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Medical roundup

by Walter Olson on September 10, 2014

  • ObamaCare challenge: D.C. Circuit vacates Halbig decision for en banc rehearing [Roger Pilon, earlier]
  • ACLU and SEIU California affiliates oppose trial lawyers’ higher-damages-plus-drug-testing Proposition 46 [No On 46, earlier] As does Sacramento Bee in an editorial;
  • Rethinking the use of patient restraints in hospitals [Ravi Parikh, Atlantic; legal fears not mentioned, however]
  • Certificate of need regulation: “I didn’t know the state of Illinois had a standard for the maximum permissible size of a hospital room.” [John Cochrane]
  • In China, according to a study by Benjamin Liebman of Columbia Law School, hired malpractice mobs “consistently extract more money from hospitals than legal proceedings do” [Christopher Beam, The New Yorker]
  • Overview of (private-lawyer-driven) municipal suits on painkiller marketing [John Schwartz, New York Times, earlier] More: Chicago’s contingency deal with Cohen Milstein on opioid lawsuit [LNL]
  • “So In The End, The VA Was Rewarded, Not Punished” [Coyote]

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Medical roundup

by Walter Olson on July 9, 2014

  • Congress responds to Veterans Administration health care scandal by throwing huge new sums at care [Nicole Kaeding, Chris Edwards, Cato] “Every Senior V.A. Executive Was Rated ‘Fully Successful’ or Better Over 4 Years.” [NYT via Instapundit] “VA Hospitals aren’t included on the federal government’s Hospital Compare web site” [White Coat]
  • Canadian judge quashes as vexatious suit over non-admission to medical school [Winnipeg Free Press]
  • Brain-damaged child cases: “14.5 Million Reasons Physicians Practice Defensive Medicine” [White Coat, Cleveland] “North Carolina Jury Deadlocks in John Edwards’ Malpractice Trial Against Doctor” [Insurance Journal, emergency medicine]
  • “Medical Licensing in the States: Some Room for Agreement — and Reform” [Charles Hughes, Cato]
  • “NY Launches Statewide Med Mal Settlement Program” [NYDN via TortsProf]
  • “Unlucky Strike: Private Health and the Science, Law and Politics of Smoking” [John Steddon and David Boaz, Cato program] Here’s the long-awaited segue to complete prohibition: British Medical Association recommends banning tobacco permanently for persons born after 2000 [WaPo]
  • Sneaky: California ballot language undoing MICRA liability limits “buried in an initiative titled The Troy and Alana Pack Patient Safety Act of 2014.” [Yul Ejnes, KevinMD]

May 23 roundup

by Walter Olson on May 23, 2014

  • Worst article of the week? Cheering on tort lawsuits as a way to trip up legalized pot [John Walters and Tom Riley, Weekly Standard]
  • Remember not long ago when they used to tout VA health care as a success story and model to be imposed on other health providers? [James Taranto, recalling Paul Krugman, Ezra Klein and many others; more thoughts from Coyote and Roger Pilon]
  • Muscle and intimidation: union + allies surge onto Oak Brook, Ill. McDonald’s headquarters property, closing key management building [Bloomberg; related earlier here, here, here, etc.] Yesterday I got into a Twitter conversation with Tim Noah (defending the protesters’ action) and William Freeland (siding with my own view), culminating in this rather startling comment from a Center for American Progress/ThinkProgress reporter: “This entire convo backs up the point the private property law itself functions as gov’t cronyism for the wealthy.” Wow!
  • Long, impassioned Ta-Nehisi Coates case for reparations [Atlantic, sidebar, Jonathan Blanks, my 2008 thoughts which eventually grew into a chapter in Schools for Misrule]
  • “Insurers Demand $2 Million for Negligent Squirrel-Torching” [Holland Twp., Mich.; Lowering the Bar]
  • R.I.P. left-wing historian Gabriel Kolko, whose project of de-mythologizing the Progressive Era won him a large libertarian fan base; initially contemptuous of that fan base, he came eventually to mellow with age and discern elements of common ground [Jesse Walker]
  • Hard lesson for Congress to learn: “Hawaiians simply aren’t American Indians in the constitutional sense” [Ilya Shapiro, Cato, background]

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From a casual glance at the account by the Pew Foundation’s StateLine in USA Today, you might think President Obama’s proposal to require overtime for home health carers (covered earlier here and here) was not so very costly or burdensome. “States wary home care worker rules could cost millions,” reads the headline. Paragraph 6 seems to confirm that the stakes are just in the low millions, which would be minor as health care policy changes go: “The U.S. Department of Labor estimates the rule will cost $6.8 million a year over a 10-year period, with private businesses and state Medicaid programs picking up the tab.”

