Should a physician reveal HIV status to patients, employer? - Dermatology Times

A situation arose in Canada recently that instigated discussion about personal responsibility if a physician tests positive for HIV - or, ultimately, is suffering from any contagious disease.

Earlier this year, officials of a children's hospital in Quebec learned that one of their surgeons had performed more than 2,500 surgical procedures over more than a decade after she had tested HIVpositive. Although the doctor had informed a hospital committee of her HIV status in 1991 and decisions were made on what surgical procedures she could and couldn't do, the hospital administration didn't learn of her illness until recently. The hospital contacted her patients from the past decade to alert them to the situation and offer HIV tests to the children.

Launched debate

The situation launched public debate in Canada, and the Quebec Medical Association has adopted a policy requiring doctors to inform their employer if they are HIVpositive, while protecting the physician's confidentiality. While the United States recognizes just one case of a health care worker infecting patients - a dentist in Florida - a Canadian HIV expert cites HIV transmission by two surgeons in France and Spain who engaged in what is described as exposure-prone procedures.

What happens north of the border can have implications in the United States down the road, and On Call wondered what dermatologists think about whether physicians have a responsibility to inform either their patients or their employers of their HIV status and when such a responsibility kicks in.

The dermatologists express mixed feelings about where the physician's responsibilities lie - the one thing they agree on is that the questions are not easily answered. Several of the doctors also raised the issue of other illnesses that can be more easily transmitted and, yet, can be nearly as devastating to a person's life.

Scott M. Debates, M.D., Omaha, Neb., outlines some of the difficulties that can arise if a physician were to make a positive HIV status public.

'There is a lot of fear in the marketplace. How many patients would go to a doctor if they knew he or she were HIV-positive - even knowing the reality is that the possibility of transmission is so clinically low on the totem pole?

'In general, the medical transmission of HIV is so very low that bringing it up may actually create more of a fearful mind-set than it probably deserves. It's a difficult issue.'

Dr. Debates, a member of a large multi-specialty clinic that is part of the Methodist Hospital System in Omaha, says the situation changes if there is a chance that transmission has occurred.

'I think there's a personal responsibility of a physician who is HIV-positive that if there would be circumstances where there would be a possibility of transmission, then they would not be silent. There is definitely a moral responsibility of the individual to take responsibility for the potential of transmission if that had happened.

'You would hope that would happen and that the person's moral compass is still working because there are medications that can be used early in the disease process that can really help.

'On the other hand, you would hate to cease providing great health care to people who need it because of unfounded fear they're going to contract HIV.'

Up to the physician

In Seattle, Wash., Rachel A. Carton, M.D., says the lack of legal requirements leaves the decision in the physician's hands.

'Ultimately it's up to each individual physician whether they want to disclose it or not - but each physician needs to consider their specialty and their practice type and determine how much they would be putting their patients at risk.

'I wouldn't favor a law requiring disclosure, but people would, or should, probably feel morally or ethically obligated to disclose it.

'I think it would basically end a physician's career - because, honestly, if a physician did disclose this, I wouldn't expect them to get many patients. Talking to co-workers, they knew of physicians who were HIVor hepatitis C-positive who were either given desk jobs, or were let go'

As Dr. Garton mentions hepatitis in the same breath as HIV, Gerald A. Gellin, M.D., in San Francisco, also raises the issue of other contagious conditions.

'I don't think it's important for a doctor to inform a patient of his or her illnesses.

'It has no relevance to the interaction between the patient and physician, possibly with the exception if the doctor has open tuberculosis. This to me would be more of a public health matter - if a doctor has open tuberculosis and is actively providing medical care.'

Even though physicians prefer to know if their patient is HIV positive because of its effect on medical care, Dr. Gellin says that doesn't happen all the time either.

'I've had patients who waited until I was ready to start surgery and then said, 'by the way, Doctor, I have HIV,' because they thought if they told me beforehand, I would not do the operation. So I think there is more risk to the doctor than there is to the patient.'

Other dermatologists weren't quite so certain.

In Cedar City, Utah, Lancing G. Ellsworth, M.D., agrees the issue is very difficult.

'People in high-risk professions for transmitting HIV - and I wouldn't want to be a judge of exactly who that would be; physicians can fit into that category, but not all physicians - should make it known to their patients that they are HIV-positive. I would think a surgeon would fit and possibly some other specialties.'

