Mrs Bremner has been appointed Chair of Epidemiology at the Rollins School of Public Health and is starting this week! She will continue her research program at EPICORE but will have this new job as well! Hands over heads clapping!
I pledge to donate the majority of my future earnings as an expert witness in Accutane litigation to a non-profit institute for transparency in medicine as a counter-balance to the pharma marketing driven information that floods the US medical field and educational system at the current time.
In 1823, an 18-year-old boy from Palmyra, New York, was visited by an angel, who told him of some magical gold plates. Armed with special glasses, he was able to translate them into a book that told about how the lost tribe of Israel was visited by Jesus in the Americas hundreds of years ago. In 1831, he started a church in Kirtland, Ohio.
He later said that church members could act as proxies for deceased persons, baptize them, and “seal” them into family clans that would be reunited in Heaven. His successor wrote about “the perfect mania” that possessed some of his followers as they started “to get up printed records of their ancestors.”
Over the next 168 years, 113 million people were introduced, after death, to the church.
Members of his church, called the Church of Jesus Christ of Latter-Day Saints (LDS, commonly known as the Mormons), are worried that their ancestors who lived before the beginning of the church won’t be able to join them in heaven. But in order to get them into the church, they have to figure out who they are first.
That makes them some pretty damn good genealogists.
They’ve got a vault carved into the solid granite of a mountain 20 miles southeast of Salt Lake City, Utah, where they store information about the births, marriages and deaths of over 2 billion people, the largest single database on the details of the human race in the world. Buried 600 feet into the mountain, protected by two nine-ton and one 14-ton doors built to withstand a nuclear blast, the Granite Mountain Vault isn’t going anywhere soon. Five billion documents are stored on 1 ½ million rolls of microfilm and 1 ½ million microfiche. Twenty-five thousand volunteers are currently working to scan and index all of these documents as well as put them on the Internet so that one day soon you can access all of this data while sitting in your kitchen in your slippers with a notebook computer on your lap.
Ancestry.com, a subscription-based service started by members of the LDS church, has 900,000 subscribers, and is growing. Ancestry put millions of documents online, including five billion names. They have census records for all of the US from the past 200 years, birth, marriage and death records, and more. In May of 2007, they dumped the military records of all of the soldiers who fought in all of the US wars, 90 million of them, online.
Genealogy is now America’s #1 hobby. Millions of documents are being put on line so that subscribers can sit in their kitchens rather than traipsing across the country in search of obscure church and governmental archives.
As the fastest-growing church in the world, you have to wonder if the Mormons are onto something. That connecting with the nodes of your family, those linked to you by sperm and eggs and DNA, looping simultaneously backward and forward through space and time, like the drooping lines connecting the electricity towers that move through mowed swaths of forest in the rural parts of America, will lead you to paradise?
Who am I to say no?
What a year! Here goes…
DSM V Shadow Team Strikes Back at Psychiatric Establishment on PTSD: My blogs about psychiatry and the DSM were the most controversial but also most read, funny how that goes. In this post I acted like an asshole in criticizing what had been written in the popular press about the process of defining PTSD.
Goodbye to You Too Yaz: That Birth Control Pill is Driving Me Bananas: Bayer spent $20 million for an advertising campaign to reverse the effects of its ad campaign promoting the oral birth control pill, Yaz, as effective for the ups and downs of daily life as well as zits and other skin blemishes. The ads showed women kicking around balloons that said stuff like “mood swings” and “fatigue” while they played the songs “Good bye to You” or “We’re Not Going to Take It.”… too bad the drug can MAKE you depressed…
DSM-V Shadow Team: Retaliations & Beware of Consequences
An article in press in Psychiatric Times which I have posted here has been circulating around that represents a remarkable critique of the process of revising the Diagnostic and Statistical Manual (DSM-5) by the American Psychiatric Association, Chaired by David Kupfer MD. What’s more chilling is that it is authored by Allen Frances, MD, who chaired the committee to write DSM-4. Dr. Frances comes up with some pretty strong language, e.g.:…
Why I am Not Getting a Flu Shot This Year. Because they don’t work? This one resulted in me having to publicly debate the head of infectious diseases from Emory. Yikes.
