Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy

Tuesday, January 31, 2012

Medical Academics Could Be Legally Liable for Ghostwritten Articles

Condemnation by ethicists and loss of grant money are not the only penalties facing academics who put their names on medical-journal articles they didn't write. Personal-injury lawyers have them in their sights now, too.

In an article published Tuesday in the journal PLoS Medicine, the authors laid out three possible areas of liability, including the federal anti-kickback statute, which can carry prison time plus fines of up to $250,000.

Researchers at major universities, including Brown, Emory, Harvard, Stanford, Tufts, and Yale, have been accused in recent years of signing their names to medical-journal articles that were written by others, articles that promoted the benefits of various medications and were produced under the auspices of pharmaceutical companies trying to boost their products. Last year The Chronicle reported that a University of Pennsylvania psychiatry professor accused five other academics of signing an article that was ghostwritten for the maker of the antidepressant Paxil and made unsupported claims for it.

"By lending his name, the author is contributing to fraud," says Bijan Esfandiari, one of the authors of the PLoS Medicine article. "And the ghostwriter is involved in the conspiracy as well."

Mr. Esfandiari is a lawyer with the firm of Baum, Hedlund, Aristei & Goldman in Los Angeles. ("For 25 years we have championed death and injury claims for thousands of clients nationwide," reads the firm's Web site.) His co-authors are Xavier A. Bosch, a professor in the department of medicine at the University of Barcelona, and Leemon McHenry, a lecturer and specialist in bioethics in the philosophy department at California State University at Northridge.

The entire story is here.

Monday, January 30, 2012

I Disclose ... Nothing

The Hard Truths About Disclosure
By Elisabeth Rosenthal
The New York Times Sunday Review
Originally Published January 22, 2012

IN New York and a growing number of American cities, diners are encountering sanitary grades in restaurants’ windows — A, B or C. That system is an example of helpful disclosure, researchers say: information that is simple and comprehensible, important to recipients and easily acted upon. I recently chose between outwardly identical Japanese noodle shops on East Ninth Street in Manhattan based on the system, walking into the A rather than the B.

But as greater disclosure has become the go-to solution for a wide range of problems — from unethical campaign financing to rising corporate carbon emissions — it has often delivered lackluster results, researchers say.

Just last week, the Obama administration announced plans to require drug companies to disclose a wide variety of payments and gifts to doctors, from speaking fees to the purchase of breakfasts for office staffs, in the hope of reducing commercial influence on prescribing practicesPresident Obama has promised to run the most open, transparent administration in history. But is more disclosure the solution?

If recent history serves as a guide, disclosure laws — meant to elucidate — do not necessarily lead to greater transparency or prevent the things they were meant to deter. Every holder of a subprime mortgage that is now underwater once signed an elaborate disclosure statement required by the Truth in Lending Act describing precisely the risky terms of their loan. Likewise, “super PACs” in the presidential campaign are technically compliant with financial disclosure laws, but have so far proved successful at hiding many of the sources of their money.

Everyone agrees that openness is a virtue in a democracy. So what is going wrong?

One fundamental problem is that disclosure requirements merely get information onto the table, but themselves demand no further action. According to political theory, disclosure is both a citizen’s right and a tool to ensure good government and consumer protection, because it provides information that leads to informed decisions. Instead, disclosure has often become an endpoint in the chain of responsibility, an act of compliance with the letter of the law rather than the spirit of transparency.

“In the beginning, disclosure was a means to an end, and now it’s often an end in itself,” said Kevin P. Weinfurt, professor of psychiatry and behavioral science at Duke University. “People think, ‘If we’ve disclosed we’ve fulfilled our responsibilities.’ ”

The entire story is here.

Sunday, January 29, 2012

From neural ‘is’to moral ‘ought’:what are the moral implications of neuroscientific moral psychology?

From Neural 'is' to moral 'ought': What are the Moral Implications of Neuroscientific Moral Psychology?

Saturday, January 28, 2012

Johnson & Johnson settles Texas lawsuit for $158M

AUSTIN, Texas (AP) — Texas and a subsidiary of health care giant Johnson & Johnson reached a $158 million settlement in a Medicaid fraud lawsuit Thursday, allowing the drugmaker to pay a fraction of the potential $1 billion in penalties and fines that state officials had initially sought.

The lawsuit was one of dozens of state and federal cases alleging that the company committed fraud by making false or misleading statements about the safety, cost and effectiveness of the expensive anti-psychotic medication Risperdal, and improperly influencing officials and doctors to push the drug.

Janssen Pharmaceuticals Inc., one of the J&J subsidiaries that had been sued, said in a statement it will pay the money to fully resolve all claims in Texas. The company said it is not admitting any liability or fault with the settlement.

