Concussions on the Rise for Young Athletes

By Denise Mann

WebMD Health News

There was about a 60% increase in the estimated number of concussions and other traumatic brain injuries (TBI) seen among young athletes during the past decade, according to the CDC.

In 2001, there were an estimated 153,375 traumatic brain injuries among people from birth to age 19. This number rose to 248,418 in 2009.

Many of these injuries occurred among bicyclers, football players, and children in playgrounds. Basketball and soccer players are also at risk for TBI, according to a new report in the CDC's Morbidity and Mortality Weekly Report.

Exactly why we are seeing this uptick is not known, but "I believe this is, at least, in part due to increased awareness," says study researcher Julie Gilchrist, MD. She is a pediatrician with the CDC's Division of Unintentional Injury Prevention in the National Center for Injury Prevention and Control in Atlanta.

"We are hoping that awareness has gotten up to the point that parents, teachers, and coaches recognize the signs and symptoms of concussion and make sure that children are evaluated," she says.

The entire story can be read here.

The Pennsylvania Psychological Association helped to pass concussion management legislation.  Through active advocacy efforts, one of our aspirational ethics, psychologists are independent professionals able to assess and determine return to play for teenagers who suffered a head injury.

N.F.L. Plans Broader Concussion Research

By Sam Borden

The New York Times

The N.F.L’s first attempt at a long-range study on the effects of concussions was riddled with problems from the manner in which data was collected to conflicts of interest for those overseeing it. After criticism from outside experts and even members of Congress, the study was shut down by the league in late 2009.

Nearly two years later, however, the N.F.L.’s committee on concussion research is planning a considerably broader study — an effort that could begin gathering data as soon as next season, according to one of the doctors involved.

The doctor, Mitchel S. Berger, the chairman of the neurological surgery department at the University of California San Francisco, said Monday that he and the N.F.L.’s subcommittee on former players and long-term effects of brain and spine injury had been holding conference calls regarding the study every two weeks with representatives from the players’ union. He added that he hoped to make a final presentation to the union and Commissioner Roger Goodell “in the near future.”

Berger said he was aware of the issues surrounding the previous study, and said the latest model was completely different.

“There was no science in that,” Berger said in reference to the study coordinated by Dr. Ira Casson, who was also the league’s primary voice in discrediting outside research on concussions. Asked if he might use any of the data from Casson’s work, Berger shook his head.

The entire story can be read here.

An Ordinary Football Game, Then a Player Dies

By Jorge Castillo
The New York Times

Football coaches and school administrators at John C. Birdlebough High School congregated in a small room off the library Monday, huddling around a computer for a most painful and unusual review of game video. They examined every play that one student was involved in, assuming the role of medical examiners.

They were trying to discern which collision of the hundreds in a football game at Homer High School on Friday night might have caused Ridge Barden, a 16-year-old defensive tackle, to fall to the turf in the third quarter and die within a few hours. The coroner attributed Barden’s death to a subdural hematoma, or a brain bleed.

“There’s nothing here; there’s still nothing there; there’s nothing there; there’s nothing there — and now he’s laying on his stomach,” Jeff Charles, the head coach, said while watching the sequence frame by frame.

As those who play and coach football learn new ways to improve safety — through training, medical response and equipment — sometimes they are left to contemplate this: brains remain vulnerable, and even the most ordinary collisions on the field can kill.

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Barden’s father, Jody, said he had no objection to the sport in the wake of his son’s death.

“I just don’t want a negative spin on this,” Mr. Barden said Sunday. “There is no blame in this. I don’t want to scare kids from playing the game. Ridge loved playing the game, and I know he wouldn’t want it to get a bad name.”

The entire story can be read here.

Stanford Hospital & Clinics vows to fight $20M class action

By Jason Green

MercuryNews.com

Stanford Hospital & Clinics vowed Monday to "vigorously defend" itself against a $20-million class-action complaint filed in the wake of a data breach that saw the medical records of 20,000 patients posted on a commercial website for nearly a year.

