boston.com Your Life your connection to The Boston Globe
White Coat Notes: News from the Boston-area medical community
Comments
Send your comments and tips to whitecoat@globe.com
Categories


Blogger
Elizabeth Cooney is a health reporter for the Worcester Telegram & Gazette.
Contributors
Boston Globe Health and Science staff:
Scott Allen
Alice Dembner
Carey Goldberg
Liz Kowalczyk
Stephen Smith
Colin Nickerson
Beth Daley
Karen Weintraub, Deputy Health and Science Editor, and Gideon Gil, Health and Science Editor.
 Short White Coat blogger Ishani Ganguli
 Short White Coat blogger Jennifer Srygley
Week of: July 29
Week of: July 22
Week of: July 15
Week of: July 8
Week of: July 1
Week of: June 24

« July 08, 2007 - July 14, 2007 | Main | July 22, 2007 - July 28, 2007 »

July 20, 2007

Beth Israel Deaconess makes leadership changes

By Liz Kowalczyk, Globe Staff

Curious changes are afoot among department heads at Beth Israel Deaconess Medical Center.

Dr. Carol Warfield, chief of anesthesia, sent an e-mail to colleagues on Wednesday, saying that hospital chief executive Paul Levy had dismissed her as chair effective immediately.

"To say the least, I was shocked," Warfield wrote. She said that she was planning to return from sabbatical in two weeks and that Levy, whom she said notified her by e-mail, gave her no reason for the dismissal.

She took over eight years ago when the department was in turmoil, and said in her e-mail that it is in "excellent financial health" today.

"After being here for 30 years, I hope to continue as a member of the department," Warfield wrote, "but since this was so sudden I have no specific plans right now."

Warfield could not be reached for comment. Hospital spokeswoman Judy Glasser said Warfield has stepped down, but she couldn't say more.

"We can't comment on personnel issues," she said.

The change in the anesthesiology department comes a week after Dr. Josef Fischer, chairman of surgery, wrote a letter to surgeons, saying that he is so busy he needs help running the department. Since October, Fischer has served as chairman of the Board of Regents for the American College of Surgeons.

With Levy's "approval and encouragement," Fischer said, he has formed an executive committee of four doctors to help run the department -- an unusual arrangement at an academic medical center.

Fischer continued to say that since he would be away a lot over the next year, a member of the executive committee will accompany him to all major meetings "so there is no loss of continuity of conversation, analysis or decision-making."

Levy and Fischer, through a hospital spokeswoman, both declined to comment on the new arrangement.

July 19, 2007

Mass. Hospital Association names new CEO

By Jeffrey Krasner, Globe Staff

The Massachusetts Hospital Association today selected Lynn B. Nicholas, former head of the American Diabetes Association, to be its chief executive.

Nicholas was the top outside candidate from a search that began in January, when the board of trustees of the hospital association fired then-CEO Ronald M. Hollander.

Nicholas also formerly headed the Louisiana Hospital Association.

When the board voted today, the choice was between Nicholas and Robert Gibbons, a longtime MHA lobbyist who has been interim CEO since January.

July 18, 2007

NEJM: Leaving against medical advice

In tomorrow's New England Journal of Medicine, a first-year internal medicine resident at Massachusetts General Hospital, writes an eye-opening essay about his experience treating a critically ill patient who, against medical advice, decided to leave the hospital.

The patient, a 29-year-old heroin addict who spoke only Spanish, was hospitalized with a heart infection and failing heart, among other problems.

"We tried deals and scare tactics, telling him as clearly as we could that he was more likely to die if he left this way," writes Dr. Viviany R. Taqueti. "When he countered with 'that is up to God,' we offered him consultation with a priest. An interventionalist, overhearing this exchange, called us warm and fuzzy. Our efforts felt futile, and we were weary. Yet it seemed wrong not to keep trying."

Later, Taqueti writes, "I listened to his heart one more time ... I heard those ominous rumbles and screeches, and they startled me with their threat of impending death, obvious even to me. But (the patient) could not hear them, and I wondered how much of his failure to hear was due to our failure to translate.

"I placed the stethoscope in his ears. (The patient) raised his eyebrows in astonishment but said nothing. I knew this simple hearing aid could not remedy his deafness, arising as it did from barriers of language, culture, denial, distrust, and drug dependency. I was left frustrated, sad, and tired."