Texas Attorney General Greg Abbott, who initially called on the company to repay $579 million that the state's Medicaid program had spent on Risperdal prescriptions plus up to $500 million in penalties, called the settlement a warning to drugmakers.

But analysts called the $158 million figure a victory for J&J, which made billions off Risperdal, because the deal allowed the company to avoid a much larger verdict in a state with a reputation as an easy place to win big jury awards.

The entire story is here.

Friday, January 27, 2012

Physician Guilty of Medicare Fraud Put Patients at Risk

By Robert Lowes
Medscape Medical News
Published January 18, 2012

A stiff prison sentence handed down to a physician in Los Angeles, California, last week for his role in a massive Medicare scam highlights how a seeming burlesque of medicine posed a danger to patients.

Alexander Popov, MD, was sentenced to 8 years and 1 month in prison in a federal court in Sacramento, California, after a jury last year found him guilty of conspiring to — and committing — healthcare fraud. An indictment issued in 2010 stated that Dr. Popov and 4 other physicians allowed a man named Vardges Egiazarian, who owned 3 clinics in the California cities of Carmichael, Richmond, and Sacramento, to submit Medicare claims in their names. Dr. Popov took on the role of co-owner and practitioner at the Sacramento clinic but never saw a patient there, according to federal prosecutors.

Over the course of 2 and a half years, Dr. Popov and the other physicians submitted more than $5 million worth of bogus claims to Medicare for nonexistent or unnecessary services, of which they received $1.7 million. The physicians' share of the take was 20% of what was paid out under their Medicare provider number.

In a sentencing memo filed in the case, federal prosecutors credit Dr. Popov and the other conspirators with doing "everything necessary to establish and operate a health clinic, with the exception of actual healthcare." As part of their hustle, they paid "cappers" to recruit and transport patients to the clinics, and the patients themselves received $100 each for showing up — a kind of reverse copay.

The patients, who were predominantly elderly immigrants who did not speak English, received little if any medical care during their visits. Clinic employees nevertheless recorded in their charts that they had received a comprehensive exam and a broad array of diagnostic tests. Staff would plug in off-the-shelf test results or would run tests on themselves and use those numbers. Dr. Popov, who lived in Los Angeles, saw none of these patients in person, but signed the charts anyway, according to prosecutors.

The entire story can be found here.

Thursday, January 26, 2012

Small medical practices greatly at risk for data breaches

They often lack sophisticated technology to deter thieves, making them bigger targets.

By PAMELA LEWIS DOLAN, amednews staff. Posted Jan. 16, 2012.

Data breach experts are issuing a warning to small practices -- don't be the vulnerable target that data thieves assume you are.

Kroll Fraud Solution's Top Cyber Security Trends for 2012 reported that small practices are more susceptible to security vulnerabilities because they are "the path of least resistance." Many rely on outdated technology. Basic security protections, such as proper use of encryption, often are overlooked as practices focus on meeting regulatory requirements, such as those related to meaningful use.

Small practices often lack the technical sophistication to know what tools to put in place to avoid attacks, said Jason Straight, managing director of Kroll's Cyber Security and Information Assurance unit. Or they have the right tools, but the tools are not implemented or monitored correctly, he said. One example is having incorrectly installed data encryption.

Large organizations have become more "hardened," meaning they spend more money to safeguard their data, said Beth Givens, founder and director of the Privacy Rights Clearinghouse, an education and advocacy group that has tracked publicly reported data-breach trends across all industries since 2005. "It only stands to reason [that data thieves] would go after small practices," she said.

The story can be found here.

Wednesday, January 25, 2012

Pro-anorexia websites pose public health challenge

Pro-Anorexia Websites Pose Public Health Challenge _ the Lancet

The Lancet published this article in the public domain.

Tuesday, January 24, 2012

Psychologist ordered to turn over evaluation of Dunwoody murder suspect

By Andrew Cauthen
The Champion
Originally published 1/12/12

Hemy Neuman
The doctor who evaluated the mental state of Hemy Neuman, accused of the November 2010 killing of a Dunwoody man, has been ordered to turn over the records of the evaluation.

Superior Court Judge Gregory Adams on Jan. 11 ordered Dr. Peter Thomas to “transmit all records in his possession concerning his evaluation of [Neuman].”

The order states that “any records received by the Court…which do not contain privileged attorney-client communications will thereafter be turned over to the state and the defendant.”

Neuman has pleaded not guilty by reason of insanity to charges that he killed Russell Sneiderman, an entrepreneur who had just dropped his child at a daycare.

The rest of the story, and some interesting comments, are here.

More details of the crime and the defense are found here.

