According to data from the U.S. Centers for Disease Control and Prevention for 2001 to 2005 (the latest years available), the number of new cases of HIV infection diagnosed among 15-to-19-year-olds in the United States rose from 1,010 in 2001, held steady for the next three years, then jumped 20 percent in 2005, to 1,213 cases.

For young people aged 20 to 24, cases of new infection have climbed steadily, from 3,184 in 2001 to 3,876 in 2005.

According to E.J. Mundell at HealthDay News, experts say a number of factors may be at play, including the fact that many HIV-infected patients are now being kept healthy with powerful drugs -- making AIDS seem like less of a threat to young people than it did in the past.

Hopefully, complacency about this serious threat will not continue.

Yes, more wierdness in a case that's had it's share.

First, Mack stabs his wife to death and shoots a judge (always the best way to endear oneself to the legal community about to determine your fate).

Darren Mack flees, he's talked into coming back by the D.A. (of all people).

Darren Mack pleads guilty (before putting on a defense); now he's changed his mind, fired attorney Scott Freeman (Mack will have a hard time if he wants to claim ineffective assistance) and hired Laub and Laub.

What's wrong with this guy?

According to Martha Bellisle, writing for the Reno Gazette today, Mack dropped his legal defense team after pleading guilty to murder and attempted murder charges, and plans to file a motion to withdraw his guilty pleas, a source close to his family said Thursday.

The withdrawal motion has yet to be filed but was in the process of being crafted, the source said.

As of Wednesday, Scott Freeman, one of Mack's trial lawyers, had signed the substitution request but David Chesnoff had not.

William Routsis, a lawyer with the Reno firm of Laub and Laub, was to take over the case, the source said.

In a surprise move, Mack, 46, stopped his murder trail on Nov. 5, just as his lawyers were about to present the defense case and agreed to plead guilty to first-degree murder of his estranged wife, Charla, 39.

She was found stabbed to death in the garage of his upscale townhouse on June 14, 2006.

Mack also entered a conditional guilty plea on the attempted murder charge in the sniper-style shooting of their divorce judge, Chuck Weller.

Under the plea, Mack said he did not intend to kill the judge but acknowledged that the prosecution had enough evidence to convict him.

Neither Freeman nor Chesnoff could be reached for comment late Thursday. Special Prosecutor Robert Daskas also did not return phone messages.

Judge Douglas Herndon had scheduled sentencing Jan. 17-18 in Las Vegas, where he moved the trial after determining an impartial jury could not be found in Washoe County.

Mack faces life in prison with the possibility of parole after

20 years on the murder charge.

In Staccato v. Valley Hospital, 123 Nev. Adv. Op. No. 49 (November 8, 2007), the Nevada Supreme Court resolved the issue of whether a physician is qualified to testify as to the proper standard of care in a malpractice action against a nurse when the allegedly negligent act implicates the physician's realm of expertise.

The Court concluded "that a physician or other medical care provider is qualified to testify as to the accepted standard of care for a procedure or treatment if the physician's or provider's experience, education, and training establish the expertise necessary to perform the procedure or render the treatment at issue."

In so concluding, the Court clarified "that a medical expert witness need not have the same credentials or classification as the defendant medical care provider. Instead, in accordance with Nevada's statutory scheme governing expert witness testimony, and in furtherance of sound public policy, the proper measure for evaluating whether a witness can testify as an expert is whether that witness possesses the skill, knowledge, or experience necessary to perform or render the medical procedure or treatment being challenged as negligent, and whether that witness's opinion will assist the jury.

In this case, the district court entered a directed verdict for the defense after disqualifying appellant's proposed expert witness, an emergency room physician, on the basis that the physician was not qualified to testify against a nurse who allegedly administered an intramuscular injection (a procedure for which the physician sufficiently demonstrated his expertise) in a manner contrary to the acceptable standard of care. Because the district court's decision was based on an incorrect legal standard, we reverse its judgment and remand this matter so that appellant's malpractice action may proceed."

The Nevada Supreme Court examined Nevada's so-called "prompt-pay" statute, NRS 690B.012, in a decision dated November 21, 2007. See, Allstate Ins. Co. v. Thorpe, 123 Nev. Adv. Op. No. 52.

That statute "requires casualty insurers to approve and pay, or deny, casualty claims, including claims for medical payment benefits, within a limited time frame. Under the statute, an insurer must pay interest on any untimely claims payments."

In the appeal before them, "the Court considered whether NRS 690B.012 grants private rights of action to medical services providers who administer care to persons insured under contracts of "casualty insurance,"[2] so that the medical services providers may sue the person's insurer, if that insurer fails to promptly pay claims."

The Court held that "NRS 690B.012 does not expressly create a private right of action in favor of an insured's medical provider to sue an insurer who fails to make prompt payments to the insured or the insured's medical providers. Instead, the statutory scheme contemplates an exclusive administrative procedure for resolving claims concerning alleged violations of NRS 690B.012, under which those persons with a direct and immediate pecuniary interest in prompt payment may proceed. We therefore conclude that (1) there is no private right of action in the district court under the statute, but (2) medical providers, as persons with a direct and immediate pecuniary interest in the prompt payment of medical payment benefits, may seek administrative remedies before the Nevada Department of Insurance (NDOI), subject to judicial review under the Nevada Administrative Procedure Act."

Las Vegas' University Medical Center would shed some controversy, save $290,000 a year and gain prestige in a new deal with the Nevada Cancer Institute.

The hospital would pay the research center $60,000 annually to direct its oncology-hematology department under a three-year contract that's expected to be approved today by Clark County commissioners.

Marshall Allen, at the Las Vegas Sun Journal, writes in an article dated November 20, 2007, that this contract would follow a $350,000 deal for UMC's chief of staff, Dr. John Ellerton, whose pay and work arrangement at the hospital came under fire after a Sun report in January.

Kathy Silver, UMC's interim CEO, said the Nevada Cancer Institute was chosen primarily for the depth of knowledge and expertise provided by its physicians who treat various forms of cancer. Plus, the institute's reputation for excellence "raises the profile of our program," Silver said. This in turn could lure more paying patients to the cash-strapped public hospital, which bears the brunt of providing care to the county's uninsured and indigent patients.

Sandy Murdock, president and chief operating officer of the Nevada Cancer Institute, said that by working at UMC doctors could treat a larger segment of the population and patients who wanted those doctors wouldn't necessarily have to go to the main office in Summerlin.

The goal of the institute, which has about a dozen physicians, is to offer clinical treatment and experimental drug trials at UMC, Murdock said. In addition, the institute's doctors would be in the neighborhood of the UMC medical residents they teach through the University of Nevada School of Medicine, she said.

The new contract would be a significant savings over UMC's current deal with Ellerton, whose contract ends December 31. Ellerton was originally paid $120,000 to direct the department. But in March 2004, without the knowledge of most of his colleagues, Ellerton was given an additional $230,000 job by CEO Lacy Thomas. This one as medical director. Thomas is under criminal investigation for allegedly giving lucrative contracts to friends, and his deal with Ellerton was seen by some as an attempt to curry favor with the chief of staff.

Ellerton's medical director contract also created a conflict of interest. As chief of staff and director of the oncology department, he was supposed to represent the needs of patients and doctors in dealing with the administration. But as medical director he was part of the administration. Ellerton has maintained that he was never an administrator and that he got the salary boost solely for his oncology services.

Silver, who at the time claimed not to know the specifics of the contract between Thomas and Ellerton, did strip Ellerton of the medical director title in February. But she allowed him to keep the $230,000 pay raise, which other local oncologists called a gross overpayment. Several called for an open competition for the contract.

In February, Silver put the contract out to bid and Ellerton, Nevada Cancer Centers and the Nevada Cancer Institute submitted proposals. Nevada Cancer Centers offered to do the job for $120,000, twice what the institute bid. Ellerton continued to ask for $350,000.

It appears that Ellerton does not yet know the details of the new contract between UMC and the cancer institute.

Nancy Sterling, his public relations consultant, said in a written statement: "Despite our requests, and the fact that this contract is a public document, we have not been provided a copy so we can't yet comment on it."

Silver, the interim CEO, said the institute could take over the oncology department for less money because, like UMC, the research center is a nonprofit organization. Ellerton demanded $350,000 to direct the oncology program, she said, and the Nevada Cancer Institute does not have the same profit motive.

Marshall Allen can be reached at 259-2330 or at marshall.allen@lasvegassun.com.

