An hour after being discharged from the Emergency Room: Conflict of interest on a potential malpractice suit

Dr. J.R.'s question:
I am a family physician. A patient I'd not seen in months passed away about an hour after being discharged from an emergency room. Her mother, also my patient, asked me to review the records and autopsy to see if she should bring a malpractice suit against the E.R. physician and the hospital. I am friends with the physician and on the hospital's board. Ought I comply with this request?


Ethicist Randy Cohen's answer:
You should not. Indeed, you cannot – not properly, not without risking charges of bias. Your attachment to your friend and your position on the hospital's board create – or may seem to create – divided loyalties. You should recuse yourself from this task, explain to the patient's mother why you are doing so and refer her to a disinterested physician with the expertise to review the records and advise her how best to proceed.

Update: J.R. met with the family but did not offer a medical opinion, explaining that the records provided insufficient information for him to do so. He said he believed that they would not be satisfied unless the matter were investigated further and so suggested they speak to a lawyer who would have a neutral expert review the case.


Advice to family members considering a lawsuit for a medical error: Consult a doctor or nurse who was not involved.


Thanks to Randy Cohen for the source article in the Ethicist column of the New York Times Magazine of May 25.

Cancer is not a football game: Teddy Kennedy's brain cancer

The mantra of "fighting" cancer drives me nuts. The caring behind it is wonderful; the metaphor is not. Cancer is not a football game. The fighting metaphor is insidious because it implies that if you fight, you can "win." And if you don't fight hard enough, you are therefore a "loser."

The challenge for Teddy Kennedy, just diagnosed with brain cancer, is to figure out where the locus of our limited control lies. He can't change the fact of his diagnosis. But he can, and already has, chosen his doctors wisely. He is putting his resources now, appropriately, into learning about his cancer, what drives it, and what might slow it down. He may have to choose additional doctors, anywhere in the world. That's great. That's the stuff that really is under his control. As is choosing how to spend his time and energy. He is already doing all the right things.

So, I would change the mantra to "Breathe, Ted, breathe." Sail your boat. Kiss your wife and your kids. Trust your doctors. Keep doing the work you love.

Advice to cancer patients: Focus, like Teddy, on what is within your control.

Read last week’s post on Teddy.

Thanks to Judy Foreman for the source article in the May 27 issue of the Boston Globe.

I should be an indignant patient-plaintiff: Apology for drug interactions and other medical errors

Amy Silverstein’s story:
For the many errors that I have witnessed as a heart transplant patient at a well-regarded New York City hospital over the last 20 years, there has been only one doctor with the courage and character to say "I'm sorry."

I should be one of the "indignant" patient-plaintiffs who send legal costs and insurance rates soaring, but I am not. Money cannot heal the ways that I – and many other patients – have been damaged.

It does not take the surgical removal of the wrong kidney or arm – the stuff of lawsuits – to bring about the kind of injury worthy of a hospital's attention. A patient fills a prescription written by her doctor, only to be warned by the package insert that the drug interacts dangerously with another medication prescribed by this same doctor, and there is error, destruction of trust and near loss of life. And no one pays attention.

Even without the threat of lawsuit, a wronged patient deserves some long, hard thought among doctors and hospital administrators.

The writer is the author of "Sick Girl," a memoir.

Advice: Read the package insert after you pick up your prescription.

Read a celebrity’s fatal drug interaction story.

Thanks to Amy for her source letter to the editor, printed in the May 26 issue of the New York Times.

Memorial Day: Veterans’ medical misadventures

We remember these Iraq veterans who have had medical errors:

Sgt. Michael Boothby
(Delayed treatment)


Corporal Cody Hill
(delayed rehabilitation for extensive burns)


Lance Corporal Jeffrey Lucey, deceased.
(lack of access to services)


Cpl. Casey Owens
(delayed approval of surgery; lack of access to services)



Sgt. John Daniel Shannon
(delayed treatment for traumatic brain injury)


Lance Corporal Michael Stubbs
(delayed diagnosis; lack of access to services)


Staff Sgt. Mark Taylor
(misdiagnosis)


Sgt. Edward Wade
(delayed care for traumatic brain injury)

Memorial Day: We Remember

This weekend we recall these victims of medical errors, among many others:

Doug Bonderud


Elaine Bromiley (anesthesia error)


Armando Castellanos
(medication error)


Jasmine Gant
(medication error)


Betsy Lehman (medication error)



Brendan McDowell


Cheatum Myers
(nursing home neglect)


Naomi Press (nursing home neglect)


Jesica Santillan (transfusion error)

Seventeen weeks today: Quitting smoking with a buddy

JLynnJ’s story:
My sister and I took the quitting plunge together. We have both smoked since we were in college, she's 36 and I'm 31. She puffed her last cigg on Jan 15th, mine was on Jan 23rd, of this year. We both used the patch and followed the directions to a "T". It's been over 4 months now, and neither of us have cheated. We even took a trip to Vegas and made it without smoking. To me, this is proof that the buddy system does work!!! So smokers, get a buddy and quit, you will be sooo glad you did.

