JCAHO

A study by the Joint Commission indicates that hospitals in the United States have significantly improved the quality of care provided for patients suffering from heart attacks, heart failure, or pneumonia over the past 4 years. The report, entitled Improving America's Hospitals: A Report on Quality and Safety, demonstrates that the effectiveness with which hospitals carry out safe practices and provide patients proven treatments for common conditions varies among states. The report indicates that room for improvement exists for most of the quality measures analyzed in the study, and that considerable variability exists in the performance of hospitals by state on most measures. There were also significant differences noted in performance between the highest and lowest performing hospitals. The report also indicates that hospital compliance is lowest for National Patient Safety Goal requirements regarding a time out to be taken by the surgical team prior to surgery to confirm the patient's identity and the correct procedure, and the requirement that certain potentially confusing abbreviations not be used in ordering medications. The full report can be viewed online at http://www.jointcommission.org.

JCAHO has issued a Sentinel Event Alert regarding the importance of healthcare organizations' attention to how emergency power systems can fail and recommending steps to keep patients safe in the event of a disaster or other major event causing loss of the facility's electrical power supply. The Alert indicates that compliance with minimum National Fire Protection Association codes is insufficient to assure the safety of patients and their care during an emergency situation. As an example, the Alert cites the fact that many healthcare organizations did not have sufficient power to cool or ventilate facilities in the aftermath of Hurricane Katrina, and patient evacuations were delayed due to the insufficiency or unavailability of elevators to transport patients. To reduce risks caused by power failures, the Alert recommends the following steps for healthcare facilities:

1. Match the critical equipment and systems needed in an extended emergency against the equipment and systems actually on the emergency power system.

2. Inventory emergency power systems and the loads they serve.

3. Provide training for, and test, those who operate and maintain the emergency power supply system.

4. Ensure that generator fuel is available and usable.

5. Assure that the organization management and clinical leaders know how long emergency power will be available and what locations within the facility will and will not have emergency power in the event of an electrical outage.

6. Establish contingency plans for doctors and other caregivers to follow during losses of electrical power.

In addition to this Alert, JCAHO is adding a new requirement for this year (2007) that organizations test emergency generators at least once every 36 months for a minimum of 4 consecutive hours, in addition to testing the generators 12 times a year for 30 minutes. If the generator fails these tests, the organization must immediately implement measures to provide for power backup until the generators can be permanently repaired or replaced.

In February 2007, JCAHO convened a Summit on Wrong Site Surgery, a revisitation of the original 2003 Summit that led to the creation of JCAHO's Universal Protocol for the Prevention of Wrong Site, Wrong Procedure, Wrong Person Surgery. Despite the implementation of the Universal Protocol and its endorsement by many healthcare leadership organizations, wrong-site surgery persists as a significant problem. This follow-up Summit reviewed experience to date with the Universal Protocol, examined the barriers to achieving consistent compliance with the performance expectations set forth in the Universal Protocol, and explored potential strategies for eliminating wrong site surgery. The consensus of the Summit was that the Universal Protocol is reasonable and effective if properly implemented and consistently followed. Participants agreed that the protocol needs to be expanded and enhanced, and supported a "zero tolerance" policy for improper use of the protocol.

The Joint Commission has released a white paper exploring the impact on patient care of poor literacy on the part of patients. The paper, "What Did the Doctor Say?: Improving Health literacy to Protect Patient Safety," identifies the communication gap between patients and healthcare providers as a series of challenges involving literacy, language, and culture, and suggests multiple steps to be taken to narrow or close the gap. The solutions proposed by this paper include a focus on making effective communication a priority in protecting patient safety; addressing patient communication needs across the spectrum of care; and pursuing public policy changes that promote better communication between healthcare providers and patients. Specific recommendations include:

1. Sensitize, educate, and train clinicians and healthcare organization leaders and staff regarding health literacy issues and patient-centered communication.

