NZ: ACC Breach Horrifies Abuse Victims

By Amelia Romanos
nzherald.co.nz
Originally published March 13, 2012

Sexual abuse victims have been thrown into a state of panic after reports that their private ACC (Accident Compensation Corporation) details might have been released.

An ACC file containing details of more than 9000 claimants was reportedly emailed to an unauthorised recipient last year.

The file is believed to contain about 250 sensitive claims cases, which deal with injuries resulting from sexual assault and sexual abuse.

One Auckland woman, who has a historic sensitive claim with ACC, said she was horrified by the possible breach.

"Things are put aside, and you're working through things and now it's all coming back,'' she told APNZ.

"You just want to get on with your life and this is shocking.''

Her claim related to an incident in 1993 involving her then father-in-law, and she was concerned any details being released now would cause problems at her daughter's wedding later this year.

"There are a lot of family members, including many who don't know, and the fallout from my name getting out could be huge,'' she said.

The whole story is here.

ACC Media Statement Regarding Privacy

13 March 2012

ACC deeply regrets this situation.

The facts are as follows.

On 1 August last year, one of our Auckland staff included amongst other information in an email to a client, a spreadsheet containing information pertaining to other clients. Details in the spreadsheet related to ACC claims that had been under review, and included client names, claim numbers and branches involved. There was no personal information in the spreadsheet.

In December, a client advised us that they were in possession of information not relevant to them.

ACC subsequently wrote to the client, requesting the information to be returned immediately.

I can now confirm that the information has been destroyed, and is no longer on the hard drive of the computer of the client who received it. Our next task is to contact each of the clients affected, to advise them of the breach and confirm that their information is now protected.

Clearly, we must review our internal processes to ensure this type of event doesn’t occur again. Can I reiterate ACC’s concern, and I’d like to apologise to all ACC clients.

Ralph Stewart
Chief Executive
Accident Compensation Corporation

Will Patient Safety Initiatives Harm Physicians?

By Brian S. Kern, Esquire
Medscape Today News
Originally published on March 12, 2012

Peer review, the patient safety method designed to identify ineffective, unethical, or impaired physicians, can help improve the delivery of medical care, provide risk-management lessons, and lead to improved policies and procedures. At the same time, some doctors and hospital administrators have expressed concern that peer review produces fodder for civil or criminal lawsuits against physicians and healthcare institutions.

The body of law on patient safety initiatives and their level of confidentiality has evolved considerably. Historically, case law, recognizing the importance of peer-review procedures -- and the need to keep them confidential -- has protected self-critical analysis and other forms of internal investigation.

For example, in Christy v. Salem (2004), a New Jersey appellate court addressed whether a hospital's peer-review committee report was discoverable in a medical malpractice case. In declining to "adopt the privilege of self-critical analysis as a full privilege," the court chose to rely on a "case-by-case balancing approach" and essentially held that facts contained within a report are subject to legal discovery, but "evaluative and deliberative materials" are not.

Shortly thereafter, the Garden State adopted the New Jersey Patient Safety Act (NJ PSA), which in large part codified Christy v. Salem. The measure was tested early when, during the discovery phase of a medical malpractice trial against an obstetrician, a plaintiff's attorney sought hospital reports related to patient safety. The defense objected, asserting that the information was privileged and thus legally protected against disclosure.

The entire story is here.

Medicare Combats Fraud with Consumer Friendly Billing

By Susan Jaffe

Kaiser Health News in conjunction with The Washington Post

Originally published March 7, 2012

In the latest effort to enlist seniors in the fight against Medicare fraud, federal officials have overhauled Medicare billing statements to make it easier to find bogus charges without a magnifying glass.

The new, more consumer friendly format, which goes online Saturday on Medicare's secure website, www.mymedicare.gov, includes larger type and explanations of medical services in plain English. The revised paper version, which is mailed to seniors every three months, will be phased in early next year.

"You can make a difference!" the revamped statement says. "Last year Medicare saved taxpayers $4 billion - the largest sum ever reported in a single year thanks to people who reported suspicious activity to Medicare."

And for those who might need an incentive to scour their bills, the new statements promise a reward of up to $1,000 for a tip that leads to uncovering fraud. Although the bonus isn't new, there's no mention of it on current forms, which are sent to about 36 million beneficiaries in traditional Medicare.

"We approached this redesign from the standpoint of making it a more consumer-friendly document for beneficiaries and also a better fraud-fighting tool," said Erin Pressley, director of creative services for the Centers for Medicare and Medicaid Services. "If they are paying attention to these documents, they are going to be the best defense we have."

The entire story is here.

