April 26, 2015

Missouri legislature proposes limits on medical malpractice awards

The Missouri legislature has sent Governor Jay Nixon a bill to limit awards for pain and suffering in medical malpractice cases.

Representative Eric Burlison (photo courtesy; Tim Bommel, Missouri House Communications)

Representative Eric Burlison (photo courtesy; Tim Bommel, Missouri House Communications)

It would cap awards that aren’t compensation for lost wages, medical costs or other quantifiable economic losses at $400,000. In cases defined by the bill as “catastrophic,” including paralysis, loss of vision or brain damage, the limit would be $700,000.

It would also extend the existing limit on non economic damages in wrongful death cases from $350,000 to $700,000, and all the caps would increase by 1.7-percent annually.

Supporters say the plan will keep liability insurance costs lower for doctors, meaning more will come to or remain in Missouri to practice. Opponents say caps will keep some patients from receiving a just award and allow doctors who harm patients to remain in practice.

House sponsor Eric Burlison (R-Springfield) said he would like the bill to have gone further.

“It’s disappointing that we’re not moving in a more competitive direction,” said Burlison. “We have states like Kansas and other states who, their caps are set at $250,000 and if you’re a practicing physician and you’re looking at where you’re going to go, if you’re in the Kansas City area you may still look at the State of Kansas. So while this is not really addressing that competitive situation, at least it’s better than the current status quo, which is that [doctors] … are open to all kinds of risk at this moment, because there are no caps.”

The state Supreme Court struck down caps on such damages in 2012.

The legislation received strong bipartisan support, clearing the state Senate 28-2 and the House 125-27.

The legislation is SB 239.

Veterinarians concerned dog flu outbreak could reach Missouri

An outbreak of dog flu hasn’t reportedly reached Missouri yet, but veterinarians in the state want dog owners to watch for symptoms.

The influenza A viral infection was first recognized in Chicago.  Wisconsin, Indiana, and Ohio have all had several cases of the influenza, but there have been no reported cases in Missouri.  The dog flu has infected around 1,000 dogs during the past few weeks and a small number of them have died.

University of Missouri Professor Leah Cohn (Photo courtesy of the University of Missouri)

University of Missouri Professor Leah Cohn (Photo courtesy of the University of Missouri)

University of Missouri Professor of Veterinary Internal Medicine Leah Cohn said the dog flu is highly contagious and told Missourinet what symptoms to look for.

“It causes dogs that are infected to develop a fever, to feel lousy, to not eat well, and have respiratory signs, so coughing, sneezing, nasal discharged, sometimes ocular discharge, just like a person with an influenza virus,” said Cohn.

Cohn said just like people with influenza, majority of dogs will recover over time.

“Some dogs on the other hand can become extremely sick and just as people with influenza can actually die of the infection, dogs can die too, but that’s the minority, most are going to be ok,” said Cohn.

Veterinarians say dogs with overall good health will be fine even if they are infected, but dogs that are older than seven years and younger than one are most at risk.  Cohn suggests keeping dogs up to date on routine vaccinations, heartworm prevention, and making sure they don’t have parasites.  Cohn said prevention relies on keeping dogs away from infected dogs.

“Avoid taking them to doggy daycares, or if you can have your animal watched in your home when you go out of town rather than going to a boarding facility or a kennel,” said Cohn.  “Perhaps avoiding dog parks in times like these because it is a contagious disease and their only going to catch it if they are exposed to other dogs.”

Cohn suggests contacting a veterinarian by phone about a sick dog before taking it to a hospital.

“You want to avoid exposing other dogs to your dog when it’s sick, so one of the very importing things to do, is try to keep your dog isolated and away from other dogs if it’s showing respiratory signs,” said Cohn.

Cohn said there is a vaccination for canine influenza, but it may not be effective for this particular new strain.  Cohn said avoiding the virus might be more effective than vaccination, and it is likely the outbreak will run its course and die down over time.

“I would avoid taking my dog to areas where there likely to be exposed to a number of other dogs right now while this epidemic plays itself out,” said Cohn.

Cohn said the dog flu does not affect humans, but the virus could be transmitted to cats.

After 6-hour delay Missouri Social Services budget failed, then passed

The proposed budget for the Missouri Department of Social Services was rejected early this morning, before the Senate reversed itself.

Senators Kurt Schaefer (left) and Rob Schaaf (right)  (photos courtesy; Missouri Senate Communications)

Senators Kurt Schaefer (left) and Rob Schaaf (right) (photos courtesy; Missouri Senate Communications)

Senators who opposed adding some 200,000 Missourians to a managed care system, in which a private company manages health benefits for consumers, held up a vote on the Social Services Department’s budget for six hours. When a vote finally came the bill failed, but on a second vote it got the 18 needed to pass.

