The Tragic Suicide Death of Junior Seau

By John M. Grohol, PsyD.

World of Psychology Blog

The evidence is in, and the death of NFL football player Junior Seau has been ruled a suicide. The speculation is that he suffered from depression as a result of the concussions he sustained as a pro football player in the U.S. Seau spent most of his football career as a San Diego Charger.

Many in the news media are portraying this as some sort of new news — that having your head repeatedly banged and bashed can cause long-lasting brain damage. Even with a padded helmet, there’s been a wealth of research demonstrating that head injuries still occur. The human head just wasn’t meant for years and years of such repeated abuse.

It’s also not the first time we’ve known of this link between football playing, concussions, and being at a much higher risk for depression (and even dementia). Perhaps this time the message will get through.

The entire blog is here.

Providers to Test Power of Apology in Malpractice Claims

By Robert Lowes

Medscape Medical News

Originally published April 27, 2012

The Massachusetts Medical Society (MMS) wants to prove that clinicians and hospitals can keep medical malpractice out of the courtroom by owning up to their mistakes with apologies — and sometimes cash as well.

The result, says the MMS, will be not only fewer lawsuits but also improved patient safety, less defensive medicine, and lower costs.

Earlier this month, the MMS and 5 other state healthcare organizations announced the start of a pilot program to promote a process called Disclosure, Apology, and Offer, or DA&O. It's a kinder and gentler approach to medical liability reform compared with measures such as caps on noneconomic (pain and suffering) and punitive damages, which are viewed in some quarters as abridging the legal rights of patients.

Like most of organized medicine, MMS supports these traditional liability reforms, but it also sees merit in avoiding the courts.

"The current liability system impedes open communication," says Alan Woodward, MD, a past MMS president and chair of its professional liability committee. "It creates a culture of blame, finger-pointing, and secrecy. We're trying to turn that around into an advocacy system that supports both patients and providers."

The entire article is here.

Thanks to Gary Schoener for this lead.

Insurers Embrace "Virtual" Doctor Visits

By Phil Galewitz
KHN Staff Writer
Originally published May 6, 2012

Tired of feeling "like the walking dead" but worried about the cost of a doctor's visit, Amber Young sat on her bed near tears one recent Friday night in Woodbury, Minn.

That's when she logged onto an Internet site, run by NowClinic online care, a subsidiary of UnitedHealth Group (which also owns UnitedHealthcare), and "met" with a doctor in Texas.

After talking with the physician via instant messaging and then by telephone, Young was diagnosed with an upper respiratory illness and prescribed an antibiotic that her husband picked up at a local pharmacy. The doctor's "visit" cost $45.

"I was as suspicious as anyone about getting treated over the computer," said Young, 34, who was uninsured then. "But I could not have been happier with the service."

Read the entire story here.

Yoo Can't Be Sued for Allegedly Authorizing Torture

By Scott Graham
The Recorder
Essential California Legal Content
Originally published May 2, 2012

John Yoo is off the hook.

John Yoo

A panel of the U.S. Court of Appeals for the Ninth Circuit that included two Democratic appointees ruled Wednesday that the former Bush administration lawyer cannot be sued personally for allegedly authorizing the torture and months-long detention of an American citizen deemed an enemy combatant.

 
The court ruled that 10 years ago, when Yoo was with Justice Department's Office of Legal Counsel, it was not "beyond debate" that suspected terrorists were entitled to the same constitutional protections as ordinary accused criminals. In fact, the court held, that law remains unsettled to this day.
 
Thus, Yoo, now a professor at UC-Berkeley School of Law, enjoys qualified immunity from a suit by Jose Padilla, who alleges he was brutalized by the government while being denied access to counsel or his family for 21 months. Although the government dropped the most serious charges against him, Padilla was ultimately convicted in 2007 of conspiring to murder, kidnap and maim people overseas, and was sentenced to 17 years in prison.

The entire story is here.

Thanks to Gary Schoener for this story.

Abbott Settles Marketing Lawsuit

By Michael S. Schmidt and Katie Thomas
The New York Times - Business Day
Originally published May 7, 2012

The pharmaceutical company Abbott Laboratories said on Monday that it had reached an agreement with the federal and nearly all state governments to pay $1.6 billion in connection with its illegal marketing of the anti-seizure drug Depakote.

