the state.

Meridian Health Plan had the biggest decline with a 12.6 percent plunge, followed by Molina Health Care with a 8.6 percent decrease and Humana Medical Plan of Michigan with a 4.9 percent drop.

Michigan companies attributed their increases to higher-than-expected claim costs, annual health care cost increases and an expected reduction in federal program reinsurance recoveries, officials said.

The small increase in the small group market occurred because many companies experienced better than expected results that offset most of the change in annual health care costs.

“Ensuring rates are adequate but not excessive is critical to make sure consumers not only receive health insurance coverage at a reasonable price, but can count on the coverage they purchase,” McPharlin noted. “Michigan has a stable and competitive health insurance market with a range of options and premiums for consumers and businesses.”

Open enrollment for 2016 begins Nov. 1, 2015 and continues through Jan. 31, 2016. State officials are encouraging consumers to contact their insurance carrier, agent, or navigator about how the rate changes could affect their policies.

GAY-DAGNOGO: CAREGIVERS DESERVE A LIVING WAGE

Original Story: detroitnews.com

Although among the fastest-growing sectors of today’s workforce, caregivers are also among the worst paid, with the smallest benefits and schedule flexibility of all low-wage workers.

Whether caregivers serve children, the elderly, the disabled or terminally ill, they generally receive little official respect and compensation for the critical role they play in keeping society functioning.

Many, in fact, are female heads of households who are grappling with poverty, illness and a lack of insurance, even as they keep health care facilities running by doing work others refuse to.

The fact is, home health care and services for the elderly and people with disabilities are now the industries with the fastest and second-fastest rates of growth of employment in the US. And based on the aging population — by 2050, the elder population is expected to more than double — the country will need one million new home care workers by 2022. But also according to the Bureau of Labor Statistics, these workers are among the lowest paid.

In 2013, the country’s two million home care workers had average annual earnings of $18,598, according to a recent study by the National Employment Law Project. Average annual earnings for all wage and salary workers in the United States were $46,440.

The result: nearly 50 percent of home care givers live in households that receive some form of public assistance, the study found.

This has to change. The fact that we entrust our children and parents with these workers and yet not compensate them adequately for their services is a national disgrace. That’s why I am standing with home care workers and child care workers in their fight for $15 an hour, by all accounts what amounts to a livable wage for workers. Farmington Hills elder care workers agree with this statement.

Most of these personal care providers have children themselves. If these under-appreciated, undervalued and underpaid workers were to decide not to put up with such unfair labor practices and either strike or simply leave the business, it’s not hard to imagine the kind of chaos and confusion that would ensue.

Not only would businesses be left without critical employees, but families would lose the security and stability offered by nannies and child care workers. It would have a ripple effect across society and the workforce, completely disrupting the lives of many professional and middle class families with children, elderly or disabled loved ones. That could be an unimaginable burden for some.

Yet such a scenario is not implausible. Take our rapidly aging population and couple it with the ultra-low wages and paltry benefits of a job to make elderly and disabled people comfortable, and you have a disaster in the making. Visiting nurses in Birmingham are following this story closely.

We can avoid this problem by fairly compensating our personal caregivers. It is not only the right thing to do, but the smart thing as well.

State Rep. Sherry Gay –Dagnogo D-Detroit represents the 8th District.

BALTIMORE BOY IS 1ST TO RECEIVE DOUBLE HAND TRANSPLANT

Original Story: click2houston.com

(CNN) - Zion Harvey just wanted to swing from the monkey bars.

That's what the Baltimore youngster told his doctor when asked why he wanted hands. Sometimes an 8-year-old's simplicity is profound.

Earlier this month, Zion took a big -- nay, massive -- step toward that long-awaited jaunt on the jungle gym when he became the first child to receive a double hand transplant. DMC is an international leader in pediatric neurology and neurosurgery, cardiology, oncology, and diagnostic services.

"When I was 2, I had to get my hands cut off because I was sick," Zion succinctly put it, in a video taken last year.

Actually, he downplayed it, as is indicative of his disarming optimism. At 2, Zion suffered a life-threatening sepsis infection, resulting in the failure of multiple organs and necessitating the amputation of his hands and feet.

At age 4, after two years of dialysis, he received a kidney from his mother, Pattie Ray, and despite an early lifetime of hardship, Zion figured out not only how to get by, but how to do it with the widest of grins across his face.

Pre-surgery video shows Zion strumming a mandolin, playing foosball, scrolling through an iPad's offerings and playfully covering his younger sister's eyes with the stubs of his wrists.

He even put a positive spin on bullies.