Senator Rob Schaaf (R-St. Joseph) led the effort against the managed care expansion, calling it a significant shift in policy that should not be made in the state’s budget.

“We’re talking about putting 200,000 Missourians on managed care without even so much as a hearing. Not even a hearing, where we could vet this. Where we could talk about it,” said Schaaf. “We’re not even allowed to have the public come and comment.”

Budget Committee Chairman Kurt Schaefer says the idea has had plenty of debate.

“The Senator from St. Francois [County] chaired a committee that met over the summer. They had multiple hearings all over the state. They heard from a lot of witnesses. It was their number one recommendation. The House has had hearings on this,” said Schaefer. “To say that there’s been no hearings on this is ridiculous.”

The two sides disagree on whether managed care is cost-effective and better for patients.

That bill and the other 12 bills that make up the proposed state budget now faces another round of debate in a House-Senate conference committee.

Schaefer says he intends to defend the proposal in that conference.

“I’m adamant in the fact that we’re going to rein in welfare growth,” Schaefer said. He said the proposed budget passed by the Senate this morning would provide the Department of Social Services more than it spent last year, “but we’re going to rein in that growth. I’m adamant on that and pushed forward with it and I’m glad that I had the support from the members that I did.”

Missouri Senate passes prescription drug monitoring program

A proposal that has been blocked in the Missouri Senate repeatedly in recent years has advanced.  The Senate has passed a bill that would establish a state prescription drug monitoring program, but some lawmakers still have concerns.

Senator David Sater  (photo courtesy; Missouri Senate)

Senator David Sater (photo courtesy; Missouri Senate)

Senator David Sater’s bill would track prescriptions and sales of highly addictive medications such as painkillers.  Similar bills in the past filed by Sater have been held up because of privacy concerns about the data collected, but this year Sater included measures meant to improve protections and penalties for misuse.

“I think we have probably the most secure, the most effective [prescription drug monitoring program] bill in the United States,” said Sater.

Missouri is the only state in the country without a prescription drug monitoring program.

Senator Ed Emery said he appreciates the work done to make this bill better than other states’, but he still opposes it.

Senator Ed Emery  (photo courtesy; Missouri Senate)

Senator Ed Emery (photo courtesy; Missouri Senate)

“I personally didn’t take an oath to those other states’ laws, or to making better laws than those states.  I took an oath to the constitution.  I still believe this is an unconstitutional provision,” said Emery.  “Regardless of the work that’s been done to try to avoid the pitfalls of other states, I still believe that we as a body should reject it.”

Senator Will Kraus is also concerned about privacy issues with the data collected.

“We’re taking personal information from individuals that have done nothing wrong and putting it into a government database, and I for one just don’t believe that’s what we should be doing,” said Kraus.  “I think that whenever you take an innocent person’s information and put it in a database that takes away their liberty that takes away their freedoms.”

Senator Will Kraus (photo courtesy; Missouri Senate)

Senator Will Kraus (photo courtesy; Missouri Senate)

Sater said prescription drug abuse amongst teens is on the rise.

“It a major problem for the abusers and also for our kids,” said Sater.  “We have a growing problem with opiate abuse in our teenage population also.”

The bill was passed 24-10 and now goes to the House, which passed its own version of a prescription drug monitoring program earlier this year.  The two chambers will now to try to compromise, or choose, between the two versions.

 

 

Missouri study: common bacteria getting bolder, more antibiotic resistant

The findings of a Washington University School of Medicine study suggest that common bacteria could be on the verge of becoming antibiotic resistant super bugs.

Researchers said a family of bacteria commonly found in hospitals may be building defenses against some antibiotics. Doctor Gautam Dantas said this resistance will likely spread globally and the results could be deadly.  Dantas said physicians need to be judicious in how they use antibiotics.

Super bug - antibiotic-resistant bacteria (CDC/James Archer)

Super bug – antibiotic-resistant bacteria (CDC/James Archer)

“It’s a little bit of a conundrum. If we don’t get the antibiotics, people might succumb, but the more we give them, the more resistant the bugs become,” said Dantas.  “Every time we use an antibiotic, we run an experiment.  We run an experiment where we challenge bacteria to get more resistant and we need to save that for the times when it’s absolutely necessary.”

The study shows two genes found in a bacteria family frequently implicated in respiratory and urinary infections in hospitals are forming resistance against a strong class of antibiotics. Carbapenems, the strong antibiotics, are what are usually used to treat gravely ill patients suffering from bacteria infections.

Dantas said sick people with weakened immune systems visiting the intensive care unit could be at risk.

“If you happen to get an infection from one of these bugs, there’s a greater than 50 percent chance you won’t make it out,” said Dantas.  “If you were healthy, you could be carrying that same bug around and it will probably do nothing to you.”

The study was conducted by researchers at Washington University in St. Louis, Barnes-Jewish Hospital, and the National University of Sciences and Technology in Pakistan.