Monday, January 23, 2012

School Psychologists and Ethical Practice: Information for Parents and Educators


Sunday, January 22, 2012

Meadowlands hospital neuroscientist fired over controversial autism treatment

By Susan K. Livio
The Star Ledger
Originally published January 10, 2012

Philip DeFina, PhD
The neuroscientist who would have overseen a controversial therapy for children with autism has been fired by Meadowlands Hospital Medical Center in Secaucus and, in a separate action, his nomination to a state commission on brain research has been delayed.

Philip DeFina was part of an ambitious plan by Meadowlands to offer hyperbaric oxygen therapy to children diagnosed with autism. The therapy, typically used to treat burns and other wounds by energizing dying tissue, required approval from the state Department of Health and Senior Services. Meadowlands would have been the first hospital in the state to offer the experimental treatment.

But the application ran into strong opposition, and questions were raised in a Nov. 27 Star-Ledger article in which traditional medical and psychological experts said the treatment offers families false hope while draining bank accounts because the experimental therapy is not covered by insurance. Some families say it has helped their children, and argued that if a method is safe and seems to be effective, it should be given a chance even if it hasn’t been thoroughly vetted through research.

The article also described DeFina’s doctorate in clinical psychology from Fielding Graduate University. The school, a mainly online university with monthly in-person sessions, is the only one to receive national accreditation from the American Psychological Association. DeFina’s experimental treatments with neurologist Jonathan Fellus for coma and brain injury have fetched as much as $100,000 from the families of patients who have not improved using traditional means. Fellus remains at Meadowlands.

There rest of the article is here.

Saturday, January 21, 2012

UConn Investigation Finds That Health Researcher Fabricated Data

By Tom Bartlett
The Chronicle of Higher Education
Originally published January 11, 2012

Dipak K. Das
A three-year investigation by the University of Connecticut has found that the director of its Cardiovascular Research Center falsified and fabricated data at least 145 times, in some cases digitally manipulating images using PhotoShop.

The researcher, Dipak K. Das, is best known for his work on resveratrol, a compound present in grapes and other foods that some research suggests can have beneficial effects on the heart and could slow aging, though recent studies have cast doubt on the latter claim.

The university has begun a process to dismiss Das, who has tenure.

Das has been quoted regularly in news articles, usually talking about resveratrol, and his papers have been cited often, as the blog Retraction Watch points out. But the importance of his research is unclear.

David Sinclair, a professor of pathology at Harvard University who is known for his discovery that resveratrol appears to extend the life of mice and fruit flies, said he had not heard of Das. “I’ve not worked with him,” Sinclair wrote in an e-mail. “Looking through it, the work is generally not published in leading molecular-biology journals.”

The entire article is here.

Another article from The New York Times is here.

Friday, January 20, 2012

What Opinions Can Psychologists Give About Persons They Have Never Met?

What Opinions Can Psychologists Give About Persons Whom They Have Never Met?

Massachusetts Appeals Court rules that judge was wrong to order mentally ill woman to have an abortion and to then be sterilized

By Peter Schworm
The Boston Globe

The Massachusetts Appeals Court today reversed a probate judge’s decision to order a schizophrenic woman to undergo an abortion and to then be sterilized, saying the woman had consistently expressed her opposition to the practice as a Catholic.

In October, the state Department of Mental Health filed a petition to have the woman’s parents named as guardians for the woman, who is only known as “Mary Moe,’’ so they could give consent for an abortion, according to the court.

Norfolk Probate and Family Court Judge Christina Harms, declared that the 32-year-old woman was not competent to make a decision about an abortion, citing “substantial delusional beliefs,” and concluded she would choose to abort her pregnancy if she were competent.

Earlier this month, Harms ordered that the woman’s parents be appointed as coguardians and that Moe could be “coaxed, bribed, or even enticed ... by ruse” into a hospital where she would be sedated and an abortion would then be performed, the ruling stated.

The judge also ordered the facility that performed the abortion to sterilize the woman “to avoid this painful situation from recurring in the future.”

The Appeal Court’s decision, released today, reversed the sterilization order in unusually strong terms.

“No party requested this measure, none of the attendant procedural requirements has been met, and the judge appears to have simply produced the requirement out of thin air,” wrote Appeals Court Judge Andrew Grainger.

The entire story is here.

Thursday, January 19, 2012

U.S. to Force Drug Firms to Report Money Paid to Doctors

The New York Times - Money and Policy
Originally published 1/16/2012

WASHINGTON — To head off medical conflicts of interest, the Obama administration is poised to require drug companies to disclose the payments they make to doctors for research, consulting, speaking, travel and entertainment.

Many researchers have found evidence that such payments can influence doctors’ treatment decisions and contribute to higher costs by encouraging the use of more expensive drugs and medical devices.

Consumer advocates and members of Congress say patients may benefit from the new standards, being issued by the government under the new health care law. Federal officials said the disclosures increased the likelihood that doctors would make decisions in the best interests of patients, without regard to the doctors’ financial interests.

