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July 26, 2010 |
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Too Bad Our
Politicians Did Not Take The Hippocratic Oath
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 By
L. Edward Seade, MD
President, Texas Orthopaedic Association
If you don't see Medicaid patients, read this. If
you do see Medicaid patients, you probably also
should read this. You see Obamacare promises
insurance to millions of uninsured patients. If we
continue down the current path we have been on for
the last year and a half, all medical insurance
companies will go bankrupt and place everyone into
the federal program. The federal programs, such as
Medicaid, are partially funded by our states. All
states are required to have a balanced budget and
our great State of Texas is no exception. The
current recession has state budgets in a tizzy.
Texas is looking to cut spending and Medicaid has a
big red bulls-eye painted right on it.
There are over 48,000 practicing physicians in the
state of Texas and less than a third of us see and
treat patients with Medicaid. The Texas Medical
Association polled its members and forty-five
percent (45%) of the respondents said that they
would limit how many Medicaid patients they see in
their offices if the already low fees are cut by as
little as 1 to 2 percent. We all want to help these
patients and we are in the business of making people
better, but we will not be able to afford the
"privilege" of doing so. We cannot pay for our
offices to operate in the red. There is not a
single business in town that can keep its doors open
and lose money year after year.
Effective September 1, 2010 the Texas Health and
Human Services Commission is expected to cut
reimbursements to try to trim the budget. Medicaid
accounts for seventy-five percent (75%) of the
entire budget of the Health and Human Services for
the state. In the TMA poll, twenty-four percent
(24%) said that they would stop treating Medicaid
patients all together if the fees dropped any
further. Houston, do we have a problem?
This is a huge dilemma. The uninsured patients, to
whom Obamacare is promising health care, will be
dumped straight into this program. With more and
more doctors withdrawing from Medicaid, who is going
to take care of these patients? The new law aims to
use Medicaid to cover over 16 million uninsured
patients and the current administration is trying to
give amnesty to about 18 million undocumented
workers here our country. Giving these undocumented
workers an American citizenship will then also grant
them access to Obamacare.
How can we afford this and who is going to take care
of these patients? Obamacare promises health
insurance for all Americans, but having insurance
and getting medical care are not synonymous under
this plan.
As we all learn more about the current Health Care
Law, we begin to see why the majority of Americans
are becoming increasingly disenchanted with it. In
the latest Rasmussen poll (conducted July 16-17)
they found that sixty-nine percent (69%) of
mainstream voters favor repeal of the law.
Fifty-four percent (54%) thought the new law would
be bad for the country versus thirty-three (33%) who
thought it would be good. Sixty-two percent (62%)
expect the law to increase the deficit and only
thirteen percent (13%) said the law will reduce the
budget. Only twenty-three percent (23%) of those
polled thought that health care will be better under
Obamacare.
Our elected officials just passed a law that will
make our delivery of health care worse and this is
bad for our patients. This new law will also put
many offices and clinics out of business.
Wow, Houston we do have a problem.
Don't just stand idle while the best health care in
the world gets sacked. Call your
Congressman/Representative, get mad and get involved
or just donate to our cause. Think of all of the
time and money you have spent to get to where you
are. Are you willing to just give it up? Don't let
these politicians tell you how to take care of your
patients. These policies are doing harm to your
patients and the way you deliver healthcare.
Click
here to find your Congressman / Representative.
Click
here to donate to the TMA PAC / Click
here to donate to the Texas Orthopaedic
Foundation. |
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Senate Committees
Shuffled, Senate State Affairs Committee Unchanged
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 By
Mike Ward | Wednesday, July 14, 2010,
01:36 PM
Austin American Statesman
The Senate
State Affairs Committee, which hears tort
issues, remains unchanged, Senate
committees shuffled.
Lt. Gov. David Dewhurst this
afternoon shuffled the leadership of eight
Senate committees, a major overhaul that
senators said came after the retirement of
Sen. Kip Averitt and a desire among some
members of the Upper Chamber and Dewhurst
for changes.
The realignments were the
most significant some time in a legislative
chamber known for its hidebound traditions.
According to two senators who
asked not to be quoted by name about
confidential conversations they had with
Senate leaders, some of the committee chairs
who were shuffled asked for the change and
others reluctantly agreed to do so.
New assignments:
Sen. Kevin Eltife, R-Tyler,
will replace Sen. Tommy Williams, R-The
Woodlands, as chairman of the Senate
Administration Committee, the panel that
manages the Upper Chamber's business affairs
and rules.
Williams will become chairman
of the plum Transportation and Homeland
Security Committee, replacing Sen. John
Carona, R-Dallas, who will become chairman
of the powerful Business and Commerce
Committee.