The urge to smoke is contagious, but quitting apparently is, too. A team of researchers who showed obesity can spread person-to-person has found a similar pattern with smoking cessation: A smoker is more likely to kick the habit if a spouse, friend, co-worker or sibling did as well. What's more, smokers tend to quit in groups and those who don't stop puffing increasingly find themselves pushed to the edge of their social circles, the researchers found.

"Your smoking behavior depends upon not just the smoking behavior of the people you know, but also the people who they know," and so on, said Dr. Nicholas Christakis, a medical sociologist at Harvard Medical School and lead author of the report.
The findings back up previous studies showing that peer influence plays a key role in a person's decision to stop lighting up and provide evidence that the "buddy system" used by smoking cessation, weight loss and alcoholism programs to change addictive behavior works.

The study appears in the most recent issue of the New England Journal of Medicine.

Advice to smokers who want to quit: Find a friend who smokes, and quit at the same time.

Read another smoking cessation story.

He liked what he saw between the binges: Recovery from addiction

In the darkest days of a 30-year drug addiction, Vera Crowl was homeless and living on the streets of southern California, getting by on odd jobs and sometimes operating outside the law. The college degree she had started decades earlier was all but gone, as was her ambition for a singing or theatre career.

"I got into the deepest, darkest addiction," she said. "I was doing all kinds of stuff for drugs and money." But today, after being clean and sober for more than seven years, Vera, 55, is taking her last class for a Bachelor's degree in psychology from the University of Dayton and is planning to begin a Master's in clinical counseling at UD in the fall. Because UD doesn't have a summer commencement, she was included in the spring ceremony this month.

She wants to become a substance abuse counselor, a call she says she received from God one evening during Blessed Adoration. By then, she had conquered her addiction and had become active in the Catholic community in Richmond, Indiana, where she now lives. "I haven't allowed myself to feel proud, because I'm so full of gratitude," she said. "Gratitude to God for calling me to His service and for His purpose. Gratitude to the recovery programs that have supported me, UD, my family, friends and the Richmond Catholic community."

Hers is a story of hope and commitment, and following God’s call. She grew up in St. Louis, graduated from a Catholic high school, and went to Southeast Missouri State, where she began "partying" too much. "I was mostly doing stimulant pills, and then I would take downer pills to sleep. It was crazy. I was young and strong," she said. "It just never occurred to me this was a problem. It was just something we did."

After four years at the school, she dropped out, a drug addict with no degree. She later moved to Berkley, Calif., to be with some friends who didn't abuse drugs and wanted to help her. She worked in a restaurant and did personal care in private homes.
"Not even these good, good friends could keep me or stop me in just progressing in my addiction," she said. "I tried to get help, but I kind of always fell prey to the need for drugs and alcohol." She ended up losing her jobs to drug use.

"It never occurred to me to stop," she said. "I kept thinking if I got it under control I would be OK. I just got worse." Eventually, another friend encouraged her to move to southern California, and he too, tried to help her. Her addiction did lessen, and she began working temporary jobs, but after several years she was back to being a full-blown addict, she said.

She moved again and ended up homeless and lived on the streets for five years. It was then she met Dick Crowl, the man she would eventually marry. He worked for the company where she did odd jobs. They began talking and spending time together. It didn't take him long to figure out she was an addict, but he told her he liked what he saw "between the binges," she said.

It was a step.

"That was my first glimmer of hope," she said. "My self-esteem was just crushed by that time. I didn't think there was anything in my life to appreciate or love, including God. I just felt so hopeless. I felt like I'd ruined my whole life."
The two decided to leave California and settled in Richmond. She was committed to getting clean, because "I didn’t want to live like that anymore," she said. It took a few tries, but recovery took hold. They married in 2000.