Pregnant women are receiving more high-tech imaging exams, exposing their babies to higher doses of radiation than a decade ago, a study said on Tuesday.

Reuters reports that while the levels of radiation exposure are low, they carry a slight risk of harm to the developing fetus, said study author Elizabeth Lazarus, a professor of diagnostic imaging at the Warren Alpert School of Medicine at Brown University in Providence, Rhode Island.

A review of 5,235 imaging examinations performed on pregnant women at Brown from 1997 to 2006 found the number of those exams rose 121 percent. The exams included computed tomography (CT), nuclear medicine and plain film X-rays.

An abdominal ultrasound, a routine exam performed during pregnancy, does not expose the patient to ionizing radiation, which can cause cell damage.

CT exams, which deliver more radiation than other procedures, saw the greatest increase in use, rising by about 25 percent a year. Use of X-rays increased 7 percent a year, and nuclear medical exams rose by 12 percent annually.

CT scans are used in pregnancy only to detect potentially life-threatening conditions such as bleeding in the brain, blood clots in the lungs or appendicitis.

Researchers estimated the average fetal radiation exposure for CT was 0.69 rads, compared to 0.04 rads for nuclear tests and 0.0015 rads for X-rays. The data were released at a meeting of the Radiological Society of North America in Chicago.

"A patient being recommended for a test like this should talk to their doctor to find out if there are any alternative tests or if there is any harm waiting," Lazarus said in an interview.

"But if one of these tests is needed, we would not discourage any patients from undergoing one, because making a diagnosis could also be life-saving."

(Reporting by Susan Kelly, editing by Philip Barbara)

Two managers at Clark County's financially struggling public hospital face criminal charges on accusations of bilking taxpayers out of thousands of dollars by stealing materials and enlisting hospital employees for their personal use, according to court documents.

Tony Cook, writing for the Las Vegas Sun yesterday, writes that Christopher Roth, an associate administrator of support services who resigned in June 2006, and Thomas Hutchison, an acting director of University Medical Center's facilities maintenance section who resigned in April 2007, face theft and other charges in a 20-count criminal complaint filed in Las Vegas Township Justice Court.

Two lower-level employees in UMC's facilities department - Sime Perkov and Peter Panagos - also face charges.

The complaint alleges that Hutchison stole $500 worth of UMC paint to use on an outbuilding on his personal property. He also is accused of stealing a $399 designer toilet, an $8,000 commercial grade compressor and at least $2,500 worth of cabinets from the hospital.

The complaint also alleges that he enlisted hospital employees, while they were on county time, to craft countertops, fashion cabinets, make signs and refurbish an antique gasoline pump. Much of the employees' efforts benefited Hutchison's personal residence, the complaint claims.

Hutchison also is accused of taking $761.61 worth of materials purchased by UMC and exchanging them at a Lowe's home improvement store for gift cards for personal use, the complaint says.

Roth also is accused of using employees and stealing materials. He allegedly had employees make signs and construct air conditioning units for his personal businesses, including an air conditioning school that he ran on the side, according to the complaint.

He also stole two patio heaters, valued at $600, and condensing and evaporator units that UMC had purchased, the complaint says.

Perkov is accused of stealing cabinets purchased by UMC and constructing air conditioning units for Roth's school while being paid by UMC.

Panagos also is accused of constructing air conditioners for Roth.

All the actions cited in the complaint allegedly occurred from January 2004 to March 2007.

If the allegations are true, some of crimes at the hospital were occurring even after it had been reported that UMC Chief Executive Lacy Thomas was under investigation for allegedly steering contracts to friends in Chicago. District Attorney David Roger is considering whether to charge Thomas.

The investigation of Thomas and the allegations against those in UMC's facilities department are unrelated, police said.

Clark County officials said they are taking the "appropriate personnel action" with Perkov and Panagos, who are still employed at the hospital. County spokesman Dan Kulin would not elaborate.

"This kind of behavior is reprehensible," he said in a statement. "It's simply intolerable and it represents a serious violation of the public trust. We are encouraging prosecution to the fullest extent of the law."

The county also plans to launch an internal investigation, Kulin said.

The hospital has instituted several operational changes, Kulin said, including tighter controls on storage areas, purchases and the use of materials.

"For example, there are now surveillance cameras in and around the stockroom and additional documentation is required when materials are removed from the stockroom," he said.

"Management is also conducting periodic audits of completed projects. Our internal investigation could lead to additional operational improvements."

All four defendants are scheduled for a preliminary hearing Dec. 18th.

Tony Cook can be reached at 259-2320 or at http://tony.cook@lasvegassun.com

In Fallon, Nevada (about an hour and a half away from Reno) residents have been experiencing high numbers of cancer diagnoses. Although the town has a population of roughly 8,500 people, 12 children were diagnosed with leukemia over a course of approximately three years. According to the American Cancer Society approximately 1.27 percent of the population (1 in 79) will come down with the disease sometime in their lifetimes, but the median (average) age for which it is diagnosed in humans is 67. The ACS also states that in the year 2007 roughly 3,800 children will develop leukemia. Considering the number of these cases occurring in Fallon alone puts it at a small percentage of the total US population, this news is alarming local residents.

Theories abound as to the causes of the leukemia, but the most prevalent is one that states that because the Air Force base is in close proximity to the town, jet fuel and exhaust fumes are causing the leukemia. Benzene has been shown to be a major cause of leukemia and it is commonly found in the fuels that jets use to fly.

Another theory is based upon the city's arsenic tainted water supply. Fallon's water supply exceeded 90 parts per billion of arsenic, while exceeding a mere 50 ppb (parts per billion) has been quoted by the EPA as being dangerous. In fact, some experts believe that any level exceeding 10 ppb is dangerous. Thirty four percent of the residents of Clark County were tested with over 50 ppb of arsenic in their urine in 2003 and although both the Air Force base and the city of Fallon have taken steps to reduce the amount of arsenic in the water supply, the damage from the high levels (100+ ppb) that were previously recorded still remains.

According to the EPA, "On November 23, 1999, EPA Region 9 issued a Findings and Notice of Violation stating that the City of Fallon was in violation of the Safe Drinking Water Act for exceeding the arsenic maximum contaminant level (MCL) of 50 ppb from 1977 to present. On August 30, 2000, Fallon received an Administrative Order requiring compliance with the arsenic MCL by September 15, 2003. This Administrative Order was replaced by a subsequent Administrative Order on August 28, 2002 that extended the deadline to April 15, 2004."

The Centers for Disease Control and Prevention state that arsenic exposure has not been linked to leukemia in adults or children. However, the Centers state that arsenic poisoning is still capable of causing cancer, even if inhaled.

Even though cancer is possible and in fact highly probable considering the possibility of exposure to arsenic, benzene or even tungsten that is occurring in Fallon, leukemia is harder to track. Part of the difficulty in tracing down a specific cause of leukemia lays in tracing down the causative agent. But Fallon itself presents something of a mystery because military families are exposed to the same substances that civilians are exposed to. Being more mobile makes the source of military families' exposure more difficult to trace because they could have been exposed prior to their entry to Fallon. In addition, the symptoms of leukemia may not become immediately apparent because they may take months or even years to present themselves.

In addition, tracing the source of exposure for military families is more difficult for a second reason: their symptoms may not start until after they've relocated to a completely new area. Any doctor that a military family approaches would have to take a systematic approach to every place that the family has been and find a commonality with other leukemia patients in terms of the area of exposure to determine definitively that being in Fallon was the "smoking gun" that caused the leukemia. It is entirely possible that a child of a military family has developed leukemia and that the family won't be aware of it for another few years. It is also possible that the same child already has leukemia and that the current doctor is looking for the causes solely in his current jurisdiction, even though the exposure actually occurred far from his office and even the town where he is practicing.

In any case, the best approach to staying healthy if you have been in Fallon for a prolonged period of time is to consult a doctor and have regular checkups. Also, if you leave Fallon it would be best if you told your current doctor that you were in Fallon. You can provide him with a copy of this blog.

This is more of my continuing series on new legislation in Nevada.

Assembly Bill 519 dated March 23, 2007 prohibits the district court from sealing a public record unless certain circumstances are met. For example, sealing the records may not have the purpose of concealing a public hazard and may not create a state of imminent danger to the public.

Before sealing a public record, the court also must hold a hearing, provide notice of such hearing to the parties and the public, and allow the parties to present evidence and briefs at the hearing.

