Yesterday we converged at Emory University to present a letter to President Jim Wagner requesting that Emory join with other dialysis centers in Atlanta, GA to help provide care for the 33 dialysis patients whose extension of life-saving dialysis ends next week. We then traveled to the Fresenius Dialysis Center at 231 14th St in Atlanta, where treatment of the patients is ending Aug 31 2010, to present a similar letter. Today there was a protest at Grady Hospital. Time is running out for these patients and it is really disheartening that money is thrown after expensive medical procedures in this country that do not clearly work, while something like dialysis that means the difference between life and death is denied to some people.

Read prior posts on the history of this issue here.

 

I invite doctors and other healthcare workers to speak out about the death sentences being handed out to patients.

Sign the petition to save the Grady dialysis patients here.

After August 31, 2010, thirty three (33) uninsured End-Stage-Renal Disease patients of Grady Memorial Hospital will no longer receive their life-sustaining dialysis treatments.

- In September 2009, Grady Memorial Hospital closed its outpatient dialysis clinic. At that time the thirty three (33) uninsured patients, most of whom are immigrants, were promised dialysis for one year from Fresenius dialysis facilities as specified in the Grady Memorial Hospital – Fresenius contract.

- On August 31, 2010 the Grady Memorial Hospital – Fresenius contract expires.

- To date, no alternative source of dialysis treatment has been made available to the remaining thirty-three patients.

- The patients will die within weeks of the August 31st deadline if they are not provided with ongoing dialysis treatment.

As advocates for human life, please sign the petition below to encourage the private dialysis providers of Atlanta, Georgia, to supply the 33 indigent patients of Grady Memorial Hospital with life saving dialysis care.

Here are some facebook groups you can join to keep abreast of the issue.

Protest the Grady Dialysis Cuts

Protest Grady Hospital’s Sentence of Death for Dialysis Patients.

Advocates for Responsible Care – Group

Read all posts about the Grady dialysis situation here.

and imminent sentence of death for 33 patients on Aug 31 2010. Interview by Grady physician Neil Shulman MD

Part 1

Part 2

Part 3

Neil Shulman MD gave a talk at a recent Emory Cardiology Research Conference about the plight of the Grady Hospital dialysis patients. (Read all of the posts about Grady dialysis here). A year ago, we the Grady patients received a death sentence after the board of directors decided to close the dialysis clinic and told the patients to go back to their countries or bugger off in general. In conjunction with the Advocates for Responsible Care we filed the patients into the board rooms and subsequent court hearings filed by Lindsay Jones on behalf of the patients. With some effort we got them to provide a year of treatment through the private clinic Fresenius, but now their time is up on August 31. At the conference one of the doctors said that the power of doctors is eroding, and increasingly it is the situation where administrators tell the doctors what to do with their patients. Funny, I didn’t think they should have the power to do that, but what the hey…

Meanwhile, at least one woman went back to Mexico, where she died because she couldn’t get dialysis, another went to Florida and almost died, then came back to Georgia, and there are several other stories like that. There still are 33 patients who need dialysis who are still alive who will be affected.

Meanwhile, the CEO of Grady, Michael Young, got a $300,000 bonus for saving money at Grady, which is the priority these days.

Pete Correll is former CEO of Georgia Pacific who runs the board of Grady. 

Baxter sells supplies for dialysis and charges twice as much for the dialysis supplies here as it does in Mexico. Maybe we should smuggle some over the border. We are asking Fresenius, DaVita, and Emory to provide compassionate care for these patients.  Robert J Parkinson, Jr, is president and CEO of Baxter.

 Kent J Thiry is CEO of DaVita, a dialysis company which has recently come under scrutiny for milking the use of the drug Epogen in dialysis patients for treatment of anemia.

Thomas Lawley MD is the Dean of the Emory Schoo of Medicine and is on the Grady Board. I have gone to the meetings but he usually just sits there and doesn’t say anything. Emory supposedly has picked up a few patients but they could do more to get these other harbingers of corporate greed to do something.

 

Ben J. Lipps, PhD, is the CEO of Fresenius who is the largest provider of dialysis in the US. They pay Lipps $4,310,000 a year in salary and compensation each year. (Maybe he could donate some to dialysis patients) Although Fresenius is a German company, they have adopted well to the American system of putting profits over people when it comes to healthcare. If a situation like the Atlanta dialysis situation occured in their home country, the local population wouldn’t stand for it.

