Date: 12/30/2008
By KEVIN FREKING
Associated Press Writer
WASHINGTON (AP) — Note to President-elect Barack Obama: Health reform doesn’t have to be all about expanding health insurance. It can be about the little things too, such as shorter waits in the doctor’s office and putting in place incentives such as free checkups that catch little problems before they became big ones.
That was the message Tuesday from two-dozen seniors who gave their views about what ails America’s health care system to former Senate Majority Leader Tom Daschle, Obama’s choice for secretary of health and human services. They listed a broad range of concerns, from four-hour waits to see a doctor, to the high cost of prescription drugs, to lack of Medicare coverage for certain treatments and medical devices.
Daschle said conversations like Tuesday’s will put the new administration “on the right track” for overhauling the nation’s health care system next year.
Alethea Campbell said she wanted more emphasis on medical research, particularly for Alzheimer’s Disease. “My family is loaded with Alzheimer’s. I feel like I’m going to be a victim of it,” she said. “What is going to happen to me four or five years down the road. Who is going to take care of me?”
Eugene Kinlow wants greater emphasis on helping people live more healthy lifestyles. “A major part of the cost problem is us. We keep driving up the cost of health care, all of us, in our daily behavior and habits,” he said.
And Frederick Gore wants medical providers to be less concerned about how they’re going to be paid when a patient walks into their room with urgent medical conditions. “The other patients could see there was something wrong with me,” he said. “I’m sitting there and can barely breathe and he’s looking at how he’s going to get paid.”
Some 8,500 meetings similar to the one at the Congress Heights Senior Wellness Center have been held around the country since Dec. 15. Daschle attended his second such meeting Tuesday, along with his mother, Betty. Obama’s transition team will gather the information from those meetings and post the material on its Web site, http://change.gov. Daschle said the information would be used to help craft a health proposal.
Daschle said lawmakers will be more likely to take up health reform if there is enough pressure from voters. In a book published earlier this year, he urged the next president to quickly capitalize on the good will that comes with a new administration. He said the meetings will add to the sense of urgency.
“It will lead to members of Congress taking note. It will lead to governors taking note,” Daschle said in an interview. “It’s going to lead to a greater degree of commitment on the part of elected people.”
About 25 people talked to Daschle about the problems they’ve confronted with the health care system. Most participate in Medicare, the government’s health insurance program for the elderly and disabled.
Although they had coverage for most treatments, they were not short of suggestions for improving the health care system. Some described waiting three or four hours before they could be seen by a doctor. Others talked of how they helped pay health care costs for uninsured children and grandchildren. And some longed for a return of the days when teenagers volunteered to work at the local hospital or at local senior centers.
“It’s conversations like this that put us on the right track,” Daschle told the audience. “It’s discussions like this that give us a better understanding of how it should be done.”
The public meetings orchestrated by Obama’s transition team resemble an effort that took place in 2005 and 2006. Congress created its Citizens Health Care Working Group that heard from 6,650 people at 84 meetings around the country and more than 14,000 in an Internet survey.
The group’s recommendations were not acted on. The recommendations included guaranteeing health coverage for specific checkups and treatments and protecting consumers from high medical expenses.
Daschle said the health care system’s problems have only grown since then, which could ensure action in Congress.
“We wouldn’t have had 8,500 of these discussions in a two-week period over the Christmas holidays a few years ago. This is an indication of the degree of severity and concern that people have all over the country,” Daschle said.
Copyright 2008 The Associated Press.
Hospitals ill from more bad debt, credit troubles
Date: 12/28/2008 12:01 AM
By LINDA A. JOHNSON
AP Business Writer
TRENTON, N.J. (AP) — Gainesville’s first community hospital has been on life support since the Shands Healthcare system in northern Florida bought it a dozen years ago.
Now, because of the recession, the plug is being pulled on 80-year-old, money-losing Shands AGH. Next fall, its eight-hospital not-for-profit parent company will shut the 220-bed hospital and shift staff and patients to a newer, bigger teaching hospital nearby as part of an effort to save $65 million over three years across the system.
Like many U.S. hospitals, Shands is being squeezed by tight credit, higher borrowing costs, investment losses and a jump in patients — many recently unemployed or otherwise underinsured — not paying their bills.
All that has begun to trigger more hospital closings — from impoverished Newark, N.J., to wealthy Beverly Hills, Calif. — as well as layoffs, other cost-cutting and scrapping or delaying building projects.
More closings and mergers are on the way, industry consultants predict.
“They’ll get swallowed up by somebody else, if they need to exist, and if they don’t, they’ll just close,” said Tuck Crocker, vice president of the health care practice at management consultant BearingPoint.
Most endangered are rural hospitals and urban ones in areas with excess hospital beds and lots of poor, uninsured I know it’s a current affairs of the erratic or seen patients — those already financially ailing.
Hospitals, which employ 5 million people, are reporting that donations and investment returns are down, patient visits are flat and profitable diagnostic procedures and elective surgeries are declining as people with inadequate insurance delay care. But those patients are turning up later at ERs, seriously ill, making it tough for hospitals to lay off nurses and doctors.