On the other hand, you might find the above-cited number to be suspiciously low, what with advocates of the rule promoting it as a major boost to the take-home pay of nearly 2 million home care workers ($6.8 million works out to about three and a half bucks per year for each such worker). Thirteen paragraphs later, the tune has changed: “California, which already applies its $8 minimum wage to home care workers, but not overtime, estimates the new overtime requirements will cost the state more than $600 million in 2015-2016.” That is to say, just one state (California) gives an annual cost estimate for the rule that’s about 100 times the national cost estimate recited earlier in the piece. What gives?

This September account from Littler Mendelson, while not itself as clear as one might like, sheds some light on the discrepancy:

The DOL estimates the new regulations will affect approximately 1.9 million home care workers in the United States. The DOL contends the primary effect is “the transfer of income from home care agencies (and payers because a portion of costs will likely be passed through via price increases) to direct care workers, due to more workers being protected under the FLSA.” While described by the DOL as a “transfer of income,” in actuality the DOL’s numbers are the estimated annual cost to the home care agencies as a result of the new regulations. With respect to annual costs incurred for minimum wages, travel wages and overtime, the DOL estimates home care agencies will pay an average of $210.2 million the first year of implementation, increasing each year to an estimated $468.3 million on average by year 10. For annual regulatory familiarization, hiring costs (based on overtime hours needed to be covered by newly hired employees), and deadweight loss, the DOL projects home care agencies will incur $20.7 million on average in the first year, decreasing to an average of $5.1 million in year 10.

However, a March 2012 Navigant Economics Study: Estimating the Economic Impact of Repealing the FLSA Companion Care Exemption suggests a much higher cost to home care agencies. Although Navigant studied the economic analysis published by the DOL in the 2011 Notice of Proposed Rulemaking (NPRM), the study continues to suggest that the DOL has underestimated the compliance costs of the new regulations. According to Navigant, the DOL has: disregarded the impact on live-in workers, a group the study contends are disproportionately more likely to incur extended periods of pay at the overtime wage under the new regulations; underestimated the cost of paying home care workers for travel time; and underestimated the increased cost to the home care agencies for compliance with the minimum wage protection afforded by the FLSA. Ultimately, the study concludes the annual cost to home care agencies is significantly higher than the DOL has predicted.

It’s almost as if DoL has been doing its part to promote the president’s proposal by systematically lowballing, complicating and hiding its costs. The USA Today story has this relevant passage about some other costs that may be less readily monetized:

Joseph Bensmihen, president of United Elder Care Services, Inc., a caregiver referral service in Boca Raton, Fla., said the most likely alternative for most of his clients, besides moving into a facility [emphasis added], will be to rotate caregivers to ensure that none works more than 40 hours a week. “This means that one of the most cherished benefits of home care among the elderly, disabled, and infirm, namely continuity of care, will be lost.”

It won’t take many hapless elderly persons moving from home and family care into nursing home facilities to exceed that absurd $6.8 million cost underestimate all by itself.

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“It’s Doctors’ Duty to Promote Gun Safety With Patients” [Art Caplan, Medscape via Bill of Health] Next step: giving patients a hard time about kitchen or camping knives? [A. Barton Hinkle]

