By NATASHA SINGER The New York Times - August 29, 2007
Patients seeking an appointment with a dermatologist to ask about a potentially cancerous mole have to wait substantially longer than those seeking Botox for wrinkles, says a study published online today by The Journal of the American Academy of Dermatology.
Researchers reported that dermatologists in 12 cities offered a typical wait of eight days for a cosmetic patient wanting Botox to smooth wrinkles, compared to a typical wait of 26 days for a patient requesting evaluation of a changing mole, a possible indicator of skin cancer.
“The difference in wait times between medical dermatology and cosmetic dermatology patients is clearly real,” said Dr. Jack S. Resneck Jr., the lead author of the study and an assistant dermatology professor at the medical school of the University of California, San Francisco. “We need to look further and figure out what is leading to shorter wait times for cosmetic patients.”
In Boston, the median Botox wait was 13 days, versus 68 days for a mole examination. In Seattle, the median Botox wait was seven and a half days, compared to 35 days for a changing mole.
The study, in which a researcher posing as a patient called every board-certified dermatologist in the 12 cities, including Miami, Cleveland and Lansing, Mich., did not examine the possible causes for the varying times.
Dr. David M. Pariser, president-elect of the American Academy of Dermatology, said it seemed clear that cosmetic patients in the studied cities had faster access to dermatologists than medical patients.
“It doesn’t make me proud to say it, but it is true,” Dr. Pariser, a dermatologist in Norfolk, Va., said.
Dr. Alexa B. Kimball, an associate professor of dermatology at the Harvard Medical School said a simple explanation might be that the demand for medical dermatologists outstrips the supply.
At a time of increased awareness about skin diseases like melanoma and psoriasis, more people seek medical appointments with dermatologists, Dr. Kimball said. Meanwhile, a wider array of doctors like plastic surgeons and even some internists offer Botox shots, she said.
“The study shows that the Botox needs of the United States are being met,” said Dr. Kimball, who has conducted studies showing that dermatologists nationwide spent an average of three to four hours a week on cosmetic treatments. “If dermatologists stopped providing cosmetic care, it would not necessarily have an impact on medical dermatology patients.”
Other dermatologists said financial incentives to perform cosmetic treatments coupled with bureaucratic obstacles in obtaining insurance reimbursement for medical treatments might also have a role in the varying wait times.
Dr. Michael J. Franzblau, a dermatologist in San Francisco, said doctors typically charged $400 to $600 for a Botox antiwrinkle treatment, for which patients pay upfront because insurance does not cover it.
Meanwhile, doctors have to wait for health insurance to reimburse them for mole examinations, for which they receive an average of $50 to $75, Dr. Franzblau said.
Dr. Resneck, the lead author of the study, said dermatologists should better monitor how their patients are scheduled.
“The office may have been trained to respond to Botox patients who expect to get in and get out quickly,” Dr. Resneck said. “But the staff may not be effective in finding the patients with worrisome conditions and getting them to the head of the queue.”
Read more
Wednesday, August 29, 2007
Poverty Rate Falls, but More Are Uninsured - Texas has highest rate of uninsured
By ABBY GOODNOUGH - The New York Times - August 28, 2007
The nation’s poverty rate fell in 2006 for the first time this decade, the Census Bureau reported today, even as the percentage of Americans without health insurance coverage hit a record high.
The results were not consistent across racial or age groups. For Hispanics, the poverty rate fell by 1.2 percentage points to 20.6 percent, while for whites, blacks and Asians, it remained statistically unchanged.
For elderly people, the poverty rate was among the lowest since 1959, when the government began collecting such data.
Median household income rose slightly for the second consecutive year, by seven-tenths of a percent, but the only statistically significant increase was in white households. It was the first real increase for white households since 1999.
Overall, the nation’s median household income rose to $48,201 in 2006, from $47,845 in 2005. It was the second consecutive year in which income rose slightly faster than inflation, after six years of decline.
“Even though overall it has not recovered to its 1999 pre-recessionary peak,” said David Johnson, chief of the housing and household economic statistics division for the Census Bureau, “the gap is narrowing.”
The slight improvements in household income and the poverty rate came even as the nation’s housing market started its steep decline and hurt employment in some states. But overall, it was a year of slow improvement in the job market and declining inflation.
The West was the only region of the country to experience a drop in the number and percentage of people in poverty. The South continued to have the highest poverty rate, at 13.8 percent, compared with 12.3 percent nationally, and the lowest median household income, $43,884.
Among large cities, Plano, Tex., had the highest median household income in 2006, while Cleveland, Miami, Buffalo and Detroit had the lowest. Among smaller cities, Youngstown, Ohio, and Syracuse had among the lowest incomes.
Census officials attributed the rise in uninsured Americans to 47 million from 44.8 million in 2005 mostly to Americans losing employer-provided or privately purchased health insurance. The percentage of people who received health benefits through an employer declined to 59.7 percent in 2006 from 60.2 percent in 2005.
The percentage of people with government-provided health insurance also dropped, to 27 percent from 27.3 percent.
The number of uninsured children increased to 8.7 million, or 11.7 percent, in 2006, from 8 million, or 10.9 percent, in 2006.
Texas had the highest percentage of uninsured residents in 2006 with 24.1 percent, while Minnesota had the lowest at 8.5 percent.
Mr. Johnson warned that even as median household incomes climbed slightly last year, both men and women brought home less pay for the third consecutive year. The household income growth was a reflection of more family members taking jobs to make ends meet, he said, and of some people earning more from sources other than wages, like investments.
Just over half of household income was concentrated in the fifth of the population with top income 2006, about the same as in 2005. Households in the lowest income quintile, on the other hand, accounted for only 3.4 percent of the nation’s household income.
Read more
OPINION = EDITORIAL;
A Sobering Census Report: Bleak Findings on Health Insurance
New York Times - Aug. 29, 2007
Read more
The nation’s poverty rate fell in 2006 for the first time this decade, the Census Bureau reported today, even as the percentage of Americans without health insurance coverage hit a record high.
The results were not consistent across racial or age groups. For Hispanics, the poverty rate fell by 1.2 percentage points to 20.6 percent, while for whites, blacks and Asians, it remained statistically unchanged.
For elderly people, the poverty rate was among the lowest since 1959, when the government began collecting such data.
Median household income rose slightly for the second consecutive year, by seven-tenths of a percent, but the only statistically significant increase was in white households. It was the first real increase for white households since 1999.
Overall, the nation’s median household income rose to $48,201 in 2006, from $47,845 in 2005. It was the second consecutive year in which income rose slightly faster than inflation, after six years of decline.
“Even though overall it has not recovered to its 1999 pre-recessionary peak,” said David Johnson, chief of the housing and household economic statistics division for the Census Bureau, “the gap is narrowing.”
The slight improvements in household income and the poverty rate came even as the nation’s housing market started its steep decline and hurt employment in some states. But overall, it was a year of slow improvement in the job market and declining inflation.
The West was the only region of the country to experience a drop in the number and percentage of people in poverty. The South continued to have the highest poverty rate, at 13.8 percent, compared with 12.3 percent nationally, and the lowest median household income, $43,884.
Among large cities, Plano, Tex., had the highest median household income in 2006, while Cleveland, Miami, Buffalo and Detroit had the lowest. Among smaller cities, Youngstown, Ohio, and Syracuse had among the lowest incomes.
Census officials attributed the rise in uninsured Americans to 47 million from 44.8 million in 2005 mostly to Americans losing employer-provided or privately purchased health insurance. The percentage of people who received health benefits through an employer declined to 59.7 percent in 2006 from 60.2 percent in 2005.
The percentage of people with government-provided health insurance also dropped, to 27 percent from 27.3 percent.
The number of uninsured children increased to 8.7 million, or 11.7 percent, in 2006, from 8 million, or 10.9 percent, in 2006.
Texas had the highest percentage of uninsured residents in 2006 with 24.1 percent, while Minnesota had the lowest at 8.5 percent.
Mr. Johnson warned that even as median household incomes climbed slightly last year, both men and women brought home less pay for the third consecutive year. The household income growth was a reflection of more family members taking jobs to make ends meet, he said, and of some people earning more from sources other than wages, like investments.
Just over half of household income was concentrated in the fifth of the population with top income 2006, about the same as in 2005. Households in the lowest income quintile, on the other hand, accounted for only 3.4 percent of the nation’s household income.
Read more
OPINION = EDITORIAL;
A Sobering Census Report: Bleak Findings on Health Insurance
New York Times - Aug. 29, 2007
The Census Bureau’s report on the state of American health insurance was as disturbing as its statistics on poverty and income. The bureau reported a large increase in the number of Americans who lack health insurance, data that ought to send an unmistakable message to Washington: vigorous action is needed to reverse this alarming and intractable trend.
The number of uninsured Americans has been rising inexorably over the past six years as soaring health care costs have driven up premiums, employers have scaled back or eliminated health benefits and hard-pressed families have found themselves unable to purchase insurance at a reasonable price. Last year, the number of uninsured Americans increased by a daunting 2.2 million, from 44.8 million in 2005 to 47.0 million in 2006. That scotched any hope that the faltering economic recovery would help alleviate the problem.
The main reason for the upsurge in uninsured Americans is that employment-based coverage continued to deteriorate. Indeed, the number of full-time workers without health insurance rose from 20.8 million in 2005 to 22.0 million in 2006, presumably because either the employers or the workers or both found it too costly.
Sadly, the one area where the nation had made progress — reducing the number of uninsured children — took a turn for the worse. The number of uninsured children under 18 dropped steadily and significantly from 1999 to 2004, thanks largely to an expansion in coverage of low-income children under two programs operated jointly by the states and the federal government, Medicaid and the State Children’s Health Insurance Program. Then last year the number of uninsured children jumped more than 600,000 to reach 8.6 million. The main reason, advocacy groups say, is that access and funding for the low-income programs became tighter while employer coverage for dependents eroded.
The challenge to the White House and Congress seems clear. The upward trend in the number of uninsured needs to be reversed because many studies have shown that people who lack health insurance tend to forgo needed care until they become much sicker and go to expensive emergency rooms for treatment. That harms their health and drives up everyone’s health care costs.
The most immediate need is to reauthorize and expand the expiring State Children’s Health Insurance Program. It has already brought health coverage to millions of young Americans. It should be reinvigorated to bring coverage to many millions more.
Read more
Sunday, August 26, 2007
Rules May Limit Health Program Aiding Children
By ROBERT PEAR - The New York Times - August 21, 2007
The Bush administration, continuing its fight to stop states from expanding the popular Children’s Health Insurance Program, has adopted new standards that would make it much more difficult for New York, California and others to extend coverage to children in middle-income families.
Administration officials outlined the new standards in a letter sent to state health officials on Friday evening, in the middle of a monthlong Congressional recess. In interviews, they said the changes were intended to return the Children’s Health Insurance Program to its original focus on low-income children and to make sure the program did not become a substitute for private health coverage.
After learning of the new policy, some state officials said yesterday that it could cripple their efforts to cover more children and would impose standards that could not be met.
“We are horrified at the new federal policy,” said Ann Clemency Kohler, deputy commissioner of human services in New Jersey. “It will cause havoc with our program and could jeopardize coverage for thousands of children.”
Stan Rosenstein, the Medicaid director in California, said the new policy was “highly restrictive, much more restrictive than what we want to do.”
The poverty level for a family of four is set by the federal government at $20,650 in annual income. Many states have received federal permission to cover children with family incomes exceeding twice the poverty level — $41,300 for a family of four. In New York, which covers children up to 250 percent of the poverty level, the Legislature has passed a bill that would raise the limit to 400 percent— $82,600 for a family of four — but the change is subject to federal approval.
California wants to increase its income limit to 300 percent of the poverty level, from 250 percent. Pennsylvania recently raised its limit to 300 percent, from 200 percent. New Jersey has had a limit of 350 percent for more than five years.
As with issues like immigration, the White House is taking action on its own to advance policies that have not been embraced by Congress.
In his budget in February, President Bush proposed strict limits on family income for the child health program. Both houses of Congress voted this month to renew the program for five years, but neither chamber accepted that proposal. Legal authority for the program expires on Sept. 30.
The administration’s new policy is explained in a letter that was sent about 7:30 p.m. on Friday to state health officials from Dennis G. Smith, the director of the federal Center for Medicaid and State Operations. The policy would continue indefinitely, though Democrats in Congress could try to override it.
The Children’s Health Insurance Program has strong support from governors of both parties, including Republicans like Arnold Schwarzenegger of California, Tim Pawlenty of Minnesota and Sonny Perdue of Georgia. When the Senate passed a bill to expand the program this month, 18 Republican senators voted for it, in defiance of a veto threat from Mr. Bush. The House passed a more expansive bill and will try to work out differences with the Senate when Congress reconvenes next month.
In his letter, Mr. Smith set a high standard for states that want to raise eligibility for the child health program above 250 percent of the poverty level.
Before making such a change, Mr. Smith wrote, states must demonstrate that they have “enrolled at least 95 percent of children in the state below 200 percent of the federal poverty level” who are eligible for either Medicaid or the child health program.
Deborah S. Bachrach, a deputy commissioner in the New York State Health Department, said, “No state in the nation has a participation rate of 95 percent.”
And Cindy Mann, a research professor at the Health Policy Institute of Georgetown University, said, “No state would ever achieve that level of participation under the president’s budget proposals.”
The Congressional Budget Office has said that the president’s budget, which seeks $30 billion for the program from 2008 to 2012, is not enough to pay for current levels of enrollment, much less to cover children who are eligible but not enrolled.
When Congress created the Children’s Health Insurance Program in 1997, it said the purpose was to cover “uninsured low-income children.” Under the law, states are supposed to make sure public coverage “does not substitute for coverage under group health plans.”
In an interview yesterday, Mr. Smith said, “The program was always meant for children in lower-income families.” As a state increases its income limits, he said, “it’s more likely to substitute for private coverage.”
To minimize the risk of such substitution, Mr. Smith said in his letter, states should charge co-payments or premiums that approximate the cost of private coverage and should impose “waiting periods” to make sure middle-income children do not go directly from a private health plan to a public program.
If a state wants to set its income limit above 250 percent of the poverty level — $51,625 for a family of four — Mr. Smith said, “the state must establish a minimum of a one-year period of uninsurance for individuals” before they can receive public coverage.
That is considerably stricter than past requirements. In February, for example, the Bush administration allowed Pennsylvania to increase its income limit to 300 percent of the poverty level after the state agreed to a six-month waiting period for children who were 2 and older with family incomes exceeding 200 percent of the poverty level.
As another precaution, Mr. Smith said, states that want to cover children above 250 percent of the poverty level must show that “the number of children in the target population insured through private employers has not decreased by more than two percentage points over the prior five-year period.”
In New Jersey, which has a three-month waiting period, Ms. Kohler said, “we have no evidence of a decline in employer-sponsored coverage resulting from the Children’s Health Insurance Program.”
In the Senate debate this month, several Republicans offered a proposal similar to the new Bush administration policy. They wanted to require states to cover 95 percent of low-income children before allowing states to expand eligibility.
Senator Max Baucus, the Montana Democrat who is chairman of the Finance Committee, argued against the proposal, saying: “No state can meet 95 percent. No state currently meets 95 percent.”
In his letter, Mr. Smith said the new standards would apply to states that previously received federal approval to cover children with family incomes over 250 percent of the poverty level. Such states should amend their state plans to meet federal expectations within 12 months, or the Bush administration “may pursue corrective action,” Mr. Smith said.