To see the full assembly bill: http://www.leg.state.nv.us/74th/Bills/AB/AB519.pdf

It's always nice to see Courts take sane approaches to the insurance industry's ongoing efforts to eliminate medical malpractice as a legal claim in America.

In a November 14, 2007 article, the Chicago Tribune notes that the "controversy over limits on medical malpractice awards was ignited again after a Cook County judge on Tuesday struck down a 2-year-old state law that capped compensation to victims, a measure that had created a friendlier environment for doctors and health-care institutions and their insurers.

At issue is the state's system of legal accountability for health-care providers. Doctors and other supporters have argued for years that rising professional insurance costs, fueled by skyrocketing jury awards, are driving physicians out of business and compromising patient care.

Attorneys for personal-injury victims and consumer groups say that caps on jury awards in medical malpractice cases strip patients of their right to seek redress in court.

Illinois lawmakers have tried to strike a balance for years but have been overruled by the courts on three occasions.

Cook County Circuit Judge Diane Larsen decided that caps on malpractice awards violated the Illinois Constitution's "separation of powers" clause, in effect ruling that the legislature can't interfere with the right of juries and judges to determine fair damages. Her ruling falls in line with a 1997 Illinois Supreme Court decision that overturned a 1995 law implementing caps on personal-injury cases.

Defense lawyers said they plan to appeal Larsen's decision. Because she found a law unconstitutional, an appeal will go directly to the state Supreme Court.

The law imposed a cap on so-called non-economic damages in medical malpractice lawsuits, which juries award for things like pain and suffering. The limit is $500,000 in the case of individual doctors and $1 million for hospitals. There is no ceiling on economic damages that cover lost wages and the costs of medical care.

Caps created competition

Largely because of the caps and other reforms that were part of the law, the state's insurance market for medical liability has gotten more competitive. There are now at least a dozen malpractice carriers in Illinois, more than double the number from two years ago.

That has led to lower insurance rates for some doctors, in particular obstetricians, who have been especially hit hard by rising malpractice costs. Although rates vary from doctor to doctor and insurer to insurer, the average annual premium for an obstetrician in Cook County is about $125,000, down from about $200,000 or more before the legislation, according to Medicus Insurance Co. of Austin, Texas.

Insurance carriers were not prepared to say Tuesday's ruling would lead to a return to higher rates, saying they believed Larsen's opinion could be overturned by the Supreme Court. But carriers like Medicus say they came into Illinois because of legislative reform, caps and additional disclosures by carriers already doing business here.

"What is pretty clear is that rates have stabilized under tort reform," said Sheldon Davidow, president of Medicus, which began offering coverage this year and now covers more than 350 doctors. "If caps are removed, there is ultimately going to be a reassessment."

Medicus said the ruling was not enough to sway it to reconsider doing business in Illinois but doctors will be watching closely how it plays out.

"While I can tell you with certainty that we are going to stay in the state," Davidow said, "without the tort reforms, I am not sure that all the doctors will."

In a statement, the American Medical Association, the nation's largest physician group, said Tuesday's decision could hurt patients. "Today's ruling to strike down the medical liability cap in Illinois is a step backward for Illinois' patients and physicians as it once again puts patients' access to care in jeopardy."

Plaintiffs' lawyers criticized the AMA for trying to scare consumers into supporting the caps.

"This is a campaign of fear that is being used across the country," said Bruce Kohen, president of the Illinois Trial Lawyers Association. "It's the same pressure they used to get the flawed law passed."

Surviving court challenges

A number of states, including California, have passed caps on medical malpractice damages that have survived court challenges. In Texas, the cap law was approved on a voter referendum.

Personal-injury lawyers vowed to challenge the 2005 Illinois law as soon as it was enacted. The law was the third attempt by lawmakers to limit damages in civil suits since the 1970s. The first placed a $500,000 cap on all damages, including economic, in medical malpractice cases. The next attempt in 1995 included caps on pain and suffering in all civil actions, not just medical malpractice cases.

In 2005, legislators crafted a narrowly focused bill that limited non-economic awards just in medical liability cases.

Since the law's passage, plaintiffs' lawyers have been waiting for a test case. The first was filed last year on behalf of a Abigaile LeBron, a 13-month-old girl who suffered a severe brain injury during birth. The suit charged Gottlieb Memorial Hospital in Melrose Park, her doctor and nurse with negligence. An attorney for the hospital said his client is disappointed with the ruling.

Two other cases that challenged the law were filed, and all three suits were consolidated before Larsen in relation to the constitutional issue. The courtroom battle has drawn high-power attorneys, including Theodore Olson, the former U.S. solicitor general, who is representing the Illinois State Medical Society and its affiliated insurance company in the issue.

Why is it little surprise that a health insurer would work to exclude sick people?

According to the American Association of Justice, quoting Lisa Girion, writing for the Los Angeles Times, "one of the state's largest health insurers set goals and paid bonuses based in part on how many individual policyholders were dropped and how much money was saved.

Woodland Hills-based Health Net Inc. avoided paying $35.5 million in medical expenses by rescinding about 1,600 policies between 2000 and 2006. During that period, it paid its senior analyst in charge of cancellations more than $20,000 in bonuses based in part on her meeting or exceeding annual targets for revoking policies, documents disclosed Thursday showed."

The insurance industry's $11 million bellyflop against Referendum 67 was an election bright spot for ruling Democrats, who otherwise took their lumps from a frugal electorate that sent establishment ideas packing.

According to Curt Woodward, writing for the AP, the referendum, which allows triple damages in lawsuits alleging bad faith by insurance companies, spawned a lively campaign pitting the industry against trial lawyers.

Supporters said R-67 would give consumers a powerful tool to punish bad actors in the insurance industry. Opponents countered that it was an unnecessary magnet for unfounded lawsuits, and would drive up insurance rates.

But even though Washington voters displayed an anti-tax mood in other races around the state, they weren't swayed by the prospect of higher rates. R-67 cruised to victory, winning about 57 percent of the vote in unofficial returns through Wednesday afternoon.

Approve R-67 spokeswoman Sue Evans said the referendum fit squarely with voters' pocketbook-first mentality: if you pay for an insurance policy, you expect the company to play fair.

"Do people believe that insurance companies are going to be fair 100 percent of the time? Obviously, they don't," Evans said Wednesday. "And obviously, they expect to get what they pay for."

Reject R-67 spokeswoman Dana Childers sounded contrite, pledging to move past the bitter election and work with Democrats in Olympia. But opponents "remain convinced that Referendum 67 will result in more frivolous litigation and higher costs for consumers," she said.

The R-67 campaign was partially a proxy battle for the political parties, since trial lawyers often support Democrats and insurers are typically aligned with Republicans.

Supporters were also asking voters to endorse a plank of the Olympia Democrats' agenda, since the measure passed the Legislature on largely partyline votes and was signed into law by Democratic Gov. Chris Gregoire.

Democratic Insurance Commissioner Mike Kreidler -- up for re-election himself next year -- ended up with the sheen of a two-time winner and is clearly feeling his oats as a consumer advocate.

Kreidler, who successfully urged a double "no" vote on 2005's bruising medical malpractice initiatives, came out strong in favor of R-67 and won.

And even though his endorsement of R-67 in TV commercials prompted the opposition to question why Kreidler would "cede his authority to trial lawyers," Kreidler predicted a return to civility at the 2008 Legislature.

"I warned them in advance that if we were going to go to war, it was going to be difficult for me to do anything other than become active in support of the referendum," Kreidler said Wednesday.

"I would have been happier if we wouldn't have had to fight the battle at all," he said.

Reno and Sparks police have indicated that they will step up enforcement of seat belt use, at least through the end of November.

The Reno Gazette reports that of 30,521 passenger vehicle occupant fatalities nationwide last year, 15,523 were not restrained.

Further, of those who were not restrained, 75 percent were killed.

Buckle up.

For more information

It's relatively amazing that Judge Chuck Weller continues to be criticized. One would think that a judge who is shot by a crazed ex-husband might garner more sympathy than critique. But that hasn't really been the case for Judge Weller. In fact, it seems that those who support him are attorneys, many of whom may remain dependent on him to render decisions in their cases.

Martha Bellisle, writing for the Reno Gazette Journal on November 16, 2007, writes that in "the aftermath of Darren Mack's murder trial, supporters of Judge Weller are planning a newspaper ad that praises him while critics are proposing a class-action lawsuit accusing him of unethical abuse of power.

