The Voting Record

Barack Obama continues to state he is the candidate of change. But he never really talks about what change would mean or what change would look like. He acts as if he is the person for collaboratively working across party lines.

But the facts are clear.

Obama was ranked the most liberal Senator in 2007 with a lifetime liberal score of 88 compared to Hillary who was ranked 16th in 2007 and has a lifetime liberal score of 79.4 based on National Journal’s vote ratings.

There is no way Obama can reach across party lines with this type of voting record and have success. He is either blowing smoke up someone’s behind or he is smoking something himself.

Statistics: Barack Obama missed 230 of 1194 votes (19%) since Jan 6, 2005. Obama has only sponsored 129 bills since Jan 4, 2005, of which 117 haven't made it out of committee and only 2 were successfully enacted.

Statistics: Hillary Clinton missed 203 of 2502 votes (8%) since Jan 23, 2001. She has sponsored 363 bills and 10 were successfully enacted which was very good relative to her peers.

Statistics: John McCain has sponsored 537 bills and 31 were successfully enacted which was exceedingly good relative to his peers.

Those wanting to believe what the Obama rhetoric is stating are being extremely gullible. He’d be worse than Jimmy Carter for the economy and national security.

China Conspiracy

How many conspiracy theorists are out there? Is China selectively trying to sabotage us in various ways?

Recently, the contaminant found in supplies of Baxter's heparin has now been traced back to the Changzhou Scientific Protein Labs (SPL) processing plant in China.

This contaminated product has been linked to an increase of adverse events and some fatalities and this comes on the back of recent lead contamination of toys and generic drug problems.

The FDA has not identified the exact contaminant, but does seem to be closer. It is thought that it is a glycosaminoglycan and a very similar compound to heparin itself.
Could this be a deliberate attempt to mask the contaminant by making it similar to the real thing?

There have been no reported adverse reactions in Japan from heparin used there and the peaks seen during testing are only being found in the heparin sent to the US.

This is most likely all just coincidental in the timing of these faulty products, but it does make you wonder!

Physicians lack of sleep

In a survey released recently most doctors are not getting enough sleep and report needing at least 7 hours but only getting 6.5 hours on average.

One chairman of the sleep institute performing the survey said that "Call hours during training and in the practice of medicine desensitize physicians to the importance of sleep. The pervasive message is that sleep is optional or dispensable." She went on to state that "Self sacrifice also may be seen as part of the lifestyle. This may impact physicians' awareness of their own, and their patients', sleep deprivation lifestyles."

The report also showed that physicians made up for the lack by sleeping longer on weekends or days off.

Forty three percent said it was due to their current work schedule but they seldom reported insomnia or difficulty initiating or maintaining sleep. About 22% did report not feeling refreshed upon waking.

Most physicians surveyed did not believe the lack of sleep adversely affected their work performance, but 18% said that it caused them to miss family or leisure activities.

The survey also showed that physicians use more caffeine than do their patients but when asked, physicians were more likely than the general population to report being in very good or excellent health: 83.6% vs. 56.0%.

Do we practice what we preach??

New use for Perfume Bottle

Things like this do happen outside the USA.

Six doctors and several nurses and staff of a government-run hospital in the Philippines are being investigated after they were linked to a YouTube video of a male patient undergoing an operation at the Vicente Sotto Memorial Medical Center (VSMMC) to take out a perfume canister that had been inserted into his rectum by a male sex partner.

I guess it would be taboo or politically incorrect to make a judgment on whether the bottle should have been placed there to begin with.

The video is no longer available on YouTube but reportedly ran for about two and a half minutes. It showed more than 10 people in the operating room as the extracted canned body spray was removed. It showed some of them laughing and cheering when the "baby" was pulled out.

I am a little surprised it took 10 Phillipinos to retrieve the one bottle but maybe they are not as technically advanced as we are here.

The patient plans to file criminal and administrative charges for violation of several provisions of the Patients Bill of Rights against those involved.

The patient reportedly has not left his house much since the incident and is planning on suing the hospital and Medical Director.

A spokesperson said they need to strengthen the hospital policies on the use of mobile phones with or without cameras inside the operating room and other areas of the hospital.

The investigation into the event is ongoing, but it has caused a lot of controversy about how to handle the individuals.

