Health Care Policy

Thank your Texas Senators for a Good Bill!

From Texas Alliance for Life:

 

Texas Senate Passes Pro-Life SB 303 to Help Families

Protect Loved Ones Near the End of Life

 

Lt. Governor David Dewhurst and Sen. Donna Campbell M.D. Deserve Thanks!

 

April 24, 2013

 

Dear Larry and Beverly:

 

Very good news! Last week the Texas Senate passed SB 303, a strong pro-life bill that will change current law to help families protect their loved ones near the end of life. Supported by pro-life Lt. Governor David Dewhurst and authored by Sen. Bob Deuell (R-Greenville), the full Senate passed SB 303 on a decisive 24-6 vote.

Your Texas state senator, Sen. Donna Campbell M.D., voted to support SB 303, a pro-life vote. Please thank Lt. Governor Dewhurst and Sen. Campbell for their support. See sample messages below.

SB 303 is strongly supported by broad coalition of pro-life and provider organizations including Texas Alliance for Life, the Texas Catholic Conference of Bishops, and the Texas Baptist Christian Life Commission. 

 

Voting for SB 303 were: Campbell, Carona, Davis, Deuell, Duncan, Ellis, Eltife, Estes, Fraser, Garcia, Hinojosa, Huffman, Lucio, Nelson, Nichols, Rodriguez, Schwertner, Seliger, Uresti, Van de Putte, Watson, West, Whitmire, and Zaffirini.Voting against SB 303 were: Hancock, Hegar, Patrick, Paxton, Taylor, and Williams. Senator Brian Birdwell was absent.

 

(snip)

Dems divided on congressional Obamacare changes – Jake Sherman – POLITICO.com

Democrats are seeking to exempt Congress and their staffers from Obamacare.

http://www.politico.com/story/2013/04/dems-divided-on-congressional-obamacare-changes-90648.html

Texas Catholic Bishops Conference Rebukes “Texas Right to Life”

Using words such as “egregious,” “cynical,” “outrageous,” and “deceive,” the Texas Catholic Bishops Conference have published the letter that they sent to Texas Legislators concerning the actions of Texas Right to Life concerning Senate Bill 303 and its companion, House Bill 1444 on April 15, 2013.

Since employees and representatives of TRL continue to “stoke fear through ridiculous claims,” (and to harass those who support the Bills)  here’s the letter (I’ve reproduced the emphasis is in the original):

The Texas Catholic Conference is compelled to publicly correct the misstatements and fabrications that continue to be perpetuated by the Texas Right to Life organization against legislation to improve end-of-life care by reforming the Texas Advance Directives Act.

It has been said that all is fair in love, war and Texas politics. However, the actions of Texas Right to Life have been so egregious and cynical, especially when comes to misrepresenting the moral and theological doctrine of the Catholic Church, that the TCC cannot stay silent.

Texas’ Advance Directives Act needs reform. Current law lacks clarity given the complexity of end-of-life care, contains definitions that could permit the withdrawal of care for patients – including food and water – and permits unilateral Do Not Resuscitate Orders without the permission of, or even consultation with, the family.

Senate Bill 303 and House Bill 1444 are based on Catholic moral principles and reasonable medical standards for defending human life and protecting the conscience of both families and physicians. Both billsprevent unilateral DNRs, improve communication between medical providers and families, ensure a clear and balanced process for resolving differences, and give families the right to challenge Do Not Resuscitate Orders before a medical ethics committee.

In both its materials and communications with legislative offices and staff, Texas Right to Life has tried to stoke fear through ridiculous claims of nonexistent “death panels” and assertions that doctors are “secretly trying to kill patients.” Both claims are absurd. The truth is, many factors are involved in the sausage-grinding process of public policymaking. Some have less to do with making good laws and more about individual personalities and fundraising opportunities of organizations.

It is outrageous that an organization purportedly committed to the rights and dignity of life would resort to such disingenuous tactics that deceive honest and caring people. What is worse is doing so in a way that perpetuates current law and may cause unnecessary patient suffering.

Texas Right to Life has no authority to articulate Catholic moral teaching, and certainly does not have permission to represent the views of the Roman Catholic Bishops of Texas. If you have any questions, please feel free to contact us at the Texas Catholic Conference. We are more than happy to answer any questions or provide the Texas Catholic Bishops’ position on any issue before the Legislature.

