Malpractice Insurers Faulted

From the September 2005 issue of Cortlandt Forum
The nation’s 15 largest malpractice insurance carriers took in three times as much in premiums last year as they paid out in claims. And over the past five years, their premiums have doubled while their payouts have remained flat, according to a newly released study.
“Doctors have been overcharged for several years,” said Jay Angoff, a former Missouri insurance commissioner who conducted the study, which was based on the insurance companies’ own data. “The numbers underscore the need for tougher oversight to prevent profiteering,” adds Richard Blumenthal, Connecticut attorney general, who joined Angoff at the New York City press conference where the study was presented.
Angoff contrasted his data with those used by insurance companies to justify rate increases or lobby for caps on malpractice awards. “Their figures are largely estimated or are unverifiable or both. They’ve been off by up to 40%,” he said. Angoff’s data come from either the companies’ annual reports or filings with state authorities — “figures that haven’t been comprehensively analyzed before,” Angoff says. The companies include AIG, HCI, The Doctors Company, American Physicians Capital, GE Medical Protective, and Continental Casualty.
Angoff found that several insurers increased their premiums even though their claims payments actually fell, in some cases substantially. ProNational and Medical Assurance, both affiliates of the ProAssurance Corporation, as well as the AIG affiliate Lexington Insurance, were among the worst offenders. Medical Assurance, for example, increased its premiums 89% in 2004 even though its payments decreased by a third. The company paid out only 10 cents in claims for each premium dollar collected. ProNational paid out 13 cents and Lexington 14 cents.
“Perhaps most striking,” said Angoff, “in 2004, these 15 insurers increased their earned premium by 9.3%, even though the amount they estimated they would pay out in the future declined by 21.1%.”
The 25-page study, Falling Claims and Rising Premiums in the Medical Malpractice Insurance Industry, is available from the Center for Justice & Democracy in New York City (www.centerjd/ANGOFFReport.pdf. Accessed August 15, 2005).

Mississippi Psychiatric Association Katrina site

Mississippi psychiatrists needed. See this new blog:
http://mpakatrina.blogspot.com/

Quest for Gas (part 2)

For those 2-3 people out there who are curious, I was able to get a rental car today at the Jackson MS airport with a full tank of gas (call ahead if you are thinking of doing this, most of the agencies are out of cars and gas, and many cars have been reserved by FEMA).
Still no electricity.

APA backs same-sex civil marriages

From Psychiatric News:
The APA Board of Trustees took a historic step at its July meeting when it made APA the first medical specialty society to support legal recognition of same-sex civil marriage.
Such a position statement had been endorsed by the Assembly at its May meeting in Atlanta (Psychiatric News, June 17). It expands APA's existing position in support of same-sex civil unions and emphasizes the mental health consequences of denying same-sex couples the same legal rights as their heterosexual counterparts. The legal rights to which these couples do not have access can include visiting an ill partner in the hospital, making health care decisions for a disabled partner, financial and retirement planning to prepare for emergencies or a financially secure future, and, in the case of parents, being able to raise a child when the biological parent is unable.
The statement, which applies to civil and not religious marriage, notes that same-sex couples "experience several kinds of state-sanctioned discrimination that can adversely affect the stability of their relationships and their mental health." It also points out that "there is ample evidence that long-term spousal and family support enhances physical and mental health at all stages of development."
I'll leave it for others to comment on this as I don't want to jeopardize my current job or my 2 future jobs.

Legendary jazz musicians missing

Fox News reports that several notable New Orleans musicians, including "Fats" Domino, are missing.

The Quest for Gas (Jackson, Mississippi)

This morning I got into a line for gasoline that was almost a quarter of a mile long. After going about 30 yards in 30 minutes, I left.
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Most of the pumps have electricity now, the problem is a fuel shortage. Most of the gas stations in the Jackson area are out of gas. I heard that there is gas in Canton (about 20-30 miles north of Jackson), but I only have enough gas in the tank to drive 10-15 miles.
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Earlier today, I thought that the easiest way to get gas might be to get a rental car with a full tank. I reserved a rental car at the local airport on-line, and even arranged a ride from a resident to pick it up tomorow morning. However, it turns out that the car rental companies are out of gas too.
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Little work is being done today at the hospital. Everyone (including myself) is obsessed with electricity, gas, and ice. Some areas are starting to get electricity (not me), but the gas situation is not expected to get better until after the Labor Day holiday.