2. Develop patient-friendly navigational aids in healthcare facilities

3. Enhance training and use of interpreters for patients

4. Redesign informed consent forms and the informed consent process

5. Develop insurance enrollment forms and benefits explanations that are client-centered

6. Use established patient communication methods such as "teach back"

7. Expand adaptation and use of adult learning centers to meet patient health literacy needs

8. Develop patient self-management skills

9. Assess the literacy levels and language needs of the communities served

10. Design public health interventions that are audience-centered and can be communicated in the context of the lives of the target population

11. Integrate the priority of patient communication into emerging physician pay-for-performance programs

12. Provide medical liability insurance discounts for physicians who employ patient-centered communication techniques

A complete copy of the white paper is available at http://www.jointcommission.org. JCAHO Press Release February 7, 2007.

JCAHO has announced that the fixed performance areas for 2007 for Random Unannounced Surveys of hospitals are: patient safety, medication management, assessment and care/services, and National patient Safety Goals. These surveys are conducted in a sample of 5% of organizations each year. Joint Commission Online: January 2007.

NEWS

A study published in the February 8 New England Journal of Medicine shows that some physicians feel no responsibility to inform patients of treatments they deem immoral or to refer them to other doctors for care. Of the physicians who responded, 17% objected to terminal sedation to render dying patients unconscious, 42% objected to prescribing birth control for adolescents without parental approval, and 52% opposed abortion for failed contraception. Most physicians felt that doctors who objected to a practice had an obligation to present all options and refer patients to someone who did not object, but 8% felt no obligation to present all options, and 18% felt no obligation to refer patients to other doctors. (Curlin et al, Religion, conscience, and controversial clinical practices. New England Journal of Medicine, 356(6), 593-600, February 8, 2007).

The New Orleans Coroner has decided not to classify the deaths of 4 patients who were allegedly euthanized in the aftermath of Hurricane Katrina as homicides. The Coroner has apparently decided that the deaths will remain unclassified. The district attorney planned to present the case to a grand jury in February 2007. It is not clear how the Coroner's decision will impact the DA's attempt to prosecute the physician and 2 nurses accused of euthanizing these patients. (Katrina Deaths Not Classified as Homicides, USA Today, February 2, 2007).

A recent study suggests that cell phones in hospitals do not present any danger in terms of interference with medical devices in hospitals. Researchers conducted an experiment at the Mayo Clinic in Rochester, Minnesota, over a 4-month period in 2006. The researchers used various cell phones and wireless handheld devices in 75 patient rooms and in the ICU, where patients were nearby or connected to a total of 192 medical machines of 23 types. In 300 tests of ringing, making calls, talking on the phone, and receiving data, there was no instance of interference with the medical devices. The authors recommend the relaxation of existing rules prohibiting cell phone use in hospitals. (Data Show How Electronics Mix with Medical Devices, New York Times, March 13, 2007).

The US Department of Health and Human Services (HHS) has launched a new program, Effective Communication in Hospitals, to assist hospitals in meeting the communication needs of people who do not speak English as their primary language or who are deaf or hard of hearing. The Office of Civil Rights (OCR) will work with state hospital associations and their members to develop and implement these programs. The OCR will help state hospital associations and their members in:

* Developing a process for assessing the communication needs of patients and their families;

* Identifying tools and strategies for developing training, best practices, educational materials, technical assistance activities, and other resources;

* Responding appropriately and efficiently to the communication needs of individuals who are limited English proficient or deaf or hard of hearing;

* Sharing the results of efforts to assist other hospitals and state associations facing similar communication issues; and

* Identifying potential resources and creative approaches to cover costs.

(HHS News Release, HHS Initiative to Assist Hospitals in Effective Communication, March 5, 2007).

A report by Medmarx released March 6, 2007 indicated that perioperative patients face an increased risk of harmful medication errors throughout the surgery process due to a lack of comprehensive oversight of medications. To improve patient safety and reduce the risk of medication errors, the study recommends that hospitals and health systems dedicate pharmacists to the perioperative units so they can oversee the distribution of medications and that surgical staff better coordinate hand-offs to eliminate the loss of patient information. Most of the errors cited in the report involved antibiotics and pain killers. Common errors included healthcare providers giving the wrong medication, giving the wrong amount of medicine or giving medication at the wrong time, forgetting to administer medication, or administering it incorrectly. (USP News Release, Hand-Offs and Lack of Coordination During the Surgical Experience Contribute to High Rate of Harmful Medication Errors. March 6, 2007).

