CAPITOL UnitedHealth agrees to Cuomo’s doctor ranking program BY VALERIE BAUMAN The Associated Press
UnitedHealth Group Inc. agreed to create a doctor ranking program that will inform consumers and physicians about how much costefficiency and quality contribute to the insurer’s decisions to designate “preferred” providers, Attorney General Andrew Cuomo said Tuesday. UnitedHealth (NYSE: UNH) had already planned to provide a doctor ranking program to its New York and New Jersey customers beginning in December when Cuomo contacted them in July asking for an explanation of how the company planned to rate physicians. The company has already implemented its program to recommend doctors to patients in 122 other markets. The program ensured that the first standard for selecting a preferred provider was a set of quality standards, afterward UnitedHealth would consider cost factors. Working with standards established by Cuomo’s office, consumers and physicians will be able to see which factors the insurer uses to add doctors to its ranking system. Cuomo began investigating the industry’s ranking practices because he was concerned insurers might rate a doctor’s quality based entirely, or “disproportionately,” on the insurance company’s economic interests. “We’ve accomplished a good thing,” Cuomo said. “And I’m excited about it, and it’s going to give the health care consumers of New York more confidence and a better relationship with the companies.” UnitedHealth will also hire a monitor to evaluate compliance with the agreement and report to Cuomo every six months. “We believe physician performance assessment programs play a key role in improving health care quality and cost-efficiency,” said Dr. Reed V. Tuckson, executive vice president and chief of medical affairs, UnitedHealth Group in a written statement. “This is good news for consumers who need information tools to help guide them through the health system and for physicians who deserve useful and accurate feedback.” The agreement will also apply to Oxford Health Plans, Inc. UnitedHealth has enrolled 70.99 million people under a range of health and drug plans. For the fi rst nine months of the year, United-Health earned $3.44 billion, or $2.50 per share, up from $2.98 billion, or $2.13 per share, during the same period a year ago. Aetna, Cigna and Empire Blue Cross Blue Shield have also agreed to adapt their existing ranking systems to Cuomo’s model, which uses nationally recognized standards to measure the quality of care. Cuomo has declined to identify any of the companies his offi ce has found problems with. UnitedHealth officials did not respond to multiple calls for comment. Group Health Incorporated and Health Insurance Plan of Greater New York, which are going through the process of merging, do not have immediate plans to create doctor ranking lists, but spokeswoman Ilene Margolin said they have also agreed to provide transparency to their customers.
I have mixed feeling about this. Even though this sounds like a real consumer winner, I have my reservations. How are these doctors rated? What constitutes a good or bad rating?
They are being rated on the past as criminals are. What if there is an excellent doctor who didn't medically preform as expected ONCE....is s/he added to the bad ranking list?
To me this is nothing more than the insurance companies trying to increase their share holders bottom line with more and more layers. Any doctor, or should I say 'good doctor' will clearly NOT want to come to NYS to set up practice if they were in their right mind. And wasn't it just a few months ago, that we read in the paper that there is a shortage of doctors in NYS already? Gee, after this one, how the hell does he expect to lure ANY good doctors to this state? Idiot!
When the INSANE are running the ASYLUM In individuals, insanity is rare; but in groups, parties, nations and epochs, it is the rule. -- Friedrich Nietzsche
“How fortunate for those in power that people never think.” Adolph Hitler
Yes, rate physicians First published: Sunday, November 25, 2007
How good is your doctor? For too long, the health insurance companies have been rushing to provide the answer, but for all the wrong reasons. In their eyes, the best doctor isn't necessarily the one who provides the best quality of care. No, it's the one who keeps costs down and saves the company money. Now Attorney General Andrew Cuomo wants to change the way doctors are evaluated, not on the basis of the bottom line but according to nationally recognized parameters, such as morbidity studies, malpractice suits, patient feedback and, above all, the quality of care delivered. The Legislature should help him by making an objective rating system a matter of state law.
A rating system makes good consumer sense, not to mention good medicine. The more informed consumers are, the more intelligent their choices of physicians will be. And consumer savvy will prompt physicians to make sure they perform well enough to rank high on the state list of good doctors.
Mr. Cuomo has done much of the spadework necessary to make a rating system fair to doctors and consumers alike. He's gotten the national and state medical societies to sign on, as well as some consumer organizations and major health care providers. All have agreed that the ratings formulas now used by several independent institutes -- and nationally recognized as reliable and fair -- should be used as the standard. They are, in fact, used right now, but are shared only within the medical community.