Obama Healthcare Plans Unlikely to Get Much Traction: Pretty pessimistic, I know, but born out by the Senate bailing on the public option for healthcare insurance, the only part that mattered. You can read about how the thing went on from there here.
DSM-5 Internet Addiction Disorder? Armaggedon and Manning the Barricades More on DSM and the process of speeding up the writing of the next Bible of Psychiatry.
Are Dermatologists Dippy? The Depressing Accutane Tale Chronicled the history of the coverup of the side effects of the acne medication.
Motherhood is Not a Medical Disorder: Just say no to mandatory screenings of moms for postpartum depression which leads them down the path of antidepressant treatment which can get in their breast milk. This one kicked off a flame war with John Grohol and his site Psych Central
What Ever Happened to Pharmagiles? Turned out he was a comic book author from England.
Taking Ecstasy Not More Dangerous Than Riding a Horse: According to Dr. David Nutt of the UK, anyway. Kicked up quite a fuss with Brit politicians, however.
Grady Hospital Tells Non-citizen Dialysis Patients to Leave or Die. Nice guys! Chronicled our political activism in Atlanta to try not to let the for profit American “model” of healthcare kill people…
Half of all Americans take prescription medications. Eighty one percent take some type of pill. 100,000 die every year from a prescription med that they either didn’t need or that was not properly prescribed. What is going on here?
While it’s true that many drugs help people live longer and better lives, it is also true that they can have unintended side effects. Pharmaceutical and supplement manufacturers have to increase sales and profits, as all businesses must, and they do so in part by developing drugs to treat disease and also by convincing people they need meds to prevent disease or lessen the perceived risk of future illness. Marketing leads to efforts to promote the positive aspects of drugs, sometimes at the expense of acknowledging the negatives. Study results are extracted to different groups, e.g. lipid lowering drugs like Lipitor are promoted for women based on studies in men. This relentless drive means that prescription meds are promoted for more and more people. Do all these people really need to be taking prescription medications?
If you followed the US guidelines, half of all men (based on their LDL cholesterol levels) would be on a statin drug like Lipitor. Half of women over age 72 would be on a bisphosphonate drug like Fosamax or Boniva, for prevention of osteoporotic fracture. And half of women over age 50 would be diagnosed with “osteopenia” and advised to “talk to their doctor” (presumably about taking a pill to prevent osteoporosis). And if you followed the USDA guidelines for minimal intake of vitamins and minerals, all of us would be on a multivitamin. More recommendations… Everyone take an aspirin and fish oil supplement to prevent heart disease, all women should take calcium, etc etc.
Have we gone nuts?
A factor that has expanded use of prescription medications happened in 1997, when the FDA lifted the ban on direct to consumer advertising along with the law that required ads to list every possible side effect. Soon after, Americans were bombarded daily with commercials for prescription drugs. The US is the only country in the world where you can turn on the TV and have an announcer tell you to go ‘ask your doctor’ for a drug.
Doctors often will give medications to patients even if they don’t think they need it. For example, one study showed that 54% of the time doctors will prescribe a specific brand and type of medication if patients ask for it. Drug companies also buy information about the medications that doctors prescribe from major chain drug stores like CVS, and then use this information to reward doctors who prescribe their drugs frequently. Research studies show that this can influence behavior, like how often a doctor will try to have a drug from that particular company put on his hospital’s formulary.
Expert guidelines promoting the use of prescription medication can also drive prescription behavior, because doctors feel like they need to be following the guidelines to adhere to accepted standards of care.
In 2005 in the aftermath of the Vioxx debacle and withdrawal from the market, Janet Woodcock, Deputy Commissioner of Operations at the FDA, said that the nation’s drug safety system had, “pretty much broken down.” She charged that neither doctors nor patients had enough information about the side effects of drugs to make informed decisions about taking them. Dr. Woodcock went on to say that, “the bottom line is that a lot of drug safety problems are actually preventable, [because] most adverse events are from known side effects.”