A hospital in Pennsylvania has been publicly criticized for asking patients to sign a waiver that mandates that any claim for injuries go through mediation or binding arbitration, legal processes used instead of filing a lawsuit. Attorneys in that state assert that patients may unknowingly sign away their right to a jury trial; the hospital states that the voluntary waiver benefits both patients and the hospital by allowing for faster resolution of malpractice claims. (Wilkes-Barre Times Leader, February 26, 2007).

Indiana has created a hospital-specific reporting system designed to prevent medical errors. The Indiana State Department of Health will provide information about medical errors within area hospitals, including the name of the hospital, the type of error, and the quarter of the year in which it occurred will be available to the public via a Web site. The state's reporting rule focuses on 27 serious adverse events, which must be reported by a hospital within 15 days of determining an event has occurred.

A study published in the February Archives of Pediatrics & Adolescent Medicine indicates that most pediatricians and pediatric residents are willing to report medical errors to hospitals and disclose errors to patients' families, but believe current reporting systems are inadequate and struggle with error disclosure. The authors assert that improving reporting systems for medical errors, encouraging physicians to report near misses, and providing training in error disclosure would help prevent future errors and increase patient trust. (AHA News Now, February 5, 2007).

A study published in the January issue of the New England Journal of Medicine suggests that hospitals participating in both public reporting and pay for performance demonstrated modest improvements in quality compared with hospitals participating only in public reporting. (AHA News Now, January 31, 2007).

A study regarding hospital liability claims indicates that although the frequency of hospital professional liability claims was unchanged for the second straight year in 2006, the size of the average liability payment increased 6%. The authors believe that state-level legislative reforms are largely responsible for the drop in frequency of claims and that patient safety initiatives being implemented will be critical in sustaining the flat frequency trend in the future. The researchers believe that the increase in average claim size is heavily influenced by the growth in expenses associated with defending the claims rather than the growth in claim payments going to the patients making the claims. (2006 Hospital Professional Liability and Physician Liability Benchmark Analysis).

A report published in the Journal of Forensic Sciences suggests that hospitals and nursing homes are not adequately protecting patients from serial killers on staff, and calls for major changes in the way medical centers operate. The researchers linked more than 2,100 suspicious deaths worldwide to 54 doctors and nurses convicted of serial murder or lesser charges since 1970. The authors believe that hospitals rarely share their suspicions when staff look for jobs elsewhere because they fear lawsuits from former employees who say negative job references damaged their reputations. The authors call for a federal law to protect hospitals when they report suspicious behavior in good faith and with good evidence. (USA Today, December 12, 2006).

The 5 Million Lives Campaign is asking hospitals to adopt up to 12 interventions to prevent harm to patients, including 6 that were adopted by hospitals participating in the 100,000 Lives Campaign. The new interventions focus on preventing methicillin-resistant Staphylococcus aureus (MRSA) infections; reducing harm from high-alert medications; adopting Surgical Care Improvement Project (SCIP) interventions; preventing pressure ulcers; improving care for congestive heart failure; and getting hospital boards of directors more involved in quality improvements. (AHA News Now, December 12, 2006).

A study published in the January 2007 issue of the Joint Commission Journal on Quality and Patient Safety indicates that hospital patients define medical errors much more broadly than the traditional clinical definitions of medical errors. The study shows that patients define this concept to include communication problems, responsiveness, and falls. The study shows the need for healthcare providers to clarify what patients mean when they talk about an error or a mistake, and need to explain exactly what is meant by the term "medical error" if patients are to become engaged in programs to prevent these errors. According to the study, 39% of patients experienced concern about at least a single type of medical error during their hospitalization. Certain groups of patients, such as middle-aged patients, parents of pediatric patients, and black patients, were more likely to be concerned about medical errors. Also more likely to be concerned were patients experiencing longer lengths of stay, more severe illnesses, and those admitted through the emergency room. The study also found a strong link between a patient's concerns about medical errors and his or her satisfaction with the entire hospital experience. (Joint Commission Resources Press Release, December 18, 2006).