There would be checks and balances, too. Doctors who want to dispute their low rankings would have a process to do so. The same is true for health care providers who might believe their member physicians deserve higher marks.
As for now, consumers are pretty much in the dark. They often rely on word of mouth before selecting a physician, or consult ratings conducted by magazines that base their findings on highly subjective criteria. What's worse, some insurance companies add to the confusion by publishing names of their best doctors without ever informing the consumer that the criterion for excellence isn't medicine but holding down the bottom line.
Some of the big names in health insurance coverage are on board with Mr. Cuomo, including Aetna, Cigna, Empire Cross Blue Shield, Oxford Health Plans Inc. and United-Health Group Inc., which had been planning such a program.
But voluntary cooperation, as welcome as it is, still leaves too many gaps for consumers to fill in. What's needed is a state law that requires all health care providers to participate in, and abide by, the ratings process. The sooner Assembly Speaker Sheldon Silver, D-Manhattan, and Senate Majority Leader Joseph Bruno, R-Brunswick, join with Mr. Cuomo, the sooner all New Yorkers can make an informed decision about where to turn for the best medical care.
THE ISSUE: Attorney General Andrew Cuomo wants to change the way doctors are evaluated.
THE STAKES: Better informed patients are best for public health.
Now Attorney General Andrew Cuomo wants to change the way doctors are evaluated, not on the basis of the bottom line but according to nationally recognized parameters, such as morbidity studies, malpractice suits, patient feedback and, above all, the quality of care delivered. The Legislature should help him by making an objective rating system a matter of state law.
Here we go folks with yet another layer of government not needed. These parameters are already in place at the private sector level with guidlines already set in place by the government.
In order to gain privileges at an acredited hospital, a physician is rated on the parameters listed above. A doctor's license is renewed based on the parameters listed above. An insurance company also uses the parameters listed above to allow payment to an acredited physician. Even nurses must meet a certain criteria when abtaining for the first time or renewing their license.
These parameters are already in place. This is duplicating an oversight of the medical profession that already exists. This is just another attempt by the government to control health care and spend more of our tax dollar.
MVP latest insurer to adopt new physician ranking code BY JAMES SCHLETT Gazette Reporter Reach Gazette reporter James Schlett at 395-3040 or jschlett@dailygazette.net.
MVP Health Care has become the sixth major New York insurance company to adopt a doctor performance measurement standard that state Attorney General Andrew Cuomo developed to help guard consumers from deceptive ranking practices. MVP Chief Executive Offi cer and President David Oliker said Monday the Schenectady insurer has agreed to adopt Cuomo’s ranking code. The code — backed by major medical and consumer groups — promises to ensure New Yorkers are not steered to preferred physicians based on cost. For years, MVP has offered a ranking program for about 2,000 Hudson Valley doctors. But the nonprofit insurer has no plans to immediately rank physicians elsewhere in the state. “MVP Health Care physician reporting does not currently include physician rankings, but we have entered into this agreement with Attorney General Cuomo because we share his belief that consumers are entitled to receive accurate and reliable information upon which to make important health care decisions,” Oliker said in a statement. Cuomo in October unveiled his office’s investigation into questionable physician ranking practices. The attorney general warned about the financial motives behind ranking methods. He requested information on those programs from several plans, including Empire BlueCross BlueShield in New York City and the Rochester-based Preferred Care. Preferred, which merged with MVP in 2006, plans to launched its ranking program in May. Cuomo had urged the Rochester insurer to delay the launch of that program, saying its patient satisfaction ratings were based largely on cost criteria. The Attorney General’s Office said MVP’s Hudson Valley performance ratings program already fulfills Cuomo’s ranking code, according to MVP spokesman Gary Hughes, partly because it lacks a cost component. “They’re not driven by cost. They’re driven by quality,” Hughes said. Hughes said MVP will eventually expand its ranking program to other regions in the state. Combined, MVP and Preferred have a network that includes 14,000 doctors and 660,000 members in New York, New Hampshire and Vermont. Senate Majority Leader Joseph Bruno and Assembly Speaker Sheldon Silver also announced Monday they would pass legislation based on Cuomo’s ranking code. The code says rankings for doctors cannot be based solely on cost and insurers must explain how much cost weighed in rankings. The code also calls for the adoption of national measures to measure quality and cost efficiency, plus measures that foster more accurate physician comparisons. Insurers must also disclose to doctors and consumers how the ranking programs are designed. Supporters of Cuomo’s ranking initiative include the Medical Society of New York State, the American Medical Association and the Consumers Union. Other insurers that have pledged to adopt the ranking code include CignaHealthcare, Aetna, Empire, United Healthcare/Oxford Health Plans, plus HIP Health Plan of New York/GHI.