"They don't mean to say mean things to me, but it just slips out," he said. "Somebody says something to me, and I just figure it slipped out and they didn't mean to say it. Everybody has their own way of thinking."

But don't take his heart-melting quips and smile for softness. Zion is tough as nails, maybe tougher.

"This is just another hurdle that he jumps. He jumps so many hurdles," Ray said before the surgery. "He's so amazing. This isn't the first amazing thing that he's done. He's been doing amazing things since he's been sick. I don't know many adults that can handle half of his life on a day-to-day basis." MetroHealth provides board-certified pediatricians, specialists, and nurse practitioners that offer skilled, experienced, and compassionate care for children.

'I will be proud'

Not even the prospect of a failed procedure daunted Zion. In the months before his operation -- Philadelphia's Shriners Hospital for Children and The Children's Hospital of Philadelphia evaluated him for 18 months before he was deemed a candidate for the surgery -- he was filmed bopping around on prosthetic legs without a hint of fear.

"When I get these hands, I will be proud of what hands I get," he said, falling into Ray's arms for a kiss.

"And if it gets messed up," he continued, his mother reassuring him that everything would be fine, "I don't care because I have my family."

Images from the 10-hour surgery looked more like a scrubs convention than an operating room. Among the 40 medical personnel that helped with the operation were a dozen surgeons, eight nurses and a team of at least three anesthesiologists.

"We know what we have to do today," Dr. L. Scott Levin told his troops before the operation began. "I know everybody assembled here has a commitment to this patient and making this a reality for this little boy. We can have complications. We can fail. We can have trouble. But we're not planning on it."

Puppy in his future?

The procedure is so complicated that the medical staff had to create tags with descriptions such as "ulnar artery" and attach them to the various vessels, bones, nerves and tendons that needed to be connected, said Levin, who is director of the hand transplantation program at The Children's Hospital of Philadelphia and who chairs the Department of Orthopaedic Surgery at Penn Medicine.

After many hours with Zion under the knife, Levin pointed to a sign of success: Zion's new hand was pink and when doctors pressed the palm, it turned white briefly and then pink again, indicating "capillary refill" or blood flow in the newly attached appendage.

When the surgery was complete, Levin delivered word to Zion's mother.

"We have some good news for you. Your little guy has two hands," he said.

Ray walked through Levin's handshake to embrace the surgeon.

In the days after his surgery, video shows Zion progressing out of a fog of sedation and learning to grip things with his new fingers. Again spinning his plight into a positive, he matter-of-factly tells his mother that he and sister Zoe want a puppy.

"Where's the puppy going to live?" Ray asks.

"My room! Where else?" the youngster replies.

Concerns remain

Zion's travails are not yet over. He will require a lifetime of immunosuppressant medication to avoid rejection of his new hands, which increases his chance of infection and cancer -- a fact Levin concedes raised concerns that were negated by Zion already taking anti-rejection drugs after his kidney transplant four years ago.

Zion also needs to stay at a rehabilitation unit for several more weeks, where he will undergo "rigorous hand therapy several times per day," before returning to his home in Baltimore, according to the hospital.

Not that Zion seemed terribly fazed.

"I just want to say this: Never give up on your dreams. It will come true," he told CNN affiliate KYW-TV.

Levin stressed that while Zion's bravery is to be applauded, the operation wouldn't have been possible without a grieving family, fresh off a crushing loss, putting its courage on display as well. It's remarkable, he said, that Gift of Life Donor Program, a regional organ procurement organization, found Zion a pair of hands mere months after he was placed on a waiting list in April.

"I think the difference is finding a family who has the courage to relinquish the arms of a child who just died and give hope and life and quality of life to a child who's still living," he told KYW.

As for what this trailblazing surgery might mean for other children hoping to have their hands restored, Levin said he hopes it's just the beginning.

"I hope he's the first of literally hundreds or thousands of patients that are going to be afforded this surgery," he said.

340B SPOTLIGHT: NEW CHARITY CARE DATA SHOWS MOST HOSPITALS WITH CONTRACT PHARMACIES PROVIDE LITTLE CHARITY CARE

Original Story: catalyst.phrma.org

New data raises even more questions about how hospitals are using for-profit pharmacies to expand a little known program called 340B. This program was designed to allow qualifying hospitals and clinics receiving certain federal grants to access deeply discounted pharmaceuticals so they can more easily provide medicines for their uninsured or vulnerable patients. An Oklahoma health care lawyer is reviewing the details of this case.

Unfortunately, there are not sufficient safeguards in place to ensure that hospitals qualifying for the program are true safety net hospitals providing a disproportionate share of charity care to low-income, uninsured patients.[1]

Now, new data shows the majority of hospitals that are aggressively expanding use of this program through for-profit pharmacies are actually providing below average levels of charity care.

