Transplant Surgeon Accused of Hastening Potential Donor’s Death

A few years ago Ohio began asking drivers at the time of license renewal whether they wished to become organ donors.  I remember that our family had several discussions on the topic; one of my relatives expressed concern that if he said yes the medical community might not be so interested in keeping him alive. 

I remember smiling and reassuring him, “Oh, they don’t take them until you’re dead, and there are many rules and regulations over transplant programs, I don’t think you should worry.”

I still believe that, but accounts like the one below, reported yesterday by CNN.com, are most unsettling. 

Thousands die every year waiting for organ transplants that never happened, mostly because donated organs are in such short supply.  If this physician is indeed guilty of the crime of prematurely ending the life of a potential donor, he deserves a stiff sentence.   Not just for the victim and his family, but for all the additional victims his actions will create.  Potential donors shouldn’t have to fear that if they say yes, the medical community might not be so interested in keeping them alive.

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LOS ANGELES (AP) — A surgeon was charged Monday with prescribing excessive drugs to a comatose, disabled patient to hasten his death and harvest his organs for transplantation.

Prosecutors in San Luis Obispo County said Dr. Hootan Roozrokh, 33, of San Francisco, gave a harmful drug and prescribed excessive doses of morphine and a sedative to 26-year-old Ruben Navarro, who died in 2006.

He was taken in a coma to Sierra Vista Regional Medical Center, 150 miles northwest of Los Angeles, in 2006 after suffering respiratory and cardiac arrest. Although Navarro was found to have irreversible brain damage and was kept on a respirator, he was not considered brain dead because he still had limited brain function.

The day before Navarro died, his family gave approval for a surgical team to recover his organs for donation, though the procedure never occurred because Navarro did not die within 30 minutes of being removed from life support. He died the next day

Read the full text on CNN.com

http://www.cnn.com/2007/US/law/07/30/transplant.charges.ap/index.html

 

Update 12/22/2008

 

The Associated Press reports that Dr. Roozrokh has been found Not Guilty in this case by a California court. http://www.google.com/hostednews/ap/article/ALeqM5hhpmLm1R9_xt1bRRdborCLyf0DMAD955F8J80

Taking Hospital Acquired Infection Seriously

At a veterans’ hospital in Pittsburgh, nurses swab the nasal passages of every arriving patient to test them for drug-resistant bacteria. Those found positive are housed in isolation rooms behind red painted lines that warn workers not to approach without wearing gowns and gloves, according to an article in the July 27th edition of the New York Times.

Every room and corridor is equipped with dispensers of foamy hand sanitizer. Blood pressure cuffs are discarded after use, and each room is assigned its own stethoscope to prevent the transfer of microorganisms. Using these and other relatively inexpensive measures, the hospital has significantly reduced the number of patients who develop deadly drug-resistant infections, long an unaddressed problem in American hospitals.

The federal Centers for Disease Control and Prevention projected this year that one of every 22 patients would get an infection while hospitalized — 1.7 million cases a year — and that 99,000 would die, often from what began as a routine procedure. The cost of treating the infections amounts to tens of billions of dollars, experts say.

The 40-bed surgical unit that began the experiment in 2001 (at the Veterans’ Hospital in Pittsburgh) has cut its infection rate by 78 percent.

Such results are not unprecedented. Several European countries, including the Netherlands and Finland, have all but eliminated MRSA through similarly aggressive campaigns.

Read full text in the New York Times (free regisration required)
http://www.nytimes.com/2007/07/27/us/27infect.html?pagewanted=1&_r=1&th&emc=th

US Physician Shortage Likely to Worsen

The Washington Post reports that a shortage of doctors is affecting healthcare in rural areas of the US.

A national shortage of doctors is hitting poor places the hardest, and efforts to bring in foreign physicians to fill the gap are running into a knot of restrictions from the war on terror and the immigration debate.

Those restrictions have only tightened in the years since 9-11, and now many believe the process will become more difficult after the attempted terrorist bombings in Britain that have been linked to foreign doctors.

J-1 visa waivers allow foreign doctors to work in underserved areas for three to five years, with a shot at eventually obtaining permanent residency.  Yet, since 9-11 (2001), the federal government has made it more difficult to qualify for the special visas and to obtain permanent residency.

Read full text from the Washington Post:
http://www.washingtonpost.com/wp-dyn/content/article/2007/07/21/AR2007072100432.html 

Related posts:

AP: Shortage of Doctors Affects Rural US
http://blogs.ilw.com/gregsiskind/2007/07/ap-shortage-of-.html

President Signs Major J-1 Physician Bill
http://www.visalaw.com/h05apr/7hapr05.html

 

Public Library of Science – PLoS Medicine

In October 2004 the Public Library of Science began publishing PLoS Medicine featuring free, full-text, peer-reviewed, articles.  This innovative medical publishing concept is still going strong nearly four years later.