Mississippi has become a 3rd World Nation

In the aftermath of Katrina, most of Jackson, the capital of Mississippi, remains without power- see this article. Some of the gas stations have gas; some have the power necessary to run the pumps; only a few have both. As described here, lines at the few open gas stations are long. As bad as things are in the capital, it is even worse in outlying areas. Some rural areas in central Mississippi will not get electric power back for several months. As I have mentioned in previous posts, if a Mississippian is lucky enough to find an open store or gas station, he better have cash. Credit cards are not usually accepted- see here.
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I feel bad about whining as plenty of people have it worse than me, especially those living to the south of me. But with the destroyed infrastructure, it is becoming increasingly difficult to function as a physician. With the power out, I have no way of doing laundry at home. Today, for the first time, I wore a t-shirt to work instead of a shirt with a collar. I guess I could ask a resident where they keep the scrubs. I run out of underwear and socks on Friday- at that point I will need to wash them in a bucket. Another option is sneaking my laundry into the hospital and using the washer on the psych ward.
I am on call (psychiatry attending call) Thursday. Since phone service is out, I will have to spend the night in the hospital to answer the pages (I am one of the few physicians in the country without a cell phone)
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I have decided that tomorrow (Thursday) I will leave the hospital in the early afternoon to get gas. For anyone that is interested, I will post my adventure tomorrow night.
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That's it for now. Sorry about the whining. Thanks to Dr. Parker for the plug. Read about the situation in Alabama here. Donate to the American Sleep Medicine Foundation Hurricane Disaster Relief Fund here.

Mississippi Katrina Update

It's a sunny, warm day here in Jackson, MS. The power is still out in most residential areas. Some gas stations are open, but lines are an hour long and it's cash only. ATM machines are down but most banks are reportedly open. My wife is planning to walk to AmSouth bank later on today to get money. I hope power comes back soon, I am running out of things to wear. Large fallen trees still block most of the streets that lead to my house.
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The situation is much worse in southern Mississippi, Louisiana, and Alabama as described in this report. Good luck to those of you living on the Gulfcoast.

Katrina Report from Ground Zero

Power began to fail at noon yesterday in central Mississippi, and pretty much went out for good at 6pm. Today (tuesday) power is still out in most parts of central Mississippi, though as of noon today a few gas stations and large grocery stores in Jackson had power.
Trees are down all over my neighborhood.
At least 80 people are dead in Mississippi, most in southern parts of the state.
Interstate 20, running east-West between Jackson and Meridian, is basically clear- but make sure you have gas before starting the trip as none of the surrounding gas stations have power.
Here is a report of the condition in Hattiesburg, which is 90 miles south of Jackson, MS.
The University of Mississippi Medical Center is fully operational for clinical care, but nonessential personnel will not return until tomorrow.

Jet Lag

ATLANTA—Already hard hit by labor strife and escalating fuel costs, the commercial airline industry faces a new crisis: an epidemic of jet lag caused by a powerful strain that is highly resistant to regular remedies like catnaps.
Airlines have set up napping-triage centers in major airports in response to the "Super Lag," but are unable to keep up with the rising tide of severely weary passengers, who number in the thousands nationwide.
"Infected travelers are really tired out, whether they're on long international flights or domestic flights as short as an hour and a half," said Delta Airlines ticket agent Olivia Gage at Atlanta International Airport, which has seen some of the most advanced cases of Super Lag. "Our supplies of thin blankets and miniature pillows are running dangerously low."
FEMA, the Federal Exhaustion Management Association, has shipped army-surplus cots and urns of hot coffee to several major hubs, but airlines continue to report record dozings. Minneapolis resident Belinda Haynes, 26, is just one of tens of thousands of Americans whose travel plans are affected.
"I'm going to go to Tampa Bay and be asleep through most of my flight," Haynes said. "That means I'm at risk for catching Super Lag and being totally tired all through my sister's whole wedding."
At the Atlanta airport Tuesday afternoon, an estimated 900 Super Lag sufferers could be seen stretched across the molded seats of gate waiting areas. The infected travelers, distinguishable by their testy demeanors and heavy eyelids, argued with ticket agents, slumped listlessly in their seats, and stared blankly at Au Bon Pain pastry displays.
Untreated victims can find themselves sleeping for hours on a plane, then sleeping soundly at night, yet still performing poorly in important business meetings or feeling too fatigued to enjoy their vacations.
Dr. Robert Sanders is one of hundreds of volunteer physicians treating Super Lag sufferers at airports nationwide.
"Jet lag was first documented in the late '50s," Sanders said. "Over the years, we've developed band-aid solutions to combat the disorder—neck pillows, laptops, in-flight movies—but it was really only a matter of time before jet lag mutated into a more virulent strain."
Despite volunteer efforts, the burden of treating Super Lag sufferers has fallen largely on flight attendants who, with little training in this area, are reporting great difficulties.
"One passenger who sleeps through the beverage service and wakes up irritated and thirsty is bad," said Midwest Airlines flight attendant Sandy Wolchek. "You multiply that by five on a Milwaukee-to-Minneapolis flight, and you're talking about a serious disruption."
Prolonged rest is the only known remedy for Super Lag, according to Bill Ziegler of the Centers For Fatigue Control. "Victims can also alleviate their symptoms by wadding jackets or sweaters into makeshift pillows," he said. "And we're recommending that airlines loosen their restriction on reclining cabin seats during the ascent and descent phases of flights."
Scientists at the CFC are working around the clock to find a Super Lag cure, but so far, they have made little progress. For now, they recommend that air-travel passengers look out for Super Lag's warning signs: irritability, an unwillingness to engage in small talk with persons in adjoining seats, and a tendency to doze off while reading in-flight magazines.
From The Onion