A bacterial outbreak at a Los Angeles area medical center in December 2006 has been linked to improper cleaning of medical instruments in that facility's neonatal intensive care unit. The hospital had to close off its NICU on December 4, 2006 after an outbreak of Pseudomonas aeruginosa that sickened 5 infants, 2 of which died possibly as a result of the infection. In a report from January 23, 2007, inspectors from California's Department of Health Services faulted hospital staff for not sterilizing laryngoscope blades. (Associated Press, January 24, 2007).

The Association for Healthcare Risk Management (ASHRM) has released a tool to improve fall prevention programs. Entitled "Falls Prevention Strategies in Healthcare Settings," the tool includes tips on establishing or improving a fall prevention program for patients, residents, workers, and visitors. It presents advice on establishing a fall prevention team, developing policies, choosing risk assessment tools and interventions, complying with Joint Commission standards, educating staff and patients/residents as well as families. A CD-ROM includes tools such as sample policies, algorithms, risk assessment forms, and educational posters. This tool is available at http://www.ashrm.org.

The Department of Health and Human Services' Agency for Healthcare Research and Quality, along with The Advertising Council, has launched a national public service campaign designed to encourage adults to take a more proactive role in their healthcare. The campaign notes that medical mistakes occurring in hospitals account for an estimated 44,000 to 98,000 deaths each year (120 deaths per day), according to the Institute of Medicine. That number surpasses the number of deaths per year caused by motor vehicle accidents, breast cancer, or AIDS. Research has demonstrated that consumers who get more involved with their healthcare can greatly improve the safety of that care, but patients are not aware of what to do to help prevent medical mistakes. This campaign, entitled "Questions Are the Answer: Get More Involved With Your Health Care," strives to encourage all patients and caregivers to become more active in their healthcare by asking questions. Consumers can call a toll-free number (1-800-931-AHRQ), and visit a Web site, http://www.ahrq.gov/questionsaretheanswer to get tips on how to help prevent medical mistakes and become a partner in their healthcare. The site features an interactive "Question Builder" that allows the consumer to generate a customized list of questions for their healthcare providers that they can bring to each medical appointment.

A national program has been started to improve the quality of healthcare provided to patients with limited English proficiency. The program, funded by the Robert Wood Johnson Foundation, and administered by the George Washington University's School of Public Health and Health Services, is entitled "Speaking Together: National Language Services Network." It aims to improve the quality of healthcare in America, while eliminating racial and ethnic disparities. The 16-month process will examine how the participating hospitals communicate with non-English-speaking patients, and will focus on how hospital staff can better structure and manage language services programs in order to have effective, efficient, and timely communication with limited English proficiency patients. Proven best practices results from this program will be shared with health professionals across the nation, giving hospitals with linguistically diverse patients concrete and tested examples of effective language services programs and interventions.

A study published in the Journal of the American Medical Association has found little variance in patient mortality rates among hospitals reporting heart attack, heart failure, and pneumonia quality measures on the Hospital Compare Web site. According to the authors, although these measures have been linked to patient outcomes in clinical trials, risk-adjusted mortality rates are likely influenced by many factors independent of these measures. Another study published in the Archives of Internal Medicine examined the same 3 hospital performance measures and found that hospitals with more registered nurses and investment in technology were likely to score better than other hospitals. (AHA News Now, December 12, 2006).

REGULATION

Healthcare organizations that use the National Practitioner Data Bank to monitor the credentials of practitioners can enroll the practitioners in a new Proactive Disclosure Service prototype. The service, effective April 30, 2007, for a limited number of organizations, will notify the organization within one business day when the database receives a report on any of the enrolled practitioners. Authorized database users can choose to enroll all their practitioners in the PDS or enroll some practitioners and continue to periodically query on others using the regular query methods. The prototype period will last 18 to 24 months before it is opened for use by all authorized Data Bank entities. A fee will be charged for this service. (Federal Register 72 (44), 10227-10228, March 7, 2007).