Dr. Ellsworth, in private practice for five years, says he has to put himself in the patient's position. He also recognizes that HIV isn't the only condition that raises this issue.

'If I were going to have surgery, I would want to know if the surgeon working on me were HIVpositive. I'm not sure I would support laws requiring disclosure, but I ought to know that as a consumer.

'It's a very hot topic. For example, there is a surgeon in our town who is hepatitis positive, and it is the same sort ofthing. And hepatitis is more transmissible than HIV I don't know if he discloses that to his patients or not, but if I were a patient, I would want to know.

'I support disclosure. I don't know that I would support law. I would hope the surgeon would want to disclose that on his or her own.'

Complicating factors

Dr. Carton agrees that other infectious diseases complicate the issue.

'Hepatitis is as big, if not a bigger issue because it's more easily contracted, but it just doesn't seem to push the buttons HIV does.

'It's not quite as controversial for people who don't know, but really it is. There are probably physicians out there with hepatitis C who need to disclose it, but, ultimately, no one is going to be forced to. Ultimately, it's up to the individual physician. They need to seriously consider the risk to the patient.

'They may not be legally obligated, but they should feel ethically obligated,' Dr. Carton says.

In some ways, Jo-David Fine, M.D., of Nashville, Tenn., almost doesn't think there should be any question.

'My assumption would be that any physician who is performing any procedures that could potentially risk infection to the patient should clearly be obligated to inform the patient prior to doing such procedures that he or she is HIV-positive.

'This is something all physicians should think through and act upon his personal views. The issue is primarily whether he or she could put a patient at risk for receiving the virus from the physician.'

Dr. Fine isn't convinced that it would be absolutely necessary to inform the patient if the physician is wearing gloves and there was no potential risk - unless with major surgical procedures - but he says, 'Even an aggressive dermatologie surgical procedure could certainly expose large open areas in the patient, and a tear in the glove could be a problem.'

Dr. Fine, in practice for 21 years and a professor at Vanderbilt University specializing in blistering diseases, says he can only speak for himself.

'Patients should be informed - that's how I practice. I would rather have 98 percent of my patients walk away from my door if they had concerns than mislead them.

'I can't imagine practicing dermatology without doing biopsies and I guess there's always a theoretical risk that there could be a puncture in my glove. I'd hate to have patients concerned about that. I think I would have to stop doing procedures if anything like that were ever to happen to me.'

Other issues

Other issues enter the picture when the discussion moves to whether physicians would owe it to their employer to disclose an HIV-positive status. The Canadian hospital did decide to track down former patients when the physician's HIV status was discovered. What is the physician's responsibility there? Where does that leave the employer?

Dr. Carton says, 'Physicians probably wouldn't last too long if they disclosed a positive HIV status to their employer, but I guess I think they should - again, just more for patient safety.

'You want people to have their privacy, and their medical condition should not be known. The chance of infecting patients probably isn't very high, but you would probably be opening yourself up and your employer to lawsuits.

'The problem is this extends even to conditions that aren't contagious. What if a person is in the beginning stages of Parkinson's? Should they operate?'

Dr. Debates says the issue of informing an employer is really wide open.

'I don't know anyone's status now, so we may have hired someone who was HIV- positive. I guess with everybody being careful and everybody taking the appropriate measures they're supposed to be taking, you hope to reduce the risk enough that it does not matter. I don't think employers are even allowed to ask that.

'I do wonder if the hospital didn't go overboard in tracking down the patients when there was no indication the disease was transmitted to anyone.'

Physician privacy

Dr. Gellin, a practitioner of 41 years and clinical professor at the University of California, San Francisco, says his patients have ranged from 2 weeks old to 107 years. He thinks that the physician's health status is his or her own business.

'Due to privacy matters, I think it is not necessary or incumbent upon the doctor to tell his employer what diseases he has that have no relevance in the provision of patient care.

'Presumably the employer is not supposed to find out about the illnesses of employees. If the employee voluntarily tells the employer, that is the employee's right to do, voluntarily. The employer is not to ask these specific questions, although I'm not sure much attention is paid to that in too many cases. Privacy takes precedence.'