 

(Edited for spelling and grammar, 4/25/13 BBN)

NIH funded study: “the tobacco industry and the Tea Party”

How reliable is a US government funded study that uses the term, “astroturf?”

Research using your tax dollars is under scrutiny – once again – and the subject of recent hearings in Congress. The National Cancer Institute, a wing of the National Institutes of Health, paid for this “study.” It was published in a “peer reviewed” journal, Tobacco Control, one of the “BMJ Group” (British Medical Journal) publications.

Discussion

The tobacco companies have refined their astroturf tactics since at least the 1980s and leveraged their resources to support and sustain a network of organisations that have developed into some of the Tea Party organisations of 2012.

***

 

What this paper adds

Rather than being a grassroots movement that spontaneously developed in 2009, the Tea Party organisations have had connections to the tobacco companies since the 1980s. The cigarette companies funded and worked through Citizens for a Sound Economy (CSE), the predecessor of Tea Party organisations, Americans for Prosperity and FreedomWorks, to accomplish their economic and political agenda. There has been continuity of some key players, strategies and messages from these groups to Americans for Prosperity, FreedomWorks and other Tea Party-related organisations.

***

• Funding This research was funded by National Cancer Institute grants CA-113710 and CA-087472. The funding agency played no role in the selection of the research topic, conduct of the research or preparation of the manuscript. SAG is American Legacy Foundation Distinguished Professor in Tobacco Control.

• Competing interests None.

• Provenance and peer review Not commissioned; externally peer reviewed.

via ‘To quarterback behind the scenes, third-party efforts’: the tobacco industry and the Tea Party — Fallin et al. — Tobacco Control.

Obama Gives $13 Million Grant to Texas Planned Parenthood! @txprolife

We’ve all been hearing about the supposed “War on Women” by Conservative law makers – and, by extension, voters – in Texas. Well, President Obama and Secretary of Health Kathleen Sebellius just fired another shot in the war against Texas and State’s rights.

UPDATE: In an emailed statement, Texas Department of State Health Services spokeswoman Carrie Williams says that the agency just received notice that it will lose the Title X grant and is “reviewing the information to get a sense of the full impact.” The agency hopes the transition is smooth and the provider base remains strong, she wrote.
EARLIER: The federal government has pulled from the state of Texas millions in family planning funding, granting the money instead to a coalition led by the Women’s Health and Family Planning Association of Texas, which says it can serve a greater number of women with the available funds.
For more than four decades, federal Title X funding has been dedicated to funding family planning services and covering clinics’ infrastructure costs. The funds are generally granted to providers (like Planned Parenthood) and/or to state health agencies. In Texas since 1980, the majority of the funding has been administered by the Department of State Health Services — roughly $18 million in 2012, for example; since 2009, DSHS has been the sole grantor of Title X funds.

(Edit, maybe it’s only half of that.)

A Little History

Before this year, Federal tax dollars came back to Texas in two major funds: the Women’s Health Program and Family Planning, or Title X funds. Texas “matched” a certain amount and the Texas Department of Health and Human Services administered the dispersion of the money. Because the money paid for or freed up other funds for staff, marketing, and “infrastructure” or office overhead, PP was helped to keep their abortion clinics running. The overall effect was that State matching tax dollars helped PP to funnel patients, if not dollars, to their abortion clinics.

Texas was forced to make severe Budget cuts across the board in 2011, including Family Planning funds. This led to prioritizing what little money we had:

“State lawmakers cut funding for family planning services by two-thirds in the last legislative session, dropping the two-year family planning budget from $111 million to $37.9 million for the 2012-13 biennium. They also approved a tiered budget system for family planning funds, which gives funding priority to public health clinics, such as federally qualified health centers and comprehensive clinics that provide primary and preventative care over clinics that only provide family planning services.”

Texas Tribune

Options gang ready to go home

We’ve been in Joplin, Missouri, learning how to run an STI (sexually transmitted diseases) clinic. Now, we’re going home!

Trial shows abortion’s ‘coarsening’ impact

http://m.bpnews.net/bpnews.asp?id=40078

Statistics and “Peer Review”

Typical of the reporting on the connection between abortion and breast cancer, a blogger at “RhealityCheck,” only reports half a sentence – the half that she likes.

I don’t know how long my comments will stay up, so here’s my part:

The author only quoted half a sentence. The article clearly states, “Induced abortion had no overall effect on the risk of breast cancer, but we found a statistically significant increase in risk among women with a history of second-trimester abortion.”

and

And here’s the link to the article in question. Please note that even this research must adjust for the age at first pregnancy and for number of pregnancies.