Everything published in PLoS Medicine is immediately freely available online throughout the world, with no restrictions on distribution, copying, printing, or legitimate use. Of course, it costs us money to publish this journal, and we must cover our expenses. But the fee-for-access business model that made perfect sense for the printed journal is no longer consistent with the mission of medical publishing because it needlessly limits the reach of the medical literature. And so we have adopted a new model. Instead of charging readers for access to our journal, we ask the authors of accepted research articles to pay a publication fee to cover the costs of peer review, editorial oversight, and production. This “open access” business model ensures our financial health as a publisher while allowing us to convey everything we publish to the widest possible audience.

Whereas some would argue that medical journals should not be accessible to patients because patients are unable to use the information effectively, we believe it is our responsibility as publishers and members of the medical community not only to give patients access, but to provide them with tools to use the medical literature wisely. Medical research is a partnership between medical scientists and millions of voluntary human participants, conducted largely with public funds. What better way to acknowledge the public’s contribution and ensure their willingness to sponsor and participate in future research than to openly share the product of this research with them?

Much like public television, supporters can also become members.

Oh, and PLoS Medicine also publishes a blog.

Via Emergiblog

Suing Putnam General and John Anderson King

Huntington West Virginia’s WSAZ3 reports on “Suing Putnam General.”

The people who are suing the former Putnam General Hospital packed a courtroom Monday in Putnam County, finally getting their cases before a jury.

It’s the first of many civil trials involving the hiring of Dr. John King and his work at the former Putnam General.

We already know the allegations that Dr. King botched more than a hundred orthopedic surgeries at the hospital when it was owned by HCA.

The question in this first trial, did the hospital do enough to check king’s background, before the doctor got temporary privileges to begin doing surgery.

The company that put King to work in Putnam County is on trial, the allegation that HCA and Putnam general rushed to get King operating privileges, despite serious flaws and omissions on his application.

See the full report: http://www.wsaz.com/newsohio/headlines/8541742.html

Update 7/31/07 –
A jury says Putnam General Hospital was negligent when it hired an osteopathic physician who later was accused of more than 100 acts of medical malpractice. http://www.dailymail.com/story/Putnam+County++News/2007073160/Jury-says-Putnam-hospital-negligent-in-hiring-doctor/

Charleston Daily Mail

The Putnam County Circuit Court jury deliberated about an hour Tuesday afternoon before holding the hospital responsible for allowing Dr. John King to practice there. The verdict means Putnam General will be a co-defendant in 122 medical malpractice lawsuits filed against King.

WSAZ News – Charleston WV
The jury found that Putnam General failed to meet the standard of care in considering King’s applications for credentials in 2002.

Jurors also said the plaintiffs can seek punitive damages against the hospital.

http://www.wsaz.com/news/headlines/8836807.html

Describing Medical Symptoms, Proposed Medicare Legislation, and Aiming for Neutral Peer Review

I’ve been working on a couple of large projects, (database and web) over the past couple of weeks, so my poor blog has suffered from neglect.  There have been several recent items worthy of note, so I’ve provided a brief summary and links to a few of them here: 

  

Describing Medical Symptoms to Your Doctor

An informative article from WikiHow entitled How to Describe Medical Symptoms to your Doctor.  The article outlines 10 steps, then adds some additional tips that will help ensure that both your time and the physician’s are well spent.

Via Kevin, M.D.

Proposed Medicare Legislation Would Benefit Deployed Physicians

Physicians may soon find it easier to maintain their medical practice during overseas military deployments thanks to Medicare legislation introduced last week in the US Senate by Ron Wyden and Trent Lott.

If passed, the new law would exempt doctors serving overseas in the military from a Medicare rule that places a 60-day cap on the amount of time other doctors can fill in on their behalf during a leave of absence.

Read full text of the article by Martin Kudston, in the Helena independent Record.

MS.1.20 and Neutral Peer Review

Michael Cassidy of MedLaw Blog addresses the specific issue of neutral peer review in an article about Joint Commission’s new MS.1.20 bylaws requirements.

“While some stakeholders in this process from all perspectives, i.e., hospitals, physicians, administrators, medical staff officers, reject the notion that sham peer review is a problem, there is nevertheless almost universal acknowledgment that the peer review process is a threatening process to physicians being investigated.”

USNews Releases 2007 Best Hospitals List

Eighteen hospitals made this year’s USNews Best Hospitals Honor Roll.  Johns Hopkins retains the number one spot. 