She became active in the church. "When I came back to the Catholic Church, all those (drug addict) memories flooded back. I was so ashamed."

It was then that she heard God's call to counseling. A few weeks later her father, an ordained deacon, received a letter informing him about a UD scholarship available to his family for his service to the church. She contacted the school, took some practice classes, and started at UD in January 2006.

She has taken a full course load of classes every semester — even summers — commuting to Dayton from Richmond several times a week. She also works part-time as a hostess in a Richmond restaurant.

"It's difficult to return to school after 30 years on the outside," she said. "It was a culture shock. But I've learned to accept success, I've learned to accept failure, and I've learned a lot about humility."

She takes inspiration from her father, who went back to school after he retired.
Vera won this year's Nora Duffy Award, presented each year to a UD adult learner who has overcome significant obstacles to achieve a baccalaureate degree and who reflects the spirit of the Marianist tradition.

Wiebke Diestelkamp, a mathematics professor at UD, nominated Vera for the award.
"Her church and her friends and her community are very, very important to her. She has a very strong sense for giving back and appreciates those gifts that she ahs been given," Diestelkamp said. "I'm very proud that she made it and that she didn't give up and that she did persevere."

Vera shares her story as a message of hope — that there is always hope — and faith.
"I wake up every morning, and I open my garage door, and I thank God. I thank Him for another opportunity to serve Him. I thank Him for my life," she said. "I have no doubt that God's hand is in everything. He allowed me to survive my own poor choices."

Advice: Help others through the problems you overcame.

Read another recovery story.

Thanks to David Eck for the source story in today's Catholic Telegraph.

Teddy Kennedy

A well-to-do man, Senator Edward Kennedy has long stood up for the underdog.

In response to the grim news this week of his terminal brain cancer, Sen. Kennedy has reached out to his family, and has even gone sailing near his beloved Cape Cod.

He lives his values, and fights for them. He consistently works with political opponents to find common ground, on immigration and education reform, to cite just two recent examples.

I hope that having fought hardest to expand healthcare over the years, that now, with the possibility of a Democratic president and Congress, he will live to see the passage of a universal healthcare bill in the next Congress.

For Jewish friends, who are encouraged to pray for an ailing person's health with the person's Hebrew name, I suggest as a Hebrew name, Thaddeus ben Shoshana (Ted, son of Rose).

Advice to people with terminal illnesses: Live your life with as much of Teddy's passion and humor as you can.

Read a story of zestful living in the “bonus round.”

One cup at a time: Alex's Lemonade Stand Foundation

Alexandra "Alex" Scott was born in Manchester, Connecticut in 1996, the second of four children. Shortly before her first birthday, she was diagnosed with neuroblastoma, a rare childhood cancer.

On her first birthday, the doctors told her parents that if she beat her cancer, it was doubtful she would ever walk. A year later, she was crawling and able to stand with leg braces. She willed herself to walk, and appeared to be getting better, until the shattering discovery within the next year that the tumors had returned. At age four, she received a stem cell transplant and told her mother, "When I get out of the hospital I want to have a lemonade stand." She wanted to give the money to doctors to help them find a cure. She held her first lemonade stand later that year, and raised $2,000 for "her hospital."

Alex continued to hold yearly lemonade stands in her front yard to benefit childhood cancer research. News spread, and people all over the world held their own lemonade stands and donated the proceeds to Alex's Lemonade Stand Foundation.

In August 2004, Alex passed away at age eight, knowing she had helped raise over $1 million to find a cure for children with cancer. Her three brothers and supporters are committed to continue her legacy.

Advice: Live with Alex as your role model.

Read another young hero’s story.

This is drawn from the foundation's bio of Alex.

Together with his oncologist: Matchmakers for new drug trials for multiple myeloma

Diagnosed last fall with smoldering multiple myeloma, 45-year-old Glenn Codderre relies on his oncologist for the standard drug regimen now used to treat the disease. Glenn, a Boston-area consulting manager for Hewlett-Packard, began his search for trials through the nonprofit Multiple Myeloma Research Foundation, which contracts with EmergingMed.

Together with his oncologist, he decided not to participate in one trial EmergingMed found because of concern about side effects and the trial drug's interaction with his current medications. He says the consultant he works with at EmergingMed "helps me save time and stay informed on clinical trial options while I continue to balance family and professional responsibilities." He hopes they will find a drug trial and that the drug being tested will slow the progression of his disease to cancer.