The hospital responses also caused additional outrage. They said they will penalize the doctors and nurses who made the mockery over the sedated patient because of the unprofessional conduct committed. Second, they are asking the help of the NBI to apprehend the student nurse who uploaded the video footage in YouTube and third, they are not going to dismiss the said health practitioners because they lack the needed staff.

I guess this national healthcare may have some benefits.

Expelled documentary

I had the opportunity to see the new documentary “Expelled” by Ben Stein this past week and thoroughly enjoyed his wit, humor, and the exposure he gave to the topic.

It did pretty well for opening weekend even though it had very little media coverage compared to other recent documentaries. The top movies at the North American box office - Forbes.com

It still continually amazes me how many people simply refuse to admit that “Darwinism” is just a theory without any more proof than “Intelligent Design”.

Intellectual honesty is completely thrown out when discussing this topic and there continues to be ample evidence in how the schools, universities and scientific community systematically try to squelch any and all discourse related to the topic.

Anyone who truly wants to be objective to the topic should view the film and then honestly answer the question; Why are we not allowing both ideas to be taught?

Even Dawkins admitted that Intelligent Design could explain what we see in our “science”. But he only was willing to say the Intelligence had to be from another planet (Directed Panspermia).

Where’s his science to back this up?

The bottom line is that whether you believe in Darwinism, Intelligent Design, or God, it is still a matter of faith.

No one can scientifically explain how the earth or we began.

Clinton defines post-modernism

Below is an article written by Gene Edward Veith.

This is a wonderfully written commentary on Hilary but it applies to both democratic candidates, as neither seems to believe that you can actually “know” things with certainty. It highlights our postmodern trend which will ultimately destroy our society if we don't make some changes.

Both his fans and his critics hail Bill Clinton as the first postmodern president. In his personal constructions of truth and morality, his continual re-invention of himself, and his insistence that even the word "is" depends upon your interpretation, President Clinton became a poster boy for the relativistic worldview.

Now Hillary Clinton is continuing her husband's political legacy.

The most flagrant example of Mrs. Clinton's embrace of contemporary philosophy is her description of a trip to Bosnia in which she had to duck sniper fire, landing with no ceremony into a war zone and running from the airplane with her head down.

When the comic Sinbad, who was on that same trip, said that he remembered being in no such danger, Mrs. Clinton first dismissed his account as coming from a mere comedian. Then others in her entourage at the time, including the pilot of her military aircraft, denied that there were any snipers. A spokesman for her campaign offered the postmodernist mantra that "everybody's perceptions are different."

In this case, though, everybody's perceptions were not different, since no one else perceived bullets flying or having to run for cover. Then CBS dug up footage of the first lady's landing in Bosnia that showed not perceptions but facts: a peaceful, conventional meet-and-greet ceremony with no gunfire from snipers, just a little girl reading a poem.

At that point, Mrs. Clinton retracted her story, saying that she "misspoke," that she made a "mistake," that she was only "human."

Some Democrats equated Mrs. Clinton's mistake about snipers with John McCain's mistake of confusing Sunnis and Shiites in a speech about Iran's support of Islamic terrorists. But his was a confusion over objective facts, immediately corrected when Sen. Joe Lieberman whispered the correct information into his ear.

Mrs. Clinton was following the postmodernist playbook: She constructed a narrative—an entire story, complete with conflict and action—to advance an agenda of power. In this case, using her own jargon, she fashioned her own identity so as to present herself as someone with "experience," in contrast to her rival Barack Obama. Of course, if getting shot at is an index of presidential experience, McCain—who was not only shot at but shot down—has Mrs. Clinton beat.

Governor's proposal for higher education

The Governor has outlined a plan for higher education access and affordability and released the following information at a higher education conference.

Governor Mitch Daniels outlined his goal to make higher education more affordable and accessible for Hoosier students and their families. The governor told college and university trustees, faculty and administrators attending a Commission for Higher Education conference that he wants to assure that Indiana high school graduates are guaranteed two years of paid tuition at Ivy Tech Community College (approximately $3,000 per year) or an equivalent amount to attend another Indiana college or university.

Such an opportunity would be available to families earning up to the state's median income, which is about $54,000 annually, and possibly beyond depending on the source and amount of funding that can be assembled for the program, either through new revenue sources or from moving funds from other programs that are not achieving results.

The governor also challenged the state's colleges and universities to consider their own participation in the effort to ensure that the tuition amounts the state provides remain affordable. Ivy Tech, for example, has committed to hold future tuition increases to the rate of inflation.