Should consumers choose hospitals based on a magazine list?

Many experts urge caution. The U.S. News rankings are perhaps the best known of a growing number of hospital performance reports, but tools that measure hospital quality are limited. And because different organizations use different data, accurate comparison is difficult.

Nevertheless, each of the hospitals on this year’s list considers it an honor (and no doubt a marketing tool) to have been included.

1. Johns Hopkins Hospital, Baltimore

2. Mayo Clinic, Rochester, Minn.

3. UCLA Medical Center, Los Angeles

4. Cleveland Clinic

5. Massachusetts General Hospital, Boston

See the complete list: http://health.usnews.com/usnews/health/best-hospitals/honorroll.htm

Get Ready to Revise Your Medical Staff Bylaws – Joint Commission Posts Final Language for MS.1.20

For those who have been following the evolution of (Joint Commission Standard) MS.1.20 over the past couple of years, which is the core Joint Commission Standard which describes the expected relationship between the organized medical staff and the hospital, and which details what provisions must be included in the bylaws versus the rules and regs, the Standard has just been published in final form.  See: http://www.jointcommission.org/AccreditationPrograms/Hospitals/revisions_std_ms120_approved.htm)

The final standard, which becomes effective July 1, 2009, is essentially a complete reversal of the proposed Standard published in 2006 which would have deferred to the hospital and the medical staff what provisions had to appear in the bylaws. Under the final MS.1.20, every substantive category dealing with privileging, credentialing, hearings, election of officers, etc.,and the process for each must be in the bylaws. The only permitted sections which can go into rules and regs are procedural details as to some of the Elements of Performance which are not substantive.

Another EP, and there are 33 of them, would allow the organized medical staff to create a process which could determine when the Medical Executive Committee is not presenting the staff’s interests and that authority delegated to the MEC can also be removed by the medical staff.

Needless to say, everyone needs to read MS.1.20 several times. Those hospitals and medical staffs who have separate hearing plans or credentialing policies which are not part of the bylaws will now have to fold them back in. Also, you must review the proposed Leadership Standards together with the Medical Staff Standards to get the full flavor of where the Joint Commission is headed with respect to the balance of authority and the integrated roles of the governing body, management and the medical staff. From my perspective, the balance clearly is being shifted to the organized medical staff.

Michael R. Callahan
Health Care Department
Katten Muchin Rosenman LLP
525 W. Monroe
Chicago, Illinois 60661-3693
Phone Number: 312-902-5634

NPI Registry Goes Live August 1st – Providers urged to review their record prior to July 16th to prevent possible release of private information

IMPORTANT NOTICE FOR PHYSICIANS AND OTHER HEALTHCARE PROVIDERS REGISTERED FOR NATIONAL PROVIDER IDENTIFIER (NPI) NUMBERS

Healthcare Providers are urged to login to the National Plan and Provider Enumeration System (NPPES) to review their NPI data prior to July 16th to make certain the information that the Centers for Medicare and Medicaid Services (CMS) has listed is correct, and to delete any optional information they do not want released.

The data may contain your social security number and other private information.

Of particular concern is the data physicians may have entered in the optional data fields. For example, the data contained in the “Other Names” and “Other Provider Identifiers” data fields are optional, as is the physician’s social security number. 

The NPI is a unique identification number that must be used by covered health care providers, plus all health plans and health care clearinghouses in the administrative and financial transactions adopted under HIPAA. In addition, covered providers must also share their NPI with other providers, health plans, clearinghouses, and any entity that may need it for billing purposes. 

All of this data will be made available as an Internet download to these groups starting on August 1st.

More information:
http://www.cms.hhs.gov/NationalProvIdentStand/06a_DataDissemination.asp

https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart

Ohio State Medical Association Announcement

Previous post on NPPES:

http://msspnexus.blogs.com/mspblog/2007/06/more-alphabet-s.html

New Patient Safety Goals from Joint Commission

The 2008 Joint Commission Patient Safety Goal requirements for hospitals have a one-year phase-in period that includes defined expectations for planning, development and testing (“milestones”) at 3, 6 and 9 months in 2008, with the expectation of full implementation by January 2009.

  • 3E – Reduce the likelihood of patient harm associated with use of anticoagulation therapy.
  • Goal 16 – Improve recognition and response to changes in patient’s condition.
  • 16A – The organization selects a suitable method that enables health care staff members to directly request additional assistance from a specially trained individual(s) when the patient’s condition appears to be worsening. 

2008 Hospital Goals:

http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/08_hap_npsgs.htm

2008 Patient Safety Goals For Multiple Organizations
http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/