Alright: what was destined to happen happened: the greedy unrealistic judge (with an anger problem perhaps) lost. As well he should have.

Here's the story as reported by the Reno Gazette Journal on June 25, 2007:

WASHINGTON (AP) -- A judge ruled Monday that no pair of pants is worth $54 million, rejecting a lawsuit that took a dry cleaner's promise of "Satisfaction Guaranteed" to its most litigious extreme.

Roy L. Pearson originally sought $67 million from the defendants, claiming they lost a pair of trousers from a blue and maroon suit, then tried to give him a pair of charcoal gray pants that he said were not his.

Pearson arrived at the amount by adding up years of alleged law violations and almost $2 million in common law fraud claims. He then lowered the amount he was seeking to $54 million.

But District of Columbia Superior Court Judge Judith Bartnoff ruled that the owners of Custom Cleaners did not violate the city's consumer protection law by failing to live up to Pearson's expectations of the "Satisfaction Guaranteed" sign once displayed in the store window.

"A reasonable consumer would not interpret 'Satisfaction Guaranteed' to mean that a merchant is required to satisfy a customer's unreasonable demands" or to agree to demands that the merchant would have reasonable grounds for disputing, the judge wrote.

Bartnoff wrote that Pearson, an administrative law judge, failed to prove that the pants the dry cleaner tried to return were not the pants he took in for alterations.

Bartnoff ordered Pearson to pay the court costs of defendants Soo Chung, Jin Nam Chung and Ki Y. Chung. The court costs amount to just over $1,000 for photocopying, filing and similar expenses, according to the Chungs' attorney.

A motion to recover the Chungs' tens of thousands of dollars in attorney fees will be considered later.

Chris Manning, the Chungs' attorney, praised the ruling, which followed a two-day trial earlier this month.

"Judge Bartnoff has spoken loudly in suggesting that, while consumers should be protected, abusive lawsuits like this will not be tolerated," Manning said in a statement. "Judge Bartnoff has chosen common sense and reasonableness over irrationality and unbridled venom."

Pearson did not respond to a call and an e-mail seeking comment. Manning, the Chungs' lawyer, said he expected Pearson to appeal.

During the trial, Pearson testified that he wanted only $2 million in damages for himself -- for his mental anguish and inconvenience -- plus $500,000 in attorney's fees for representing himself. Any additional money that the judge might award would go into a fund "to educate people of their rights under the consumer protection act," he said.

The case garnered international attention and renewed calls for litigation reform.

"This case was giving American justice a black eye around the world, and it was all the more upsetting because it was a judge and lawyer who was bringing the suit," said Paul Rothstein, a Georgetown University law professor.

Rothstein said Monday's ruling "restores one's confidence in the legal system."

Anyone who's spent anytime in Northern Nevada's rural communities knows that healthcare can be an issue. This article comes from John Wheeler, special to the Reno Gazette Journal, and was published on June 24, 2007.

When it comes to economic development, rural communities readily see the benefit in attracting traditional businesses, such as warehouses or processing plants.

But they might get more bang for the buck by recruiting a doctor or some nurses, said Caroline Ford, assistant dean and director of the Center for Education and Health Services Outreach at the University of Nevada School of Medicine.

"Good quality medical care is an important recruitment piece for people moving to a community and for industries to locate in those communities," said Ford, whose duties include directing the Nevada Office of Rural Health.

It wasn't long ago that Nevada's rural hospitals were bleeding money. However, in 2000, rural hospitals received important support from the Nevada Rural Hospital Flexibility Program, a federally funded program administered by the Nevada Office of Rural Health.

"The program helps small rural hospitals receive the designation Critical Access Hospital. It's helped keep doors open and also recruit physicians by offering better salaries, bonuses and enhancements," said program director John Packham.

The key benefit of the designation is that it allows rural hospitals to receive Medicare reimbursement for the actual cost of care, rather than on the traditional set-fee payment schedule, which often cost hospitals money. Nevada certified its first critical access hospitals in 2000 and now has 11 designated facilities.

Matt Rees, administrator of Pershing General Hospital in Lovelock, said that the hospital also has worked hard to change community attitudes.

"Basically changing the perception of people that we're a Band-Aid station and that you have to go out of the area for quality care," he said.

The Flex Program also provides health services research and financial analysis to rural hospitals. This research helps rural hospitals avoid costly mistakes. For example, a 2006 feasibility analysis for a kidney dialysis center at Humboldt General Hospital in Winnemucca concluded that such a center would likely be a money loser.

A Flex Program assessment of payroll and job impact shows that rural hospitals are key economic drivers in their communities.

"County commissions typically think of the health sector being a drain on county budgets, but they not only generate jobs and payroll in their own right, they have added impacts because they purchase goods and services in the local economy," Packham said.

