Las Vegas Review-Journal –

Mar. 8: Washington - Rep. Dina Titus is emerging as a potential swing vote as Democratic leaders search for support to pass a final health care reform bill. Titus, D-Nev., voted for the House bill that passed 220-215 in November.

But she has spoken out against a Senate version that passed Dec. 24. She did not like its "Cadillac" tax on certain high- value plans, the special deals for states such as Nebraska and Florida, and certain consumer protections she said were not as strong as in the House version.

Changes being proposed by President Barack Obama have addressed some of those problems, Titus said. But as House and Senate Democrats try to forge a final compromise, and devise a way to get it passed over what is expected to be almost unanimous Republican opposition, Titus said she has not committed her vote.

"I am waiting to see what the fix is," Titus said Thursday. "I am not going to commit until I see not only the substance of the fix but what is going to be the process. These things change by the day."

One thing that is unclear is how the voting process would work under the "reconciliation" procedure Democrats are likely to use to overcome Republican obstacles in the Senate.

Like many House Democrats, Titus is leery of voting first on controversial bills only to have the Senate dither. She said she would be "hesitant" to vote for a health care bill without assurances the Senate could finish the job.

White House officials reportedly have been warning Democrats that if they voted for the bill last fall and then vote against the upcoming one, they risk being labeled as flip-floppers in their campaigns this fall.

But Titus said she has laid out her principles for what she will support in the bill and if they not met, she will vote no.

"I want to see it do what I have said all along: Bring down the cost of health care; provide more accessibility; preserve Medicare," she said. "Those are the things I am looking for in the bill, not whether it gets me re-elected.

"If the Senate bill is not fixed, that is not a flip-flop," she said. "I see that as standing by your convictions.

"I think the general public in my district thinks something needs to be done, and until they can see a final bill and can understand what is in there, there is a lot of uncertainty," she said.

The Associated Press -

Mar. 11: Washington - House Democratic leaders Thursday walked their rank-and-file members through last-minute agreements that could move President Barack Obama's overhaul of the nation's health care system a step closer to reality.

Although some issues remained unresolved including a divisive battle over restricting taxpayer funding of abortion House Speaker Nancy Pelosi, D-Calif., said: "We have enough to move forward."

White House officials and congressional Democratic leaders met Wednesday evening in Pelosi's office. Aides said they agreed on scaling back a health insurance tax that unions object to, and on gradually closing the Medicare prescription drug coverage gap. They were not far apart on other major issues, including Medicaid funding for states that already provide above-average benefits, and on improving subsidies that would be available under the plan to help individuals and families pay their premiums.

It will come down to a phenomenal effort by congressional leaders and the White House to win over skittish lawmakers after a year of incendiary debate, even as Obama keeps up campaign-style appearances designed to fire up public support.

At stake is the fate of the president's call to expand health care to some 30 million people who lack insurance and to prohibit insurance company practices such as denial of coverage on the basis of pre-existing medical conditions.

Almost every American would be affected by the legislation, which would change the ways people receive and pay for health care, from the most routine checkup to the most expensive, lifesaving treatment.

Democrats still need to see a final cost estimate from the Congressional Budget Office and want to ensure it stays around $950 billion over 10 years.

The costs of the bill would be covered through a combination of Medicare cuts and tax increases. Among the new levies, the Medicare payroll tax would be applied to the investment earnings of upper-income earners, including proceeds from capital gains. Until now, the tax has solely been levied on wages.

In a bit of bookkeeping, the Congressional Budget Office on Thursday released its final cost estimates for the bill the Senate passed on Christmas Eve — the 10-year, $875 billion plan would reduce the federal deficit and cover 31 million people who'd otherwise be uninsured. The Senate bill is the foundation of the proposal that Obama wants Congress to pass in the next few weeks. But the numbers will change yet again with the new version.

Obama invited members of the Congressional Black Caucus and the Congressional Hispanic Caucus to meet with him Thursday at the White House to discuss the health legislation. The White House also said Obama would travel to northeastern Ohio on Monday for an appearance near the hometown of an uninsured cancer patient named Natoma Canfield, whom the president has made a symbol of the need for reform.

It will be Obama's third event on health care in a week. In St. Charles, Mo., on Wednesday Obama shouted to a crowd: "The time for talk is over. It's time to vote."

House and Senate Democrats are working on a complex rescue mission for the health care legislation, which appeared on the cusp of passage late last year before Senate Republicans gained the strength to sustain a filibuster that could prevent final passage. The White House is pushing for a vote by the House before Obama leaves on a foreign trip at the end of next week.