For-profit matchmaker firms like EmergingMed help patients identify experimental drugs that might help them and connect patients with the appropriate clinical trials. In Glenn's case, an effective drug might slow the progression of his disease to cancer. EmergingMed narrows its searches by taking into account the stage of the disease and the patient's prior treatments.

EmergingMed gets paid through fees that it charges medical centers, advocacy groups and research sponsors. The company's web tool is free to patients. The company doesn't disclose personal information gathered on its web site.

Advice to the families of cancer patients: Consider using a matchmaking service to find a clinical trial of a drug that could help your loved one.

Read another clinical trial story.

Thanks to Laura Landro for the source article in the Wall Street Journal of May 14.

Twice he was given last rites: Staph infection from a knee replacement

Robert Besse's painful journey began when he checked into a Cincinnati hospital a year ago to get his right knee replaced. The 60-year-old retired pharmacist had worn down the joint skiing and hiking and working on his feet for years.

Ten days after leaving the hospital, his knee was still oozing bits of fluid. "The pain was off the scale," he said. One of his surgeons took a look and immediately had him admitted to a different hospital, where he declined rapidly. Twice during the first night he was given last rites. But he survived until the morning when the surgeon opened up his knee again and found a raging staph infection that took two rounds of surgery to clean up. He spent the next several months on infused antibiotics and pain medication. He was barely able to celebrate his 60th birthday with his family in Breckenridge, Colorado.

He might have fared better at a specialty hospital – one of 200 centers in the U.S. that focuses on the care of a particular body part like the heart, spine, or joints, or a specific disease such as cancer. A study by the University of Iowa on thousands of Medicare patients found that rates of bleeding, infections, or death ("complications") are 40% lower for hip and knee surgeries at specialty hospitals than at big community hospitals. A study funded by Medicare in 2006 found that mortality rates for orthopedic surgery, e.g., knee replacements, are 75% lower for orthopedic patients in specialty hospitals than for other hospitals.

Advice to patients about to have surgery: Consider having the surgery at a specialty hospital.

Read another knee replacement story.

Thanks to David Whelan for the source article in the March 10 issue of Forbes magazine.

Read all about it: UCLA Medical Center's healthcare for Farrah, Britney Spears, Tom Cruise & Mariah Carey

California health regulators have connected 14 more people affiliated with UCLA Medical Center, including four physicians, to the improper viewing of celebrity medical records, bringing the number of current and former workers apparently implicated in the snooping scandal to 68.

The additional violations came to light in a report by the California Department of Public Health, which was sent to the hospital Friday. The findings are the latest to stem from reports in The Los Angeles Times about UCLA employees' prying into records of celebrities and co-workers. The regulators faulted UCLA for failure to maintain patient confidentiality and report the breaches to regulators.

One employee reviewed the records of actress Farrah Fawcett on 104 days between July 1, 2006, and May 21, 2007. She also looked at the records of pop star Britney Spears, whose medical files have been viewed inappropriately by dozens of other UCLA workers. The employee was indicted by a federal grand jury last month for allegedly selling information to the news media from medical records of celebrity patients. If convicted, she faces up to 10 years in prison.

Earlier news stories described the inappropriate viewing of the UCLA Medical Center's healthcare records of Tom Cruise and Mariah Carey.

State inspectors found that 13 other people affiliated with UCLA apparently snooped on Britney's records between July 2006 and May 2007. That is in addition to 53 staffers identified in three previous state reports who looked at her records on other occasions. The 13 included three physicians, a physician trainee, three registered nurses, two outside contractors, a volunteer and three support staff.

A note on this blog's policy on the "outing" of healthcare organizations where errors have occurred: Normally I do not name the organization. In this case, because of their published history of numerous repeated errors with no apparent system safeguard to prevent their recurrence, I have referred to UCLA Medical Center by name.

Advice to Hollywood celebrities: Choose other places than UCLA Medical Center to get your healthcare, unless you want riffraff like me to read about it.

Read another privacy story.

Thanks to Charles Ornstein for the source article in the May 14 issue of the Los Angeles Times.

My passion of drumming in a smoky bar: A Cystic Fibrosis musician

There are days when 26-year-old Emily Schaller can barely breathe because of cystic fibrosis – and playing in smoke-filled bars hasn't helped. She works in a store as her day job. At night, she's the drummer for Hellen, a Detroit rock band that performs concerts to support CF research. She plays in an annual "Just Let Me Breathe" concert fund-raiser.