All those problems are aggravating long-standing stresses: stingy reimbursements from commercial insurers, even-lower payments that generally don’t cover costs for Medicare and Medicaid patients, and high labor and technology costs.
Hospital executives and consultants say the growing number of people with high-deductible health plans is boosting unpaid patient bills. Many worry health reform efforts by the Obama administration could bring cuts in Medicare reimbursements, and many cash-strapped states already have begun cutting payments for poor people covered by Medicaid.
In the past few months, patients and insurers have been paying hospital bills more slowly. As a result, some think hospitals will start demanding up-front payments for elective procedures.
In November, Moody’s Investors Service changed its 12- to 18-month outlook from “stable” to “negative” for nonprofit and for-profit hospitals, citing “prospects of a protracted recession,” bad debt and the credit crunch.
“Looking forward, the cost of borrowing will likely be higher — and may be nonexistent for lower-rated hospitals,” Moody’s noted, a problem because hospitals borrow for everything from expansions and equipment to payroll and supplies.
Since October, there’s been “a dramatic slowdown” in plans for new wings and building upgrades, with many delayed indefinitely, said Paul Keckley of the Deloitte Center for Health Solutions.
“It probably means we won’t have as many new things in the hospital,” he predicted.
Tim Goldfarb, CEO of Gainesville-based Shands Healthcare, said his system, Florida’s second-largest provider of charity care, this year has seen bad debt jump 20 percent from patients with no insurance.
“We write them off,” Goldfarb said. “It’s a burden that we cannot carry any longer.”
Florida started cutting Medicaid reimbursements two years ago, when its economy started to slow, Goldfarb said. He fears another huge cut next year.
Shands already has paid off variable-rate bonds to avoid higher interest rates, deferred roughly $25 million in equipment purchases, shifted management meetings to church halls and adopted employee suggestions to save millions more.
Goldfarb believes closing Shands AGH will save nearly $100 million over seven years, mainly by avoiding costly renovations, but some administrative jobs will go.
Around the country, while some hospitals still are doing well, closings and bankruptcies seem to be picking up.
In New Jersey, where 47 percent of hospitals posted losses in 2007, five of the 79 acute-care hospitals closed this year, and a sixth may close soon. In Hawaii, nearly every hospital is in trouble, with two filing for bankruptcy and one nearly closing recently.
All over, hospitals are cutting costs by outsourcing services like housekeeping and security and trimming staff through layoffs, hiring freezes and attrition. Most are trying not to touch patient care jobs — nurses, pharmacists, therapists and X-ray technicians — as those already have staff shortages.
“The last thing we can do is skinny down our staffing right where we need it the most,” said Mike Killian, marketing vice president for the three Beaumont Hospitals in suburban Detroit.
There, auto industry job losses and other factors now equal fewer patients with commercial insurance. The system expects a $22 million loss, its first in at least 40 years, Killian said.
So Beaumont this fall announced a $60 million restructuring program that includes 4-10 percent pay cuts for doctors and managers, reducing overtime for some employees and eliminating 500 jobs, 200 already vacant, mostly outside of patient care.
Rich Umbdenstock, chief executive of the American Hospital Association, said some of the hardest-hit hospitals began reducing staffing and services as early as last spring and more will follow. He expects some to eliminate services — money-losers such as behavioral health treatment, or those with high operating costs such as burn units — rather than weaken their entire operation.
An association survey of more than 700 hospitals found two-thirds have seen elective procedures and overall admissions fall since July, and half have seen moderate or significant jumps in nonpaying patients.
An industry database on more than 550 hospitals found their third-quarter investment results amounted to a combined loss of $832 million, down from a $396 million gain a year earlier. During the quarter, those hospitals paid 15 percent more in borrowing costs and swung to a 1.6 percent average loss, from an average 6.1 percent profit margin a year ago.
“They’re having serious problems getting the capital they need for needed renovations and upgrading their facilities,” said Mike Rock, a lobbyist at AHA, which is seeking increased federal reimbursements from Medicaid and Medicare.
At Exempla Healthcare, with three hospitals in Denver and its suburbs, Chief Executive Jeff Selberg said there’s usually a 5-7 percent annual profit margin, but this year investment losses wiped that out. He’s scaled back a $200 million plan to upgrade facilities, information technology and clinical equipment and may halt construction of a new maternity unit and operating rooms at one hospital.
Selberg has seen a slight increase in bad debt and expects more problems.
“We feel like the wave is coming, but it hasn’t hit yet, and we don’t know how big this wave is going to be,” he said.
Copyright 2008 The Associated Press.
By LINDA A. JOHNSON
AP Business Writer
TRENTON, N.J. (AP) — Gainesville’s first community hospital has been on life support since the Shands Healthcare system in northern Florida bought it a dozen years ago.
Now, because of the recession, the plug is being pulled on 80-year-old, money-losing Shands AGH. Next fall, its eight-hospital not-for-profit parent company will shut the 220-bed hospital and shift staff and patients to a newer, bigger teaching hospital nearby as part of an effort to save $65 million over three years across the system.
Like many U.S. hospitals, Shands is being squeezed by tight credit, higher borrowing costs, investment losses and a jump in patients — many recently unemployed or otherwise underinsured — not paying their bills.