Large numbers of doctors receive payments from drug and device companies every year — sometimes into the hundreds of thousands or millions of dollars — in exchange for providing advice and giving lectures. Analyses by The New York Times and others have found that about a quarter of doctors take cash payments from drug or device makers and that nearly two-thirds accept routine gifts of food, including lunch for staff members and dinner for themselves.

The entire article is here.

Research misconduct in the UK: Time to Act

By Fiona Godlee, Editor in Chief, and Elizabeth Wager, Chair
British Medical Journal

Research misconduct can harm patients, distort the evidence base, misdirect research effort, waste funds, and damage public trust in science. Countries all over the developed world are now recognising the need to set up systems to deter, detect, and investigate research misconduct. Why does the United Kingdom have no plans to do the same?

As Aniket Tavare outlines in the linked feature (doi:10.1136/ bmj.d8212), high profile cases of misconduct have led the United States, Canada, Sweden, Norway, and Poland, among others, to create formal mechanisms for overseeing research integrity. In most countries responsibility lies with the institutions, but oversight varies greatly, and it is unclear which systems are most effective and efficient. None is perfect—the remit of the US Office of Research Integrity is limited to publicly funded health research; Australia’s recently established Research Integrity Committee is already being criticised for lacking teeth. But each system shows that the problem has been acknowledged, that institutions accept primary responsibility, and that governments and funders are seriously committed to tackling misconduct openly and with a range of statutory powers.

In contrast, the UK has no official national body. The UK Research Integrity Office was established in 2006 and has done some useful things. But its function has always been advisory, and now that the major funders represented by Research Councils UK (RCUK) have decided not to continue the funding, it relies on voluntary funding from institutions. The Research Integrity Futures Working Group, set up by RCUK and Universities UK (UUK) and other bodies, has also apparently come to nothing. The working group’s report commissioned in 2009 called for an independent advisory body, similar to the
UK Research Integrity Office but operating across all research sectors and with a stronger monitoring and preventive function. But RCUK pleaded budget cuts and decided not to implement the  recommendations.  It says it is working with UUK on a “concordat” to take some aspects forward, but two years on nothing has been announced.

The entire editorial can be found in the public domain.

BMJ 2012;344:d8357 doi: 10.1136/bmj.d8357

Wednesday, January 18, 2012

Should Forensic Psychiatrists Conduct Psychological Testing?

Frank Dattilio, Ph.D., ABPP, Bob Sadoff, M.D., Eric Drogin, J.D., Ph.D., ABPP, 
and Tom Gutheil, M.D.
Journal of Psychiatry & Law (Vol. 39, #3), Spring 2012

Most forensic experts have encountered at least one civil or criminal case in which a forensic psychiatrist has independently conducted psychological testing.

In some instances, the psychiatrist will consult a psychologist on the interpretation of test outcomes, while in others he or she may simply rely on one of the many computerized scoring programs that provide a "canned" analysis and narrative interpretation of results.

Predictably, this phenomenon has occasionally stirred controversy regarding the clinical, ethical, and legal dimensions of appropriateness of selection, skillfulness of administration, accuracy of scoring, validity of interpretation, sufficiency of training, and codified scope of forensic practice.

The primary purpose of this article is to address the ambiguous nature of psychiatrists employing psychological testing in their forensic work, and to arrive at a definitive answer as to whether or not forensic psychiatrists should offer services in this domain.

Key to making this determination will be a review of what differentiates psychological tests from other forms of assessment, such as appraisals, rating scales, and inventories.

 Also addressed are jurisdictionally based legal and ethical issues and a review of what would constitute adequate training and supervision.

[end excerpt]

A clear distinction needs to be made between what constitutes a 'psychological test' versus an 'appraisal,' 'rating scale,' or 'technique.'   Rating scales, such as the Zung Depression Scale or the Beck Anxiety Inventory, have no standardized format for administration and lack complexity in scoring and interpretation.  Projective techniques (i.e., Draw a Person, etc.) are so variably conducted that their best use is typically in support of psychotherapy formulations as opposed to forensic application.  However, these terms are often interchangeable with the terms 'psychological test' or 'psychodiagnostic test.

[another excerpt]

Forensic psychiatrists without access to--and proper review of--administration manuals may be eroding the reliability of psychological test results from the outset.

[another excerpt]

When asked about psychological tests in court, most psychiatrists respond by saying that they have not been trained to administer, score, or interpret psychological tests and that it would be inappropriate and unethical for them to administer them without proper training.  Furthermore, most psychiatrists do not comment on testing because they are not able to provide a comprehensive or valid response due to their lack of expertise.

