Case Update -- Jada Ruiz-Jones

The case of 9-month-old Jada Ruiz-Jones continues in an Akron, Ohio court.  Jada's mother wants to heed physician recommendations to discontinue life support.  The father does not.  

On Tuesday, three physicians from Akron Children's Hospital testified that Jada should be allowed to die naturally.  John Pope, the director of the PICU testified that if Jada remains on life support, she will need surgery to place rubes for breathing and feeding.  But Pope (no relation) doubts that there is any doctor who would even perform such surgery given Jada's condition.  (Akron Beacon-Journal)

Vegetative Patients React to Tchaikovsky

We have read about the fMRI studies with vegetative patients that show certain brain activity in response to certain questions.  Now, in a new article forthcoming in Clinical Neurophysiology, Francesco Riganello and Italian colleagues show that music affects the heart rates of vegetative patients in just the same way that it affects the heart rate of healthy patients.  "Positive" music slows the heart rate, while "negative" pieces like Tchaikovsky's sixth symphony increased heart rate.  Of course, the fact that "automatic" brain functions work does not mean that any higher cognitive ones do too.

National Advisory Council for Healthcare Research and Quality: Request for Nominations for Public Members

[75 Fed. Reg. 38,819] -- Section 921 (now Section 941 of the Public Health Service Act (PHS Act)), 42 U.S.C. 299c, established a National Advisory Council for Healthcare Research and Quality (the Council). The Council is to advise the Secretary of HHS (Secretary) and the Director of the Agency for Healthcare Research and Quality (AHRQ) on activities proposed or undertaken to carry out the agency mission including providing guidance on (A) Priorities for health care research, (B) the field of health care research including training needs and information dissemination on health care quality and (C) the role of the Agency in light of private sector activity and opportunities for public private partnerships. 

Seven current members' terms will expire in November 2010. To fill these positions in accordance with the legislative mandate establishing the Council, we are seeking individuals who are distinguished: (1) In the conduct of research, demonstration projects, and evaluations with respect to health care; (2) in the fields of health care quality research or

health care improvement; (3) in the practice of medicine; (4) in other health professions; (5) in the fields of health care economics, information systems, law, ethics, business, or public policy; and (6) individuals who could represent the interests of patients and consumers of health care; and (7) the private health care sector (including health plans, providers, and purchasers) possibly including distinguished administrators of health care delivery systems., Individuals are particularly sought with experience and success in activities specified in the summary above. 

DATES: Nominations should be received on or before 60 days after date of publication. 

ADDRESSES: Nominations should be sent to Ms. Karen Brooks, AHRQ, 540 Gaither Road, Room 3006, Rockville, Maryland 20850. Nominations may also be e-mailed to mailto: AHRQ National Advisory Council@AHRQ.hhs.gov or faxed to (301) 427-1201. 

FOR FURTHER INFORMATION CONTACT: Ms. Karen Brooks, AHRQ, at (301) 427-1801. 

SUPPLEMENTARY INFORMATION: Section 941 of the PHS Act, 42 U.S.C. 299c, provides that the Secretary shall appoint to the National Advisory council for Healthcare Research and Quality twenty one appropriately qualified individuals and specifies that at least seventeen members shall be representatives of the public and at least one member shall be a specialist in the rural aspects of one or more of the professions or fields listed in the above summary. In addition, the Secretary is directed to designate, as ex officio members, representatives from Federal agencies specified in the authorizing legislation, principally agencies that conduct or support health care research, as well as other Federal officials the Secretary may consider appropriate. The Council meets in the Washington, DC, metropolitan area, generally in Rockville, Maryland, approximately three times a year to provide broad guidance to the Secretary and AHRQ's Director, as described above, on the direction of and programs undertaken by AHRQ. 

Seven individuals will be selected presently by the Secretary to serve on the Council beginning with the meeting in the spring of 2011. Members generally serve 3-year terms. Appointments are staggered to permit an orderly rotation of membership. 