All that has begun to trigger more hospital closings — from impoverished Newark, N.J., to wealthy Beverly Hills, Calif. — as well as layoffs, other cost-cutting and scrapping or delaying building projects.
More closings and mergers are on the way, industry consultants predict.
“They’ll get swallowed up by somebody else, if they need to exist, and if they don’t, they’ll just close,” said Tuck Crocker, vice president of the health care practice at management consultant BearingPoint.
Most endangered are rural hospitals and urban ones in areas with excess hospital beds and lots of poor, uninsured I know it’s a current affairs of the erratic or seen patients — those already financially ailing.
Hospitals, which employ 5 million people, are reporting that donations and investment returns are down, patient visits are flat and profitable diagnostic procedures and elective surgeries are declining as people with inadequate insurance delay care. But those patients are turning up later at ERs, seriously ill, making it tough for hospitals to lay off nurses and doctors.
All those problems are aggravating long-standing stresses: stingy reimbursements from commercial insurers, even-lower payments that generally don’t cover costs for Medicare and Medicaid patients, and high labor and technology costs.
Hospital executives and consultants say the growing number of people with high-deductible health plans is boosting unpaid patient bills. Many worry health reform efforts by the Obama administration could bring cuts in Medicare reimbursements, and many cash-strapped states already have begun cutting payments for poor people covered by Medicaid.
In the past few months, patients and insurers have been paying hospital bills more slowly. As a result, some think hospitals will start demanding up-front payments for elective procedures.
In November, Moody’s Investors Service changed its 12- to 18-month outlook from “stable” to “negative” for nonprofit and for-profit hospitals, citing “prospects of a protracted recession,” bad debt and the credit crunch.
“Looking forward, the cost of borrowing will likely be higher — and may be nonexistent for lower-rated hospitals,” Moody’s noted, a problem because hospitals borrow for everything from expansions and equipment to payroll and supplies.
Since October, there’s been “a dramatic slowdown” in plans for new wings and building upgrades, with many delayed indefinitely, said Paul Keckley of the Deloitte Center for Health Solutions.
“It probably means we won’t have as many new things in the hospital,” he predicted.
Tim Goldfarb, CEO of Gainesville-based Shands Healthcare, said his system, Florida’s second-largest provider of charity care, this year has seen bad debt jump 20 percent from patients with no insurance.
“We write them off,” Goldfarb said. “It’s a burden that we cannot carry any longer.”
Florida started cutting Medicaid reimbursements two years ago, when its economy started to slow, Goldfarb said. He fears another huge cut next year.
Shands already has paid off variable-rate bonds to avoid higher interest rates, deferred roughly $25 million in equipment purchases, shifted management meetings to church halls and adopted employee suggestions to save millions more.
Goldfarb believes closing Shands AGH will save nearly $100 million over seven years, mainly by avoiding costly renovations, but some administrative jobs will go.
Around the country, while some hospitals still are doing well, closings and bankruptcies seem to be picking up.
In New Jersey, where 47 percent of hospitals posted losses in 2007, five of the 79 acute-care hospitals closed this year, and a sixth may close soon. In Hawaii, nearly every hospital is in trouble, with two filing for bankruptcy and one nearly closing recently.
All over, hospitals are cutting costs by outsourcing services like housekeeping and security and trimming staff through layoffs, hiring freezes and attrition. Most are trying not to touch patient care jobs — nurses, pharmacists, therapists and X-ray technicians — as those already have staff shortages.
“The last thing we can do is skinny down our staffing right where we need it the most,” said Mike Killian, marketing vice president for the three Beaumont Hospitals in suburban Detroit.
There, auto industry job losses and other factors now equal fewer patients with commercial insurance. The system expects a $22 million loss, its first in at least 40 years, Killian said.
So Beaumont this fall announced a $60 million restructuring program that includes 4-10 percent pay cuts for doctors and managers, reducing overtime for some employees and eliminating 500 jobs, 200 already vacant, mostly outside of patient care.
Rich Umbdenstock, chief executive of the American Hospital Association, said some of the hardest-hit hospitals began reducing staffing and services as early as last spring and more will follow. He expects some to eliminate services — money-losers such as behavioral health treatment, or those with high operating costs such as burn units — rather than weaken their entire operation.
An association survey of more than 700 hospitals found two-thirds have seen elective procedures and overall admissions fall since July, and half have seen moderate or significant jumps in nonpaying patients.
An industry database on more than 550 hospitals found their third-quarter investment results amounted to a combined loss of $832 million, down from a $396 million gain a year earlier. During the quarter, those hospitals paid 15 percent more in borrowing costs and swung to a 1.6 percent average loss, from an average 6.1 percent profit margin a year ago.
“They’re having serious problems getting the capital they need for needed renovations and upgrading their facilities,” said Mike Rock, a lobbyist at AHA, which is seeking increased federal reimbursements from Medicaid and Medicare.
At Exempla Healthcare, with three hospitals in Denver and its suburbs, Chief Executive Jeff Selberg said there’s usually a 5-7 percent annual profit margin, but this year investment losses wiped that out. He’s scaled back a $200 million plan to upgrade facilities, information technology and clinical equipment and may halt construction of a new maternity unit and operating rooms at one hospital.