Northern Nevada Medical Center and Universal Health Services, Inc. announced the promotion of Lisa Wilson to chief operating officer for Northern Nevada Medical Center in Sparks.

Wilson was an associate administrator at Northwest Texas Healthcare System, a 489-bed hospital in Amarillo, Texas.

Wilson's previous experience includes more than nine years in various leadership roles.

She received her bachelor's degree from Stephen F. Austin State University in Nacogdoches, Texas, her master's degree in biomedical sciences from the University of Texas Southwestern Medical Center in Dallas; and her Master of Business Administration from Wayland Baptist University, Amarillo, Texas.

I occasionally detour from the law.

Last week my wife and I mountain biked up Angora Lakes Road in South Lake Tahoe, California. Straight up a long hill, beautiful views of Fallen Leaf Lake and Lake Tahoe with two idyllic lakes at the very top and Desolation Wilderness even further above.

This week the entire area is evacuated by a fire that has burned more than 2000 acres and South Lake is facing what some are saying is the worst crisis in its history. More than 200 homes burned, 500 more threatened; and a friend at the lake just told me that the high school is now in serious danger of burning as well..

All very sad and sure to call into sharp question the Tahoe Regional Planning Agency's forestation rules.

I encourage everyone to consider donations to the residents of South Lake who lost their homes.

Everywhere you look in Northern Nevada hospitals are expanding (and advertising more).

This article by Zack Hall from today's Reno Gazette Journal provides detail:

The region's major hospitals want people in Northern Nevada to know that the reasons for leaving Nevada for health care are waning.

Renown Health, Saint Mary's Regional Medical Center, Carson-Tahoe Regional Medical Center and Northern Nevada Medical Center all are in expansion mode, and that means more services are being offered to more people.

In fact, Northern Nevada's three largest hospitals will complete nearly $500 million in new construction by this summer, the product of a three-year building binge at Saint Mary's, Renown and Carson-Tahoe.

Nowhere is that more apparent than at Reno's Renown, which other than changing its name from Washoe Medical Center, soon will open its $240 million patient tower and has plans for future growth in the millions of dollars.

Jim Miller, president/CEO of Renown, the area's largest health care network, says the rapid expansion of all the hospitals has allowed for better service in such fields as oncology and cardiology, areas where a lack of specialists in Northern Nevada previously sent patients to California.

"They don't need to leave as they used to to get their care," Miller said. "Specifically, things that come up are children's services and cancer. We believe that with the services available in the hospitals in our community, we should be able to treat most cases that people have."

With the new Tahoe Tower, Renown also will have more private and amenity-rich rooms, something that Saint Mary's also is looking to include.

Renown also has stepped up its efforts with cardiology, adding a Women's Heart Program, and neurosurgery, becoming one of the first 20 hospitals in the country to offer Novalis Shaped Beam Radiosurgery, which allows non-invasive surgery on such maladies as brain tumors, officials say.

But expansion hasn't stopped with Renown.

Prescriptions for success

Saint Mary's expansion has included its $160 million Center for Health, an outpatient facility that has helped the hospital expand such services as orthopedics as well as preventative care efforts with its three-story fitness center housed inside the building.

Northern Nevada Medical Center, which along with Saint Mary's has struggled to get contracts with health insurance providers that give access to the Sparks facility, has invested in a $1.8 million lab for cardiac services and has plans to expand laboratory services for outpatient treatment and to add an imaging center for Spanish Springs.

Carson-Tahoe, with its new facility in north Carson City, started its cancer center and a cardiac care unit, to give more expansive care to its patients.

"We have cancer patients telling us that in the past they would have chosen to go to maybe Davis (Calif.) or San Francisco or somewhere else," said Diane Rush, marketing coordinator for Tahoe Regional Healthcare. "Now we have the capability of treating that all here in one comprehensive place. And we have gone above and beyond to make sure that we measure up with the technology, with the skilled physicians, getting the (American College of Surgeons) accreditation."

Vital signs

The hospitals in the region are big business, have a huge economic impact in the area and are ultra-competitive.

In total, hospitals account for 9,000 direct jobs and 7,000 indirect jobs, according to a report by area hospitals released in May.

But each hospital is taking a different approach to its growth.

Northern Nevada Medical Center has tried to focus on its patient service, including its guarantee that a staff member will see a patient within 15 minutes of entering the emergency room; it also has added its first urologist to its emergency department.

The Sparks hospital, the smallest of the major hospitals, is trying to get better access to patients by contracting with insurance companies.

Most health-care contracts in Northern Nevada are negotiated exclusively for patients to be treated at either Saint Mary's Health Network or, to a much larger extent, Renown Health. Northern Nevada and Saint Mary's want to change that.

To that end, Northern Nevada entered last year into a contract with Blue Cross/Blue Shield of Nevada, one of the largest carriers in the state, and is in negotiations with carriers such as United Health and Aetna to make its services more widely available.

