Banning health clinics is a post from Overlawyered - Chronicling the high cost of our legal system

Florida Medicaid records show the number of children – some just months old – who were prescribed the drugs went from 9,364 seven years ago to 18,137 in 2006. No records for privately insured patients are available.

As I mentioned earlier this week, putting the blame on the pharmaceutical industry is an oversimplistic reaction to how psychiatry, psychology,and our culture have transformed childhood into a diagnostic checklist. As mentioned in Ed’s post, the litigation in Florida appears to be the recommendation by agencies receiving Medicaid funds to use these drugs in children with ADHD who also had tics. While none of the atypical antipsychotics, to my knowledge, are FDA approved for this condition, it is common knowledge among mental health professionals that the most effective treatment for tics are dopaminergic antagonists such as atypical antipsychotics. True, the recent National Institute of Health’s CATIE study demonstrated that most of the atypicals were no better than the older ones. But that doesn’t mean that the newer atypicals aren’t effective or an appropriate treatment. Perhaps, our current social construction of adolescence is partly to blame for the boom in mental health diagnosis in our children.

Florida Mulls Lawsuit Over Antipsychotic Programs is a post from Overlawyered - Chronicling the high cost of our legal system

Even more on autism and thimerosal is a post from Overlawyered - Chronicling the high cost of our legal system

On appeal, the First Circuit vacates the award and grants judgment for the defendants. In an opinion that is heavy on the factual details of the incident – and particularly the facts as they appeared at the time to the key decision makers – the First concludes that the jury instructions were incorrect. Among other things, the district court refused to provide instructions about the security provisions of Federal Aviation Act that governed the captain’s actions. In light of the flawed instructions, the Court concludes that the verdict cannot stand.

Moreover, the Court concludes that there is no evidence to sustain the jury’s conclusion that the plaintiff was discriminated against because he appeared to be middle eastern. In particular, neither of the two key decision makers – the captain and a manager in American’s Dallas headquarters – even saw the plaintiff until trial, and there is no other evidence to suggest that their decision was based on assumptions about the plaintiff’s race. Accordingly, the defendants are entitled to judgment notwithstanding the verdict.

Irrespective of the appellate decision, the initial jury verdict of $400,000 says a lot about how justice seems proportionality unfair and unmeasured given the facts of this case.

(Earlier at Overlawyered: Jan. 17.) Update Mar. 2: Cerqueira responds.

Cerqueira v. American Airlines is a post from Overlawyered - Chronicling the high cost of our legal system

On the heels of the Pittman case, comes this weeks Frontline program which explored the explosive growth of children being diagnosed with bipolar disorder. Unlike ADHD, bipolar disorder is generally treated with antipsychotic medications which can have profound and lasting side-effects. Yet, the desire to place the blame at the foot of the pharmaceutical industry is misplaced; the psychiatric community has a long tradition of capturing behaviors within their diagnostic net and transforming them into pathologies. All of the pharmaceuticals in the world do nothing to our children without a mental health culture which favors medicine as the first line of treatment for troubled children. And that mental health culture is not just a product of myopic physicians or Big Pharma, but very much one of our own creation.

The confused world of child psychiatry is a post from Overlawyered - Chronicling the high cost of our legal system

Maternity leave during high school is a post from Overlawyered - Chronicling the high cost of our legal system

The measure makes D.C. the first in the country to license pharmaceutical company sales representatives, able to revoke that license if a salesperson’s activities were deemed fraudulent… The bill, dubbed SafeRx, also mandates that drug reps have a bachelor’s degree, adhere to a code of ethics and refrain from giving doctors gifts.”

As the Journal alludes to later in the story, the lawsuits have begun.

Cometh the Regulation is a post from Overlawyered - Chronicling the high cost of our legal system

The study by Schechter and Grether in this issue of the Archives provides additional evidence of the lack of association between thimerosal exposure and the risk of autism in the US population. Using an ecologic design and data from the California Department of Developmental Services, the authors showed that the prevalence rate of autism increased continuously during the study period even after the discontinuation of the use of thimerosal in US vaccines in 2001. Had there been any risk association between thimerosal-containing vaccines and autism, the rate of autism should have decreased in young children between 2004 and 2007. Instead, the rate increase did not attenuate, indicating that thimerosal exposure bears no relationship to the risk of autism.

Whatever the science says, there’s at least three reasons why people continue to believe in a vaccine-autism link. Yet like the Vioxx litigation, science only gets you so far once litigation is introduced to the mix.

Thimerosal Disappears but Autism Remains is a post from Overlawyered - Chronicling the high cost of our legal system

Alison Cowan has this article in last Friday’s New York Times highlighting a recent case involving the suicide of Ruth Farrell. By all accounts Farrell had been quite depressed for a very long time. As is the case with some people who struggle with chronic depression, Ms. Ferrell was admitted to the hospital for care and observation related to her depression and suicidal ideation. Sadly, Ms. Farell hanged herself with her own pants between the standard 15 minute “checks” performed by staff on psychiatric wards. In turn, her estate sued her doctors and the hospital claiming improper care.

At first blush, one may ask how could such a terrible outcome occur if Ms. Ferrell had received proper psychiatric care? After all, it was depression and her suicidal ideation for which she was seeking treatment. One would hope that inpatient psychiatric treatment would at the very least prevent someone like Ferrell from harming herself. As much as these sentiments are understandable, they simply are not practical nor do they account for drive for privacy that permeates our health care institutions these days.

Most patients who are admitted to inpatient psychiatric facilities these days arrive there because they are either suicidal or psychotic. Short stays are the norm, and thus hospital staff are given the difficult task of caring for numerous patients who are very sick. Indeed, caring for the very sick is what hospitals do; but assuring safety for patients who are actively intent on hurting or killing themselves has always been a difficult task. Patients who are chronically suicidal often spend a great deal of time contemplating the method of their demise and it takes very little time to accomplish this goal once the final decision is made. A century ago, state mental hospitals kept patients in dormitory-styled facilities for this very reason (one layout at Worcester State Hospital was designed in a circle with the nurses station at the middle of “spokes” to optimize observation of patients). Modern psychiatric hospitals now look much like regular hospitals with many offering individual patient rooms to maximize privacy. Such changes follow the trend of the past 30 years of reducing the stigma associated with mental illness. These changes are largely laudable, but all change comes with a cost.

It may be tempting to think that in Ms. Ferrell’s case that cost for these changes was very high indeed; perhaps if psychiatric care had been delivered as it was 50 years ago she would be alive today. But such conclusions are erroneous and have their own untoward consequences towards our health care system. No psychiatric system, no matter how elaborately conceived, can assure us that a desperately depressed patient driven by suicidal thoughts will not harm himself. By seeking to hold someone responsible for the unfortunate events like those that occurred with Ms. Ferrell, our legal system drives the health care industry to spend inordinate amounts of monies to reduce patient risk to as close as zero as possible. Such pursuits invariably raise costs and limit services within our health care system which operates within a finite fiscal reality of uneven private and Medicaid reimbursements. The likely upshot with the health care system involved with Ms. Ferrell’s care will be employee seminars, new procedures and forms, extensive auditing of the delivery of care by hospital attorneys, and an increase in the pervasive fear of litigation that imbues so much of our health care system these days. However, very little will change in terms of patient care and outcomes, because it cannot. The fact is that sometimes bad things happen in hospitals which are nobody’s fault.

When is it nobody’s fault? is a post from Overlawyered - Chronicling the high cost of our legal system