I’m not saying that some drugs don’t ever successfully prevent disease, or that newly described diseases and syndromes are necessarily invalid. But the fact is that no matter how you look at it, the US (and to a lesser extent other countries) has a prescription drug problem. The US spends two times more on drugs, and takes twice as many drugs, as other countries, and has worse health. In fact, we have some of the worst healthcare outcomes in the industrialized world, including total life expectancy, and survival of children to their 5th birthday. In a survey of 13 industrialized nations, the US was found to be last in many health-related measures, and overall was 2nd to the last. Even England, which has higher rates of smoking and drinking and a fattier diet, has better health than the US.
Did you know that you shouldn’t go to the doctor if you are not sick and have no risk factors for disease? Who says that? The American Medical Association! Why? Because there isn’t any evidence that screening for disease really improves health outcomes.
Given medical scares like Vioxx it’s not surprising that Americans have become wary of the FDA and drug companies, and both of their public images are beginning to suffer. The Economist reported that less than 50% of us perceive drug companies as “favorable.” That’s only slightly above the low favorable ratings we give oil and tobacco companies.
Many Americans have become disgusted with prescription drugs and the American medical establishment, so they turn to alternative medicine, who frequently promote vitamins, herbs and supplements.
However vitamins and supplements can and do indeed cause harm. And unfortunately the government has contributed to misinformation about vitamins and supplements. The US Department of Agriculture (USDA), whose job it is to promote the interests of agriculture (i.e., makers of meat and milk) and not health, regulate foods and beverages. Vitamins and supplements are classified as foods, not drugs. Lobbyists for the vitamin and supplements industry have blocked efforts by the Department of Health and Human Services (DHHS), the federal agency responsible for health, to get involved.
The USDA’s Recommended Daily Allowance (RDA) of vitamins and minerals has been great for the vitamin and supplement industry, as well as cereal makers who supercharge sales by adding vitamins, and minerals to breakfast foods, and then convince customers they need to eat these fortified products to get their minimal daily requirements of vitamins and minerals. This is despite the fact that there is no way to get enough of the recommended vitamins and minerals in normal food without overeating. Government recommendations are actually four times higher than what you really need. The fact is that you don’t need extra vitamins, and that if you stick with fresh vegetables and fruit and other whole foods, you will stay healthy. Those making big money on vitamins and supplements are often doing so at the expense of your pocket book, and sometimes your life.
Ironically most recent health gains have come through increased knowledge of health risks and better health practices (or prevention). We smoke less, have better access to nutritious fruits and vegetables year round, pay more attention to cleanliness and hygiene, and have improved safety in general. For instance, in the 19th century it was not known that dirty water and shared cups could spread disease. Hand washing is still the single most powerful way to prevent the spread of communicable disease, but this was not discovered until 1847, when Ignaz Semmelweis, a young Viennese doctor in an obstetrics ward, observed that midwives who washed their hands had lower mortality rates among their patients than doctors, who often went from autopsy room to delivery ward without so much as a hand wipe.
Future advances in health will likely come more from changes in lifestyle, diet and exercise, than from medications. Almost all of the chronic conditions for which pills are prescribed are preventable through such changes. Other conditions like cancer are partially preventable.
It is time for Americans to rethink the role of medications and other pills in their lives in relation to other actions that can be taken to maximize health, such as making changes in diet; incorporating exercise into one’s daily routine; learning and using stress reduction techniques; and changing other behaviors like quitting smoking. The most common disorders, like diabetes and heart disease, are always better treated and prevented through changes in diet, exercise, and lifestyle that they are with medication.
via Bertie Skellie of Grady Advocates
Dear Friends of Grady Patients & Workers,
Please see below several articles and links related to the closing of the dialysis clinic at Grady. They are listed in this order: AJC on today’s ruling by the judge (with other AJC links), a link to Dr. Doug Bremner’s report from the courtroom on Monday, Dianne Mathiowetz’ article for Worker’s World, Wall Street Journal, & New York Times.
I will let you know details of our next action related to the dialyis clinic closure. It will most likely be Monday, when the Grady Authority has a meeting & when the case is likely to be back in court.
Peace,
Bert
By Shelia M. Poole and Craig Schneider
The Atlanta Journal-Constitution, 9/25/09
A Fulton County Superior Court judge this morning cancelled a temporary restraining order that had stopped Grady hospital from closing its outpatient dialysis clinic.