Sen. Troy Fraser, R-Horseshoe
Bay, who had been chairman of Business and
Commerce, will shift to become chairman of
the Natural Resources Committee that was
formerly headed by now-retired Averitt.
Averitt, R-Waco, resigned
last spring for personal reasons.
Sen. Chris Harris,
R-Arlington, will move from the chairmanship
of the Economic Development Committee to
head the Jurisprudence Committee, which has
been chaired by Sen. Jeff Wentworth, R-San
Antonio.
Wentworth will move to chair
a new Senate Select Committee on Veterans
Health, a lower echelon assignment for such
a longtime senator.
Wentworth, who has been the
focus of speculation that he may resign to
take a high-level job with the Texas A&M
System, could not immediately be reached for
comment.
Sen. Mike Jackson, R-La
Porte, who had been chairman of the
Nominations Committee, will become chair of
the Economic Development Committee. He will
be replaced as Nominations chair by Sen.
Robert Deuell, R-Greenville, who previously
had no chairmanship.
In a statement, Dewhurst
explained the changes this way: "Texas is
facing a number of complicated challenges,
from creating jobs and balancing the budget,
to securing our border, improving public
education, building new highways and
ensuring a clean environment.
"That is why it is critical
to continue to have experienced legislators
serving as committee chairs, as we prepare
to meet these important challenges when the
82nd Legislature convenes in January."
Get more Legislative coverage
inside the
Virtual Capitol. For a complete
list of the 81st Legislature - Interim Texas
Senate Committees click
here.
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This Week In Texas: Mignon
McGarry's Memos
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 By Mignon McGarry
TOA Legislative Advocate
TOA Online Version: All Memos
Wednesday, July 21, 2010
Last week, Lt.
Governor David Dewhurst announced changes to
Senate committee membership for the 81st
Legislature, including eight committee
chairmanships. To view the complete list,
click
here.
The latest
campaign finance reports are posted on the
Texas Ethics Commission website. In the
race for governor, Gov. Rick Perry and
challenger Bill White both raised around $7
million for their campaigns during the
latest reporting period. White reports
having $9 million cash on hand compared to
Perry's $6 million. The latest poll from
Rasmussen Reports shows Perry with the
support of 50 percent of likely voters,
compared to White's 41 percent.
Many
legislators will head to Louisville,
Kentucky next week for the Annual
Legislative Summit held by the National
Conference of State Legislatures. Featured
speakers include U.S. House Speaker Nancy
Pelosi, U.S. Senate Republican Leader Mitch
McConnell and former Florida Governor Jeb
Bush. This is one of three national
conferences where state legislators gather
to exchange ideas with their counterparts
from other states. |
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Commissioner of
Workers' Compensation Appoints New Medical Advisor
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 Dr.
Donald Patrick will join the Texas
Department of Insurance, Division of
Workers' Compensation as the Medical Advisor
effective July 12, 2010.
Dr. Patrick served as
the Executive Director of the Texas Medical Board
until August 2008. Prior to this position, Dr.
Patrick practiced neurosurgery in Austin from 1969
to 2001. Currently he is a Diplomate of the American
Board of Neurological Surgery and a member of the
Austin EMS Advisory Committee, the Texas A&M
Kingsville Foundation Board and Board of Managers
for Central Health (formerly the Travis County
Healthcare District).
In addition to his
distinguished medical career, Dr. Patrick also
earned a J.D. from the University of Texas, School
of Law in 1996 and is certified to practice law in
the State of Texas.
Dr. Patrick's
additional distinctions and honors include:
Distinguished Alumnus of Texas A&M University
Kingsville; Chief of Staff of Brackenridge Hospital
in 1984; President of the Pflugerville Independent
School District Board of Trustees, serving from
1985-88; and President of the Texas Association of
Neurological Surgeons in 1988-1989. |
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Study Finds Inherent Risk For
Nerve Injury With RF Cautery In Primary Cruciate Substituting TKA
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 By
Bob Kronemyer
Orthopedics Today (June 1, 2010)
Three
statistically significant risk factors for
developing postoperative neuropathy when
using intraoperative saline-irrigated
bipolar radiofrequency hemostasis for total
knee arthroplasty are female gender, low
body mass index, and those with rheumatoid
arthritis, according to a retrospective
review comparing hemostasis with this device
to electrocautery.
"Our study found inherent, but low risk of
nerve injury," said principal investigator
Steven T. Lyons, MD, a staff orthopedic
surgeon at Florida Orthopedic Institute in
Tampa, Fla., who pointed out that many other
physicians use bipolar radiofrequency (RF)
for hemostasis successfully without similar
findings. "I think it's not a problem with
the device as much as it is a problem with
technique," said Lyons.