Two Republican senators, Charles E. Grassley of Iowa and Pat Roberts of Kansas, urged the Bush administration last week to deny New York’s request to cover children with family incomes up to four times the poverty level. The proposal, they said, violates the original intent of Congress.
But Gov. Eliot Spitzer of New York said that, “contrary to the senators’ objections,” federal law allows states to set higher income limits. “Granting this expansion,” Mr. Spitzer said, “is essential to the health and well-being of New York’s children.”
Read more in The New York Times
The Bush administration, continuing its fight to stop states from expanding the popular Children’s Health Insurance Program, has adopted new standards that would make it much more difficult for New York, California and others to extend coverage to children in middle-income families.
Administration officials outlined the new standards in a letter sent to state health officials on Friday evening, in the middle of a monthlong Congressional recess. In interviews, they said the changes were intended to return the Children’s Health Insurance Program to its original focus on low-income children and to make sure the program did not become a substitute for private health coverage.
After learning of the new policy, some state officials said yesterday that it could cripple their efforts to cover more children and would impose standards that could not be met.
“We are horrified at the new federal policy,” said Ann Clemency Kohler, deputy commissioner of human services in New Jersey. “It will cause havoc with our program and could jeopardize coverage for thousands of children.”
Stan Rosenstein, the Medicaid director in California, said the new policy was “highly restrictive, much more restrictive than what we want to do.”
The poverty level for a family of four is set by the federal government at $20,650 in annual income. Many states have received federal permission to cover children with family incomes exceeding twice the poverty level — $41,300 for a family of four. In New York, which covers children up to 250 percent of the poverty level, the Legislature has passed a bill that would raise the limit to 400 percent— $82,600 for a family of four — but the change is subject to federal approval.
California wants to increase its income limit to 300 percent of the poverty level, from 250 percent. Pennsylvania recently raised its limit to 300 percent, from 200 percent. New Jersey has had a limit of 350 percent for more than five years.
As with issues like immigration, the White House is taking action on its own to advance policies that have not been embraced by Congress.
In his budget in February, President Bush proposed strict limits on family income for the child health program. Both houses of Congress voted this month to renew the program for five years, but neither chamber accepted that proposal. Legal authority for the program expires on Sept. 30.
The administration’s new policy is explained in a letter that was sent about 7:30 p.m. on Friday to state health officials from Dennis G. Smith, the director of the federal Center for Medicaid and State Operations. The policy would continue indefinitely, though Democrats in Congress could try to override it.
The Children’s Health Insurance Program has strong support from governors of both parties, including Republicans like Arnold Schwarzenegger of California, Tim Pawlenty of Minnesota and Sonny Perdue of Georgia. When the Senate passed a bill to expand the program this month, 18 Republican senators voted for it, in defiance of a veto threat from Mr. Bush. The House passed a more expansive bill and will try to work out differences with the Senate when Congress reconvenes next month.
In his letter, Mr. Smith set a high standard for states that want to raise eligibility for the child health program above 250 percent of the poverty level.
Before making such a change, Mr. Smith wrote, states must demonstrate that they have “enrolled at least 95 percent of children in the state below 200 percent of the federal poverty level” who are eligible for either Medicaid or the child health program.
Deborah S. Bachrach, a deputy commissioner in the New York State Health Department, said, “No state in the nation has a participation rate of 95 percent.”
And Cindy Mann, a research professor at the Health Policy Institute of Georgetown University, said, “No state would ever achieve that level of participation under the president’s budget proposals.”
The Congressional Budget Office has said that the president’s budget, which seeks $30 billion for the program from 2008 to 2012, is not enough to pay for current levels of enrollment, much less to cover children who are eligible but not enrolled.
When Congress created the Children’s Health Insurance Program in 1997, it said the purpose was to cover “uninsured low-income children.” Under the law, states are supposed to make sure public coverage “does not substitute for coverage under group health plans.”
In an interview yesterday, Mr. Smith said, “The program was always meant for children in lower-income families.” As a state increases its income limits, he said, “it’s more likely to substitute for private coverage.”
To minimize the risk of such substitution, Mr. Smith said in his letter, states should charge co-payments or premiums that approximate the cost of private coverage and should impose “waiting periods” to make sure middle-income children do not go directly from a private health plan to a public program.
If a state wants to set its income limit above 250 percent of the poverty level — $51,625 for a family of four — Mr. Smith said, “the state must establish a minimum of a one-year period of uninsurance for individuals” before they can receive public coverage.
That is considerably stricter than past requirements. In February, for example, the Bush administration allowed Pennsylvania to increase its income limit to 300 percent of the poverty level after the state agreed to a six-month waiting period for children who were 2 and older with family incomes exceeding 200 percent of the poverty level.
As another precaution, Mr. Smith said, states that want to cover children above 250 percent of the poverty level must show that “the number of children in the target population insured through private employers has not decreased by more than two percentage points over the prior five-year period.”
In New Jersey, which has a three-month waiting period, Ms. Kohler said, “we have no evidence of a decline in employer-sponsored coverage resulting from the Children’s Health Insurance Program.”
In the Senate debate this month, several Republicans offered a proposal similar to the new Bush administration policy. They wanted to require states to cover 95 percent of low-income children before allowing states to expand eligibility.
Senator Max Baucus, the Montana Democrat who is chairman of the Finance Committee, argued against the proposal, saying: “No state can meet 95 percent. No state currently meets 95 percent.”
In his letter, Mr. Smith said the new standards would apply to states that previously received federal approval to cover children with family incomes over 250 percent of the poverty level. Such states should amend their state plans to meet federal expectations within 12 months, or the Bush administration “may pursue corrective action,” Mr. Smith said.
Two Republican senators, Charles E. Grassley of Iowa and Pat Roberts of Kansas, urged the Bush administration last week to deny New York’s request to cover children with family incomes up to four times the poverty level. The proposal, they said, violates the original intent of Congress.
But Gov. Eliot Spitzer of New York said that, “contrary to the senators’ objections,” federal law allows states to set higher income limits. “Granting this expansion,” Mr. Spitzer said, “is essential to the health and well-being of New York’s children.”
Read more in The New York Times
Saturday, August 25, 2007
Dentists' discipline hidden from view - The agency is struggling to protect the public, critics say
By DARREN BARBEE - Star-Telegram staff writer - Mon, Jun. 11, 2007
Second in a four-part series examining state regulation of health professionals
One dentist was accused of botching root canals, bridges and crowns and writing 100 prescriptions after his controlled-substances permit had expired.
Another dentist was sentenced to 27 months in prison for overbilling a government program to help the poor. Still another, from Euless, was shot in the chest while breaking into his in-laws' home. He received probation after pleading guilty to criminal trespass and assault charges.
The dentists all have at least two things in common: They're currently licensed to practice in Texas, and the Texas State Board of Dental Examiners only shares details about their past if a request is made in writing -- just don't expect a quick answer.
Some say the governor-appointed board has struggled in recent years to fulfill its basic mission: protecting the public.
Board member Tammy Allen, a Hurst dental hygienist, said the board does the best it can with the resources it has. But she is troubled by a sharp decline -- 58 percent over three years -- in the number of dental professionals disciplined. She's also concerned penalties are handed out too subjectively.
"Two dentists can have the same violation and one will get a warning and the other a $1,000 fine," Allen said. "That's not right, it's not fair, and as a board member, that bothers me."
The state has taken the board to task for such problems as failing to enforce its disciplinary actions and not meeting deadlines.
Consumer advocates are concerned that, while the board can give bad dentists and even those who are convicted criminals a second chance, its Web site merely states if a dentist has faced discipline and the type of penalty imposed. It offers little information about the nature of their offenses.
Supporters say the board in recent years has cleared a large backlog of complaints, some stretching back more than six years. During that time, disciplinary actions exceeded state-set benchmarks, although last year they were lagging.
Fread Houston, the board's general counsel, said the agency's penalty system has been overhauled in recent years to make it more evenhanded. More consistent results would come if the small agency with 29 budgeted employees had more funding, he said.
State reports show last fiscal year the board generated $4.5 million more than it spent. But that money, largely from fees related to licensing, credentialing and examinations, went to the state's general fund. The board spent $1.8 million.
Among other needs is an updated computer system.
"It's crazy," Houston said. "Literally, I look at the screen and it's as if you're in 1980."
Houston said the board is making progress.
"Can it be made better? Yes. I think there is room for improvement."
Backlog of complaints
The board's job is big: Each year it must screen the approximately 12,000 dentists and 10,000 hygienists it licenses, on top of investigating hundreds of complaints.
It has fallen short in both areas, according to the most recent state auditor's report on the board.
Houston said he doesn't agree with some conclusions reached in the August 2005 report, including the discovery that six convicted felons weren't investigated during the licensing process.
The board uses the Texas Department of Public Safety to conduct criminal background checks but relied on a report that showed only changes in criminal records during the prior four months, rather than a full criminal history as required by law.
The board responded by saying that it would work with the DPS to ensure it obtained full histories on all new licensees.
"It wasn't that we weren't doing our job," Houston said. "It was that the information we were getting back was just not complete."
The audit also found that sanctions imposed against dentists and hygienists weren't enforced. One dentist, for instance, was required to receive peer assistance for a substance-abuse problem. The day after the board was notified the dentist hadn't done so, its staff renewed his license.
In response, the board noted that it is not authorized to use the license-renewal process as a disciplinary tool.
In a separate report by the Legislative Budget Board, the board took hits for failing to investigate complaints on time. In 2005, for instance, it averaged about a year to resolve problems, about 80 days longer than the state benchmark. Last year, the board again averaged a year response time, but the state upped the deadline to 400 days.
Earlier this spring, the board faced a backlog of about 270 complaints, including a 2001 case.
The slow response to a backlog of complaints resulted from employees leaving for other agencies or the private sector, Houston said.
From June through December 2005, for instance, the executive director, director of enforcement, five investigators, an attorney and two administrative employees left the board. As a result, new employees were constantly being trained and were unfamiliar with the system. In the legislative session that just ended, the board was granted eight new positions it requested.
Thief's license reinstated
Greed got the best of Amarillo dentist Charles T. Carr.
In the late 1990s, he began overbilling a government poverty program for the care he provided. In the end, it cost him two years in prison, but not his profession.
"You know, it was just a case of seeing a way to maybe make a little extra money," Carr said.
He was stripped of his license but in 2003 received a new one from the board. He's at a loss to explain why the board granted his application.
"I haven't got a clue," said Carr, who is barred from billing the state or federal government for patients. "I've prayed about it a lot."
The board considers the nature of the crime, the amount of time passed, recommendations from court personnel and other information when deciding whether to license a dental professional.
Cases such as Carr's aren't detailed on the board's Web site. The site notes if a dental professional has faced disciplinary action in the past. In another part of the Web site, there's a listing of the penalty a dental professional received, but it only goes back about three years.
Dr. Robert Baratz, a Massachusetts physician and dentist who helps run the watchdog Web site dentalwatch.org, said it ought to be easier for the public to know about disciplinary actions. "As the consumer, I would like to know. ... A lot of boards want you to go through hoops to try to get it," Baratz said. "I would just as soon click on it and read it."
New York state's Web site, for instance, gives the day action was taken against a dentist, a summary of the infraction -- such as "admitted to the charge of filing a false report" -- and details about penalties, such as the terms of probation and amounts fined.
Dr. Richard Black, an El Paso dentist and past president of the Texas Dental Association, said the group doesn't support adding more information to the Web site.
"I feel that's a privacy issue between the licensees and the people who are disciplined," he said.
The association supported increasing the board's budget.
Online.
Filling the coffers
Like most regulatory agencies of its kind, the Texas State Board of Dental Examiners is a moneymaker for the state, spending less than a third of its revenues.
A look at fiscal 2006 revenue and expenses:
Net revenue: $6,337,539
Net expenditures: $1,806,608
Excess: (to the state general fund): $4,530,931
Source: State of Texas 2006 Annual Cash Report
About the Consumer Report Card series
Evaluating healthcare professionals
This report is part of the first installment of a periodic series of stories examining how well Texas is fulfilling its consumer protection role. Findings are based on documents and data compiled by the state, and the Consumer Report Card criteria employ some of the measures the state has devised to judge performance. Evaluations were determined by weighing a variety of factors and reflecting the state's overall performance.
Tell us about your problems
What happened when you had a problem with a medical professional? Go to www.star-telegram.com to comment on your experience or to suggest other topics for future consumer report cards.
For information on filing a complaint about a licensed healthcare professional, call the state's toll-free hot line: 800-821-3205
Second in a four-part series examining state regulation of health professionals
One dentist was accused of botching root canals, bridges and crowns and writing 100 prescriptions after his controlled-substances permit had expired.
Another dentist was sentenced to 27 months in prison for overbilling a government program to help the poor. Still another, from Euless, was shot in the chest while breaking into his in-laws' home. He received probation after pleading guilty to criminal trespass and assault charges.
The dentists all have at least two things in common: They're currently licensed to practice in Texas, and the Texas State Board of Dental Examiners only shares details about their past if a request is made in writing -- just don't expect a quick answer.
Some say the governor-appointed board has struggled in recent years to fulfill its basic mission: protecting the public.
Board member Tammy Allen, a Hurst dental hygienist, said the board does the best it can with the resources it has. But she is troubled by a sharp decline -- 58 percent over three years -- in the number of dental professionals disciplined. She's also concerned penalties are handed out too subjectively.
"Two dentists can have the same violation and one will get a warning and the other a $1,000 fine," Allen said. "That's not right, it's not fair, and as a board member, that bothers me."
The state has taken the board to task for such problems as failing to enforce its disciplinary actions and not meeting deadlines.
Consumer advocates are concerned that, while the board can give bad dentists and even those who are convicted criminals a second chance, its Web site merely states if a dentist has faced discipline and the type of penalty imposed. It offers little information about the nature of their offenses.
Supporters say the board in recent years has cleared a large backlog of complaints, some stretching back more than six years. During that time, disciplinary actions exceeded state-set benchmarks, although last year they were lagging.
Fread Houston, the board's general counsel, said the agency's penalty system has been overhauled in recent years to make it more evenhanded. More consistent results would come if the small agency with 29 budgeted employees had more funding, he said.
State reports show last fiscal year the board generated $4.5 million more than it spent. But that money, largely from fees related to licensing, credentialing and examinations, went to the state's general fund. The board spent $1.8 million.
Among other needs is an updated computer system.
"It's crazy," Houston said. "Literally, I look at the screen and it's as if you're in 1980."
Houston said the board is making progress.
"Can it be made better? Yes. I think there is room for improvement."
Backlog of complaints
The board's job is big: Each year it must screen the approximately 12,000 dentists and 10,000 hygienists it licenses, on top of investigating hundreds of complaints.
It has fallen short in both areas, according to the most recent state auditor's report on the board.
Houston said he doesn't agree with some conclusions reached in the August 2005 report, including the discovery that six convicted felons weren't investigated during the licensing process.
The board uses the Texas Department of Public Safety to conduct criminal background checks but relied on a report that showed only changes in criminal records during the prior four months, rather than a full criminal history as required by law.
The board responded by saying that it would work with the DPS to ensure it obtained full histories on all new licensees.
"It wasn't that we weren't doing our job," Houston said. "It was that the information we were getting back was just not complete."
The audit also found that sanctions imposed against dentists and hygienists weren't enforced. One dentist, for instance, was required to receive peer assistance for a substance-abuse problem. The day after the board was notified the dentist hadn't done so, its staff renewed his license.
In response, the board noted that it is not authorized to use the license-renewal process as a disciplinary tool.