A group of local lawyers who practice in front of Weller in family court are gathering signatures for an advertisement that slams the media's coverage of Weller and states that his work on the bench is done with "integrity, professionalism and thoughtfulness."

"We think he's gotten a really bad deal," said Reno lawyer Marilyn York, one of the promoters of the Weller ad slated to be published in the form of a letter "to the citizens of Washoe County."

"He was being made out to be a monster," she said Thursday, referring to the harsh comments made about Weller by the jurors in the Mack trial. "He needs to know that he's got support out there because all he's hearing is negative."

Meanwhile, another group has posted plans for a class-action lawsuit against Weller on the Internet site Craigslist and have started a Web site looking for people who want to join, claiming he abused his position as a judge and caused "unnecessary emotional and financial stress."

"A number of people have come together and want to push forward with this lawsuit," said Laurel Armbrust, a former legislative staffer who is organizing the suit that seeks to unseat Weller and collect damages from the county and the state.

"They're frustrated with the unprofessional and unethical behavior of Judge Weller," she said. "It's unacceptable to have someone like that on the bench."

Weller said he had heard something about positive efforts by some lawyers, but did not know about any attempts to sue him.

"I appreciate their support," Weller said of the attorneys behind the proposed ad.

After viewing the Web site concerning the suit against him, Weller said: "Being supported by lawyers and being criticized by a murderer (Mack) is OK with me."

The public campaign by both sides followed Weller's testimony in the trial ended Nov. 5 with surprise guilty pleas just before the defense team was to begin its case.

Mack, 46, pleaded guilty to first-degree murder in the June 12, 2006, stabbing death of his estranged wife, Charla, 39.

Under the agreement with prosecutors, the judge will sentence Mack to life in prison with parole possible after 20 years. If the judge strays from that plan, Mack can drop his plea and go back to trial.

He also entered an "Alford" plea to one count of attempted murder with a deadly weapon in the sniper-style shooting of Weller, who was handling their contentious divorce. The special plea meant that Mack denied he was trying to kill Weller, but acknowledged that the prosecution had enough evidence to convict him.

During the trial, Weller testified about what happened the day he was hit with shrapnel as he stood in his third-floor chambers, and about his decisions in the Mack's hard-fought divorce.

When pressed by Mack lawyer David Chesnoff, Weller also defended his work on the bench and denied claims that he favored lawyers who supported his campaign. At one point, Weller was admonished by Judge Douglas Herndon for making the unsolicited statement that he had never had his reputation attacked in this way.

That comment and others drew harsh criticism from 11 jurors who agreed to speak publicly after the trial ended. Several called Weller "a jerk" and most said that his demeanor on the stand was offensive.

York said the proposed ad states that the jurors' comments should not have been reported by the media without comments from some of the lawyers who practice in front of Weller, and who find him to be fair.

"The jurors have no idea how Judge Weller manages his courtroom or practices as a judicial officer," the letter ad states. "It is outrageous that Judge Weller is being victimized yet again after a shooting that nearly took his life while he was doing the job that he was elected to do."

Family court cases are some of the most violent in the legal system, York said. And Weller should be commended -- not criticized -- for taking on a difficult job, she said.

"The point is you don't shoot people, and when they are shot, you rally around them and say it's not OK," York said.

Armbrust disagrees that Weller has done a good job.

She said she has been contacted by about 20 people who have been in Weller's courtroom and found him to be unfair, to the point of violating their constitutional rights. She said she has never had a case with Weller, therefore feels safe to go public with the suit, while others wish to remain anonymous out of fear of retaliation.

"Some still have active cases with him," Armbrust said.

The Web site calls for people to participate in the proposed lawsuit if they feel they've been "mistreated by this judge." The suit's intent is to hold Weller, the county and state "accountable for unethical, illegal, and unprofessional conduct of family court matters in Judge Charles Weller's courtroom."

"The lawsuit will demonstrate where Judge Charles Weller willfully, intentionally, and with absolute malice violated parties constitutional rights to due process and further through the abuse of his position and power cost parties unnecessary emotional and financial stress," the site states.

It seeks to remove Weller from the bench and seeks "an undisclosed financial settlement."

The rate of patients admitted to American hospitals with depression as a secondary diagnosis nearly tripled from 1995 to 2005, a new report found.

Jason Hildalgo, writing for The Reno Gazette Journal on November 19, 2007, writes that the number of patients admitted to hospitals for other conditions but are also found to suffer from depression jumped from 93 per 10,000 people to 247 per 10,000 people, according to the U.S. Agency for Healthcare Research and Quality. Meanwhile, the number of patients admitted solely for depression within the same 10-year period remained stable -- falling slightly from 45 per 10,000 people to 42 per 10,000 people.

In Nevada, hospitalizations for depression alone dropped from 4.1 per 10,000 people to 2.6 per 10,000 people from 2002 to 2005, said Pam Owens, senior research scientist for the agency. Add secondary diagnoses for depression to the list, however, and the rate climbs up from 45.9 per 10,000 people to 58.1 per 10,000 people Owens said. The agency couldn't provide an analysis of how much Nevada's numbers may have changed from 1995, Owens said.

"Unfortunately, we're only able to look at four years worth of data for Nevada because previous data wasn't available," Owens said. "The data seems to suggest that some of the trends we're seeing nationally are also going on in Nevada."

According to the study, people with a secondary diagnosis of depression were 3.5 times more likely to have a primary diagnosis of alcohol and substance abuse than patients who didn't have depression. The 2.9 million stays in 2005 that had depression as a primary or co-existing illness cost nearly $22 billion.

The report also focuses on numbers alone and doesn't delve into potential reasons why cases for depression are on the rise. Contributing factors can include an actual increase in the number of people suffering from depression, improved recognition of depression by health care providers and family members, or even more willingness among insurers to pay for treatment of depression, Owens said. The true reason won't be known, however, until an actual study is done to find out the cause for the increase in depression cases, Owens added.

"Mental health is an under-recognized condition," Owens said. "Clearly, more attention needs to be paid to hospitalizations and the treatment of depression. Studies have shown a strong link between the mind and the body. We need to investigate why this is happening."

A 30-year-old woman was one of four patients infected with HIV and hepatitis after an organ transplant.

According to a Yahoo! News Article dated November 16, 2007, the woman was not informed that the donor engaged in high-risk activities and, after the transplant, she was not immediately tested for HIV. These two circumstances put the University of Chicago, where the procedure was done, and the Gift of Hope Organ and Tissue Donor Network ,in violation of the U.S. Center for Disease Control and Prevention regulations (and also obviously exposes those institutions to potential civil liability.

The only information teh victim received about the donor was that he was a healthy young man. Two years earlier, the woman had rejected a donor because of his high risk lifestyle, leading one to believe that if she had been properly informed about this donor, she may have rejected this donor as well.

The donor was tested for HIV and hepatitis, but the test results were negative. He was listed as a high risk donor because he was a sexually active 38-year old gay man. CDC guidelines say that this type of person should only be used as a donor in case of an emergency.

A petition is being filed on the woman's behalf in Cook County. It asks officials to prevent hospitals and organ procurement centers from destroying or altering records about a donor.

According to an article by the Better Business Bureau dated October 19, 2007, the number of drivers across the United States, but especially in Nevada, without insurance is higher than would be expected.

In a recent study by the Insurance Research Council, one out of seven at-fault drivers is uninsured. In Nevada this number rises even more with seventeen percent of drivers uninsured. This can be compared with a fourteen percent national average.

While the article does not go into details about why this is the case, it does offer some suggestions for any driver to protect himself in the event of an accident.

When a motorist is uninsured, the victim of the accident has the responsibility to pay for everything himself. The BBB recommends that every driver gets uninsured motorist coverage on their policy so that he can be protected from the majority of these high costs. It also suggests getting rental car coverage so the motorist does not have to be without a vehicle while it is being repaired.

The last recommendation of the article is for all motorists to get underinsured motor vehicle coverage. In the event that an at-fault driver only has the bare minimum coverage on their policy, the victim of an accident may still have to pay for some of the damages himself. Underinsured motorist coverage pays the difference between the at-fault driver's limits and the actual costs of the damages. It also gives protection to a motorist who hits a pedestrian.

To see the full article, go to http://reno.bbb.org/WWWRoot/SitePage.aspx?site=100&id=aba21efe-da25-4c75-ad61-2d30bbb646da&art=1431.

