Russian Health Care

The Bulletin of the Humboldt-Del Norte County Medical Society has run a series of articles by J Kim Bauriedel, MD, FACS, reporting on the five weeks he spent in Siberia as part of a Rotary International exchange. In a recent issue he wrote about specific public health issues affecting life span. He says most Russians are heavy consumers of alcoholand he saw, at least in one instance, a surgeon having a shot of vodka between cases. It was not unusual to see physicians at lunch consume several bottles of vodka, whether at a restaurant or in the hospitals. However, he did not notice a lot of people who were incapacitated, sleeping on the streets or in doorways. The water piped to homes is not pure. Bottled water is also contaminated, and only a few brands are trusted. Most Russians boil tap water for cooking and consumption. Dr. Bauriedel feels the lack of safe water contributes to the use of alcohol. He also reports that most Russians over the age of 14 are smokers. However, they were respectful of the nonsmoking American doctors and did not smoke in their presence. When riding in cars, the Russians would stop every 20 to 30 minutes, and get out of the car to have their cigarette before continuing the journey.

Narcotics are also a major problem, particularly in Siberia where drugs are imported from Mongolia and Kazakhstan. The abuse rate is very high; there are few rehabilitation centers, needle exchanges and methadone programs. Life spanin Russian is decreasing. In the late 1980s, life span was 68 years. It is currently 58 years. Bauriedel feels that in addition to the above, infectious diseases, pollution, congenital anomalies, high rates of accidents and trauma contribute to this decline. However, he remains optimistic about Russian medical care, primarily because Russian doctors are communicating via the Internet with the rest of the world, learning about new drugs and technology. They are also traveling outside of Russia for additional training and conferences.

Rancho Los Amigos

When I was evaluating pulmonary fellowships in the 1960s, I visited USC and Chief of Pulmonary Medicine Dr. Oscar Balchum took me on a tour of the famous Rancho Los Amigos Hospital, where iron lungs were prevalent. It is now a national rehabilitation center. It is also on the chopping block and will close on June 30, by a 4 to 1 vote of the Board of Supervisors, absent an emergency infusion of funds by May. It must be hard for politicians to understand when they’re treading on sacred medical ground.

HIPAA

A number of the county medical society journals had articles on the Health Insurance Portability and Accountability Act. The Southern California Physician’s staff writer Dina L Burwell, notes breaches in confidentiality and asks, “Do HIPAA regs assure patient privacy?” According to the California HealthCare Foundation, about 20 percent of U.S. adults believe a health care professional, insurance plan, government agency or employer has improperly disclosed personal medical information. Half believe it resulted in personal embarrassment or harm.

After HIPAA modifications were published on August 14, legislators and patient advocates pounced on the Privacy Rule. After the original Privacy Rule was published in December 2000, HHS received more than 50,000 comments on its workability. A common concern was voiced: “The healthcare industry believed that the ‘consent to use information’ requirement would halt and complicate the provision of health care,” says Ken Gordon, an attorney with the national law firm Jenkens & Gilchrist and leader of its Health Law Practice Group. “Their argument was that a person admitted to a hospital expects his health information to be used by his health care provider in the hospital,” he says. “To add another consent requirement for the use of the information didn’t make any sense and interfered with access to healthcare. So, the administration backed off and said that if covered entities are going to use private healthcare information for treatment, payment or health care operation, they don’t need to get a separate consent form from the patient.” Hence, the rule made consent for routine health care delivery purposes optional. “The Privacy Rule says doctors are allowed to provide certain information to insurers and related entities.” He also states, “Marketing is redefined so patients can be contacted directly about their medicines,” says Deborah Peel, MO, immediate past president of the National Coalition of Mental Health Professionals and Consumers. “These privacy breaches are renamed ‘recommending treatment.’” But the law specifically prohibits covered entities from selling lists of patients and enrollees to third parties or from disclosing protected health information to a third party without the individual’s authorization. “For example, drug stores can’t sell their prescription lists to drug companies for further marketing,” says Serena Simon, an attorney with Miller & Chezalier in Washington, DC.

Patient privacy groups are particularly concerned that privacy violations could have a chilling effect on patients’ frankness with their doctors. “More and more people are becoming afraid to talk openly with their doctors,” Metz says. “According to the California HealthCare Foundation, one in seven Americans has kept personal medical information confidential, such as withholding information from their healthcare provider, providing inaccurate information to a health plan or paying out of pocket for covered care.”

Many patient advocates, nonetheless, remain dissatisfied with HIPAA.

Hispanic Employees

Carol Kleiman, columnist for the Chicago Tribune, writing in Southern California Physician, reminds us that for Hispanic workers, family always comes first. “The 2000 Census found that the nation’s Hispanic population has jumped by 58 percent since 1990, to 35.3 million from 22.4 million,” says Pauline E. Kayes, president of Diversity Works Inc., a consulting and training firm in Champaign, IL. “Currently, Hispanics comprise 11.4 percent of the U.S. work force and will increase to about 22 percent in this decade,” Therefore, it’s important to know what families mean to most Hispanic people. “For Hispanics, our children are the most important things in our lives,” says Mezzetta, who is on the boards of the Indianapolis Chamber of Commerce and Hispanic Chambers of Commerce. The experts encourage employers to be flexible.

Adolescent Sex

In a recent issue of Southern California Physician, Dr. Michael Klein, MD, a retired OB-Gynecologist from Claremont wrote that he “handed out contraceptives, treated STDs and even performed abortions for about 25 years. Condoms have a 3 percent failure rate under the best of conditions, a much higher failure rate in actual practice and probably give almost no protection against condylomata, herpes and other STDs. They are better than nothing, but if tires had a 3 percent failure rate, they would be recalled. A little abstinence, at least until after high school graduation, might be helpful.”