Thank Cuomo for getting health insurers to rate doctors By FRED LeBRUN First published: Tuesday, November 27, 2007
Bringing transparency and fairness to the rating of doctors by insurance companies is the latest no-brainer issue getting a legislative boost.
As obvious as it is, credit still goes to Attorney General Andrew Cuomo for forcing the issue on behalf of consumers, and hard-working doctors themselves, for that matter.
It was Cuomo's investigation of health insurers suspected of directing patients to cheaper doctors that got it started. Now, nearly every major insurer in the state, with more coming aboard daily, is signing on to the Cuomo plan. That means creating independently monitored ranking and rating systems that follow broad national standards for quality, allow for consumer input and even corrections by physicians who feel they aren't being rated fairly.
The end result should be less about steering than legitimately informing, and that's great. Although frankly, I always assumed those thick books of preferred doctors that yearly came with my medical insurance information were more a listing of docs who play better ball with the insurer than those not listed, and not about quality at all. But I certainly could see where a less-cynical consumer might be bamboozled.
Many insurers, after all, are in business to make as much as money as they can, so their actions always invite suspicion. Where we really get blindsided in terms of ranking and rating physicians, and where it matters most, is by our own state Health Department, which supposedly oversees their conduct.
I say supposedly, because a perennial sore point is how both frustratingly secretive and lax the disciplining of doctors is in this state. The state Health Department's Office of Professional Medical Conduct has a long-standing reputation for protecting rather than punishing, a reputation that was officially reinforced by a state comptroller's report in August critical of the OPMC's lack of initiative in seeking out cases of medical misconduct to review.
The latest poster child for OPMC's ineffectiveness as a shield for the consumer concerns a Long Island anesthesiologist named Dr. Harvey Finkelstein.
According to news stories, Dr. Finkelstein was discovered to have reused syringes, potentially exposing hundreds of patients to blood-borne illnesses like hepatitis B and C and HIV. This case is getting a lot of print downstate.
Two weeks ago, 34 months after Health Department investigators confirmed Finkelstein's syringe practices, officials finally sent out letters to 628 of his patients recommending they be tested. That's nearly three years from the time the problem was discovered, to when patients were informed by the Health Department. So far, one case of hepatitis C has been confirmed.
This is very much a live issue at the moment, because Governor Spitzer was "deeply troubled" by the length of time it took to alert patients. Hard questions are being asked in the Health Department. The governor has been promised answers. Maybe. If any state agency can throw a total blanket over something like this, it is the Health Department.
But there's more. According to The New York Times, Finkelstein has settled 10 malpractice suits in nine years that may or may not have anything to do with those syringes. The settlements are listed on the Health Department's Web site. Yet for all of this, he's still practicing. Why? because in 2005, he changed his syringe usage to conform to recommendations issued by the Centers of Disease Control and Prevention, and so the Health Department decided he had seen the light and didn't need disciplining. In a 2003 survey of medical malpractice settlements in New York, doctors with 10 or more settlements in a decade accounted for just one-tenth of 1 percent of the docs in the state, according to the health research group Public Citizen. The same survey showed that 81 percent of the state's physicians made no malpractice payments at all over the last decade.
And yet, of the one-tenth of 1 percent with 10 or more malpractice settlements in 10 years, only 28 percent have been sanctioned by the Health Department's Office of Professional Medical Conduct.
Now maybe this is fully justified, although it is hard to imagine how that can be. But we'll never know, because every aspect of the sanction process happens behind closed doors. If there is discipline, it does get listed in an uninformative shorthand on the Web site. But who looks at the Web site?
is no requirement that a physician alert patients that he or she is under investigation. There is no requirement for a doc to inform patients that discipline has occurred.
So. Yes, of course, applause to the attorney general for his work with insurance companies. Now let's find a way to pry open the secrecy around the disciplining of physicians so that patients and consumers in the state have a better idea of the medical person they're dealing with, and whether that person belongs in the life- and-death business of medicine at all. LeBrun can be reached at 454-5453 or by e-mail at flebrun@timesunion.com.