The current plan is for the House to approve the Senate-passed bill from late last year, despite serious objections to numerous provisions. Both houses then would pass a second bill immediately, making changes in the first measure before both could take effect. The second bill would be debated under rules that bar a filibuster, meaning it could clear by majority vote in the Senate without Democrats needing the 60-vote supermajority now beyond their reach.

Republicans have vowed to do everything they can to thwart the plan, and for the Democrats, some policy questions remain unsettled.

Obama already has moved to eliminate a couple of special deals in the Senate bill that turned off voters when they became public, including extra Medicaid funding for Nebraska derided by critics as the "Cornhusker kickback." Late Wednesday the White House said the president was pushing to strip out a number of deals that remain, possibly including a provision sought by Sen. Max Baucus, D-Mont., providing Medicare coverage for residents of Libby, Mont., who suffer from asbestos-related illnesses because of a now-closed mining operation.

Pelosi and other House Democrats want to include Obama's proposed overhaul of the nation's student loan programs in the second, fix-it health care bill. The measure would require the Education Department to originate all student assistance loans, effectively eliminating a role for banks and other private lenders. That idea has run into opposition from several Senate Democrats.

The New York Times -

Mar. 11: St. Charles, Mo. President Obama continued his drive for a health care overhaul on Wednesday, ordering a crackdown on Medicare and Medicaid waste and fraud, while in Washington, House leaders said they hoped to have a completed bill to present to rank and file members Thursday morning.

As he left a meeting with Congressional leaders Wednesday evening in the office of Speaker Nancy Pelosi, the White House chief of staff, Rahm Emanuel, said, “Lots of progress.” Mr. Obama, in his second health care rally this week, said he was unleashing auditors around the country as part of a special program to ferret out government overpayments to hospitals and doctors, as well as to other contractors.

“The health care system has billions of dollars that should go to patient care, and they’re lost each and every year to fraud and abuse and massive subsidies that line the pockets of insurance company executives,” Mr. Obama told about 500 mostly supportive local residents in the gymnasium of St. Charles High School here.

His initiative is designed to woo Americans on both sides of the political fence; both conservatives and liberals can embrace going after wasteful government spending and overpayments to insurance companies.

Mr. Obama said the auditors would have an incentive to find improper payments because they would receive a small percentage of the savings. “It’s estimated that improper payments cost taxpayers almost $100 billion last year alone,” he said. “If we created a Department of Improper Payments, it would actually be one of the biggest departments in our government.”

The auditors — whom some White House officials are already referring to as “bounty hunters” — would have high-tech computer programs that would troll through billing records for fraudulent claims. White House officials said that a pilot program run by Medicare in California, New York and Texas recaptured $900 million in taxpayer money between 2005 and 2008.

For their part, Republicans said the government could step up its efforts against fraud without passing the Democrats’ bill. “Why can’t we crack down on fraud without a big-government takeover of health care?” asked the House Republican leader, Representative John A. Boehner of Ohio.

Mr. Obama sent his secretary of health and human services, Kathleen Sebelius, to take on insurance companies Wednesday. Speaking in Washington at the annual policy conference of America’s Health Insurance Plans, a trade group, she said, “It’s not too late to work on this issue together, for insurance companies to come to the table and work with us.”

In addition, Ms. Sebelius asked insurance companies to disclose all their requests for increases in premiums, along with data showing costs and other factors that would justify the higher rates.

Karen M. Ignagni, president of America’s Health Insurance Plans, immediately accepted the suggestion. She said her group would work with the National Association of Insurance Commissioners to develop a standard template for disclosure of data on premiums and costs.

Ms. Ignagni said her group would also suggest ways to improve the health care bill by strengthening its control of health costs.

Ms. Sebelius said that “over the last year, we have seen tens of millions of dollars, by the insurance industry, spent on ads and lobbyists to help kill health reform.” She said she could not understand such efforts because Mr. Obama was not trying to “eliminate the private insurance market and go to some kind of single-payer system like Europe or Canada.”

Indeed, the president’s proposal would provide hundreds of billions of dollars in subsidies to help moderate-income people buy private health insurance.

Las Vegas Review-Journal -

Mar. 6: What Dr. Dale Carrison, head of emergency room services at University Medical Center, knows is this: When Clark County Commissioner Chris Giunchigliani held a Feb. 19 meeting with staff in an ER break room, patient safety was compromised.

"There was only one nurse on duty for 12 patients, when there should have at least been three," he said Wednesday, a day after his heated exchange with Giunchigliani during a commission meeting. "The commissioner should have been clear with supervisors that she only wanted to talk with staff on break and held the meeting away from the ER."

Giunchigliani, however, denies that she had anything to do with compromising patient safety. "Whoever wanted to could just wander in," she said. "The union had set up this meeting."