"We must elevate quickly the number of our young people who pursue education beyond high school. The careers of tomorrow will almost all require training beyond that available in high school today. It is our job to see these students are ready in greater numbers," said Daniels.

"I believe that if we can address the affordability issue, if we can say to every Indiana high school kid that if you graduate from high school, we will provide you the wherewithal to go to our community college, or, it's your choice and your family's choice to have that as a head start on any other school," he said.

The governor invited higher education leaders to offer input and ideas for the concept over the next several weeks.

Background information

• 651,609 Hoosiers completed high school but have no college
• education (February 2008 Indiana Chamber of Commerce report Indiana's Adult Education and Workforce Skills Performance)
• 524,029 Hoosiers have not completed high school (or equivalent)
• (Chamber report)
• Indiana ranks 44th among states for share of population over age
• 25 with a bachelor's degree (Chamber report)
• Indiana ranks 41st among states for share of working-age adults
• with an associate degree or higher (Chamber report)
• Indiana lags the nation in first-year retention rates at public
• two-year colleges with only 49 percent staying in school (Chamber
• report)
• Approximately two-thirds of all students borrow money to pay for
• college. The average debt load for a student graduating with a bachelor's degree has climbed to $20,000 up from $9,000 in 1993 (Commission for Higher Education, March 14, 2008, "Reaching Higher with
• Affordability")
• Over the last 10 years (1997 to 2007) tuition at Indiana's
• public four-year universities has risen an average of 105 percent - over the same period Hoosiers personal income grew by 44.2 percent and CPI (inflation rate) grew by 29 percent (Commission for Higher Education)
• 69 percent of Indiana high school juniors from families without
• a college graduate in the household and 40 percent with a college graduate in the household did not think they could afford to go to college (Commission for Higher Education)

Opportunities for Hoosiers

• Each year of education beyond high school enables an individual
• to increase annual earnings by 10 percent.
• Better education leads to better jobs. Forty-four of the state's
• 50 "Hoosier Hot Jobs" in greatest demand require an education beyond high school
• The Indiana Department of Workforce Development estimates that
• by 2014 there will be an additional 222,410 high-wage, high-demand Indiana jobs requiring a post-secondary degree.
• According to the 2007 Kauffman State New Economy Index, Indiana
• ranks 16th among the states for the "fastest-growing firms," but ranks 43rd for workforce education level.

Audio of the governor's comments may be found at this link:

http://www.in.gov/gov/files/Audio/041608_HigherEducation.mp3

Is it the government’s responsibility to pay for the education for only a select part of the population?

If we all pay taxes then the opportunity should be available for everyone.

Reprint of American Suicide

In 2005 Dick Lamm, former Governor of Colorado (Democrat), gave a very poignant speech at an immigration overpopulation conference in Washington, DC.

I thought with this being an election year and immigration being an important issue, it might be nice to revisit his thoughts.

His speech was on how to destroy America. In this speech, he described eight methods for the destruction of the United States.

He said, "If you believe that America is too smug, too self-satisfied, too rich, then let's destroy America. It is not that hard to do. No nation in history has survived the ravages of time. Arnold Toynbee observed that all great civilizations rise and fall and that 'An autopsy of history would show that all great nations commit suicide.'"
"Here is how they do it. First, to destroy America, turn America into a bilingual or multi-lingual and bicultural country. History shows that no nation can survive the tension, conflict, and antagonism of two or more competing languages and cultures. It is a blessing for an individual to be bilingual; however, it is a curse for a society to be bilingual. The historical scholar, Seymour Lipset, put it this way: "The histories of bilingual and bi-cultural societies that do not assimilate are histories of turmoil, tension, and tragedy." Canada, Belgium, Malaysia, and Lebanon all face crises of national existence in which minorities press for autonomy, if not independence. Pakistan and Cyprus have divided. Nigeria suppressed an ethnic rebellion. France faces difficult times with Basques, Bretons, and Corsicans."

Lamm went on: Second, to destroy America, "Invent 'multiculturalism' and encourage immigrants to maintain their culture. Make it an article of belief that all cultures are equal. That there are no cultural differences. Make it an article of faith that the Black and Hispanic dropout rates are due solely to prejudice and discrimination by the majority. Every other explanation is out of bounds.