July 18, 2007

Legislators may tinker with health insurance law

By Alice Dembner, Globe Staff

The state Legislature will probably make a round of changes in the one-year-old law mandating near universal health insurance, but not before late fall, according to Senator Richard T. Moore, co-chairman of the Joint Committee on Health Care Financing.

The committee heard testimony today from about two dozen advocates, medical providers, patients, and self-employed individuals pressing for changes in controversial aspects of the law, such as how much employers should contribute to health insurance and the most individuals should have to pay for coverage.

More than 75 senators and representatives have signed on as sponsors of a bill to modify the law, called S661 and H1166.

During testimony, Moore said he endorsed a proposal to require that businesses pay at least 50 percent of the premiums for employees’ health insurance if they want to avoid a penalty of up to $295 per employee. Currently, the requirement is 33 percent, set by the administration of former Governor Mitt Romney. Two weeks ago, Moore asked the administration of Governor Deval Patrick to make the change.

If they don’t, he said, “it’s my intention that would be put into the statute.” But he said there was no rush to do that. His co-chair, Representative Patricia Walrath, was mum for now on the issue, although she has previously said she wanted a tougher business requirement.

Other changes proposed at the hearing included setting the maximum that anyone would have to pay for insurance – including premiums, copayments and deductibles – at 10 percent of income. The Commonwealth Health Insurance Connector, the state agency implementing the law, has set limits based only on premiums, and costs for many individuals and families are certain to top 10 percent.

After the hearing, Moore said he wanted to wait for financial analysis on the cost of some proposed changes, as well as a report from the state’s Inspector General on the law’s implementation, before deciding what changes to push forward.

“A couple more months will give us a better handle” on what’s needed, he said.

Posted by Karen Weintraub at 06:26 PM
July 18, 2007

Short White Coat: To care intensively

Short White Coat is a blog written by fourth-year Harvard medical student Jennifer Srygley. Her posts appear here as part of White Coat Notes. E-mail Jennifer at jen.shortwhitecoat@gmail.com.

srygley- -short white coat106.bmp

The intensive care unit is the most aptly named wing of any hospital. Everything about the ICU at Children’s Hospital Boston is intense: the patients are acutely ill and many require the simultaneous monitoring of each breath and heartbeat. Caring for these patients is intellectually and emotionally demanding for the nurses and doctors.

Many of the patients in the ICU are intubated and sedated and therefore unable to speak. As a student, I visit and examine the patients I am following before rounds every morning. This ritual of pre-rounding is usually my favorite part of the day -— a chance to chat with the patients in order get to know them better, and also an opportunity to practice my physical exam skills.

Pre-rounding in the ICU, however, is different. One of the patients I am following is recovering from a neurologic injury so severe that she is unable to talk to me or even to open her eyes by herself. In the absence of speech, the many monitors chirp her progress. While in many instances the physical exam during pre-rounding feels perfunctory, in the ICU the physical exam is one of the few windows into a patient’s overall condition. I shine a light into my patient’s eyes and watch her pupils constrict, a reflex that reveals that the nerves that sense light and cause the pupil to get smaller are intact along their entire tract in the brain. Wielding only a red rubber hammer, I document the reflexes in her arms and legs. I am meticulous, because the smallest change in her physical exam could be the symptom of a larger change in her brain or other vital organ.

In the ICU, lifesaving drugs and advanced technology help keep my patient alive, but as one of her caregivers, all I can do is monitor her progress and wait and hope for her to get better. More than the machines or the array of illnesses, I think it is the collective waiting and hoping of parents and nurses and doctors that makes the intensive care unit so intense.

Posted by Jennifer Srygley at 10:54 AM
July 17, 2007

State signals its open to retail medical clinics

By Liz Kowalczyk, Globe Staff

State public health officials are moving to allow medical clinics to open in retail stores, but are delaying a decision on whether to let CVS Corp. open 20 to 30 "MinuteClinics" in the Boston area.

The state announced today that it will propose new regulations by Aug. 8 to permit the operation of "limited scope" medical clinics. But the plan postpones the Department of Public Health's decision about whether to allow CVS to open primary care clinics in its pharmacies, beginning in Weymouth. CVS had hoped to open its first clinics this fall, but the start date could be delayed because the company will have to reapply under the new regulations.

