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Archive for the ‘Ethics’ Category

As the new year starts, some ome items of note from near and far:

The breast implant scandal strips away the glossy euphemisms of cosmetic surgery

S. Korea approves Asia’s first anti-leukemia drug

Nicotine Gum and Skin Patch Face New Doubt

No Benefits for Sick Job Seekers: After battling leukemia, man is denied unemployment benefits

Opinion: Why are Washington’s nonprofit health insurers sitting on huge surpluses?

“Gizmo idolatry,” robotic prostatectomy, and real data

Final Thoughts from A Dying Cancer Researcher

Number of uninsured in WA hits 1 million

Drug research routinely suppressed, study authors find

FBI crackdown on unproven stem cell therapies

 

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Moving forward

Regence fined $100K for denying women coverage

[Washington] State Insurance Commissioner Mike Kreidler has fined Regence BlueShield $100,000 for denying contraceptive coverage to 984 women.

Regence had covered the women’s use of an IUD, or intrauterine contraceptive device, but not the removal of it. When the women wanted to remove the device because it was outdated, or because they wanted to get pregnant, the insurance giant did not consider those reasons as “medically necessary,” state officials said Monday.

“There’s an important lesson here,” Kreidler said in a statement.

“If you believe you’ve been unjustly denied coverage, don’t just accept it, call us. Of the 984 women who were denied contraceptive coverage by Regence, only three appealed the decision – and all the denials were upheld.”

He said one woman’s call to his office resulted in coverage for nearly a thousand other women who were denied coverage over the span of eight years.

Going backward

Tobacco Giants Sue to Block Graphic Warning Labels

Five tobacco companies have filed suit against the U.S. government claiming that government-ordered graphic warning labels on cigarette packs violate their First Amendment rights.

Starting on Sept. 22, 2012, cigarettes sold in the U.S. will have to carry graphic images warning of the dangers of smoking. These images include a tracheotomy hole, rotting teeth, diseased lungs, and a body on an autopsy table.

The images will be accompanied by dissuasive wording on cigarettes and smoking, including “cigarettes are addictive,” “cigarettes cause cancer,” and “smoking can kill you.” They must be displayed on at least half of the front and back of cigarette packs, and 20% of the top of the pack.

The lawsuit was filed by four of the nation’s largest tobacco companies — including R.J. Reynolds Tobacco and Lorillard, and one smaller company (Sante Fe Natural Tobacco Company) — against the FDA and the Department of Health and Human Services.

The companies are seeking to prevent enforcement of the images, arguing that the government cannot legally force them to espouse an anti-smoking advocacy message….

This is yet another area of health promotion in which the US has long fallen short. Graphic warning labels on cigarette packs have been used in Canada since 2001, and dozens of other countries have followed suit.

A bit of both, local news that is national  :

Army whistle-blower fights to clear name

Madigan Army Medical Center surgeon Michael Eisenhauer says his military career foundered as he exposed cozy dealings between an Army doctor and a medical-equipment manufacturer. His whistle-blowing helped lead to the criminal conviction of one doctor; but Eisenhauer is still fighting to clear his own name.

Eisenhauer detailed a cozy relationship between the medical-equipment manufacturer Boston Scientific and two Madigan cardiologists, who insisted on sole-source purchases of that company’s implant devices.

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The long-standing practice of drug companies and medical-equipment manufacturers offering doctors free trips, speaking honorariums and other payments is controversial. Critics say the money may often represent kickbacks for favoring a company’s drugs or devices.

Still, in civilian practices such payments are generally considered legal. In the military, however, doctors are prohibited from taking such payments.

“Military doctors must owe their allegiance to the soldiers and families they treat — not to drug companies or makers of medical devices,” said U.S. Attorney Jenny Durkan in a statement announcing the plea deal reached with Davis.

“That is why we have a bright line rule: doctors employed by the government cannot accept payments or gratuities from an outside source — especially one that is seeking government business.”

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Kudos to Insurance Commissioner Mike Kreidler, who took action on behalf of consumers!   From the OIC  blog:

Health insurance rate requests now public

Individual and small employer health insurance rate requests are now public. See the complete filings received since July 1, as well as a summary for each request.

Several health insurers filed rate requests prior to July 1, but have voluntarily made their filings public. They include: Asuris Northwest Health, Kaiser Foundation Health Plan, and Regence BlueShield.

