CT Center for Patient Safety Newsletter
January 3, 2009 
In This Issue
Patients should know risks

 Hospitals Affiliated with Harvard Limit Outside Pay
Sounds good doesn't it?  But please look closely - no more than $5,000 a day for actual work attending board meetings. And these boards are usually pharmaceutical or biotechnology companies. Criticism has been mounting as the conflicting roles of some medical leaders have been disclosed through Congressional investigations. For example, Dr. Ausiello, chief of medicine at Mass General was paid more than $220,000 last year by Pfizer.  This is clearly not good for our health.  Dr. Ausiello said that he was proud of his board work and that he was not there to make money!
Other academic institutions are looking to follow Harvard's leadership.  We need better standards than this and all financial conflicts have to be made public immediately.
In Connecticut we want all payments over $1,000 to be made public.  We will look to legislation to be passed this coming year that will address these very important issues. We cannot expect to get the best and most scientific based health care with money perhaps influencing the standards.

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Health Lobbying Explodes in 2009

According to USA Today, as many as 1,000 groups hired lobbyists to represent them on the Hill since the beginning of the year.  Last year, during that same period, there were just 505 groups.  And $422 million was spent during the first nine months.

Thank you again for your financial support to the CT Center for Patient Safety.  It is your support that makes a difference in our ability to hold truth to power.
And remember, all contributions are fully tax deductible. 
Happy New Year
I am trying to be positive about what the coming year holds for the health care consumer.  We have had a lot of media coverage in 2009 and it is my hope that the close scrutiny will provide the impetus to establish systems leading to increased accountability and transparency. The Attorney General, AARP, National Physicians Alliance are just some of the allies we count on to move our legislative agenda.  At the national level we are still pressing to have consumer input in the implementation of whatever health reform bill passes.  We are working to see that there are common definitions in insurance policies.  Hospitalization needs to mean the same in all policies.   No more small print and the discovery that hospitalization coverage starts the second day and not the first and most expensive day in the hospital. With the blog, Facebook, our videos on YouTube, we our e-membership is growing, thereby adding to the volume demanding quality health care.  By passing a fairly comprehensive health care bill at the national level, Congress has acknowledged that there is a fundamental right to health care. We believe that quality  healthcare is a right - we have lots of work ahead of us.
Join the discussion on our blog.  Your views are what have shaped the organization.
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As a member of the chiropractic examining board, I will be hearing two full days of testimony on this very issue this week.  Rick Green presents one opinion - I will be hearing many others.
Patients Should Know Risks
Rick Green December 29, 2009


Fit and 48 years old, Janet Levy went to a chiropractor to try to relieve a sore shoulder back in 2002. She nearly lost her life. A manipulation of her neck led to a stroke, then brain surgery, paralysis and years of therapy for the Woodbridge woman.

But that personal battle seems small compared with the struggle that Levy has undertaken to try to bring a basic reform to chiropractic care in Connecticut. Levy - who leads Victims of Chiropractic Abuse and is behind those ads on the sides of Connecticut Transit buses warning about chiropractors - and a handful of others have for years waged a failing effort to persuade the state legislature to enact legislation to force chiropractors to be a little more frank about what they do.

Now, the two sides will dramatically face off again Jan. 5 at 10 a.m. at a hearing at the Legislative Office Building in Hartford before the obscure state Board of Chiropractic Examiners, which has been asked to make a "declaratory ruling" on whether chiropractors should be required to inform their patients about the risks of neck manipulation. The outcome could affect chiropractors, and their patients, throughout the country.

No state currently requires that patients be warned of a stroke risk from cervical manipulation. I've written about this strange conflict surrounding "informed consent" a few times before, mostly because I can't understand why chiropractors - who are in the business of relieving pain - are trying to block something that would help their patients make educated decisions.

"I, unfortunately, was not given that information, which would have saved me two years out of my life," Levy says in testimony she has filed with the chiropractic board in advance of the hearing. "Chiropractors need to give their patients informed consent to tell them about the possibility of a stroke. ... The controversy about how often it occurs should not be the primary concern. The severity of the outcome is what should matter."

The reality is, the risk of stroke is remote. But shouldn't patients at least know? Shouldn't they be told how to recognize a stroke in case a problem develops after a visit to the chiropractor? Not according to the various trade groups fighting Levy and another woman, Britt Harwe, who leads the Connecticut-based Chiropractic Stroke Awareness Group. The International Chiropractic Association says - remarkably - that informed consent wouldn't "best serve the public interest."

This, by the way, is the same group that thinks that patients should "be made aware of the possible adverse effects of vaccines upon a human body." In testimony submitted for the hearing, the association's George B. Curry assures the public that "the chiropractic profession maintains a vigilant watch on safety and clinical effectiveness issues." This is known as the fox guarding the henhouse. Another group, the Connecticut Chiropractic Council, says in testimony by David Steinberg that it is "not necessary to address the risk and/or possibility of the occurrence of a stroke or cervical artery dissection as a side effect."

This is because "no doctor is required to disclose every single conceivable risk from a proposed procedure." "There is no human experimental evidence that chiropractic adjustments or neck manipulations are causally related to strokes," Steinberg says. Yet, Harwe and her lawyer, Norman A. Pattis, point out that the risk of stroke has long been a concern among chiropractors. This includes professors at the University of Bridgeport College of Chiropractic, who have supported informing patients of the various potential risks from treatment.

Critics aren't saying that chiropractors shouldn't do their manipulation. They are saying patients should know that in rare cases things can go very wrong. In a letter to Matthew W. Scott, the chairman of the state Board of Chiropractic Examiners, Attorney General Richard Blumenthal notes that informed consent provides the facts to help a patient decide "whether to engage in the proposed course of therapy."

The Connecticut Medical Examining Board, in comments submitted to the Board of Chiropractic Examiners, says that disclosing the "significant risks" from adjustments to the cervical spine are a "required element of the patient's care." It's not more complicated than this. Chiropractic patients should know the risks.

They should also be told, in writing and orally, what the signs of a stroke are in the event that a problem develops later and isn't immediately recognized. This controversy has dragged on for too long. It's time for state regulators to act.

Rick Green's column appears on Tuesdays and Fridays. Read his blog at courant.com/rick.