In a separate report by the Legislative Budget Board, the board took hits for failing to investigate complaints on time. In 2005, for instance, it averaged about a year to resolve problems, about 80 days longer than the state benchmark. Last year, the board again averaged a year response time, but the state upped the deadline to 400 days.
Earlier this spring, the board faced a backlog of about 270 complaints, including a 2001 case.
The slow response to a backlog of complaints resulted from employees leaving for other agencies or the private sector, Houston said.
From June through December 2005, for instance, the executive director, director of enforcement, five investigators, an attorney and two administrative employees left the board. As a result, new employees were constantly being trained and were unfamiliar with the system. In the legislative session that just ended, the board was granted eight new positions it requested.
Thief's license reinstated
Greed got the best of Amarillo dentist Charles T. Carr.
In the late 1990s, he began overbilling a government poverty program for the care he provided. In the end, it cost him two years in prison, but not his profession.
"You know, it was just a case of seeing a way to maybe make a little extra money," Carr said.
He was stripped of his license but in 2003 received a new one from the board. He's at a loss to explain why the board granted his application.
"I haven't got a clue," said Carr, who is barred from billing the state or federal government for patients. "I've prayed about it a lot."
The board considers the nature of the crime, the amount of time passed, recommendations from court personnel and other information when deciding whether to license a dental professional.
Cases such as Carr's aren't detailed on the board's Web site. The site notes if a dental professional has faced disciplinary action in the past. In another part of the Web site, there's a listing of the penalty a dental professional received, but it only goes back about three years.
Dr. Robert Baratz, a Massachusetts physician and dentist who helps run the watchdog Web site dentalwatch.org, said it ought to be easier for the public to know about disciplinary actions. "As the consumer, I would like to know. ... A lot of boards want you to go through hoops to try to get it," Baratz said. "I would just as soon click on it and read it."
New York state's Web site, for instance, gives the day action was taken against a dentist, a summary of the infraction -- such as "admitted to the charge of filing a false report" -- and details about penalties, such as the terms of probation and amounts fined.
Dr. Richard Black, an El Paso dentist and past president of the Texas Dental Association, said the group doesn't support adding more information to the Web site.
"I feel that's a privacy issue between the licensees and the people who are disciplined," he said.
The association supported increasing the board's budget.
Online.
Filling the coffers
Like most regulatory agencies of its kind, the Texas State Board of Dental Examiners is a moneymaker for the state, spending less than a third of its revenues.
A look at fiscal 2006 revenue and expenses:
Net revenue: $6,337,539
Net expenditures: $1,806,608
Excess: (to the state general fund): $4,530,931
Source: State of Texas 2006 Annual Cash Report
About the Consumer Report Card series
Evaluating healthcare professionals
This report is part of the first installment of a periodic series of stories examining how well Texas is fulfilling its consumer protection role. Findings are based on documents and data compiled by the state, and the Consumer Report Card criteria employ some of the measures the state has devised to judge performance. Evaluations were determined by weighing a variety of factors and reflecting the state's overall performance.
Tell us about your problems
What happened when you had a problem with a medical professional? Go to www.star-telegram.com to comment on your experience or to suggest other topics for future consumer report cards.
For information on filing a complaint about a licensed healthcare professional, call the state's toll-free hot line: 800-821-3205
Chiropractic board slow to act - Agency hopes to clear up a backlog of complaints
By Darren Barbee - Star-Telegram staff writer - Tue, Jun. 12, 2007
Third in a four-part series examining state regulation of health professionals
Some of the worst charges hurled against chiropractors involve sexual assault, theft and fraud. Year after year, the state's response to consumer complaints has been unwavering: sluggishness for all.
But the Texas Board of Chiropractic Examiners, the agency responsible for investigating, has its reasons for the delays.
Consider first quarter, 2004: A backlog of complaints, including a court case 1,500 days old, skewed response times.
Or fourth quarter, 2005: The agency's sole investigator quit. No cases were closed.
Or third quarter, 2006: Officials complained that the state's 125-day deadline for resolving complaints wasn't enough time. And the latest investigator quit.
Plagued by high employee turnover, limited staff and a tight budget, the board has seen its ability to protect patients deteriorate in recent years. Consumers seeking information about a chiropractor must consult Web sites that offer enforcement data nearly 15 months old and rely on licensing information that Executive Director Glenn Parker cautions isn't dependable.
But Parker, who took the job last summer, said his top priority is enforcement.
"The real reason that most of these licensing agencies exist, at least in theory, is to ensure that the people out there practicing are competent," he said.
The board failed to meet one measure of that goal in recent years. In fiscal 2006, the board disciplined seven chiropractors. But the state had projected that 21 chiropractors would be penalized.
This fiscal year got off to a better start: From September through November, the board disciplined 34 licensees, which Parker cited as evidence of the board's commitment to consumer protection.
Yet most of those cases were old, near completion, and penalties were easier to negotiate with licensees.
Most of the discipline consisted of reprimands or fines; one license was revoked and eight licenses were suspended.
"Simply stated, we took the opportunity to close some of the easier disciplinary cases," Parker said.
Parker said the board stands a better chance of protecting patients with an additional $149,000 approved by the Legislature last month. The money will pay for a second investigator for the 200 or more complaints the board receives each year and will also help clear old complaints.
Fifteen are more than three years old, including one from 1999.
Performance suffers
Since June 2005, the board has employed four different investigators. The latest left this year, and the board spent a month finding a replacement. That meant most significant cases again came to a halt.
Turnover is a problem in all positions, officials said. In October, for instance, a state report found that six of the board's then eight workers, Parker among them, had been at their jobs for less than a year.
"On a smaller board, it's magnified because if you've only got one person doing one type of job, as soon as that person is gone there's going to be some lag time" as new employees are trained, said Dr. Scott Isdale, a Killeen chiropractor who serves on the board's enforcement committee.
In 2004, the Sunset Advisory Commission cited the board's ineffectiveness due to limited resources.
The commission reported that the board had one of the worst ratios of enforcement staff to licensees in the state -- one enforcement position for 4,700 chiropractors. The ratio is about the same today.
The report also noted that from 2001 to 2003, chiropractors fraudulently acquired workers' compensation claims totaling about $15.8 million.
Parker said the board has stepped up cooperation with other agencies, such as the Texas Department of Insurance, to combat fraud.
Public access criticism
D. Vincent Baugher, a Denton chiropractor, says consumers should have access to disciplinary records when choosing a chiropractor.
"I hate to say it, because it does reflect on me," he said.
In early 2001, Baugher was treating a female patient who was in the midst of some emotional difficulties, he said. To Baugher, the woman seemed to be reaching out for someone to show her affection. In what he said was a moment of weakness, Baugher crossed a line.
"I was under the impression that she wanted me to touch her breasts. I did, through her clothing," Baugher said.
The woman later confronted him, and Baugher said he immediately apologized. She reported the incident to the board in 2001, and Baugher took a course on ethics and boundaries and was placed on a two-year probated suspension -- almost four years later.
"I'm still very caring about my patients, male and female, and yet there's no question about whether that caring could ever overstep those bounds again," he said.
If patients knew which archived newsletter to look in, they could find details about Baugher's case on the board's Web site. But the newsletters are hit and miss, and the site otherwise provides little information about why chiropractors were disciplined and is out of date.
"There is virtually no information that would help a patient make an informed decision," said Alex Winslow, executive director of Texas Watch, a consumer advocacy group.
For example, a former Austin chiropractor, Hartwin Peterson, is listed on the site as having his license revoked in 1999. No other details about his case are provided. State Office of Administrative Hearings records show that he was accused of sexual misconduct with a patient.
Though he is listed on some Web sites as a chiropractor, he offers what Parker described as natural methods of healing that are not regulated by the board. He apparently shares a receptionist with his brother, a licensed chiropractor.
Peterson, who denied the allegations in court documents, did not return calls seeking comment.
The board uses the Texas Online Professional Profiling System, an Internet database, to provide limited information on chiropractors, including whether an individual has been disciplined.
The Star-Telegram found that some chiropractors do not appear to be in the database. Parker said that's because the list isn't always up to date. "That's why I caution people not to depend on that as an absolute," he said.
He plans to add a searchable database to the agency's own Web site sometime this year.
Online.
Financial snapshot
Officials at the Texas Board of Chiropractic Examiners say the agency has been underfunded for several years while making a profit for the state. In 2006, the board's revenue topped $2 million, but expenses were $428,000, according to the State of Texas 2006 Annual Cash Report. Excess revenue of about $1.6 million was transferred to the state's general fund.
ILLUSTRATION: Consumer Report Card: Chiropractors
About the Consumer Report Card series
Evaluating healthcare professionals
This report is part of the first installment in a periodic series examining how well Texas is fulfilling its consumer protection role. Findings are based on documents and data compiled by the state, and the Consumer Report Card criteria include some of the measures the state has devised to judge performance. Evaluations were made by weighing a variety of factors and reflect the state's overall performance.
Coming up
Wednesday: nurses
If you missed a part of the series, you can find the reports at www.star-telegram.com.
Tell us about your problems
What happened when you had a problem with a medical professional? Comment on your experience or to suggest other topics for future consumer report cards.
For information on filing a complaint about a licensed healthcare professional, call the state's toll-free hot line: 800-821-3205.
Read more in the Fort Worth Star Telegram.
Third in a four-part series examining state regulation of health professionals
Some of the worst charges hurled against chiropractors involve sexual assault, theft and fraud. Year after year, the state's response to consumer complaints has been unwavering: sluggishness for all.
But the Texas Board of Chiropractic Examiners, the agency responsible for investigating, has its reasons for the delays.
Consider first quarter, 2004: A backlog of complaints, including a court case 1,500 days old, skewed response times.
Or fourth quarter, 2005: The agency's sole investigator quit. No cases were closed.
Or third quarter, 2006: Officials complained that the state's 125-day deadline for resolving complaints wasn't enough time. And the latest investigator quit.
Plagued by high employee turnover, limited staff and a tight budget, the board has seen its ability to protect patients deteriorate in recent years. Consumers seeking information about a chiropractor must consult Web sites that offer enforcement data nearly 15 months old and rely on licensing information that Executive Director Glenn Parker cautions isn't dependable.
But Parker, who took the job last summer, said his top priority is enforcement.
"The real reason that most of these licensing agencies exist, at least in theory, is to ensure that the people out there practicing are competent," he said.
The board failed to meet one measure of that goal in recent years. In fiscal 2006, the board disciplined seven chiropractors. But the state had projected that 21 chiropractors would be penalized.
This fiscal year got off to a better start: From September through November, the board disciplined 34 licensees, which Parker cited as evidence of the board's commitment to consumer protection.
Yet most of those cases were old, near completion, and penalties were easier to negotiate with licensees.
Most of the discipline consisted of reprimands or fines; one license was revoked and eight licenses were suspended.
"Simply stated, we took the opportunity to close some of the easier disciplinary cases," Parker said.
Parker said the board stands a better chance of protecting patients with an additional $149,000 approved by the Legislature last month. The money will pay for a second investigator for the 200 or more complaints the board receives each year and will also help clear old complaints.
Fifteen are more than three years old, including one from 1999.
Performance suffers
Since June 2005, the board has employed four different investigators. The latest left this year, and the board spent a month finding a replacement. That meant most significant cases again came to a halt.
Turnover is a problem in all positions, officials said. In October, for instance, a state report found that six of the board's then eight workers, Parker among them, had been at their jobs for less than a year.
"On a smaller board, it's magnified because if you've only got one person doing one type of job, as soon as that person is gone there's going to be some lag time" as new employees are trained, said Dr. Scott Isdale, a Killeen chiropractor who serves on the board's enforcement committee.
In 2004, the Sunset Advisory Commission cited the board's ineffectiveness due to limited resources.
The commission reported that the board had one of the worst ratios of enforcement staff to licensees in the state -- one enforcement position for 4,700 chiropractors. The ratio is about the same today.
The report also noted that from 2001 to 2003, chiropractors fraudulently acquired workers' compensation claims totaling about $15.8 million.
Parker said the board has stepped up cooperation with other agencies, such as the Texas Department of Insurance, to combat fraud.
Public access criticism
D. Vincent Baugher, a Denton chiropractor, says consumers should have access to disciplinary records when choosing a chiropractor.
"I hate to say it, because it does reflect on me," he said.
In early 2001, Baugher was treating a female patient who was in the midst of some emotional difficulties, he said. To Baugher, the woman seemed to be reaching out for someone to show her affection. In what he said was a moment of weakness, Baugher crossed a line.
"I was under the impression that she wanted me to touch her breasts. I did, through her clothing," Baugher said.
The woman later confronted him, and Baugher said he immediately apologized. She reported the incident to the board in 2001, and Baugher took a course on ethics and boundaries and was placed on a two-year probated suspension -- almost four years later.
"I'm still very caring about my patients, male and female, and yet there's no question about whether that caring could ever overstep those bounds again," he said.
If patients knew which archived newsletter to look in, they could find details about Baugher's case on the board's Web site. But the newsletters are hit and miss, and the site otherwise provides little information about why chiropractors were disciplined and is out of date.
"There is virtually no information that would help a patient make an informed decision," said Alex Winslow, executive director of Texas Watch, a consumer advocacy group.
For example, a former Austin chiropractor, Hartwin Peterson, is listed on the site as having his license revoked in 1999. No other details about his case are provided. State Office of Administrative Hearings records show that he was accused of sexual misconduct with a patient.
Though he is listed on some Web sites as a chiropractor, he offers what Parker described as natural methods of healing that are not regulated by the board. He apparently shares a receptionist with his brother, a licensed chiropractor.
Peterson, who denied the allegations in court documents, did not return calls seeking comment.
The board uses the Texas Online Professional Profiling System, an Internet database, to provide limited information on chiropractors, including whether an individual has been disciplined.
The Star-Telegram found that some chiropractors do not appear to be in the database. Parker said that's because the list isn't always up to date. "That's why I caution people not to depend on that as an absolute," he said.
He plans to add a searchable database to the agency's own Web site sometime this year.
Online.
Financial snapshot
Officials at the Texas Board of Chiropractic Examiners say the agency has been underfunded for several years while making a profit for the state. In 2006, the board's revenue topped $2 million, but expenses were $428,000, according to the State of Texas 2006 Annual Cash Report. Excess revenue of about $1.6 million was transferred to the state's general fund.
ILLUSTRATION: Consumer Report Card: Chiropractors
About the Consumer Report Card series
Evaluating healthcare professionals
This report is part of the first installment in a periodic series examining how well Texas is fulfilling its consumer protection role. Findings are based on documents and data compiled by the state, and the Consumer Report Card criteria include some of the measures the state has devised to judge performance. Evaluations were made by weighing a variety of factors and reflect the state's overall performance.
Coming up
Wednesday: nurses
If you missed a part of the series, you can find the reports at www.star-telegram.com.
Tell us about your problems
What happened when you had a problem with a medical professional? Comment on your experience or to suggest other topics for future consumer report cards.
For information on filing a complaint about a licensed healthcare professional, call the state's toll-free hot line: 800-821-3205.
Read more in the Fort Worth Star Telegram.
Medicare's missing $34 million
Star-Telegram - Thu, Aug. 16, 2007
Imagine if $34 million slipped through your fingers. For Medicare officials, no imagination is required. Medicare Advantage patients should have received that amount of additional benefits or reduced premiums from companies administering the alternative Medicare program, the federal Centers for Medicare & Medicaid Services determined after reviewing 2003 audits of the companies. But in May, the federal agency gave up trying to recover the money, saying it lacked the legal authority. A recent government audit says the agency does have the authority, but it needs to say so when writing contracts with the companies. Read full Government Accounting Office report.