A Reno pediatrician has told state lawmakers that a federal program designed to bring physicians to underserved areas of Nevada has resulted in "indentured servitude" for some of the foreign doctors.

Frank Mullen, reporting for the Reno Gazette Journal on Tuesday, writes that:

From 2001 until August 2006, Dr. Shaji Mathew was part of the J-1 program, in which Nevada doctors sponsor physicians from other nations to work in rural areas and other parts of the state where doctors are needed. The employment contracts generally last about three years, and doctors may then apply for citizenship.
Mathew told a legislative committee last month that his Las Vegas sponsor financially cheated him and threatened him with deportation if he refused to extend his employment agreement and cosign a loan to finance the Reno clinic where he worked.

The J-1 program is designed to bring doctors to medically underserved areas of the country. But some doctors say the system is largely unregulated and leaves doctors vulnerable to being overworked, underpaid and subject to threats against their work visas. The Nevada Health Division and state lawmakers are investigating the allegations, state officials said.

Mathew worked about five years for the Nevada Children's Clinic in Reno and left to start his own pediatrics practice. His former sponsor in the J-1 program is suing him for breach of contract; Mathew has filed a counterclaim in the case.

Michael Stein, the Las Vegas lawyer handling the claim against Mathew, said the doctor's allegations of indentured servitude have no merit. He said Mathew made wages much higher than he could have earned in India and is ungrateful for his opportunity.

"My client did a lot of nice things for this guy," Stein said. He said Mathew left the Reno clinic on short notice and the pediatrics practice had to close because there wasn't enough time to recruit and train other doctors to serve the clinic's patients.

"This is a breach of contract case and has nothing to do with indentured servitude," Stein said. "The J-1 visa issue is interesting, and I can't speak for the other doctors who complained. But in Dr. Mathew's case, an agreement was violated. "I'm confident our case will prevail."

Last month, the Las Vegas Sun published a series on J-1 doctors who said they were forced to work up to 100 hours a week at low pay, required to sign for loans to benefit their sponsors and were threatened with deportation if they complained.

"When I read about the other doctors in Las Vegas, I decided to testify (to the Legislative Committee on Health Care)," Mathew said. "I had experienced some of the same things."

Mathew's lawyer, Scott Tisevich of Reno, said his client's case is about a violation of the 13th Amendment, which prohibits slavery and indentured servitude. Mathew's counterclaim alleges he was "forced" to execute a loan guarantee of $75,000 as a condition of continuing his employment agreement.

Mathew admitted he walked away from his extended employment agreement last year but, in his counterclaim, contended the agreement is "void as being contrary to public policy" and "was obtained under duress" and therefore void.

Other states also are investigating allegations of abuse within the J-1 program and Congress is scheduled to reauthorize the program in June.

Scientists in the U.S. announced today in the journal Nature that they had created the first cloned monkey utilizing the same cloning techniques that brought us Dolly the Sheep (is Dolly still kickin'?) and other engineered animals including mice, pigs, cats, cows and dogs. The monkey is a rhesus macaque and was created (as I understand) from the cloned embryos of numerous rhesus macaque monkeys.

Needless to say, the progression of cloning has far-reaching implications. While numerous countries have legal bans on various aspects of cloning, most countries do not.

Ever wonder if a Red Bull could mess with your physiology? A better question for anyone who's ever had one might be: ever wonder how it couldn't?

A new study suggests a potential correlation between energy drinks and heart and blood pressure issues. Yahoo cites a new story from Will Dunham at Reuters:

The increasingly popular high-caffeine beverages called energy drinks may do more than give people a jolt of energy -- they may also boost heart rates and blood pressure levels, researchers said on Tuesday.

The results of a small study prompted the researchers to advise people who have high blood pressure or heart disease to avoid energy drinks because they could impact their blood pressure or change the effectiveness of their medications.

The drinks generally have high levels of caffeine and taurine, an amino acid found in protein-rich foods like meat and fish that can affect heart function and blood pressure, the researchers said.

"We saw increases in both blood pressure and heart rate in healthy volunteers who were just sitting in a chair watching movies. They weren't exercising. They were in a resting state," James Kalus of Henry Ford Hospital in Detroit, who led the study, said in an interview.

The increases did not rise to dangerous levels in the group of 15 healthy volunteers, whose average age was 26, the researchers said.

But the increases potentially could be significant in people with cardiovascular disease or those taking drugs to lower heart rate or blood pressure, they told a meeting of the American Heart Association in Orlando, Florida.

"While the amount of caffeine in energy drinks or coffee may cause a slight and temporary increase in blood pressure, it would have no greater effect than walking up a flight of steps," the American Beverage Association industry trade group said in a statement responding to the findings.

"So singling out energy drinks in a unique manner, particularly when compared to a more commonly consumed caffeinated beverage like coffee, does not provide a full and proper context for consumers."

BOOSTING ENERGY

The products have names like Full Throttle, Amp and Rush. Red Bull, made by Austrian company Red Bull GmbH, is a market leader. Beverage companies market various energy drinks as soft drinks that can boost a person's energy.

Kalus declined to say which brand of energy drink was used in the study. He said the drinks generally contain similar ingredients, adding, "By giving the brand, it would dilute the message that all of these drinks need to be looked at."

Coca-Cola Co. makes Full Throttle.

The study participants were asked not to consume other forms of caffeine for two days before starting the study and then throughout a study in which they consumed two cans of energy drinks daily over seven days. Each can contained 80 milligrams of caffeine and 1,000 milligrams of taurine.

The volunteers' heart rates rose by about 8 percent on the first day and 11 percent on the seventh day.

Maximum systolic blood pressure -- the top number in blood pressure readings that represents pressure while the heart contracts -- rose by 8 percent on the first day and 10 percent on the seventh day, the study showed.

Diastolic blood pressure -- the bottom number that gives the pressure when the heart relaxes between beats -- rose by 7 percent on the first day and 8 percent on the seventh day.

The study did not identify ingredients responsible for the changes, but Kalus said it probably was caffeine and taurine.

Kalus said the study did not address possible health effects from the way some people consume these drinks, such as mixing them with alcohol.

It's interesting that some Americans still seem oblivious (sometimes) to the fact that plastic surgery is dangerous. Patients sign informed consents (sometimes) without reading them and are surprised when a complication arises.

Americans are also too quick (sometimes) to blame their doctors when things go wrong.

Perhaps by way of example (perhaps not...), here's an opener from Yahoo's "omg!" column dated yesterday:

"The doctor who performed a tummy tuck and breast reduction on the mother of Kanye West is a plastic surgeon to Hollywood's elite and something of a celebrity himself, with a TV show of his own and a host of appearances on programs from "Extra" to 'Oprah.'

What Dr. Jan Adams hasn't publicized, however, is that the state medical board is investigating whether to revoke or suspend his license over alcohol-related arrests; that he has been the target of malpractice lawsuits; and that he's paid out nearly $500,000 in civil settlements."

I've brought suits against a lot of doctors over a lot of years, and one thing I know is that "nearly $500,000 in civil settlements" could mean something or it might not. The point is that $500,000 is not an outrageous amount of money to be paid in settlements by a doctor who's been practicing, assumedly, for a good number of years.

Similarly, a doctor's history of alcohol-related driving incidents may indicate he has chemical abuse problems or may mean he exercised very poor judgment and very bad luck on several isolated occasions.

The doctor in this case may become (or may already be) the victim of the press.

Americans should wait for the facts and the truth.

According to a Las Vegas Review Journal article, a physician and alternative medicine doctor in Carson City, Frank Shallenberger, entered a guilty plea admitting to malpractice for failure to diagnosis colon cancer in one of his patients. This misdiagnosis ultimately lead to the patient's death.

The doctor never performed any tests or examinations after the patient complained of symptoms of bleeding and pain that are frequently found in people with colon cancer. Rather, he treated the patient for hemorrhoids.

Dr. Shallenberger was fined $5,000.00, ordered to take 16 hours of classes on cancer screening, issued a public reprimand, and ordered to pay investigation costs of $6,500.00.

To view the entire article, please go to http://www.lvrj.com/news/9975426.html.

Apparently, it's the year of the product recall.

Now it's Nike, with their recall of 235,000 football helmet chin straps after receiving reports of head and facial injuries that resulted after the strap broke.