Third, "We could make the United States an 'Hispanic Quebec' without much effort. The key is to celebrate diversity rather than unity. As Benjamin Schwarz said in the Atlantic Monthly recently: "The apparent success of our own multiethnic and multicultural experiment might have been achieved not by tolerance but by hegemony. Without the dominance that once dictated ethnocentricity and what it meant to be an American, we are left with only tolerance and pluralism to hold us together."

Lamm said, "I would encourage all immigrants to keep their own language and culture. I would replace the melting pot metaphor with the salad bowl metaphor. It is important to ensure that we have various cultural subgroups living in America enforcing their differences rather than as Americans, emphasizing their similarities."

"Fourth, I would make our fastest growing demographic group the least educated. I would add a second underclass, unassimilated, undereducated, and antagonistic to our population. I would have this second underclass have a 50% dropout rate from high school."

"My fifth point for destroying America would be to get big foundations and business to give these efforts lots of money. I would invest in ethnic identity, and I would establish the cult of 'Victimology.' I would get all minorities to think that their lack of success was the fault of the majority. I would start a grievance industry blaming all minority failure on the majority population."

"My sixth plan for America's downfall would include dual citizenship, and promote divided loyalties I would celebrate diversity over unity. I would stress differences rather than similarities. Diverse people worldwide are mostly engaged in hating each other- that is, when they are not killing each other. A diverse, peaceful, or stable society is against most historical precedent. People undervalue the unity it takes to keep a nation together. Look at the ancient Greeks. The Greeks believed that they belonged to the same race; they possessed a common Language and literature; and they worshipped the same Gods. All Greece took part in the Olympic Games. A common enemy, Persia, threatened their liberty. Yet all these bonds were not strong enough to overcome two factors: local patriotism and geographical conditions that nurtured political divisions. Greece fell. "E. Pluribus Unum"-- from many, one. In that historical reality, if we put the emphasis on the 'Pluribus' instead of the'Unum,' we will balkanize America assuredly as Kosovo."

"Next to last, I would place all subjects off limits; make it taboo to talk about anything against the cult of 'diversity.' I would find a word similar to 'heretic' in the 16th century – that stopped discussion and paralyzed thinking. Words like 'racist' or 'xenophobe' halt discussion and debate. Having made America a bi-lingual/bicultural country, having established multiculturalism, having the large foundations fund the doctrine of 'victimology,' I would next make it impossible to enforce our immigration laws. I would develop a mantra: That because immigration has been good for America, it must always be good. I would make every individual immigrant symmetric and ignore the cumulative impact of millions of them."

In the last minute of his speech, Governor Lamm wiped his brow. Profound silence followed. Finally he said, "Lastly, I would censor Victor Hanson Davis's book "Mexifornia." His book is dangerous. It exposes the plan to destroy America. If you feel America deserves to be destroyed, don't read that book."

It was reported that there was no applause and the atmosphere was described as a chilling fear that quietly rose like an ominous cloud above every attendee at the conference.

I am astonished that this particular speech came from a Democrat, but it is reassuring that there are a few out there who haven't checked their brains at the door of the democratic party.

In this time of election, I have major concerns over these same issues and the thought of Clinton or Obama becoming president is very disturbing. Both of them are poised to do exactly as described above and will continually erode what has made America great; common beliefs based on Judeo-Christian principles.

We claim toleration but certainly do not tolerate things when they have a Judeo-Christian statement or origin. Why is that?

We now have over 100 languages tearing at our educational and business systems rather than requiring English to be the national language. What purpose other than division does having all these languages provide to society?

It is time for America to make some tough decisions and acknowledge that what has made the USA great is our historical unity in Judeo-Christian moral and values.

It is time to bring these principles back as we make decisions for the future.

Dictionary Addition

Subject: A new word for the dictionary.

Electile Dysfunction : the inability to become aroused over any of the choices for President put forth by either party in the 2008 election year.

Gulf War Link

I have seen several Gulf War vets with the strange and undiagnosed problems and it is good to see there is some evidence that they may have been exposed to some chemical.

It is always frustrating for both patients and doctors to not have an answer. Many times, patients would rather have an answer that is not good rather than to continue to know they are having symptoms and not being able to find the cause.

The causal agent at the present time seems to be that exposure to acetylcholinesterase inhibitors played a role in illness in Gulf War veterans.

A number of studies so far have found a significant positive correlation between acetylcholinesterase inhibitor-related exposures and illness in Gulf War veterans.