Risk and Reward Are Processed Differently in Decisions Made Under Stress

By Mara Mather and Nichole R. Lighthall

Current Directions in Psychological Science

February 2012, vol. 21, no. 1, pp 36-41.

Abstract

Years of research have shown that stress influences cognition. Most of this research has focused on how stress affects memory and the hippocampus. However, stress also affects other regions involved in cognitive and emotional processing, including the prefrontal cortex, striatum, and insula. New research examining the impact of stress on decision processes reveals two consistent findings. First, acute stress enhances selection of previously rewarding outcomes but impairs avoidance of previously negative outcomes, possibly due to stress-induced changes in dopamine in reward-processing brain regions. Second, stress amplifies gender differences in strategies used during risky decisions, as males take more risk and females take less risk under stress. These gender differences in behavior are associated with differences in activity in the insula and dorsal striatum, brain regions involved in computing risk and preparing to take action.

Beginning of the article:

The word stress describes experiences that are emotionally or physiologically challenging (McEwen, 2007). Stressful experiences elicit sympathetic-nervous-system responses and stimulate the release of stress hormones (e.g., cortisol in humans; Sapolsky, 2004) that mobilize the body's resources to respond to a challenge. The physiological effects of a stressful experience such as making a speech are evident not only during the event, but also in the next hour or so (Dickerson & Kemeny, 2004). When stressors are constantly present or anxiety about potential stressors is high, stress levels may become chronically elevated. Beyond the physiological effects of stress, a substantial literature indicates that both acute and chronic stress affect cognitive function.

Until recently, most studies examining stress and cognition have focused on stress effects on memory; effects on other aspects of cognition, including decision making, have received less attention. However, it is crucial to understand whether and how stress may alter decision making, as important decisions are often made under stress. For example, decisions about finances, health care, and social relationships are frequently accompanied by stress or cause stress. Early work on stress and decision making determined that stressors like time pressure and noise impaired decision making, resulting in decision making that is hurried, unsystematic, and lacking full consideration of options (Janis & Mann, 1977).

More recent work focuses on how stress influences how people respond to the risks and rewards of decisions. Acute stress potentiates dopaminergic reward pathways in the brain (Ungless, Argilli, & Bonci, 2010), which may intensify the allure of potential gains associated with decision options. The core brain-body feedback loops involved in the stress response also are involved in assessing risk and reward (Bechara & Damasio, 2005). As part of this brain-body feedback system, the insula helps represent somatic states and signals the probability of aversive outcomes during risky decisions (Clark et al., 2008). Both physical and psychological stress activate the insula, but differently for males and females (Naliboff et al., 2003; Wang et al., 2007).

In the following sections, we review recent evidence for two distinct effects of stress. First, stress enhances learning about positive choice outcomes and impairs learning about negative choice outcomes. This effect appears to be similar across gender and age groups. Second, stress affects decision strategies differently for males and females, with behavior diverging under stress when decision making involves immediate risk taking.

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The article and abstract are here.

This article is pertinent to ethical decision-making while experiencing stress and anxiety.

Special thanks to Ken Pope for this information.

DSM-5 Critics Pump Up the Volume

By John Gever, Senior Editor, MedPage Today

Published: February 29, 2012

With crunch time looming for the ongoing revision of the psychiatry profession's diagnostic manual, critics hoping to stop what they see as destructive changes are taking their campaign to the consumer media.

In early February, British psychologists and psychiatrists unhappy with proposed changes in the fifth edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders -- the DSM-5, in its forthcoming incarnation -- staged a successful press conference in London, which generated news coverage around the world.

Meanwhile, the most prominent U.S.-based critic of DSM-5, Allen Frances, MD -- chairman of the task force that developed the fourth DSM edition in 1994 -- has become a regular contributor to the popular Huffington Post website. Last week, he suggested there that the government should force the APA to abandon some of the proposed changes.

And the explosion in social media has allowed other, less well-connected mental health professionals and interested laypeople to create their own platforms for airing concerns about DSM-5 -- starting websites and writing comments on others.

At least in part, the rising furor is driven by the DSM-5 revision schedule. The APA has committed to releasing the final version at its May 2013 meeting. Its internal process for ratifying it requires that it be in essentially final form this winter.

Thus, only a few months remain for critics to sway the DSM-5 leadership.

The entire story is here.

Penn Clears Two Faculty Psychiatrists of Research Misconduct Charges

by Jocelyn Kaiser
Sciencemag.org
Originally published on March 2, 2012

The University of Pennsylvania has found no merit to an allegation that two of its psychiatry faculty committed research misconduct when they co-authored a 2001 paper written with help from writers hired by a drug company. But the university says that under current rules, the two faculty members would have been required to acknowledge the role of a "medical writer" in preparing the paper.   