The company indicated in a statement today that it would reapply.

Still, the announcement indicates that Massachusetts health officials are open to allowing retail medical clinics -- and other types of smaller clinics run by community health centers or hospitals -- to help ease emergency room overcrowding, provide better access to basic medical care, and as a convenience to consumers.

"What we believe is that there is enough evidence that the provision of limited clinical services in what might be called non-traditional settings has benefit that is worthy of consideration," said public health commissioner John Auerbach.

Retail medical clinics are taking off nationally, with about 400 in drugstores, discount chains, and supermarkets in other states.

At MinuteClinics in other states, nurse practitioners and physician assistants typically spend about 15 minutes with a patient, treating 20 or so common conditions, such as bladder infections, strep throat, and poison ivy, giving pregnancy tests and vaccines, removing stitches, and writing prescriptions. The clinics usually charge $59 a visit, and CVS officials said they are negotiating with Massachusetts health insurers to cover their members' visits.

The average wait is 20 minutes, company officials said, and MinuteClinics don't require appointments and have evening and weekend hours. Their motto: "You're sick. We're quick!"

In its application, CVS asked the health department to waive some of the state's current requirements for licensing clinics. For example, none of the conditions treated at MinuteClinics require blood tests, so the company does not believe it should have to comply with requirements for blood collection equipment and facilities.

But groups representing doctors, hospitals and community health centers had objected to giving CVS special consideration, and called for a public hearing on the proposal. They also had raised concerns about how patient safety and infection control would be monitored in the clinics. Today, the groups praised the health department for deciding to propose uniform rules that apply to all applicants and to hold a public hearing, probably sometime in the fall.

Auerbach said that, rather than granting numerous waivers to CVS, issuing new regulations would make the requirements clear to any entity that wants to apply to operate a limited-service clinic. For example, he said, a community health center could apply to open a satellite clinic in a homeless shelter.

James Hunt, president of the Massachusetts League of Community Health Centers, said he would encourage members to apply. But he said the organization remains opposed to retail clinics because they "fragment care," encouraging people to get treatment outside their regular doctor's office or health center, which are most familiar with their medical history.

The new regulations could include provisions requiring medical clinics to report a patient's visit quickly to the patient's regular doctor, Auerbach said.

July 17, 2007

Consumer group criticizes hospital chief's blog

By Liz Kowalczyk, Globe Staff

The Center for Science in the Public Interest, a consumer-advocacy group in Washington, D.C., took Boston hospital president Paul Levy to task this week over a recent posting on his popular blog, Running a Hospital. Levy, chief executive of Beth Israel Deaconess Medical Center, wrote on July 8 about a potential new treatment for asthma that uses catheter-delivered heat to reduce bronchial muscle spasms, which he said could be a huge development in treatment of the disease.

The center criticized Levy on its website, http://www.cspinet.org/integrity/watch/200707161.html, saying he had not disclosed that Beth Israel Deaconess is a clinical trial site for the treatment and a consultant to the company that makes the device, Asthmatx Inc. of Mountain View, Calif.

"The blogosphere operates without rules, even when the blogger runs one of the nation's leading teaching hospitals," the center wrote.

It's not that simple, however. Beth Israel Deaconess is not a clinical trial site, having decided not to participate when its data coordinator left, and it referred all patients it recruited to Brigham and Women's Hospital. The hospital received about $21,500 from the company for study administration and patient screening costs, according to the company. Dr. Armin Ernst, who was to be the principal investigator, was paid $1,500 in fees and expenses for speaking at an Asthmatx symposium in May 2006.

Levy said he did not know about any of this background when he wrote his blog item, but he said he agrees with the general principle raised by the center -- and yesterday he amended his July 8 blog entry.

"It has come to my attention that BIDMC has had commercial relationships with the company engaged in these trials. I was not aware of this before today, and I apologize for not mentioning it in my original post," he wrote. "I will consult with the BIDMC contracts office from now on before discussing new therapies and devices on this blog."

In an e-mail, he told the Globe, "The CSPI is exactly right that bloggers should disclose commercial relationships on items like this. I appreciate their bringing it up as an issue and will make sure to be more careful about it in the future."