[another excerpt]

It is our opinion that psychiatrists should never administer psychological tests without intensive training and supervision.  Once again, proper training and education remain critical and, without such training, they should not attempt to incorporate psychological testing into their own examination procedures.  Forensic psychiatrists would need to become familiar with the nuances of standardization and how important it is to the test results and interpretations.  It may also be essential when administering psycho-logical tests to take certain notes regarding observations.  Some of these notes and observations are generated by individuals who administer the tests and score them, interpreting the results on a regular basis, which, obviously, can only come from being very familiar with the tests administered and with scoring.

[another excerpt]

The issue at hand is not one of territoriality--as some might surmise--but rather one of forensic standards and professional ethics, particularly as they pertain to protecting the public.  The appropriate selection, administration, scoring, and interpretation of psychological tests require extensive training and supervision, of a sort that cannot be obtained during a weekend seminar or on the basis of casual, incidental supervision.  Proper testing in forensic cases calls for a thorough grounding in test construction and assessment procedures as well as a firm knowledge of instrumental reliability and validity.  Cross examination on such notions as 'standard error of measurement,' 'confidence intervals,' and 'normative populations' is fair game.  Test users unfamiliar with core psychometric principles expose their reports and testimony to negative scrutiny, imperil the work of retaining counsel, haphazardly affect the fate of litigants, and run the risk of allegations of unethical behavior.  In keeping with the current trend in professional training and development, psychological testing should be viewed as a 'competency'.

The author note provides the following contact information: Frank M. Dattilio, Ph.D., ABPP, Department of Psychiatry, Harvard Medical School, MMHC-Shattuck, 180 Morton St., Jamaica Plain, MA 02130. E-mail: frankdattilio@cs.com.

Thanks to Ken Pope for the information and excerpts.

Tuesday, January 17, 2012

The Application of Virtue Ethics to the Practice of Counseling Psychology

Virtue Ethics in Counseling Psych

This dissertation can be found in the public domain here.

NJ school district moves to fire teacher who made anti-gay Facebook comments

By Star Ledger Staff
It was three months ago when anti-gay comments posted on Facebook by a Union High School teacher caused a nationwide controversy. Now, those comments may cost the instructor her job.

The Union Township school board announced today it has filed tenure charges against Viki Knox, the longtime teacher and faculty adviser to the high school’s Bible study group.

Board president Francis R. Perkins said the charges were formally filed in late December after a three-month investigation of Knox’s conduct, the first step in what could be a lengthy and costly process to fire her.

"Every student, no matter what race, creed color or sexual orientation ought to be able to come to school and feel comfortable in a learning environment that’s welcoming and nurturing," Perkins said.

Knox, 50, who has been on paid administrative leave, could not be reached. Sandy Oxfeld, Knox’s attorney, said he would have no comment on the case while it is in litigation.

The move by the Union school board has rekindled a broader issue of free-speech rights of teachers in the growing age of social media.

The entire story is here.

Monday, January 16, 2012

Contracts with Patients in Clinical Practice

By Michael L Volk, Sarah R Lieber, Scott Y Kim, Peter A Ubel, & Carl E Schneider
(Volume 379, Issue 9810; January 7)

Written documents called contracts are increasingly present in clinical practice and medical publications.

There are behavioural contracts for management of so-called difficult patients, opioid contracts, suicide prevention contracts, and healthy living contracts.

Some practices have even asked patients to sign contracts in which they promise not to litigate or post defamatory comments on the internet.

Despite widespread adoption, the use of contracts in medicine has had little critical appraisal.

Patients' contracts do different things in different clinical situations: they can serve administrative purposes, by deterring mistreatment of clinical personnel or diversion of narcotic drugs; some are educational, drawing patients' attention formally to information; and others clarify expectations and foster transparency, such as when a prospective organ recipient agrees to respect rules on substance misuse.

Other contracts--e.g., for suicide prevention--can help doctors to express concern for their patients, or help patients hold themselves to better health practices, by bolstering willpower with a written commitment (Ulysses contracts).

The effectiveness of contracts in general is uncertain.


A unilateral or authoritarian style of implementing contracts might cause patients to feel threatened or coerced, and perhaps even to view the contract as a "prelude to abandonment".


In view of the inconclusive evidence about the effectiveness of these contracts and their possible disadvantages, we have some recommendations.

First, clarify terminology; written patient-physician agreements generally do not fit the usual definition of a contract.

Second, clarify aims; for example, if the main aim is to state non-negotiable terms (such as substance-misuse criteria for transplant candidacy) it would be franker to label the document an acknowledgment of clinical policies.

Third, treat the contract as part of a therapeutic process--a standard form contract is one thing, and helping patients set and meet goals is another.

This is the fundamental principle behind motivational interviewing, a technique with strong empirical support.

Finally, patients should be given resources and assistance to meet their goals; for example, structured weight-loss programmes work better than advice to diet and exercise.