The settlement comes as the Justice Department and the states have increased scrutiny of the sales and marketing practices of pharmaceutical companies, particularly in cases in which they market drugs for uses that are not approved by the Food and Drug Administration.

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Doctors may prescribe drugs for any purpose, but pharmaceutical companies are prohibited from promoting drugs for conditions that are not approved by the agency.

The entire story is here.

GPs Reminded to Regularly Assess Depressed Patients for Risk of Suicide

Originally Published on May 4, 2012

The Medical Defence Union

GPs are being advised to ensure patients with depression are regularly assessed for a risk of suicide. The Medical Defence Union (MDU) issued the advice after being notified of a small number of complaints in which GPs were criticised for failing to appreciate that the patient was a suicide risk.

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The MDU's advice for GPs to help them avoid such problems includes:

• Be aware of the current guidance on the treatment of depression, including the role of non-drug interventions.
• Ensure patients understand what is being prescribed and have been warned about the risks involved, any side-effects and alternatives to treatment.
• Have a system in place to review patients on long-term medication.
• All patients who present with depression need to be assessed regularly for risk of suicide.
• Be prepared to refer patients for specialist treatment where necessary and have a system to track referrals.
• Take care with prescriptions for drugs with similar names and with dosages.

The entire story is here.

NY Fines 15 Insurers over Mental Health Notices

Associated Press
The Wall Street Journal
Originally published May 9, 2012

ALBANY, N.Y. — New York regulators have fined 15 insurers $2.7 million for failing to notify small businesses they were eligible to buy special coverage for mental illnesses and children with serious emotional disturbances.

Superintendent of Financial Services Benjamin Lawsky says they are the first fines under Timothy's Law, named for a teen who committed suicide after his parents were unable to obtain needed mental health treatment. The law took effect in 2007.

The rest of the story is here.

More information on Timothy's Law is here.

Psychoactive Medication Use Among Children In Foster Care

The Children's Hospital of Philadelphia
"Hope Lives Here"
Originally published April 30, 2012

A few months after the federal Government Accountability Office (GAO) issued a report on the use of psychoactive drugs by children in foster care in five states, a national study from PolicyLab at The Children's Hospital of Philadelphia describes prescription patterns over time in 48 states. The updated findings show the percentage of children in foster care taking antipsychotics - a class of psychoactive drugs associated with serious side effects for children - continued to climb in the last decade. At the same time, a slight decline was seen in the use of other psychoactive medications, including the percentage of children receiving 3 or more classes of these medications at once (polypharmacy).

Psychoactive drugs prescribed at higher rates for foster children

As public scrutiny has increased about the use of psychoactive medication by children over the past decade, children in foster care continue to be prescribed these drugs at exceptionally high rates compared with the general population of U.S. children. According to the PolicyLab study, 1 in 10 school-aged children (aged 6-11) and 1 in 6 adolescents (aged 12-18) in foster care were taking antipsychotics by 2007.

The entire story is here.

Contact: Dana Mortensen, Children's Hospital of Philadelphia, 267-426-6092

Vignette 13: Troubles in the ICU

You are a psychologist in a busy acute care hospital where you receive frequent consultation requests by the trauma service.  A physician requests a psychological evaluation of a 46-year-old man who attempted suicide via over dose of prescription medications along with alcohol. You arrive in the intensive care unit where the patient’s respiratory status is rapidly deteriorating. He is marginally coherent and unable to give any consistent responses.  However, upon his arrival in the emergency department, the medical record quotes the patient as saying, “This wasn’t supposed to have happened.”

The ICU nurse asks you to offer an opinion regarding the patient’s capacity to accept or refuse intubation.

While you are there, a family member arrives with a copy of a notarized advance directive, created within the last year, which specifically outlines the patient’s wishes not to be placed on a ventilator or any artificial life support. The ICU staff asks for your input.

What are the ethical issues involved?

What would you do in this situation?

Would your answer differ if the advanced directive was created 7 years ago or greater?

Would your answer differ if there were no advanced directives?