Five Palm Beach County hospitals cited for denying ER care 

Implant Firms Pay Doctors Millions

A man who told police he threw his ailing wife off their fourth-floor balcony because he couldn't afford to pay for her medical care was arraigned Thursday on charges of second-degree murder.

Stanley J. Reimer, 51, appeared in Jackson County Circuit Court to hear the charge in the death late Tuesday of Criste Reimer, 47.

Reimer did not have a lawyer at the hearing and requested representation by the public defender's office. He remained jailed on $250,000 bond.

Reimer walked his wife to the balcony of their apartment Tuesday night and threw her over, according to court documents filed in Jackson County Circuit Court.

Criste Reimer's body was found that night outside the apartment building, located near an upscale shopping district.

In the probable cause statement, police said Reimer told them he could no longer pay the bills for his wife's treatment for neurological problems and uterine cancer.

Criste Reimer had been in ill health for several years, according to Jackson County Probate Court records. Her weight had fallen to 75 pounds and she was partly blind. Court records also said she had no health insurance to pay for medical bills that ranged from $700 to $800 per week.

An official with the Nelson-Atkins Museum of Art who spoke on condition of anonymity said that Reimer had worked in the museum's finance department since 1996 and that the museum offers full family insurance coverage to its employees. She would not say whether the Reimers had that coverage, citing privacy concerns.

The judge scheduled another hearing for Sept. 10.
© 2007 Kansas City Star and wire service sources. All Rights Reserved.
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In this micro-lecture, I will discuss the origin and use of the biopsychosocial model as it is presently understood and explain how the Doe approach to this medical theory is irretrievably flawed.

First, it should be clear from the above that the biopsychosocial model (“BPS” model) is a genuine medical approach. Unfortunately for anyone attacking the use of the term as illegitimate, it is in fact a recognized theory of medicine originating in 1977 with George Engel an internist/psychiatrist. It was used and studied principally at Rochester Hospital, where Engel worked, and is now principally used by mental health professionals. The BPS theory makes the unexceptionable observation that an “illness”, defined roughly as a disorder perceived by the patient, is in many cases not simply a result of a single biologic factor. Instead, an “illness” is better viewed as a combination of inter-relating factors, which may both “cause” and “be caused by” the illness. To clarify, a person may have neck pain after an auto accident. This neck pain limits the person’s activity, which limits their ability to work, which limits their ability to earn income, which produces a feeling of worthlessness, which increases an underlying depression, which increases their limitation of activity, which increases their isolation, which gives them less distraction from the neck pain, which increases the perceived neck pain, etc. The BPS approach postulates that proper treatment of this neck pain involves recognition of all the factors mentioned above that contribute to the perceived illness, the neck pain.

“Acute” and “chronic” do not refer necessarily to severity of pain; both can be of any degree of severity. Nor do the terms refer to the inciting event; both can be produced by the same event. Although the terms do imply a time course difference, in fact we have come to understand that this distinction is simply a marker for the time required for development of the biological processes producing chronic pain. In this sense, the time course difference of chronic vs. acute pain has a “biological correlate.”

Other distinguishing features of chronic vs. acute pain have biological correlates as well. For instance, chronic pain is often associated with few findings on physical examination. The biological correlate, we shall see, is the fact that chronic pain is in a sense “all in the head”; that is, mostly located in the central nervous system rather than in the peripheral anatomy.

Chronic pain is often regarded by physicians and laypersons alike as principally a psychiatric phenomenon, if it is regarded as a genuine illness at all. The biological (and medical) correlate of this belief is that chronic pain often involves the same or similar neurotransmitter chemicals and central nervous structures that are also involved in such “psychiatric” illnesses as depression and anxiety.

Dear Sirs,

Dr. Brennan’s recent Sounding Board piece on the Institute of Medicine report struck me as a piece of “spin” that ignored the facts and conclusions generated by Dr. Brennan himself in earlier studies.

Dr. Brennan states “ . . . neither study cited by the IOM as the source of data on the incidence of injuries due to medical care involved judgments by the physicians reviewing medical records about whether the injuries were caused by errors.” He then uses that assertion to justify his criticism of the IOM report, and to assert that “the reliability of identifying errors is methodologically suspect.” These statements strangely ignore Dr. Brennan’s use of “suspect methodology” in his own studies to determine the rate of adverse events due to negligence, a statistic then extrapolated in those studies to justify the conclusion that malpractice litigation rarely compensates the negligently injured patient.

Surely, using the same statistics to argue out of both sides of one’s mouth is a marvel of expostulation. Perhaps Dr. Brennan ought to consider a career as a litigator. Dr. Brennan goes on to excuse the lethargy in medicine that prompted the public concern about the IOM report by observing that error detection and correction is costly, that it is epidemiologically difficult, and that it might break up the cozy code of Omerta that now shields even the most egregious negligence from effective scrutiny, both by the medical profession and by the consumers of its services.

If voluntary error reporting is inhibited by public scrutiny, as Dr. Brennan asserts, then mandatory reporting and investigation is the better course. Such investigations, conducted impartially, would likely have an effect opposite from the one Dr. Brennan fears. Instead of more litigation, a well-conducted investigation of serious error with public revelation of the method and results would reduce litigation by creating a disincentive to bring cases that were found not to result from negligence. Furthermore, hospitals and physicians, confronted with an impartial report identifying their culpability, might be more willing to fairly compensate the injured individual and avoid the expensive litigation route that injured parties are now forced to choose.

As a lawyer and physician, I have observed and participated on both sides of this battle over just compensation for medical injury. It know that the closed system of peer review will never serve any interests other than those of physicians, particularly including pecuniary interests; that doctors who “get along” with their colleagues are never effectively called to account for negligent acts; that hospitals which engage in sloppy care are shielded from redress and corrective action by mutual dependence with their own medical staffs; and that the attempts to introduce systematic error-detection and correction are stymied by physicians’ arrogant labeling of any system as “cookbook medicine.”

Medicine has long had the opportunity to police its errant members and reduce its concentration on financial goals to the detriment of individuals; it has botched the job. Physicians and hospitals can no longer claim the moral high ground in this debate. It is past time for the consumer of medical services to have full information on the services she is buying. It is past time for the light of day to shine on the medical profession.

Sincerely,

Clark Newhall MD JD