July 16, 2007

MIT trio wins nation's top honors for science, technology

By Colin Nickerson, Globe Staff

Two professors at the Massachusetts Institute for Technology and the institute's former president have been chosen to receive the nation's highest honors for science and technology, the White House announced today, an extraordinary concentration of achievement for one university.

Tapped by President George W. Bush to receive the 2006 National Medals of Science were Robert S. Langer, renowned for developing new ways to administer drugs to cancer patients, and Daniel Kleppner, an authority on atomic physics and quantum optics.

Charles M. Vest, who served for 14 years as president of MIT until 2004, was named by Bush to receive the National Medal of Technology. He won acclaim during his tenure for his efforts to strengthen national policy on science, engineering, and education.

Langer and Kleppner bring to 47 the number of MIT scientists to receive the prestigious Medal of Science. Vest is the fifth MIT engineer or inventor to win the Medal of Technology.

MIT was the only New England university to win the medals for 2006 and the only university in the country to win more than one. A total of eight science medals and five technology medals were awarded.

"MIT is extraordinarily proud that three esteemed members of our community have been selected for this honor," said Susan Hockfield, president of MIT.

The winners, she said, have "made enormous contributions to MIT, to our nation, and to science."

The National Medal of Science was established in 1959 to honor individuals who have made outstanding contributions to "physical, biological, mathematical, or engineering sciences." In 1980, Congress extended the award to include social and behavioral sciences.

The National Medal of Technology was created in 1980 to honor individuals who make "lasting contributions to America's competitiveness, standard of living, and quality of life through technological innovation," according to the White House.

Langer was cited for "revolutionary discoveries" that led to better ways to administer drugs. These treatments, the citation said, "have profoundly affected the well-being of mankind."

In the 1970s, chemical engineer Langer teamed with oncologist Judah Folkman at Children's Hospital Boston to develop methods that would allow large proteins to enter membranes in a highly controlled manner to combat angiogenesis, the process by which tumors recruit blood vessels that sustain them. The treatment helped fight cancer by making it more difficult for tumors to spread to other organs.

Kleppner received the medal for pioneering studies of the interaction between atoms and light, and for "lucid explanations of physics to non-specialists."

In 1960, Kleppner developed with Harvard physicist Norman Ramsey the "hydrogen maser," an atomic clock of great stability used in radio signalling, radio astronomy, and satellite-based global positioning systems.

Kleppner also helped create a whole new field of physics, the study of "ultra-cold" gases.

Vest was cited by President Bush for "visionary leadership in advancing America's technological workforce and capacity for innovation."

The medals will be presented by the president at a White House ceremony on July 27.

July 16, 2007

ALS patient garners national award

By Stephen Smith, Globe Staff

Avi Kremer, the Harvard Business School grad who uses his MBA moxie to battle the disease that is killing him, today received a top prize from the national ALS Association.

Kremer, an Israeli native, received the Lawrence A. Rand Prize for "raising awareness about the disease as well as millions of dollars for research in Israel and the US," according to the ALS association. Kremer, 32, was diagnosed with the lethal condition, also known as Lou Gehrig's disease, during his first semester at Harvard.

Since graduating, Kremer, who continues living on the business school's Boston campus, has devoted himself to a competition he and friends started to energize the hunt for ALS treatments. Called Prize4Life, the competition aims to provide answers to questions that have stymied researchers by tapping into scientists whose work has not already come to the attention of major research institutions.

July 16, 2007

Mental illness group starts affiliate for Latinos

By Carey Goldberg, Globe Staff

NAMI-MA, the Massachusetts chapter of the National Alliance of Mental Illness, is opening its first affiliate aimed specifically at Latino families, it announced today.

Like other NAMI groups, NAMI-LATINO will help family members cope with the mental illness of their loved ones. But it will have a specifically Latino orientation, organizers say, trying to provide more support for Spanish-speaking families that might otherwise tend not to avail themselves of it.

The group will focus on such issues as the family’s role in a member’s recovery and the ongoing stigma surrounding mental illness in Spanish-speaking communities, said Carmen Rivera, the new affiliate’s president, in a statement.

The group meets at the South End Community Health Center at 1601 Washington St. in Boston. It is currently seeking more participants for its sessions, which are conducted in Spanish. More info: 617-421-0056.

NAMI-MA hopes to open other Latino-oriented branches where needed around the state.

Sponsored Links