To bad for us....it still leaves the insurers at the "healthcare helm"......still no info for the layman to weigh......this is just one of those "safety features" for a national health care, along with HIPPA and a national ID card.......sheeple wake up and smell the coffee.....pandering for votes---AGAIN.....
due to our need to live forever and fear of death we go to doctors for every little thing......I'm not saying dont go-I do...but the only MD's that need ranking are those for the quick buck and without couth or personal conviction, and such doctors have the most attention in the most tittlating way in the media driven society---cosmetic surgery MD's.......
As people we choose not to listen to our bodies and take care....a doctor is not the maker......
not to mention---PRACTICING MEDICINE IS NOT AN EXACT SCIENCE----have we come a long way baby??? the earth still spins on it's axis(unless Al Gore is right)
...you are a product of your environment, your environment is a product of your priorities, your priorities are a product of you......
The replacement of morality and conscience with law produces a deadly paradox.
STOP BEING GOOD DEMOCRATS---STOP BEING GOOD REPUBLICANS--START BEING GOOD AMERICANS
One by one over the past few weeks, the major health insurers serving New York state have agreed to be more upfront about the criteria they use for the preferred doctor lists they provide their subscribers. The agreements by the likes of Cigna, Aetna, MVP, Oxford and Empire Blue Cross/BlueShield are a result of an investigation earlier this year by Attorney General Andrew Cuomo which found that some insurers were basing their recommendations more on their doctors’ cost-effectiveness than the quality of care they might have offered. In essence, the insurers were trying to steer their customers to the doctors that would save them (the insurers) the most money. As a result of the agreements, which state lawmakers are saying they’ll soon seek to codify, health-care consumers should have an easier time choosing a doctor for the right reason — whether that’s quality of care, cost-effectiveness or some combination of those or other criteria. Under the voluntary constraints, the frugality with which a doctor practices medicine can still be factored into an insurer’s equation, but it can no longer be the primary consideration. And insurers will have to make some attempt to convey how their rankings are determined — in other words, how much the docs’ cost-effectiveness, as opposed to other factors, weighed in the ratings. It remains to be seen how clearly this information will be conveyed, but Cuomo plans to meet with the insurance companies on a regular basis to see that it is. A good idea. In the meantime, if the Legislature wants to pass a law mandating the practice, so much the better. There’s little worse than a system purportedly designed for the benefit of consumers doing quite the opposite.
Under the voluntary constraints, the frugality with which a doctor practices medicine can still be factored into an insurer’s equation, but it can no longer be the primary consideration. And insurers will have to make some attempt to convey how their rankings are determined — in other words, how much the docs’ cost-effectiveness, as opposed to other factors, weighed in the ratings.
everyone here raise your hand if you are interested in a frugal doctor.....hhhmmm,,,,plastic heart catheter from China or US???
insurers conveying how their rankings are determined--HA---ask the companies' shareholders.....they will eventually throw up their hands and hand the whole kit-n-caboodle to the government.....and this is where accreditation comes in to play....you must have certain criteria to function for the government to put you and your company into the "New and Improved National Healthcare system"---turns into a circle jerk and who knows who and---POWER....
BTW--unless the lay public goes to anatomy and physiology class and biology and the rest---most of us would just shake our head yes to the MD and say "At least I am alive, now where is my Big Mac, cigarette, beer and tv remote".................
the whole bunch of crap will turn out no different than the wonderful ways NYS deals with NYRA.....what a joke....
just as the sheeple line up for lotto/scratchoffs/numbers etc,,,,,we will be lining up for enemas.......Mr.Cuomo is doing about the same as Mr.Spitzer did before he ran for office......go figure.....
...you are a product of your environment, your environment is a product of your priorities, your priorities are a product of you......
The replacement of morality and conscience with law produces a deadly paradox.