Selberg has seen a slight increase in bad debt and expects more problems.
“We feel like the wave is coming, but it hasn’t hit yet, and we don’t know how big this wave is going to be,” he said.
Copyright 2008 The Associated Press.
Multiple problems hurting hospitals’ bottom lines
Date: 12/28/2008 12:02 AM
By The Associated Press
U.S. hospitals are beset by financial pressures from all sides. Issues cited by hospital executives, industry consultants and other experts include:
—More patients aren’t paying their bills or are taking longer to do so. Reasons include increases in people who are unemployed and have lost their health insurance, employers increasing workers’s copayments and premiums, and more people getting insurance plans that carry very high deductibles.
—More patients are putting off care until illnesses are very serious, then showing up at emergency departments, unable to pay.
—Patients are delaying diagnostic procedures and elective surgery such as joint replacements, which generally are moneymakers.
—Overall admissions are down at many hospitals, also cutting revenues.
—Government subsidies for uncompensated, or charity, care have been cut in some states due to their budget problems, and some states are starting or expected to cut reimbursements for Medicaid programs, typically one of their biggest budget items.
—Credit has become tighter, increasing borrowing costs at best and leaving hospitals unable to borrow in some cases.
—Hospital endowments and other funds invested for later use have been hurt by the stock market’s plunge, with many hospitals seeing considerable losses.
—Wealthy hospital patrons, some of whom also have suffered big investment losses, have started cutting back on donations.
—Many individual doctors and small group practices are pressuring hospitals with which they are affiliated to buy their practices because they can’t afford expensive technology upgrades, particularly computerized patient record systems.
In addition, some experts fear expected health care reforms under the new Obama administration could include cuts in the levels of Medicare and Medicaid reimbursements, a crucial issue because hospitals on average get about 55 percent of all patient revenues from those two government programs, which already don’t cover full costs of care.
___
Source: American Hospital Association, AP interviews.
Copyright 2008 The Associated Press.
By The Associated Press
U.S. hospitals are beset by financial pressures from all sides. Issues cited by hospital executives, industry consultants and other experts include:
—More patients aren’t paying their bills or are taking longer to do so. Reasons include increases in people who are unemployed and have lost their health insurance, employers increasing workers’s copayments and premiums, and more people getting insurance plans that carry very high deductibles.
—More patients are putting off care until illnesses are very serious, then showing up at emergency departments, unable to pay.
—Patients are delaying diagnostic procedures and elective surgery such as joint replacements, which generally are moneymakers.
—Overall admissions are down at many hospitals, also cutting revenues.
—Government subsidies for uncompensated, or charity, care have been cut in some states due to their budget problems, and some states are starting or expected to cut reimbursements for Medicaid programs, typically one of their biggest budget items.
—Credit has become tighter, increasing borrowing costs at best and leaving hospitals unable to borrow in some cases.
—Hospital endowments and other funds invested for later use have been hurt by the stock market’s plunge, with many hospitals seeing considerable losses.
—Wealthy hospital patrons, some of whom also have suffered big investment losses, have started cutting back on donations.
—Many individual doctors and small group practices are pressuring hospitals with which they are affiliated to buy their practices because they can’t afford expensive technology upgrades, particularly computerized patient record systems.
In addition, some experts fear expected health care reforms under the new Obama administration could include cuts in the levels of Medicare and Medicaid reimbursements, a crucial issue because hospitals on average get about 55 percent of all patient revenues from those two government programs, which already don’t cover full costs of care.
___
Source: American Hospital Association, AP interviews.
Copyright 2008 The Associated Press.
BIAA Continues Advocacy As 2008 Winds Down
From the Brain Injury Association of America:
End of The Year Update
More Info
BIAA Continues Advocacy As 2008 Winds Down
As this year comes to a close, the Brain Injury Association of America (BIAA) would like to thank you for your support during 2008 – a year which included many accomplishments in advocacy on behalf of individuals with brain injuries and their families. Chief among these accomplishments, of course, was successful reauthorization of The Traumatic Brain Injury Act!
Yet, as we reflect during this holiday season on the advocacy achievements we are thankful for this year, we also know that much more needs to be done to improve brain injury care and services in this country.
BIAA is uniquely positioned to carry this important message into 2009, and to the incoming Obama Administration, as well to continue its leading advocacy role on Capitol Hill, urging the nation’s lawmakers to adequately address the public health epidemic of brain injury.
Last week, BIAA was invited to meet with members of the Obama Administration transition team to discuss disability and health care policy issues, as well as to share BIAA’s leading public policy priorities. On Tuesday, December 16, BIAA’s President and CEO, Susan Connors, and BIAA’s National Medical Director, Dr. Gregory O’Shanick, represented the organization at this meeting.
They communicated to the members of the Obama team that BIAA’s chief public policy concern centers on improving access to health care for survivors of brain injury. Specifically, Ms. Connors and Dr. O’Shanick described how every day, hundreds – perhaps thousands – of brain injury suvivors are depived of the acute care, rehabilitation, and related services they need to regain maximum function and quality of life after their injury. They further explained that this is largely due to the widespread use of unfair and unjust tactics by health insurers, such as inconsistent pre-admission policies, arbitrary limits on scope and duration of care, outright coverage denials, absurd payment rates, and capricious post-treatment audits. The hope was expressed to the Obama team that any effort to reform the nation’s health care system must address these delays and denials of access to care, as our nation is needlessly increasing permanent disability among people who sustain brain injuries.