Weight Loss Secrets

PURCHASE, NY—Joining a field already crowded with such non-caloric beverages as Coke Steam and Hollo Yello, PepsiCo announced the creation Monday of Pepsi Negative-220, a diet cola that burns twice the calories it contains. "You'll love PN-220 for the super-slimming rush of thyrotropin, PC1 enzymes, and that zesty hint of lemony leptin that zaps away fat, muscle tissue, and some nerve sheathing," PepsiCo spokesperson Ned Caen said. "But you'll drink it for that refreshing cola taste." Despite an FDA label warning of potential cardiac arrhythmia, renal shutdown, intestinal necrosis, and spontaneous erosion of the meninges, plans are underway to debut Pepsi Negative-220 in early October. "For radical and uncompromising weight loss, it's the cola," Caen said.
From The Onion

Nobel Foundation Urged to Strip Lobotomy Prize

From the August 2005 edition of Psychiatric Annals (not, to my knowledge, available on-line):
Relatives of people who underwent lobotomies between the 1930's and 1970's are petitioning the Nobel Foundation to revoke the 1949 prize for medicine given to Egas Moniz, the Portugese neurologist who developed the procedure in 1936. A new book says that of the 50,000 people in the United States who underwent the procedure, only about 10% were helped. Family members have already asked the foundation to remove or revise an article on its Web site about Moniz and the procedure.

Doing Away With Tips

From Cnn.com:
Effective September first, Per Se, one of the most highly rated Manhattan restaurants, is instituting a 20 percent service charge to all checks in lieu of a tip. The service charge will then be used by the restaurant to help pay all hourly employees -- kitchen staff, waiters, and busboys -- a flat hourly wage.
Management at Per Se doesn't seem particularly troubled by these concerns.
Chef Keller has said he instituted a service charge at one of his other restaurants, The French Laundry in Napa Valley, and it has gone well.
A spokesman for Per Se said the stable salary -- which also comes with benefits like vacation and health insurance -- would create a more professional environment and increase motivation. He also said the customers might find it convenient not having to contemplate a tip.
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Instead of a service charge, why not just increase prices by 20% (and put up a sign eliminating tipping)

Medicare Benzodiazepine Exclusion

Psychiatric News reports on the Medicare Benzodiazepine exclusion:
Last month APA praised Reps. Benjamin Cardin (D-Md.) and Jim Ramstad (R-Minn.) for co-sponsoring legislation that would reverse the exclusion of benzodiazepine medications from reimbursement under the new Medicare Part D drug benefit. The Medicare Modernization Act of 2003 (MMA) contained language that required that benzodiazepines be excluded from coverage by the new drug benefit, which begins January 1, 2006 (Psychiatric News, February 4). Psychiatrist Stevan Gressitt, M.D., founder of the Maine Benzodiazepine Study Group, told Psychiatric News during an interview for a previous article, "The alternatives really are grim. If these patients don't have access to benzodiazepines after January 2006, then they will most likely be switched to something that is covered—an SSRI or an atypical antipsychotic. Neither one of those would be my first choice for an elderly or disabled patient with multiple medical problems who is probably taking several other medications."
Dr. Gressitt's comments don't make sense. For an elderly patient, an SSRI is often a better choice than a benzo. Most psychiatrists try to avoid benzodiazepines in the elderly due to the cognitive side effects and the risk of falls.

Asthma Drug Withdrawal

The New York Times reports: A panel of lung experts is being convened today to advise the government on whether three popular asthma drugs should stay on the market or be withdrawn because of safety concerns.
The drugs are Advair and Serevent, made by GlaxoSmithKline, and Foradil, made by Novartis and sold in the United States by Schering Plough. Advair and Serevent contain the same drug, salmeterol; in Serevent, salmeterol is alone, while in Advair it is combined with another medicine. Foradil does not contain salmeterol; its active ingredient is formoterol.
Concerns have arisen about the three drugs, the Food and Drug Administration said, because in a small number of patients they "have been associated with severe asthma exacerbations."
It will be chaos in the asthma clinics if Advair is withdrawn from the market; most asthmatics at the U of MS asthma clinic are on it. Advair combines serevent with an inhaled steroid and is a convenient and effective treatment for asthma.