Reasons unclear
Lyons said he has no idea why these three
factors pose a risk. "But a fourth risk
factor, which is probably the largest risk
factor and the common thread in all my
patients during total knee replacement, is
the complete removal of the posterior
cruciate ligament," Lyons told Orthopedics
Today. "This exposes the posterior
compartment of the knee a lot more.
Anatomically, the tibial nerve is right
behind the posterior compartment of the
knee, where we treat with the RF device.
Therefore, I think it is prudent to use
extreme caution, specifically in the center
of the knee, when cauterizing using the RF
device."
Prior to 2007, Lyons
had not encountered this kind of nerve injury
complication in his patient database. "It was a very
specific type of injury, if you will – limited to a
numbness on the bottom of the foot," he said. A few
of the complaints were associated with foot drop,
"but most were simply random numbness on the bottom
of the foot. Because this was a bit out of the
ordinary from what I normally witness, I tried to
determine the new modifier that could have caused
this."
Comparative review
The only new modality Lyons had introduced in 2007
was bipolar RF hemostasis, which he deployed for
total knee replacement between July 2007 and October
2008. For the review, he compared his 241
consecutive cases of integrated saline/RF energy
during this time period with his previously 241
consecutive primary TKR cases of electrocautery to
achieve hemostasis conducted between October 2006
and July 2007. The two groups were demographically
and clinically comparable.
RF treatment used in the posterior compartment of
the knee.
Outcomes were presented at the annual meeting of the
American Academy of Orthopaedic Surgeons (AAOS)
in New Orleans. Overall, 3.73% (nine of 241 cases)
in the RF group had neuropathies documented by
electromyography (EMG). Furthermore, 14% of the RF
group had sensory changes in the medial plantar
nerve, 29% had problems with the lateral plantar
nerve, and 57% had the entire bottom of the foot
affected.
"No nerve injuries occurred in the comparison
group," Lyons said. Conversely, no vascular injuries
were detected in the RF group.
"Among thin, females with rheumatoid arthritis, one
needs to tread very carefully using a bipolar RF
device in the back of the knee to cauterize for
hemostasis," said Lyons, a clinical assistant
professor of orthopedics at the University of South
Florida, who no longer routinely uses bipolar RF
cautery for hemostasis in knees, but does for hips.
"However, I will use RF in knees of patients who are
Jehovah's Witnesses, patients who are anemic, or
have conditions to prevent significant blood loss."
References:
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Lyons, ST;
Morrison, K. Sensory neuropathy associated with
cauterization using bipolar radio frequency
device in primary TKA. Paper 162. Presented at
the 2010 Annual Meeting of the American Academy
of Orthopaedic Surgeons. March 9-13. New
Orleans.
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Steven T. Lyons,
MD, Florida Orthopedic Institute, 7171 N. Dale
Mabry Highway, Suite 502, Tampa, FL 33614;
813-936-5075; e-mail:
slyons14@gmail.com.
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Mission Of Hope Haiti: Golf
Tournament in Austin
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 By
Erik Lofgren
Austin MOH Haiti Golf Tournament
The upcoming
Austin MOH Haiti Golf
Tournament
will benefit the Mission of Hope's hospital project
as this hospital will provide orthopedic, pediatric,
dental and prosthetic services to a community who
has virtually no available health care today. A
quick review about the medical effort at Mission of
Hope can be seen with this
video.
The Mission of Hope has been in Haiti for over 15
years and has been providing a school to 1,200
children, an orphanage to 60 children and a medical
clinic to the area northwest of Port au Prince.
Since the earthquake in January, the Mission of Hope
has truly been a beacon of light in a country of
much darkness. From minutes after the earthquake
they began providing advanced medical care including
having the only sterile operating room in Port au
Prince, a city of 3 million people. In that little
20' x 20' room they have done over 4,000 surgeries
and advanced medical procedures. Since the January
12th over 6 million meals have been served by the
Mission of Hope and the school is forecasted to grow
to 4,000 children and the orphanage to 240 children.
We
have a few hole sponsorships still available as well
as some other options for your organization to be
involved in this kickoff event to the $500,000 fund
raising effort to build the hospital at the Mission
of Hope. If I can help you share
the Mission of Hope story with your colleagues or
you have any questions, please do not hesitate to
contact me. I can attest from my time at the Mission
of Hope that it is truly a place doing great works
fulfilling the commission of helping those in need.
There are many causes in the world that are worthy
efforts, but I think this opportunity in Haiti is a
unique opportunity for us in Austin to help rebuild
a country that has been broken for so long. If I can
answer any questions or be of any assistance please
contact me at 512-560-9390 or via
email. |
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