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Can This Go On? Go to the Internet and enter the "Weitz and Luxenberg" web site. Their home page proudly announces that New York State Assembly Speaker Sheldon Silver has joined their firm as "of Counsel" on negligence cases. The firm advertises itself as one of the foremost mass torts, product liability, and personal injury law firms in the United States. Now New York State Assembly Speaker is on their payroll. Talk about a CONFLICT OF INTEREST! Sheldon Silver, by all accounts, has prevented numerous bills regarding tort reform from coming to the Assembly floor for discussion. In fact, according to state assembly members and senators with whom I have spoken, there will be no New York State tort reform because Mr. Silver, one individual, is doing all he can to prevent debate and the opportunity to vote on issues vital to the citizens of New York. Many times bills on tort reform are never even allowed to be considered by our elected representatives. These bills quickly die in committee, their merits never seeing the light of day. While no lawful employment disqualifies a citizen from becoming an elected official, judges throughout our nation routinely recuse themselves from cases in which they might have any conflict of interest. Nor can attorneys represent a client if they have any relationship with the opposing party. Why as citizens do we not have the right to expect our elected officials to do the same? How can the Assembly Speaker fairly represent the citizens of our state if he is on the payroll of a law firm with such a large vested interest in preventing any meaningful reform of the system? How is it that Sheldon Silver feels no obligation to recuse himself when there is such an obvious conflict of interest? It is bad enough when there is the appearance of impropriety. Sheldon Silver, by refusing to allow debate on tort reform, has ventured beyond a mere appearance of impropriety. This conflict of interest has gone on too long. Actions like these do not serve the public interest, and undermine the public's faith in representative government. I call on Sheldon Silver to stand aside on all issues of tort reform, and allow them to come to the Assembly floor for vote. Sincerely, President Nassau County Medical Society
Dear Doctor:
SEVERE ACUTE RESPIRATORY SYNDROME (SARS) Since November 1, 2002, there have been a total of 2,781 probable cases reported worldwide, with the majority of cases (2,288 cases) from China and Hong Kong. Since SARS is currently a diagnosis of exclusion, the status of a reported case may change over time. In the United States, there have been 154 suspect cases of SARS with 22 cases in New York State. To date, all SARS cases in New York State have been related to travel to affected areas. The Centers for Disease Control and Prevention (CDC) has defined the affected areas as mainland China, including Hong Kong; Hanoi, Viet Nam; and Singapore. Clinical Description SARS has been diagnosed primarily in previously
healthy adults aged 25-70 years. Few cases have been reported in
children aged <15 years. The typical incubation period for SARS
is 2 ¡V 7 days with isolated reports suggesting an incubation period as
long as 10 days. The illness begins generally with a prodrome of
fever >100.4„aF (>38.0„aC). Fever is often high, and may
be accompanied by chills, rigors and other symptoms, including headache,
malaise, and myalgias. At the onset of illness, some persons have
mild respiratory symptoms. Typically, rash and neurologic or
gastrointestinal findings are absent; however, some patients have reported
diarrhea during the febrile prodrome. Chest radiograph may be normal throughout the febrile prodrome and course of illness. However, in a substantial proportion of patients, the respiratory phase is characterized by early focal infiltrates progressing to more generalized, patchy, interstitial infiltrates. Some chest radiographs of patients in the late stages of SARS also have shown areas of consolidation. Early in the course of disease, the absolute lymphocyte count is often decreased with overall white blood cell counts normal or decreased. At the peak of the respiratory illness, approximately 50% of patients have leucopenia and thrombocytopenia or low-normal platelet counts (50,000¡X150,000/£gL). Early in the respiratory phase, elevated creatine phosphokinase levels (as high as 3,000 IU/L) and hepatic transaminases (two to six times the upper limits of normal) have been noted. In the majority of patients, renal function has remained normal. The severity of illness is highly variable, ranging from mild illness to death. Some close contacts of cases have reported a mild, febrile illness without respiratory signs or symptoms, suggesting the illness might not always progress to the respiratory phase. Empiric therapy has included antibiotics for atypical pneumonia and antiviral agents such as oseltamivir or ribavirin sometimes in combination with steroids. At present, the most efficacious treatment regimen, if any, is unknown. Case Definition and Reporting In order to enhance surveillance for SARS, the NYSDOH is requesting immediate reporting of any suspect cases. The CDC has developed the following case definition: Respiratory illness of unknown etiology with onset since February 1, 2003, and the following criteria:
* Close contact is defined as having cared for, having lived with, or having direct contact with respiratory secretions and/or body fluids of a patient known to be suspect SARS case. Effective April 10, 2003, on an emergency basis, SARS was added to the reportable disease list (Section 2.1 of the New York State Sanitary Code). Physicians should immediately report any suspect cases to the local health department. If there are difficulties reaching your local health department, please contact the NYSDOH. During business hours, call 518-473-4436; after hours, call 1-866-881-2809. In New York City, call the Bureau of Communicable Disease at 212-788-9830; after hours, call the Poison Control Center at 212-764-7667 or 1-800-222-1222. Triaging Patients and Infection Control In the health care setting, it is critical that all personnel who are the first points of contact be trained for SARS screening. It is important to question patients carefully to try to distinguish SARS from respiratory viruses circulating at this time of year. Questions related to travel are key in formulating the differential diagnosis. Upon presentation to the office, patients should be questioned as to travel to China; Hong Kong; Hanoi, Viet Nam; or Singapore within 10 days prior to illness, or exposure to a known or suspected SARS case. If possible, these types of patients should be scheduled at the end of the day, and be brought in the least public entrance. Precautions much like those taken for varicella should be employed. A surgical mask should be placed immediately on the patient and they should be ushered into a remote examining room. The door should remain closed while the patient is in the room. Health care workers who will examine or interact with the patient should use both contact precautions (e.g., gloves, gown and eye protection) and airborne precautions (e.g., an isolation room with negative pressure relative to the surrounding area and use of an N-95 [or equivalent] filtering disposable respirator. If respirators are not available, healthcare workers should wear a surgical mask.) Attention to careful hand hygiene must be emphasized. Environmental Cleaning Gloves are to be worn for all cleaning of the environment in the room where a suspect SARS case was seen. Frequently touched surfaces in the examining room (exam table, counter tops, any non-critical equipment used, such as blood pressure cuffs) should be wiped down with an Environmental Protection Agency (EPA)-registered low - or intermediate ¡V level disinfectant and allowed to dry as per manufacturer¡¦s instructions. After cleaning is performed, gloves are to be removed, and hand hygiene must be performed. After the patient leaves the room, in a room that has 1-2 air changes per hour, the door shall remain closed to new patients for approximately 140 minutes to achieve a removal efficiency of 99%. Etiology Limited reports on testing results have indicated the virus to be a previously unknown coronavirus. Both polymerase chain reaction and serologic methods have been use in multiple laboratories to reach this point. Metapneumovirus has also been seen in several cases, but there is not enough information to determine what role, if any, human metapneumovirus might have in causing SARS. Definition of the etiology of SARS is ongoing. Additional Information For additional information on SARS, please consult the following sites:
Updates on this outbreak, as well as the CDC and WHO alerts, will be posted on the NYSDOH’s Health Alert Network (HAN): https://commerce.health.state.ny.us/hpn Adverse Cardiac Events Following Smallpox Vaccination The CDC has developed new guidance regarding potential adverse reactions to smallpox vaccination, as well as identifying additional health conditions that should be the basis for deferment of vaccination (available at: http://www.bt.cdc.gov/agent/smallpox). Evidence from recent vaccinations, primarily of military personnel, shows that smallpox vaccination increases a vaccinee¡¦s risk of developing myocarditis, pericarditis, or a combination of the two, myopericarditis. The rate of these conditions among recent military vaccinees (1 per 20,000) has been far in excess of the rate among military personnel during 1998-2000 (1 per 100,000). Cases have been generally mild, although one person experienced heart failure that subsequently resolved. Vaccinees who experience chest pain, shortness of breath, or other symptoms suggestive of cardiac disease, should immediately seek medical care. Myocardial infarction (MI) has occurred among five vaccinees (four civilians and one military vaccinee); two other persons (both civilians) have experienced angina. Three persons that experienced a heart attack have died. Vaccination may not have caused these conditions; they may have occurred by chance alone. Additional studies regarding a possible link between vaccination and MI/angina are underway. In the interest of safety while these additional