·
· N.J.: No Grady dialysis patients
· Advocates rally to demand Grady dialysis stay open
· States won’t take Grady patients
· Court orders Grady clinic open
· Grady dialysis patients get reprieve
· Grady offers to relocate patients
· Grady dialysis center to close soon
The clinic is expected to close in about a week. Earlier, officials said the clinic was to close Saturday.
The hospital had planned to close the clinic Sept. 19, but patients and advocates asked the court to stop it, saying they would suffer harm without the service. Many of the patients are illegal immigrants who are poor and Grady is the only major hospital in metro Atlanta that offers them free outpatient dialysis service.
In a ruling this morning, Judge Ural Glanville said that the patients lacked the legal standing to bring the request to the court.
“The court is unpursuaded at this time that the plaintiffs have a constitutional right to the sought-after relief,” the judge wrote in his decision.
The judge had granted the temporary restraining order a few days ago pending a hearing. His decision followed the earlier hearing.
“I think it’s a travesty,” said Dorothy Leone-Glasser, patient advocate and co-founder of Grady Adovates for Responsible Care. “I don’t know how anyone involved in Grady can sleep at night because I can tell you that none of the patients that we know about — 34 of them — and their families will be able to sleep at night. I dont’ know how they can do it.”
Abebech Tadesse said her 69-year-old father, Tadesse A. Amdago, a green card-holder from Ethiopia, has no options other than Grady.
“The only option is to count the days until he dies. It’s not a peaceful death,” she said. ”I will pray and see what’s going to happen.”
See just below to Dr. Doug Bremner’s report from the courtroom on 9/23, entitled “Do I have the right to live.”
http://www.beforeyoutakethatpill.com/index.php/2009/09/23/do-i-have-the-right-to-live/
real death panel
By Dianne Mathiowetz
Atlanta
Published Sep 23, 2009 6:24 PM
More than 100 patients, their family members, doctors, other health workers and community activists packed into the board room at Grady Hospital on Sept. 14 to press for the continued operation of the outpatient dialysis clinic, a function of the once-public hospital for 62 years.
Ignoring the appeals of the crowd, many of whom held signs reading “How Many Will Die?” and “Keep the Clinic Open,” the corporate-dominated privatized board voted unanimously to close the life-sustaining treatment facility on Sept. 20.
Photo: Jonathan Springston, |
Despite boasting of raising more than $280 million for the financially stressed hospital, Board Chairman Pete Correll, former head of Georgia-Pacific, justified the decision by stating that the dialysis clinic was “a big money loser.”
About 100 patients suffering from renal failure and kidney disease currently receive dialysis at Grady. Some of them must go three times a week to rid their bodies of the deadly toxins that build up. Many of them are long-time immigrant residents who have lived in the Atlanta area for decades but under Georgia law are ineligible for Medicaid coverage.
Others who are U.S. citizens or have a green card have not yet been approved for Medicaid. Georgia has one of the highest rates of application rejection in the country, requiring sick people to apply multiple times or wait extraordinarily long times for acceptance into the program.
In August, social workers began to tell these critically ill people that the clinic was closing. People were given a seven-page list of for-profit dialysis centers to call to see if the centers would accept them as patients.
Their other options were to return to their home country, move to another state where Medicaid is available to undocumented immigrants, or go to an emergency room when the poison build-up brings them dangerously close to death. Federal law mandates emergency dialysis treatment if death is likely.
As a gesture of “care and compassion” for these patients, Grady officials offered to pay for plane tickets to Mexico, Thailand, Honduras and Ethiopia as well as transportation to the 11 states identified as providing immigrant care. Inexplicably, when contacted by reporters from the Atlanta Journal-Constitution, health officials in at least three of those states—North Carolina, Virginia and New Jersey—said they also do not pay for outpatient dialysis treatment for undocumented sick people. Florida, another state on the list, requires a six-month residency, an impossible wait for a dialysis patient.
The patients who testified at news conferences, rallies and at the board meeting repeatedly said they had nowhere to go. Many are unable to work. All have family and children in the Atlanta area who care for them, take them to their doctor appointments and dialysis treatments.
One woman said through her tears: “I have no one in Mexico. Who will look after me?” Her three young granddaughters carried a carefully printed sign that read, “Don’t send our grandmother away.”