"We are focused on giving people an opportunity to choose us for their services," said Brandt Wright, chief executive and managing director of the Sparks hospital. "(The Blue Cross/Blue Shield contract) gave about 60,000 people in our immediate service area access to our hospital who didn't have access to our hospital. Obviously, if you are talking about developing new services and investing new capital, people have to have access to your services in order to get a return on that investment."

Healthy competition

Competition with Renown, which has the only Level II-trauma center and neonatal care facility, has been difficult for the two smaller hospitals in the Reno-Sparks area.

Saint Mary's just three years ago fell into financial trouble, losing $10 million in 2004, when it began layoffs and other cuts that eliminated more than 200 jobs.

Like Northern Nevada Medical Center, Saint Mary's is healthier these days and joined Catholic Healthcare West, a network of more than 40 hospitals throughout the West, allowing the hospital to pool resources with other, larger hospitals outside the area.

The hospital has plans to open urgent care centers in Spanish Springs and Fernley to give patients better access to Saint Mary's.

Saint Mary's also has plans to double its emergency room capacity, something all four hospitals are dealing with as the area's population has exploded.

"Doubling the size of our emergency department is really going to be a significant improvement for us," said Lisa Dettling, director of marketing and business development for Saint Mary's. "In our particular ED, we were designed for 30,000 visits a year, and we are seeing 50,000."

Critical collaboration

Tensions are high among the area's hospitals, most commonly in reaction to Saint Mary's and Northern Nevada Medical Center's complaints about Renown's exclusive contracts with insurance providers.

But officials for all four of the hospitals agree they do work together to provide better care.

In fact Renown, Carson-Tahoe and Northern Nevada joined together to launch a marketing campaign this spring named "your hospitals, your community -- together we thrive."

The effort is a campaign to inform the public of the services Northern Nevada hospitals provide, ranging from free health and wellness clinics to subsidized care.

"I believe the level of cooperation among the hospitals is very high," Miller said. "While federal anti-trust laws require us to compete somewhat, when you take a look at quality initiatives, standardizations, creating protocols and so forth, I believe the hospitals in our community are getting together and working through those issues."

The hospitals have partnered for such programs as free immunizations for children and flu shots.

It's not a perfect relationship between the hospitals, but Rush says it works for Northern Nevada patients.

"When we pull together, we have a lot to offer," Rush said. "We are here 24 hours a day, seven days a week. There are not a lot of businesses that are like that. I think we do a pretty good job."

Here's a handy guideline to HIPPA that was sent to me by the Institute for Paralegal Education. This was apparently written by attorney Heather Brochu (a short bio is at the bottom of this blog):

The primary purpose of HIPPA is to outline circumstances in which an individual's protected health information may be used or disclosed by covered entities.

Covered Entities Under HIPPA

- Health care clearinghouses
- Any plan that pays for medical expenses
- Health care providers who transmit health information in connection with certain transactions

Information Protected Under HIPPA

- Past, present, or future physical or mental health condition
- Specific health care treatment provided to an individual
- The past, present, or future payment of health care treatment

How to Obtain Medical Records

- Subpoena or Authorization
- Records can only be subpoenaed once litigation has begun
- If using a subpoena, you must provide notice to the individual whose records you are requesting
- Authorization must be HIPPA compliant in order to obtain an individual's medical records

Information That Makes an Authorization HIPAA Compliant

- Specific information concerning the information to be released
- The person(s) to whom the information is to be released
- Expiration date of the authorization
- Right to revoke (in writing)

OCR Privacy Rule, United States Department of Health & Human Services (May, 2003)

Heather Brochu is an attorney in the law firm of Clark, Long, Werner & Flynn, P.C., where she practices in the area of civil defense litigation. Prior to becoming an attorney, Ms. Brochu worked as a paralegal. Ms. Brochu earned her B.A. degree in paralegal studies from Notre Dame College in Manchester, NH. She became an attorney through a four year clerkship in Burlington and is admitted to the Vermont Bar. She spoke at IPE's "Medical Record Evaluation for Paralegals" seminar 4-10-2007 in Burlington , VT.

This from AAJ using a blurb from the North Country Gazette:

"The judge at the center of the infamous $65 million lawsuit against his long-time dry cleaner for losing a pair of his pants is the subject of an ethics complaint filed against him by the American Association for Justice. Jon Haber, CEO of AAJ, has written a letter to the District of Columbia Bar, asking that it open an investigation into Judge Roy Pearson, a DC administrative hearings judge, for his pursuit of the dry cleaner lawsuit...In his letter, Haber stated: 'Our court system has no place for those who abuse the instruments of justice for personal gain or the intimidation of others.' In addition to the call for an investigation, AAJ President Lewis S. 'Mike' Eidson stated 'As attorneys who are committed to helping Americans receive justice throughout courts, we are outraged by the very idea of a $65 million claim over a pair of pants. It is not only ridiculous -- it is offensive to our values.' Eidson and Haber have also personally pledged to contribute to a defense fund established to support the dry cleaners."