Shana Springer filed the complaint on Sept. 28 in Los Angeles County Superior Court, on behalf of fellow patients treated in Stanford's emergency room between March 1, 2009, and Aug. 31, 2009. She is seeking $1,000 per patient, as well as other penalties, damages and attorneys fees.

The nine-page complaint alleges the hospital violated the Confidentiality of Medical Information Act, a state law that requires medical providers to safeguard patient information and prohibits its disclosure without written consent.

"On its website, Stanford claims that its patients' 'health care experience is [its] highest priority.' Thus, it should be no surprise that when patients are treated at Stanford's facilities, they expect that their private medical information will be kept confidential and will not be disclosed to anyone without their authorization," the complaint states.

In a brief statement released Monday, Stanford placed the blame on complaint codefendant Multi-Specialty Collection Services LLC, saying it was the subcontractor that mishandled the data. The hospital has since cut ties with the Woodland Hills-based company, which provided collection and billing services.

The entire story can be read here.

Third-party cases pose liability risks to doctors

By Alicia Gallgos

amdnews.com staff

The Utah Supreme Court is reviewing whether the children of a patient can sue their father's physician for medication mismanagement after the patient shot his wife to death. In a similar case, the Supreme Court of Georgia has ruled that a psychiatrist can be sued for medication negligence after a patient fatally attacked his mother.

The cases raise concerns about doctors' potential liability for criminal actions committed by their patients and what duty, if any, physicians owe to nonpatients. Experts say the cases remind doctors to take note of circumstances that could increase their liability risk to third parties.

In the Georgia case, the father of Victor Bruscato filed a lawsuit on behalf of Victor against psychiatrist Derek O'Brien, MD. He alleged that the doctor's discontinuation of Bruscato's two antipsychotic medications aggravated his son's violent tendencies. After the drugs were stopped, Bruscato, a mentally ill patient with a history of violence, stabbed his mother to death.

Dr. O'Brien had ordered two of Bruscato's medications stopped for six weeks to rule out the possibility that Bruscato was developing neuroleptic malignancy syndrome, according to court documents. A trial court dismissed the case in favor of Dr. O'Brien, ruling that public policy does not allow the Bruscatos to benefit from any wrongdoing, namely the killing of Lillian Bruscato. The appeals court reversed the decision.

In its Sept. 12 opinion, the Supreme Court affirmed, allowing the lawsuit to proceed. Though public policy prevents profiting from a wrongdoing in court, an exception exists if a mentally ill patient isn't aware of what he is doing, the court said. Bruscato was never found guilty of a crime; instead, he was ruled incompetent to stand trial and committed to a state mental hospital.

The rest of the story can be found here.

Judge says Prozac factor in teen murder

Winnipeg Free Press

Sympatico.ca News

WINNIPEG - A Manitoba judge says a Winnipeg teen was driven to fatally stab another teen due to the adverse effects of an anti-depressant drug.

Provincial court Judge Robert Heinrichs agreed to keep the case in youth court, where the male youth now faces a maximum sentence of just four more years behind bars on the charge of second-degree murder.

Heinrichs said Friday the use of Prozac resulted in “unique circumstances” which he was forced to consider.

He described how the youth, who was 16 at the time of the stabbing in 2009, went from a loving, happy-go-lucky kid to a dark, depressed drug abuser who began to act out violently and even tried to harm himself on several occasions.

Heinrichs said it’s clear the youth's parents did the right thing in bringing their concerns to his various doctors, but they were largely ignored and the drug's dosage was increased.

Since his arrest, the youth is now clean of all drugs, has expressed remorse for his actions and greatly reduced his risk to the public.

“His basic normalcy now further confirms he no longer poses a risk of violence to anyone and that his mental deterioration and resulting violence would not have taken place without exposure to Prozac,” Heinrichs said in a written decision.

The entire story can be read here.