Imagine if $34 million slipped through your fingers. For Medicare officials, no imagination is required. Medicare Advantage patients should have received that amount of additional benefits or reduced premiums from companies administering the alternative Medicare program, the federal Centers for Medicare & Medicaid Services determined after reviewing 2003 audits of the companies. But in May, the federal agency gave up trying to recover the money, saying it lacked the legal authority. A recent government audit says the agency does have the authority, but it needs to say so when writing contracts with the companies. Read full Government Accounting Office report.
Nursing board sets high standards - Some state lawmakers want agency to relax its tough rules
By YAMIL BERARD - Star-Telegram staff writer - Fri, Aug. 17, 2007
Last in a four-part series examining state regulation of health professionals
An applicant for a state nursing license is being questioned in front of a licensing panel about a minor criminal infraction committed years ago. The discussion turns from the infraction to an unrelated topic: the applicant's extramarital affairs.
This is not a scene out of Desperate Housewives. It is a documented exchange in front of the Texas Board of Nurse Examiners.
The board is perhaps the most aggressive healthcare regulator in Texas, taking patient safety to heart.
It was the first nurse professionals oversight board in the nation to embark on a program to conduct criminal background checks on every nurse. Nursing applicants now undergo the checks and submit fingerprints to be screened against an FBI database. In the next several years, the board will also run checks on the 264,450 nurses already working in Texas.
The board has no problem, either, with listing on its Web site the names of nurses whose licenses have been suspended or revoked for violating one of the profession's rules. And in the next few months, it will beef up that portion of the site to give detailed information about specific violations.
What's more, it is the only health-practitioner board that posts on its Web site color photographs of impostors -- in this case, people impersonating nurses at doctors' offices and health clinics.
"That's so people could recognize these individuals," Executive Director Katherine Thomas said. "Some of them use aliases."
Texas lawmakers who scrutinized the nursing board last year said it is one of the state's best-run agencies. "They do take their job seriously," said Rep. Donna Howard, D-Austin, who is a nurse.
The irony is that lawmakers and others have criticized the board for being too tough, saying that the board's stance, at some level, has contributed to Texas' nursing shortage.
"We agreed that we need good nurses; we just need more of them," said Dan Sutherland, spokesman for Rep. Vicki Truitt, R-Keller, vice chairwoman of the Sunset Review Commission, which scrutinized the nursing board in September 2006.
Legislators pounced on the board for asking more questions about one applicant's extramarital affairs than about the minor criminal infraction when the applicant was 18 years old. They said the board's focus should be to ensure nurses are minimally competent to practice rather than setting standards so high that only select groups could attain them, and advised the board not to be so obsessed with image.
They also said that the criminal background checks can easily bog down the board. So they've recommended that the board only focus on serious crimes and try to ignore offenses they said were not relevant to nursing.
Some attorneys who defend nurses say the board has gone overboard. At times, the board punishes nurses for what amounts to transgressions of staff members' personal moral values, rather than nursing standards, said Elizabeth Higginbotham, an Austin attorney who used to be an assistant general counsel for the board.
Nurses often don't appeal board decisions because they can't afford to hire attorneys to defend them, said Rachel Sheeran, a Fort Worth attorney and former nurse.
But other attorneys say the organization is a tough act to follow.
"I do think they do a great job," said Joyce Stamp Lilly, a Houston medical malpractice attorney who also represents nurses under investigation by the board. "They'll investigate any call they can as far as I know. They're serious."
And many nurses think almost any questionable activity can tarnish a nurse's ability to provide care -- and that such issues are germane to nursing.
Americans rate nurses at the top of the list of trusted professionals. And there's plenty of reason why, Thomas said. Nursing requires a higher order of integrity because nurses visit homes and have access to patients' belongings.
"Patients are very vulnerable. They are sick, elderly, very young, unconscious," Thomas said. "Often, they are not able to make decisions for themselves."
After the board started the criminal checks, the number of board investigations soared. Investigations climbed to 8,623 in 2006, from 5,274 in 2003.
Last year, criminal background checks discovered that a number of new nurses and nurses renewing their licenses had a record with law enforcement. All told, 14 percent of registered nurse applicants and 17 percent of licensed vocational nurse applicants had records; of the renewing nurses, 7.5 percent of registered nurses and 18.5 percent of licensed vocational nurses had records.
Applicants who had committed what were seen as "youthful indiscretions" were most often approved, but those with more serious criminal activity in their pasts were almost always denied, regulators said.
"In any group or profession, there is always a certain group who are not good and should not be in the field," said Mark Majek, spokesman for the board. "We catch them."
Online.
About the Consumer Report Card series
Evaluating healthcare professionals
This report is part of the first installment of a periodic series of stories examining how well Texas is fulfilling its consumer protection role. Findings are based on documents and data compiled by the state, and the Consumer Report Card criteria employ some of the measures the state has devised to judge performance. Evaluations were determined by weighing a variety of factors and reflecting the state's overall performance.
Missed part of the report?
If you missed part of the series, you can find the reports at www.star-telegram.com.
Tell us about your problems
What happened when you had a problem with a medical professional? Go to www.star-telegram.com to comment on your experience or to suggest other topics for future consumer report cards.
For information on filing a complaint about a licensed healthcare professional, call the state's toll-free hot line: 800-821-3205
Filling the coffers
Like most regulatory agencies of its kind, the Texas Board of Nurse Examiners is a moneymaker for the state.
A look at fiscal 2006 revenue and expenses:
Net revenue: $13,847,075
Net expenditures: $5,954,416
Excess: $7,892,659
Source: State of Texas 2006 Annual Cash Report; Texas Board of Nurse Examiners
Read more in the Fort Worth Star Telegram
Last in a four-part series examining state regulation of health professionals
An applicant for a state nursing license is being questioned in front of a licensing panel about a minor criminal infraction committed years ago. The discussion turns from the infraction to an unrelated topic: the applicant's extramarital affairs.
This is not a scene out of Desperate Housewives. It is a documented exchange in front of the Texas Board of Nurse Examiners.
The board is perhaps the most aggressive healthcare regulator in Texas, taking patient safety to heart.
It was the first nurse professionals oversight board in the nation to embark on a program to conduct criminal background checks on every nurse. Nursing applicants now undergo the checks and submit fingerprints to be screened against an FBI database. In the next several years, the board will also run checks on the 264,450 nurses already working in Texas.
The board has no problem, either, with listing on its Web site the names of nurses whose licenses have been suspended or revoked for violating one of the profession's rules. And in the next few months, it will beef up that portion of the site to give detailed information about specific violations.
What's more, it is the only health-practitioner board that posts on its Web site color photographs of impostors -- in this case, people impersonating nurses at doctors' offices and health clinics.
"That's so people could recognize these individuals," Executive Director Katherine Thomas said. "Some of them use aliases."
Texas lawmakers who scrutinized the nursing board last year said it is one of the state's best-run agencies. "They do take their job seriously," said Rep. Donna Howard, D-Austin, who is a nurse.
The irony is that lawmakers and others have criticized the board for being too tough, saying that the board's stance, at some level, has contributed to Texas' nursing shortage.
"We agreed that we need good nurses; we just need more of them," said Dan Sutherland, spokesman for Rep. Vicki Truitt, R-Keller, vice chairwoman of the Sunset Review Commission, which scrutinized the nursing board in September 2006.
Legislators pounced on the board for asking more questions about one applicant's extramarital affairs than about the minor criminal infraction when the applicant was 18 years old. They said the board's focus should be to ensure nurses are minimally competent to practice rather than setting standards so high that only select groups could attain them, and advised the board not to be so obsessed with image.
They also said that the criminal background checks can easily bog down the board. So they've recommended that the board only focus on serious crimes and try to ignore offenses they said were not relevant to nursing.
Some attorneys who defend nurses say the board has gone overboard. At times, the board punishes nurses for what amounts to transgressions of staff members' personal moral values, rather than nursing standards, said Elizabeth Higginbotham, an Austin attorney who used to be an assistant general counsel for the board.
Nurses often don't appeal board decisions because they can't afford to hire attorneys to defend them, said Rachel Sheeran, a Fort Worth attorney and former nurse.
But other attorneys say the organization is a tough act to follow.
"I do think they do a great job," said Joyce Stamp Lilly, a Houston medical malpractice attorney who also represents nurses under investigation by the board. "They'll investigate any call they can as far as I know. They're serious."
And many nurses think almost any questionable activity can tarnish a nurse's ability to provide care -- and that such issues are germane to nursing.
Americans rate nurses at the top of the list of trusted professionals. And there's plenty of reason why, Thomas said. Nursing requires a higher order of integrity because nurses visit homes and have access to patients' belongings.
"Patients are very vulnerable. They are sick, elderly, very young, unconscious," Thomas said. "Often, they are not able to make decisions for themselves."
After the board started the criminal checks, the number of board investigations soared. Investigations climbed to 8,623 in 2006, from 5,274 in 2003.
Last year, criminal background checks discovered that a number of new nurses and nurses renewing their licenses had a record with law enforcement. All told, 14 percent of registered nurse applicants and 17 percent of licensed vocational nurse applicants had records; of the renewing nurses, 7.5 percent of registered nurses and 18.5 percent of licensed vocational nurses had records.
Applicants who had committed what were seen as "youthful indiscretions" were most often approved, but those with more serious criminal activity in their pasts were almost always denied, regulators said.
"In any group or profession, there is always a certain group who are not good and should not be in the field," said Mark Majek, spokesman for the board. "We catch them."
Online.
About the Consumer Report Card series
Evaluating healthcare professionals
This report is part of the first installment of a periodic series of stories examining how well Texas is fulfilling its consumer protection role. Findings are based on documents and data compiled by the state, and the Consumer Report Card criteria employ some of the measures the state has devised to judge performance. Evaluations were determined by weighing a variety of factors and reflecting the state's overall performance.
Missed part of the report?
If you missed part of the series, you can find the reports at www.star-telegram.com.
Tell us about your problems
What happened when you had a problem with a medical professional? Go to www.star-telegram.com to comment on your experience or to suggest other topics for future consumer report cards.
For information on filing a complaint about a licensed healthcare professional, call the state's toll-free hot line: 800-821-3205
Filling the coffers
Like most regulatory agencies of its kind, the Texas Board of Nurse Examiners is a moneymaker for the state.
A look at fiscal 2006 revenue and expenses:
Net revenue: $13,847,075
Net expenditures: $5,954,416
Excess: $7,892,659
Source: State of Texas 2006 Annual Cash Report; Texas Board of Nurse Examiners
Read more in the Fort Worth Star Telegram
Who's looking out for patients in Texas?
By YAMIL BERARD - Star-Telegram staff writer - Fri, Aug. 17, 2007
The Web site for orthopedic surgeon Jack Thomas shows the doe-eyed medical doctor with a "great bedside manner" and lists kindness and compassion as "hallmarks of his care."
Photographs of Thomas with an elderly patient appear as the words, "Dr. Thomas helped me to walk again. ... He is the most caring doctor I have ever had," take turns flashing across the home page.
The Texas Medical Board Web site also shows that Thomas -- who practices in a small community 45 miles northeast of Dallas -- has published a book on medical ethics. In fact, the only blemish that was on the site's profile of the physician earlier this spring was a December 1991 report of "mental incapacity."
But those who browsed another Web site -- the Texas Department of Public Safety -- would have discovered that Thomas pleaded guilty to three felonies, including Medicare fraud and illegally prescribing many dosage units of dangerous narcotics to people who weren't his patients. The federal Drug Enforcement Administration yanked his controlled-substances prescription license, and he served a 10-year probation until 2001.
A phone call to the Texas Medical Board would have revealed that Thomas, who was diagnosed with bipolar disorder, surrendered his medical license in 1991. He got it back in 1999.
Such gaps in the board's physician profiles are one of the cracks in the system that was supposed to add new layers of protection for Texas patients. Lawmakers supplied the board with more money -- a 50 percent increase in 2004 -- and new powers. The commitment was that patients would be more aggressively protected in the wake of new legislation that, in effect, made it more difficult for patients to sue doctors for malpractice. But after the initial push, resources have been cut back, and state data do not indicate that the Legislature has made good on its promises to beef up protections.
Public records show that some disciplinary actions against physicians have dropped since the 2003 change in law, particularly for some of the severest penalties. Fewer physicians are having their licenses suspended, and license revocations are flat, statistics show. What's more, lawmakers in 2003 created a state office to guide patients when they filed complaints with the medical board against their medical practitioners. But the Patient Protection Office lost its staff two years ago, when the Legislature stopped funding it. Now, it just has a Web site.
And the public still can't depend on the medical board's Web site for complete, accurate and timely information about doctors.
The upside, the board says, is that it is conducting more thorough investigations of individual complaints as a result of gaining resources, setting priorities, demanding more documentation and drawing on 400 expert witnesses who weigh in on cases.
Armed with new powers, the board is suspending some doctors within two weeks of reports of questionable activity, and the board now can immediately yank the licenses of doctors identified as being an immediate danger to patients.
Perhaps most importantly, the board is now using "teethier" restrictions -- such as barring physicians from treating certain types of patients or performing certain procedures -- and enforcing the penalties it imposes, said Don Patrick, the agency's executive director. In the past, he said, suspensions didn't mean much because doctors who were put on probation were allowed to continue to practice. Not anymore.
The board now also publishes a biannual newsletter listing all the doctors who have been disciplined, the cause of the action and the penalty. That deters bad behavior, Patrick said.
"Every doctor in the state learns from that disciplinary order," he said. "It is a powerful, powerful weapon."
But the case reviews are limited to the complaint at hand, Patrick acknowledged. Once a doctor is subject to a complaint, the board staff has no time to review other charts and documents that could give a better idea of the doctor's overall standard of care and analyze the root cause of problems.
"We want to see more, not just snapshots" of doctors' standard of care, Patrick said. "What we hope to see is a short movie."
The board doesn't pursue more extensive reviews because its resources have been stretched thin in the past two years.
And there is concern from consumer watchdog groups that the board is negotiating lesser penalties, such as minimal fines, rather than imposing more severe punishments, such as license revocations, because physicians are hiring attorneys to battle the board.
Their mere presence at board proceedings raises the threat of lawsuits, making the board more likely to negotiate punishment, doctors are being advised. So board hearings have become increasingly like court proceedings.
"I really handle those almost like a lawsuit," said Russell Thornton, a Dallas attorney who defends doctors in front of the board.
Thornton said that doctors who have legal representation and plenty of documentation can avoid what he deems "unreasonable recommendations" for discipline.
"The board doesn't want to see you again, so even if there's a problem, they don't want to pull your license. They understand you may have some problems in the way you practice medicine," Thornton said. "So I tell them, 'Look, when we go down there ... you've got to demonstrate to them why this kind of thing won't happen again and what steps you have taken proactively.'"
Another concern of consumer groups is that Texas is now drawing questionable doctors from other states.
The state's move to make it more difficult to sue doctors triggered an unprecedented number of applicants from states where Patrick says it is easier to sue doctors for malpractice, such as New York and Michigan.
All the applications -- a 92 percent increase from the first half of 2003 to the first half of 2006 -- added to the medical board's workload. That resulted in a backlog of processing applications.
Consumer groups have questioned why the board has licensed some of the physicians, including one who had her license revoked in several other states. She received a license to practice in Houston but is prohibited from practicing surgery.