The simmering feud between ER management and Giunchigliani that grew out of the break room meeting already had compelled ER nurse manager Evelyn Lundell to write a letter of complaint about compromised patient safety to County Manager Virginia Valentine, and a subsequent letter seeking whistle-blower protection. Giunchigliani, meanwhile, had written a letter to University Medical Center CEO Kathy Silver complaining that Lundell was rude to nurses.

And on Wednesday, former higher education chancellor Jim Rogers fired off a letter to the commission chairman, warning that Giunchigliani's conduct could jeopardize an effort to find top-tier hospitals to partner with UMC.

In her letter of complaint on Feb. 24, Lundell charged that Giunchigliani did not consult the management of the emergency department before holding her meeting:

"These actions to remove staff from the workplace jeopardized patient care and could have caused substantial and specific danger to the health and safety of our patients and hospital."

Lundell said that given what happened on "November 30, 2009," UMC must emphasize public safety.

It was on that day more than three months ago that a 25-year-old pregnant Las Vegas woman didn't receive help in the ER despite spending six hours there in distress.

Several hours after they arrived at UMC, Roshunda Abney and her fiance gave up hope of being seen. She eventually went home and gave breech birth to a baby girl, who died. Abney said she did not realize she was pregnant.

Lundell wrote a subsequent letter Feb. 26 in which she said she would like to invoke her whistle-blower protection. Under state law, an employer cannot discharge an employee if a complaint is filed by the employee regarding a violation of health and safety statutes.

Las Vegas Review-Journal -

Mar. 8: Dr. Dipak Desai, who ran the clinics linked to Southern Nevada's hepatitis C outbreak, has filed for personal bankruptcy. The Friday filing automatically halts all civil lawsuits against Desai in state court, including the first medical malpractice trial against him.

That trial, involving former patient Michael Washington, 69, was set for May 3. It would have been the first trial involving a patient with a hepatitis C infection genetically linked to other clinic patients. Health investigators have said that unsafe injection practices spread infection among patients.

"Filing bankruptcy just once again postpones, prolongs and victimizes everybody once again," said his lawyer, Ed Bernstein. In his Chapter 11 bankruptcy, Desai claims personal assets of more than $22 million, including his $2 million house at Red Rock Country Club, $1.1 million in bank accounts and more than $18 million in various investments and businesses.

His liabilities include a $1.2 million mortgage, $375,000 owed to the Bailey Kennedy law firm and a $350,000 medical malpractice claim. Those figures don't include the potential damages that could arise from hundreds of pending civil lawsuits by former patients, with estimated liabilities in the millions of dollars.

UNLV law professor Nancy Rapoport said the bankruptcy filing won't protect Desai's assets from civil judgments. However, it does bring them under the same court, which could help divide the assets equitably, unlike the piecemeal litigation spread among many state district courts, she said.

For Desai, the bankruptcy puts those lawsuits on hold indefinitely. "He's using the automatic stay to give him some breathing room," Rapoport said.
The postponement also saves Desai the legal costs to fight them.

According to the bankruptcy documents, Desai paid more than $240,000 in the past three months to various law firms, including the one handling his bankruptcy and the one handling any criminal case.

Las Vegas police have recommended criminal charges against Desai and others who worked in the clinics. County prosecutors expect to take that case before a grand jury in the near future.

Meanwhile, Washington can ask U.S. Bankruptcy Judge Mike Nakagawa to lift the postponement in his case, but that would take months, Bernstein said. By then the trial date will be past, and a new trial date likely won't be available until next year.

"It's one roadblock after the next," Bernstein said. "This is a stalling tactic. They're hoping to outlast all these plaintiffs." Patients suing Desai and his clinics were in a similar spot last summer when the Gastroenterology Center of Nevada, Endoscopy Center of Southern Nevada and Desert Shadow Endoscopy Center filed for bankruptcy.

Nakagawa allowed a handful of lawsuits to go forward because they were close to trial. Most of those have been rescheduled, but trials involving Washington and former Desert Shadow patient Henry Chanin were on schedule for this spring.

Chanin's trial, set for April 12, names Dr. Rajat Sood instead of Desai because Sood performed the procedure. A two-year investigation by public health officials determined that as many as 115 patients were infected with hepatitis C because of unsafe injection practices at the Endoscopy Center and Desert Shadow clinics.

Nine of the cases were linked to the clinics, while the other 106 were possibly linked, according to the Southern Nevada Health District.

Hundreds of former patients have sued. Most of those lawsuits also include a product liability claim against Israel-based Teva Pharmaceutical Industries, which made the anesthetic used to sedate patients during their procedures.

Lawyer Will Kemp, who represents former patients, said the bankruptcy could backfire on Desai by opening the possibility to tap into his family trusts, where money from the clinics was funneled.