Not surprisingly, the chin strap was made in China. The strap was sold between 2006 and 2007.

You can see pictures of the strap at http://www.cpsc.gov/cpscpub/prerel/prhtml08/08081.html

I often borrow from D. Garth Sullivan, Esq. at Indox Consulting (www.indoxconsulting.com).

Here's an interesting study about Myspace and the disclosure of teen health risks:

Social networking sites, such as MySpace and Facebook, have become popular Internet venues for adolescent social interaction. Approximately 25% of the estimated 150-160 million users of MySpace, the largest site, are under age 18. Social networking Web sites allow users to create personal profiles, communicate with others, and join groups. Given that the adolescent developmental stage prioritizes peer relationships and identity exploration, the immense popularity of MySpace among adolescents may bring little surprise.

Personal Web profiles are multimedia creations featuring text, pictures, blogs, audio, and video all posted by the profile owner to represent his or her identity. Web profiles may be public and available to anyone on the Internet, or private and available only to those who the profile owner designates as "friends."

Recent media reports have highlighted cases in which young adults posted information about risk behaviors, such as sexual activity and substance use, on their publicly accessible Web profiles and experienced repercussions of these disclosures. It is worth noting that posting risk behavior information on a public Web profile may place adolescents at risk, regardless of whether or not that information is valid. These risks may include unwanted contact and adverse reactions from potential employers, school admissions officers, and others. Another risk is that displaying risk behavior information on Web profiles normalizes risky behavior within the adolescent cohort and may encourage peers to engage in risky behavior themselves.

The goal of this study was to determine how common such health risk behavior disclosures were in the public MySpace profiles of adolescents who actively use MySpace. We also assessed the prevalence of display of personally identifying information, such as name, picture, and hometown. Posting both identifiable and risk behavior information creates additional risks to adolescents, as individuals may be targeted on the basis of the display of risk behavior information, then easily identified and located.

Results of the Study

Our results demonstrate that several important risk factors can be identified effectively and efficiently using publicly available Web profiles. Some sites also feature internal search engines that allow rapid identification of profiles displaying risk behavior. On MySpace, for example, it is possible to search for users who self-identify as drinkers and smokers. Further, social networking Web sites typically allow direct access to a large number of adolescents through email.

Educators and providers may also create or work through one of the thousands of groups devoted to health topics on MySpace. Previous studies have demonstrated that Internet approaches to modify behavior can be effective in older populations. Social networking sites may provide a new venue for identification, assessment, and interventions to prevent or reduce health risks.

An important factor to consider when viewing information posted on MySpace is that social networking Web sites provide no verification of any information displayed on individuals' Web profiles. The validity of online personal risk behavior information has not been completely evaluated, but there are reasons to be concerned that such disclosures reflect either intent or actual behaviors.

Previous studies of Internet behaviors have shown that computer use often encourages self-disclosure and "hyperpersonal" information, which supports the validity of Internet self-report. Most teens reported that the majority of their online self-representation reflects their identity, but the presentation may not be entirely current. Previous studies have also shown that even on Web sites designed to promote identity experimentation and exploration, such as chat rooms, subjects generally evolved their online presentations to fit their own identities.

The Media Practice Model summarizes these findings by stating that adolescents choose and interact with media on the basis of who they are, or who they want to be, at the moment. This theory suggests that adolescent disclosures made on MySpace profiles reflect either actual behaviors or behavioral intent, both of which are of interest to healthcare providers, educators, and parents.
Limitations to this study include that, as described above, information displayed by profile owners, including ages, pictures, and behavioral descriptions, cannot be objectively verified. In particular, anecdotal reports suggest that teens frequently misrepresent their age on Web profiles in order to bypass security restrictions placed on the profiles of younger teens. We studied profiles within the class of 2008 group in an effort to improve the likelihood of viewing profiles of actual 16- and 17-year-old adolescents. However, targeting 16 and 17 year olds through this MySpace group biased our sample population to adolescents in school and who join online groups, limiting generalizability.

Finally, although our prevalences were stable between data checkpoints, this study conducted a detailed evaluation of a relatively small number of profiles compared with the total 11,000 available for the class of 2008 group. The results of this study nonetheless indicate that adolescents who are active users of MySpace regularly post health risk behaviors and display personal identification

Merck agreed to pay more than $4 billion to settle the majority of the claims that have arisen from their popular drug Vioxx. Victims and their families claim that Vioxx causes heart attacks and strokes.

Merck has won most of the Vioxx cases that have gone to trial and many observers actually believed that this was a favorable settlement for Merck.

Approximately 38,000 or the 60,000 Vioxx plaintiffs must agree to the settlement for it to proceed. Merck has indicated that it will defend all claims not included in the ultimate settlement.

For more information on this settlement, see the InjuryBoard.com Vioxx page. http://www.injuryboard.com/topic/vioxx--rofecoxib.aspx

See also, Jane Akre's InjuryBoard National News Desk: http://www.injuryboard.com/national-news/merck-to-settle-vioxx-claims.aspx?googleid=28392

As many Northern Nevadans are aware, a Reno jury recently handed down a major verdict against drug giant, Wyeth.

This comes from David Parker writing for the Reno Gazette Journal:

Wyeth plaintiffs Arlene Rowart, from left, of Incline Village, Jeraldine Scofield of Fallon and Pamela Forrester of Yerington listen shortly after the jury ruled in their favor in the trial against the pharmaceutical maker.

Three Nevada women, including one from Fallon, were awarded $99 million by Reno jurors in punitive damages Monday.

The women had claimed hormone replacement drugs distributed by pharmaceutical giant Wyeth caused their breast cancer.

An attorney for Wyeth called the award "an aberration" and said it would be appealed.

The Washoe County District Court jury initially issued a $134.5 million judgment against Wyeth last week, but Judge Robert Perry slashed that to $35 million after it became clear some of the jurors were under the mistaken belief the award was to include punitive damages intended to punish the company.

After lawyers for both sides gave closing arguments again Monday, the judge instructed the five-man, two-women jury to move to the punitive stage of the trial to consider whether the company's actions were so "reprehensible" that additional damages were warranted to punish it and discourage such behavior in the future.

"This verdict is an extreme aberration," said Heidi Hubbard, a partner in the law firm representing Wyeth. "It is inconsistent with every other hormone therapy case to be tried to date and it is inconsistent with the evidence."

The judgment for Jeraldine Scofield, 74, of Fallon; Arlene Rowatt, 67, of Incline Village; and Pamela Forrester, 65, of Yerington is by far the largest award to date against the Madison, N.J.-based company, which faces about 5,300 similar lawsuits across the country in state and federal courts.

All involve the drugs Premarin, an estrogen replacement, and Prempro, a combination of estrogen and progestin, prescribed for women to ease symptoms of menopause.

The jurors returned at 1 p.m. Monday, two hours after they began deliberations following an impassioned plea by one of the women's lawyers to return a large enough judgment to "get the attention and hold responsible" a company with a net worth of $14.6 billion.

"You already found Wyeth acted with fraud and malice. You found they did wrong. Now you can punish them for what they did to these women," Zoe Littlepage told the jurors.

"We're talking about a company that decided year after year to put their profits and money over the safety of their patients who got breast cancer," she said.

Dan Webb, Wyeth's lead attorney, urged the jury to re-examine the evidence thoroughly and resist the temptation to reissue the original $100 million judgment.

"You'll decide whether you've already punished Wyeth enough," Webb said. "For Ms. Littlepage to suggest you have not captured Wyeth's attention with your verdict is just wrong.

"My client has received the message."

Geraldine Scofield, 75, of Fallon said she was diagnosed with breast cancer seven years ago and is "somewhat optimistic" about her health.

Scofield, whose mother is 93, and who has no breast cancer in her family, remains active.

A mother and grandmother, she loves to quilt and meets weekly with a quilters group here.

When Scofield, who is a widow, was asked why she sued Wyeth, she answered, "because I'm mad and I'm upset that I have to go through the rest of my life worrying about having breast cancer."

Rural Texas is still waiting for the doctors tort reform was supposed to deliver. This comes from the American Association of Justice quoting Suzanne Batchelor writing for the Texas Observer:

The flood of beguiling baby photographs began cascading into mailboxes across Texas as the 2003 fall election drew near. Gracing the cover of a slick brochure, the infant smiled as a stethoscope--held by an unseen but presumably kind physician--was pressed to its chest. "Who Will Deliver Your Baby?" the mailer asked.