The problem is that medical decision making is slowly being taken away from the doctors and put into the hands of people who don’t have the experience of connecting with people about their healthcare. Witness how administrators at Grady asked the doctors there to sign a statement saying that it would be fine for dialysis patients to get their dialysis only through the ER and on an as needed basis. They refused.

If each of these entitities would take on a few charity cases, like they used to in the old days, the problem would be solved.

Note: the post was updated one day after the initial posting.

See this article by UW-Seattle nephrologist Rudolph Rodriguez MD arguing that physicians have an ethical imperative to help these patients.

That’s right, The Snake Pit. It’s not the freaky mental hospital in the movie “One Flew Over the Cuckoo’s Nest.” It is the modern American jail, which now holds more mentally ill people than psychiatric hospitals.

I listened to a lecture by Judge Steve Leifman of the Miami-Dade County Court system, who realized five years ago that he was seeing many mentally ill people who were arrested for minor crimes like pushing a shopping court down the street (many of them were homeless), or whose family called the police, hoping to get help, only to have their loved one thrown into the slammer. People that are mentally ill stay in jail eight times longer for minor misdemeanors than other people. Often they get lost in places like “The Forgotten Floor” of Miami-Dade County jail (it’s actually four floors), because the State of Florida does not have enough psychiatric facilities to take them as a transfer. And so they stagnate in the County jail system.

Check out this video of an investigative report called “The Forgotten Floor”. It’s frightening.

Judge Leifman has taken an active role in reform, helping to create programs to divert mentally ill people who get arrested away from the criminal system and directly into treatment, and pushing the state to take responsibility for the mentally ill. Our State of Georgia has had its share of problems, with a rash of documented deaths occuring in inpatient psychiatric facilities due to neglect and over crowding. Maybe we could learn something.

This weekend we had the Emory International Medical Volunteerism Conference here in Atlanta, GA. George Lundberg MD was the keynote speaker and there were sessions on volunteering in third world countries, advocacy for patient rights and a range of other topics.

Lindsay Jones, the attorney who took on the case of the Grady Hospital dialysis patients who got yanked off dialysis with a certain death sentence, talked about advocating for the uninsured (See “Grady Hospital Tells Dialysis Patients to Leave or Die” and my posts from the court room “These are Real People” and “Healthcare is a Right“). Well, at least it is a right in most of the world, but not in the US, I guess, where a convicted mass murderer at least has the chance to have his day in court before they take his life away, unlike the unisured in this country, who get yanked off of dialysis with no due process. The Europeans who joined the Grady facebook page (see links in my prior posts, we got a couple hundred members) thought we were complete barbarians for acting like that.

Lindsay made the point he argued in court that healthcare is a right, and that you can’t deprive a person of their life without due process.

The Grady patients are currently getting dialysis with the private treatment program Fresenius until September of this year.

I gave a lecture about advocating for victims of medication related problems along with other members of the Grady Coalition who banded together to advocate for the dialysis patients who had no voice, and were being deprived of life as victims of the corporate medical model where sickness is viewed as a way to make money and making profits is put ahead of people’s lives.

Isn’t it great to live in America!

There was an interesting editorial written by Rita Redberg MD yesterday in the Archives of Internal Medicine about President Barack Obama’ latest physical. Sure, we all think that the Commander-in-Chief should pull out the stops to make sure he is healthy, but should we doctors condone his use of expensive technologies that have not been shown to add anything to health except cost? Especially when he is advocating healthcare reform that will cut costs?

Consider what this healthy middle aged under 50 male went through. Electron Beam Computed Tomography (EBCT) for measurement of the calcium in his coronary arteries, a super hyped procedure whose costs go into the hundreds if not thousands of dollars, and that has not been shown to have any beneficial effect on health outcomes. Next, a virtual colonoscopy, in a man who is recommended to get a one dollar stool guac test for early detection of colon cancer.
It’ not that these useless and expensive medical tests are so benign. The EBCT increased his risk of cancer by 9 out of 100,000 possible cases. The chairman of radiology here at Emory famously had a “routine” CT screening and ended up in the ICU because of all the tests that followed (in the end he had no disease).

So if Obama can’t give us a rational example of how to approach healthcare, who can?
Discuss!

I justed posted a guest blog on the Dear Thyroid website, which is a advocacy group for patients with thyroid disease here.

A local FOX Atlanta show, you can see me and read about it here.

