Posts Tagged ‘psychiatry’

Medical roundup

  • More on effort to blame federal budget cuts for Ebola [Chris Edwards chart at Cato; Nick Gillespie, Reason; Michael Tanner, earlier] How Firestone, rare multinational firm with a large presence in Liberia, fought the disease [NPR] More: Heck of a job, Nicole: administration already has Ebola czar [Mollie Hemingway]
  • Train wreck postponed: “Administration Delays Home-Care Worker Minimum-Wage, Overtime Protections” [Kaiser Health News, earlier here, here, etc.; California will not delay]
  • “Should it be OK to fire employee for using medical marijuana?” [Debra Saunders, San Francisco Chronicle/syndicated, and thanks for quote; Jacob Sullum on Colorado “any lawful activity” statute]
  • Venture capital interest dwindles in cardiac and orthopedic medical device sectors amid concerns over regulatory hassle, tax, reimbursement problems [WSJ (also Avalon), Arnold Kling]
  • Billing code for “repeat doctor visit after being sucked into jet engine” probably little-used [Lowering the Bar, and surprise sequel]
  • British ambulance workers’ strike will hit scheduled patient visits rather than emergencies, so that’s okay [BBC]
  • Does Takings Clause, in combination with unconstitutional-conditions doctrine, require feds to compensate hospitals for EMTALA emergency-treatment mandate? [Haavi Morreim, Regulation, PDF] EMTALA, disability discrimination, and claimed “dumping” of psychiatric patients [Alison Somin on Gail Heriot dissent]

Pharmaceutical roundup

  • “Report: Government warnings about antidepressants may have led to more suicide attempts” [Washington Post]
  • Celebrity doc known for touting diet-health snake oil told off by Senators known for touting socio-economic snake oil [NBC, Business Week]
  • Physicians’ prescription of drugs off-label may “seem odd to the uninitiated, but it is called the practice of medicine, and there is absolutely nothing wrong with [it].” [Steven Boranian/D&DLaw, Sidley, Steve McConnell/D&DLaw (False Claims Act angle, with much background on that law generally)]
  • “23andMe Closer to FDA Approval” [Matthew Feeney/Cato, earlier]
  • FDA guidance could foreclose most use of tweets, Google ads and other character-limited vehicles in pharmaceutical promotion [Jeffrey Wasserstein/FDA Law Blog, Elizabeth N. Brown/Reason]
  • Average wholesale price (AWP) litigation: “Pennsylvania High Court Joins Judicial Stampede That’s Trampling State Attorneys-General/Plaintiffs’ Bar Alliances” [WLF, Beck, earlier]
  • California infant’s death opens window on lucrative (for some prescribers) intersection of workers’ comp and compounded pharmaceuticals [Southern California Public Radio]

“Firefighter’s Fear Of Burning Buildings Does Not Qualify As A Disability”

“The Texas Supreme Court overturned a $362,000 disability discrimination judgment awarded to a captain for the City of Houston fire department who was removed from firefighting duties because his fear of entering burning buildings made him a danger to himself and others. City of Houston v. Proler, No. 12-1006 (Tex. June 6, 2014). According to the court, no reasonable jury could have found that his fear of entering burning buildings constituted a disability under the ADA or Texas law.” However, the court based its decision on the state of the law before Congress drastically widened ADA eligibility in 2009, so it’s not clear how such a case might come out if filed today. [Kevin Cox, Kollman & Saucier, P.A.; Eric B. Meyer]

June 12 roundup

  • John McGinnis: As information technology disrupts the legal profession, will lawyers’ clout decline? [City Journal]
  • Law schools, especially of the more leftward persuasion, collecting millions of dollars in cy pres lawsuit diversions [Derek Muller]
  • Who’s still defending embattled medical examiner Steven Hayne? Mississippi attorney general Jim Hood, for one [Radley Balko, earlier here, here, here]
  • Life in America will become more drab if Campaign for Safe Cosmetics gets its way [Jeffrey Tucker via @cathyreisenwitz, earlier on “CPSIA for soap”]
  • LSAT settled with DoJ demands re: disabled accommodation back in 2002 and again just now, and the differences between the two settlements tell a story [Daniel Fisher, earlier] Some prospective students will be losers [Derek Muller]
  • “‘Swoop and Squat': Staged car accidents, insurance fraud rise in L.A.” [Los Angeles Times]
  • Toughen duty for California psychiatrists to inform on dangerous patients? Awaiting backfire in three, two, one… [Scott Greenfield]

Employer knew of Navy Yard shooter’s mental instability

This fairly gripping New York Times account by reporter Serge Kovaleski gives the backstory of the horrendous Navy Yard massacre — a contract employee with a security clearance had been displaying increasingly florid symptoms of paranoid schizophrenia, yet was not taken off his job — but is missing one angle I was curious about:

On Aug. 9, the director of human resources for the Experts spoke to Mr. Alexis’ mother, who told the director of his previous paranoid behavior, the person with knowledge of the investigation said. His mother told the director that Mr. Alexis’ paranoia tended to subside with time, but that “he likely needed to see a therapist.”