Through Hellen and her organization, the Rock CF Foundation, she has generated thousands of dollars for the Cystic Fibrosis Foundation. CF is a chronic disease, genetic in origin, that causes the body to produce thick mucus that clogs the lungs.

"Just in the past few years I thought I wanted to do something I love, which is fund-raising," she says. She feels for her peers who can’t go out for fear of getting sick. "That makes me feel not really good, because I'm playing in a bar two nights a week. But you've got to weigh it. Is it sitting at home and watching a movie, which you don't really want to do, or is it going after my passion, which is drumming in a smoky bar?"

"My parents have always treated me like I don't have CF. It's not going to stop me from doing anything."

Advice: Dedicate yourself to living as fully as you can with your disease, and help beat your disease, like Emily.

Read another hero story.

Thanks to Natasha Robinson for the source article in the May 11 issue of the Philadelphia Inquirer.

Not just a job: A compassionate nurse

Karen Becker's Nomination Letter:
Gail Benedetti was my nurse in the days and nights immediately following my Whipple procedure (a complex gastrointestinal procedure). After more than 7 hours of surgery, I was in no shape to advocate or care for myself. The surgeon may have saved my life but my nurse made it bearable.

Gail did everything for me, from painlessly removing my nasal-gastric tube to gently giving me a sponge bath. I wasn't her only patient but she made me feel that I was. When I woke up, she was there. When I went to sleep, she was there. Bells and lights went off. Tubes and bags needed changing. Gail was there to make it right. It was uncanny. I didn’t have to worry. My nurse was looking out for me. Because Gail took the time to explain each procedure, medication, and piece of equipment to me, I knew what to expect. That shared information was both comforting and empowering to me as a patient. When pain was an issue, Gail made it her priority to advocate for me. She truly was my angel of mercy. The memory of her unflagging compassion and competence still brings tears to my eyes. I will be forever in her debt.

During my eight days on the ninth floor the Farr Building at BIDMC, I saw Gail interact with other patients, nurses, and the medical staff. She was energetic, engaged, and empathetic at all times. Gail was equally respectful and responsive to the needs and requests of everyone, patients as well as physicians. Gail proves that nursing is not just a job but a calling.

Advice: If your nurse isn't compassionate, politely ask the Nurse Manager or patient care advocate for a replacement.

Read another compassionate nurse story.

Thanks for the source article in the Sixth Annual Boston Globe "Salute to Nurses" advertising supplement in the May 4 issue.

It worked like a charm: Alcohol monitor ankle bracelets

Dr. Howard Markel's story:
Like most patients assigned to my substance abuse clinic these days, John, a stylish 22-year-old cosmetology student, did not arrive voluntarily.

John had had two drunken driving violations, one in which another driver was injured. A judge had ordered John to attend my weekly recovery group for young adults facing legal trouble. The judge had also ordered him to obtain and wear a boxy plastic ankle bracelet – a SCRAM – Secure Continuous Remote Alcohol Monitor.

The SCRAM records his alcohol intake by measuring air and perspiration emissions from the skin every hour. Once a day, John goes to a modem so it can transit data from the last 24 hours to a monitoring agency and his probation officer. "SCRAM keeps me from even thinking about drinking," John said.

Last year, American judges ordered SCRAM devices for thousands of defendants released on bond and awaiting trial for alcohol-related offenses, those sentenced on probation, and under-age drinkers.

Yet the device is not perfect. When John was chosen by a favorite instructor to work on a fashion show at the airport, he worried about how to inform her before security personnel discovered it. I urged him to be honest, and fortunately the teacher proved to be entirely supportive. She suggested letting the others in their group pass through security first and a little later, explaining the situation to the inspectors. "It worked like a charm," John told me the next week.

John is beginning to understand the severity of his alcohol addiction and how it threatens his life and well-being. Over the past five months, he has remained sober and has made significant progress.

One could argue that SCRAM and the threat of jail bought those five months of sobriety and treatment for John. As a physician, I remain uncomfortable aiding and abetting coercive methods like SCRAM. But this concern is overshadowed by a far greater one surrounding his long-term health. Soon John will "graduate" from his court-supervised treatment. His real test of recovery begins the day his SCRAM device is removed from his ankle.

Advice to families of problem drinkers: If your drinker has been involved with the criminal justice system, consider asking law enforcement officials about SCRAM.

Read another recovery story.

Thanks to Dr. Howard Markel for the source article in the May 6 issue of the NY Times.