Reported By: Beth Galvin | Edited By: Leigha Baugham

Nearly 20 percent of American doctors get paid by drug companies to be consultants or speakers, and in some cases, they’re making quite a lot of money. So does that influence the decisions your doctor makes about your care?

Doctors earn money by giving professional talks to their peers about the latest research and the practice is pretty common.

For years it’s been unclear how much money physicians were actually earning for these speeches. Now, three major drug companies are going public revealing who is on their payrolls and how much money they’re making.

On Eli Lilly’s website, the company lists faculty on the drug company’s payrolls, including educators, advisors and contractors.

Nearly 200 Georgia doctors are on the list and they pulled in over $2.2 million dollars last year.

Some of Georgia’s highest paid physicians on the list are Emory urologist Dr. Muta Issa, who earned $ 91,000 from GlaxoSmithKline. Atlanta endocrinologist Dr. David Robertson cashed in over $78,000 from Eli Lilly and Roswell psychiatrist Dr. Michael Banov banked over $68,000 from Eli Lilly.

Some healthcare providers are earning much more by working for several companies at the same time.

“It’s common, that people who are very active, can make several hundred thousand dollars or more,” said Emory psychiatrist, Dr. Doug Bremner.

“We don’t sell medications. We simply educate physicians about data, and they make their own mind up,” said Dr. Banov.

Dr. Banov, a private practice psychiatrist, was paid over $68,000 by Eli Lilly. The Roswell doctor said he gives speeches for about five companies with competing medications.

“I think my patients welcome the fact they have a doctor who is meeting other doctors, actively involved in research, actively communicating with other physicians, someone who’s on top of the game,” Dr. Banov said.

Dr. Banov said the drug company, not him, creates the materials used in his speeches, and he also said there’s a reason for that. “We are only able to present the data. We’re not able to present our personal opinions, our personal preferences, how we use the medication off label, any of that. So we’re held to a very tight standard by the FDA.”

Emory’s Dr. Bremner said he thought paying doctors to speak for drug makers was a bad idea. Bremner said he used to do it, until he got a wakeup call about six years ago.

“I was going out to give a talk and the sales, the marketing guy like, slapped me on the back and said, ‘Go on out there and sell some,’ I’m not going to say the name of the drug. ‘Sell some of that drug,’” said Dr. Bremner.

Dr. Bremner said he worried that even the most independent doctor can get hooked on all that extra cash coming in. “Doctors are human, and once you get into this routine of making outside income, you become dependent on it.”

When asked how receiving money from the drug companies could from influencing how a doctor treats a patient, Dr. Banov said, “When I close that door, and I’m with a patient, my 100 percent interest is in getting that patient better.”

Last fall, Emory University’s School of Medicine banned staffers from making promotional talks for drug companies after congressional investigators accused the school’s chief of psychiatry, Dr. Charles Nemeroff of failing to report to the university over a million dollars he got from pharmaceutical and medical device manufacturers.

Dr. Nemeroff resigned his chairmanship, and has since left the school.

Another Emory staffer, urologist Dr. Issa listed his earnings as $91,000 in the first three months of 2009 from GlaxoSmithKline. Dr. Issa declined to comment on this story. A school spokesperson said Dr. Issa left the speaker’s bureau when Emory changed its policies.

Atlanta diabetes specialist Dr. David Robertson, who earned $78,000 for giving 47 promotional talks for Eli Lilly, said he only speaks about medications he actually prescribes.

“I think a presentation a physician makes should represent their own practice,” said Dr. Robertson. The doctor did admit that some physicians spend too much time promoting too many products. “That’s bad for everyone. That’s bad for the pharmaceutical companies, that’s bad for physicians as a profession and that’s bad probably for physicians as recipients of information because they become mistrustful.”

So are public lists like this a good thing?

Doctors on both sides say yes.

“I think it’s gotten to the point where the public is looking at it for what it is and they’re saying, ‘What’s going on here?’” said Dr. Bremner.

“Why not let the public know? There is nothing to hide. There is no shame. We’re not doing anything illegal,” said Dr. Banov. “I think it’s terrific. [It] should be completely open.”

So far, GlaxoSmithKline, Eli Lilly and Merck have published online lists of who’s on their payroll. Pfizer will be doing the same this spring.

Related Links: statements and public registries for Eli Lilly, Merck (also see here) and

GlaxoSmithKline (also see here).