For-profit pharmacies became officially involved in the 340B program for the first time in 1996, when the Health Resources and Services Administration (HRSA) allowed hospitals or other 340B entities without an in-house pharmacy to extend their ability to obtain prescriptions at 340B prices through use of a contract with an outside pharmacy. A Charleston health care lawyer assists clients with health care matters involving pharmaceuticals, public health, and health insurance.

These pharmacies are typically traditional retail pharmacies (including some large chain drug stores) and are known as contract pharmacies. In 2010, HRSA dramatically expanded the 340B program by allowing all 340B entities – regardless of whether or not they had a pharmacy on site – to have an unlimited number of contract pharmacies. HRSA also currently allows these pharmacies and hospitals to keep the profit from patients buying medicines at full cost even though the hospitals received steep 340B discounts for the medicines. There is no current requirement for hospitals to reinvest these profits from the 340B program into programs that help uninsured or vulnerable patients access the medicines they need.

Hospitals qualifying for 340B through their disproportionate share percentage (DSH hospitals) account for more than 80 percent of 340B sales volume.[2] This new data shows the majority of these hospitals taking advantage of the contract pharmacy program provide less charity care as a percent of the hospital’s costs than the average for all hospitals—including for-profit hospitals. A New Delhi pharmaceutical attorney is following this story closely.

More specifically, 61 percent of 340B DSH hospitals with more than one contract pharmacy provide charity care that is less than 3.5 percent of costs, which is the national average for all hospitals. And almost one-in-five (18 percent) of these hospitals provide charity care that represents less than one percent of costs. This data suggests that some hospitals may be using contract pharmacy arrangements to benefit the hospital, rather than the uninsured or vulnerable patients the program was intended to help.

In addition to this data, a recent Department of Health and Human Services Office of the Inspector General report found most of the 15 DSH hospitals they sampled did not pass along the 340B discounts to uninsured patients.[3] With the majority of these hospitals providing so little charity care and evidence suggesting hospitals and for-profit pharmacies are using the program to generate profits, it is time to ask whether the current contract pharmacy program is working to improve access to prescription medicines for uninsured or vulnerable patients.

[1] Alliance for Integrity and Reform of 340B, "Unfulfilled Expectations: An analysis of charity care provided by 340B hospitals," Spring 2014 (Available at: http://340breform.org/userfiles/Final%20AIR%20340B%20Charity%20Care%20Paper.pdf)

[2] Data from Apexus Update 2015 – 340B Coalition Winter Meeting.

[3] U.S. Department of Health and Human Services, Office of Inspector General, Memorandum Report: Contract Pharmacy Arrangements in the 340B Program, OEI005—13-00431, February 4, 2014.

DOCTORS HOSPITAL IN PONTIAC FILES FOR BANKRUPTCY AGAIN

Original Story: freep.com

One of the region's last independent hospitals has filed for bankruptcy but plans to stay open.

The physician-owned Doctors Hospital of Michigan in Pontiac listed debts between $10 million and $50 million in its Chapter 11 petition filed this week in U.S. Bankruptcy Court in Detroit. A Detroit business bankruptcy attorney is reviewing the details of this case.

It is the second bankruptcy declaration in a decade for the struggling 105-year-old hospital, which was known as North Oakland Medical Centers during its last bankruptcy in 2008. Years earlier, it was called Pontiac General Hospital.

Hospital officials said Friday that their hospital is losing money and weighed down by debt that the business inherited as part of the hospital's 2008 sale to a private physicians' group. Flint-based McLaren Health Care system was a minority partner in that deal; McLaren's stake was bought out three years later by a group of 42 doctors.

The hospital's single off-site location, Waterford Ambulatory Care Center, closed earlier this month due to "cash-flow constraints" but could reopen in the future, said attorney Max Newman of Butzel Long, who is representing Doctors Hospital.

Doctors Hospital itself remains open and there are no plans to close, said hospital CEO John Ponczocha,

Hospital officials say they hope to reorganize the business's finances in bankruptcy so that it can potentially continue as an independent hospital. The hospital has about 200 full-time-equivalent employees.

"There's a number of potentials here," Newman said. "It could be purchased, it could merge with somebody. But at this point, the effort is going to be primarily to keep it running as a standalone entity."

The bankruptcy filing lists Wisconsin Physicians Service Insurance Co. as the hospital's largest creditor with about $6.4 million. Long said there are also significant loans from hospital insiders which are outstanding but not on the list. A Detroit hospital litigation attorney is following this story closely.