Dr. Ellsworth agrees with that to some extent.

'I don't think the physician has to disclose that information to their employer, although it still may depend on whether it is a high risk occupation. And I still don't know how you would define high risk. The doctors should also take into consideration that they could be leaving their employer open to liability if they aren't informed.'

Dr. Fine points out that in many cases state medical boards and hospital boards would have policies on disclosure - and when it comes to patient safety, he would have to say that privacy was not the major issue.

'I would think it should be necessary to tell an employer only in situations where physicians could, in any way, put patients at risk for acquiring the disease. It would also depend on the rules of the institution in which the individual works - or the state guidelines of an individual state medical board. My impression from getting licenses in so many states over the years is that state licensing boards all have very rigid policies. If they don't require disclosure then I wouldn't think a physician would have to disclose the information.

'Since I try to adhere to the traditional philosophy of'first do no harm,' I personally believe that patient safety should take precedence over concerns of invasion of a physicians' own privacy. I would want to do nothing (by lack of disclosure) that might negatively impact the relationships I try to foster with my own patients.

'And I would obviously adhere strictly to any written guidelines prescribed by my state licensing board, the state health department, the Centers for Disease Control, or any other appropriate health-related agency.'

[Sidebar]

Karen Nash

What happens north of the border can have implications in the U.S. down the road.

[Sidebar]

'In general, the medical transmission of HIV is so very low that bringing it up may actually create more of a fearful mind-set than it probably deserves. It's a difficult issue.'

- Scott M. Debates, M.D., Omaha, Neb.

[Sidebar]

'The problem is this extends even to conditions that aren't contagious. What if a person is in the beginning stages of Parkinson's? Should they operate?'

Rachel A. Carton, M.D., Seattle, Wash.

[Author Affiliation]

REGIONAL NEWS: MIDWEST.(includes information on various hospitals' operations) - Modern Healthcare

KANSAS CITY, Kan.-The University of Kansas Hospital Authority has received an underlying A rating on $55.5 million of debt set to be issued the week of Sept. 20. Fitch IBCA, a New York-based credit rating agency, assigned the rating based on the hospital's strong debt service coverage, low debt burden and excellent clinical reputation. It also expressed confidence the university hospital will be able to compete more effectively in its marketplace as a result of its separation from the state of Kansas. As of Oct. 1, 1998, the hospital went off the state budget and became an independent organization with its own board of directors (Oct. 5, 1998, p. 24). Fitch expects the public authority status to allow the hospital more management flexibility, easier access to capital and better options for finding business partners. Under such conditions, the hospital's 5% operating margin should improve, according to Fitch. University of Kansas Hospital has 620 licensed beds and 411 staffed beds. The bond issue will be used to finance capital expenditures, refinance bank debt, reimburse previous capital expenses, refinance leases and establish a debt-service reserve fund.

WORTHINGTON, Ohio-Ohio State University Medical Center has approved a merger with 24-bed Harding Hospital, a behavioral health hospital in Worthington. OSU and Harding have operated jointly since January 1996, when Columbus-based OSU acquired an equity stake in Harding. OSU's equity reached 50% last year. The merger is expected to be completed by December. George Harding IV, M.D., grandson of the hospital's founder, will continue to have a seat on the OSU/Harding Hospital board.

MADISON, Wis.-Wisconsin's 24 HMOs lost more than $18.6 million during the first half of the year ended June 30, according to a new report from the state insurance commissioner. The HMOs collected $1.5 billion in total revenues during that same period. HMO performance has declined dramatically when compared with the same two quarters a year ago. During the first half of 1998, the state's HMOs earned $676,000 on total revenues of $1.3 billion, according to state figures.

CHICAGO-HMO enrollment in Illinois grew 3.8% last year, according to a new report on the Illinois healthcare market. Last year's slower growth comes after double-digit increases in HMO enrollment in 1995 and 1996, according to the report by Allan Baumgarten, a Minneapolis-based healthcare analyst who studies managed-care trends in seven states. HMO enrollment grew by 4.8% in 1997. In Illinois, about 2.4 million residents-just less than 20% of the state's population-are enrolled in an HMO.