My testimony begins at 1 hour, 12 minutes in on the video of the hearing. I actually focused on the protective effect of pregnancy, especially early pregnancy, according to the National Cancer Institute. This information is only given to women and girls who are already pregnant, after all.

Interestingly, we learned how little the Committee members understood about scientific research and resources. Follow the hours of testimony on HB 2945 and HB 2365 and Rep.Jessica Farrar’s obsession and apparent slow realization about the meaning and significance of “peer review” and “PubMed” and “Medline.“At one point, 1:26, Ms. Farrar, who admits that she “barely got through biology,” asks whether the research was “peer reviewed” by “the Medline or PubMed.”

As the day went on, it seems that Farrar was educated that peer review is conducted by the Journals themselves, and that PubMed and Medline are merely indexes of scientifc literature.

Texas will pay for destructive human embryo cloning at Texas Universities

The Committee Substitute was passed this afternoon with 9 yes votes in the House State Affairs Committee. The Chairman of the Committee, Byron Cook voted “yes,” after assuring the Committee that the Bill (which is not available online or in the Committee) will not outlaw human cloning at Universities.

Voting “no” were four brave Republicans – I’ll list them all as soon as I can verify and make sure I don’t miss anyone. Unfortunately, some of our conservative members weren’t present. I will also name them when I can do so without missing anyone.

I worked with Representative Raymond’s office to come up with good definitions, but I don’t know how much of those definitions made it into the final Bill.

Luckily, in spite of the lies we’ve read over the years, no one has yet been able to clone a human embryo.

What is now encouraged is the purposeful creation of a human embryo by cloning. The embryo may never be implanted, but the Bill declares that the nascent human should be killed and broken up

You decide: Physician-Assisted Suicide — NEJM

You can comment, let the New England Journal of Medicine editors and the world know your thoughts.

Do you believe that Mr. Wallace should be able to receive life-terminating drugs from his physician? Which one of the following approaches to the broader issue do you find appropriate? Base your choice on the published literature, your own experience, and other sources of information.

To aid in your decision making, each of these approaches is defended in the following short essays by experts in the field. Given your knowledge of the patient and the points made by the experts, which option would you choose? Make your choice and offer your comments at NEJM.org.

via Physician-Assisted Suicide — NEJM.

My opinion is that poisoning Mr. Wallace, or writing the prescription so that he can attempt to intentionally commit suicide, is a direct infringement of Mr. Wallace’s inalienable right not to be killed.

Lieutenant Governor David Dewhurst

Talking about Texas’s history of conservative pro-life and pro-family laws.

Texas Alliance for Life Leadership Luncheon

Joe Pojman, standing at the podium. Our President, Davida Stike is seated at the head table. Next up, our Lieutenant Governor, David Dewhurst.

painkiller-poster_vert-41d783296ca44c5e35a435dd8c25bf5217907c5e-s31.png (PNG Image, 462 × 616 pixels)

Why is the City doing this?  painkiller-poster_vert-41d783296ca44c5e35a435dd8c25bf5217907c5e-s31.png (PNG Image, 462 × 616 pixels).

Back to Basics on Texas Advance Directive Act

Laws relating to ethics debates are generally behind medical advances. This is good because it means that there *are* medical advances.

However, the debates often become emotional and heated, and the individuals who are affected face real dilemmas and emergencies. When law-making is controversial, it’s best to go back to the basics of ethics for guidance: the inalienable rights to “Life, Liberty and the Pursuit of Happiness,” the Declaration of Independence, and Constitution.

 
All laws limit our rights, but good laws strike a balance between seemingly conflicting rights: they are meant to prevent one person from harming another. Most laws prohibit or punish harmful actions, they don’t *compel* a desired action against our will. Nor do they prohibit actions based on thoughts and opinion. In other words, laws prohibit harming or taking from another, but they usually don’t make you protect, nurture or give to another.

 
However,since the right to life trumps the right to liberty and property, there are very rare circumstances when it is appropriate for laws to compel individuals to act for the benefit of another. Parents are required to care for and protect their minor children. Doctors and lawyers must be licensed, obtain certain levels of education, and follow specific, positive actions when they wish to withdraw from a professional relationship with a patient or client. These laws should only go so far as to protect the life and safety of the vulnerable, for a limited time with the goal of allowing safe transfer of the obligation of the person with more power to someone else.