Opponents of the closure won a temporary restraining order on Sept. 16 that mandated the hospital continue serving dialysis patients and prohibited it from pressuring patients to leave the state. On Sept. 23, there will be a hearing to determine if the injunction will stay in effect.
In his initial ruling, Judge Ural Glanville stated that before he would allow the clinic to close, Grady would have to provide all patients with a “plan that does not jeopardize their lives or medical needs.”
The Grady Coalition, which has been an activist voice for quality patient care and for workers’ rights at the hospital for 10 years, is being joined in the struggle to save the dialysis clinic by Grady Advocates for Responsible Care, a group of doctors, clinicians and patients.
Articles copyright 1995-2009 Workers World. Verbatim copying and distribution of this entire article is permitted in any medium without royalty provided this notice is preserved.
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· SEPTEMBER 24, 2009, 11:06 A.M. ET
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ATLANTA — Publicly funded Grady Memorial Hospital has served as a lifeline for this city’s indigent for more than a century, but a plan to shutter its dialysis clinic has sparked a lawsuit on behalf of dozens of undocumented immigrants who say the decision amounts to a death sentence.
The case in Fulton County Superior Court throws into sharp relief some of the hottest issues in ongoing skirmishes over health care and the government’s role in providing medical services: how and whether undocumented aliens should receive free treatment, and how far hospitals must go to provide lifesaving care for them.
“The issue is, do my clients have a fundamental right to life?” said Lindsay Jones, an attorney for the plaintiffs, during a packed hearing before Judge Ural Glanville on Wednesday.
Mr. Jones said one elderly patient, a partially paralyzed and undocumented immigrant from Colombia who was wheeled into the courtroom on a bed, recently returned from Florida after being told he wasn’t immediately eligible for regular dialysis treatment there. He had been receiving such treatment at Grady.
Bernard Taylor, a lawyer for Grady, told the judge that the charity hospital can no longer afford to provide regular dialysis treatment for the slightly fewer than 100 patients of the clinic. He said the clinic is posting annual losses of about $2 million and would require another $2 million to bring the facility up to date even though it serves a tiny portion of the hospital’s patient base.
Mr. Taylor said Grady has taken steps to help about 90% of the patients find alternative care and is committed to finding solutions for the remaining patients, who require dialysis to prevent kidney failure. Grady is the only large hospital in Atlanta still providing regular dialysis for undocumented immigrants — most of whom can’t afford the treatment, which typically costs a few hundred dollars a session.
Judge Glanville said he expected to rule on the matter later this week. He ordered a temporary injunction last Thursday — one day before Grady planned to close the dialysis clinic — requiring the hospital to continue providing the service until it presents “a suitable alternative treatment plan” for affected patients.
Grady estimates about two-thirds of the patients who use its dialysis clinic are undocumented immigrants without health insurance. Mexicans make up the largest single group; others are from countries including El Salvador, Nigeria, Egypt, India and Cambodia.
The dispute highlights conflicting views in state capitals of what constitutes emergency care. Under U.S. law, hospitals are required to treat patients in danger of death regardless of their immigration status or ability to pay. Treatment typically takes place in emergency rooms, with the resulting costs split between the states and the federal government.
Some states also offer undocumented immigrants regular dialysis treatment three times a week outside of the emergency room if the patients don’t have money or insurance. That is because many such patients would return to the emergency room every two weeks or die without regular treatment. Local hospitals can then be reimbursed under Medicaid, a state-federal health-care plan. But other states, including Georgia, don’t approve regular dialysis treatment under Medicaid.
“States have flexibility” in determining what qualifies as an emergency medical condition, said Mary Kahn, a spokeswoman at the Center for Medicare and Medicaid Services, the federal agency that oversees government-funded health care benefits.
Grady has nearly 1,000 beds, serving mostly the poor and uninsured in downtown Atlanta since 1892. It posted an overall loss of $33.5 million last year and relies heavily on federal funding to support operations. Two local counties have provided massive subsidies to bridge Grady’s deficits.
In an effort to shore up the finances, management of Grady was handed over to a nonprofit corporation last year. The board is chaired by A.D. “Pete” Correll, the former head of Georgia-Pacific Corp. But the hospital is still owned by the public Fulton-Dekalb Hospital Authority.