"We're running the risk of Texas becoming a state haven for bad doctors," said Alex Winslow, spokesman for Texas Watch, an Austin consumers group that is tracking the licensing of doctors new to Texas. "Instead of improving healthcare for patients, it is getting even more dangerous for Texans."
Flaws in the system
What else needs attention to protect Texas patients? These are flaws in the system that can leave patients vulnerable.
Reliance on self-reporting
On its Web site, the board maintains physician profiles that are supposed to provide a way for patients to check doctors' disciplinary records.
But the board relies on physicians to self-report any criminal convictions and malpractice lawsuits, and some doctors don't provide that information. The Legislature doesn't require the board to monitor the Web site for accuracy.
After the Star-Telegram raised questions about the profile for Dr. Jack Thomas, because it did not list his felony convictions, the Texas Medical Board acknowledged "a crack" in the reliability of the information.
"We're going to have to look at how to fix this," spokeswoman Jill Wiggins said. "We don't have the staff or the resources to monitor it."
The board won't say whether it will pursue disciplinary action against Thomas for failing to report his criminal record on the Web site, but Executive Director Don Patrick said the board will typically take action if a doctor does not report accurate information.
After the Star-Telegram called the medical board, Thomas changed the profile to accurately reflect his record, Wiggins said.
The 56-year-old orthopedic surgeon did not return calls for comment.
Obstacles to obtaining information
By law, the board cannot release criminal records that it may have obtained as a result of its investigations, except under court order.
Other impediments: The board won't disclose if a physician is under investigation, so it may be months before the public learns of complaints. In some cases, information about doctors' self-reported alcohol or drug addictions is not disclosed to the public unless the physician has violated the state's standard of care.
Even when a doctor loses his controlled-substance prescription license, as Thomas did, the board may make no mention of it on the physician profiles.
Watchdog groups, such as Public Citizen, say that such an action should be routinely publicized by state medical boards.
Yet another hindrance: The public may not be able to locate disciplinary actions against doctors on the Web site because the information is provided in a "Texas Medical Board Bulletin."
While the bulletin is on the Web site, nothing states that it contains disciplinary information.
An agency official said that's because the bulletin's primary audience is doctors, not the general public.
Computer problems
The board's Web site link that would give the public access to doctors' discipline orders doesn't always work. "A lot of people have that problem," Wiggins said. "There seems to be an incompatibility with our system."
She doesn't see it getting fixed. It would take countless hours of programming to make it accessible, she said. "We have a limited IT staff."
Limited powers
The medical board itself is blocked from access to data that could boost its regulatory powers. Texas doesn't have access to confidential orders from other states, and it doesn't share its confidential orders with them. That is because confidential orders are based on physicians' self-reported information, officials said.
Insufficient resources
The 2004 boost in funding to $8.5 million allowed the board to hire more attorneys and support staff. But funding later fell, making enforcement more difficult. "There is concern about the agency's ability to maintain its current level of strength and vigilance in the current climate of diminishing resources," according to the board's strategic plan for 2007-11.
Last year, because of budgetary restraints, the board let vacant positions go unfilled, and ultimately it received an emergency deficiency grant so it could carry out pending enforcement actions and related technology improvements.
For 2007-08, the Legislature granted the board an additional $1.2 million, enough to repay the deficiency grant, restore funding to the 2004 level and meet state-required pay increases and other legislative mandates. It will also receive $600,000 to hire six additional full-time employees to help manage the surge of licensing applications.Without the extra staff, the board could not handle the thousands of complaints it gets every year.
"It would be better if we had some ability to do other things than just crank cases out the door," Patrick said.
Online: www.tmb.state.tx.us
Filling the coffers
Like most regulatory agencies of its kind, the Texas Medical Board is a moneymaker for the state.
A look at fiscal 2006 revenue and expenses:
Net revenue: $30,753,086
Net expenditures: $9,958,420
Excess: (to the state general fund): $20,794,666
Sources: State of Texas 2006 Annual Cash Report; Texas Medical Board
About the Consumer Report Card series
Evaluating healthcare professionals
This is the first installment of a periodic series of stories examining how well Texas is fulfilling its consumer protection role. Findings are based on documents and data compiled by the state, and the Consumer Report Card criteria employ some of the measures the state has devised to judge performance. Evaluations were determined by weighing a variety of factors and reflecting the state's overall performance.
What happened when you had a problem with a medical professional? Comment on your experience or suggest other topics for future consumer report cards.
For information on filing a complaint about a licensed healthcare professional, call the state's toll-free hot line: 800-821-3205
Read more in the Fort Worth Star Telegram
The Web site for orthopedic surgeon Jack Thomas shows the doe-eyed medical doctor with a "great bedside manner" and lists kindness and compassion as "hallmarks of his care."
Photographs of Thomas with an elderly patient appear as the words, "Dr. Thomas helped me to walk again. ... He is the most caring doctor I have ever had," take turns flashing across the home page.
The Texas Medical Board Web site also shows that Thomas -- who practices in a small community 45 miles northeast of Dallas -- has published a book on medical ethics. In fact, the only blemish that was on the site's profile of the physician earlier this spring was a December 1991 report of "mental incapacity."
But those who browsed another Web site -- the Texas Department of Public Safety -- would have discovered that Thomas pleaded guilty to three felonies, including Medicare fraud and illegally prescribing many dosage units of dangerous narcotics to people who weren't his patients. The federal Drug Enforcement Administration yanked his controlled-substances prescription license, and he served a 10-year probation until 2001.
A phone call to the Texas Medical Board would have revealed that Thomas, who was diagnosed with bipolar disorder, surrendered his medical license in 1991. He got it back in 1999.
Such gaps in the board's physician profiles are one of the cracks in the system that was supposed to add new layers of protection for Texas patients. Lawmakers supplied the board with more money -- a 50 percent increase in 2004 -- and new powers. The commitment was that patients would be more aggressively protected in the wake of new legislation that, in effect, made it more difficult for patients to sue doctors for malpractice. But after the initial push, resources have been cut back, and state data do not indicate that the Legislature has made good on its promises to beef up protections.
Public records show that some disciplinary actions against physicians have dropped since the 2003 change in law, particularly for some of the severest penalties. Fewer physicians are having their licenses suspended, and license revocations are flat, statistics show. What's more, lawmakers in 2003 created a state office to guide patients when they filed complaints with the medical board against their medical practitioners. But the Patient Protection Office lost its staff two years ago, when the Legislature stopped funding it. Now, it just has a Web site.
And the public still can't depend on the medical board's Web site for complete, accurate and timely information about doctors.
The upside, the board says, is that it is conducting more thorough investigations of individual complaints as a result of gaining resources, setting priorities, demanding more documentation and drawing on 400 expert witnesses who weigh in on cases.
Armed with new powers, the board is suspending some doctors within two weeks of reports of questionable activity, and the board now can immediately yank the licenses of doctors identified as being an immediate danger to patients.
Perhaps most importantly, the board is now using "teethier" restrictions -- such as barring physicians from treating certain types of patients or performing certain procedures -- and enforcing the penalties it imposes, said Don Patrick, the agency's executive director. In the past, he said, suspensions didn't mean much because doctors who were put on probation were allowed to continue to practice. Not anymore.
The board now also publishes a biannual newsletter listing all the doctors who have been disciplined, the cause of the action and the penalty. That deters bad behavior, Patrick said.
"Every doctor in the state learns from that disciplinary order," he said. "It is a powerful, powerful weapon."
But the case reviews are limited to the complaint at hand, Patrick acknowledged. Once a doctor is subject to a complaint, the board staff has no time to review other charts and documents that could give a better idea of the doctor's overall standard of care and analyze the root cause of problems.
"We want to see more, not just snapshots" of doctors' standard of care, Patrick said. "What we hope to see is a short movie."
The board doesn't pursue more extensive reviews because its resources have been stretched thin in the past two years.
And there is concern from consumer watchdog groups that the board is negotiating lesser penalties, such as minimal fines, rather than imposing more severe punishments, such as license revocations, because physicians are hiring attorneys to battle the board.
Their mere presence at board proceedings raises the threat of lawsuits, making the board more likely to negotiate punishment, doctors are being advised. So board hearings have become increasingly like court proceedings.
"I really handle those almost like a lawsuit," said Russell Thornton, a Dallas attorney who defends doctors in front of the board.
Thornton said that doctors who have legal representation and plenty of documentation can avoid what he deems "unreasonable recommendations" for discipline.
"The board doesn't want to see you again, so even if there's a problem, they don't want to pull your license. They understand you may have some problems in the way you practice medicine," Thornton said. "So I tell them, 'Look, when we go down there ... you've got to demonstrate to them why this kind of thing won't happen again and what steps you have taken proactively.'"
Another concern of consumer groups is that Texas is now drawing questionable doctors from other states.
The state's move to make it more difficult to sue doctors triggered an unprecedented number of applicants from states where Patrick says it is easier to sue doctors for malpractice, such as New York and Michigan.
All the applications -- a 92 percent increase from the first half of 2003 to the first half of 2006 -- added to the medical board's workload. That resulted in a backlog of processing applications.
Consumer groups have questioned why the board has licensed some of the physicians, including one who had her license revoked in several other states. She received a license to practice in Houston but is prohibited from practicing surgery.
"We're running the risk of Texas becoming a state haven for bad doctors," said Alex Winslow, spokesman for Texas Watch, an Austin consumers group that is tracking the licensing of doctors new to Texas. "Instead of improving healthcare for patients, it is getting even more dangerous for Texans."
Flaws in the system
What else needs attention to protect Texas patients? These are flaws in the system that can leave patients vulnerable.
Reliance on self-reporting
On its Web site, the board maintains physician profiles that are supposed to provide a way for patients to check doctors' disciplinary records.
But the board relies on physicians to self-report any criminal convictions and malpractice lawsuits, and some doctors don't provide that information. The Legislature doesn't require the board to monitor the Web site for accuracy.
After the Star-Telegram raised questions about the profile for Dr. Jack Thomas, because it did not list his felony convictions, the Texas Medical Board acknowledged "a crack" in the reliability of the information.
"We're going to have to look at how to fix this," spokeswoman Jill Wiggins said. "We don't have the staff or the resources to monitor it."
The board won't say whether it will pursue disciplinary action against Thomas for failing to report his criminal record on the Web site, but Executive Director Don Patrick said the board will typically take action if a doctor does not report accurate information.
After the Star-Telegram called the medical board, Thomas changed the profile to accurately reflect his record, Wiggins said.
The 56-year-old orthopedic surgeon did not return calls for comment.
Obstacles to obtaining information
By law, the board cannot release criminal records that it may have obtained as a result of its investigations, except under court order.
Other impediments: The board won't disclose if a physician is under investigation, so it may be months before the public learns of complaints. In some cases, information about doctors' self-reported alcohol or drug addictions is not disclosed to the public unless the physician has violated the state's standard of care.
Even when a doctor loses his controlled-substance prescription license, as Thomas did, the board may make no mention of it on the physician profiles.
Watchdog groups, such as Public Citizen, say that such an action should be routinely publicized by state medical boards.
Yet another hindrance: The public may not be able to locate disciplinary actions against doctors on the Web site because the information is provided in a "Texas Medical Board Bulletin."
While the bulletin is on the Web site, nothing states that it contains disciplinary information.
An agency official said that's because the bulletin's primary audience is doctors, not the general public.
Computer problems
The board's Web site link that would give the public access to doctors' discipline orders doesn't always work. "A lot of people have that problem," Wiggins said. "There seems to be an incompatibility with our system."
She doesn't see it getting fixed. It would take countless hours of programming to make it accessible, she said. "We have a limited IT staff."
Limited powers
The medical board itself is blocked from access to data that could boost its regulatory powers. Texas doesn't have access to confidential orders from other states, and it doesn't share its confidential orders with them. That is because confidential orders are based on physicians' self-reported information, officials said.
Insufficient resources
The 2004 boost in funding to $8.5 million allowed the board to hire more attorneys and support staff. But funding later fell, making enforcement more difficult. "There is concern about the agency's ability to maintain its current level of strength and vigilance in the current climate of diminishing resources," according to the board's strategic plan for 2007-11.
Last year, because of budgetary restraints, the board let vacant positions go unfilled, and ultimately it received an emergency deficiency grant so it could carry out pending enforcement actions and related technology improvements.
For 2007-08, the Legislature granted the board an additional $1.2 million, enough to repay the deficiency grant, restore funding to the 2004 level and meet state-required pay increases and other legislative mandates. It will also receive $600,000 to hire six additional full-time employees to help manage the surge of licensing applications.Without the extra staff, the board could not handle the thousands of complaints it gets every year.
"It would be better if we had some ability to do other things than just crank cases out the door," Patrick said.
Online: www.tmb.state.tx.us
Filling the coffers
Like most regulatory agencies of its kind, the Texas Medical Board is a moneymaker for the state.
A look at fiscal 2006 revenue and expenses:
Net revenue: $30,753,086
Net expenditures: $9,958,420
Excess: (to the state general fund): $20,794,666
Sources: State of Texas 2006 Annual Cash Report; Texas Medical Board
About the Consumer Report Card series
Evaluating healthcare professionals
This is the first installment of a periodic series of stories examining how well Texas is fulfilling its consumer protection role. Findings are based on documents and data compiled by the state, and the Consumer Report Card criteria employ some of the measures the state has devised to judge performance. Evaluations were determined by weighing a variety of factors and reflecting the state's overall performance.
What happened when you had a problem with a medical professional? Comment on your experience or suggest other topics for future consumer report cards.
For information on filing a complaint about a licensed healthcare professional, call the state's toll-free hot line: 800-821-3205
Read more in the Fort Worth Star Telegram
Thursday, August 23, 2007
Texas Watch urges: Take Action Today to End Insurance Overcharging
Texas Watch - August 23, 2007
Because of public pressure by Texas Watch, our activists, and other citizens, Insurance Commissioner Mike Geeslin recently rejected a proposed rate increase of 5.9 percent by Allstate.
The commissioner also ordered the company to submit any further rate changes to the Texas Department of Insurance before they could take effect.
This is a good first step, but we must keep the pressure on. Write Commissioner Geeslin today and tell him end the insurance industry practice of overcharging policyholders once and for all by
- Conducting a comprehensive review of Texas insurance rates;
- Identifying companies that are overcharging their policyholders; and
- Forcing the offending companies to reduce rates and refund overcharges to policyholders.
Commissioner Geeslin has the power to stop overcharges, once and for all. Make sure he knows where you stand on this issue by writing him today.
Because of public pressure by Texas Watch, our activists, and other citizens, Insurance Commissioner Mike Geeslin recently rejected a proposed rate increase of 5.9 percent by Allstate.
The commissioner also ordered the company to submit any further rate changes to the Texas Department of Insurance before they could take effect.
This is a good first step, but we must keep the pressure on. Write Commissioner Geeslin today and tell him end the insurance industry practice of overcharging policyholders once and for all by
- Conducting a comprehensive review of Texas insurance rates;
- Identifying companies that are overcharging their policyholders; and
- Forcing the offending companies to reduce rates and refund overcharges to policyholders.
Commissioner Geeslin has the power to stop overcharges, once and for all. Make sure he knows where you stand on this issue by writing him today.
Sunday, August 12, 2007
Our Assumptions About What Causes Chronic Diseases Could Be Wrong
Discoveries about how chemicals and environmental toxins interact with our DNA and make us susceptible to disease could revolutionize our concept of illness.