Last July, Penn psychiatrist Jay Amsterdam alleged in a letter to the federal Office of Research Integrity that five researchers, including Penn's Laszlo Gyulai and Dwight Evans, chair of the Penn psychiatry department, had "engaged in scientific misconduct by allowing their names to be appended to a manuscript that was drafted by" Scientific Therapeutics Information (STI), a medical communications company, that had been "hired by" GlaxoSmithKline (GSK). The paper, which appeared in June 2001 in the American Journal of Psychiatry, reported on a small clinical trial of the antidepressant Paxil, partly funded by GSK and the National Institutes of Health. Amsterdam also claimed the paper was "biased" in favor of Paxil's safety and efficacy.

Amsterdam's letter argued that ORI should be involved because NIH Director Francis Collins has written that ghostwriting "may be appropriate for consideration as a case of plagiarism," which falls under the federal definition of research misconduct.

But Penn has concluded that no plagiarism occurred. In a statement yesterday, the university says that a faculty committee found "there was no plagiarism and no merit to the allegations of research misconduct" because Evans and Gyulai helped conduct the research and analyze the results and "contributed to the paper." The paper "presented the research findings accurately," Penn says.

The entire article is here.

$375M health care scheme went unnoticed for years

By Norman Merchant
Associated Press
Published on March 1, 2012

DALLAS (AP) — The Texas doctor accused of "selling his signature" to process almost $375 million in false Medicare and Medicaid claims went unnoticed for half a decade by a fraud detection system that some critics say is broken.

Authorities say Jacques Roy and six others indicted for health care fraud certified 11,000 Medicare beneficiaries through more than 500 home health providers over five years. Those numbers would have made Roy's Medicare practice the busiest in the country. But an investigation into Roy and his business practices didn't begin until about a year ago, officials said.

The federal agency that administers Medicare has two sets of contractors: one to pay claims and another evaluating those claims for fraud. U.S. Health and Human Services investigators have found that health officials often have a hard time tracking the work of contractors that are supposed to detect Medicare fraud — estimated by some to reach $60 billion annually.

Federal officials who announced the indictment against Roy and six others in Dallas acknowledged the problems with the system. They contend they have improved data analysis and are working to move away from having to "pay and chase" offenders.

Others say Medicare is still very vulnerable to fraud.

"It's a trust-based system that is ripe for the picking by criminals," said Kirk Ogrosky, a Washington, D.C., attorney at the law firm Arnold & Porter and a former top health care prosecutor at the U.S. Department of Justice.

The entire story is here.

Are the American Psychological Association’s Detainee Interrogation Policies Ethical and Effective? Key Claims, Documents, and Results

By Ken Pope

Abstract:

After 9–11, the United States began interrogating detainees at settings such as Abu Ghraib, Bagram, and Guantanamo. The American Psychological Association (APA) supported psychologists’ involvement in interrogations, adopted formal policies, and made an array of public assurances. This article’s purpose is to highlight key APA decisions, policies, procedures, documents, and public statements in urgent need of rethinking and to suggest questions that may be useful in a serious assessment, such as, “However well intended, were APA’s interrogation policies ethically sound?”; “Were they valid, realistic, and able to achieve their purpose?”; “Were other approaches available that would address interrogation issues more directly, comprehensively, and actively, that were more ethically and scientifically based, and that would have had a greater likelihood of success?”; and “Should APA continue to endorse its post-9–11 detainee interrogation policies?”

The entire article is here.

Forced medication of Jared Lee Loughner OK'd by court

By Carol J. Williams

Los Angeles Times

Originally published March 5, 2012

Jared Lee Loughner

Reporting from Los Angeles — Tucson shooting suspect Jared Lee Loughner can be forcibly medicated with antipsychotic drugs, a federal appeals court ruled Monday.

In a 2-1 ruling, the U.S. 9th Circuit Court of Appeals said prison authorities have the right to treat an inmate who would otherwise be a danger to himself or others around him.

Loughner, 23, has been charged with 49 felony counts in the Jan. 8, 2011, shooting rampage outside of a Tucson supermarket in which six people were killed and 13 others injured, including U.S. Rep. Gabrielle Giffords. The congresswoman was holding a meet-the-public event when the shooter attacked.

Loughner’s defense attorneys had objected to his being forcibly treated with antipsychotic drugs. They argued that because he is a pretrial detainee who has not been convicted of any crime that he has the right to refuse medication that he believes could harm or kill him.

The entire article is here.