Whenever possible, written agreements should be bilateral, tailored to the individual patient, and presented in a way that signals continuing commitment.  Otherwise, we risk alienating patients and damaging the therapeutic alliance."

Thanks to Ken Pope for the story and excerpts.

British science needs 'integrity overhaul’

Medical Academics Voice Concern Over Research Misconduct
By Daniel Cressey

British scientists are fundamentally failing to deal with research misconduct, which is widespread in the country, leading experts have warned.

At a conference in London yesterday, participants were united in calling for more action on the issue.

“There is a recognition that we have a problem,” said Fiona Godlee, editor-in-chief of the British Medical Journal (BMJ) and one of the driving forces behind the meeting.

Coinciding with the meeting, a BMJ survey of 2,782 doctors and medical academics showed that 13% claimed to have firsthand knowledge of “inappropriately adjusting, excluding, altering or fabricating data”. Six per cent said that they were aware of cases of possible research misconduct at their institutions that they thought had not been properly investigated.

Research-integrity issues in the United Kingdom have long been fretted over. Last year the House of Commons science and technology select committee said that they found “the general oversight of research integrity in the UK to be unsatisfactory”. Similar concerns have been raised by others, going back more than a decade.

Elizabeth Wager, chairwoman of the international Committee on Publication Ethics, warned the meeting that one US editor had told her that UK institutions are the worst to deal with in cases of suspected misconduct. “Our reputation in the world is not looking good,” she said.

She added that although the concern is being driven mainly by medical researchers, their worries apply to other scientific fields.

UK mechanisms for ensuring ethical conduct in research “need to be strengthened”, concluded a communiqué from the meeting. In addition, the meeting said, the UK Research Integrity Office (UKRIO) should be enhanced, and ongoing funding for it should be secured. (At one point last year, the future financing of UKRIO was unclear, although it now seems to be secure.)

The entire sotry can be found here.

Sunday, January 15, 2012

Texas Abortion Law Can Go Into Effect Immediately

Associated Press

AUSTIN, Texas—A federal appeals court cleared the way Friday for the immediate enforcement of a new abortion law in Texas requiring doctors to conduct a sonogram before the procedure.

The three-judge panel on Tuesday lifted a temporary stay issued by a district court judge who found the new law potentially unconstitutional, but didn't issued a legal mandate. On Friday, the judges agreed to a request by Texas Attorney General Greg Abbott to cut short the typical three-week waiting period between a ruling and its implementation.

The new law requires doctors to conduct a sonogram before performing an abortion, to show the woman the image, to play the fetal heartbeat aloud and describe the features of the fetus at least 24 hours before the abortion. There are exceptions in the case of rape, incest, fetal deformities and for women who have to travel great distances to reach a doctor.

The most recent order doesn't give time for doctors fighting the law to appeal the decision, which under normal circumstances woudn't have gone into effect until Jan. 31. The Center for Reproductive Rights, which supports the doctors, didn't have an immediate reaction to Friday's order.

The entire story is here.

American College of Physicians Ethics Manual - Sixth Edition

American College of Physicians Ethics Manual -- The college released a new version of its professional guidelines and included a section about considering costs involved in treatment. "The manual is not a substitute for the experience and integrity of individual physicians, but it may serve as a reminder of the shared duties of the medical profession. ... Physicians must base their counsel on the interests of the individual patient, regardless of the insurance or medical care delivery setting. ... Physicians have a responsibility to practice effective and efficient health care and to use health care resources responsibly. Parsimonious care that utilizes the most efficient means to effectively diagnose a condition and treat a patient respects the need to use resources wisely and to help ensure that resources are equitably available" (Snyder et al., 1/3).

The supplement to the code of ethics can be found here.

Saturday, January 14, 2012

Assisted suicide should be legal, says major report to parliament

MPs told that people with a terminal illness could be safely offered the choice to end their own lives

By Esther Addley
The Guardian
Originally published Wednesday 4 January 2012

MPs should consider changing the law on assisted suicide to allow some terminally ill people to end their lives at home with the help of their doctor, a major report into the subject has concluded.

The Commission on Assisted Dying, chaired by the former lord chancellor Lord Falconer, says a choice to end their own lives could be safely offered to some people with terminal illnesses, provided stringent safeguards were observed.

Describing the current law on assisted dying as "inadequate and incoherent", the commission will today outline a legal framework that would permit only those who had been diagnosed with less than a year to live to seek an assisted suicide, and then only if they met strict eligibility criteria. These would include:
  • Two independent doctors were satisfied with the diagnosis.
  • The person was aware of all the social and medical help available.
  • They were making the decision voluntarily and with no sense of being pressurised by others or feeling "a burden".
  • They were not acting under the influence of a mental illness, and were capable of taking the medication themselves, without help.
The 400-page report follows a year of investigation by the commission, whose members also include the former Metropolitan police commissioner Lord Blair, a former president of the General Medical Council, a leading consultant in disability equality, an Anglican priest, and medical, mental health, palliative care and social care specialists.