OMAHA, Neb.-Two-hospital Nebraska Health System and two-hospital Nebraska Methodist Health System, both of Omaha, will merge their mental health services into a single facility. The agreement, which was signed Sept. 8, provides for shared ownership of an inpatient facility, 121-bed Richard Young Center, formerly called Methodist Richard Young. Comprehensive psychiatric services will be housed in three Nebraska Methodist-owned buildings to be renovated with $4 million provided equally by both systems. Sandra Carson is president and chief executive officer of Richard Young. University of Nebraska Medical Center will use Richard Young as a teaching facility. Governance will be through an eight-member board, with three members each from Nebraska Health and Nebraska Methodist, and two nonvoting members from UNMC.

Fees push managed accounts off 401(k) default lists; Plan sponsors are concerned about their fiduciary responsibility.(News) - Investment News

Byline: Jenna Gottlieb

Managed accounts aren't popular default options in 401(k) plans, because fees are too high for plan executives to justify, leaving them concerned about fulfilling their fiduciary responsibility, experts say.

The Pension Protection Act of 2006 encouraged plan sponsors to enroll employees automatically in 401(k) plans.

In October, the Department of Labor said managed accounts - along with target date and balanced funds - are qualified default investment alternatives.

Some industry experts are concerned that plan executives may be subject to litigation to explain additional fees that managed accounts charge.

'Managed-account providers should be worried, and plan sponsors should be concerned,'' said Richard Glass, president of Investment Horizons Inc., a Pittsburgh defined contribution communications company.

'The majority of target date fund providers keep fees in the [0.5% to 0.7%] range, but with managed accounts, how can they justify all the additional fees?'' he said.

Managed-account fees can run as high as 1% of assets.

Litigation concerns

How a fiduciary is defined has been turned on its head since the first round of 401(k) fee lawsuits was filed in September 2006, said Mr. Glass.

Some executives think that adding managed accounts as a default option could leave them open to litigation over excessive fees.

Historically, plan executives have fulfilled their fiduciary duties by selecting the providers that have offered the best service at competitive fees, Mr. Glass said.

But that has changed, he said, because of the heightened litigation environment.

Many plan sponsors are turned off by higher managed-account fees, preferring the lower fees for target date funds, said Lori Lucas, Chicago-based DC practice leader for Callan Associates Inc. of San Francisco.

'Plan executives, in this fee environment, want to be careful. I'm not saying managed accounts don't fit for some plans, but many don't like them as a default,'' she said.

Several Callan clients have added managed accounts as a stand-alone option in their 401(k) plans, but not many have used them as default options, Ms. Lucas said.

'We see a lot of them come to us and ask about managed accounts as just one option, not the default. We're seeing more of that,'' Ms. Lucas said.

Many 401(k) plan executives are apprehensive about managed-account fees, said Mike Francis, president of Francis Investment Counsel in Pewaukee, Wis.

'I think many plan [executives] see target date funds as the less expensive option, and picking the right default does have something to do with what kind of plan you have,'' he said.

'It's a lot different if you are talking about a law firm,'' where employees tend to make more money, than a manufacturer, where employees tend to make less, Mr. Francis said.

Managed accounts are a valid investment option, but offering them as a default could be problematic, Mr. Glass said.

'If an employee earns $30,000 a year and he's defaulted into a managed-account structure and stays there, how can the sponsor justify that?'' he asked.

Managed accounts make more sense for highly compensated employees with larger balances.

The Nebraska Methodist Health System in Omaha opted for target date options as the default for automatically enrolled 401(k) participants in its $200 million 401(k) plan. Plan executives considered using managed accounts as the default option but decided that they didn't make sense for the bulk of members of their work force.

Ryan Husing, director of employee benefits, said target date funds are a safer, more obvious default option than managed accounts. 'We feel that participants get the best value with target date [funds]. It was an easy decision for us,'' Mr. Husing said.

Some plan executives think that managed accounts make sense as an option but not as a default.

William F. Quinn, chairman of American Beacon Advisors of Fort Worth, Texas, which oversees American Airlines' $12.1 billion 401(k) plan, said the plan in January added managed accounts provided by Financial Engines Inc. of Palo Alto, Calif.

American is using them as an option but not as the default because managed accounts make sense for employees with higher balances, which can offset fees.

One plan that uses managed accounts as its default option is the $255 million 401(k) plan of Standard Register Co. in Dayton, Ohio. The company uses Financial Engines too.

