Author Archives

Matthew Holt

Prosecution in organ harvest case faces hurdles at trial

Mar 25, 2008• 4

By Sarah Arnquist

Although neither the prosecution nor defense has shown its entire case, the unusually long eight-day preliminary
hearing for transplant surgeon Hootan Roozrokh revealed considerable details about what happened during Ruben Navarro’s final hours and the hurdles both sides must overcome at trial.

San Luis Obispo County prosecutors jumped their final pretrial hurdle March 19, when a judge ruled that a jury would decide whether Roozrokh committed dependent adult abuse Feb. 3 and 4, 2006, at Sierra Vista Regional Medical Center in San Luis Obispo.

Never before in the United States has a transplant surgeon been tried criminally under similar circumstances, and the transplant and medical communities have followed the case closely. No trial date has been set, but if the preliminary hearing is any indication, the trial likely will be lengthy with many witnesses and substantial expert testimony.

Entering Unfamiliar Territory

Mar 24, 2008• 13

By Kristen Trusko

If universal coverage mandates that employers provide health insurance or that people secure it themselves, it is highly likely that the majority will choose the lowest cost option, or “low premium” (aka HDHP or high deductible health plan). These plans enable consumers to open an associated financial account – HSAs. In addition to helping consumers plan their spending, savings and investment for current and future health needs, HSAs provide a triple tax free opportunity to save for retiree health.

Criminal charges filed against transplant surgeon

Mar 23, 2008• 10

By Sarah Arnquist

Prosecutors in a small town on California’s Central Coast are making history. For the first time in the United States, they brought criminal charges against a transplant surgeon, alleging he prescribed excessive amounts of medication in an attempt to hasten a disabled man’s death and harvest his organs. The case cleared its final pretrial hurdle Wednesday and will now go before a jury later this year.

San Francisco surgeon Hootan Roozrokh faces one felony charge of dependent adult abuse, for which the maximum punishment is four years in prison. Roozrokh, 34, has pleaded not guilty and his attorney, M. Gerald Schwartzbach said his client looks forward to clearing his name at trial.

The Roozrokh case has attracted much national attentionand raises worrisome questions about whether the transplant community is pressing too hard to increase the nation’s organ supply, thereby creating situations ripe for blurring ethical boundaries, such as this one.

A Detailed Analysis of Barack Obama’s Health Care Reform Plan

Mar 21, 2008• 115

Thanks to a very high Google ranking this has been the most popular ever post on THCB. And it's an excellent analysis by Robert Laszewski. who writes The Health Policy and Marketplace Blog. However, it was written during the Democratic primaries in 2008 and is of course out of date. THCB suggests that you checkout a few other intriguing posts too.

For more recent posts on health care reform, try a smattering of these:

Health Reform and Obama's Leadership by Rahul Parikh
The Affordability Model by Robert Laszewski
No Country for Old Men by Jeff Goldsmith
Two Rules by Which to Judge a Health Reform Bill by Matthew Holt
Ditching the Public Option by Robert Laszewski
No Alternative: An Analysis of the GOP Plan by Harris Meyer

and of course enjoy Bob's analysis too!:

By Robert Laszewski

Rt_obama_070116_sp_1 Barack Obama’s health care plan follows the Democratic template—an emphasis on dramatically and quickly increasing the number of people who have health insurance by spending significant money upfront.

The Obama campaign estimates his health care reform plan will cost between $50 and $65 billion a year when fully phased in. He assumes that it will be paid from savings in the system and from discontinuing the Bush tax cuts for those making more than $250,000 per year.

By contrast, the McCain Republican strategy for health care reform would first emphasize market reforms aimed at making the system affordable so more Americans can be part of the system and he claims that there would be no additional upfront cost.

Obama breaks his health care reform plan down into three parts saying that it builds “upon the strengths of the U.S. health care system.”

The three parts are:

1. Quality, Affordable & Portable Health Coverage For All
2. Modernizing The U.S. Health Care System To Lower Costs & Improve Quality
3. Promoting Prevention & Strengthening Public Health

Obama claims that his health care reform plan will save the typical family up to $2,500 every year through:

* Health information technology investment aimed at reducing unnecessary spending that results from preventable errors and inefficient paper billing systems.
* Improving prevention and management of chronic conditions.
* Increasing insurance industry competition and reducing underwriting costs and profits in order to reduce insurance overhead.
* Providing reinsurance for catastrophic coverage, which will reduce insurance premiums.
* Making health insurance universal which will reduce spending on uncompensated care.

Will Obama be able to cut the typical family’s health care costs by $2,500 a year?

Well, yes and no.

A Doctor Grows in Brooklyn

Mar 21, 2008• 34

By THCB staff

Doctor Jay Parkinson became a media celebrity last year as word spread about his unconventional practice in Williamsburg, Brooklyn. Instead of maintaining a traditional office and paying support staff, Parkinson’s operation is entirely virtual and requires almost no overhead. (Unless you consider a Mac overhead.) Using his apartment as a base, He runs a web site loaded with Web 2.0 touches that allows patients to communicate with him easily and explains his services in plain English. After an initial in-person consultation, exchanges can be online and are conducted through either instant messaging or web chat.