Workers with exposure to acetylcholinesterase inhibitor in an agricultural setting also report multiple symptoms that match those in Gulf War veterans, including fatigue, muscle complaints and cognitive dysfunction. Such symptoms have also been reported in victims of terrorist attacks in Japan using sarin gas.

These findings do not imply that all illness in Gulf War veterans or illness in all Gulf War veterans is the result of acetylcholinesterase inhibitor but there is mounting evidence to suggest at least some link to many of the symptoms.

Lymphoma

A recent review in the March 10 issue of the Archives of Internal Medicine used data from the Surveillance, Epidemiology and End Results (SEER) program to show that survival rates for Non-Hodgkin’s lymphoma (NHL) have increased in recent years.

Although this is a very general statement concerning this very diverse disease; it is good news.

The results showed that between 1990 and 2004, 5-year relative survival for NHL patients has increased from 50.4% to 66.8% and 10-year relative survival has increased from 39.4% to 56.3%.

This study hits close to home as we have a family member battling it now and we continue to follow any and all new treatment strategies.

The problem with this general statement is that there are multiple subcategories of NHL and some respond extremely well whereas the poorer categories really have not changed much in overall prognosis.

The improvements seen are probably related to 2 key factors. The first is the use of the drug rituximab (Rituxan/MabThera, Roche) that is a type of antibody therapy. The second factor probably contributing to the improved outlook is the decrease in recent years in the number of cases of NHL related to human immunodeficiency virus (HIV) which is directly related to the improved treatment of HIV related illnesses.

Overall, this is good news, but there is still a lot of room to improve outcomes further!

IRS and Tax scams

As the dreaded tax season is upon us, so are the scam artists.

The IRS continues to warn people of the frequent e-mail and telephone scams whose aim is to latch onto a victim's personal and financial data.

A recent scam involves a person who calls and identifies himself as an IRS employee promising a sizable "rebate" if the taxpayer files early.

The caller will then need the person's bank account information for the direct deposit of the refund and if the person declines, the caller states the offer is withdrawn.

A similar scam is also occurring by e-mail that is purportedly from the IRS. These instruct the person to click on a link to claim his or her refund and the site is a typical phishing page that looks legitimate. It will attempt to gather personal data, credit card numbers or bank accounts.

The IRS wants people to know that they never gather personal information about taxpayers by telephone or unsolicited e-mails.

They have a website that you can go to if you have questions about your refund:"Where's My Refund?"

Wal-Mart Expands into Healthcare

For all the Wal-Mart lovers, they are getting into the healthcare business beginning in April in Atlanta, Dallas, and Little Rock.

They plan to increase the number to 400 co-branded, in-store medical clinics by 2010.

Wal-Mart is working with a company called RediClinic who has been a leader in the retail-clinic business.

The new clinics will all operate on a common electronic health records platform and plan to work cooperatively with local hospitals.

This may be another opportunity for our local hospitals to partner with Wal-Mart’s in the area to provide some after hour care.

Wal-Mart wins because they have in-house pharmacies and you can always buy something at Wal-Mart.

Two-Faced

One of the rarest malformations in humans is diprosopus or commonly called craniofacial duplication. This is a rare syndrome where a child is born with two faces, one head, and one body. Since 1884, there have been only about 35 reports of this disorder in the world medical literature but there appears to be a new one in India. (see the following link) Craniofacial Duplication

This anomaly had been considered a type of conjoined twin but it differs because it is not normally due to the fusion or incomplete separation of two separate embryos. This anomaly is the result of an abnormal protein called Sonic Hedgehog homolog that somehow signals craniofacial development.

The medical literature is scant but most of these cases also involve other congenital disorders, particularly anencephaly, neural tube defect and cardiac malformations.

Most neonates with this disorder are stillborn so this particular case is unusual and will be interesting to see what other abnormalities are associated.

I don’t think reincarnation is the underlying etiology, but they certainly believe it.

What world have they been living in?

Have these people had their head buried in the sand or what?

In one of the first physician satisfaction surveys on insurers made public the doctors in the Houston area gave poor marks to six area health insurers and stated they have failed patients, employers and doctors on patient-care, payment and customer service issues.

The chairman of the society’s managed care committee said she was surprised how bad it was.

She went on to say “the survey shows insurance companies are failing patients, doctors and employers who pay for healthcare services by creating ways and resistance to hold onto their money.”