The rest of the story is here.

Friday, January 13, 2012

Report Finds Most Errors at Hospitals Go Unreported

New York Times - Health
Published: January 6, 2012

Hospital employees recognize and report only one out of seven errors, accidents and other events that harm Medicare patients while they are hospitalized, federal investigators say in a new report.

Yet even after hospitals investigate preventable injuries and infections that have been reported, they rarely change their practices to prevent repetition of the “adverse events,” according to the study, from Daniel R. Levinson, inspector general of the Department of Health and Human Services.

In the report, being issued on Friday, Mr. Levinson notes that as a condition of being paid under Medicare, hospitals are to “track medical errors and adverse patient events, analyze their causes” and improve care.

Nearly all hospitals have some type of system for employees to inform hospital managers of adverse events, defined as significant harm experienced by patients as a result of medical care.

“Despite the existence of incident reporting systems,” Mr. Levinson said, “hospital staff did not report most events that harmed Medicare beneficiaries.” Indeed, he said, some of the most serious problems, including some that caused patients to die, were not reported.

Adverse events include medication errors, severe bedsores, infections that patients acquire in hospitals, delirium resulting from overuse of painkillers and excessive bleeding linked to improper use of blood thinners.

The rest of the story is here.

Thursday, January 12, 2012

Prison psychologist loses license, job

Former staffer who faked rape has license suspended by the Board of Psychology
By Laura Newell, Telegraph Staff Writer
Laurie Ann Martinez

A psychologist who allegedly faked her own rape earlier this year has lost her job with the California Department of Corrections and Rehabilitation.

Laurie Ann Martinez, a licensed psychologist for the state prison system who worked at New Folsom Prison, was terminated from her post. Her last day was Dec. 22, three days after her court appearance.

Her license has also been suspended by the state Board of Psychology.

The board is seeking to permanently revoke her license.

“The criminal allegations against Ms. Martinez are serious enough to warrant this action,” said Board Executive Officer Robert Kahane. “Our mission is to protect consumers, and we think allowing Martinez to continue to practice poses a threat to consumer health and safety.”

The rest of the story is here.

Other posts related to this story can be found here and here.

Wednesday, January 11, 2012

Vignette 9: Psychologist as Character Witness?

A psychologist receives a phone message from a former patient.  The former patient is asking for the psychologist to be a “character witness” as he has an upcoming hearing for a minor criminal offense. His attorney believes that some good, written character references will really help out with the case.

The psychologist pulls the former patient’s chart.  The psychologist has not worked with the patient for about two years. Additionally, none of the treatment issues had to do with impulse control or antisocial tendencies. Therapy lasted about a year and focused on depression and relationship issues. The psychologist recalls that the patient had always been good-natured, attended appointments regularly, and worked well in therapy.  The psychologist remembers the former patient as a likeable person.

How would you feel about receiving this request?

What ethical issues are involved?

What are your potential options?

If you decide to provide information, would you consider communicating with the prior patient’s attorney?  What would you need from the attorney?

Tuesday, January 10, 2012

One Ethical Decision-Making Model

Ethical Decision Making Model

This article can be found in the public domain here.

Company withdraws contracts controlling online comments by patients

The move comes after a complaint alleged that Medical Justice's business practices are unethical.

By ALICIA GALLEGOS, amednews staff. Posted Jan. 2, 2012.

Medical Justice Inc. is retiring its "vaccine against libel," a set of contracts providing authority to doctors over online comments posted by patients.

The contracts' demise follows a complaint made to the Federal Trade Commission alleging that Medical Justice is engaging in unethical business practices. A dentist is being sued for using one of the agreements.

The complaint and the lawsuit were filed on Nov. 29, 2011.

A day later, Medical Justice announced it will end its use of the contracts, said neurosurgeon Jeff Segal, MD, CEO and founder of Medical Justice. The company has informed its 3,000 physician and dentist members that the contracts are retired. Medical Justice recommends that doctors use its latest online tool -- the eMerit system -- to combat false posts and protect their reputations. But Dr. Segal said members are "free to do what they want to do," which includes continuing to use the contracts if they see fit. He said the company has not suggested that doctors call their patients to inform them of the contracts' retirement.

The entire story can be read here.

Monday, January 9, 2012

Lawsuit Accuses Company Of Fraudulently Cycling Patients Through Nursing Homes, Hospice Care

By Jordan Rau
Kaiser Health News Staff Writer
Originally published January 4, 2012

A national hospice company improperly cycled patients through nursing homes and hospice with a goal of making as much profit as possible from Medicare, according to a whistleblower lawsuit announced this week.