The Centers for Medicare and Medicaid Services (CMS) has issued guidance to state Medicaid directors on their obligations under the Deficit Reduction Act of 2005 to implement certain education requirements for providers and others who receive at least $5 million a year in Medicaid payments. The law became effective on January 1, 2007, and states were given until March 31, 2007, to bring their plans into compliance. The states are required to incorporate the requirements into provider enrollment agreements. Specifically, the requirements include providing to all employees, agents, and contractors:

1. written policies that include detailed information about the federal and state false claim acts, administrative remedies for false claims, whistle-blower protections under federal and state laws, and the role of these laws in preventing and detecting fraud, waste, and abuse;

2. detailed provisions regarding the entity's policies and procedures for detecting and preventing fraud, waste and abuse; and

3. information or those policies within any employee handbook, if it has one.

The information may be provided in electronic or paper form, as long as it is "readily available." Entities may post policies on an internal Web site, or distribute the policies by e-mail. This rule became effective on January 1, 2007.

CMS has published a final rule on patient rights that must be followed by short-term, psychiatric, rehabilitation, long-term, children's and alcohol/drug treatment facilities and all other hospitals participating in the Medicare and Medicaid programs. The rule requires more rigorous training for healthcare staff who use restraints and seclusion to curb violent or self-destructive behavior, and adds trained registered nurses and physician assistants to the category of practitioners who may conduct the "face-to-face" evaluation required within an hour of a patient being restrained or secluded. An RN or PA who performs the evaluation must consult a physician or other licensed independent practitioner as soon as possible after the examination. Hospitals are also required to provide patients or their family members with a formal notice of their rights on admission. The rule also imposes stricter standards for when a facility must report a death associated with restraints or seclusion. (AHA News Now, December 11, 2006).

LEGISLATION

A law has been proposed in California to address the alleged dumping of homeless patients on downtown Los Angeles streets. The proposed law would require hospitals to transport discharged patients to their residence or, if they lack one, to the place they identify as their home, typically a shelter. The law calls for a jail term of up to 2 years and a fine of $1,000 for anyone violating the law. Hospitals could be fined $10,000 and placed on probation, opening the way to court orders dictating how they treat discharged patients who are homeless. A similar measure introduced last year was not successful. ("Dumping" of Homeless by Hospitals Stirs Debate, New York Times, February 23, 2007).

The Governor of California has signed an executive order to stiffen state mandates to adopt health information technology, to make information on prices and care quality more available, and to increase accountability for public and private healthcare systems. This order is in line with a federal initiative promoted by the Bush administration as well as a reform plan released by the Governor in January. The goal of the order is to reduce medical errors, improve patient care, and keep medical costs in check by giving accurate, updated information to patients where they are treated. The provisions of this order include:

1. Establishment of a cabinet-level work group of representatives from both the public and private sector to develop a strategy to improve the quality, transparency, and accountability of healthcare delivery in the state by the end of 2007;

2. Expansion of the Office of Statewide Health Planning and Development's ability to collect data on the results of health treatment, and on costs and pricing for consumers, employers, health plans, and providers; and

3. Promotion of ways to align incentives between health plans and providers to improve quality and efficiency.

SETTLEMENTS/VERDICTS

A jury in Rhode Island has awarded $21.5 million to the family of a woman who they claim died after receiving negligent care from an emergency room physician. The verdict is the largest jury award in Rhode Island since 1999. The woman had gone to the same hospital 3 times in 4 days with flu-like symptoms and ended up dying of complications from Streptococcus pneumonia. The family claimed that the physician who saw her on the second visit failed to recognize and react to signs of bacterial infection and sent her home without antibiotics, with instructions to see another doctor in 5 days. In less than 2 days, she was back in the hospital, where another physician immediately recognized that she had pneumonia and severe sepsis. The family claimed that if the defendant had admitted her and treated her with antibiotics, she would have made a full recovery. (Family Awarded $21.5 Million in Malpractice Case, Rhode Island News, February 8, 2007).

An appeals court in Pennsylvania has confirmed for the second time a $20 million verdict against a Philadelphia hospital after finding that the trial court's error in allowing a punitive damages claim to go forward did not contribute to the verdict and did not prejudice the defendant. Gallagher v Temple University Hospital (14 No. 10 Andrews Health Law Litigation Reporter 6, February 22, 2007).

The former owner of several nursing homes in Texas has pleaded guilty in federal court in Austin to defrauding Medicare and Medicaid of more than $4 million by diverting money from the 2 federal health insurance programs to his own personal and business uses between 1998 and 2001. U.S. v Lemon (12 No. 6 Andrews Health Care Fraud Litigation Reporter 7, December 14, 2006).

