A Chance to Cut is a Chance to Cure

(b) In addition to any other fines or penalties imposed by any local jurisdiction or the department, the department shall administer and collect fees for the following traffic offenses:(1) Any driver who is convicted of driving at a speed of 85 miles per hour or more on any road or highway in Georgia or 75 miles per hour or more on any two-lane road or highway in Georgia, as defined in Code Section 40-6-187, shall be classified as a 'super speeder,' and a fee of $200.00 shall be imposed;

(2) Any driver who has his or her driver´s license or driving privileges suspended pursuant to the provisions of subparagraph (c)(1)(B) of Code Section 40-5-57 or suspended for points pursuant to the provisions of Code Section 40-5-57.1 shall, upon application for reinstatement, be subject to a fee of $100.00.

(3) Any driver who has his or her driver´s license or driving privileges suspended in whole or in part for a conviction for any of the traffic violations listed in this paragraph shall, upon application for reinstatement, be subject to a fee of $200.00. For purposes of this paragraph, 'traffic violations' means a conviction for any of the following offenses:(A) Racing under Code Section 40-6-186;(B) Leaving the scene of an accident under Code Section 40-6-270; or(C) Fleeing from or attempting to elude a police officer under Code Section 40-6-395.

(4) Any driver who has his or her driver´s license or driving privileges suspended and the suspension is partially based on a conviction for any of the traffic violations listed in this paragraph shall, upon application for reinstatement, be subject to a fee of $300.00. For purposes of this paragraph, 'traffic violations' means a conviction for any of the following offenses:(A) Driving a commercial vehicle with a blood alcohol concentration of 0.04 percent or greater under Code Section 40-5-151;(B) Driving under the influence under Code Section 40-6-391;(C) Feticide by vehicle under Code Section 40-6-393.1;(D) Homicide by vehicle under Code Section 40-6-393; or(E) Serious injury by vehicle under Code Section 40-6-394.

(5) Any driver who has been declared a 'habitual violator' pursuant to Code Section 40-5-58 shall be subject to a fee of $300.00, payable upon application for a regular driver´s license. This paragraph shall not alter the fines and penalties due upon application for a probationary license as provided for in Code Section 40-5-58.

(6) Any driver who accumulates:(A) Seven to nine points under Code Section 40-5-57 shall be subject to a $100.00 fee;(B) Ten to twelve points under Code Section 40-5-57 shall be subject to a $125.00 fee; or(C) Thirteen to fourteen points under Code Section 40-5-57 shall be subject to a $200.00 fee.

(f) All fees collected under the provisions of this Code section shall be deposited in the general fund of this state with the intent that these moneys be used to fund a trauma care system in Georgia and the direct and indirect costs associated with the administration of this Code section. The Office of Treasury and Fiscal Services shall separately account for all of the moneys received under the provisions of this Code section."

Labels: Georgia, Tort reform, Trauma System Development

Doctor, Respectfully, you don't know what you're tal(k)ing about. EMTALA is not an unfunded mandate. It only applies to hospitals that accept medicare/medicaid. Don't like the federal rules, don't take federal money.

An unfunded mandate is a statute that requires government or private parties to carry out specific actions, but does not appropriate any funds for that purpose.

Families like the Fretwells seem to be forgotten in the annual turf war between doctors and lawyers in Georgia's Capitol about who should be protected from malpractice lawsuits.

Like others, Rodney and Sherry Fretwell paid scant attention to the state tort reforms approved two years ago, worrying instead about making their next house payment, keeping food on the table and making sure their two young daughters were happy and safe.

But they were soon confronted with one of the least-known provisions of the 2005 law, an obscure section that makes it nearly impossible for patients to win medical malpractice lawsuits against emergency room doctors. Now their story, and others, has prompted Georgia lawmakers to propose retooling the laws and make it easier for alleged malpractice victims to make their case in court.

It started in February of last year, when Sherry insisted that her 39-year-old husband go to the Columbus Medical Center's emergency room so doctors could treat a headache that wouldn't go away after four days and numbness on the left side of his body began to grow.

