July 12, 2000
Page A3
ïhv Jînrtlanb ffihaeruer
Oealth/Education
Study finds people likely to call 911 for others, not self
CONTRIBUTED STORY
People recognize the benefit ofcalling
an a m b u la n c e i f they w itn ess
someone else having possible heart
attack symptoms. But individuals
personally experiencing the same
symptoms often choose not to use
emergency medical services, a study
in C irculation: Journal ofthe American
Heart Association says.
“Little is known about a patient’s
d e c is io n to u se e m erg en cy
tra n s p o rta tio n w h en th ey are
experiencing chestpain,” says N. Clay
Mann, Ph.D., an associate professor
at the University o f Utah School o f
Medicine in Salt Lake City. “With this
study, we wanted to determine if
community members realized the
benefit ofusing EMS during a cardiac
em ergency, then contract these
findings with actual EMS use.” The
study was conducted at the Oregon
H e a lth
S c ie n c e
U n iv e rsity
department o f emergency medicine
in Portland.
O f the 1.1 million Americans who
experience a coronary attack each
year, more than h alf die before
reaching a medical facility. Early
treatment is critical, says Mann. Clot-
busting drugs and other therapy can
reduce the chance o f death from a
heart attack by 25 percent if given
so o n a fte r the o n se t o f acu te
sy m ptom s such as ch e st p ain ,
discomfort in the left arm, jaw orneck,
sw eating, nausea or w eakness.
“Unfortunately,” he says, “only a
fraction o f patients who are eligible
for these treatments receive therapy
in time; this is due, in large part, to the
time delay between the onset o f
symptoms and arrival at the hospital.”
M ann’s team randomly telephoned
962 people in 20 communities across
the United States and asked, “If you
thought someone was having a heart
attack, what would you do?” Two
optional responses were (1) call 9-1 -
1 or an ambulance or (2) drive the
person to a hospital. On average, 89
percent ofthe respondents from each
community said they would call 9-1 -
1 if they witnessed a person having a
heart attack - the action recommended
by the American Heart Association.
About eight percent said they would
co n sider driving som eone w ith
possible heart attack symptoms to
the h o s p ita l.R e s e a rc h e rs also
c o lle c te d in fo rm a tio n on 875
individuals in the same communities
who arrived at the emergency room
with chest pain. These individuals
were asked how they arrived at the
hospital and what factors caused them
to go quickly or to wait.
Contrary to intentions expressed by
the non-patient community members
in the telephone poll, few actual chest-
pain sufferers used EMS - only 23
percent. Someone else drove about
60 percent to the emergency room,
while 16 percent drove themselves to
the hospital.
Some people delayed calling EMS or
going to the hospital because they
took a sp irin , or b elieved their
symptoms were due to heartburn and
took and antacid, Mann said. Others
put offcallingEM S after speaking to
their doctor.
The study indicates 83 percent of
patients who spoke with a physician
and were later admitted to the hospital
for a heart attack did not use
emergency transportation.
“It is problematic that communication
with a doctor decreased EMS use,”
Mann says. “Speaking with a doctor
may have reduced patient anxiety in
a way that made EMS transport seem
optional.”The people most likely to
call EMS were those who were older,
lived alone, had a history o f heart
disease or lived in a community with
free ambulance service due to a tax-
based prepayment plan, Mann says.
The study reports that the presence
o f a tax-based prepaid EMS system,
similar to those financed by taxpayers
in much o f the Northwest, doubled
the likelihood ofusing EMS compared
w ith com m unities w ith no such
system. Though certain variables may
bias this finding, Mann says other
studies have documented a similar
pattern. He believes programs that
offset the cost o f EMS transportation
should be studied further.
“These programs could represent a
major factor among people e valuatmg
o p tio n s
fo r
em e rg e n c y
transportation,” Mann says.
A cc o rd in g to R ose M arie
Robertson, M.D., president o f the
American Heart Association, the
asso ciatio n stro n g ly ad v o cates
calling 9-1-1 immediately when a
cardiac emergency is detected. “Our
Operation Heartbeat initiative, which
is launching in m ore than 100
communities (including Portland),
helps provide tools to get the Call 9-
1-1’ message out to the general
p u b lic ,” she says. “ T his study
provides more evidence that the
public needs to hear this message.”
Co-authors ofthe study are Adam L.
Brown, B.S.; Mohamud DayaM .D.,
M .S.; R obert G oldberg. Ph.D .;
Hendrika Meischke, Ph.D.; Judy
Taylor, E.D.D.; Kebin Smith, M.A.;
Stavroula O sganian, M .D .; and
Lawton Cooper, M.D.
The AHA spent about $327 million
during fiscal year 1998-99 on research
support, public and professional
education and community programs.
W ith m ore th an fo u r m illio n
volunteers, the association is the
nation’s largest voluntary health
organization fighting cardiovascular
diseases, which annually kill close to
1 millionAmericans.