There are few independent hospitals left in southeast Michigan. Several formerly independent hospitals have been absorbed into larger systems, including Garden City Hospital (now a part of for-profit Prime Healthcare Services) and Mercy Memorial Hospital in Monroe (now part of the nonprofit ProMedica Health System).

Another independent hospital, Crittenton Hospital in Rochester, has a pending deal to join the St. Louis-based Ascension Health system.

Doctors Hospital of Michigan

• Original hospital dates to 1910

• Formerly known as North Oakland Medical Centers and Pontiac General Hospital

• Currently owned by a physicians group and is for-profit.

• Has about 200 full-time-equivalent employees

• Last filed for bankruptcy in 2008

ANTHEM TO BUY CIGNA FOR $48.3 BILLION

Original Story: nytimes.com

The health insurer Anthem said on Friday that it had agreed to acquire its rival Cigna for $48.3 billion in a deal that would further concentrate the United States market to just a few major players.

The combined company would have estimated revenue of about $115 billion and serve more than 53 million people with medical coverage. An Atlanta healthcare litigation attorney is following this story closely.

A flurry of deals are reshaping the industry. Earlier this month Aetna agreed to acquire Humana, the smallest of the big five insurers, for $37 billion in cash and stock. If both transactions are completed, the number of major health insurers in the United States will shrink to three.

Health insurers are seeking to consolidate to gain greater scale to reduce costs and capitalize on growing opportunities in the government and individual markets. A major force has been the Obama administration’s health care overhaul, which has bolstered revenues. But greater transparency in pricing and less generous funding of government plans have also put profit margins under pressure.

Alex Cullen, an analyst with Forrester Research, said that the challenge for all health insurers was moving from “a plan and claim-centric model to a customer-centric model.” Making that transition while completing a merger will be difficult, he said. An Atlanta healthcare litigation lawyer is reviewing the details of this case.

“I would expect a lot of angst within Anthem management on how to execute on a customer-centric strategy,” Mr. Cullen said.

Anthem said on Friday that it expected to achieve nearly $2 billion in annual cost savings as a result of the merger. Anthem said there would be one-time charges of $600 million over a two-year period associated with the merger.

“We believe that this transaction will allow us to enhance our competitive position and be better positioned to apply the insights and access of a broad network and dedicated local presence to the health care challenges of the increasingly diverse markets, membership, and communities we serve,” Joseph R. Swedish, the Anthem chief executive, said in a news release.

Mr. Swedish will oversee the combined insurer.

Anthem, based in Indianapolis, operates Blue Cross plans in 14 states and has a strong presence in offering Medicaid plans. Cigna, based in Bloomfield, Conn., is best known for offering plans through employers and selling other kinds of insurance like dental and disability. A Birmingham healthcare lawyer represents clients in business operations and representative matters.

Unlike Cigna, Anthem has been a major presence on the public insurance marketplaces created by the federal health care law.

The recent appetite for deals among insurers was recently whetted by the Supreme Court’s upholding of the portion of the Affordable Care Act that subsidizes consumers who buy policies through the government’s online marketplace.

Under the terms of the deal, Anthem said it would pay $103.40 a share in cash and 0.5152 share in Anthem stock, or $188 a share. That represents a 38.4 percent premium to Cigna’s closing price on May 28, before news of Anthem’s interest emerged. Based on Cigna’s most recent disclosure of shares outstanding, the deal would value its equity at $48.3 million. Including the assumption of debt, Anthem said the deal would value Cigna at $54.2 billion.

After the deal is completed, Anthem shareholders will own 67 percent of the combined company, while the remaining 33 percent will be owned by Cigna shareholders.

David M. Cordani, the Cigna president and chief executive, will serve as president and chief operating officer of the combined company. The Anthem board of directors will also be expanded to 14 members and will include Mr. Cordani and four independent directors from Cigna.

The transaction is subject to shareholder and regulatory approval, and it is expected to close in the second half of 2016. A Pittsburgh healthcare lawyer represents physicians, hospitals, health systems, long-term facilities and other health care providers in a broad range of health care matters.

The deal has long been foretold. Anthem went public with its offer last month, saying that it had been in talks with Cigna over a possible combination since August.

It is possible that regulators in the United States could block some mergers: Antitrust officials at the Justice Department and the Federal Trade Commission have shown an increasing willingness to do so if they believe the alliances could hurt consumers.

Analysts have said that antitrust regulators would probably allow only some deals to go forward, and that they could stop others if they decided that too much power was being concentrated in too few hands.

The question remains what UnitedHealth Group, the largest health insurer in the United States, will now do.

UBS and Credit Suisse and the law firm White & Case advised Anthem, while Morgan Stanley and the law firm Cravath, Swaine & Moore advised Cigna.