Complete statement from Emory University School of Medicine regarding its new Conflict of Interest policy.

“In June of 2009, Emory’s School of Medicine adopted a comprehensive new policy governing faculty relationships with industry. The policy meets the recommendations of the Association of American Medical Colleges, the Association of American Universities, and the Institute of Medicine. Professors Issa, Pacifici, and Schulman are respected faculty members who are in compliance with that policy. Dr. Nemeroff resigned his position at Emory in fall of 2009 to become chair of psychiatry at another medical school.”

The situation at Grady Hospital in Atlanta of cutting off dialysis for poor patients without insurance (which will make them, um, die) is an echo of the national political farse of throwing out public option health insurance and throwing more good money after bad (Karen Ignagni and her group of health insurance criminals). I am glad to see that Max Baucus (D-Mont) who was the author of the bogus healthcare reform bill (and a top recipient of pharma contributions) was able to get some extra healthcare money for some miners from Libby, Montana, as well as shell out even more profits to the pharmaceutical industry, health insurance, etc. Here he is in action shelling out the pork.

Here is an update on the Grady story from Neil Shulman MD:

IT IS SAD.  I had a meeting with the woman who wrote the book THE GRADY BABIES and a woman who works at Channel 11 and the nurse from Nigeria who has been here ten years, Is married to an American and just got her Green card.  SHE NEEDS TO BE HERE 5 MORE YEARS BEFORE GEORGIA MEDICAID PAYS FOR HER DIALYSIS.  The Channel 11 lady and the author (WROTE A GREAT BOOK WITH DICK GREGORY) are connecting with Dorothy to get the book on the dialysis crisis rolling (30 people who may lose their lives after Jan 3rd when the inner city hospital stops supporting dialysis for their kidney failure.)  They are planning on putting personal stories about the patients on the internet.

In the meantime,  there is a movement by some docs within Grady Hospital to change things such that humanization takes precedence over monetazation. ALSO,  THERE IS A PLAN TO TAKE A BUS LOAD  OF THE DIALYSIS PATIENTS TO A HOSPITAL EMERGENCY ROOM ……….ALL AT ONCE…EVERY FEW DAYS ……after Jan 3rd.

 ON another front,  the medical volunteerism conference WWW.EMORYIMVC.ORG  is MOVING ALONG VERY WELL…………..we have some fantastic presenters,  the first edition of the book about  these heroes is almost ready,  the White House is sending folks………….AN OUTPOURING OF SUPPORT FROM HUMANIZERS.

IF YOU HAVE SOME TIME,  WE SHOULD AT LEAST CHAT ON THE PHONE TODAY.  I AM AT 404-321-0126.  IF NO ANSWER,  JUST LEAVE YOUR NUMBER AND I WILL RETURN YOUR CALL SHORTLY.

NOW A SHORT OVERVIEW OF THE CURRENT CIVIL WAR IN THIS COUNTRY:

We are in the middle of a war in this coutry between the monetizers and the humanizers.  Sadly,  the victims of this war are poor sick people.  IF everybody was a humanizer as the folks involved in the medical volunteer activites………….there would be no problem.  We would have peace and poor sick people would not suffer and die……. One of the major obstacles to winnning this war is the barrier between the poor sick patients and everybody else.  The caring nurses and doctors AND LAY FOLKS who are on the front lines Understand the current atrocitIES.  The further one is away from connecting with poor sick people,  the less likely you can empathize with them.  It is easy to use words like “ILLEGAL ALIENS”  OR “LIMITED RESOURCES FOR POOR SICK AMERICANS”  and just let people suffer and die when you don’t have to look in the eyes of these people or hear their stories. 

One of the free clinics in South Atlanta struggles with getting patientsurgent health care by specialists every day.  Recently, there was a case of a man needing back surgery before “he became paralyzed.”  The community clinic (docs, nurses, and pastors) FOUGHT HARD AND got the patient into Grady Hospital for the surgery.  On the other hand, there are folks like the 23 year old woman who recently died in Grady because she was shut out of her access to steroids for her Lupus.  She did know how to overcome the new barriers (more paperwork and more upfront fees to be seen for a few minutes so she could get her refills).  She ended up in Grady’s ER very very sick. She was admitted and died. Medical students and staff docs told me the story.  Many folks are familiar with this recent tragedy.  There are many folks in similar situations every day who die at home without even getting to the emergency rooms.