Smoking

A reader (MaryBeth) asks Why isn't SMOKING treated with the same intensive interventions as other addictive substances, like alcohol, drugs, food, . Why even the 12 step programs , don't include smoking, among them.Any information or thoughts on this is appreciated.
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In my opinion, doctors do treat smoking intensively, at least from a medication standpoint. In the resident internal med clinic I work in, we ask patients about smoking status and offer medication treatment for cessation (Wellbutrin, nicotine patch, nicotine gum, etc). I think the reason that there are no 12 step programs for smoking is because it does not ruin the average smoker's life (at least not right away). Drug addicts and alcoholics often destroy their lives while still young- for example stealing to support a crack habit, drunk driving convictions, blackouts, financial devastation, divorce, etc. Most cigarette smokers remain productive members of society throughout the normal working years. Usually they don't develop lung cancer or severe COPD until they're older (this is a generalization, some smokers develop health problems at a younger age, some never do)

Rising Medicaid Costs in Mississippi

Rising Medicaid Costs in Mississippi (and other states) are forcing a cut in benefits:
Starting Friday, most Medicaid recipients in Mississippi will be limited to five prescription drugs at a time, with no process for appeal. The cap appears to be the most restrictive in the nation, but is just one of many measures being taken by states seeking to rein in soaring Medicaid costs.
Obesity is one of the causes of rising Medicaid costs:
Mississippi's rate of obesity is not simply a matter of vanity or even of health — it's a fiscal crisis and a physical crisis for those carrying around a dangerous amount of weight.Mississippi has been identified as "ground zero" in the prevalence of obesity in the nation.The most recent U.S. Centers for Disease Control study ranked Mississippi No. 1 in obesity prevalence with an obesity rate of 26 percent.
The two major national obesity studies indicate that Mississippi spent $263 per capita or some $757 million annually on medical costs related to obesity — the 23rd highest amount in the nation.But because of Mississippi's poverty and high Medicare and Medicaid recipient populations, the more disturbing number indicated in the studies are the fact that the taxpayers are subsidizing an estimated annual $223 million in Medicare costs and $221 million in Medicaid costs that are attributable to obesity.That estimated $444 million annual taxpayer burden related to obesity in Mississippi includes direct health care costs in the Medicaid and Medicare programs. They manifest themselves in the high costs of treating diseases like Type II diabetes and other obesity-related health problems.
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Over 1/4 of Mississippi adults are obese. Other contributors to poor health in Mississippi include high rates of poverty and smoking. The health status of poor Mississippians will worsen with the Medicaid cutbacks, which started several days ago. I will witness this from ground zero in the U of MS resident Internal Medicine clinic as a new academic year starts. I hope the new interns are up to the task.

Scientology Sucks

Other physician bloggers have been blogging about Scientology's/Cruise's attack on psychiatry. These Bloggers have been putting asterixes in the word Scientology to avoid detection by search engines. I have nothing new to say about Scientology, but I could use more readers so I left the asterixes out.

Infant Psychiatry

I saw this ad today in Psychiatric News:
INFANT PSYCHIATRY FELLOWSHIP. The Section of Child and Adolescent Psychiatry at Tulane University Health Sciences Center is seeking a full-time Fellow in Infant Psychiatry. This one or two year fellowship includes clinical and research experiences with the multidisciplinary Infant Mental Health group at Tulane. Completion of a fellowship in Child and Adolescent Psychiatry preferred. Faculty appointment at the Instructor level is possible. Applications will be accepted until a suitable qualified candidate is found. Applicants should send letter of interest, updated CV and list references to Charles Zeanah, MD, Vice Chair and Director of Child and Adolescent Psychiatry, 1440 Canal Street TB52, New Orleans, LA 70112. Interested eligible applicants may obtain further information regarding this position by contacting Dr. Zeanah at 504-988-5402 or czeanah@tulane.edu. Tulane is strongly committed to policies of non-discrimination and affirmative action in student admission and in employment.
I can't imagine trying to practice psychiatry with infants. They're too young for both meds and psychotherapy, though I guess their parents could be taught behavioral interventions. I'd be interested in knowing what an infant psychiatrist actually does.

Why did Drudge Link This?

The Drudge Report links to the following news report about a 10 year-old girl being raped and impregnated by her step-father. Maybe I've been in psychiatry too long, but this story does not seem surprising or unusual to me. I've heard many stories from young and middle-aged adults of being sexually abused when they were children. I guess 10 is a little young to go through puberty and be biologically capable of being pregnant, but it' not unheard of. This story does not seem unusual enought to be newsworthy to me. Sexual abuse and rape happens to children all the time.