OHSU transplant team receives $210,000in research funds
• OHSU Awarded International Grant
CONTRIBUTED STORY
A n O reg o n H ealth S cien ces
University transplant team is one o f
five in the United States to receive
part o f a $ 1 million grant from the
R o ch e O rg an T ra n sp la n ta tio n
Research Foundation to improve the
outcome o f organ transplantation.
Susan L. Orloff, M .D., assistant
professor o f surgery, and molecular
microbiology and immunology in the
School o f Medicine at OHSU, leads
the team. She was awarded $210,000
for a three-year project studying the
role o f cytom egalovirus-encoded
c h e m o k in e re c e p to rs in the
acceleration o f transplant vascular
sclerosis. The grant was one o f nine
awarded internationally.
O r lo f f ’s stu d y ex a m in e s the
acceleration o f the vascular lesion
called transplant vascular sclerosis
or TVS, which is the hallmark lesion of
chronic organ rejection. During a
tra n sp la n t p ro ced u re an organ
r e c ip ie n t’s im m une sy stem is
suppressed so that his/her body is
less likely to reject the organ. During
this time, an organ recipient is
vulnerable to a type o f herpes virus
called cytomegalovirus orCMV. This
virus is dormant in 70 percent to 90
Oregonians are
calling it quits
CONTRIBUTED STORY
t
"The Oregon Tobacco Quite Line” has been in operation only for 18 months
and w e're proud to be serving so many people,” said Clay Parton, manager o f
Tobacco Prevention and Education for the Department o f Human Services,
Oregon Health Division. “Oregon is a leader in this effort, and the system is
really working well.”
Stacy Duggan ofPortland has used the service. “I’ve been smoking since I was
15 years old, and now I’m finally free,” Duggan said. “I go for long walks, I take
the kids to the park, I feel better and I look better.” She smoked one pack o f
cigarettes a day for 15 years before quitting four months ago. “The Quit Line
was there when I needed answers. I don’t think I could have done it without
the people on the other end o f the line,” Duggan said. “The thing that makes
me feel really good about quitting is that my kids are no longer exposed to
secondhand smoke. “This has done wonderful things for my self-confidence.
I am like a new person.”
This specific program is available only in Oregon. A few other states offer quit
lines and Washington State and Montana are considering similar programs.
Every day dozens o f smokers phone the Quit Line to get help from a trained
counselor. These counselors analyze the callers’ tobacco use patterns and
help them identify upcoming stressful events and coping strategies. Together
they develop a personal quitting plan.
Ani O ’Hara, Quit Line Director, believes that this personal approach is the key.
“A lot o f people want to quit. There is social and financial pressure. Cigarettes
cost a lot o f money and people want to spend their money in ways that give
them more pleasure,” said O ’Hara. Cigarettes cost as much as $3.00 per pack.
In addition to a personalized quit plan, callers receive an “Oregon Tobacco Quit
Kit” in the mail. Inside the kit is a worry stone and other helpful tools to keep
smoker’s hands busy. Doug Pitts is a smoking counselor with the Quit Line.
“What we find is that people need to have something to pull on, unwind, or
bend. Anything to keep their hands busy helps because a lot o f smoking
behavior involves manipulation,” Doug Pitts said.
“Oregon is unique,” Pitts said. “Anybody who lives in Oregon and wants to
quit can call us for free and talk to us for 20 or 30 minutes. They also get a free
Quit Kit. This is special.”
O ’Hara says that the Quit Line is making a difference in the lives o f those they
serve. “When someone calls us and tells us that their lives changed, that they
feel better and their life is better because they quit, we know w e’re in the right
business," she said. The Oregon Tobacco Prevention and Education Program
is a comprehensive effort to reduce the use o f tobacco and exposure to
secondhand smoke. It includes programs in local communities, schools,
businesses, media and special populations. The program is funded by a
tobacco tax increase approved by the voters in 1996. Ten percent o f the new
revenue is allocated to tobacco use prevention and reduction. Oregonians
who are ready to quit tobacco, call toll-free 1 -877-270 STOP(English), or 1 -877-
2NOFUME( Spanish), or 1-877-772-6534 (TTY).
percent o f the population and can be
activated when the immune system is
suppressed. W hen the virus is
activated, it increases the acceleration
ofTVS.
The virus expresses a chemokine
receptor, which is similar to cellular
chem okine receptors. Interaction
b e tw e e n the v ira lly enco d ed
chem okine receptor and various
chemokines has recently been shown
to cause smooth muscle cells to
migrate from the outside o f blood
vessels to the inside. These smooth
muscle cells are the predominant cell
type in the vascular lesion TVS. As
the cells build up on the inside o f the
blood vessel, blood flow is dimished.
The decrease in blood flow is what
leads to graft failure. OrlofFs team
w ill stu d y the C M V -encoded
chemokine receptors involved in the
acceleration o f the vascular lesion
that directly affects the rate ofchronic
rejection.