Richard Mayer, director of benefits, said managed accounts are a great way for less financially savvy investors to manage their retirement assets. He declined to comment further.

Managed-account providers, for the most part, aren't concerned.

Financial Engines and Chicago-based ProManage Inc., two of the largest managed-account providers, have very different fee structures.

`very competitive'

Christopher Jones, executive vice president of investment management and chief investment officer at Financial Engines, said that the firm's average managed-account fee is about 0.6%.

'To say that managed accounts are more expensive than target date funds is not quite fair,'' he said.

'Depending on how they are set, [fees] can range from [0.35% to 0.6%],'' Mr. Jones said. 'I can't speak about other [managed-account] providers, but we are very competitive with target date funds.''

Financial Engines has 10 default-plan clients where employees could opt out if they choose.

'Fees are a very significant issue with 401(k) plans in general. We recognize that sponsors are fee-sensitive,'' Mr. Jones said.

'We take advantage of institutionally priced investments. With life cycle funds, the fees are bundled,'' Mr. Jones said.

'In the managed-account world, you see all the underlying fees.''

Tony Sabos, president of ProManage, said the firm's fees of up to 0.6% are very competitive with target date funds. And the safe harbor provided in the QDIA regulations ease the concerns of plan sponsors.

CAPTION(S):

Hearts and Minds - Healthcare Informatics

When it comes to automating workflow and image management for cardiology, CIOs are finding radiology was a piece of cake.

Cindy Eggert, vice president of information systems and CIO at Good Samaritan Hospital in Los Angeles, knew it would be a challenge to bring state-of-the-art cardiology PACS to the 408bed academic medical center. However, as the volume of cardiologie studies continued to climb, Eggert knew it was a challenge she had to tackle.

For one thing, says Eggert, who has been CIO for over 10 years at the hospital, it had become clear that both cardiologists and radiologists at Good Samaritan needed IT upgrading at the same time. The hospital's radiology department was still film-based in radiology in early 2007, a fact that Eggert acknowledges was both unusual for an urban, academic hospital, and also spoke to the overall focus on cardiology - for several years cardiologists had been working with a standalone electronic imaging system.

Radiology PACS went live in August 2007, while cardiology, echocardiography, and cardiac ultrasound were up with PACS in February of this year. Additionally, in May, the cardiac catheterization lab also went live with the hospital's new system.

For both cardiology and radiology, Good Samaritan is using Alpharetta, Ga.-based McKesson Corporation. Going with a single vendor is the realistic way to achieve a level of interoperability at this point in vendor development, Eggert says.

The results have been highly successful already, Eggert says, with cardiologists, as well as radiologists, expressing strong faction with the ability to share images, data, and communications across specialties. What's more, the developments fit into a strategic approach that calls for creating an enterprise-wide image management system. Eggert and her colleagues are also about to launch a physician portal to facilitate access to images and data, and inter-clinician communication.

Nationwide, diff�rent approaches

Industry experts say that planning and implementing cardiology PACS is turning out to be more of a challenge than anyone had anticipated.

'I think the biggest issue is that cardiology is much more complex than radiology,' says Joseph Marion, principal at Healthcare Integration Strategies, a Waukesha, Wis.-based consulting firm, and an HCI blogger (www. healthcare-informatics.com/joe_marion). 'That's the primary issue: there are just a lot more data elements to integrate. As a result, they're playing catch-up to radiology in terms of the standardization necessary to integrate all the elements.'

The reality, he adds, is that hospital organizations are turning to single vendors for cardiology image management, as interoperability remains a problem due to insufficient communications standards.

'Cardiology PACS' evolution has paralleled the evolution of radiology PACS, but has always been behind,' notes Joe Biegel, vice president, product management, for the Medical Imaging Group at McKesson. One very basic reason for the lag in cardiology is the diverse medical technologies, outputs, and clinical workflows involved in the sphere, which encompasses echocardiography, electrocardiography, cardiac catheterization, and angiography/hemodynamic monitoring.

With different medical technologies creating different kinds of outputs, the technological environment in cardiology is far more complex than radiology, Biegel stresses. Therefore, he says, it's not surprising that patient care organizations have difficulty automating workflow processes, image viewing, and imageand data-sharing.