A doctor there told the burly builder that the problem was likely a pulled muscle, and sent him home with prescriptions for a muscle relaxer and blood pressure medicine.

Within a few hours, Fretwell said his left side was paralyzed. He rushed back to the hospital, but the same physician told him once more he suspected a pulled muscle and sent Fretwell home.

The next morning, he was back - this time, by ambulance. His vision had blurred and his vomiting grew worse overnight. After tests, doctors confirmed he had suffered a stroke.

A month later, the family sought out a lawyer to see if they could sue. They were told if the doctors had originally diagnosed a stroke, they could have treated him with medication to reduce its severity. But the lawyers also said the new state law gives emergency room almost complete immunity from malpractice lawsuits, making a lawsuit a long shot.

That could soon change. A bipartisan group of lawmakers, including Republican Senate Majority Leader Tommie Williams, R-Lyons, and Democratic Senate Minority Leader Robert Brown, D-Macon, say they fear the provision goes too far. They back a measure that would scrap language requiring patients to prove emergency room doctors acted with "gross negligence" in malpractice cases, a standard that forces lawyers to prove they knowingly mistreated the patients.

The influential group's opposition to the changes is giving the proposal's supporters fits. Republican Sen. Seth Harp, the bill's sponsor, has taken to calling the measure "the physician's protection bill" to smooth over legislators who fear butting heads with the medical association.

He says that the "gross negligent" standard is so fuzzy that malpractice insurers are refusing to cover some ER doctors.

"It's a misfortune," says Harp, a Republican from Midland, a few miles from where the Fretwell family lives. "They're not protecting physicians and we're trying to make sure they have that coverage." The legislation faces a series of hurdles before it reaches a vote, which is why Rodney Fretwell wants legislators to know his story.

In an action involving a health care liability claim arising out of the provision of emergency medical care in a hospital emergency department or obstetrical unit or in a surgical suite immediately following the evaluation or treatment of a patient in a hospital emergency department, no physician or health care provider shall be held liable unless it is proven by clear and convincing evidence that the physician or health care provider´s actions showed gross negligence.

Labels: EMTALA, Georgia, Tort reform

Labels: Grand Rounds

Labels: Match, medical education

Augusta —- With its sprawling campus, hundreds of medical students and millions in research dollars, the Medical College of Georgia has long been a jewel for this city east of Atlanta.

People in Augusta want to keep it that way.

For weeks, lawmakers and politicians here have waged an increasingly vocal turf war over plans to open an MCG campus in Athens, fearing the Augusta school would play second fiddle to the flagship if a joint UGA/MCG program goes forward as planned.

University system Chancellor Erroll Davis, along with MCG president Daniel Rahn and dean Douglas Miller, tried to calm fears in this community, answering questions about what the Athens campus would —- and would not —- be.

"The medical college is going nowhere," Davis told the crowd. "The focus will remain here."

On Friday, Gov. Sonny Perdue reiterated that point during his own trip to the city. He was in Augusta to announce a new T-Mobile customer service center, but instead was asked to respond to those who worry the expansion to Athens is the beginning of the end for MCG.

"We've invested hundreds of millions of dollars here in the last few years. We'll continue to do that," Perdue said. "One of the challenges of a medical education is the patient load. We've already overextended our capacity for patients here in this area. We're already exporting some of our residents out to other areas to get that clinical training. So it's a natural extension. The Medical College of Georgia is going to thrive right here in Augusta."

Barbara Simms, an Augusta state representative, said she worries medical students will chose Athens over Augusta if given the choice. The expansion proposal has "been met with sheer terror," she said.

MCG's past to understand the skittish reaction of Augustans.

Since MCG's founding in 1828, the scrappy college has fought off numerous attempts by lawmakers to close the school or move it to Athens, he said.

In 1909, a Northerner named Abraham Flexner, who was sent around the country by the Carnegie Foundation to inspect medical colleges, recommended the Augusta campus close its doors.