 
On Tuesday, March 19, 2013, the Texas Senate Health and Human Services Committee, under Chair Senator Jane Nelson, heard testimony on two Bills that would change TADA: SB 303 from Senator (Dr.) Bob Duell’s  and SB 675 by Senator Kelly Hancock.

 
The Texas Advance Directive Act of 1999 (TADA), in addition to describing “Advance Directives to Physicians” (a “Living Will),  was an attempt to outline the procedure for resolving the disagreement between a doctor and patients or their surrogates regarding end of life care.

When I first read the Act, I (naively) thought it was malpractice protection for doctors who did not want to withdraw or withhold care, such as the Houston Methodist Hospital doctors who invoked the act when they repaired Dr. Michael Debakey’s aortic aneurysm against his previously stated wishes – http://www.theheart.org/article/762619.do – in 2006.

 
Most of the time, however, TADA is invoked in cases when the attending physician disagrees with a request to actively administer medical treatment that he or she believes is medically inappropriate. The steps laid out in the law involve the doctor’s notification of the patient or the surrogate, rules for assisting with transfer of care to another doctor who believes the treatment request is appropriate, and convening an ethics committee at the hospital. If there is no other willing doctor can be found and the ethics committee agrees with the doctor, the treatment can be withheld or withdrawn. It does not allow patients to be killed by medicines.

 
Unfortunately, the Act has become known as the “Texas Futile Care Law,” and divides even the pro-life community. One side says doctors and hospitals have too much power and are killing people. While I’ve heard horror stories about doctors who have abused or broken the law, I maintain that there is no “Futile Care Law,” only a difference of opinion as to who should decide what is medically appropriate treatment. In the few cases that have come under the Act, patients and their advocates report trouble finding other doctors willing to provide the treatment the first doctor thought was inappropriate. In my opinion, that difficulty is due to physicians’ common education and shared experiences.

Although TADA lays out requirements for hospitals and hospital medical ethics committees, the fact is that it applies to the “attending physician” who could be forced to act against his conscience. Texas law is clear that only doctors may practice medicine by diagnosing and treating patients directly or “ordering” other medical personnel. These treatments are not one-time events and they aren’t without consequences. They are interventions that must be monitored by observation and tests, and adjustments need to be made so that the treatment is effective and not harmful. Medical judgment is how doctors utilize our education, experience, and consciences as we plan and anticipate the effect of each medical intervention.

Senator Duell’s Bill, SB 303, significantly improves TADA. Among other things, the Bill would add protection of the patient’s right to artificially administered hydration and nutrition, increased access to assistance, records, and time before and after the ethics committee meeting, and prohibits so-called “secret DNR’s.”

Senator Hancock’s Bill, SB 675, focuses on the intentions and motives of the doctor, requiring the medical committee to decide whether the disagreement is due to: “(1) the lesser value the physician, facility, or professional places on extending the life of an elderly, disabled, or terminally ill patient compared to the value of extending the life of a patient who is younger, not disabled, or not terminally ill; or “(2) a disagreement between the physician, facility, or professional and the patient, or the person authorized to make a treatment decision for the patient under Section 166.039, over the greater weight the patient or person places on extending the patient ’s life above the risk of disability.”

Our laws normally prohibit actions and only very rarely compel people to act. Under the conditions laid out in SB 303, the doctor can be forced to act against his conscience and best medical judgment, but only for a limited, stated time. SB 303 improves the Texas Advance Directive Act by protecting the patient’s access to artificially administered hydration and nutrition. It also adds time to prepare for the ethics committee meeting and to transfer care a new doctor. It is an attempt to balance the patient’s wishes for medical intervention with the right of conscience of the doctor. In contrast, SB 675 would attempt to legislate intentions or thoughts, with none of the added protections of SB 303.

Edited 4/27/13 to fix the link to the article about Dr. Debakey and 4/30/13 for grammar and formatting – BBN.

Senate panel OKs abortion bill requiring stricter standards – Houston Chronicle

One woman claimed that the standards shouldn’t be the same as an ambulatory surgical center because they do abortions on 9 year olds!

Minimal standards are considered too much by the abortion industry. They’ve fought every move to keep women and girls safe, and whip out those coat hangers every chance they get.

Women who have D&C’s after a miscarriage have them at a hospital or surgical center, not at in an office setting. But according to the abortionists, healthy mothers having abortions – or 9 year old girls – should be happy with a clinic setting.