Ms. Connors and Dr. O’Shanick also discussed with the Obama team the importance of maintaining and increasing the health and function research portfolio, including the TBI Model Systems of Care program, within the National Institute on Disability and Rehabilitation Research (NIDRR), as well as the need for TRICARE to officially cover cognitive rehabilitation for returning servicemembers.
As 2009 approaches, BIAA encourages you to visit President-Elect Obama’s webpage on health care reform, and submit yoown comments about how to improve the nation’s health care system to better address the needs of brain injury survivors.
Happy Holidays!
End of The Year Update
More Info
BIAA Continues Advocacy As 2008 Winds Down
As this year comes to a close, the Brain Injury Association of America (BIAA) would like to thank you for your support during 2008 – a year which included many accomplishments in advocacy on behalf of individuals with brain injuries and their families. Chief among these accomplishments, of course, was successful reauthorization of The Traumatic Brain Injury Act!
Yet, as we reflect during this holiday season on the advocacy achievements we are thankful for this year, we also know that much more needs to be done to improve brain injury care and services in this country.
BIAA is uniquely positioned to carry this important message into 2009, and to the incoming Obama Administration, as well to continue its leading advocacy role on Capitol Hill, urging the nation’s lawmakers to adequately address the public health epidemic of brain injury.
Last week, BIAA was invited to meet with members of the Obama Administration transition team to discuss disability and health care policy issues, as well as to share BIAA’s leading public policy priorities. On Tuesday, December 16, BIAA’s President and CEO, Susan Connors, and BIAA’s National Medical Director, Dr. Gregory O’Shanick, represented the organization at this meeting.
They communicated to the members of the Obama team that BIAA’s chief public policy concern centers on improving access to health care for survivors of brain injury. Specifically, Ms. Connors and Dr. O’Shanick described how every day, hundreds – perhaps thousands – of brain injury suvivors are depived of the acute care, rehabilitation, and related services they need to regain maximum function and quality of life after their injury. They further explained that this is largely due to the widespread use of unfair and unjust tactics by health insurers, such as inconsistent pre-admission policies, arbitrary limits on scope and duration of care, outright coverage denials, absurd payment rates, and capricious post-treatment audits. The hope was expressed to the Obama team that any effort to reform the nation’s health care system must address these delays and denials of access to care, as our nation is needlessly increasing permanent disability among people who sustain brain injuries.
Ms. Connors and Dr. O’Shanick also discussed with the Obama team the importance of maintaining and increasing the health and function research portfolio, including the TBI Model Systems of Care program, within the National Institute on Disability and Rehabilitation Research (NIDRR), as well as the need for TRICARE to officially cover cognitive rehabilitation for returning servicemembers.
As 2009 approaches, BIAA encourages you to visit President-Elect Obama’s webpage on health care reform, and submit yoown comments about how to improve the nation’s health care system to better address the needs of brain injury survivors.
Happy Holidays!
Seoul hospital refuses to end coma patient’s life
Date: 12/17/2008 12:55 AM
SEOUL, South Korea (AP) — A South Korean hospital said Wednesday it will appeal a court order to let a comatose patient die by removing her from a respirator, saying the case could prompt a trend in devaluing human life.
The order issued by the Seoul Western District Court last month was for Severance Hospital in Seoul to end the life of a 76-year-old patient, citing the people’s right to die with dignity.
The decision — the first court ruling of its kind in South Korea — was issued after the patient’s children filed a lawsuit following the hospital’s refusal to end the women’s life.
Severance Hospital announced Wednesday that it cannot accept the court’s ruling because it could lead to a social trend to take human life too lightly.
“We should make decisions carefully on matters of human life,” hospital spokesman Lee Sung-man said.
Lee said the hospital plans to appeal the ruling directly to the Supreme Court and skip an appellate court because the issue needs to be settled as soon as possible.
The hospital will first need the patient’s family — the plaintiffs in the case — to agree to the streamlined process, and if they refuse the hospital will appeal the case to an ordinary appellate court.
The patient’s children have said their mother had always opposed keeping people alive on machines when there is no chance of revival.
The patient, only identified by her family name Kim, has been in a vegetative coma since suffering brain damage in February. The Seoul district court said in a ruling that doctors at major Seoul hospitals agreed that she has no chance of revival and could live as long as three or four months.
Copyright 2008 The Associated Press.
SEOUL, South Korea (AP) — A South Korean hospital said Wednesday it will appeal a court order to let a comatose patient die by removing her from a respirator, saying the case could prompt a trend in devaluing human life.
The order issued by the Seoul Western District Court last month was for Severance Hospital in Seoul to end the life of a 76-year-old patient, citing the people’s right to die with dignity.
The decision — the first court ruling of its kind in South Korea — was issued after the patient’s children filed a lawsuit following the hospital’s refusal to end the women’s life.
Severance Hospital announced Wednesday that it cannot accept the court’s ruling because it could lead to a social trend to take human life too lightly.