Put it in writing: Wrong site knee surgery

A surgical team at a southern California hospital made repeated errors that led to a patient operation on the wrong knee, according to a state investigation that was just made public. Even after the patient noted what knee needed surgery, the surgical team still performed the operation on the wrong side, the report says.

The surgery schedule incorrectly indicated that the patient was to have surgery on the right knee. During a preoperative interview, the patient told a nurse the surgery was for the left knee. That nurse then notified the anesthesiologist and the surgeon about the correction.

Hospital records show the word "right" was crossed out and the word "left" was written in by hand, according to the state report.

Another nurse told state investigators that the left knee was marked for surgery but she incorrectly prepared the right knee for surgery. The patient was not asked to verify the correct knee, nor was the patient's history reviewed before the surgery, as called for in the hospital's protocol, the report says.

Before the surgery, the surgeon read out loud that the surgery was for the right knee.

The error was discovered when the patient woke up in the recovery room and pointed out the mistake, the report says.

Advice: Put it in writing. On your own skin, write "the right place to operate" and "do not operate here" on the wrong place, before surgery.

Read another wrong site surgery story.

Thanks to Courtney Perkes for the source story in the May 7 issue of the Orange County Register.

Their commitment to stem cell research: San Diego Consortium for Regenerative Medicine

The California stem cell institute Wednesday awarded $271 million in grants to 12 institutes for the construction of buildings to house stem cell research.

Among the funding was a $43 million grant to the San Diego Consortium for Regenerative Medicine for the construction of a building in Torrey Pines where scientists from four major institutes will combine efforts in stem cell research.

In the proposed $115 million building to be built near the Torrey Pines Gliderport, teams of scientists from across San Diego will collaborate in efforts to unlock the regenerative mysteries of stem cells and how they can be used to address critical health issues.

The San Diego consortium, and the 11 other grant recipients, have committed to invest a total of $560 million from charitable donations and their internal reserves to construct the facilities, bringing the total statewide investment in new research space to $831 million.

"As a patient advocate, I am inspired by the amount of leverage California research institutions have contributed from their charitable donors and from their reserves," said Robert Klein, chairman of the state stem cell institute.

"Their incredible commitment underscores the promise that stem cell research holds for patients suffering from chronic disease and injury," Robert said. His son is such a patient, motivating Robert to become a champion of such research.

The San Diego consortium, which includes University of California San Diego, the Burnham Institute for Medical Research, the Scripps Research Institute and the Salk Institute, plan to build a four-story building, with a basement, full of research equipment, on a 7½ -acre parcel at North Torrey Pines Road and Torrey Pines Scenic Drive. The land, owned by UCSD, is valued at about $15 million and is within walking distance of all four member campuses.

Scientists from all four member institutions will work there, combining expertise on stem cells as well as bioengineering, computational biology, chemistry and clinical sciences. The idea is that by sharing their resources and different expertise, the four institutes will be better equipped to bring new therapies, diagnostics and research tools to market more quickly and efficiently.

The structure the scientists envision would meet federal requirements for a green building and would contain 23,740 square feet of laboratory and support space. Labs would be built without walls separating them. There would also be a cafeteria, as well as an auditorium, to be named for the philanthropic donor, whose name has not yet been announced.

The center will be a highly visible symbol of the region's commitment to stem cell research, and a place where the taxpayers footing the bill can see what progress their money has fueled, said Dr. Edward Holmes, the consortium's president and formerly head of UCSD's medical school.

The San Diego consortium expects it needs to raise at least $72 million to complete funding for the center. And it expects to spend $40 million in faculty recruitment and other costs, bringing the total for the new San Diego Center for Regenerative Medicine to $155 million.

Investment in research infrastructure to extend California's state-of-the-art research capacity is a critical part of the strategic plan established by the California Institute for Regenerative Medicine. The institute was created under Proposition 71, a $3 billion bond initiative approved by state voters in November 2004, to fund stem cell research. The initiative makes California the leader globally in funds dedicated to stem cell research.

Because of the ability of stem cells to evolve into the more than 200 types of cells in the body, the field is believed to hold the promise of curing diseases such as diabetes, Parkinson's and Alzheimer's.

All the institutions receiving these major facilities grants have agreed to expedited construction schedules that will deliver nearly 800,000 square feet of facilities with researchers in the labs within two years.

"This will go a long way toward medical research that could save lives and improve them for people with chronic diseases," Gov. Arnold Schwarzenegger said in a statement Wednesday.