Again, what is surprising is that anyone who has worked as a physician or with a physician in private practice would make this statement publicly.

I am unsure how much louder physicians can voice their discontent with the current system and third party payers.

The release of this survey was just one of a number of efforts by physicians to turn up the heat on health insurers, which organized medicine claims are putting profits ahead of patient care.

Another example of turning up the heat is New York Attorney General Andrew Cuomo’s plans to file suit against UnitedHealth Group for allegedly gerrymandering reimbursement rates paid to physicians and other healthcare providers.

The Houston survey also showed the following:

**More than 65% of the doctors reported they have experienced difficulty getting their patients’ medical services approved.
**Some 69% have problems with prompt payment, and 64% say they are paid less than their contracted rate.
**On education, 58% say their patients do not understand benefits, co-payments, deductibles and limitations of their coverage.
**65% say their patients rarely understand preventive services and care-coordination services available to them.

The response from one of the insurers in the area said that although we had no advance notice of the survey, Blue Cross is very aware of physician dissatisfaction on the issues raised in the survey. Being aware does little to fix the problems.


There were 487 physicians who took the survey and it evaluated the plans in their area, which included Aetna, Cigna Corp., Humana, the Texas Blues, UniCare and UnitedHealthcare.

Doctors gave stories like a patient with macular degeneration turning into lost eyesight because the patient could not get treatment approved, and another patient died while waiting for his insurer to preauthorize a magnetic resonance angiography, a test that could have revealed the carotid artery dissection that triggered his stroke.

Doctors complained about a range of issues including delayed reimbursements, paying less than contracted rates, providing services without reimbursement, and time spent trying to preauthorize medical services.

None of these complaints are new and no one should be surprised just because suddenly a survey was published showing the details.

Offices have to hire additional staff just to handle insurance problems and the insurers continually hassle offices wanting to know why we are ordering medical services and prescriptions and want us to provide three peer-reviewed articles to prove what we want to do.

If that doesn’t convince you not to order the test or drug they say you have to then discuss it with their medical director.

The barriers that are placed by the insurers cause significant delays and denial of care and has been worsening.

Making the results of these type of surveys public is a new twist and it will help prevent the problems from being swept under the rug or kept private.

Efforts to manage these issues privately have failed and it took a legislative measure to mandate that insurers pay physicians in 45 days when a clean claim is filed.

As more and more payers launch Web sites to rate doctors, it is high time insurers are publicly rated and held accountable.

One for the Good Guys

Here is a reprint of an Indiana State Medical Association (ISMA) memo showing physicians have won a significant decision in the Indiana Courts.

The Dec. 31, 2007, ISMA Reports discussed an amicus curiae (friend of the court) brief in Ho vs. Frye, a retained sponge case. The Indiana Supreme Court on Feb. 21 ruled in favor of Dr. Ho – and all Indiana physicians.

"The ISMA was the only health-related entity or association in Indiana to file an amicus brief in this case," said Jon Marhenke, M.D., ISMA president. "Once again, we have clear evidence of our members' dues dollars at work, and we thank the AMA for supporting our efforts."

Facts of the case
As a board certified ob/gyn, Dr. Ho performed abdominal surgery on his patient, Ms. Frye, at Putnam County Hospital in 2000. The hospital-employed nurse indicated to Dr. Ho, who was not a hospital employee, that the pre- and post-operation sponge counts matched. In fact, they did not.

The patient sued the hospital and Dr. Ho for injuries associated with the retained sponge. The medical review panel unanimously found both Dr. Ho and the hospital failed to meet the applicable standard of care. The hospital settled the case.

At trial, the jury found in favor of Dr. Ho, but the court overturned the decision and ordered a new trial. On appeal, Dr. Ho argued that issues of material fact existed regarding whether he was negligent and that he was not strictly liable. Further, he should be entitled to present his expert testimony to the jury. The plaintiff argued that, as a matter of law, Dr. Ho was negligent in failing to remove the sponge.

Appeals court ruling
The Indiana Court of Appeals adopted plaintiff's arguments. It refused to consider any evidence the surgical nurse was an employee of the hospital charged with the duty to count sponges. Relying on Indiana Supreme Court case law from 1932, it stated surgeons cannot "delegate the absolute authority and responsibility to a nurse or nurses to account for sponges and to thus escape responsibility himself."

This theory, premised on the idea that a surgeon is ultimately responsible as a matter of law for essentially everything that occurs during a surgery, was later identified as the captain-of-the-ship doctrine.