By Laura Wright, OnEarth Magazine - Thurs., August 9, 2007
This story is reprinted from OnEarth magazine and was written by Laura Wright, the senior editor. Write to her at lwright@nrdc.org.
By Laura Wright, OnEarth Magazine - Thurs., August 9, 2007
This story is reprinted from OnEarth magazine and was written by Laura Wright, the senior editor. Write to her at lwright@nrdc.org.
Saturday, August 11, 2007
Mosquito Control and West Nile Virus
By Faith Chatham - Aug. 11, 2007
West Nile Virus remains in the news. Several cities have websites with links concerning Mosquito Control and the West Nile Virus. The City of Arlington's Environmental HEALTH = Infectious Diseases Page has a number of useful links:
Texas Department of Health: West Nile Virus Public Health Response Plan
EPA: Mosquitos and How to Control Them
EPA: Pestisides and Mosquito Control
Protection Times of Mosquito Repellents
Tarrant County Public Health
Texas Dept. of State Health Services: West Nile Virus in Texas
CDC: West Nile Virus Information Page
CDC: West Nile Related Links
Contans links to other organizations and governmental agencies' publications on West Nile Virus including:
FDA West Nile Virus Site
National Institute of Health Allergy and Infectious Diseases (NAID)
NIAID Research on West Nile Virus
Cornell University's Environmental Risk Program: What's going on with West Nile Virus
West Nile Virus remains in the news. Several cities have websites with links concerning Mosquito Control and the West Nile Virus. The City of Arlington's Environmental HEALTH = Infectious Diseases Page has a number of useful links:
Texas Department of Health: West Nile Virus Public Health Response Plan
EPA: Mosquitos and How to Control Them
EPA: Pestisides and Mosquito Control
Protection Times of Mosquito Repellents
Tarrant County Public Health
Texas Dept. of State Health Services: West Nile Virus in Texas
CDC: West Nile Virus Information Page
CDC: West Nile Related Links
Contans links to other organizations and governmental agencies' publications on West Nile Virus including:
FDA West Nile Virus Site
National Institute of Health Allergy and Infectious Diseases (NAID)
NIAID Research on West Nile Virus
Cornell University's Environmental Risk Program: What's going on with West Nile Virus
Friday, August 10, 2007
Think Tank Officials Respond To Samuelson Opinion Piece In Washington Post
Friday, Aug. 10, 2007
The Washington Post on Wednesday published responses from three think tank officials to a recent opinion piece by Post columnist Robert Samuelson. In his piece last week, Samuelson wrote that the "major presidential candidates -- Republican and Democratic -- are dodging one of the thorniest problems they would face if elected: the huge budget costs of aging baby boomers" for Medicare, Medicaid and Social Security, and "Washington's vaunted think tanks -- citadels for public intellectuals both liberal and conservative" -- also have "tiptoed around the problem."
He proposed that "some public-spirited sugar daddy ... sponsor a short book" that would invite six think tanks, three liberal and three conservative, to discuss the issue. Such a book "would force think tanks to compete," he wrote, adding, "They'd have to make their vision of the future explicit within the untidy framework of government's past commitments. It would illuminate the connections between defense spending, retirement benefits, health care, economic growth and much more" (Kaiser Daily Health Policy Report, 8/1). Summaries of responses appear below.
Robert Bixby, Concord Coalition: "Think tanks are not political parties," Bixby, executive director of the Concord Coalition, writes, adding, "They are a collection of scholars who do not necessarily agree on specifics. Thus the absence of a competition among them on specific plans does not, as Samuelson implies, indicate venal motives." Bixby concludes, "The problem is not timid think tanks. It is timid politicians" (Bixby, Washington Post, 8/8).
Stuart Butler, Heritage Foundation: "Another book-length compendium of detailed plans, as Samuelson proposes, would do nothing to resolve" U.S residents' "emotional and contradictory feelings about entitlements and intergenerational obligation," Butler, vice president for domestic and economic policy studies at the Heritage Foundation, writes. He concludes, "That's why leading think tanks are focused on understanding and changing public perceptions about the values and risks involved in controlling entitlements, to improve the climate for political debate," adding, "That's why {The Brookings Institution] and Heritage have joined others in talking directly to real Americans and why we are working to structure public dialogues to explore ways to craft serious reform" (Butler, Washington Post, 8/8).
Maya MacGuineas, New America Foundation: "Samuelson suggests that think tanks aren't proposing specific solutions to the demographic and budgetary crises facing the country. As the recipient of more than my fair share of angry e-mails from people who haven't appreciated some of the specifics our think tank has recommended, I would respectfully disagree," MacGuineas, fiscal policy program director at the New America Foundation, writes. She continues, "Samuelson is right, of course, that one of the important roles of a think tank is to provide bold policy solutions to help move the political discussion forward. That is what the New America Foundation has been doing for years" (MacGuineas, Washington Post, 8/8).
Additional responses from think tank officials are available online as a part of the Post's regular Think Tank Town, which features such organizations debating public policy.
Reprinted with permission Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at The Kaiser Daily Health Policy Report, a free service of The Henry J. Kaiser Family Foundation. © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
The Washington Post on Wednesday published responses from three think tank officials to a recent opinion piece by Post columnist Robert Samuelson. In his piece last week, Samuelson wrote that the "major presidential candidates -- Republican and Democratic -- are dodging one of the thorniest problems they would face if elected: the huge budget costs of aging baby boomers" for Medicare, Medicaid and Social Security, and "Washington's vaunted think tanks -- citadels for public intellectuals both liberal and conservative" -- also have "tiptoed around the problem."
He proposed that "some public-spirited sugar daddy ... sponsor a short book" that would invite six think tanks, three liberal and three conservative, to discuss the issue. Such a book "would force think tanks to compete," he wrote, adding, "They'd have to make their vision of the future explicit within the untidy framework of government's past commitments. It would illuminate the connections between defense spending, retirement benefits, health care, economic growth and much more" (Kaiser Daily Health Policy Report, 8/1). Summaries of responses appear below.
Robert Bixby, Concord Coalition: "Think tanks are not political parties," Bixby, executive director of the Concord Coalition, writes, adding, "They are a collection of scholars who do not necessarily agree on specifics. Thus the absence of a competition among them on specific plans does not, as Samuelson implies, indicate venal motives." Bixby concludes, "The problem is not timid think tanks. It is timid politicians" (Bixby, Washington Post, 8/8).
Stuart Butler, Heritage Foundation: "Another book-length compendium of detailed plans, as Samuelson proposes, would do nothing to resolve" U.S residents' "emotional and contradictory feelings about entitlements and intergenerational obligation," Butler, vice president for domestic and economic policy studies at the Heritage Foundation, writes. He concludes, "That's why leading think tanks are focused on understanding and changing public perceptions about the values and risks involved in controlling entitlements, to improve the climate for political debate," adding, "That's why {The Brookings Institution] and Heritage have joined others in talking directly to real Americans and why we are working to structure public dialogues to explore ways to craft serious reform" (Butler, Washington Post, 8/8).
Maya MacGuineas, New America Foundation: "Samuelson suggests that think tanks aren't proposing specific solutions to the demographic and budgetary crises facing the country. As the recipient of more than my fair share of angry e-mails from people who haven't appreciated some of the specifics our think tank has recommended, I would respectfully disagree," MacGuineas, fiscal policy program director at the New America Foundation, writes. She continues, "Samuelson is right, of course, that one of the important roles of a think tank is to provide bold policy solutions to help move the political discussion forward. That is what the New America Foundation has been doing for years" (MacGuineas, Washington Post, 8/8).
Additional responses from think tank officials are available online as a part of the Post's regular Think Tank Town, which features such organizations debating public policy.
Reprinted with permission Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at The Kaiser Daily Health Policy Report, a free service of The Henry J. Kaiser Family Foundation. © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Texas Medicaid Beneficiaries Lack Access To Care, State Medical Association Says
Medical News Today - The Kaiser Daily Health Policy Report, Wed. Aug. 9, 2007
Only 18% of physicians in Austin, Texas, accept all new Medicaid beneficiaries, according to a survey of physicians by the Texas Medical Association, the Austin American-Statesman reports. According to the American-Statesman, "Austin has become ground zero in what some in the medical community are calling an unfolding Medicaid crisis in Texas."
The medical association's survey, which is conducted every two years, found that the number of physicians accepting all new Medicaid beneficiaries statewide declined from two-thirds in 2000 to 38% last year. The survey also found that 9% of orthopedic surgeons in the state accept all new Medicaid beneficiaries, and the percentages of some other specialists who accept all new beneficiaries also are in the single digits, the American-Statesman reports. Over the past year, the Texas Health and Human Services Commission said it has paid travel expenses for about 100 Medicaid beneficiaries in Austin to receive care in San Antonio, Texas.
William Hinchey, head of the state medical association, said, "Some of us believe [Medicaid] has collapsed because these patients do not have access to care like they should." Regina Rogoff, head of the People's Community Clinic in Austin, said Medicaid in the state has "effectively collapsed," adding, "If the state paid a fair rate for Medicaid, then those patients would be able to be seen in the private sector."
However, Stephanie Goodman, a spokesperson for the commission, said, "I could not disagree more strongly with that." Goodman said that the program has problems but is still functional, adding, "We pay for more than half of all births and two-thirds of all nursing home care. It is a huge program and takes up a quarter of the state's budget. Are there issues out there? Yes. But the good works shouldn't be lost."
Goodman said the situation should improve after Medicaid reimbursement rates to physicians are increased Sept 1. Some of the increases are required by a settlement in a 14-year-old class-action lawsuit filed by parents of children receiving Medicaid benefits who had difficulty finding physicians because of low reimbursements. Reimbursements for physicians who care for child beneficiaries will increase by an average of 25%, and reimbursements to dentists who treat children will increase by 50%. The state Legislature also increased physician reimbursements for adult care by 10% (Jaspin, Austin American-Statesman, 8/6).
Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Only 18% of physicians in Austin, Texas, accept all new Medicaid beneficiaries, according to a survey of physicians by the Texas Medical Association, the Austin American-Statesman reports. According to the American-Statesman, "Austin has become ground zero in what some in the medical community are calling an unfolding Medicaid crisis in Texas."
The medical association's survey, which is conducted every two years, found that the number of physicians accepting all new Medicaid beneficiaries statewide declined from two-thirds in 2000 to 38% last year. The survey also found that 9% of orthopedic surgeons in the state accept all new Medicaid beneficiaries, and the percentages of some other specialists who accept all new beneficiaries also are in the single digits, the American-Statesman reports. Over the past year, the Texas Health and Human Services Commission said it has paid travel expenses for about 100 Medicaid beneficiaries in Austin to receive care in San Antonio, Texas.
William Hinchey, head of the state medical association, said, "Some of us believe [Medicaid] has collapsed because these patients do not have access to care like they should." Regina Rogoff, head of the People's Community Clinic in Austin, said Medicaid in the state has "effectively collapsed," adding, "If the state paid a fair rate for Medicaid, then those patients would be able to be seen in the private sector."
However, Stephanie Goodman, a spokesperson for the commission, said, "I could not disagree more strongly with that." Goodman said that the program has problems but is still functional, adding, "We pay for more than half of all births and two-thirds of all nursing home care. It is a huge program and takes up a quarter of the state's budget. Are there issues out there? Yes. But the good works shouldn't be lost."
Goodman said the situation should improve after Medicaid reimbursement rates to physicians are increased Sept 1. Some of the increases are required by a settlement in a 14-year-old class-action lawsuit filed by parents of children receiving Medicaid benefits who had difficulty finding physicians because of low reimbursements. Reimbursements for physicians who care for child beneficiaries will increase by an average of 25%, and reimbursements to dentists who treat children will increase by 50%. The state Legislature also increased physician reimbursements for adult care by 10% (Jaspin, Austin American-Statesman, 8/6).
Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Sunday, August 5, 2007
U.S. Senate OKs wider kids' health program
By JULIE HIRSCHFELD DAVIS - Associated Press Writer - Fri. Aug 3, 2007
WASHINGTON - The Senate passed legislation Thursday to add 3 million lower-income children to a popular health insurance program in bipartisan defiance of President Bush's threatened veto.
The 68-31 vote, one day after the House passed a more ambitious and expensive version over bitter Republican opposition, handed Democrats a solid achievement to trumpet as they leave Washington for a summer break.
It also gave Democrats, who secured a veto-proof margin, a chance to draw a stark distinction between their priorities and Bush's on an issue that resonates with voters.
"For the life of me, I can't understand why the president would want to veto this legislation," said Sen. Max Baucus, D-Mont., the Finance Committee chairman. "It's moderate, it's bipartisan, it helps low-income kids. ... It's just the right thing to do for the country."
Bush has proposed spending $5 billion to extend the State Children's Health Insurance Program. He says the Senate's $35 billion expansion would balloon the decade-old program beyond its original mission of covering working poor children and would move more people toward government-run health care.
The program expires Sept. 30.
The Senate measure now must be reconciled with the House-passed $50 billion expansion, which was paid for partly by cutting government payments to Medicare health maintenance organizations.
Both bills include hefty tax increases on tobacco products to pay for the spending increase.
Architects of the legislation "have seized the reauthorization of SCHIP as a license to raise taxes, increase spending and take a giant leap forward into the land of government-run health care," said Sen. Mitch McConnell, R-Ky., the minority leader.
He was one of 31 Republicans to oppose the measure, while 18 Republicans joined 48 Democrats and two independents to support it.
The health program is designed to subsidize the cost of insurance for children whose families earn too much to participate in Medicaid, but not enough to afford private health insurance.
Through federal waivers, the program has expanded in many states to include middle-income children and adults. That has led Republicans to argue that it has become a backdoor way to extend government-provided health care to an increasing number of people.
National polls show overwhelming majorities of voters support expanding the children's health program and are more likely to support candidates who back it.
Read more
WASHINGTON - The Senate passed legislation Thursday to add 3 million lower-income children to a popular health insurance program in bipartisan defiance of President Bush's threatened veto.
The 68-31 vote, one day after the House passed a more ambitious and expensive version over bitter Republican opposition, handed Democrats a solid achievement to trumpet as they leave Washington for a summer break.
It also gave Democrats, who secured a veto-proof margin, a chance to draw a stark distinction between their priorities and Bush's on an issue that resonates with voters.
"For the life of me, I can't understand why the president would want to veto this legislation," said Sen. Max Baucus, D-Mont., the Finance Committee chairman. "It's moderate, it's bipartisan, it helps low-income kids. ... It's just the right thing to do for the country."
Bush has proposed spending $5 billion to extend the State Children's Health Insurance Program. He says the Senate's $35 billion expansion would balloon the decade-old program beyond its original mission of covering working poor children and would move more people toward government-run health care.
The program expires Sept. 30.
The Senate measure now must be reconciled with the House-passed $50 billion expansion, which was paid for partly by cutting government payments to Medicare health maintenance organizations.
Both bills include hefty tax increases on tobacco products to pay for the spending increase.
Architects of the legislation "have seized the reauthorization of SCHIP as a license to raise taxes, increase spending and take a giant leap forward into the land of government-run health care," said Sen. Mitch McConnell, R-Ky., the minority leader.
He was one of 31 Republicans to oppose the measure, while 18 Republicans joined 48 Democrats and two independents to support it.
The health program is designed to subsidize the cost of insurance for children whose families earn too much to participate in Medicaid, but not enough to afford private health insurance.
Through federal waivers, the program has expanded in many states to include middle-income children and adults. That has led Republicans to argue that it has become a backdoor way to extend government-provided health care to an increasing number of people.