“We should make decisions carefully on matters of human life,” hospital spokesman Lee Sung-man said.
Lee said the hospital plans to appeal the ruling directly to the Supreme Court and skip an appellate court because the issue needs to be settled as soon as possible.
The hospital will first need the patient’s family — the plaintiffs in the case — to agree to the streamlined process, and if they refuse the hospital will appeal the case to an ordinary appellate court.
The patient’s children have said their mother had always opposed keeping people alive on machines when there is no chance of revival.
The patient, only identified by her family name Kim, has been in a vegetative coma since suffering brain damage in February. The Seoul district court said in a ruling that doctors at major Seoul hospitals agreed that she has no chance of revival and could live as long as three or four months.
Copyright 2008 The Associated Press.
Mild Brain Injury – Coping Skills
by the legal times staff
thelegaltimes.net
Many years ago I suffered a “mild brain injury” which resulted in a seizure disorder. It’s one of those hidden disabilities which are so popular in the news currently. I can function in a crowd, for short periods of time. Overload is an ongoing problem which I have used many different strategies to overcome. My comfort zone has been to avoid anything confusing, busy, noisy or new…but I am not one to give up.
Brain injury is a dilemma for those who suffer from it. You can’t take an hour to explain to people you meet what sets you off, or what overwhelms you. Most of the time you have to just do the best you can.
Some years ago I began Tae Kwon Do classes. During one of the first classes, in the midst of a class routine, I seized. I have the kind of petit mal seizures that allow me to still hear everything going on around me, but I lose the ability to respond. My instructor asked if I was all right and in a moment I was and went on with the class, slightly embarrassed that I just appeared to have something mentally wrong with me. It’s the sort of embarrassment that often defeats those with brain injury…but I prevailed.
I cleverly learned never to position myself where I could see the class in the mirrors…my mind couldn’t process the double load of visual information. I learned that even if I couldn’t absorb a complicated routine on the first run through when everyone else was getting it, the next time I would come back with the information totally processed and be fine. I learned not to panic when I couldn’t filter out the instructor’s voice in a room full of background noise. I became hyper-observant. Over time I developed very complicated coping skills all designed to hide the fact that something was “wrong” with me. I earned my black belt and a heightened control over the seizures, panic and need to withdraw which I started with.
Last summer it was sort of brought to mind again as I took my dog through agility classes. I would listen very carefully to instructions, overworking to filter out the noise around me, and then find that listening didn’t mean processing. It’s somewhat lucky I had a smart dog, she usually picked up on what expectations were before I did. We always came back strong the following class when we both were on the same page. It helped to have a dog to turn to when the overload became too much, she became a convenient time out. We would go home and I would crash, totally exhausted by having to be so hyper-attentive. Much like the exhaustion that came after a karate class.
I was proud of myself for working through coping strategies which enabled me to tackle some pretty major accomplishments. In the end, it didn’t make the brain injury disappear. In some ways it made it harder to live with. People look at the accomplishments and not the effort it took to get there against all odds.
What they don’t see is the toll those efforts took, the amount of “down time” needed to recuperate, the hours I spent in total quiet to give an overworked and low frustration level brain time to recharge. They see independence in the isolation I maintain. They don’t see the meltdowns from overload, because I maintain that isolation. They don’t see how one thing can throw me off track for days. I have learned to cover, hide, avoid and conceal very well. I have even learned it is better to be quiet, because the seizures aren’t so noticed when they do occur. I have hit upon a definition of “normal” that I can live with.
In a world where the press is finally addressing the devastation brain injury can have on an individual, I still wonder if the majority of those affected don’t follow the easier course of creatively coping with their deficits? After all, you’re not likely to advise a prospective employer of your lack of ability to concentrate or tell a potential date that you have a brain injury and sometimes have issues with emotional response. It’s not only a hidden disability, it carries with it the fear of being labeled as “different”. Social awareness is a two-edged sword when it comes to brain injury. The public has been given enough information to acknowledge it exists and not enough information to understand how profoundly it affects the individual living with it.
thelegaltimes.net
Many years ago I suffered a “mild brain injury” which resulted in a seizure disorder. It’s one of those hidden disabilities which are so popular in the news currently. I can function in a crowd, for short periods of time. Overload is an ongoing problem which I have used many different strategies to overcome. My comfort zone has been to avoid anything confusing, busy, noisy or new…but I am not one to give up.
Brain injury is a dilemma for those who suffer from it. You can’t take an hour to explain to people you meet what sets you off, or what overwhelms you. Most of the time you have to just do the best you can.
Some years ago I began Tae Kwon Do classes. During one of the first classes, in the midst of a class routine, I seized. I have the kind of petit mal seizures that allow me to still hear everything going on around me, but I lose the ability to respond. My instructor asked if I was all right and in a moment I was and went on with the class, slightly embarrassed that I just appeared to have something mentally wrong with me. It’s the sort of embarrassment that often defeats those with brain injury…but I prevailed.