studies are underway, persons with known heart disease and risk factors
for heart disease have been added to the list of who should not be
vaccinated. Known heart disease includes coronary artery disease, previous
heart attack, angina, congestive heart failure, cardiomyopathy, stroke,
transient ischemia attack, chest pain or shortness of breath on exertion,
and other heart conditions under a physician’s care. Three or more known
major risk factors for heart disease are also a reason not to be
vaccinated, specifically high blood pressure, increased cholesterol,
diabetes, a parent or sibling with a heart condition before age 50 years,
or a current Physicians with questions about potential adverse reactions to vaccination should contact their county health department. If there are difficulties reaching your local health department, please contact the NYSDOH. During business hours, call 518-473-4436; after hours, call the duty officer at 1-866-881-2809. In New York City, contact the Provider Access Line anytime at 1-866-NYCDOH1. As always, we thank you for your ongoing interest and involvement in these important public health issues. We will keep you informed as new information becomes available. Sincerely, Antonia C. Novello, M.D., M.P.H., Dr.P.H.
MSSNY has launched a statewide campaign seeking financial support from all physicians for the newly formed Tort Reform Action Committee (TRAC). When Immediate Past President Ann Cea, MD, urged the packed audience at State Legislation Day to “put your money behind you verbal anxiety,” a number of physicians wrote out $1000 checks on the spot. Contribution forms can be downloaded from the MSSNY website at www.mssny.org and this month’s News of New York (you should have received it this week) includes a form on the inside pages. “We cannot fight the trial bar without financial support from physicians,” said newly elected President Jeffrey Ribner, MD. These contributions are for advocacy purposes and are not deductible as charitable contributions for federal or state income tax purposes.
Among other things, he strongly supported a $250,000 cap on non-economic damages. In light of these incredibly encouraging remarks, it is now more important than ever before that physicians across New York State come together. We must use one united voice to urge Albany to enact comprehensive tort reform now. “Stand Up” for Tort Reform in your community on May 20th! Please contact your local county medical society today and get involved - find out where physicians will be meeting in your community on May 20th to “Stand Up” for tort reform. Join your colleagues on that day.
The Executive Budget proposal in Albany would eliminate the state Medicaid obligation to pay for Medicare cost sharing amounts for low-income elderly and disabled New Yorkers who are eligible for both Medicaid and Medicare. Medicare currently pays only a portion of the cost of covered services, leaving the remaining amount to be paid through beneficiary cost-sharing in the form of deductibles and coinsurance. For psychiatric services, the amount paid by Medicare is limited to 50% of the Medicare approved amount. Medicare pays 80% of the approved amount for all other medical services. Currently, for persons eligible for Medicare and Medicaid, Medicaid pays the remaining co-payment. Under the proposal, the Medicaid payment will not be made in virtually all cases. This will cost physicians $152 million. Furthermore, such a short-sighted reduction undercuts our shared goal of ensuring that Medicaid beneficiaries have the advantage of a true “medical home” for primary, preventive and specialized care. Please take one minute to send a letter to your legislators, who are negotiating a final state budget right now, to strongly oppose this proposed health care cut. Just click on this link: http://capwiz.com/mssny/issues/alert/?alertid=1890716 and follow the instructions. Thank you.
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The
New York State Department of Health (NYSDOH) would like to provide you
with an update on two rapidly evolving medical issues, Severe Acute
Respiratory Syndrome (SARS) and adverse cardiac events following smallpox
vaccination. The information below is the most current as of April
10, 2003.
On
April 4, 2003 Governor George E. Pataki, in a rousing address to
hundreds of physician leaders from all over New York who were gathered
at the MSSNY House of Delegates, decried the failure of our current tort
system promising physicians that he would “fight for tort reform.”