Grady says it can’t afford to keep running the money-losing dialysis clinic without cutting off essential services to other patients in need. It says funds currently being spent on treating nearly 100 dialysis patients could finance 75,000 outpatient visits at its neighborhood health centers, which provide preventive care.
“Those who are less fortunate or who have less access to care will always have a home at Grady. But even in that context, Grady has some tough decisions to make. Otherwise, we won’t be in business,” said Matt Gove, a senior vice president at the hospital.
The hospital began informing dialysis patients earlier this summer that it would be closing the clinic. It recommended patients return to their home countries for treatment or move to one of about a dozen states it says provide the service for undocumented immigrants under Medicaid. Grady also has offered some financial assistance.
Salvador De Lara, the Mexican consul general in Atlanta, said half a dozen Mexican patients had returned to their home country as of Tuesday. He said the consulate was working to ensure continued care for the repatriated patients in Mexico and helping them financially.
But several patients told The Wall Street Journal they still hadn’t lined up alternative care and weren’t sure where to go if the Grady clinic shuts down.
“I don’t know what I’m going to do,” said Rosa Lira Ramirez, a 78-year-old immigrant from Mexico who lives in the Atlanta area. She said she obtained a U.S. permanent resident card four years ago but that she won’t qualify for medical benefits until next year.
Write to Mike Esterl at mike.esterl@wsj.com
·
By KEVIN SACK , New York TImes
Published: September 23, 2009
ATLANTA — If Grady Memorial Hospital succeeds in closing its outpatient dialysis clinic, Tadesse A. Amdago, a 69-year-old immigrant from Ethiopia, said he would begin “counting the days until I die.” Rosa Lira, 78, a permanent resident from Mexico, said she also assumed she “would just die.” Another woman, a 32-year-old illegal immigrant from Honduras, said she could only hope to make it “back to my country to die.”
David Walter Banks for The New York Times
An illegal immigrant says treatment is hours away in her home country.
David Walter Banks for The New York Times
Tadesse A. Amdago says the Atlanta clinic’s closing would have him “counting the days until I die.”
David Walter Banks for The New York Times
Rosa Lira, like Mr. Amdago, said she would expect to die if the clinic closed.
Erik S. Lesser for The New York Times
A lawsuit has put in limbo a plan to close a dialysis clinic at Grady Memorial Hospital in Atlanta.
The patients, who have relied for years on Grady’s free provision of dialysis to people without means, said they had no other options to obtain the care that is essential to their survival. But the safety-net hospital, after years of failed efforts to drain its red ink, is not backing away from what its chairman, A. D. Correll, calls a “gut-wrenching decision”: closing the clinic this month.
The sides confronted each other in state court on Wednesday morning as lawyers for the patients sought to keep the clinic open until other arrangements for dialysis could be secured. Dialysis patients and their families packed the benches and 60-year-old Nelson Tabares, a seriously ill illegal immigrant from Honduras, was wheeled into court in a portable bed.
Despite a judge’s urging that the two sides negotiate a solution Wednesday, there was no agreement by the end of the day on how to go forward. For the time being, a restraining order keeping the clinic open stands. The judge is considering whether to extend it.
The dialysis unit on Grady’s ninth floor might as well be ground zero for the national health care debate. It is there that many of the ills afflicting American health care intersect: the struggle of the uninsured, the strain of providing uncompensated care, the inadequacy of government support, and the dilemma posed by treating illegal immigrants.
Grady is one of many public hospitals that have been battered by the recession as the number of uninsured has mounted. New York City’s public hospital system is eliminating 400 positions and closing some children’s mental health programs, pharmacies and clinics. University Medical Center in Las Vegas has closed its mammography center and outpatient oncology clinic.
“It comes down to which service do you need to keep open,” said Larry S. Gage, president of the National Association of Public Hospitals. “You try your hardest to cut back on services that are going to be available elsewhere in the community.”
Public hospital officials are concerned that the health care legislation being negotiated in Washington could worsen their plight before making it better. Under bills traveling through both houses of Congress, as the number of uninsured declines there would be commensurate reductions in Medicaid subsidies to hospitals that provide large amounts of uncompensated care.