I cleverly learned never to position myself where I could see the class in the mirrors…my mind couldn’t process the double load of visual information. I learned that even if I couldn’t absorb a complicated routine on the first run through when everyone else was getting it, the next time I would come back with the information totally processed and be fine. I learned not to panic when I couldn’t filter out the instructor’s voice in a room full of background noise. I became hyper-observant. Over time I developed very complicated coping skills all designed to hide the fact that something was “wrong” with me. I earned my black belt and a heightened control over the seizures, panic and need to withdraw which I started with.
Last summer it was sort of brought to mind again as I took my dog through agility classes. I would listen very carefully to instructions, overworking to filter out the noise around me, and then find that listening didn’t mean processing. It’s somewhat lucky I had a smart dog, she usually picked up on what expectations were before I did. We always came back strong the following class when we both were on the same page. It helped to have a dog to turn to when the overload became too much, she became a convenient time out. We would go home and I would crash, totally exhausted by having to be so hyper-attentive. Much like the exhaustion that came after a karate class.
I was proud of myself for working through coping strategies which enabled me to tackle some pretty major accomplishments. In the end, it didn’t make the brain injury disappear. In some ways it made it harder to live with. People look at the accomplishments and not the effort it took to get there against all odds.
What they don’t see is the toll those efforts took, the amount of “down time” needed to recuperate, the hours I spent in total quiet to give an overworked and low frustration level brain time to recharge. They see independence in the isolation I maintain. They don’t see the meltdowns from overload, because I maintain that isolation. They don’t see how one thing can throw me off track for days. I have learned to cover, hide, avoid and conceal very well. I have even learned it is better to be quiet, because the seizures aren’t so noticed when they do occur. I have hit upon a definition of “normal” that I can live with.
In a world where the press is finally addressing the devastation brain injury can have on an individual, I still wonder if the majority of those affected don’t follow the easier course of creatively coping with their deficits? After all, you’re not likely to advise a prospective employer of your lack of ability to concentrate or tell a potential date that you have a brain injury and sometimes have issues with emotional response. It’s not only a hidden disability, it carries with it the fear of being labeled as “different”. Social awareness is a two-edged sword when it comes to brain injury. The public has been given enough information to acknowledge it exists and not enough information to understand how profoundly it affects the individual living with it.
Scientists back brain drugs for healthy people
Date: 12/7/2008
By MALCOLM RITTER
AP Science Writer
NEW YORK (AP) — Healthy people should have the right to boost their brains with pills, like those prescribed for hyperactive kids or memory-impaired older folks, several scientists contend in a provocative commentary.
College students are already illegally taking prescription stimulants like Ritalin to help them study, and demand for such drugs is likely to grow elsewhere, they say.
“We should welcome new methods of improving our brain function,” and doing it with pills is no more morally objectionable than eating right or getting a good night’s sleep, these experts wrote in an opinion piece published online Sunday by the journal Nature.
The commentary calls for more research and a variety of steps for managing the risks.
As more effective brain-boosting pills are developed, demand for them is likely to grow among middle-aged people who want youthful memory powers and multitasking workers who need to keep track of multiple demands, said one commentary author, brain scientist Martha Farah of the University of Pennsylvania.
“Almost everybody is going to want to use it,” said Farah.
“I would be the first in line if safe and effective drugs were developed that trumped caffeine,” another author, Michael Gazzaniga of the University of California, Santa Barbara, declared in an e-mail.
The seven authors, from the United States and Britain, include ethics experts and the editor-in-chief of Nature as well as scientists. They developed their case at a seminar funded by Nature and Rockefeller University in New York. Two authors said they consult for pharmaceutical companies; Farah said she had no such financial ties.
Some health experts agreed that the issue deserves attention. But the commentary didn’t impress Leigh Turner of the University of Minnesota Center for Bioethics.
“It’s a nice puff piece for selling medications for people who don’t have an illness of any kind,” Turner said.
The commentary cites a 2001 survey of about 11,000 American college students that found 4 percent had used prescription stimulants illegally in the prior year. But at some colleges, the figure was as high as 25 percent.
“It’s a felony, but it’s being done,” said Farah.
The stimulants Adderall and Ritalin are prescribed mainly for people with attention deficit hyperactivity disorder, but they can help other people focus their attention and handle information in their heads, the commentary says.
Another drug called Provigil is approved for sleep disorders but is also prescribed for healthy people who need to stay alert when sleep-deprived, the commentary says. Lab studies show it can also perk up the brains of well-rested people. And some drugs developed for Alzheimer’s disease also provide a modest memory boost, it says.
Ritalin is made by Switzerland-based Novartis AG, but the drug is also available generically. Adderall is made by U.K.-based Shire PLC and Montvale, N.J.-based Barr Pharmaceuticals Inc., and some formulations are also available generically. Provigil is made by Cephalon Inc. of Frazer, Pa.
While supporting the concept that healthy adults should be able to use brain-boosting drugs, the authors called for:
—More research into the use, benefits and risks of such drugs. Much is unknown about the current medications, such as the risk of dependency when used for this purpose, the commentary said.
—Policies to guard against people being coerced into taking them.
—Steps to keep the benefits from making socio-economic inequalities worse.
—Action by doctors, educators and others to develop policies on the use of such drugs by healthy people.
—Legislative action to allow drug companies to market the drugs to healthy people if they meet regulatory standards for safety and effectiveness.