A physician in Texas has been convicted by a federal jury in Houston on multiple counts of healthcare fraud and has been ordered to forfeit the $10 million he received form insurers. The physician was convicted on 26 counts of healthcare fraud and 18 counts of mail fraud. U.S. v Klein (12 No. 6 Andrews Health Care Fraud Litigation Reporter 9, December 14, 2006).

A Texas company that operated 13 hospitals throughout the country has paid the government $7.5 million to settle a whistle-blower kickback and Medicare billing fraud suit. This agreement resolves a qui tam suit filed by former employees. Among other things, the company was accused of paying kickbacks to doctors for patient referrals. U.S. v SCCI Health Services Corporation (12 No. 7 Andrews Health Care Fraud Litigation Reporter 8, January 12, 2007).

The owners of 2 facilities in Miami have settled a kickback case for $15 million. They were accused of physician kickbacks to doctors for Medicare and Medicaid patient referrals and Medicare and Medicaid false billing arising from billing for allegedly unnecessary medical treatments. U.S. v Michel (12 No. 6 Andrews Health Care Fraud Litigation Reporter 10, December 14, 2006).

A jury in Pennsylvania has awarded $20 million to a 6-year-old child who became blind after physicians and the hospital where he was born prematurely at 26 weeks' gestation failed to properly treat a curable retinal condition. Reese v Koller (14 No. 8 Andrews Health Law Litigation Reporter 5, December 20, 2006).

A nurse in Wisconsin has reached a plea agreement in her prosecution for 2 misdemeanors in the accidental death of a patient. She was originally charged with a felony (negligence of causing great bodily harm); the plea agreement amended the charges to dispensing of a drug by someone other than a pharmacist, and possession of a drug by a person to whom it had not been prescribed. The patient died as a result of a drug mix-up, receiving epidural anesthetic by IV instead of the intended medication, penicillin. The nurse was placed on 3 years probation and will be prohibited from performing any critical care nursing and from working in emergency rooms, recovery rooms, or obstetrics. Her nursing license was suspended for 4 months, and she will be prohibited from working long hours for at least 2 years, as fatigue from working long hours prior to the shift in which the incident occurred was felt to have played a part in the error. ("I'd Give My Life to Bring Her Back"-Nurse Gets Probation in Pregnant Teen's Death, Wisconsin State Journal, December 16, 2006).

A judge in San Francisco Superior Court has granted final approval of a settlement covering more than 780,000 uninsured patients at all of Catholic Healthcare West's hospitals. The agreement resolves class-action claims regarding the hospital organization's pricing and collections practices. (Modern Healthcare Alert, January 11, 2007).

CASES

A California-certified nursing assistant (CNA) is suing Kaiser Permanente and a nurse staffing agency for blackballing her as a result of her participation in a criminal investigation of an alleged patient dumping incident. The CNA claims that Kaiser's hospital in Bellflower stopped employing her after she cooperated with the Los Angeles city attorney's probe into allegations that the facility dumped a homeless woman on the street. Hernandez v Nursefinders of Long Beach (12 No. 9 Andrews Health Care Fraud Litigation Reporter 15, March 15, 2007).

An appeals court in Indiana has ruled that when physicians and minors in that state discuss treatments for reproductive health conditions that are related to sexual activity, the conversation is private. This decision put to an end that state's attorney general's effort to force Planned Parenthood of Indiana to turn over medical records of 73 low-income girls who sought medical services. Planned Parenthood v Carter.

The highest court in Connecticut has determined that a physician is not qualified to provide expert testimony regarding the standard of care required of a nurse. The ruling was based on a state law requiring an expert to be a "similar health care provider" to the provider about whom the expert proposes to testify. Markland v Abrams (41 Conn. L. Reporter No. 8, 202, July 3, 2006).

A federal court of appeals has ruled that the theft of $451,000 by a clerical worker from a methadone clinic was not healthcare fraud under federal law, and reversed the worker's conviction. The court determined that the theft was not "in connection with the delivery of or payment for health care benefits, items or services" under the federal healthcare fraud statute. US v Jones (12 No. 7 Andrews Health Care Fraud Litigation Reporter 9, January 12, 2007).

