HERE COMES THE FLOOD

California Healthcare News first published this article, Here Comes the Flood, on October 8, 2019.

“For as in the days that were before the flood they were eating and drinking, marrying and giving in marriage, until the day that Noe entered into the ark.” 

—  Matthew 24:38 (King James Version)

Yesteryear

         Once upon a time the world existed without the system of interconnected computer networks to link devices across the globe. Information was sparse and communication slow in this modern day antiquity, a time when people relied upon encyclopedias and regular mail instead of Wikipedia and the act of composing and sending electronic messages, typically consisting of alphabetic and numeric characters, between two or more users of mobile or laptop devices.

         Equally barbaric was the need to develop film upon returning from a trip and waiting, sometimes days, before viewing these photographs for the first time.  In health care, radiology was still a physical department, and “the x-ray” referred to a large machine that produced a large film that a real physician on site had to review before rendering certain diagnoses.  It was a time when “telemedicine” meant speaking with your doctor on a telephone, and sometimes with a rotary dial. … Read more →

Administrative, Clinical, Community, Health Care Law, Historical, Hospitals, News, Regulatory

The Insanity of Treating the Insane

This article the Insanity of Treating the Insane first appeared in Healthcare News on July 9, 2019.

The Insanity of Treating the Insane

“Heaven wheels above you, displaying to you her eternal glories, and still your eyes are on the ground.” – Durante di Alighiero degli Alighieri

There Is No Safety In Numbers

Not long ago, health care practitioners treated mental illness by severing connections in the brain’s prefrontal cortex.  Surgeons employed this procedure known as “the lobotomy” to reduce symptoms of mental disorder.  Those who survived the lobotomy sometimes experienced relief from mental illness as well as less spontaneity, responsiveness, self-awareness and self-control.  While the lobotomy has drifted off to medical obscurity, 75 years later an estimated 20 million Americans still embrace the idea that restricting the intellectual and emotional range of the sick mind also cures it.

Treating mental illness relies upon the subjective, while somatic matters approach illness through diagnostic testing which can often yield a more precise diagnosis.  That which is psycho has a seemingly unfair disadvantage to somatic, although general medicine has enjoyed far more decades to advance from its early days of leeches and amputations.  By comparison mental health treatment exists in its infancy.  For the patient, opioids have replaced the orbitoclast (lobotomy’s primary surgical instrument, described as an ice pick with some gradation marks), although the nine million Americans who suffer from mental illness fall somewhere within an estimated 20 million also suffering from substance use disorder (“SUD”).

The concentric circle occupied by the brain both sick and sickened may as well be infinite, at least to the extent modern medicine understands co-occurring disorders.  … Read more →

Administrative, Clinical, Health Care Law, Health Care Reform, Historical, Hospitals, News, Non Clinical, Regulatory, Technology

Infecting the Hippocratic Oath

Healthcare News first published this article “Infecting the Hippocratic Oath” on April 9, 2019.

“We live in a society exquisitely dependent on science and technology, in which hardly anyone knows anything about science and technology.” 

–Carl Edward Sagan

Medicine Gets Sick

Somewhere deep within the labyrinth of regulations promulgated since Congress passed the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and the Health Information Technology for Economic and Clinical Health Act (“HITECH”) in 2009 exists health care’s very own Kobayashi Maru. Mindful of the draconian consequences in deviating from the so-called HIPAA Privacy Rule, health care practitioners who follow these national standards to defend individual medical records and other protected health information (“PHI”) sometimes must stand down like a Star Fleet cadet forced to watch the entire crew and passengers of another vessel perish. On the other hand, those rogue clinicians who chose rescue over risk may face attack from federal and state authorities.

Governmental response to lapses in safeguarding PHI is due, in part, to algorithmic steps undertaken by malware, including exfiltration attempts between the malware and attackers’ command and control servers, not to mention the possibility of malware propagating to other systems, potentially affecting additional sources of electronic PHI (“ePHI”). While digitizing patient medical records remains a top national priority, fear of compromising confidentiality is still its greatest obstacle. To the unwitting health care provider, the choice between an investigation by the Office of Civil Rights (“OCR”) or a threat from ordinary malware may be just as devastating as an attack from a Klingon Negh ‘Var-class warship.

The Cost to Comply

Health care must finally surrender to systemic futility when providers wage war against disease with an arsenal that protects PHI first. Even under the guise of the Hippocratic Oath and its sacrosanct directive to help or at least do not harm the patient, the physician may not risk PHI exposure. Hippocrates’ lesser known principle included an obligation to keep the “holy things” of medicine confidential, and federal and state regulations remain vigilant as to both. Those responsible for drafting patient privacy laws, however, never imagined a malicious software from cryptovirology could make public PHI or perpetually block all access until a ransom is paid, or that it would occur 181.5 million times in the first six months of 2018 alone. … Read more →

Administrative, Clinical, Health Care Law, Health Care Reform, Historical, Hospitals, Technology

How to Spell Health Care Without R-E-F-O-R-M

Healthcare News first published this article How to Spell Health Care Without Reform on January 8, 2019.

“God gives the nuts, but he does not crack them.” – Franz Kafka

The Federal Bench

There are more than 850 justices and judges (excluding magistrates and administrative law judges) in the United States federal court system, spread out over 94 judicial districts, 13 appellate courts and one Supreme Court.  In 2017, there were 274,547 cases filed in the District Court, 295,956 cases terminated, while another 338,013 cases remained.  For the same time period in the U.S. Court of Appeals, 49,816 cases commenced, 53,756 terminated, yet still 38,876 remained.

Any dispute involving (1) the United States government, (2) the U.S. Constitution or a federal law, or (3) a controversy between states or between the U.S. government and any foreign government, falls under the jurisdiction of the federal court system.  Additionally, 30,000 more judges oversee another 90 million state court lawsuits filed each year in America’s 50 states and 3 districts (District of Columbia, Guam and Puerto Rico).

Federal and state courts share the burden in resolving domestic health care disputes, although the federal system bears the heavier load when it comes to Medicare and the 2010 Patient Protection and Affordable Care Act (ACA), also known as “Obamacare.”  Still, it is neither plausible nor prudent for less than 0.12 percent of the federal judiciary to effectively “veto” a system so important as health care.  In 2017, approximately 294.6 million Americans had health insurance coverage to rest in one of the 894,575 beds in any of the 5,534 United States hospitals, or see one of 953,000 actively licensed allopathic and osteopathic physicians, still leaving room for the other 31 million people in the United States without health insurance.  While the ACA qualifies as landmark legislation, historical hindsight may someday place health care reform’s success in its first decade on par with President Lincoln’s Emancipation Proclamation. … Read more →

Administrative, Clinical, Community, Health Care Law, Health Care Reform, Historical, Hospitals, News, Regulatory, Uncategorized