North Country Gazette 6/03/07

More African American women die of breast cancer. A recent Yale study found, however, that there was no association was observed between perceived racial discrimination and nonadherence to age-specific mammography screening guidelines.

D. Garth Sullivan, from Indox Consulting, expands in a recent mass email:

Perceived racial discrimination is not associated with nonadherence to screening mammography guidelines among African American women, according to findings published in the June issue of the American Journal of Epidemiology.

"The mortality rate from breast cancer continues to be significantly higher for African American women than for white women," lead author Dr. Amy B. Dailey explained in an interview with Reuters Health. "Thoroughly investigating factors that may contribute to this persistent racial disparity is crucial in order to find ways to reduce this gap."

To this end, Dr. Dailey, of Yale University School of Medicine, New Haven, Connecticut, and colleagues prospectively studied 1229 women between the ages of 40 and 79 years who underwent an index screening mammography between October 1996 and January 1998 and completed baseline interviews and follow- up interviews an average of 29 months later. Sixty-one percent of the women were white and 39% were African American.

The researchers assessed perceived discrimination using questions regarding lifetime experiences in seven possible situations. These included attending school, looking for employment, obtaining medical care, at work, at home, situations in a public setting, and treatment by the police or the courts.

Nonadherence to screening recommendations was defined as failing to obtain at least one mammogram within 2 years of the index examination for subjects aged 40 to 49 years and failing to obtain at least two screenings within 2 years of the index examination for subjects aged 50 years or older.

Lifetime racial discrimination was reported by approximately 42% of African-American women and 10% of white women. The most frequently racial discrimination episodes were at work, by the police or in the courts.

Overall, 47.8% of the total study population was nonadherent to screening mammography guidelines. African American women were more likely to be nonadherent than white women (odds ratio = 1.48). However, in multivariate analysis no association was observed between perceived racial discrimination and nonadherence to age-specific mammography screening guidelines.

SB7, effective October 1, 2007, establishes civil liability for certain acts involving the provision of alcohol and controlled substances.

Existing law provides immunity from civil liability to a person who serves or sells an alcoholic beverage to another person for damages caused by an intoxicated person as a result of that service or sale. (NRS 41.1305) Section 2 of this bill limits that immunity to a person who serves, sells or furnishes an alcoholic beverage to another person who is at least 21 years of age. In contrast, section 2 makes a person liable in a civil action for damages caused as a result of the consumption of alcohol by an underage person if he knowingly served, sold or furnished alcohol to the underage person or allowed the underage person to consume alcohol on premises or in a conveyance belonging to him or over which he had control. The liability created does not apply to a person who is licensed to serve, sell or furnish alcoholic beverages or to an employee or agent of such a person.

Section 1 of this bill further makes a person liable in a civil action for damages caused as a result of the use of a controlled substance by another person if the person knowingly served, sold or furnished the controlled substance or allowed the other person to use a controlled substance in an unlawful manner on premises or in a conveyance belonging to the person allowing the use or over which he has control.

NBCSanDiego.com reports that a skin cancer patient was recently awarded $5.7 million in a failure to diagnose case:

A Superior Court jury awarded $5.7 million in damages to a bedridden man who claimed a doctor failed to diagnose his skin cancer.

The verdict is the largest medical-malpractice award in California this year, but will be cut to $1.9 million under a state statute limiting damages in malpractice suits.

Regis M. Reilly, 53, claimed dermatologist Dr. James C. Powers failed to biopsy a cyst that later metastasized into cancer. Reilly has a family history of skin cancer.

I wanted my clients to hear someone say that what they went through had real value," said Reilly's attorney, N. Denise Asher.

The award included $3 million in general damages for Reilly's wife to compensate for the negative impact on the couple's marriage. Reilly won another $1.6 million for his own mental pain and suffering and $1.1 million for lost income.

Powers' attorney, Nancy Vaughan, could not immediately be reached for comment.

Reilly went through several surgeries to remove the cancer and is now confined to his home where he receives 24-hour care.

The verdict exceeded a $5.3 million settlement in a malpractice case, also in San Diego, involving a brain-damaged infant and a $556,900 award in another misdiagnosis case.

Another Nevada legislative session has come and is almost gone.

I will report on interesting legislative developments over the next few months.

AB 468, effective October 1, 2007, requires providers of health care who refer patients to or recommend physical therapy to a patient to provide a written disclosure to the patient of any financial interests that the provider of health care has in a facility recommended or to which a patient is referred. This bill also clarifies that this new requirement does not authorize a referral or recommendation which is otherwise prohibited.