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Medical roundup

by Walter Olson on April 17, 2014

  • Academics have underestimated sensitivity of medical system to liability pressures [Michael Frakes, SSRN via TortsProf]
  • “Nobody has gone out and bought a new home” — Mark Lanier talks down his verdict knocking $9 billion out of Takeda and Lilly after two hours of deliberation by a Lafayette, La. jury [Reuters] Japanese drugmaker says it had won three previous trials [ABA Journal]
  • Nursing home in living-up-to-its-name town of West Babylon sued over hiring male strippers to entertain residents [NYP, more (wife of complainant attended display), ABA Journal]
  • “Reining in FDA regulation of mobile health apps” [Nita Farahany, Volokh/WaPo]
  • Another setback for plaintiffs as Arkansas tosses $1.2 billion Risperdal marketing case against Johnson & Johnson [AP/Scottsbluff Star-Herald, Eric Alexander/Drug and Device Law, earlier here and here]
  • “Spacecraft collision injuring occupant”: docs scratch their heads at new revamp to billing codes [Steven Syre, Boston Globe via Future of Capitalism]
  • FDA preclearance, drug litigation: “Most [patients] never know they were harmed, because we never know what we might have had.” [John Stossel]

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Farm and food roundup

by Walter Olson on February 18, 2014

Medical roundup

by Walter Olson on February 10, 2014

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Medical roundup

by Walter Olson on October 25, 2013

  • Sen.-elect Cory Booker (and Mayor Bloomberg too) on liability reform and fixing health care [NJLRA] How plaintiff’s lawyers get around caps [Alex Stein, Bill of Health] Missouri protects health volunteer workers [John Ross]
  • Like an Ayn Rand novel: Massachusetts ballot initiative pushes confiscation of private hospital profits [Ira Stoll, NY Sun]
  • Advice: plan now to lower your 2014 income to get valuable ObamaCare subsidies [San Francisco Chronicle]
  • Medicare comes off poorly: “Quality Of Care Within Same Hospital Varies By Insurance Type” [Tyler Cowen]
  • Revisiting a panic over alleged mass drug injury: “Avandia’s posthumous pardon” [David Oliver, earlier here and at Point of Law]
  • Louisiana lawmakers use malpractice statute to discourage abortion [Alex Stein, Bill of Health]
  • Georgia committee looks at plan to replace med-mal suits with administered compensation [Georgia Report via TortsProf, Daily Report Online (constitutionality), Insurance Journal]
  • Uwe Reinhardt on professional licensure and doctors’ monopoly [David Henderson]

“A federal appeals court has shot down a Massachusetts consumer protection case against two doctors, a medical journal and its publisher over an allegedly flawed article cited by defendants in birth-injury medical malpractice cases. That means plaintiffs’ attorneys will have to challenge the article’s validity in each case in which the defense wishes to cite it.” The First Circuit did not reach the issue of constitutional free speech, but upheld a lower court’s ruling that the plaintiff had not shown adequately that expert testimony reliance on the allegedly faulty article had resulted in the loss of the litigation in question. [Sheri Qualters, NLJ] Earlier on A.G. v. Elsevier here.

A plaintiff’s lawyer is suing a medical journal and two doctors for publishing a case report that makes it harder to win some birth-injury lawsuits.

Here are the details, as reported by Sheri Qualters of the National Law Journal. Some newborns are found to be suffering from brachial plexus injury, a type of harm to a child’s shoulder, arm, or hand that in a minority of cases results in permanent disability (so-called Erb’s palsy or a number of related conditions). A large volume of birth-injury litigation goes on as a result, in part because courts have tended to accept the idea that the only medically recognized cause of those conditions in newborns is excessive or traumatic use of physical force by clinicians (“traction”). In 2008, however, the American Journal of Obstetrics & Gynecology published a case report of a delivery in which an infant was found to be suffering such injury although the physician by her own account had not applied any excessive traction during the birth. If instead natural forces of labor could cause the dislocation resulting in the condition, many lawsuits might rest on shakier ground. Since then, defense lawyers have cited the report — by Henry Lerner of Harvard Medical School and Eva Salamon of the Bond Clinic in Winter Park, Fla. — in litigation.

A Boston lawyer who claims to have debunked the Lerner-Salamon case study has proceeded to sue its two authors, Elsevier — which publishes AJOG and many other medical and scientific journals — and Dr. Salamon’s clinic for publishing and refusing to retract it. The damages are said to be $3 million each to two families of infant plaintiffs whose lawsuits did not succeed allegedly because of the case report. The lawsuit invokes a Massachusetts consumer protection law which allows treble damages, and also asks for a court order forbidding the report to be entered as evidence in future litigation. A trial court dismissed the case, in part on the grounds that the plaintiffs had not shown that the article was a material cause of the families’ failure to prevail in the suits. Now the case is on appeal to the First Circuit, where defense lawyers are arguing, inter alia, that if there are weaknesses in the article the remedy for plaintiffs is to introduce evidence to that effect to counter it in trials. “As for its own role, Elsevier argued that applying a state consumer protection law to its published material would violate its free-speech right under the First Amendment.”