After 3 motions to compel, a New York woman has been granted access to the full records of other patients who underwent the same treatment as her husband, who died. She alleges that the hospital duped her husband into trying a useless cancer treatment, leading to his death. Ryan v Staten Island University Hospital (12 No. 7 Andrews Health Care Fraud Litigation Reporter 11, January 12, 2007).

A lawsuit has been filed to try to stop the closure of hospitals in New York, alleging that the state violated the Constitution by allowing appointed members of a commission to make sweeping changes in that state's healthcare policy.

The entire 8th Circuit court of Appeals has agreed to rule on South Dakota's appeal seeking to reinstate a law that would require physicians to inform patients that abortion ends the life of "living human beings" and poses medical and psychological risks to women. A 2-1 panel of the appellate court ruled in October 2006 that the law is an unconstitutional violation of free speech. On January 9, 2007, the panel vacated that decision and granted the state's petition for a rehearing in front of the entire panel. Planned Parenthood v Rounds (14 No. 9 Andrews Health Law Litigation Reporter 2, January 25, 2007).

A federal appeals court is being asked to reinstate the claim of the widow of a Kansas man who died of a heart attack in 2003. She claimed that a local hospital failed to give her husband a proper medical screening in the emergency room in violation of its own policy. A federal judge dismissed her claim in December 2006. The widow claimed that the hospital's ER clerk sought insurance information from the patient before he had been triaged in violation of EMTALA; and that the hospital violated EMTALA as well as its own policies by making the patient wait for a medical examination. Parker v Salina Regional Health Center (14 No. 9 Andrews Health Law Litigation Reporter 3, January 25, 2007).

A federal judge has ruled that an Illinois woman who suffered a miscarriage in a hospital bathroom can sue the facility for failing to examine and treat her condition upon her arrival to the emergency room. The judge, from the Northern District of Illinois, denied the hospital's motion to dismiss, stating that the woman has made a proper claim for damages under EMTALA (the Emergency Medical Treatment and Active Labor Act). Barrios v Sherman Hospital (14 No. 9 Andrews Health Law Litigation Reporter 4, January 25, 2007).

The Oklahoma Supreme Court has held that a state law requiring that expert affidavits accompany medical malpractice complaints is unconstitutional because it blocks the public's right to access the courts which is guaranteed by the state constitution. The statute was part of a 2003 tort-reform law passed by the state legislature. Zeier v Zimmer, Inc. (14 No. 9 Andrews Health Law Litigation Reporter 7, January 25, 2007).

The highest court in New York State has ruled that the estate of a Florida man cannot sue an organ donor group that allegedly misdirected a kidney a dying friend promised to him. The court found that the plaintiff had no property right to his friend's kidney, thus the donor group cannot be held liable for giving the organ to another patient. Colavito v N.Y. Organ Donation Network (14 No. 9 Andrews Health Law Litigation Reporter 10, January 25, 2007).

An appeals court in California has rejected the appeal of a former primary care physician at UCLA who claims he was fired in retaliation for challenging the quality of care at the university clinic. The appeals court confirmed the lower court's finding that UCLA's student health services department fired the physician for insubordination and not for advocating for patients. Sarka v University of California (14 No. 9 Andrews Health Law Litigation Reporter 12, January 25, 2007).

Five nurses from Bulgaria and a Palestinian doctor have been sentenced to death by a court in Libya for allegedly deliberately infecting more than 400 children with HIV, more than 50 of whom have died. The case, which has now gone on for almost 8 years, has drawn international attention and criticism. The providers came to Libya in February 1998 to work at a children's hospital in the country's second largest city. By August of that year, children at the hospital began testing positive for HIV. An investigation concluded that the infections came from the wards where the Bulgarian nurses had been assigned. The nurses were tortured into confessing. Experts on HIV have concluded that the virus predated the nurses arrival in Libya and was probably spread by contaminated needles. The court did not allow these experts to testify. (Libya Again Sentences Nurses and Doctor to Die in HIV Case, New York Times, December 20, 2006).

Bibliography