“The healthcare industry is so stuck in 1994,” he says, “The only way they’ve used the Internet is to provide information. I look at the Internet as something that provides communication.”

Health 2.0: Weighing In With a Reality Check

Mar 21, 2008• 5

By Michael Millenson

Maybe you saw the article: “Health 2.0 Helps, But Personal Contact Remains Top Weight Loss Strategy.”

OK. I made up the headline. But the information comes from an article that provides food for thought for those of us who speak, blog and otherwise evangelize about the good things the Internet is bringing to
health care. Here’s one question to start with: is there a different ethical obligation for those promoting the efficacy of an online health intervention than for those promoting a site to help you find a great
hotel?

Mother-Power Online

Mar 21, 2008• 2

By Jane Sarasohn-Kahn

4 in 5 moms go online at least once a month, according to My Mommy’s Online. The report is based on 2007 data from Simmons Consumer Research Survey published by eMarketer.

"Being a parent makes going online almost a necessity," according to eMarketer.

40% of all women who go online in the US are mothers with kids under 18. There are 35 million of them (including me).

Intriguingly, virtually all women who are pregnant (94%) use the Internet, and half of the mothers surveyed use the Internet more since having a child.

What do Moms do online?

94% visit portals
88% visit retailers
74% go for news and information
70% go for conversation.

BabyCenter found that 68% of moms regularly make purchases online. This makes sense: moms are busy people, shopping online is convenient and substitutes trips to the store.

Speaking of BabyCenter, it was arguably the most heavily shopped site in 2007 according to comScore (even though it is categorized the site as a media site).

In any case, BabyCenter reaches 78% of pregnant women and mothers of kids up to 24 months in the U.S.

The site also maintains a 60,000-mom panel for market research which is a rich mine for finding out What Moms Want. Since mothers are primary caregivers in the household, this is an important site for health.

Lessons From a Sad Error

Mar 20, 2008• 2

By Paul Levy

I think many people have seen this sad story of a wrong-sided kidney removal in Minnesota. We all feel the pain for this poor patient. It is difficult for us non-physicians to understand how this happens, for the pathway to the error seems remarkably clear after the fact. But, we have to understand that the actual delivery of medical care contains multiple opportunities for mistakes, and even extremely competent and well meaning doctors and nurses can find themselves in shock afterwards when this kind of thing occurs.

Here are two emails I have received on the topic which both offer useful perspectives on the matter.

First, my buddy E-patient Dave writes:

I’ve caught a couple of errors on my radiology reports, and have had them corrected. Both VERY minor compared to this. Can there be any doubt that patients need to have access to their records, as PatientSite allows, and need to be aware of their need (and ability) to read them?

Second, from one of our senior surgeons to his colleagues:

As copied below, another high profile event, to remind us how easily error can occur. In this case the consent was wrong when done in the office, and it was the only document used to confirm sidedness at the time out. As you read the article, you will note this tragedy extends not only to the patient but to the entire team, as well as the institution.

I would remind you that we had our own "near miss" here at BIDMC, which was caught by the attending surgeon, and confirmed on reviewing the images. In our case, the patient had confirmed the wrong site to the nurses, residents and fellows involved, so patients are not infallible. To best avoid this we (multiple providers) must use multiple sources of information (including the patient, exam, imaging and documentation), and we must have all OR participants agree actively that the patient ID, procedure, side and site are correct. Also as highlighted by this case, the episode of surgical care and opportunity to err starts the first time we see the patient.

A Different Right to Privacy

Mar 19, 2008• 9

By Eric Novack

Given Matthew’s quite visceral response to some complaints that broad-based, government-encouraged (mandated, I suspect), electronic medical records I am interested in both his and THCB readers’ thoughts on the Bangor Daily News editorial staff’s approach to health care reform.

They suggest that transparency is the key – "lawmakers should require health providers and insurance companies to report all of their costs to the public."

Nobody Told Me There Would Be Days Like This

Mar 19, 2008• 3

Shiri Sandler was diagnosed with RSD, (Reflex Sympathetic Dystrophy or Complex Regional Pain Syndrome), after surgery on a broken bone in her foot at the age of 20. Years later she faces severe chronic pain that has spread throughout her body and requires regular treatment with powerful painkilling drugs to control.

In this segment, she discusses the challenge of coping and how she use uses ReliefInsite, an online pain diary, to help manage her condition. She also talks about the stigma those with chronic pain can face when they seek treatment.

“I went to a GP in my neighborhood. And I said I have RSD. And he said. ‘Well, what does that mean?’ Well I have a lot of burning pain in my foot. And he looked down at my foot and said. You wear the wrong shoes. You’re making this up. And He kept going. You’re too young for this. You’re a hypochondriac. These drugs are going to kill you. That was my personal favorite. And he yelled at me for an hour and a half. And I sat there crying. Because you never feel you have to yell back at a doctor. Being told that what you’re feeling is in your head is terrible … ”