Saturday, November 26, 2011

Potential Solutions to the Drug Shortage Problem

Currently there are over 180 prescription drugs that are in a dangerously short supply.  These drugs include many important and lifesaving antibiotics, chemotherapy and cardiovascular drugs.
There are a few things the government is doing to try to tackle the problem. The Preserving Access to Life-Saving Medications Act of 2011 is a bill that is currently active that would require drug manufacturers to notify the FDA six months in advance of potential drug manufacturing interruptions. 
An additional problem with the drug shortage situation is that those manufacturers that do have the drugs are charging higher than normal prices for their drugs.  Evidence has been discovered that shows that five drug companies have charged seven to eighty times the regular prices of shortage drugs.  Since the discovery of this information, President Obama has issued an executive order that seeks to reduce this price gouging problem by asking the Department of Justice to examine price increases for shortage drugs to see if the increases violate the law.
I will continue to watch for developments on this issue.

Trapp, D., Obama Targets Prices of Shortage Drugs, American Medical News, November 21, 2011.
Current Drug Shortages, FDA, November 23, 2011,

Sunday, November 13, 2011

Update on Judge Directed Negotiation in Medical Liability Lawsuits in New York

       A few months ago I wrote about a new pilot program in effect in New York in which judges lead negotiation in medical liability cases as opposed to having them go through the traditional litigation process.  Over 1,000 cases have gone through the program and so far the results have been positive. 
        Since implementation of the program medical liability payments and settlements have decreased,  and the expenses spent in defending medical liability cases has declined.  The average time cases are completed has declined from three years to nine months.  Doctors that are found to have no responsibility in the cases are weeded out within the first six months of the program (in traditional liability cases these doctors cannot be removed from lawsuits until after the discovery process which can be more than a year after the case is filed).
        It seems that this may be another solution to dealing with the medical liability crisis.  I will be keeping a close eye on the progress of this program.

Gallegos, A., Cutting Costs From the Bench, American Medical News (November 7, 2011).

Saturday, November 12, 2011

Stanford University Program Offers Apology and Financial Compensation to Patients Affected by Adverse Events-Since then Liability Premiums and Numbers of Claims Have Dropped

       Stanford University has developed a new way to deal with high liability payments by creating a more transparent and patient centered approach to dealing with adverse events.  In this new program, they identify adverse events that have been reported by physicians or patients within 90 days of its occurrence.  Investigations are made, and if the event is determined to have been avoidable, the patient and or family is contacted with the results, an apology is made and compensation is discussed. 
       According to Stanford, liability claim frequency has dropped 36% since implementation of the program in 2007 and they estimate that they have saved $3.2 million in annual premiums since the program has been established.  It seems like this may be a good thing to identify adverse events early, holding physicians accountable, apologizing and rectifying the situation when possible.

O’Reilly, K., Stanford Cuts Liability Premiums with Cash Offers After Errors.  American Medical News (November 7, 2011).

Friday, November 11, 2011

Washington State Lifts Limits on Medicaid Patient ER Visits

      A few months ago I wrote a blog post about Washington State implementing a law starting October 1, 2011 that limited the amount of ER visits for Medicaid patients to three visits a year.    Many physicians, including myself felt it was extremely dangerous to place these limits on patients.  The  Washington State chapter of the American College of Emergency Physicians, Seattle Children's Hospital, Washington State Medical Association, and the Washington State Hospital Association filed a lawsuit challenging this.  Yesterday the Court lifted the limit on the ER visits.

      Of note,  when they looked closer at the numbers they discovered that 97 percent of Washington's Medicaid clients did't even exceed three ER visits a year. "They blamed a "small, but expensive group" of patients for running up large numbers of visits.  Some of those patients have more than 100 visits a year, often for chronic conditions and a need for painkillers, officials said."

Read more:

State lifts three-visit ER limit for poor patients

Sunday, November 6, 2011

Is it Okay for Physicians to Prescribe Medication to their Family and Friends?

Before the ink is even dry on your medical school diploma, you have family and friends asking you for medical advice and asking you to write a prescription.  But I have often wondered, is it okay to write a prescription for a friend or family member?  According to the Texas Medical Board, it is not illegal to do so, but physicians must be aware that doing so poses some risks.  In a recent article, they caution that friends and family must be treated like any other patient, and an adequate history and medical assessment must be obtained.  They also caution that it would be a good idea to maintain medical records on these individuals and your interactions with them.  In addition, the Texas Medical Association Board of Councilors advised that it is ethical to treat family and friends.  They also believe that medical records should be maintained, but they do note that in “urgent or episodic situations” that it may not be practical to do so.
            There is one important caveat however.  The Texas Medical Board absolutely prohibits physicians from writing prescriptions for controlled substances (e.g., narcotics) to family, friends or even themselves unless there is an emergency situation.  Physicians can prescribe a small amount of controlled substances for a 72 hour period in emergency.
            So if you are a physician in Texas, it is okay to prescribe medication to family and friends, but be aware of the possible need of maintaining medical records and be extremely cautious about prescribing controlled substances to family and friends (better yet, don’t do it at all).

Conde, C., Treating Your Own:  It’s Legal, But It Can Be Risky, Texas Medicine (October 2011).