First Amendment? Let’s not go to extremes. If we start applying the First Amendment, how are lawyers supposed to silence publications that inconvenience them?

Our “watch what you say about lawyers” tag — which perhaps we should rename as “watch what you say about lawyers or their cases” — is here (cross-posted at Cato at Liberty; & welcome readers from Jesse Walker, Reason, Prof. Bainbridge).

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“Kentucky claims that writing an advice column that appears in a newspaper in the state — in the specific case of their complaint, the Lexington Herald-Leader, though it appears in others as well — is not an act of freedom of the press, but rather practicing psychology without the required license.” [Brian Doherty] “John Rosemond has been dispensing parenting advice in his newspaper column since 1976, making him one of the longest-running syndicated columnists in the country.” The Kentucky Board of Examiners of Psychology had its attention called to Rosemond by a local complaint about a column in which he advised parents about how to handle a sullen teen but did not recommend they seek professional help. The Board, along with the state’s attorney general, proceeded to demand that he submit to a cease-and-desist order on such matters as whether he can be bylined as a “psychologist”; Rosemond is licensed as such in his home state of North Carolina, but not in Kentucky. The Institute for Justice is defending Rosemond and has filed an action against the state. [AP]

Update from the Kentucky AG’s office: don’t blame us, we let our lawyers lend themselves out for state agency work and it was by inadvertence that our letterhead was used on what went to Rosemond. As Caleb Brown notes, this opens up new questions even if it answers some others.

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Caleb Brown of Cato interviews me:

Official DNA database use and obligatory testing is now sure to expand; where might it be headed? “If states are using DNA to verify paternity on births to underage women, why not use it to verify paternity on all births?” [Glenn Reynolds] “The 2018 Ezra Klein column on how it’s insane we’re not testing all this DNA for public health purposes writes itself.” [@andrewmgrossman] Michelle Meyer also has some ideas. Earlier here.

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Asking existing employees about their family medical history might offer safety benefits in the workplace, both by indicating vulnerabilities that might be countered by protective measures, and by helping to distinguish ailments with a strong congenital influence from those that might signal occupational disease. However, the Equal Employment Opportunity Commission says that such questioning is “genetic discrimination” and unlawful under the Genetic Information Nondiscrimination Act (GINA), which became law in 2009. Fabricut, a decorative fabrics firm, will pay $50,000 to settle charges that it improperly asked about family medical history and also that it improperly engaged in disability discrimination by refusing to employ as a clerk a woman it regarded as having carpal tunnel syndrome. [EEOC press release]

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They were seeking a second opinion on whether the baby needed heart surgery, and didn’t trust the care they were getting from Sutter Memorial Hospital in Sacramento, so parents Anna and Alex Nikolayev went over to Kaiser Permanente to get a second opinion. Police and Child Protective Services then showed up at their house to seize five-month-old Sammy. “A judge ordered Monday that the child be moved to Stanford Medical Center in Palo Alto, a decision which the Nikolayevs consider a win,” and also ordered that they obey all medical advice. [KSL, Today, Good Morning America (auto-plays)]

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A New Jersey man claims that he was injured by an insomnia therapy recommended on TV by the high-profile Dr. Mehmet Oz, involving the use of microwave-heated raw rice in a bag to warm the feet. Instead the man got third-degree burns, according to his lawsuit. [Associated Press/NJ.com]

The Minnesota Supreme Court ruled that a Duluth physician was not defamed by a contributor to a consumer-review site who criticized his bedside manner and referred to the doctor as a “real tool.” [Minneapolis Star-Tribune, ABA Journal, earlier here, etc.]

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“In the topsy-turvy world of health care, doctors and hospitals have a very powerful influence on how you are treated,” he [a university investigator] said. [San Jose Mercury-News] Topsy-turvy indeed — who would have guessed such a thing? (& InsureBlog)

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