AUSTIN – Abortion clinics would be required to meet stricter standards under a bill approved 5-2 by the Senate Health and Human Services Committee Tuesday after emotional testimony over whether the measure would protect women’s health or risk it by causing clinics to close.

“My intent in filing this bill is only to protect Texas women who undergo this procedure,” said Sen. Bob Deuell, R-Greenville, who authored the measure with two fellow doctors, Republican Sens. Donna Campbell of New Braunfels and Charles Schwertner of Georgetown.

Planned Parenthood called the measure, Senate Bill 537, a “back-door abortion ban.”

via Senate panel OKs abortion bill requiring stricter standards – Houston Chronicle.

Florida Senate panel rejects Medicaid expansion | Modern Healthcare

Good for the Florida Legislature!

A Florida Senate committee has essentially killed Gov. Rick Scott’s plan to expand Medicaid coverage to roughly 1 million of Florida’s poorest residents.

Instead, the committee proposed Monday that the state adopt a managed care system that requires patients have a copayment.

*****

A House panel last week also rejected expanding Medicaid.

via Florida Senate panel rejects Medicaid expansion | Modern Healthcare.

Neuroscience, Special Forces, and Ethics at Yale | Psychology Today

What would you do?

Last month, a proposal to establish a U.S. Special Operations Command (SOCOM) Center for Excellence in Operational Neuroscience at Yale University died a not-so-quiet death. The broad goal of “operational neuroscience” is to use research on the human brain and nervous system to protect and give tactical advantage to U.S. warfighters in the field. Crucial questions remain unanswered about the proposed center’s mission and the unusual circumstances surrounding its demise. But just as importantly, this episode brings much needed attention to the morally fraught and murky terrain where partnerships between university researchers and national security agencies lie.

via Neuroscience, Special Forces, and Ethics at Yale | Psychology Today.

Hat Tip to James J. Hughes and the Institute for Emerging Ethics and Technology newsletter

Cloned “Clone and Kill” Bill

I testified in front of the Texas House State Affairs Committee on Tuesday. The video is here, House State Affairs 2/20/13 (Free RealPlayer program required.) Mr. Raymond comes up at about 3:30 minutes in, and my effort starts at 8 minutes in. It’s short and sweet.)

HB 142, authored by Representative Richard Raymond of Texas’ House District 42 in Laredo, looks a lot like his HB 1829 from 2007. These are “clone and kill bills, which nominally ban cloning, but actually redefine cloning, and would force the killing of any human embryo intentionally killed by nuclear transplantation. HB 142 ignores the history of the last 6 years, and uses inaccurate terminology.

Watch this space for alternative language that would actually ban human cloning.

Diabetes Complications:New LifeEthics.org post

New on LifeEthics.org, my blog on medical technology and ethics, a post on the use of adult stem cells for the treatment of diabetic retinopathy.

How to comment on latest IRS ObamaCare regulations

Those regulations on penalties and exemptions for not buying insurance are not “final regulations” until after the comment period, which ends May 2, 2013 and a public hearing on May 29, 2013.

The IRS publication document can be found here, http://www.irs.gov/PUP/newsroom/REG-148500-12%20FR.pdf

Here’s how to comment

1. “Snail Mail,” or old fashioned paper letters and postcards –
CC:PA:LPD:PR (REG-148500-12), room 5203, Internal Revenue Service, PO Box 7604, Ben Franklin Station, Washington, DC 20044.
2. Hand-deliver your comments –
“Monday through Friday between the hours of 8 a.m. and 4 p.m. to CC:PA:LPD:PR (REG-148500-12), Courier’s Desk, Internal Revenue Service, 1111 Constitution Avenue, NW., Washington, DC.”
3. Send comments by e-mail –
“electronically via the Federal eRulemaking Portal at http://www.regulations.gov (IRS REG-148500-12).”
4. In person at the public hearing:
“May 29, 2013, beginning at 10:00 a.m., in the Auditorium, Internal Revenue Building, 1111 Constitution Avenue, NW, Washington, DC.”

IRS: Cheapest Obamacare Plan Will Be $20,000 Per Family | CNS News

Update 2/3/13: these are not “final regulations” until the comment period has passed. Information on comments to the IRS is appended st the end of this post.

We thought it couldn’t get worse:

(CNSNews.com) – In a final regulation issued Wednesday, the Internal Revenue Service (IRS) assumed that under Obamacare the cheapest health insurance plan available in 2016 for a family will cost $20,000 for the year.