The direct-mail pitch was one of many churned out by insurance and medical interests as they spent millions urging voters to pass Proposition 12, a constitutional amendment that would limit the amount of money patients or their survivors could recover in medical malpractice lawsuits.

Swaddled in the glossy brochures was a dire threat. Greedy lawyers were besieging doctors with unwarranted lawsuits that were making malpractice insurance rates skyrocket. Doctors were fleeing Texas, leaving scores of counties with no obstetricians to deliver babies, no neurologists or orthopedic surgeons to tend to the ill. Without Proposition 12, the ad campaign warned, vast swaths of rural Texas would go begging for health care.

Choosing between greedy trial lawyers and cuddly babies was no contest for most Texas voters. Proposition 12 passed. Four years later, vast swaths of rural Texas are going begging for health care.

Proposition 12, and the far-reaching changes in Texas civil law that it dragged behind it, was built on a foundation of mistruths and sketchy assumptions. The number of doctors in the state was not falling, it was steadily rising, according to Texas Medical Board data. There was little statistical evidence showing that frivolous lawsuits were a significant force driving increases in malpractice premiums.

Perhaps the most insidious sleight of hand employed by Proposition 12 backers was their repeated insistence that medical malpractice insurance rates were somehow responsible for doctor shortages in rural Texas.

"Women in three out of five Texas counties do not have access to obstetricians. Imagine the hardship this creates for many pregnant women in our state," Gov. Rick Perry told a New York audience in October 2003 at the pro-tort-reform Manhattan Institute for Policy Research. "The problem has not been a lack of compassion among our medical community, but a lack of protection from abusive lawsuits."

The campaign's promise, that tort reform would cause doctors to begin returning to the state's sparsely populated regions, has now been tested for four years. It has not proven to be true.

Since Proposition 12 passed, insurance companies--many grudgingly--have lowered their rates. More doctors are coming to Texas, as a recent New York Times article trumpeted. That is proof, say Proposition 12's backers, that so-called tort reform is working.

"Texas has seen a tremendous success in luring doctors to practice in our state thanks to tort reform passed in 2003," says Krista Moody, Perry's deputy press secretary. Moody noted that the Texas Medical Board is having to add staff to handle a backlog of doctors applying for state licenses.

Those doctors are following the Willie Sutton model: They're going, understandably, where the better-paying jobs and career opportunities are, to the wealthy suburbs of Dallas and Houston, to growing places with larger, better-equipped hospitals and burgeoning medical communities.

On a Texas map inside the beguiling-baby mailer, blood red marked the 152 counties in Texas that did not have obstetricians in 2003. Rural doctor shortages were kept front and center as the state's physicians, led by the Texas Medical Association and the Texas Association of Obstetricians and Gynecologists, campaigned for Proposition 12.

A flier printed by the TMA in English and Spanish and posted in waiting rooms across the state told patients that "152 counties in Texas now have no obstetrician. Wide swaths of Texas have no neurosurgeon or orthopedic surgeon. ... The primary culprit for this crisis is an explosion in awards for non-economic (pain and suffering) damages in liability lawsuits. ... vote "YES!" on 12!"

As of September 2007, the number of counties without obstetricians is unchanged--152 counties still have none, according to the Observer's examination of county-by-county data at the state Medical Board.

Nearly half of Texas counties--124, or 49 percent--have no obstetrician, neurosurgeon, or orthopedic surgeon. Those specialists aside, 21 Texas counties have no physician of any kind. That's one county worse than before Proposition 12 passed, when 20 counties had no doctor.

The TMA counts 186 new obstetricians in Texas since Proposition 12 passed, and President Dr. William Hinchey offers that as proof of tort reform's effectiveness.

No independent study has shown what caused the increase, though Texas medical schools have graduated increasing numbers, by the hundreds, of physicians every year since 1997, the earliest year for which TMB posts data. And the state's growth probably played some part. According to the U.S. Census Bureau, Texas' population grew 12.7 percent between 2000 and 2006, compared with 6.4 percent for the country as a whole. The number of obstetricians in Texas increased only 4.27 percent over the same six years, including three years under tort reform.

More telling is where the new obstetricians--and neurosurgeons and orthopedic surgeons--decided to go.

The Medical Board's latest obstetrician data for the 254 Texas counties reveals that several counties led the gains.

Collin County, the Dallas suburb that is the wealthiest in Texas in terms of per capita income, gained the most obstetricians. Its 34 new ones increased its obstetrician ranks by an impressive 45 percent since Proposition 12 passed.

In second place is Montgomery County, Houston's northern neighbor along the booming Interstate 45 corridor, and the state's fourth-fastest growing county, according to the U.S. Census 2006 estimate. Montgomery gained 19 obstetricians. Tarrant County followed with 17.

Next, at 12 each, are Galveston and Hidalgo counties. Among the rest, a few counties gained in single digits, a few lost, and the majority of counties--two thirds--remained the same.

With well-equipped, well-staffed hospitals, plenty of colleagues, and insured patients, it's not hard to see why Collin County would attract the most obstetricians or offer them the most jobs. Collin's population grew 42.1 percent from 2000 to 2006; the county encompasses Plano, Carrollton, and a small part of Dallas.

The county's Presbyterian Hospital of Plano alone has 73 obstetricians and 30 neonatologists for newborns. Two allied hospitals serve nearby Allen and Dallas, and the three are far from Collin's only hospitals.

Margot and Ross Perot gave $6 million last October to the Presbyterian Hospital of Plano for maternal and infant care. The Margot Perot Center for Women and Infants has been named "Best Place to Have a Baby" by DallasChild magazine 11 years in a row. The Presbyterian system has even been honored locally for its baby sign-language classes.

The pattern of doctors' opting to practice in more affluent, urban areas holds true for Texas' overall gains in neurosurgeons (36) and orthopedic surgeons (185) since 2003.

The number of neurosurgeons statewide increased 8.8 percent in the past four years. The biggest share, again, went to Collin County, which gained seven. Bexar and Harris counties each gained five, while Lubbock gained four, and Tarrant, three. At last count 216 counties, or 85 percent, have no neurosurgeon.

Texas has added 185 orthopedic surgeons since 2003, a 10.3 percent increase. Harris County gained the most with 25, followed by Dallas County with 21, Tarrant County with 19, Travis County with 16, and Collin County with 15. There are no orthopedic surgeons in 169 Texas counties.

The following comes from the American Associaiton of Justice quoting Sheri Qualters at the National Law Journal:

American businesses are filing and fighting fewer lawsuits, according to Fulbright & Jaworski's fourth annual Litigation Trends Survey. Seventeen percent of respondents have not defended a lawsuit in the past year, compared with 11% in the prior year. The rate of corporations bringing at least one new lawsuit dropped to 65%, compared with more than 70% in the prior year and 88% in 2004. Only 22% of in-house counsel expect their companies to be involved in more legal disputes during the next year."

Yesterday I blogged on some of the negative aspects of binding arbitration. Here's more information on why this often misunderstood form of alternative dispute resolution can be problematic.

Buried in the fine print of most consumer contracts - such as credit cards, insurance plans and car deals - is a clause, which waives the buyer's constitutional right to trial by jury. These contracts mandate that consumers give up their rights before a dispute even occurs - this is called "mandatory, binding, pre-dispute arbitration." Arbitration was conceived as an informal, expedited process for resolving routine disputes between businesses. But when it is imposed on a weaker party, such as a consumer, arbitration can be used to defeat valid claims. Arbitration has several unique characteristics that stack the deck against consumers, making it harder for individuals to prevail in a dispute with a business.

Costs are high:An injured party must pay steep filing fees just to initiate a case--seldom less than $750. These fees do not cover the arbitrator's hourly charges, which are generally in the range of $200 to $300 per hour, split between the parties. All these fees must be deposited in advance, and almost always amount to thousands of dollars. Because the injured person has usually sustained a serious loss in the dispute with the business--foreclosure on a home, firing from a job, denial of medical care--most individuals covered by an arbitration clause cannot afford these costs and are forced to drop their cases.

Biased Arbitrators: Even though arbitrators are supposed to be impartial, they are often biased toward business, since only businesses will be repeat users of a particular arbitrator. If an arbitrator knows that a business may use them again and again, they are inclined to rule in their favor.