National polls show overwhelming majorities of voters support expanding the children's health program and are more likely to support candidates who back it.
Read more
U.S. House OKs prescription drug imports
By ANDREW TAYLOR - Associated Press Writer - Fri, Aug. 3, 2007
WASHINGTON - The House passed legislation Thursday effectively permitting the importation of lower-cost prescription drugs from places such as Canada, Australia and Europe.
The move came as lawmakers passed a $91 billion spending measure funding farm subsidies and nutrition programs for the budget year beginning Oct. 1.
The bill, passed by a 237-18 vote, faces a promised veto from President Bush over its price tag, and the administration also opposes the drug importation provision.
The sprawling measure is the final domestic spending bill to pass the House. It contains almost $1 billion more than requested by Bush. But the overall measure is more than $10 billion below comparable costs for the current budget year because it does not contain farm disaster aid and reflects lower crop subsidy costs due to the good farm economy.
The administration "strongly opposes" the drug provision, which would effectively permit individuals, wholesalers and pharmacists to import lower cost U.S.-made and FDA-approved prescription drugs from Canada and other countries.
The White House says there is no system in place to protect consumers from counterfeit or unsafe drugs, but an administration policy statement stops short of an outright veto threat.
"I understand the intention to lower drug prices to the seniors, that is critically important," said Rep. Mike Rogers, R-Mich. "What we're doing is throwing open the gates to every (drug) counterfeiter in the world."
A move supported by drug companies to strike the drug importation provisions from the bill was defeated 283-146.
Supporters of the idea say it would save consumers great sums by allowing them to purchase U.S.-made medications from other countries where they often sell for much lower prices than in the U.S. Under current law, consumers are permitted to buy a 90-day supply in Canada.
Overseas, drugs can cost two-thirds less than they do in the United States, where prices for brand-name drugs are among the highest in the world. In many industrialized countries, prices are lower because they are either controlled or partially controlled by government regulation.
"I would prefer to stand up for my constituents in Missouri as opposed to the pharmaceutical companies keeping competition and low prices out of this country," said Rep. Jo Ann Emerson, R-Mo.
Similar drug importation language has passed the House in recent years but has been forced out by GOP leaders and the White House during House-Senate negotiations.
On spending matters, the measure funds both mandatory programs such as farm subsidies — whose budgets are set according to eligibility criteria — as well as discretionary funding set by lawmakers each year.
The Women, Infants and Children program, which provides food aid to pregnant women and children, would receive $233 million, or 4 percent, more than requested by Bush.
The bill also finances farm subsidies and loan programs, whose costs have gone way down because of high commodity prices. The Commodity Credit Corp. would receive $13 billion, a $10 billion cut from current levels.
The measure also seeks to block the practice of slaughtering horses for human consumption by making it illegal to transport or export horse for that purpose. The House last year passed a bill banning horse slaughter for human consumption, but the Senate failed to act.
Tensions flared late in the debate as the House voted on a GOP motion to require a further amendment to the measure ensuring that illegal immigrants would not benefit from any programs funded by the bill. Rep. Rosa DeLauro, D-Conn., insisted illegal immigrants weren't eligible anyway.
The vote was close as almost 20 swing district Democrats initially supported the idea.
Just as Rep. Michael McNulty, D-N.Y., gaveled the vote to a close and said the GOP motion failed on a 214-214 tie, the tally board inside the chamber read that it had passed by a 215-213 vote. After final switches by Democrats, the tally moved back in their column.
Republicans cried "Shame, shame, shame," and Majority Leader Steny Hoyer, D-Md., moved for a revote.
Read more
WASHINGTON - The House passed legislation Thursday effectively permitting the importation of lower-cost prescription drugs from places such as Canada, Australia and Europe.
The move came as lawmakers passed a $91 billion spending measure funding farm subsidies and nutrition programs for the budget year beginning Oct. 1.
The bill, passed by a 237-18 vote, faces a promised veto from President Bush over its price tag, and the administration also opposes the drug importation provision.
The sprawling measure is the final domestic spending bill to pass the House. It contains almost $1 billion more than requested by Bush. But the overall measure is more than $10 billion below comparable costs for the current budget year because it does not contain farm disaster aid and reflects lower crop subsidy costs due to the good farm economy.
The administration "strongly opposes" the drug provision, which would effectively permit individuals, wholesalers and pharmacists to import lower cost U.S.-made and FDA-approved prescription drugs from Canada and other countries.
The White House says there is no system in place to protect consumers from counterfeit or unsafe drugs, but an administration policy statement stops short of an outright veto threat.
"I understand the intention to lower drug prices to the seniors, that is critically important," said Rep. Mike Rogers, R-Mich. "What we're doing is throwing open the gates to every (drug) counterfeiter in the world."
A move supported by drug companies to strike the drug importation provisions from the bill was defeated 283-146.
Supporters of the idea say it would save consumers great sums by allowing them to purchase U.S.-made medications from other countries where they often sell for much lower prices than in the U.S. Under current law, consumers are permitted to buy a 90-day supply in Canada.
Overseas, drugs can cost two-thirds less than they do in the United States, where prices for brand-name drugs are among the highest in the world. In many industrialized countries, prices are lower because they are either controlled or partially controlled by government regulation.
"I would prefer to stand up for my constituents in Missouri as opposed to the pharmaceutical companies keeping competition and low prices out of this country," said Rep. Jo Ann Emerson, R-Mo.
Similar drug importation language has passed the House in recent years but has been forced out by GOP leaders and the White House during House-Senate negotiations.
On spending matters, the measure funds both mandatory programs such as farm subsidies — whose budgets are set according to eligibility criteria — as well as discretionary funding set by lawmakers each year.
The Women, Infants and Children program, which provides food aid to pregnant women and children, would receive $233 million, or 4 percent, more than requested by Bush.
The bill also finances farm subsidies and loan programs, whose costs have gone way down because of high commodity prices. The Commodity Credit Corp. would receive $13 billion, a $10 billion cut from current levels.
The measure also seeks to block the practice of slaughtering horses for human consumption by making it illegal to transport or export horse for that purpose. The House last year passed a bill banning horse slaughter for human consumption, but the Senate failed to act.
Tensions flared late in the debate as the House voted on a GOP motion to require a further amendment to the measure ensuring that illegal immigrants would not benefit from any programs funded by the bill. Rep. Rosa DeLauro, D-Conn., insisted illegal immigrants weren't eligible anyway.
The vote was close as almost 20 swing district Democrats initially supported the idea.
Just as Rep. Michael McNulty, D-N.Y., gaveled the vote to a close and said the GOP motion failed on a 214-214 tie, the tally board inside the chamber read that it had passed by a 215-213 vote. After final switches by Democrats, the tally moved back in their column.
Republicans cried "Shame, shame, shame," and Majority Leader Steny Hoyer, D-Md., moved for a revote.
Read more
Scientists Probe How HIV Infection Turns Into AIDS
By E.J. Mundell - Reuters HealthDay Reporter - Fri Aug 3, 2007
FRIDAY, Aug. 3 (HealthDay News) -- The common scientific wisdom on how HIV infection proceeds to full-blown AIDS might be wrong, two U.S. researchers say.
They hope that their new insights, if proven, will lead to exciting new treatment targets down the line.
Working from a complex mathematical model of viral replication and immune cell death, the researchers now suspect that AIDS begins when one especially fast-killing strain of HIV gains the upper hand over a less-lethal, but more prolific, strain.
"This throws into question a lot of the notions that have been accepted about the evolution of the virus" within a typical infected human, explained study co-author Dominik Wodarz, associate professor of biology at the University of California, Irvine.
He and another researcher, David Levy, of New York University, published their findings in the July 31 issue of the Proceedings of the Royal Society B.
Since its first recorded appearance nearly three decades ago, HIV infection has followed the same deadly path: a short, weeks-long period of acute flu-like symptoms followed by years of asymptomatic dormancy, and then symptoms of immune system breakdown that herald the emergence of AIDS.
But what is it that tips asymptomatic, low-level infection into AIDS?
The common dogma among scientists has long been that various strains of HIV battle a silent war within the body over time until the fittest -- defined as the strain that reproduces itself the most -- wins. That strain then goes on to overwhelm the body's immune cells and destroy the host's defenses against disease.
To test that theory, Wodarz and Levy constructed a complex mathematical model that took into account two factors about HIV: how fast the various strains replicate and how fast they kill cells (not always the same thing, the researchers noted). They also factored in human immune system responses to HIV.
What the two scientists found surprised them. According to the new model, AIDS actually begins when a less fit variety of HIV wins the day. This strain kills immune system cells extremely widely and quickly, but, in doing so, also limits the number of copies of itself it can produce. "It basically kills its own habitat, its house," Wodarz explained.
However, because this form of HIV is very good at quickly killing large numbers of immune cells, "once these less-fit strains emerge, they can plunge the patient into AIDS," Wodarz said.
In many cases, two or more strains of the virus can co-infect the same immune system cell, he added. If a fast-killing variety is one of those strains, it kills the cell before slower -- but better-replicating -- versions can go to work making millions of new viral particles.
"But without this ganging up on the same cell, the killer virus [that leads to AIDS] would go extinct, because evolution would select against it -- because it is less fit and replicates less," Wodarz explained.
That means that -- according to the model -- one way of keeping AIDS at bay might be to make sure that only one type of HIV invades a cell at any given time.
Specific cellular mechanisms do allow a second or third viral particle to enter a cell, and a medicine that thwarted these "party crashers" might keep the deadliest form of HIV from ever emerging, Wodarz speculated.
He pointed to wild monkeys that are infected throughout their lives with HIV-like simian immunodeficiency virus (SIV) but never get sick.
"Some of them have a lot of the virus, and it evolves a lot, but it does not cause AIDS, ever," Wodarz said. He suspects the monkey's immune cells may have evolved to block secondary viral entry and thereby keep the most dangerous strain of SIV at bay.
Not everyone is convinced by the new model, however.
Dr. Benigno Rodriguez is assistant professor of medicine at Case Western Reserve University in Cleveland, and a specialist in the evolution of HIV disease. He called Wodarz and Levy's paper "an interesting concept," but said it contained a few significant flaws.
First of all, he said, most of the available data suggests that HIV does get better at forming copies of itself as AIDS progresses. And Rodriguez believes the two scientists have left another important factor out of their model -- the fact that most AIDS patients' immune cells are not killed off by the virus directly but are destroyed by so-called "bystander" mechanisms that accompany AIDS.
"In an individual with advanced disease, if you look at the number of cells that are actually infected [with HIV], we are talking less than 1 percent," he said. "But, in reality, that individual may have lost 20, 30, 50 percent of his immune cells."
Rodriguez also questioned the importance of multiple strains of HIV infecting the same immune cell. "The data that we already have in hand shows that multiple infection is relatively infrequent," he said.
The bottom line, according to the Cleveland expert: As with any mathematical model, this one needs to be tested out in the laboratory.
Wodarz agreed that experimental verification is necessary, but he said mathematical disease models more often than not prove to be right.
In fact, he said, it was just such a model that led scientists to discover that HIV never stops evolving in the body -- even during infection's years-long asymptomatic phase.
"In HIV, mathematical models have led to great progress before," Wodarz said.
More information
To find out more about HIV/AIDS, head to the U.S. National Institute of Allergy and Infectious Disease.
FRIDAY, Aug. 3 (HealthDay News) -- The common scientific wisdom on how HIV infection proceeds to full-blown AIDS might be wrong, two U.S. researchers say.
They hope that their new insights, if proven, will lead to exciting new treatment targets down the line.
Working from a complex mathematical model of viral replication and immune cell death, the researchers now suspect that AIDS begins when one especially fast-killing strain of HIV gains the upper hand over a less-lethal, but more prolific, strain.
"This throws into question a lot of the notions that have been accepted about the evolution of the virus" within a typical infected human, explained study co-author Dominik Wodarz, associate professor of biology at the University of California, Irvine.
He and another researcher, David Levy, of New York University, published their findings in the July 31 issue of the Proceedings of the Royal Society B.
Since its first recorded appearance nearly three decades ago, HIV infection has followed the same deadly path: a short, weeks-long period of acute flu-like symptoms followed by years of asymptomatic dormancy, and then symptoms of immune system breakdown that herald the emergence of AIDS.
But what is it that tips asymptomatic, low-level infection into AIDS?
The common dogma among scientists has long been that various strains of HIV battle a silent war within the body over time until the fittest -- defined as the strain that reproduces itself the most -- wins. That strain then goes on to overwhelm the body's immune cells and destroy the host's defenses against disease.
To test that theory, Wodarz and Levy constructed a complex mathematical model that took into account two factors about HIV: how fast the various strains replicate and how fast they kill cells (not always the same thing, the researchers noted). They also factored in human immune system responses to HIV.
What the two scientists found surprised them. According to the new model, AIDS actually begins when a less fit variety of HIV wins the day. This strain kills immune system cells extremely widely and quickly, but, in doing so, also limits the number of copies of itself it can produce. "It basically kills its own habitat, its house," Wodarz explained.
However, because this form of HIV is very good at quickly killing large numbers of immune cells, "once these less-fit strains emerge, they can plunge the patient into AIDS," Wodarz said.
In many cases, two or more strains of the virus can co-infect the same immune system cell, he added. If a fast-killing variety is one of those strains, it kills the cell before slower -- but better-replicating -- versions can go to work making millions of new viral particles.
"But without this ganging up on the same cell, the killer virus [that leads to AIDS] would go extinct, because evolution would select against it -- because it is less fit and replicates less," Wodarz explained.
That means that -- according to the model -- one way of keeping AIDS at bay might be to make sure that only one type of HIV invades a cell at any given time.
Specific cellular mechanisms do allow a second or third viral particle to enter a cell, and a medicine that thwarted these "party crashers" might keep the deadliest form of HIV from ever emerging, Wodarz speculated.
He pointed to wild monkeys that are infected throughout their lives with HIV-like simian immunodeficiency virus (SIV) but never get sick.
"Some of them have a lot of the virus, and it evolves a lot, but it does not cause AIDS, ever," Wodarz said. He suspects the monkey's immune cells may have evolved to block secondary viral entry and thereby keep the most dangerous strain of SIV at bay.
Not everyone is convinced by the new model, however.
Dr. Benigno Rodriguez is assistant professor of medicine at Case Western Reserve University in Cleveland, and a specialist in the evolution of HIV disease. He called Wodarz and Levy's paper "an interesting concept," but said it contained a few significant flaws.
First of all, he said, most of the available data suggests that HIV does get better at forming copies of itself as AIDS progresses. And Rodriguez believes the two scientists have left another important factor out of their model -- the fact that most AIDS patients' immune cells are not killed off by the virus directly but are destroyed by so-called "bystander" mechanisms that accompany AIDS.
"In an individual with advanced disease, if you look at the number of cells that are actually infected [with HIV], we are talking less than 1 percent," he said. "But, in reality, that individual may have lost 20, 30, 50 percent of his immune cells."
Rodriguez also questioned the importance of multiple strains of HIV infecting the same immune cell. "The data that we already have in hand shows that multiple infection is relatively infrequent," he said.
The bottom line, according to the Cleveland expert: As with any mathematical model, this one needs to be tested out in the laboratory.
Wodarz agreed that experimental verification is necessary, but he said mathematical disease models more often than not prove to be right.
In fact, he said, it was just such a model that led scientists to discover that HIV never stops evolving in the body -- even during infection's years-long asymptomatic phase.
"In HIV, mathematical models have led to great progress before," Wodarz said.