At Grady, about four in 10 patients are uninsured, and an additional 25 percent are insured by Medicaid, which reimburses at rates so low they often do not cover actual costs. As a result, the hospital lost $33.5 million last year, with the dialysis clinic accounting for about $2 million of that total, said Denise R. Williams, the hospital’s executive vice president.
Nonetheless, as a taxpayer-supported hospital with the mission of serving the indigent, Grady is expected to take all comers in need of emergency care, like dialysis. Treatment there does not depend on a patient’s insurance or immigration status.
The hospital has been encouraging some of the dialysis patients to move to other states or back to their home countries, offering to defray some costs.
Hospital officials estimate that two-thirds of the outpatient clinic’s roughly 90 patients are illegal immigrants. They do not qualify for Medicare, which covers dialysis regardless of a patient’s age, and they are excluded in Georgia from Medicaid and other government insurance programs. Legal immigrants face a five-year waiting period before becoming eligible. That leaves Grady to absorb costs of up to $50,000 a year per dialysis patient, some of whom have availed themselves of the thrice-weekly treatments for years.
After years of fiscal desperation and management turmoil at Grady, Atlanta business leaders stepped in last year to force a restructuring, from a quasi-governmental authority to a nonprofit corporate board. In response, the Robert W. Woodruff Foundation pledged $200 million over four years to replace dilapidated beds and modernize computers. A $20 million gift from Bernie Marcus, a founder of Home Depot, is helping to update the emergency department, which provides regional trauma services.
But the hospital’s operating deficits have continued. Grady’s senior vice president, Matt Gove, estimated that its uncompensated care would grow by $50 million this year, up 25 percent. The new nonprofit board eliminated 150 jobs this year, closed an underused primary care clinic and began charging higher fees to patients who live outside of the two counties that support Grady with direct appropriations.
The closing of the outpatient dialysis clinic was recommended by consultants in 2007, who said that equipment was outmoded, that most hospitals did not provide outpatient dialysis and that Atlanta had scores of commercial dialysis centers. When the hospital’s chief executive at the time tried to shut it down, the resulting firestorm helped prompt his dismissal.
This July, the new board voted to try again. The hospital gave patients a month’s notice of the scheduled Sept. 19 closing, and vowed to assist them in finding local dialysis providers, relocating elsewhere and qualifying for public insurance. “We committed that not a single person would be left behind,” Mr. Correll wrote in a newspaper advertisement published on Sunday.
About a third of the patients have been successfully moved, including several illegal immigrants who returned to Mexico with the hospital’s financial help, Mr. Gove said. But others have said they have no place to go, have no means to pay for dialysis or are too ill to travel.
The female illegal immigrant from Honduras, who has a 7-year-old son, said her parents live more than a four-hour drive from the nearest dialysis center, in Tegucigalpa. She is mindful that her sister died from a stroke while being driven to a hospital there. She said she had no money to pay for dialysis because she was too weary from her kidney condition to hold down a job.
“I feel like they are trying to get rid of me because I don’t work,” she said, her eyes tearing. “But being sick is not my fault.”
Samuel Tabares, who rolled his father into court in his bed, said his father, who was paralyzed by a stroke, would probably not survive the strain of relocation or repeated trips to the emergency room in search of treatment.
“They’re treating the closing of this clinic like it’s the closing of a dental clinic,” Mr. Tabares said, “as if people’s lives don’t depend on it.”
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Bert
404-378-5883
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Yeah! We got an award for our beforeyoutakethatpill.com site for investigative blogs in healthcare from the “Health and Life Articles” website. Thx! http://healthlifeandstuff.com/. There are some other great blogs mentioned there that I read on a regular basis like neuroskeptic and furious seasons, Scientific Misconduct. ClinPsyc and Hooked. I’ve never gotten an award before! (sniff, sniff). Or at least the last time I got one I had to dance with a sweaty person, and that was a long time ago.
So from all of us here at Drug Safety and Health News, Thanks!
Yep! For a nickel you can now get several years of research and the contents of hundreds of research articles read by someone who is not on the payroll of pharmaceutical companies. That would be in the form of a used copy of my book Before You Take That Pill, purchased on amazon.com. Or if you want a new book that might have an overstock mark you can pay $2.78.