Advice: Fight your disease by channeling your energy like Robert Klein.

Read another story about Robert Klein’s work.

Thanks to Terri Somers for the source story in yesterday's issue of San Diego Online.

What's risky for teens is parents: Insulin pumps for controlling diabetes

Many newspapers described the FDA study by Dr. Judith Cope and others in this month's issue of the medical journal Pediatrics on the risks to teenagers of insulin pumps for their diabetes. Here’s the reaction of Reagan Schweers' mom, from her blog:

"Insulin Pumps Risky for Teens" was the title of an article I read in the Dallas News this morning. Right next to the article was a picture of my son's insulin pump.

I read the article with a fairly open mind. I know that the idea of a headline is to grab attention. Ok, so I was grabbed. The article wasn't especially informative so I got online to check out the "study" that was mentioned. The study was from a well-known medical journal, Pediatrics. Since I worked in pharmaceutical sales and have read MANY medical articles, I'm not afraid to wade through the data to figure out what the study really said.

 So here's my take on things.

What the FDA found over the course of 10 years of data was that teens do risky things and aren't the best at caring for their $6000 medical device. Many of the incidents that had occurred were due to teens doing stupid things - dropping their pump, ignoring error messages, ignoring alarms, not checking their infusion lines. Of course, my question in all this is, since when is it the sole responsibility of the TEEN to do what the PARENT should be doing? Folks, diabetes is a serious long-term disease. Why would you not review your teen's blood sugar numbers? Why would you not make sure they are using their pump properly? This is a matter of life and death and you are FOOLISH as a parent to ASSUME that your teen is doing everything perfectly.

 I must admit that my son takes care of his pump and his diabetes 100% himself. He is FASTIDIOUS about keeping his blood sugar in control. But my husband and I always check behind him. His endocrinologist checks behind him. The diabetes educator in the endocrinology office checks behind him. And his HbA1C doesn't lie. If it's off, then we know he's not controlling his blood sugar or something is amiss with the pump.



In order to get a pump in the first place, the endocrinology office made Reagan test drive a pump for 4 days to see if he'd like it or not. You also have to go through their training program to even be considered for a pump. Then the pump manufacturer representative came to our house to train us extensively for using the pump. Reagan and I both reviewed the materials that came with his pump.



What we have had with his pump is MUCH better diabetic control of his blood sugar. This means (and is scientifically proven) that he will have less chance of losing his eyesight, losing a kidney or even a foot later in life. He has more freedom to live a "normal life" than he did giving himself multiple injections per day. We are able to closely titrate his insulin dose round the clock with the pump - much closer than we could with multiple injections of insulin.

AND...we just got the new continuous glucose monitoring system and he will be trained on that on Wednesday. He will be able to tell 24/7 - anywhere - anytime - what his blood sugar is. I can't tell you how important that is given the fact that he is will soon be driving solo. Or how important it will be when he's participating in a marching band competition and can't carry his blood sugar test kit with him everywhere. And, NO, insurance wouldn't even pay for it...(but that's a blog for another day).



I guess what makes me most frustrated is that this now gives insurance companies more ammo to say "no" to a device that has given many teens and their parents enormous freedom and peace of mind. In fact, the majority of teens who use an insulin pump will live longer and healthier lives - check that 10-year study. Honestly, what's risky for teens is parents who aren't involved in their lives. It's a partnership with your teen and the endocrinology staff. The pump is the best thing that's happened to Reagan as a diabetic.

Advice: Managing your child's diabetes calls for a partnership of you, your child, and the endocrinology staff.

Read another story about partnership in diabetes care.

Thanks to Reagan Schweers' mom for the source story in her blog, "A little of this and that."

A "do it now" kind of guy: Slow medicine at the end of life

Edie Gieg, 85, strides ahead of people half her age and plays a fast-paced game of tennis. But when it comes to health care, she is a champion of "slow medicine," an approach that encourages less aggressive – and less costly – care at the end of life.

At the end of her husband's life, she was spared extreme options because she lives at Kendal at Hanover, a retirement community affiliated with Dartmouth Medical School where it is possible – even routine – for residents to say "No" to hospitalization, tests, surgery, medication or nutrition.