More information
To find out more about HIV/AIDS, head to the U.S. National Institute of Allergy and Infectious Disease.
China draws up export blacklist amid health scares
Reuters - Sat., Aug. 4, 2007
BEIJING (Reuters) - China has blacklisted more than 400 exporters for violating trade rules following a series of food, drug and other health scares across the world, the Commerce Ministry said on Saturday.
The list included two pet food manufacturers that had exported to the United States. Washington stepped up inspections of imports from China after a chemical additive in pet food caused the death of some pets there earlier this year.
Since then, poisonous ingredients have been found in Chinese exports of toys, toothpaste and fish, while the deaths of patients in Panama was blamed on improperly labeled Chinese chemicals that were mixed into cough syrup.
In the latest scare, U.S. toy maker Mattel Inc. said on Wednesday that it was recalling 1.5 million Chinese-made toys worldwide because their paint may contain too much lead.
Chinese Vice Commerce Minister Gao Hucheng stressed the government line that Chinese products were overwhelmingly safe and of high quality, and called on foreign media not to hype the problems of a small minority of goods or companies.
But on the ministry Web site, he said 429 Chinese firms on the blacklist had been punished for violating export regulations. The Web site did not elaborate.
"China will strengthen international cooperation on the safety of products," Gao was quoted as saying.
China said on Friday it had banned seafood imports from Indonesia because many contained "toxic substances," Xinhua said.
A delegation of U.S. officials in Beijing hammered out "basic frameworks" for two agreements seeking to reassure U.S. consumers that Chinese-made goods met safety standards, Secretary of Health and Human Services Mike Leavitt said on Friday.
China, where the former drug and food safety watchdog chief was executed last month for corruption, has also cancelled the licenses of six medicine manufacturers.
The China Daily said 270 "on-the-spot drug test" vans would soon hit the roads of rural China to weed out counterfeit drugs.
Read more in Reuters
BEIJING (Reuters) - China has blacklisted more than 400 exporters for violating trade rules following a series of food, drug and other health scares across the world, the Commerce Ministry said on Saturday.
The list included two pet food manufacturers that had exported to the United States. Washington stepped up inspections of imports from China after a chemical additive in pet food caused the death of some pets there earlier this year.
Since then, poisonous ingredients have been found in Chinese exports of toys, toothpaste and fish, while the deaths of patients in Panama was blamed on improperly labeled Chinese chemicals that were mixed into cough syrup.
In the latest scare, U.S. toy maker Mattel Inc. said on Wednesday that it was recalling 1.5 million Chinese-made toys worldwide because their paint may contain too much lead.
Chinese Vice Commerce Minister Gao Hucheng stressed the government line that Chinese products were overwhelmingly safe and of high quality, and called on foreign media not to hype the problems of a small minority of goods or companies.
But on the ministry Web site, he said 429 Chinese firms on the blacklist had been punished for violating export regulations. The Web site did not elaborate.
"China will strengthen international cooperation on the safety of products," Gao was quoted as saying.
China said on Friday it had banned seafood imports from Indonesia because many contained "toxic substances," Xinhua said.
A delegation of U.S. officials in Beijing hammered out "basic frameworks" for two agreements seeking to reassure U.S. consumers that Chinese-made goods met safety standards, Secretary of Health and Human Services Mike Leavitt said on Friday.
China, where the former drug and food safety watchdog chief was executed last month for corruption, has also cancelled the licenses of six medicine manufacturers.
The China Daily said 270 "on-the-spot drug test" vans would soon hit the roads of rural China to weed out counterfeit drugs.
Read more in Reuters
U.S. issues new botulism warning for green beans
REUTERS - Fri. Aug. 3, 2007
WASHINGTON (Reuters) - Consumers should not eat certain brands of French-cut green beans because of concerns they could be tainted with the toxin that causes botulism, U.S. health officials warned on Friday.
The green beans were manufactured by Lakeside Foods Inc. of Manitowoc, Wisconsin, and packaged in 14.5-ounce cans, the Food and Drug Administration said.
The FDA said the beans may not have been processed adequately to eliminate the potential for botulinum toxin, which can cause a life-threatening illness.
"The canned green beans may cause botulism if consumed. FDA is providing this warning to make consumers aware of the possible risk of serious illness from eating these products," an FDA statement said.
Lakeside Foods said on Wednesday it was voluntarily recalling 15,000 cases of green beans because of the botulism concern. No botulinum toxin has been found in any cans that were tested, David Aggen, Lakeside's vice president of quality assurance and product safety, said in an interview on Friday.
The FDA said no illnesses had been reported due to consumption of the green beans as of August 1.
The green bean warning is unrelated to a recall last month of chili sauce, canned meat products and dog food made by Castleberry's Food Co., a unit of Connors Bros. Income Fund's Bumble Bee Foods division. Four people became seriously ill with botulism poisoning associated with eating Castleberry's Hot Dog Chili Sauce, officials have said.
The FDA said the affected Lakeside French-cut green beans are sold nationwide under the brands Albertson's, Happy Harvest, Best Choice, Food Club, Bogopa, Valu Time, Hill Country Fare, HEB, Laura Lynn, Kroger, No Name, North Pride, Shop N Save, Shoppers Valu, Schnucks, Cub Foods, Dierbergs, Flavorite, IGA, Best Choice and Thrifty Maid.
The warning applies to cans with the following codes:
EAA5247, EAA5257, EAA5267, EAA5277, EAB5247, EAB5257, ECA5207,
ECA5217, ECA5227, ECA5297, ECB5207, ECB5217, ECB5227, ECB5307.
Consumers who have the products should dispose of them immediately, the FDA said.
Botulism symptoms include dizziness, double vision, difficulty in breathing and abdominal problems. People with those symptoms who may have eaten the recalled green beans should seek immediate medical attention, the FDA said.
Read more in Reuters
WASHINGTON (Reuters) - Consumers should not eat certain brands of French-cut green beans because of concerns they could be tainted with the toxin that causes botulism, U.S. health officials warned on Friday.
The green beans were manufactured by Lakeside Foods Inc. of Manitowoc, Wisconsin, and packaged in 14.5-ounce cans, the Food and Drug Administration said.
The FDA said the beans may not have been processed adequately to eliminate the potential for botulinum toxin, which can cause a life-threatening illness.
"The canned green beans may cause botulism if consumed. FDA is providing this warning to make consumers aware of the possible risk of serious illness from eating these products," an FDA statement said.
Lakeside Foods said on Wednesday it was voluntarily recalling 15,000 cases of green beans because of the botulism concern. No botulinum toxin has been found in any cans that were tested, David Aggen, Lakeside's vice president of quality assurance and product safety, said in an interview on Friday.
The FDA said no illnesses had been reported due to consumption of the green beans as of August 1.
The green bean warning is unrelated to a recall last month of chili sauce, canned meat products and dog food made by Castleberry's Food Co., a unit of Connors Bros. Income Fund's Bumble Bee Foods division. Four people became seriously ill with botulism poisoning associated with eating Castleberry's Hot Dog Chili Sauce, officials have said.
The FDA said the affected Lakeside French-cut green beans are sold nationwide under the brands Albertson's, Happy Harvest, Best Choice, Food Club, Bogopa, Valu Time, Hill Country Fare, HEB, Laura Lynn, Kroger, No Name, North Pride, Shop N Save, Shoppers Valu, Schnucks, Cub Foods, Dierbergs, Flavorite, IGA, Best Choice and Thrifty Maid.
The warning applies to cans with the following codes:
EAA5247, EAA5257, EAA5267, EAA5277, EAB5247, EAB5257, ECA5207,
ECA5217, ECA5227, ECA5297, ECB5207, ECB5217, ECB5227, ECB5307.
Consumers who have the products should dispose of them immediately, the FDA said.
Botulism symptoms include dizziness, double vision, difficulty in breathing and abdominal problems. People with those symptoms who may have eaten the recalled green beans should seek immediate medical attention, the FDA said.
Read more in Reuters
Anniversary of the Americans with Disabilities Act is Marked by Introducing the ADA Restoration Act
National Multiple Sclerosis Society - Fri. Aug. 3, 2007
Thursday, July 26 marked the 17th anniversary of the Americans with Disabilities Act (ADA). This landmark legislation helped ensure that people living with disabilities had the opportunity to lead independent, self-sufficient lives in their communities. However in recent years, court decisions and inconsistent policies have eroded the intent of this seminal law — often not providing enough protections for people with disabilities. To honor the anniversary and combat this trend, Representatives Steny Hoyer (MD) and James Sensenbrenner (WI) introduced the ADA Restoration Act of 2007 (H.R. 3195). The ADA Restoration Act aims to restore the ADA's clear and comprehensive national mandate for the elimination of discrimination on the basis of disability.
This bi-partisan legislation would amend the ADA by changing the definition of disability to underscore the true intent of the original authors of the ADA. In addition, (H.R. 3195) would change the language to focus on whether a person has experienced discrimination "on the basis of disability," rather than requiring individuals with disabilities to first demonstrate that they are substantially limited in some major life activity.
People who live with disabilities are too often treated unfairly and inappropriately in the work place and their communities. Despite the ADA's intent to create a level playing field, the full promise of the law has never been fulfilled. Issue Briefs & Factsheets
ADA Restoration Act of 2007
Position: Signed into law on July 26, 1990, the Americans with Disabilities Act (ADA) is the landmark disability legislation that helps ensure that individuals living with disabilities can lead independent, self-sufficient lives in their communities. However in recent years, the Supreme Court, lower court decisions, and inconsistent policies have eroded the intent of this law-often not providing enough protections for people with disabilities.
The National Multiple Sclerosis Society supports the ADA Restoration Act of 2007 (H.R. 3195) as introduced by Representatives Steny Hoyer (D-MD) and James Sensenbrenner (R-WI) on the 17th anniversary of the original Act. The goal of this bill is to amend the ADA in order to restore, clarify, and codify the protections and intent of the landmark law as passed by Congress in 1990. It will help restore protections for people living with multiple sclerosis and other disabilities.
Request: Help restore protections for people living with MS and other disabilities. Ask your Representative to support people who live with disabilities and become a co-sponsor the ADA Restoration Act of 2007 (H.R. 3195).
Background: Individuals with disabilities are too often treated unfairly and inappropriately in the work place and their communities. People living with MS manage their symptoms with medication to help prevent or ease their disability. But that can sometimes make them appear too functional and could preclude them from ADA protections. Despite the ADA's intent to create a level playing field in the workplace, the full promise of the law has never been fulfilled. For example, often employers claim a person is too disabled to do the job, but not disabled enough for protection under the ADA.
The ADA Restoration Act aims to restore the ADA's clear and comprehensive national mandate for the elimination of discrimination on the basis of disability.
The ADA Restoration Act of 2007 (H.R. 3195) seeks to underscore the true intent and protections granted by the original authors of the ADA in 1990. H.R. 3195 specifically amends the definition of disability so that the people whom Congress originally intended to protect from discrimination are indeed covered under the ADA. For example, people with MS, epilepsy, cancer, and mental impairments tend to fall into a category of individuals who have success controlling their condition but need this protection when a flare up or episode occurs making their condition disabling.
Specifically, the bill would:
- eliminate the "substantial limitation" on a "major life activity" requirement,
- define terms used in the definition of disability (such as "physical impairment" and "mental impairment"),
- and add a rule to the definition of disability that would prohibit courts from considering whether a person uses mitigating measures or from considering whether the manifestations of an impairment, such as MS, are "episodic, in remission, or latent" when determining if a person has an impairment.
This bi-partisan legislation also would amend the ADA to focus on whether a person has experienced discrimination "on the basis of disability," rather than requiring individuals with disabilities to first demonstrate that they are substantially limited in some major life activity. This would help guard against reverse discrimination claims by clarifying that discrimination "on the basis of disability" means discriminating against an individual with a disability.
Thursday, July 26 marked the 17th anniversary of the Americans with Disabilities Act (ADA). This landmark legislation helped ensure that people living with disabilities had the opportunity to lead independent, self-sufficient lives in their communities. However in recent years, court decisions and inconsistent policies have eroded the intent of this seminal law — often not providing enough protections for people with disabilities. To honor the anniversary and combat this trend, Representatives Steny Hoyer (MD) and James Sensenbrenner (WI) introduced the ADA Restoration Act of 2007 (H.R. 3195). The ADA Restoration Act aims to restore the ADA's clear and comprehensive national mandate for the elimination of discrimination on the basis of disability.
This bi-partisan legislation would amend the ADA by changing the definition of disability to underscore the true intent of the original authors of the ADA. In addition, (H.R. 3195) would change the language to focus on whether a person has experienced discrimination "on the basis of disability," rather than requiring individuals with disabilities to first demonstrate that they are substantially limited in some major life activity.
People who live with disabilities are too often treated unfairly and inappropriately in the work place and their communities. Despite the ADA's intent to create a level playing field, the full promise of the law has never been fulfilled. Issue Briefs & Factsheets
ADA Restoration Act of 2007
Position: Signed into law on July 26, 1990, the Americans with Disabilities Act (ADA) is the landmark disability legislation that helps ensure that individuals living with disabilities can lead independent, self-sufficient lives in their communities. However in recent years, the Supreme Court, lower court decisions, and inconsistent policies have eroded the intent of this law-often not providing enough protections for people with disabilities.
The National Multiple Sclerosis Society supports the ADA Restoration Act of 2007 (H.R. 3195) as introduced by Representatives Steny Hoyer (D-MD) and James Sensenbrenner (R-WI) on the 17th anniversary of the original Act. The goal of this bill is to amend the ADA in order to restore, clarify, and codify the protections and intent of the landmark law as passed by Congress in 1990. It will help restore protections for people living with multiple sclerosis and other disabilities.
Request: Help restore protections for people living with MS and other disabilities. Ask your Representative to support people who live with disabilities and become a co-sponsor the ADA Restoration Act of 2007 (H.R. 3195).
Background: Individuals with disabilities are too often treated unfairly and inappropriately in the work place and their communities. People living with MS manage their symptoms with medication to help prevent or ease their disability. But that can sometimes make them appear too functional and could preclude them from ADA protections. Despite the ADA's intent to create a level playing field in the workplace, the full promise of the law has never been fulfilled. For example, often employers claim a person is too disabled to do the job, but not disabled enough for protection under the ADA.
The ADA Restoration Act aims to restore the ADA's clear and comprehensive national mandate for the elimination of discrimination on the basis of disability.
The ADA Restoration Act of 2007 (H.R. 3195) seeks to underscore the true intent and protections granted by the original authors of the ADA in 1990. H.R. 3195 specifically amends the definition of disability so that the people whom Congress originally intended to protect from discrimination are indeed covered under the ADA. For example, people with MS, epilepsy, cancer, and mental impairments tend to fall into a category of individuals who have success controlling their condition but need this protection when a flare up or episode occurs making their condition disabling.
Specifically, the bill would:
- eliminate the "substantial limitation" on a "major life activity" requirement,
- define terms used in the definition of disability (such as "physical impairment" and "mental impairment"),
- and add a rule to the definition of disability that would prohibit courts from considering whether a person uses mitigating measures or from considering whether the manifestations of an impairment, such as MS, are "episodic, in remission, or latent" when determining if a person has an impairment.
This bi-partisan legislation also would amend the ADA to focus on whether a person has experienced discrimination "on the basis of disability," rather than requiring individuals with disabilities to first demonstrate that they are substantially limited in some major life activity. This would help guard against reverse discrimination claims by clarifying that discrimination "on the basis of disability" means discriminating against an individual with a disability.
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