Indiana Supreme Court decision
On appeal to the Indiana Supreme Court, the ISMA and AMA filed a joint amicus brief explaining that the captain-of-the-ship doctrine is outdated. Indiana has since abolished the charitable immunity doctrine on which it was founded, and medicine has set clearly delineated roles and responsibilities for surgeons and hospitals (and their employees).

Therefore, persuaded the ISMA and AMA, the court should follow the majority of other states in recognizing the antiquated doctrine should not be used to impose liability on physicians for actions of hospital employees as a matter of law.

The Indiana Supreme Court accepted the case and unanimously agreed with Dr. Ho and the ISMA. The court acknowledged the 1932 language cited by the Court of Appeals, but pointed to a different part of the opinion stating: "It is for the jury to determine from the evidence whether the omission of certain treatment, like the failure to remove a lap-sponge used in the operation before the incision was closed, was or was not negligence."

The court then clarified the historical case did not hold that a surgeon is absolutely liable as a matter of law for failure to remove unnecessary sponges used in a patient during surgery. Rather, "notwithstanding a surgeon's assignment to assistants the task of tracking surgical sponges, the surgeon's failure to remove a sponge is evidence of medical negligence and will support a jury verdict finding liability on the part of the surgeon."

In short, the physician's negligence is an issue of fact for the jury. Further, the physician is entitled to present expert witness testimony. Therefore, the Supreme Court reinstated the jury verdict in favor of Dr. Ho.

"We are pleased that the Supreme Court continues to find the careful balance between health care provider liability and patient recovery," said Julie Reed, ISMA legal counsel.

"The case reaffirms physicians' legal rights to defend their own professional actions and provides assurances that they will not be held strictly liable for the negligent actions of other health care providers who are not their employees. Additionally, it does not infringe on wrongfully injured patients' rights to properly recover damages from the negligent party."

New Deadly Game Kids Play

An article recently appeared in the MMWR Unintentional Strangulation Deaths from the "Choking Game" Among Youths Aged 6--19 Years --- United States, 1995--2007 and it describes an activity called "the choking game," which has led to the death of at least 82 children and adolescents since 1995.

The choking game is a dangerous activity that older children and early adolescents sometimes play in an attempt to get a brief high.

This activity is similar to another referred to as autoerotic asphyxiation. Here the goal is to reach an enhanced sexual stimulation state by coming close to strangulation.

They may either choke each other or use a noose to choke themselves and the risk is passing out which can lead to asphyxia and death

Boys were much more likely to die from the choking game than girls and 87% of victims in the report were boys.

Most of the children that died were 11-16 years old (89%).

Nearly all of the children who died were playing the game alone when they died.

Deaths have occurred all over the United States and isn’t limited to one area of the country.

The warning signs that parents, educators, health-care providers, or peers should look for include the following:

*Discussion of the game or its aliases
*Sexual material or magazines
*Bloodshot eyes
*Marks on the neck
*Wearing high-necked shirts, even in warm weather
*Frequent, severe headaches
*Disorientation after spending time alone
*Increased and uncharacteristic irritability or hostility
*Ropes, scarves, and belts tied to bedroom furniture or doorknobs or found knotted on the floor
*The unexplained presence of dog leashes, choke collars, bungee cords, etc.
*Petechiae (pinpoint bleeding spots) under the skin of the face, especially the eyelids, or the conjunctiva (the lining of the eyelids and eyes)

There are other names that this game is called and they include the Pass-out game, space monkey, suffocation roulette, Scarf game, the American dream, fainting game, something dreaming game, purple hazing, blacking out/blackout, dream game, flat liner, California choke, space cowboy, airplaning, purple dragon, and cloud nine.

Kids can “pass-out” in just a few seconds and can die within a few minutes if the strangulation is severe enough.

Repeated episodes of hypoxia from the game can cause the typical hypoxic brain injury. Other injuries include concussions or broken bones (including jaws) from falls associated with the choking game and various eye problems including hemorrhages.

Malpractice realities

Many physicians get named in “shotgun” lawsuits and even though most get dismissed at some point, it takes its toll in emotional distress and costs.

In most states, attorneys filing malpractice claims on behalf of adult patients must do so within a certain time frame from the date of injury.

Fear of excluding the true defendant from a suit often leads plaintiffs' attorneys to name anyone and everyone remotely involved in the case, otherwise, the attorney could potentially have some liability.