At the moment, 'the workflow in hospitals has been shifting from very analog to partially digital, and towards digital,' Biegel continues. But is it the ongoing surge in cardiology volume that is driving the development of cardiology imaging systems?

Indeed, says Robert Tkachyk, a Cleveland-based staff consultant at CSC Corporation (Falls Church, Va.), it is cardiologists themselves who are aggressively pushing CIOs to implement image management systems, as they try to keep up with an increasing volume of activity. Inevitably, individual cardiologists run into bandwidth problems, particularly if they are trying to access images online. 'The images in cardiology can be so large that transmitting them reliably over a network can be a very, very significant challenge,' he says.

So far, he says, the most advanced hospital organizations 'have probably partnered with a vendor and come up with a combination cardiology PACS and a cardiology information system that they may even have worked with the vendor to develop.' Not surprisingly, he notes, the cardiology information systems, analogous to the radiology information systems (RIS), lag behind the needs of today's cardiologists.

Progress in Omaha and Cleveland

At the six-hospital Nebraska Methodist Health System in Omaha, Senior Vice President and CIO Roger Hertz notes, 'We've had a strategy of integration since the onset of our journey into the EMR back into the mid-1990s.' For Hertz and his colleague Shawn Wiese, Nebraska Methodist's applications development manager, moving forward on cardiology PACS has been a natural fit with their overall strategy. Methodist Health went live in midJanuary with PowerChart ECG, from the Kansas City, Mo.-based Cerner Corporation, in two hospitals, 'pushed by the sunsetting of the legacy system we had had,' Wiese notes. Previously, the hospital system had had a standalone ECG product that 'required techs to print everything out - it was really only semi-automated, very inefficient,' he recalls.

Hertz and Wiese feel the same way that Eggert and her colleagues do at Good Samaritan. For them, it was only natural that they should move forward with cardiology PACS development, given the importance of cardiovascular services to the Nebraska Methodist's bottom line. 'Cardiology seems to be the natural follow-on to radiology,' Wiese reflects. 'And that department is similar to radiology in that you've got a number of different medical devices, and the vendors have positioned themselves to support DICOM compliance. So it makes sense to follow on in that area; and in terms of reimbursement, it makes sense.'

At the Cleveland Clinic Health System in northern Ohio, implementing cardiology PACS while staying focused on overall integration and interoperability has been vital, says Robert Cecil, Ph.D., network director, cardiology and radiology. In fact, says Cecil, 'We negotiated for almost two years to get the right terms and conditions from our vendor,' the Malvern, Pa.-based Siemens Medical Solutions (Cleveland Clinic has been collaborating on radiology PACS development with Siemens for some time). Cecil and his colleagues have implemented cardiology PACS - they went live at the system's main facility this spring, while piloting the technology at a subsidiary hospital last summer.

Cecil notes that, in addition to the technological differences, there is a strong political dimension to cardiology PACS implementation that CIOs dare not ignore. 'Radiology has always been perceived as a service organization,' he notes. 'Radiologists service other physicians. And if you were to go into a thirdparty hospital and take over radiology, there might be some grumblings, but you wouldn't be perceived as taking over the whole hospital. That's not true of cardiology. So politically, cardio-PACS is much dicier than going enterprise-wide with radiology. There are very few single private-practice radiologists, but there are a lot of privatepractice cardiologists, and they don't want to share information.'

Indeed, when asked what the key success factors have been in the implementation at Good Samaritan, CIO Eggert says that three stand out clearly. 'First, you must have physician champions in each subspecialty,' she says firmly. 'It wouldn't have mattered if I'd had the CEO, CMO, or CNO on my side. But we had excellent physician champions in every area.' Second, she says, implementing cardiology PACS relies on having strong cardiology technologists in every sub-area, who really understand 'what each machine is supposed to do, and what images are supposed to look like as you move towards storage.' Finally, she says, 'You need really strong project management,' given the extent to which such areas as the cardiac cath lab are constantly handling emergency patients.

In the end, says, Eggert, a combination of volume increases and storage needs, and clinician demands, will compel cardiology PACS to move forward nationwide. 'There will be a push to bring it into a more consolidated environment rather than standalones. It will be slow-going,' she adds, 'but it will get there. I wouldn't have said 10 years ago that I'd be seeing what I am now,' she concludes.