STOP BEING GOOD DEMOCRATS---STOP BEING GOOD REPUBLICANS--START BEING GOOD AMERICANS
CAPITOL Stricter doctor oversight urged BY VALERIE BAUMAN The Associated Press
New Yorkers would be let in on the secret when their doctor is charged with misconduct or crimes under a proposal by New York Gov. David Paterson expected to be announced today. The measure would end the protection for doctors against disclosure of the allegations until a final determination is made. Paterson is introducing a broad patient safety measure designed to tell the public more about everything from physician drug use to infectious disease risks. It addresses concerns raised by past detractors, including a critical 2005 report from the New York Comptroller’s Office that found the state could do much better at rooting out bad doctors. “It signals that the health department is going to get tough on dangerous doctors,” said Blair Horner, a spokesman for the New York Public Interest Research Group. The proposal was partially prompted by Long Island anesthesiologist Dr. Harvey Finkelstein, who health officials said dipped syringes more than once into vials of medicine, contaminating the drugs and infecting at least one person with hepatitis. The bill would give more power to the state Office of Professional Medical Conduct, which monitors and disciplines physicians. “New York is in line with efforts of other states, and really trying to strengthen the information that comes to the office of professional medical conduct,” said Lisa Robin, senior vice president of member services for the Federation of State Medical Boards. “I know much of it reflects the Federation’s policies, with increasing the reporting requirements.” Any professional discipline charges would be made public. Right now the public isn’t notifi ed of physician misconduct unless and until the OPMC finds that a doctor is guilty. Charges are issued after an investigation is complete, which can take an average of about six months. State law is currently silent about when officials can disclose charges of professional misconduct to the public, but attorneys for the state say legal precedent requires a legislative change before misconduct charges against a doctor can be released. The comptroller’s office found that the OPMC was thorough in its investigation of cases of potential misconduct, but wasn’t proactively rooting it out. Instead, the report said the OPMC relied primarily on referrals from outside sources — which didn’t always let them know about every instance of potential misconduct. This has hindered the office’s ability to protect consumers. “Some of the older reporting and disciplinary things had more to do with hospitals,” New York Health Commissioner Dr. Richard Daines said. “Now we’re carrying it into office-based surgery and office-based practices, so we have reporting and oversight.” Paterson’s proposal would require the OPMC to continuously review medical misconduct claims reported to the Department of Health to identify potential misconduct and investigate those instances. “These are common sense measures that I think most New Yorkers would be surprised aren’t currently the law,” Horner said. “Sadly it’s been a long time since anything serious has been done to improve patient protection in New York, and we think this is a good step in that direction.” Courts would also be required to report to OPMC any time a doctor was sentenced for misdemeanor or felony offenses. Health officials say that right now they eventually find out about criminal sentences, but the bill would get them that information much faster. Another major change would be that the proposal would also extend existing laws on infection control to keep up with the changing world of medically transmitted infections. The infection-related aspects of the proposal were, in part, a reaction to Finkelstein’s story. The investigation was triggered in December 2004 health officials in Nassau County found two of his patients had hepatitis C. Since then, Finkelstein has said he corrected his method. The state Health Department didn’t determine until 2006 that it was necessary to notify thousands of Finkelstein’s patients that they should be tested for HIV and hepatitis. “Over the course of the last few months, in looking at the Finkelstein case, it has been determined that we need a more aggressive stance,” said Joseph Baker III, assistant deputy secretary for Health and Human Services. The comptroller’s report had also raised concerns about how long it could take to investigate instances of potential misconduct. Paterson’s proposal would authorize the health commissioner to inform the public of health threats, despite the fact that the information would otherwise be considered confidential. In cases of potential communicable disease threats, the commissioner would also be able to order doctors to ’cease and desist’ performing specific procedures until the OPMC can hold a hearing. “He wants to make sure the commissioner has all the tools and the powers at his disposal to protect the public health, and, while protecting the due process rights of doctors, making sure that doctors that commit misconduct are either properly retrained and, or taken out of the system — if that’s what needs to happen,” Baker said. Much of Paterson’s bill is focused on speeding the state’s response to public health threats and getting information to patients more quickly. “While in many instances, yes, you can get a subpoena, you can get a court order — there are ways to get things done — we need to be able to act very swiftly,” Daines said.
the failure of the government to concede to the fact that MD's go to school for a very very long time and that medicine is not an exact science and that it was the governement/free market/consumers all to blame for the 3rd party oversight with such specialized areas that has completely removed the MD from the bedside and the individuality of care that makes medicine/healthcare work-----everyone feels they 'deserve' a specialist and that someone else should pay for it, whether it be the private insurance or government......the government sets up rules(cried for into action by the public made voting system) and then procedes to state"They are the Doctor and they are the experts, HOWEVER, they must do it this way, because we are the government."
I'm not feelin' it........ >
...you are a product of your environment, your environment is a product of your priorities, your priorities are a product of you......
The replacement of morality and conscience with law produces a deadly paradox.