Federal attorneys also sued the hospice company, AseraCare, alleging it milked Medicare’s hospice benefit by pressuring its employees to enroll people into hospice who weren’t dying and resisted discharging them despite evidence they weren’t deteriorating. One hospice patient who should have been immobile from end-stage heart disease was healthy enough to go to his granddaughter’s graduation and a berry-picking excursion with a friend, the government charges.

For years, some critics of Medicare’s hospice benefit have said that the way the government pays providers gives them financial incentives to abuse the system. The suits against AseraCare, a Fort Smith, Ark.-based hospice company operating in 19 states, follow several other suits against big hospice companies but go further in their allegations that the company coordinated its use of nursing care and hospice care to maximize Medicare reimbursements.

The entire story is here.

Sunday, January 8, 2012

Jury Rules in Favor of Man Suing Therapist for Sparking Relationship with his Wife during Counseling

by TaMaryn Waters
Tallahassee Democrat

This is not a made-for-television-movie scenario, but it felt like one for Richard Webb. His 25-year marriage was crumbling so he sought counseling from Kevin Ragsdale from September 2007 to January 2008, court records show.

Within the four-month span of counseling, Webb's wife was brought in to joint counseling sessions.

But Webb didn't know Ragsdale conducted private sessions with his wife and later sparked a relationship.

Webb sued Ragsdale, who married Webb's wife in January 2010, for emotional damages and a Leon County jury has ruled the therapist violated several code of ethics...


Dana Brooks, Webb's attorney, said the jury ruled Ragsdale was 65 percent responsible for negligence that caused a "legal cause of harm or loss" to Webb and 35 percent of the negligence was caused by Webb.

Brooks, however, said there was no evidence presented at trial related to Webb's role in negligence.

She plans to file a motion for a post trial hearing.

Brooks said a judge will make a judgment on what the final verdict should be for Webb, including damages, during the post trial, which could be sometime next month.

She said her client, the father of three children ages 14, 18 and 21 during the time of the counseling, said Webb continues to have "a great deal of difficulty on any kind of parenting issues" now that Ragsdale has married his ex-wife.

"My client feels like he is being completing supplanted and replaced," she said.


Thanks to Ken Pope for this story.

For some reason, the Tallahassee Democrat no longer has the full story on their web site.

Saturday, January 7, 2012

Ask the Ethics Committee: Releasing Third Party Reports

Dear Ethics Committee:

I have a question about the release of third party records.  I understood that we are NOT to release records from third parties that we have in our charts (e.g., from other medical providers).

A colleague recently told me that this has changed.  If 3rd-party information is in our charts, then the expectation is to release it when asked for records.

Can the committee offer some guidance on this?

Thank you.

Ethics Committee Response:

There is no absolute prohibition against sending records received from third parties in response to a signed patient release. However, this may not be a good practice.  In many cases, the psychologist cannot ensure that the third party records are the most recent or the most comprehensive set of records available.

For example, a psychologist receives a release of information from a patient that graduated from therapy about one year ago.  The release specifies that the psychologist send “all records.”  In file, there is a report from a physician in file that is now five years old. By sending the old report from the physician, the psychologist may be doing a disservice because the psychologist does not know if the patient has had more recent contact with the physician.  Additionally, the psychologist cannot be sure if the physician's report is now inaccurate or misleading.

Therefore, we suggest that it is preferable to have the patient get the information directly from the third party.

There are certain situations in which good clinical and ethical judgment may indicate a different course.  As stated above, there is no rule that prohibits a psychologist from sending out information generated from third parties, if legally compelled or clinically indicated.

For example, a psychologist receives a copy of a psychiatric evaluation in file from the outpatient clinic of a psychiatric hospital that had closed several years ago. The former patient is now working with a different psychiatrist.  An appropriately signed release asks for “all records” to be sent to the current treating psychiatrist.  In this situation, the patient’s current treatment may be enhanced with this longitudinal data.

In another situation, a former patient, who is applying for Social Security Disability, requests that “all records” be sent to a State Agency.  In file, there are old reports from several inpatient psychiatric interventions.  Instead of sending a seriously mentally ill, and perhaps disabled, patient on a long and potentially futile effort to find out what happened to those old records, the patient may benefit from releasing those older records directly to that State Agency so that the most accurate decision can be made.

In forensic cases, it is sometimes expected that psychologists will send information gained from third parties, especially if it was used as a basis to formulate their opinions.

There may be other situations where it is legally or clinically indicated to send out records from third parties that psychologists have in their charts. The examples provided are not meant to be exhaustive.

However, as noted above, it is usually better for patient records to come directly from the original source.

Thoughts and comments about this response are welcome.