Under Obamacare, Americans will be required to buy health insurance or pay a penalty to the IRS.

via IRS: Cheapest Obamacare Plan Will Be $20,000 Per Family | CNS News.

Send your comments to

CC:PA:LPD:PR (REG-148500-12), room 5203, Internal Revenue Service, PO Box 7604, Ben Franklin Station, Washington, DC 20044. Submissions may be hand-delivered Monday through Friday between the hours of 8 a.m. and 4 p.m. to CC:PA:LPD:PR (REG-148500-12), Courier’s Desk, Internal Revenue Service, 1111 Constitution Avenue, NW., Washington, DC, or
sent electronically via the Federal eRulemaking Portal at http://www.regulations.gov (IRS REG-148500-12).

The comment period ends May 2, 2013, and there will be a public hearing “May 29, 2013, beginning at 10:00 a.m., in the Auditorium, Internal Revenue Building, 1111 Constitution Avenue, NW, Washington, DC.”

The IRS publication document can be found here, http://www.irs.gov/PUP/newsroom/REG-148500-12%20FR.pdf. The examples begin on page 67.

Review & Outlook: It’s a Mad, Mad, Mad, Mad ObamaCare – WSJ.com

30 day review and comment, dump of regulations, and still no one knows what we’re dealing with, come January 1st:

 

To take one example, for the better part of a year states and groups like the bipartisan National Governors Association and the National Association of Medicaid Directors have been begging HHS merely for information about how they’re required to make ObamaCare work in practice. There was radio silence from Washington, with time running out. Louisiana and other states even took to filing Freedom of Information Act requests, which are still pending.

Now post-election, new regulations are pouring out from HHS—more than 13,000 pages so far and yet nuts-and-bolts questions are still unanswered. Most of what we know so far comes from a 17-page question-and-answer document that HHS divulged this week, though none of the answers have the force of law and HHS says they’re subject to change at any moment.

HHS is generally issuing rules with only 30 days for public comment when the standard is 60 days and for complex regulations 90 days and more. But the larger problem is that HHS’s Federal Register filings reveal many of the rules were approved in-house and ready to go as early as May. Why the delay?

****
In other implementation hilarity, no fewer than 18 Democratic Senators and Senators-elect came out last week against ObamaCare’s $28 billion tax on medical device sales—and not just the usual penitents from Massachusetts and Minnesota. The list includes Chuck Schumer, Dick Durbin and Patty Murray.

“With this year quickly drawing to a close, the medical device industry has receive little guidance about how to comply with the tax—causing significant uncertainty and confusion for businesses,” they write about the tax most of them voted for.

The last entitlement to get off the ground was President Bush’s Medicare prescription drug benefit. Those rules were tied up with a bow by January 2005, giving business and government nearly a year to prepare—and that was far simpler than re-engineering 17% of the economy. No one knows where the current magical mystery tour is headed, especially not HHS. via Review & Outlook: It’s a Mad, Mad, Mad, Mad ObamaCare – WSJ.com.

Map: Approved women’s health program providers in North Texas | Dallas-Fort Worth Breaking News – News for Dallas, Texas – The Dallas Morning News

Note that the providers are up to date and much more widespread than the few PP clinics. The numbers of patients served in 2011 are all before the new program was established along with the outreach by DSHS to contract with more doctors and clinics.

The dots represent approved state women’s health program providers as of October, such as clinics or private physician practices. Many have more than than one doctor at the location.The color designates the number of Medicaid Women’s Health Program clients the provider saw in fiscal 2011, the most recent year data is available.

via Map: Approved women’s health program providers in North Texas | Dallas-Fort Worth Breaking News – News for Dallas, Texas – The Dallas Morning News.

Medical Regulation, Texas Style

The Texas Institute for Health Care Quality and Efficiency Draft Report is posted for public comment.

You only have a day and a half to comment, since the next meeting of our Board of Directors is Thursday, November 15th. All comments should be sent by 1 PM on Wednesday, November 14th.

Report to the Texas Legislature on Activities to Improve Health Care Quality and Efficiency
Report Number: 2012-001

The following downloads are available:
Report 2012-001: 2012-001-Draft-Report.pdf
Appendix E: AppendixE.pdf
Appendix F: AppendixF.pdf

Instructions on submitting your comments are here.