"If the University of Georgia were to break the slender thread that connects them," he declared at the time, "the school could not survive the amputation."

Augusta residents and school officials balked, promising to make the school an integral part of UGA. The Legislature passed a bill giving UGA sole control over the Augusta school's property and assets and, over the next 20 years, the college operated solely as the medical department of UGA.

In the 1930s, the Board of Regents shut it down, citing a lack of classroom space and funding, and Augusta residents again rallied around their school, sending telegrams, letters and petitions to the regents. Gov. Eugene Talmadge, a regent, went to Augusta and, after seeing the public support for the school, promised to reopen it. But it wasn't until the 1950s that the medical college finally shed its ties to UGA and became a free-standing school, the only public health sciences college in the state.

Labels: MCG, medical education, UGA

Labels: Grand Rounds

The nation's organ-transplant network is preparing a major change in how it rations scarce kidneys that would favor young patients over old in an effort to wring more life out of donated organs.

The new policy is being developed by the United Network for Organ Sharing, the nonprofit body that develops organ-distribution policy under a government contract.
Surgeons and others leading the process expect the final proposal will rely significantly -- though not exclusively -- on the concept of "net benefit," which seeks to give kidneys first to those who will benefit most from them.

"Waiting time is arbitrary," said Alan Leichtman, a University of Michigan kidney doctor helping to craft the policy. "It seems like a real shame that we're not being better stewards of the organs."

Deceased donors provided 10,816 kidneys for transplant in 2005. Another 6,500 came from living donors, who usually give to a close friend or relative. But those organs fall far short of meeting demand, and the waiting list for a kidney has grown to more than 70,000 people. The reasons include the surge of diabetes, a principal cause of kidney failure, and the aging U.S. population. Some 4,000 people die waiting each year

The concept is gaining traction among transplant doctors but creating anxiety for some patients and surgeons who worry the new system won't be fair to all. "Is it correct or permissible for the system to say the five or six more years of life that a 60-year-old is going to get are less valuable, less important than the 15 more years of life the 30-year-old is going to get?" asked Richard Freeman, a transplant surgeon at Tufts-New England Medical Center in Boston.......
......Supporters of keeping the current approach say it's the fairest because it ensures that those waiting, if they hold out and stay alive, will eventually make it to the top of the list.

"We need a system which offers hope to all regardless of age," said Glenda Rosenbloom, a liver-transplant recipient, at a recent forum in Dallas organized by UNOS. Ms. Rosenbloom, who spoke on behalf of the Transplant Recipients International Organization, said she is in her 60s.

Statistics show that age is by far the biggest factor predicting how long someone will live after a transplant. A typical 25-year-old diabetic will gain an extra 8.7 years of life from a transplant, while a typical 55-year-old diabetic will gain only 3.6 extra years, according to the Scientific Registry of Transplant Recipients, a private group in Ann Arbor, Mich., that tracks data under a government contract. Other factors affecting survival include underlying illness and whether a person is overweight or has had a previous transplant. They, too, are included in the "net-benefit" calculation.

Transplants performed under the existing system generate about 44,000 extra years of life for the people who receive new kidneys each year, according to the registry. If all kidneys were distributed using a net-benefit calculation, that number would rise to more than 55,000 years, it says.


The registry has also calculated how the ages of recipients would change if net benefit became the decisive factor. The calculation shows that the share of kidneys going to patients in their 20s would rise to 19% from 6% today. Just 2.7% of kidneys would go to patients 65 and up, versus nearly 10% today.

Young diabetics would get a particular boost. They typically do poorly on dialysis -- where a machine performs the blood-cleansing function of the kidney -- but well with a transplant. Older diabetics who developed the disease as adults now get 18% of the kidneys but would get just 4.5% under a pure net-benefit system.

The committee is likely to revise the net-benefit formula to account for how long someone has been on dialysis, Dr. Stegall said. Under the leading idea, he said, the healthiest kidneys would be distributed through a formula that relies largely on net benefit, while the formula for kidneys coming from older or sicker donors would give greater weight to time on dialysis.