That same day, the director convened a meeting of “senior-level personnel” at the Experts who concluded that he could be sent back to work. The Hewlett-Packard investigation found that the Experts did not attempt to get Mr. Alexis to seek mental health care, a finding that the Experts has not disputed.

…In an e-mail message, the Experts said that a Hewlett-Packard manager in Newport said she was “comfortable” having Mr. Alexis come back to work after he reported hearing voices.

Hewlett-Packard said its manager in Newport was a low-level employee who was not given full details by the Experts about Mr. Alexis’ problems. The company said it has placed that manager on administrative leave.

The missing angle is: what if any role was played by the legal constraints on the various entities that directly or indirectly employed Mr. Alexis? Severe mental illness is a protected condition under the ADA, and employers may not be free to take workers off their duties unless and until they can assemble evidence that would stand up in court documenting a “direct threat,” “undue hardship” or other adequate reason for removal; the law places limits on the employer’s right to demand medical exams to evaluate the exact contours of disability; and privacy rules limit sharing of medically relevant information between different entities, as we saw in the Seung-Hui Cho/Virginia Tech case. All these rules apply to ordinary larger private businesses, but some come in especially stringent form when applied to federal contractors.

Did any of these legal doctrines influence the course of decision-making by which Mr. Alexis received oddly hands-off treatment even as his mental state spun out of control? One hopes a future NYT article will return to take a look at those questions.

In mental health care, a legacy of litigation

Starting in the 1960s a wave of foundation-backed lawsuits (Wyatt v. Stickney, etc.) resulted in the closure or drastic shrinkage of most larger state mental health facilities, with the hope that patients would benefit instead from more humane and decentralized “community-based care.” I have decidedly mixed feelings about the results of that episode: the old system inflicted abuses and deprivation of freedom that cried out for oversight and reform, but the new system has handed a great deal of power to unaccountable litigators managing consent decrees in pursuit of their own, sometimes quite debatable, view of clients’ and society’s best interest. Among the roads not taken: strengthening the inspectorate concept, which places oversight authority in a class of appointees intended to be independent of the care institutions but answerable to judges, elected officials, or both. I’m quoted at length on these issues in Neil Maghami’s new Capital Research Center profile of the Edna McConnell Clark Foundation, a key funder of the suits.

Medical roundup

  • New ACA regulations from the feds restrict employer wellness programs [Jon Hyman; Leslie Francis, Bill of Health]
  • Frequent-flyer defense medical examiner comes to grief in New York [Eric Turkewitz]
  • Fecal transplants (that’s not a misprint) appear to hold out hope of saving a lot of lives, except for the mountain of FDA paperwork blocking them [Amar Toor/The Verge, Maggie Koerth-Baker] Enter the grey market [Beth Skwarecki]
  • Why can’t the FDA catch up with Europe on sunscreens? [Alex Tabarrok]
  • “The banning of catastrophic-only plans infuriates me the most…. the only plans that are actually financially sensible for a healthy individual to purchase.” [MargRev comments section]
  • More on the recent study of malpractice suits by a group of Johns Hopkins researchers [Christopher Robinette]
  • For all his public health pretensions, Michael Bloomberg “has no idea what he’s talking about” on medical marijuana [Jacob Sullum]
  • Another look at asylums? [James Panero, City Journal]
  • Feds’ war on Google pharma ads reflects no credit on D.C. [Brian Doherty]

Canada: man who killed cellmate sues jail staff

Justin Caldwell Somers, in jail for not paying a jaywalking fine, brutally murdered his sleeping cellmate by stomping him to death on the cement floor, but was found not criminally responsible because he had been acting under the influence of delusions and hallucinations. Now he is suing various personnel of the remand center for not preventing the incident, in part by not heeding the recommendation of a nurse and psychiatrist that he be housed alone: since the murder Somers “has experienced severe mental anguish and mental distress as a result of his role in causing the death of Mr. Stewart, as well as a result of the conditions of his incarceration.” [Edmonton Journal]