CONTINUE THE CONVERSATION

Contract Award: Nebraska Methodist Hospital Wins Federal Contract for Medical Services - US Fed News Service, Including US State News

WASHINGTON, Feb. 1 -- VA Nebraska Western Iowa Health Care System (Omaha Division) (Department of Veterans Affairs), Department of Veterans Affairs Nebraska Western Iowa Health Care System, has awarded a $59,200.00 federal contract on Jan. 26 for medical services.

Contractor Awardee: Nebraska Methodist Hospital, 717 N 190th Plz, Ste. 2500, Elkhorn, NE 680223987 For any query with respect to this article or any other content requirement, please contact Editor at htsyndication@hindustantimes.com

REGIONAL NEWS: MIDWEST. - Modern Healthcare

SUPERIOR, Wis.-A new Duluth clinic will replace two existing clinics on the campus of 42-bed St. Mary's Hospital of Superior. The $13.2 million facility will be called Duluth Clinic-Superior. The clinic and hospital are part of the Duluth, Minn.-based St. Mary's/Duluth Clinic Health System. The new clinic also will house a pharmacy and optical shop.

Disability law may cover gene flaws.(protection for those predisposed to ailments)(Brief Article) - Science News

A recent Supreme Court ruling has fostered a fledgling legal strategy that could protect people from discrimination based on their genes. The ruling suggests that the power of the Americans with Disabilities Act (ADA) might extend to people who are genetically predisposed to disease--before they fall ill.

As researchers identify genes associated with diseases such as breast cancer, colon cancer, or Huntington's disease, the danger arises that employers or insurance companies could discriminate against people who carry genetic defects. No federal law specifically protects people from genetic discrimination. 'It's about all of us, folks,' said Francis S. Collins, director of the National Human Genome Research Institute in Bethesda, Md. 'We're all at risk for something.'

Lawyers, scientists, genetic counselors, advocates for the disabled, and congressional staffers met Feb. 19 in Washington, D.C., to brainstorm about legal protections for people who carry identified genetic risk factors. The conference, sponsored by Collins' institute and the National Action Plan on Breast Cancer of the Public Health Service, focused on last year's Supreme Court case Bragdon v. Abbott.

In that ruling, an HIV-positive plaintiff was found to be protected under the ADA even though she had not developed any symptoms of AIDS. The woman sued her dentist after he refused to fill her cavity. The ADA defines as disabled, and therefore protected under the act, any person who is limited in a 'major life activity.' The plaintiff argued that she met this criterion because, after learning that she carried the AIDS virus, she decided not to have children. The court agreed, in a 5-4 decision.

Bragdon v. Abbott demonstrated that the ADA can extend to people who may, sometime in the future, develop a disease. Because it rested on the plaintiff's decision not to have children, however, a strict interpretation of that ruling would not protect people whose reproductive choices are unaffected by their genetic risk factors, said Paul Miller, commissioner of the Equal Employment Opportunity Commission in Washington, D.C. 'The broader question is whether the ADA protects against discrimination on the basis of diagnosed but asymptomatic genetic conditions--those that have the potential to limit major life activities,' said Miller. The ADA should apply in such cases, he said.

Whether it will is an open question. The commission would vigorously support a test case, Miller said, and might use a legal strategy that does not rely on major life activities. The ADA also protects people who are 'regarded as' disabled, he pointed out. Arguably, someone denied a promotion because of a genetic risk factor would be regarded as disabled by the employer and therefore covered under the ADA.

Ideally, identifying genetic risks for disease should help tailor health care to individuals, said genetic counselor Jill Stopfer of the University of Pennsylvania Cancer Center in Philadelphia. For example, women with mutations in the genes BRCA1 or BRCA2 have a heightened risk of developing breast and/or ovarian cancer. Such women may choose to have frequent mammograms, take anticancer drugs such as tamoxifen, or undergo prophylactic removal of cancer-prone tissue, says Stopfer.

Fear of discrimination, however, deters some women from being tested, said attorney Kathy Zeitz of the Nebraska Methodist Health System in Omaha. Her daughter, who has a family history of breast cancer, refuses to undergo genetic screening for fear that she may someday be denied health insurance.