In effect, this system would tell older people who have been on dialysis a long time that they could still have a shot at a kidney, but the chances would be much better if they took a lesser-quality one. Patients, working with their doctors, could calculate the odds and decide how poor a kidney they were willing to accept.

This system could have the added benefit of getting more patients to accept marginal kidneys when they are offered, experts said. As it is, patients near the top of the waiting list often pass on these kidneys when they become available, knowing they will remain at the top of the list for the next high-quality kidney.(Emphasis mine)

The UNOS committee has sidestepped one explosive issue. Computer modeling shows that African-American patients do better than average on dialysis and therefore gain less "net benefit" with a transplant. The committee specifically ruled out using race as an explicit factor in allocating kidneys.

ISSUE: Perfect matches
Current policy: Donor kidneys that match a recipient on all six antigens are automatically given to that recipient. About one in five kidneys is allocated this way. Regions that receive kidneys from other areas must pay back the donor region with a future kidney.
Possible change: Eliminate these "zero mismatch" trumps, which provide less of a medical advantage than they once did due to better drugs. Eliminate paybacks.

ISSUE: Waiting time
Current policy: Transplant candidates get one point for every year they have been waiting on the list, making this the dominant factor in kidney allocation
Possible changes: Substitute time on list with time on dialysis; use time as a secondary factor in allocating kidneys, particularly for the best-quality kidneys

ISSUE: Children on the waiting list
Current policy: Kidneys from donors under age 35 are automatically offered first to children under 18, if any are on waiting list in same region.
Possible change: Policy not likely to change.

ISSUE: Living donors
Current policy: Living donors who have given away one of their two kidneys or any other organ get extra points if they need a kidney transplant
Possible change: Likely to maintain advantage for prior living donors

ISSUE: B blood type
Current policy: No special treatment. Because there are more patients than donors with B type blood, the wait is much longer. Black patients are more likely to have B blood type, so they are particularly disadvantaged.
Possible change: Allow some A blood type kidneys, which are compatible with A or B patients, to be offered to B-type patients.

ISSUE: Highly sensitized patients
Current policy: Some patients have antibodies that make them unable to accept 80% of kidneys and get extra points to help them snag those kidneys that are a good match
Possible change: Likely to maintain advantage for highly sensitized patients

Labels: Transplantation

Once upon a time, the answer was simple -- doctors made the decisions. They gave you the diagnosis (if they chose to) and they told you what to do about it. Your job was merely to follow "doctor's orders."

Fortunately, those days are gone. Starting in the 1970 s, a long-overdue patients rights movement arose, exemplified by the recognition of living wills to enable people to refuse life support and by requirements that patients give their informed consent before undergoing treatment or participating in research. In effect, the relationship between doctors and patients was renegotiated to incorporate patients' wishes into medical decisions. Doctors were expected to offer advice on the basis of their expertise, but patients would decide whether to take it.

In just a few decades, we've swung from one extreme to another. The shift is reinforced by various "consumer-directed" health system reforms that place more of the financial burden on individuals. Patients are sovereign purchasers who choose from a menu of options put before them by their doctors. They search the Internet for information and compare notes with friends to help make their choices. For their part, doctors lean over backward to be neutral.

"With great power comes great responsibility"

Adding to doctors' hands-off attitude is the fact that managed care made some people suspicious ; they worried that doctors (or the health plans for which they worked) might have a financial interest in recommending a particular course of action. One way for doctors to deal with that concern was to be non-directive. Also, primary-care doctors came under great pressure to see patients quickly, and it takes less time simply to present options than to evaluate them and make decisions jointly. When specialists are involved, primary-care doctors may rely on them to guide decision making, even though there may be several specialists involved and no coordination among them.

As patients, your best bet is to ask your doctors what they would do in your place, and persist until you get a straight answer. If nothing else, that forces doctors to imagine being in your shoes, at least for a moment, and it may cause them to think more deeply about what you should do.

Labels: Physician/patient relations

Labels: Grand Rounds