Her husband, Charley Gieg, was 86 at the time, and was suffering from a heart problem, an intestinal disorder, and the early stages of Alzheimer's Disease when doctors suspected he also had throat cancer. A specialist outlined what he was facing: biopsies, anesthesia, surgery, radiation or chemotherapy. His wife doubted he had the resiliency to bounce back. She worried, instead, that the treatments would usher in a prolonged period of decline and dependence. This is what the Giegs feared even more than dying, what some call "death by intensive care."

During her husband's out-of-town consultation with a doctor, Edie stayed in touch by email with a nurse practitioner (NP) at Kendal.

"It is imperative that none of this be rushed! Think about all the what-ifs," wrote the NP. The doctors the Giegs had chosen, she wrote, “tends to be a 'do-it-now' kind of guy." The NP asked whether Charley would want treatment if he was found to have cancer. If not, why go through a biopsy, which might further weaken his voice? Or risk anesthesia, which could accelerate his dementia?

"Those are the very questions in my mind too," Edie replied. The Giegs took their time, opted for no further tests or treatment, and Charley came back to the retirement community to die.

Outside of Kendal, it is rare for patients and their families to make these vital decisions. As the chief medical officer for UCLA Medical Center explained, the culture at an acute care hospital "has a built-in bias that everything that can be done will be done." The pace of care at the hospital, he added, discourages "real heart-to-heart discussions." Once a patient is drawn into that system, "it's really hard to pull back from it."

Advice: Decide how you want to live your life – even at the end.

Read another end of life story.

Thanks to Jane Gross for the source article in today's NY Times.

His family was hopeful he would fully recover: Enterobacter Aerogenes infection

On September 2, 2006, 27 year old Josh Nahum was injured in a skydiving accident near Boulder, Colorado. He had broken his femur and fractured his skull and was admitted to the Intensive Care Unit (ICU). His family was hopeful that, even though the doctors believed Josh would have a long road ahead, he would, with rehabilitation, fully recover within a year or two.

During his recovery in ICU he suddenly developed a bacterial infection - Staph. His neurosurgeon prescribed Vancomycin which cleared it up. As the weeks went by, Josh began to get better, even taking brief walks with the help of his walker and his Physical Therapist, Brian.

After 6 weeks or so in ICU, he was transferred to a nearby Rehab facility until he suddenly developed a 103-degree fever and was sent back to ICU. Tests reported that Josh had yet another bacteria named "Enterobacter Aerogenes." 

On Monday, October 9th Josh coded and stopped breathing, becoming comatose with no respiratory effort whatsoever. The Emergency Room was called and he was put on a ventilator. An excessive pressure buildup on his brain due to the bacterial infection caused a portion of his brain to be pushed into his spinal cord, permanently interrupting his ability to breathe on his own as well as his ability to move his head, arms or legs ever again. 

In a matter of moments, Josh had become a ventilator dependent quadriplegic. Less than two weeks later, he died, not from his original injuries, but from complications arising from virulent bacteria he caught in ICU.

Advice: Help strangers protect themselves against medical errors by telling your stories widely, as Josh's mother, Victoria Nahum, has been doing.

Read another young athlete’s hospital infection story.

Thanks to Victoria Nahum for the source story in hospitalacquiredinfections.blogspot.com and to Adam Gee and Elizabeth Cohen.

Medical negligence acknowledged in detainee's cancer death: A lawsuit

The federal government has acknowledged it was negligent in the death of an immigrant whose cancer went undiagnosed for nearly a year while he was in custody at the San Diego Correctional Facility.

The government last week acknowledged medical negligence, an allegation contained in a lawsuit filed by the family of Francisco Castaneda, 36.

"Was there medical negligence and we're saying yes," U.S. attorney's spokesman Thom Mrozek said yesterday. The claim carries maximum damages of $250,000, he said.

Francisco, an illegal immigrant from El Salvador, was placed in immigration custody after serving an eight-month state prison sentence on a 2005 drug conviction. While at the San Diego facility, he notified immigration officials that he had a large, painful, growing lesion.
Despite recommendations from several doctors, the cancer was never biopsied and Francisco received no treatment except for pain pills during his 11 months in detention, government records indicated.

Francisco was released last year, went to a hospital and was diagnosed with metastatic squamous cell carcinoma. He died in February.

Advice to families of detainees: Advocate vigorously for your relative's health while they are in custody.

Read another detainee’s story.

Thanks to the Associated Press for the source story, printed today in SignOnSanDiego.com. Staff writers Jose Luis Jiménez, Pauline Repard, Mike Lee and Sandra Dibble contributed to this report.