In developing countries where there is lack of access to health care………..at least there is not a COVER-UP.  When we brought a little girl from Kenya to Univ of Alabama Med Center for heart surgery…………..the Kenya media, the local Kenya politicians,  the local roatary club,  THE HAVES AND THE HAVE NOTS…..ALL JOINED TOGETHER AND HELPED SAVE THIS LITTLE GIRL’S LIFE.  IT WAS AN ENTIRELY DIFFERENT CULTURE.  THERE WAS NO HIDING OF “THE FACTS.”  THERE WAS NO INTIMIDATION OF THE CARING FOLKS BY  MONETIZERS.  We are experiencing a larger and larger class of HAVE-NOTS in this country because of the economy.

DAILY MEDIA ATTENTION SHOULD BE FOCUSED ON EFFORTS OF THE HUMANIZERS TO HELP POOR SICK PEOPLE.  THIS WOULD GALVANIZE EVEN MORE PEOPLE TO JOIN IN.  THIS WOULD GALVANIZE MORE PEOPLE TO ADVOCATE FOR LEGISLATION TO ELIMINATE THESE ATROCITIES.  Maybe we could even get the Georgia Legislature to allow poor people to get medicaid coverage BEFORE THEIR CANCER SPREADS.  THE MEDIA WILL NOT INFOMORM THE PUBLIC THAT IF YOU HAVE A MALIGNANT MELANOMA ON YOUR SKIN AND YOU ARE POOR…………..THE STATE MEDICAID EMPLOYEES ARE FORCED TO TELL YOU “SORRY MEDICAID DOES NOT COVER YOU UNTIL YOUR CANCER SPREADS THROUGHOUT YOUR BODY.” 

 We need more media attention, legal action, and MORE folks EDUCATED AND involved.  IT IS A STRUGGLE WHICH CAN ONLY BE WON WITH AN ARMY OF HUMANIZERS.  I have found that people with resources who are humanizers are MUCH HAPPIER than people with resources who are monetizers.  You are surely one of the humanizers.

 IF THE MAJORITY OF MEMBERS OF THE US CONGRESS WERE NOT MONETIZERS………….THEN TRULY MEANINGFUL NEW LEGISLATION WOULD BE PASSED TO ELIMINATE THE BASIC HEALTH DISPARITIES BETWEEN  THE HAVES AND THE HAVE-NOTS.  WE CAN STILL HAVE PEOPLE WITH BIG HOUSES AND SMALL HOUSES, PEOPLE EATING AT FANCY RESTAURANTS AND PEOPLE EATING BASIC HEALTHY FOOD AT HOME,  PEOPLE GOING ON  EXPENSIVE VACATIONS AND FAMILIES DOING MEDICAL MISSIONS………..BUT AT LEAST WE WOULD HAVE A COUNTRY WHERE POOR SICK PEOPLE HAD ACCESS TO BASIC HEALTH SERVICES AND BASIC MEDICAL THERAPIES……….WHICH ARE AVAILABLE TO MOST PEOPLE IN EUROPE, CANADA, JAPAN, KOREA, ETC.

AND BY THE WAY,  IT WOULDN’T HURT IF MEDICAL LITERACY WAS AN INTEGRAL PART OF OUR EDUCATIONAL SYSTEM………..WHY DO JUST DOCTORS AND NURSES LEARN HOW TO EXAM THE HUMAN BODY, WHAT SYMPMTOMS ARE IMPORTANT, HOW TO PERFORM SIMPLE PROCEDURES LIKE TAKING BLOOD PRESSURES?……………..WHY NOT EMPOWER CONSUMERS SO THEY CAN USE THE HEALTH CARE SYSTEM MORE EFFICIENTLY.  READING, WRITING AND ARITHMETIC ARE IMPORTANT BUT YOU CAN’T DO ANY OF THOSE IF YOU ARE DEAD.  MARTIN LUTHER KING EMPOWERED FOLKS BY TEACHING THEM HOW TO VOTE.

LET’S EMPOWER AMERICANS BY TEACHING THEM MEDICAL LITERACY………….LET’S EDUCATE THE SCIENCE TEACHERS SO THEY ARE MEDICALLY LITERATE, SO THEY CAN TEACH OUR FUTURE GENERATIONS ON HOW TO EFFICIENTLY USE THE HEALTH CARE SYSTEM.

BEST,

NEIL SHULMAN