Now, for a few comments on my observations as a Board member:

Believe it or not, the time frame from the passage of the legislation in SB 7 last June, 2011, to today and in anticipation of preparing for legislation beginning in January, 2013, is too tight. The Institute’s staff and coordinators did a good job of herding cats in the Board. In addition, the Board members worked hard to make all the meetings, to participate, and to contribute. We have met at least once a month, sometimes more than twice, since our appointment. The Board isn’t paid or even reimbursed for expenses by the State, and many gave up work in order to attend meetings far from their homes.

I haven’t commented on the draft until now, because the Board received our first full copy for review and comment on November 2, and comments were due by 5 PM, Election Day, November 6th. We’re all appointed by the Governor — it stands to reason that a few of us would be actively involved in the election and campaigns. I didn’t even open the email until Nov. 7.

I’m not happy with the length of the report, but I guess the nuances of our discussions over the last few months needed to be documented somewhere. Go to the page 34 in the pdf, numbered “26” in the Draft, for the actual recommendations made by vote in the Board meetings.

Finally, my main concern has been with the bureaucracy and regulation that the members of the Board have sometimes appeared to support. In the end, I believe that we have limited recommendations for regulation and “hassle factors” more than some would like. My hope is that the Legislature will decide to focus initially on implementing any new measures in our own State health plans and not interfere directly in private health care practice and systems, except where and when the State foots the bill.

Since President Obama won reelection, I believe that the ability of the 83rd Texas Legislature to adapt and react to Federal Regulations  – Obamacare – will be improved by the work of the Institute.

The Right to Life, Sonograms, and Your Vote

WingRight.org was referenced by another blogger who listed “a woman’s right to chose” as her first reason to vote for President Obama.

We all know that what that woman is choosing is to end the life of her own child. Usually, nearly 97% of the time, both mom and baby are healthy. And far too often, she doesn’t feel like she really has a choice.

I contend that the protection of the right not to be killed  should be the first reason to vote against Obama and all Democrats, from the President on down to the local County and State offices.

The right to life – the right not to be killed – of a human being is the primary inalienable right. If that right is not protected, then all other rights are subject to the power of others; they are also infringed. What is liberty, if one human or the State can determine that some humans aren’t human enough to have their God-given right not to be killed defended by the rest of us?

The fact is that all women undergoing an elective abortion already have a sonogram.  The standard of care for abortion or any procedure requiring instrumentation of the uterus now includes a an ultrasound examination.  The law in Texas not only ensures that the standard of care is followed, but that the timing allows the woman to be fully informed before the abortion, and before she is sedated and prepped for the abortion.

The same law that ensures that the woman will be offered a chance to see her sonogram and hear the heartbeat also makes sure that she’s referred to agencies that will help her actually have a “choice.” The Woman’s Right to Know Act included the mandate that women and girls be given access to a ) list of all the resources (State, Federal, private and charities) that are available to help the mother while she’s pregnant and after the baby is born. The State Department of Health Services compiles the list, using funds raised by licensing those abortion facilities.

The purpose of Government, according to the Declaration of Independence is to “secure” our inalienable rights to life, liberty and the pursuit of happiness. The Preamble of the Constitution of the United States goes further, stating that the government not only protects those of us who are citizens, but must also  “secure the Blessings of Liberty to ourselves and our Posterity.” Vote to protect our “Posterity,” the children of tomorrow.

Texas Medical Association @TexMed “Friendly Incumbent” rule

A fellow Texas Medical Association member asked me today how I felt about TexPAC – was it even worth giving them money and “what about their endorsements for judges?” He had been surprised to notice the TMA’s endorsement of some Democrat candidates after the Judicial endorsements caught his eye. (He even asked whether the list was just a pet of some of the more wealthy docs in the TMA.)

I explained that, while the TMA generally opposes ObamaCare, the Association unfortunately has what they call the “friendly incumbent” rule.  I also agreed that the policy doesn’t explain all of the choices on the TexPAC list. But for the most part, It’s virtually a given that the PAC endorses the incumbent in a race, even if the candidate doesn’t agree with the TMA on such vital issues as ObamaCare and the (Un-) Sustainable Growth Rate (“SGR”) or even the “RAC audits.” (“Recovery Audit Contractors” – *private* contractors who audit Medicare “providers” – doctors and hospitals, and earn more for finding more “fraudandabuse.”)