Interested persons may nominate one or more qualified persons for membership on the Council. Self-nominations are accepted. Nominations shall include: (1) A copy of the nominee's resume or curriculum vitae; and (2) a statement that the nominee is willing to serve as a member of the Council. Selected candidates will be asked to provide detailed information concerning their financial interests, consultant positions and research grants and contracts, to permit evaluation of possible sources of conflict of interest. Please note that once you are nominated, AHRQ may consider your nomination for future positions on the Council. In accordance with a Memorandum from the President dated June 18, 2010, Federally registered lobbyists are not eligible for positions on Federal advisory councils. 

The Department seeks broad and diverse geographic representation on the Council. In addition, since AHRQ is mandated to conduct and support research concerning priority populations, which under 42 U.S.C. 299(c) includes: Low-income groups; minority groups; women; children; the elderly; and individuals with special health care needs, including individuals with disabilities and individuals who need chronic care or end-of-life health care, nominations of individuals with expertise in health care for these priority populations are encouraged.  

Blumenauer to Announce Revamped End of Life Care Legislation

This afternoon, Congressman Earl Blumenauer (D-Ore) will announce the introduction of bipartisan legislation that would provide a Medicare and Medicaid benefit for voluntary patient-physician consultations regarding advance care planning. These consultations will ensure that individuals' values and goals for care are identified, understood, and respected.



Blumenauer introduced similar legislation was in 2009, which former Governor Sarah Palin warned would lead to the creation of "government death panels." The bill passed the House of Representatives as part of the health care reform bill, and Palin's assertion was named "Lie of the Year" by PolitiFact.



The legislation also provides grants to states to create Physician Orders for Life Sustaining Treatment (POLST) programs, allows portability of advance directives across states, and requires standards to include completed advance care planning documents within a patient's electronic health record, increasing the likelihood these documents are kept up-to-date and available. The Personalize Your Care Act will be introduced when Congress returns from recess. 

Donald Berwick Now Heads CMS

Today, President Obama appointed Donald Berwick the administrator of the Centers for Medicare & Medicaid Services.  

Obama appointed Berwick under a recess appointment, allowing him to bypass the Senate confirmation procedures. Under the recess appointment, Berwick can stay in his position through the end of 2011.  Berwick had been facing a difficult nomination fight as Republicans have attacked him since he was nominated for the post in April, claiming he supports health care rationing. 

EXTRAORDINARY MEASURES? HOSPITAL WANTS RIGHT TO DENY THEM

From the July 2010 Medical Malpractice Law and Strategy 27(10): 5.

In the case of Betancourt v. Trinitas Regional Medical Hospital, A-3849-08, a New Jersey appellate court is being asked to decide for the first time whether hospitals should be permitted a say in whether extraordinary measures are employed to keep comatose patients alive.  In the suit, the hospital claims that “compelling a hospital and its independent physicians to provide medical services that are contrary to recognized standards of care to a moribund permanently vegetative person which will do nothing more than prolong an inhumane, painful death” is inconsistent with state law. The case arose after 72-yearold Ruben Betancourt suffered brain damage after accidentally removing his own ventilating tube following an operation. After he had spent a year in a persistent vegetative state, Betancourt's daughter became concerned that his doctors were unilaterally making medical decisions for him, such as by discontinuing his dialysis and issuing a “Do Not Resuscitate” order.  She therefore went to court and was appointed guardian. The hospital appealed. In May 2009, before oral argument at the Appellate Division, Betancourt died. Now the plaintiff wants the case dropped as moot, while the hospital wants it to go forward, arguing that the appellate court should hear the case because it “presents issues of grave public importance.” 

Studholme Responds to Codey and Ryan

The series of op-eds concerning the Betancourt v. Trinitas Hospital case keeps growing.  Today, Anne Studholme (counsel for American Association of People with Disabilities, Disability Rights New Jersey, the National Spinal Cord Injury Association, the Center for Self-Determination, the National Council on Independent Living, Not Dead Yet and ADAPT) responds, in The Record to an earlier column by hospital amici Patricia Codey (NJ Catholic Healthcare Partnership) and Elizabeth Ryan (NJ Hospital Association).