Limited discovery: Discovery is the process by which parties in a legal dispute obtain information and evidence in the possession of their opponent or third parties. In arbitration, discovery is a privilege, not a right, and many businesses draft arbitration clauses to severely restrict the consumer's ability to obtain necessary evidence. Moreover, since arbitrators do not have the power to enforce subpoenas, claimants must sometimes file lawsuits to get compliance--defeating the purpose of arbitration.

Prohibition of class actions: Nearly every arbitration clause prohibits participation in class action lawsuits. Class actions are the only effective remedy for wide-scale scams that rip off individual consumers or farmers in small amounts. Individuals do not have the time or resources to recognize, investigate, or prove the existence of such fraudulent practices.

Inconvenient locations: Arbitration clauses often require that hearings be held in a location inconvenient to the injured consumer or worker. Individuals may have to bear the cost of long-distance travel to have their case heard. For example, the Internet auction site e-Bay requires its customers to travel to its home turf of San Jose, California, to arbitrate any dispute.

One-way requirements. Most arbitration clauses require only the weaker party (the consumer, employee, or franchisee) to arbitrate his or her claims, while allowing the dominant party (the corporation) to sue in court on its claims. Thus, a sexual harassment victim can be forced to arbitrate a discrimination claim against a former employer, but if the employer sues to stop her from joining a competitor, the employer's claims are heard in court.

No public record. While proceedings and records of the courts are open to the public, most arbitration clauses and provider organizations require that proceedings be kept confidential. As a result, only the businesses that impose arbitration can track past decisions and know which arbitrators have ruled for them. Public discussion of the fairness of an arbitration ruling is discouraged, even if the case raises policy issues of wide concern. Moreover, arbitration sets no legal precedents to guide companies' future conduct.

Limited judicial review. Parties are allowed only limited judicial review of an arbitration award. A decision may only be overturned when there is fraud or "manifest disregard of the law." This is a very high hurdle to overcome because arbitrators are not required to issue written findings of fact or legal conclusions. Oddly enough, courts will refuse to hear appeals of arbitration decisions even when both sides have agreed to let a court do so!

Limited remedies. Courts can provide a range of remedies that are not available to a claimant in arbitration. Injunctive relief--a court order compelling the offending party to do something, or prohibiting that party from taking some action--cannot be obtained through arbitration. Arbitrators often split the difference between the two sides in awarding damages instead of determining the true costs of injuries. As a result, arbitration awards to consumers and employees are substantially lower than court awards.

Information for this blog comes from http://www.peopleoverprofits.org

There have been recent efforts by federal legislators to impose binding arbitration in a variety of contexts.

You may have never heard of Binding Mandatory Arbitration, but that would not prevent this unfair practice, visited on unsuspecting consumers, from destroying your life. Buried in the fine print of many consumer contracts for credit cards, new homes and cars are clauses that stack the deck against American consumers, forcing you to give up your rights to seek justice through the courts. And these contracts force you to surrender your rights before a dispute even occurs.

Binding Mandatory Arbitration prevents defrauded or wronged consumers from taking their cases to court. Instead, their cases are decided by arbitrators who are not bound by the rules that ensure consumers get a fair shake in the civil justice system. Their cases are never heard by a judge or jury and the arbitrators decision is usually impossible to appeal.

Currently, most Americans are bound by at least one Binding Mandatory Arbitration clause, often without their knowledge. Each day more home buyers, credit card users, insurance holders, and car buyers are forced to give up their constitutional right to have their case heard by a jury of their peers. So when powerful business interests take advantage of them, they are left with no recourse or remedy to recover their losses.

Do not get stuck the next time you apply for a credit card, buy a car or sign a contract for a new home. Do not let big corporations push you around.

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CARSON CITY, Nev. (AP) -- While state regulators have approved UnitedHealth Group's $2.6 billion purchase of Sierra Health Services Inc., Nevada's largest health insurer, the American Medical Association continued its fight against the deal during a congressional hearing Thursday.

The AMA's immediate past president, Dr. William Plested, asked the House Committee on Small Business to urge the federal Justice Department to block the purchase, saying it's part of a trend that will lead to a few big companies "that operate in the interest of shareholders rather than patients."

The Justice Department's approval is the last one needed for the deal to go through. Regulators in Nevada, California and Arizona already have endorsed the plan -- although Nevada Attorney General Catherine Cortez Masto still could intervene.

Plested told the House committee that the United-Sierra deal will "drastically" reduce competition because United would end up with 80 percent of the market in Nevada, and 94 percent of the market in the Las Vegas area, the state's population center.

Plested argued that the result could be a health insurer able to "raise prices, decrease compensation and reduce quality without fear of meaningful competitive market responses."

Sierra Health spokesman Peter O'Neill said discussions involving Sierra, UnitedHealth and the Justice Department are likely to continue "for the next several weeks." He also said the companies are cooperating with the Nevada attorney general's requests for information.

During hearings in Nevada, representatives of the two companies sought to reassure regulators that Las Vegas-based Sierra Health would retain its own leadership and expand services without raising rates.

While Nevada's insurance commissioner has approved the deal, Cortez Masto could go to state or federal court if she determines there's an antitrust violation.

Conditions imposed by state Insurance Commissioner Alice Molasky-Arman include a requirement that no acquisition costs be passed onto consumers or health care providers; and that premium costs and provider fees not be increased as a result of the deal.

The insurance commissioner also said local home office, management and employment should continue; and benefit plans shouldn't be scaled back.

Sierra Health has 310,000 members in employer-sponsored plans in Nevada and another 320,000 people in plans for retirees and government workers. The company posted 2006 profit of $140.5 million on revenue of $1.72 billion.

From Reno Gazette Journal: http://news.rgj.com/apps/pbcs.dll/article?AID=/20071025/NEWS18/710250363&oaso=news.rgj.com/breakingnews

Written by Brendan Riley of Associated Press

From D. Garth Sullivan at Indox Consulting:

Rapid assessment and treatment of a first transient ischemic attack (TIA) or minor ischemic stroke dramatically reduces risk for subsequent major stroke.

Two separate studies - one in the Lancet and the other in Lancet Neurology - show that such an approach reduces recurrent stroke risk by about 80%.

Initially presented in June 2007 at the 16th European Stroke Conference and reported by Medscape Neurology & Neurosurgery at that time, the Early Use of Existing Preventive Strategies for Stroke (EXPRESS) study from Oxford University, in the United Kingdom, showed a relative risk reduction at 90 days in major recurrent stroke of more than 80% among patients who received early, aggressive treatment for TIA or minor stroke.

"Our data indicate that urgent assessment and early initiation of a combination of existing preventive treatments can reduce risk of early recurrent stroke after TIA or minor stroke by about 80%. . . . Extrapolated across the UK population, this equates to the prevention of nearly 10,000 strokes per year," the EXPRESS investigators write.

The study is published online October 9 in the Lancet.

New Standard for Treatment of TIA

Known as the SOS-TIA program, neurological, arterial, and cardiac imaging that took place within 4 hours of admission assessed TIA patients. The study's primary outcome was stroke within 90 days.

The study is published online October 9 in Lancet Neurology.

The study included 1085 patients with suspected TIA who entered the SOS-TIA program between January 2003 and December 2005. Of these, 574 were seen within 24 hours of symptom onset; 701 had confirmed TIA or minor stroke and 144 had possible TIA.

The 643 patients with confirmed TIA all began a stroke prevention program, with 43 individuals undergoing urgent carotid revascularization and 44 individuals treated for atrial fibrillation with anticoagulants.

At 90 days, the stroke rate was 1.24%, compared with an expected rate of 5.96%. According to the authors, this suggests immediate treatment through a dedicated clinic reduced the risk for recurrence of TIA by almost 80%.

"We show prompt evaluation and treatment of patients with TIA in a dedicated outpatient unit is associated with a lower-than-expected risk of subsequent stroke. Because almost three-quarters of patients were discharged home on the same day as the diagnosis, the TIA clinic is also likely to involve lower costs and greater patient satisfaction about their management than is treatment without such a clinic," they write.

In an accompanying comment in Lancet Neurology, Walter Kernan, MD, and Joseph Schindler, MD, from Yale University School of Medicine, in New Haven, Connecticut, say Dr. Amarenco and colleagues have forged an important new paradigm for the early treatment of TIA and minor ischemic stroke.

"Rapid assessment and intervention is emerging as the new standard for TIA care. . . . We believe that the time is right to accept this new standard and to begin use of rapid access as a platform for rigorous testing of innovative strategies for TIA care," they write.