STOP BEING GOOD DEMOCRATS---STOP BEING GOOD REPUBLICANS--START BEING GOOD AMERICANS
the failure of the government to concede to the fact that MD's go to school for a very very long time and that medicine is not an exact science and that it was the governement/free market/consumers all to blame for the 3rd party oversight with such specialized areas that has completely removed the MD from the bedside and the individuality of care that makes medicine/healthcare work-----everyone feels they 'deserve' a specialist and that someone else should pay for it, whether it be the private insurance or government......the government sets up rules(cried for into action by the public made voting system) and then procedes to state"They are the Doctor and they are the experts, HOWEVER, they must do it this way, because we are the government."
I'm not feelin' it........ >
I ran out of breath. I need some punctuation here.
CAPITOL Stricter doctor oversight law likely this session BY VALERIE BAUMAN The Associated Press
Lawmakers say Gov. David Paterson’s proposal to increase doctor oversight and prevent misconduct has a good chance of passing this session — but with changes. Assembly Health Committee Chairman Richard Gottfried, a New York City Democrat, says both legislative chambers will have a few concerns about Paterson’s proposal to tell the public more about medical misconduct. Gottfried says he’s confident that some version of the bill will pass this session, but declined to comment on his concerns until he had more time to review the legislation. “The infection control and physician discipline issues are very important,” Gottfried said. “The governor’s initiative should help focus attention and bring about an agreement that can become law this session.” State Senate Health Committee Chairman Kemp Hannon, a Long Island Republican, has introduced his own measure, with goals that overlap with the governor’s. Overall, he says New York will likely pass legislation to increase patient safety, infection control and oversight of practitioners before the end of session in June. “We try to be a little more pointed about dealing with infection control and education about infection control and about aiming that at ambulatory and outpatient settings,” Hannon said of his own proposal. “We also added in a requirement that the patient safety center annually review the physician profiles.” Under Paterson’s proposal, any professional discipline charges would be made public. Right now the public isn’t notifi ed of physician misconduct unless and until the doctor is found guilty. Charges are issued after an investigation is complete, which can take an average of about six months. The goal is to give the Office of Professional Medical Conduct more power and oversight of physicians, to provide more information to New Yorkers in the case of public health threats and to prevent problems from happening in the first place. “I don’t see the issues here as breaking down on partisan lines, fortunately,” Gottfried said. “I think this is an issue where it’s certainly doable for the Legislature to come together and work out whatever issues we may have.” Vito Grasso, executive director of the New York state Academy of Family Physicians, said it’s crucial to increase oversight, but Paterson’s approach could unfairly damage the career of a physician who’s not ultimately found guilty. “I would also hope that if the individual was completely acquitted that information would be just as well-documented and publicized,” Grasso said. In 2007, the state Health Department received 8,163 complaints against doctors. Of those, officials opened 4,151 investigations. Ultimately charges were brought against just 311 physicians and health officials said the vast majority of those were sustained — the doctor was found guilty of misconduct. State law is currently silent about when officials can disclose charges of professional misconduct to the public, but attorneys for the state say a legislative change is necessary before charges against a doctor can be released. A 2005 investigation by the comptroller’s office found that the OPMC was thorough in its investigation of cases of potential misconduct, but wasn’t proactively rooting it out. “The publication of charges is something that I would say is very common across the states,” said Lisa Robin, senior vice president of member services for the Federation of State Medical Boards. “So I would applaud the governor’s office for introducing this legislation.” Paterson’s proposal would also require the OPMC to continuously review medical malpractice claims reported to the Department of Health to identify and investigate potential misconduct. Courts would have to report to OPMC any time a doctor was sentenced for misdemeanor or felony offenses. Another major change would be that the proposal would extend existing laws on infection control to keep up with the changing world of medically transmitted infections. The infection-related aspects of the proposal were, in part, a reaction to Dr. Harvey Finkelstein, an anesthesiologist from Long Island accused of dipping syringes more than once into vials of medicine, contaminating the drugs and infecting at least one person with hepatitis.
It all depends who is paying the bills as to who has the authority----this is a foundational 'plumb line' for universal heath care.....pay attention to what we build.......
...you are a product of your environment, your environment is a product of your priorities, your priorities are a product of you......
The replacement of morality and conscience with law produces a deadly paradox.
STOP BEING GOOD DEMOCRATS---STOP BEING GOOD REPUBLICANS--START BEING GOOD AMERICANS
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