But during the months and years that these cases sometimes drag on, physicians have this black cloud hanging over their head. It can cause problems with malpractice carriers and anytime you apply to become a provider in a new insurance plan or hospital, you have to recapitulate the facts of the case and provide in great detail why you believe you are not at fault.

This is time-consuming and can prevent you from being accepted on an insurance plan or medical staff.

Some physicians spend hours on the cases trying to go back through records etc. and psychologically it really can take its toll. But when you are finally dismissed, there is no apology, no reimbursement and nothing to compensate for the emotional stress. No letters go out to all the places you had to explain this issue with and no one to hold at fault.

All this wasted time and emotional distress is many times unnecessary. In some states malpractice claims are preceded by a medical expert's signed affidavit. This would help limit some physicians getting named.

Then, when doctors are dismissed from a lawsuit without any settlement, shouldn't courts expunge any mention of the original litigation from the records?

In the current system, physicians are not only considered guilty until proven innocent, they're still regarded as suspect after claims against them have been dropped. This seems unfair as well.

The consequences of being named as defendant in a malpractice case are too devastating, for doctors who are subsequently dismissed and plaintiff’s attorneys should have some accountability.

Recommendations from consultants are that if a physician is named as part of a shotgun suit, physicians need to take it seriously because their practice and reputation are at stake, and they will be reported to the National Practitioner Data Bank when a payment is made as the result of a settlement or verdict if they are not dropped. That could trigger a hike in their insurance premium and could jeopardize their ability to get any coverage.

This is not an overall complaint about malpractice attorneys. The ones I know and actually consider friends are very good about doing their due diligence before filing suits. But just as with physicians, a few bad ones can really cause a lot of problems!!

Sudden Awakening

Here is some more East-coast nonsense.

In Danbury Connecticut, officials have been notified they are being sued by a student who was awakened in class by a teacher who made a loud noise.

The allegation stems from a 15 year old who states he suffered pain and very severe injuries to his eardrum when his teacher woke him by slamming her hand down on his desk.

As of now, documents have been filed with the Town Clerk and this is usually a prelude to a lawsuit.

A city official stated the matter has been referred to Danbury's insurance carrier to take care of any future claim.

I am not sure what is more troublesome, the student or the attorney willing to file the claim. Where is our legal system heading?

What happened to personal responsibility?

Men and Women eating patterns

Do men and women have a propensity for different eating behaviors and disorders?
A recent study may lend some support to this thought.

This study shows that young adult women exposed prenatally to testosterone have a reduced likelihood of developing eating disorders.

The researchers studied data on 582 twins enrolled in the Michigan State University Twin Registry. The participants included 583 twins and a control group of 69 women who were raised with at least one brother and the age range was 18 to 29 years.

Disordered eating behaviors were assessed with the Minnesota Eating Behavior Survey which measures perception of body dissatisfaction, weight preoccupation, binge eating, and compensatory behavior such as purging to control weight. All of these behaviors are exhibited much more frequently in women.

It is believed that females from opposite sex twin pairs are thought to be exposed to increased levels of prenatal testosterone, leading to "masculinization" of the central nervous system.

The results from this review did show that the masculinizing effects of prenatal testosterone, characteristic of male development, may play a significant role in the decreased frequency of the eating patterns in these females.

Reporting Bias

It is troubling when what gets published is so misleading and a recent example is that of a study regarding spinal stenosis and surgery benefits.

Most of what has been reported in various places seems to have come from the following press release.

This news story presented a summary of a major new study comparing surgery to nonoperative treatments for lumbar spinal stenosis.

When you really evaluate the study and what was found, you would probably conclude that surgery is not all that great.

This story focused on those results that showed the greatest advantage for surgery; e.g. dramatic differences in patient-perceived “major improvement” of 63% vs. 29%, but the “truth,” many observers would say, likely lies somewhere between the minimal/modest benefits that the news story did not report and the larger benefits that it did.

In addition, the story seems to imply that surgery should be the treatment of choice for all patients with spinal stenosis but the study really does not support this.

The news story thus misses a key point and that being surgery appears to be a good choice for some people but it is not for everyone.

The news story failed to mention the possible harms of surgical treatment and it would have been worthwhile to hear from other surgeons not associated with the study to get their opinion.

The reporting on this was incomplete and arguably biased more than most medical studies.