You might want to do it fast though because with all of this free publicity the book has been getting lately it might go fast. At this point either the book, or me, will be going fast I think.
If this seems like gratuitous self promotion, that’s because, well, it is. If you aren’t interested in the book you might want to buy it as an act of solidarity since my university refused to issue a press release and otherwise squashed publicity and my local paper the Atlanta Journal Constitution refused to write about it even though I only said that drinking a sugar added beverage each day would make you gain five pounds a year, and didn’t actually use the word “soda” (OK, I said it).
Here is a recent amazon review from Carolyn, July 6, 2009 (no I don’t know her)
Now that every other commercial on television is urging us to “talk to your doctor about” and dispensing marketing disguised as bogus medical advice, we need objective information if we are to avoid the pitfalls of being over medicated for no good reason.
You can read this book cover to cover, as i did, even though i take no medication or you can look up the chapters that apply to you. here’s a perfect example: i sent the book to my 85 year old father to read. for some reason, he had been put on simvastatin. after reading the chapter on cholesterol lowering medication, he decided to stop taking it. when he told his cardiologist, the doctor said “i don’t know why you were ever on it to begin with!”
Obviously, another doctor had prescribed it a long time ago and no one was keeping track. so aside from helping to keep the country’s wildly out of control medical costs in check, my dad also noticed that a mysterious rash he had developed went away, in addition to muscle aches which he had attributed to his age.
He also quit his advair and has had no problems so far without it.
Now he is like any normal healthy 85 year old living in a country that doesn’t ram drugs down people’s throats to keep stock options soaring- he mows his own lawn, trims his hedges, treated his garage for termites and is getting ready to rehang all the windows in his house.
Yes, some people need drugs for short periods to fight infections and save their lives. but this chronic use of drugs for everything and forever is nonsense. we are certainly no healthier for it and certainly way poorer.
That a doctor was willing to examine his profession objectively and point out this very big weakness is something we must be grateful for.
Thank you, Dr Bremner
You’re welcome, hon.
President Barack Obama basically gave away the farm today when he indicated that he was open to giving up the public option for healthcare insurance, saying that he would not “draw a line in the sand” over the issue. Rahm Emanuel was quoted as saying:
The goal is to have a means and a mechanism to keep the private insurers honest. The goal is non-negotiable; the path is negotiable.
Them’s some ominous words.
With both Charles Grassley (R-Iowa) in the Senate and Max Baucus (D-Montana) opposed to a public option, it looks like our leaders have sold us down the river yet again as I have predicted before. It is my opinion that without a public option things will only deteriorate as the healthcare industrial complex cannot cut costs on its own.
The Obama administration state that they want nonprofit cooperatives to compete with private insurance plans. They say that if they don’t find evidence of competition, that the public option will “kick in” at a later date.
There has been a lot of negotiating going on. For instance, the hospital lobby just agreed to taking 155 billion in cuts over the next decade, mostly in reduced Medicare and Medicaid payments. This is in addition to cuts agreed to by pharma. They have been admonished not to bitch about the process if they want to keep their spot at the negotiating table with Baucus. Meanwhile we stories like this one about expensive treatments for prostate cancer that are being performed with the cost of over $100,000 when they have never been shown to be better than the “wait and see” approach (i.e. doing nothing). Only in America guys.
It looks our industry friends will agree to just about anything with the Obama administration to avoid going on a diet. Problem is they are for-profit and motivated by making money.
Richard Umbdenstock (AHA), Karen Ignagni (AHIP), Nancy Nielsen (AMA), Billy Tauzin (PhRMA), and David Nexon (AMTA)
Yep. Our friends from the American Hospitals Association (AHA), American Health Insurance Plans (AHIP), American Medical Association (AMA), and American Medical Techonology Association (AMTA) can all be counted on for one thing. Following their instincts. Which are greed.
I wonder if David is going to get some of the yummies or if they are going to let him get up to the table.
Meanwhile, 69% of Americans support a public option insurance plan, as do 59% of doctors. Only a third are opposed to it. And only 19% of doctors are members of the AMA, which officially opposes it. So those right wingers like Dr Bill Frist in the Senate do not represent our views.