Insurance Commissioner Mike Kreidler proposed the legislation (HB 1220) making health rates public on behalf of the consumers who contact his office, demanding to know what’s driving their higher premiums. State law prevented him from sharing the information that insurers use to justify rate requests – even after the rate was approved.

The new law makes most individual and small employer health insurance rate filings public shortly after they’re received. This includes how much of the requested rate will be spent on medical claims, administrative costs and profit. Also, the public will see if their rate change includes any benefit changes.

Kreidler’s office is building an interactive web tool where the public can search rate requests, post comments, and sign-up to get an e-mail when their health plan requests a change and a decision is made. The new tool is scheduled to go live early this fall.

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Recent news and commentary of note on US and global issues related to health and well-being:

Medicare Part D Ups Patient Compliance, Reduces Hospital Costs

Why do 70 dead in Norway rank higher than tens of thousands in Somalia?

For-Profit Hospices Keep Patients Longer, Push Costs Up

Where’s the Advocacy, Komen?

Divided Appeals Court Rules That Companies May Patent Breast Cancer Genes, but Invalidates Patents on Comparing the Genes

Big Pharma wants to ‘friend’ you

Drug prices to plummet in wave of expiring patents

Two Steps Forward, One Step Back on Hospital Transparency

The most and least expensive cities for health care

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Can We Afford Personalized Medicine?

Special treatment for ‘high profile’ patients; exasperation for the rest of us

Health Insurers Making Record Profits as Many Postpone Care

People Who Donate Organs For Transplants Can Have Difficulty Getting Insurance

Foundations, Conflicts Of Interest And Drugmakers

Mission Crash: The Intolerable Policy Incoherence in US AIDS Policy, Global and Domestic

 Office of Minority Health Awards Major Project to Support
CCHI’s work on Healthcare Interpreter Certification

WA Governor signs precedent-setting healthcare worker safety laws

Washington is first state in nation to ban toxic pavement sealants

HHS awards $4.9 million to support families of children with special health care needs

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On tonight’s evening news, King 5 TV, our local CBS affiliated carried a story about a Microsoft worker who lost his job after being diagnosed with leukemia.  Duncan Sutherland came forward after after seeing another report the night before about  Ken Knightley, a Microsoft worker who is now being denied paid leave to undergo treatment for a brain tumor.   Knightley told reporters that he was informed that his request for paid leave under the company’s short-term disability plan, was denied because at Microsoft  links disability pay to performance reviews.  When Knightley’s severe symptoms had caused him to miss work for medical care, he had been unable to fulfill some project deadlines. He then received a negative performance review, despite his excellent track record and promotions during his 11-year tenure with the company.  His future uncertain, he now also may lose his home if he needs to go out on long-term disability, for which there is a 6-month waiting period.  Sutherland shared that his own experience was similar, and  King 5 reports that they have been contacted by other former Microsoft employees who shared similar experiences. Microsoft has declined to speak to the media, stating it cannot discuss personnel matters.

Listening to these stories was a déjà vu experience for me on an issue that still doesn’t seem to be going away. Fifteen years ago this month I was laid off from my job at a large private child & family service agency after being diagnosed with lymphoma. During several weeks of  diagnostic tests, I’d re-arranged my work schedule in collaboration with my co-workers and supervisor. One of the administrators had asked me what kind of accommodations  I needed, and I indicated my need for a flexible schedule.  I took off 5 days for the first cycle of chemotherapy in order to rest up for returning to work. When I came back the following Monday, I was called into a meeting where I was told that my job had been eliminated , effective that week. I was not offered an exit interview, not given  information on how to sign up for COBRA, nor advised that I was eligible to receive benefits from the disability plan I’d been paying into over the years.  I was not allowed to either use or cash out my several months-worth of accrued sick and vacation leave, and I later learned that an request by my co-workers to donate sick leave to me had been denied by the agency.

I pursued legal action and had to endure a mediation session where the employer lied , claiming that they had no idea that I was sick and that the department that I worked in was being shut down and my job was simply the first one to be eliminated. The employer further claimed that this was part of a secret business plan that employees had not been told about, as we had been given a written document describing the expansion of the department.  Although my attorney felt  my case was strong, the Bush-era EEOC issued a negative ruling, saying that they could not second guess a business plan. At this point, my condition was worsening and the attorney urged me to settle , to avoid a protracted  and expensive case. Later I learned  that there had been agency employees at other sites who also had been laid off when they got sick. A  memo was evidently later circulated  expressing regrets that some  situations may not have been been handled appropriately, and  instructing supervisors on how to avoid  future untoward situations.