The policy – along with the heavy-handedness of some of the leaders of the PAC –  leads to such debacles as their mistaken endorsement of Jeff Wentworth, who opposed tort reform, over  Dr. Donna Campbell, the eventual winner (by a 2 to 1 vote!) of the Texas Senate District 25 Republican Primary,

I suggested that he include a note about his disagreements with the PAC in any check he writes in the future. As for this election, I advised my friend – who is very opposed to ObamaCare – to ignore any recommendation that didn’t have an “R” for “Republican” in front of the candidate’s name – especially when it comes to the candidates for our Third Court of Appeals: Scott Fields is a much better choice for conservative voters than the incumbent. (I could say the same about Congressional District 35, where I hope my neighbors will vote for Susan Narvaiz, rather than Layoff Lloyd Doggett.)

Report on 2nd Presidential Debate, October 16, 2010

We had twenty good Republicans turn out to watch the Presidential Debate at the Comal County Republican Party Election Headquarters tonight.

I tweeted (@bnuckols) throughout the debate, (Twitter search, “#debates”) and read the new Dem talking points over and over and re-tweeted:

It turns out that calling “Latinos” “Hispanics,” is equivalent in the eyes of some to calling Black people, “Colored.”

According to a couple of Dems, it’s “racist” to use the word “illegals.” One even said that it’s racist for all races!

Several libs tweeted that the request for continued security in Libya was for Tripoli, not Bengazi Actually, wasn’t the security for the Ambassador and the staff?

 

Here’s some information you might find interesting:

From @EWErickson: “Here’s the Rose Garden transcript. President blamed a video, not terrorists. http://is.gd/PqIMAe  || Attn @CANDYCROWLEY”

From me, Beverly Nuckols, MD ‏@bnuckols

“natural gas production on federal and Indian lands has steadily fallen, . . began around fall 2002.” http://ow.ly/1OZYSi  #debates

Sally C. Pipes, Founder of the Benjamin Rush Society, at Docs4PatientCare @D4PC

Health care policy expert, Sally C. Pipes, spoke to our @D4PC meeting this morning about the Benjamin Rush Society. The Society is an organization that she founded in order to inform and enable medical students and residents to defend the traditional medical ethic that the doctor should work for the patient, not a  third party, and “certainly not one that wields the coercive force of law.”

While the topic of the talk was the Benjamin Rush Society, Ms. Pipes also discussed her own experience as a former citizen of Canada and about her mother’s death from colon cancer after being refused a colonoscopy under the Canadian health care system. The reason given was that “Seniors” weren’t given colonoscopies and that those under 65 years old had a several months long waiting period, even if bleeding. When Ms. Pipes’ mother began bleeding from the colon, she spent 3 days in the Emergency Department and passed away 2 weeks later with metastatic colon cancer.

There were also comments from members in the audience about the United Kingdom’s National Health Service, which has even longer wait times for services, including heart surgery.

Ms. Pipes is married to Charles Kesler, whose book, I AM the Change, Barack Obama and the Crisis of Liberalism, will be released on September 11. Mr. Kesler spoke to out group yesterday.

Another reason to vote Romney

Robin Alta Charo, the lawyer/ethicist-for-hire, one time Clinton advisor turned Obama transition advisor then FDA consultant, has been appointed to 2 new positions at the National Institutes of Health.

In her new role, Charo will advise on ethical and regulatory issues raised by translational research, such as privacy and civil rights concerns raised by research using human tissues residing in large biobanks or public health implications of deploying genetics and personalized medicine to target drug development toward narrower segments of the population. She will also participate in overseeing the peer review process for research proposals submitted to NCATS.

Ms. Charo, the inventor of the “Endarkenment,” supports sex-selection abortion, believes cloning will finally prove there’s no God, and frequently writes op-eds for the New England Journal of Medicine, specializing in her opposition to conscience rights. She likens Medicine to a “public utility, obligated to provide service to all who seek it. Claiming an unfettered right to personal autonomy while holding monopolistic control over a public good constitutes an abuse of the public trust — all the worse if it is not in fact a personal act of conscience but, rather, an attempt at cultural conquest.”

Texas Whooping Cough (Pertussis) Kills 5 Kids, Sickens 1,000 @texmed

Please consider getting your Whooping Cough vaccine.

By the time you start coughing, we can’t change your course – you will probably cough for the next month or more. The new pertussis vaccine in the “D-TaP” or “T-DaP” is “acellular,” not the old one that so many worried about in the past. http://www.immunize.org/catg.d/p4212.pdf

From the Texas Medical Association’s “Me and My Doctor:”

FRIDAY, SEPTEMBER 7, 201