The Best Treatment Of Anxiety May Not Involve The Drugs That Recent Literature Suggests

Medical News Today

A recent data analysis that was published in the British Medical Journal (BMJ) suggested that antidepressant drugs may offer the best treatment for generalized anxiety disorder. This new data analysis that is published in the recent issue of Psychotherapy and Psychosomatics suggests that BMJ is faulty and biased by conflict of interest.

Generalized anxiety disorder, the constant and fearful worry and fearful anticipation of events, is a common disturbance. A recent data analysis that was published in the British Medical Journal (BMJ) suggested that antidepressant drugs may offer the best treatment for generalized anxiety disorder. A new data analysis that is published in the recent issue of Psychotherapy and Psychosomatics suggests that BMJ is faulty and biased by conflict of interest.

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Although the study was allegedly independent, all authors had financial ties with Lundbeck and other pharmaceutical companies which manufactured the drugs that were included and discussed in the meta-analysis. The meta-analysis performed by Baldwin and colleagues is likely to yield misleading conclusions, particularly for the busy clinician who has no time to check its faulty procedures and the lack of appropriate clinical integration. The publication of this paper calls for a reassessment of journals' policies concerned with reviews, editorials and meta-analyses.

The entire article can be found here.

Barriers High in Mental Health Care

By Nancy Walsh
Staff Writer, MedPage Today

For mental health care, how bad are things, really?

That was the question posed by a group of physicians in Boston who had found difficulties in providing psychiatric referrals for their patients.

So they undertook a "simulated patient" study, telephoning all 64 Blue Cross Blue Shield in-network psychiatric facilities within 10 miles of the center of Boston, according to Rachel Nardin, MD, of the Cambridge Health Alliance in Cambridge, and colleagues.

This summary article can be found here.

The original article in the Annals of Emergency Medicine can be found here.

The article concludes:

"Although there are many contributors to the inadequacy of our mental health system, managed care has hit psychiatric services hard. Private insurers aggressively constrain patients' access to services by stringently limiting provider networks. As our study shows, this is often covert; insurers provide lists of in-network providers, but most are unavailable. Reimbursements for psychiatric services are far lower than for other types of care, so institutions frequently restrict access as stringently as possible, often, as in our study, by requiring that a patient have an in-system primary care provider (even though the insurer requires no referral). Many private practitioners refuse to accept insurance payments altogether. Improved reimbursements for psychiatric care will be an important step in reducing the barriers to care experienced by patients with severe depression."

Suspended Nova Scotia doctor may get licence back

CBC News.
Former patient blames doctor for suicide

A Nova Scotia doctor who used a patient to get a narcotic drug for her personal use will be allowed to return to the practice of medicine if she fulfils several conditions imposed by the College of Physicians and Surgeons of Nova Scotia.

Dr. Violet Hawes of Middle Musquodoboit had her licence suspended in November 2009 after the allegations surfaced.

The following month, one of her former patients committed suicide and left a note blaming her.
Doug Carpenter, 49, took his life in the parking lot of the Musquodoboit Valley Memorial Hospital in December 2009.

He left a note for his family saying "Dr. Hawes did this to me."

According to Carpenter's medical records, Hawes prescribed him Hydromorph Contin — a narcotic — for the first time in January 2008.

Carpenter's mother, Phyllis, said her son had described an arrangement with his doctor when she prescribed the drug.

"She would have a prescription ready for him when he went in there for his drug. He would fill it and give it to her," Carpenter told CBC News last December.

The entire CBCNews-Canada story can be here.

There was a similar case in central Pennsylvania in which a physician used numerous patients to obtain narcotics for himself.  In the Pennsylvania case, the physician's patient did not commit suicide, but he apparently told patients the drugs were for a dying parent.  Physicians using patient to obtain narcotics occurs.

Some of that information can be found here.

Petitioner was charged with five misdemeanor counts of unlawful procurement of prescription drugs in violation of 63 P.S. � 390-8(13) - however, the misdemeanor conviction is not at issue in this proceeding. Both the felony and misdemeanor charges involved Hydrocodone (Lortab) a Schedule III controlled substance. I.G. Ex. 8, at 1.