Over the years I have met and heard of others here in  western Washington who suffered similar treatment,  including Seattle journalist Jeanne Sather who was fired in 2000 by OnHealth  who had hired her specifically to write a column about her experiences of living with breast cancer. When a recurrence forced Jeanne to alter her work schedule, OnHealth let her go.

And even for those whose jobs are in workplaces required to comply with the Americans with Disabilities Act, the law is not much protection when employers use every artifice to get around the requirements, especially in at-will employment states like ours.  Workers who even have sick leave that may become a source of contention are in a better position than most, as some 38% of US workers have no sick leave at all, according to data compiled from federal government sources by the Economic Policy Institute.   The study found the ranks of haves and have-nots correlate along economic lines with only 19% of low-wage workers (mostly service workers)  having paid sick days, compared with 86% of high-wage workers. While there is  no federal or state mandate for paid sick leave, there is no excuse for the behavior of  thriving mega-corporations like Microsoft who have chosen to offer employees benefits and then manipulate them in ways that harm their workers. These cases illustrate once again too what’s wrong with a system that links health insurance with employment.

For locals interested in this issue , the Seattle Coalition for a Healthy Workforce will be holding a town hall meeting on the evening of May 11 to discuss the needs of some 190,000 Seattle workers who have no paid sick days.

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Things are still beyond grim as the work on Washington State’s  budget continues. However, on February 4, there was a more hopeful sign when the  Senate approved its version of the Supplemental Budget, including a provision to continue the Basic Health Program, although in reduced scope, by drawing on the Life Sciences Discovery Fund. The  LSDF was established in 2005 from WA’s share of national tobacco settlement funds.  Both the Governor’s budget and the one previously approved by the House had cut  BHP, along  with the DSHS long-standing  interpreter services program for  Medicaid and CHIP patients  These potentially promising developments however have garnered less attention than another set of proposals in HB 1847 ,which would  to sustain funding for BHP by eliminating tax exemptions for Big Banking,  and sales taxes on elective cosmetic surgery and private jets. 

While advocates regard these developments as positive, the struggle is far from over. The Supplemental budget is now undergoing the reconciliation process by both houses and will needs the Governor’s approval; the Biennial budget  will have its turn next. Both contain deep cuts in virtually every area of life affecting Washingtonians, with the worst cuts affecting the most vulnerable populations, especially immigrants and refugees. WA Budget cuts 2011.

The history of these two programs is of particular note at this critical time.  The original intent of the Master Tobacco Settlement Agreement was to fund health services in the states for those affected by smoking.  At the time, Gov. Gregoire, aware that the state would come into additional funds from that source by 2009, planned a move to combine them with private monies to develop a biotech sector.  In a  2005 commentary prescient of current threat of extinction for the Basic Health Program (which began as a 1987 pilot project and became permanent in 1993) the Seattle Weekly had reported:

It will be controversial because originally the tobacco settlement money was supposed to be used to help states offset the health care costs associated with smoking. In 2003, when Gary Locke floated an idea similar to the Life Science Discovery Fund—he called it Bio21—Senate Majority Leader Brown told Seattle Weekly she didn’t like the idea of using tobacco money for biotechnology. “We are one of the few states that has remained true to using that money for health care,” she said at the time. Expect the debate over the best use of the tobacco money to continue.

As I had written previously, in late October 2010, after the Governor had issued her call for “across the board budget cuts” from every state agency, the LSDF awarded $5 million to a private company engaged in personalized medicine research.  Last week, LSDF awarded $600,000 in commercialization grants to four research projects.

The Interpreter Services program also was created as a result of federal litigation, in this case as a result of a 1991 Consent Decree negotiated with the Office of Civil Rights in response to lawsuits and civil rights complaints filed against DSHS for failing to provide equal access to services for clients with limited English proficiency  By law, in this case the Civil Rights Act of 1964, title VI, recipients of federal funds must not discriminate against program beneficiaries on the basis of race, color, or national origin.  Courts have defined lack of language access as a form of discrimination based on national origin. However, the responsibility to fund language services is ultimately that of providers. Since  techncially Washington funded the DSHS program voluntarily, it is now able to seek to de-fund it, unlike other mandatory programs. But in doing so, the state would also forgo specific federal funds that it has been receiving that have covered 50-75% of the total costs, as the Washington State Coalition for Language Access explains in a fact sheet:  WASCLA DSHS Interpreter Services Talking Points January 2011

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