Dr. Nora Volkow, director of the National Institute on Drug Abuse, said she agreed with the commentary that the nonprescribed use of brain-boosting drugs must be studied.
But she said she was concerned that wider use of stimulants could lead more people to become addicted to them. That’s what happened decades ago when they were widely prescribed for a variety of disorders, she said.
“Whether we like it or not, that property of stimulants is not going to go away,” she said.
Erik Parens, a senior research scholar at the Hastings Center, a bioethics think tank in Garrison, N.Y., said the commentary makes a convincing case that “we ought to be opening this up for public scrutiny and public conversation.”
One challenge will be finding ways to protect people against subtle coercion to use the drugs, the kind of thing parents feel when neighbor kids sign up for SAT prep courses, he said.
And if the nation moves to providing a basic package of health care to all its citizens, it’s hard to see how it could afford to include brain-boosting drugs, he said. If they have to be bought separately, it raises the question about promoting societal inequalities, he said.
___
On the Net:
Nature: http://www.nature.com/nature/
Copyright 2008 The Associated Press.
By MALCOLM RITTER
AP Science Writer
NEW YORK (AP) — Healthy people should have the right to boost their brains with pills, like those prescribed for hyperactive kids or memory-impaired older folks, several scientists contend in a provocative commentary.
College students are already illegally taking prescription stimulants like Ritalin to help them study, and demand for such drugs is likely to grow elsewhere, they say.
“We should welcome new methods of improving our brain function,” and doing it with pills is no more morally objectionable than eating right or getting a good night’s sleep, these experts wrote in an opinion piece published online Sunday by the journal Nature.
The commentary calls for more research and a variety of steps for managing the risks.
As more effective brain-boosting pills are developed, demand for them is likely to grow among middle-aged people who want youthful memory powers and multitasking workers who need to keep track of multiple demands, said one commentary author, brain scientist Martha Farah of the University of Pennsylvania.
“Almost everybody is going to want to use it,” said Farah.
“I would be the first in line if safe and effective drugs were developed that trumped caffeine,” another author, Michael Gazzaniga of the University of California, Santa Barbara, declared in an e-mail.
The seven authors, from the United States and Britain, include ethics experts and the editor-in-chief of Nature as well as scientists. They developed their case at a seminar funded by Nature and Rockefeller University in New York. Two authors said they consult for pharmaceutical companies; Farah said she had no such financial ties.
Some health experts agreed that the issue deserves attention. But the commentary didn’t impress Leigh Turner of the University of Minnesota Center for Bioethics.
“It’s a nice puff piece for selling medications for people who don’t have an illness of any kind,” Turner said.
The commentary cites a 2001 survey of about 11,000 American college students that found 4 percent had used prescription stimulants illegally in the prior year. But at some colleges, the figure was as high as 25 percent.
“It’s a felony, but it’s being done,” said Farah.
The stimulants Adderall and Ritalin are prescribed mainly for people with attention deficit hyperactivity disorder, but they can help other people focus their attention and handle information in their heads, the commentary says.
Another drug called Provigil is approved for sleep disorders but is also prescribed for healthy people who need to stay alert when sleep-deprived, the commentary says. Lab studies show it can also perk up the brains of well-rested people. And some drugs developed for Alzheimer’s disease also provide a modest memory boost, it says.
Ritalin is made by Switzerland-based Novartis AG, but the drug is also available generically. Adderall is made by U.K.-based Shire PLC and Montvale, N.J.-based Barr Pharmaceuticals Inc., and some formulations are also available generically. Provigil is made by Cephalon Inc. of Frazer, Pa.
While supporting the concept that healthy adults should be able to use brain-boosting drugs, the authors called for:
—More research into the use, benefits and risks of such drugs. Much is unknown about the current medications, such as the risk of dependency when used for this purpose, the commentary said.
—Policies to guard against people being coerced into taking them.
—Steps to keep the benefits from making socio-economic inequalities worse.
—Action by doctors, educators and others to develop policies on the use of such drugs by healthy people.
—Legislative action to allow drug companies to market the drugs to healthy people if they meet regulatory standards for safety and effectiveness.
Dr. Nora Volkow, director of the National Institute on Drug Abuse, said she agreed with the commentary that the nonprescribed use of brain-boosting drugs must be studied.
But she said she was concerned that wider use of stimulants could lead more people to become addicted to them. That’s what happened decades ago when they were widely prescribed for a variety of disorders, she said.
“Whether we like it or not, that property of stimulants is not going to go away,” she said.
Erik Parens, a senior research scholar at the Hastings Center, a bioethics think tank in Garrison, N.Y., said the commentary makes a convincing case that “we ought to be opening this up for public scrutiny and public conversation.”
One challenge will be finding ways to protect people against subtle coercion to use the drugs, the kind of thing parents feel when neighbor kids sign up for SAT prep courses, he said.
And if the nation moves to providing a basic package of health care to all its citizens, it’s hard to see how it could afford to include brain-boosting drugs, he said. If they have to be bought separately, it raises the question about promoting societal inequalities, he said.
___
On the Net:
Nature: http://www.nature.com/nature/
Copyright 2008 The Associated Press.