Orloffhas extensive experience in the
transplantation field and is very
excited about the grant. “I feel very
fortunate. I look forward to making a
major contribution,” she said. OrlofTs
letter of intent was chosen out o f 61
international applicants.
T he R O T R F is a n o n o ro fit,
in d e p e n d e n t and au to n o m o u s,
registered medical charity dedicated
to advancing organ transplantation
by su p p o rtin g re se a rc h w ith
operating grants.
Grant recipients must be established
m em bers o f acad em ic s ta f f at
universities, transplant centers or
research in stitu tes. R e c ip ie n ts’
research findings are published in
the ROTRF’s annual report.
The RO TRF’s areas for funding
include research in long-term survival
o f transplanted organs, prevention
o f c h ro n ic tra n sp la n t o rgan
dysfunction, development o f new
agents for use in transplantation and
induction o f tolerance, among other
areas.
A uditors say O H SU
d o cto rs im p ro p e rly
charged $338,000
A state agency has found that Oregon Health Sciences University
doctors overbilled Medicaid patients nearly $340,000, including bills for
I services the doctors could not prove they delivered, The Oregonian
I reported Monday.
According to documents released to the newspaper under state public
records laws, auditors for the state Office ofMedical Assistance Programs
originally proposed $2.1 million in reimbursements and penalties after
reviewing charges submitted to Medicaid m 1995 and 1996 by University
Medical Group.
After lengthy negotiations with the medical group, which acts as the
billing office for most OHSU doctors, the repayment was reduced to
I $338361.
In one case, auditors found a bill for $581.64 for a cosmetic “tummy tuck”
after the doctor claimed it was as a medically necessary “tissue transfer.”
“It appears to be a blatant attempt to get payment for something that was
not covered,” said former Office ofMedical Assistance Programs auditor
Paul Boughton.
University Medical Group officials say the errors found by the audit were
either inadvertent or auditors disregarded documentation that proves the
medical procedures were properly billed to Medicaid.
Dr. E. Paul Kirk, University Medical Group president, said the doctors are
concerned with patient care, not whether the records will satisfy
government billing requirements.
Kirk also said that, at the time o f the state audit, Medicaid rules were
unclear and could have led to errors by University Medical Group.
Medicaid billing rules “have been somewhat ofa shifting target,” he said,
leaving the university with “the presumption that we are not to be
trusted.”
The state audit turned up cases similar to those under scrutiny in a
separate, federal criminal investigation into Medicare fraud at OHSU.
The federal inquiry was launched in 1998 and is being conducted by the
U.S. Department o f Health and Human Services and the FBI.
While the state audit is a civil case, federal investigators are looking at
possible criminal violations. The federal inquiry is looking for cases in
which OHSU doctors charged for services that were actually performed
by nonphysicians or medical residents.
Residents are licensed physicians who are paid directly by OHSU and are
ineligible to bill Medicare, the federal health care program for the elderly.
The state review, which began in November 1996, found one ofevery five
bills charged to taxpayers caused an overpayment.
The audit concludes Medicaid overpaid University Medical Group
doctors by about 8 percent ofthe $3.8 million billed from January 1995 to
July 1996.
But no repayment has been made because University Medical Group has
been contesting the findings for nearly two years. Settlement talks began
last fall.
“It certainly has taken longer than it should have and longer than we
would like for it to take,” said state Office ofMedical Assistance Programs
director Hersh Crawford.
The state agency launched its audit ofUniversity Medical Group in 1996
while the U.S. Department o f Health and Human Services also was
reviewing Medicare billings by physicians at teaching hospitals across
the country.
Federal audits resulted in hefty paybacks by several medical schools,
including the University o f Pennsylvania, $30 million; University o f
Pittsburgh, $ 17 million; Thomas Jefferson University in Philadelphia, $ 12
million; University ofVirginia, $8.7 million; and Georgetown University
in Washington, D.C., $5.2 million.
Lawyer Decries Tobacco Ads
A ssociated P ress
A jury award of$ 154 billion in punitive
damages to sick Florida smokers
would bankrupt the nation’s five
biggest cigarette makers 10 times over,
a tobacco attorney said Tuesday in
closing arguments.
“That’s a request for a death warrant
for each o f these five companies,”
said lead tobacco attorney Dan Webb,
who represents Philip Morris Inc.,
the nation’s largest cigarette maker.
“It’s more than financially destroyed.
They’re gone.”
The requested verdict range o f $ 123
billion to $196 billion is so high it
c o u ld n ’t ev en be c o n sid e re d
ridiculous but “makes a mockery of
this case and this proceeding,” Webb
said.
Webb portrayed Stanley Rosenblatt,
representing an estimated 300,000 to
700,000 sick Florida smokers in the
landmark class-action trial, as greedy,
saying his purpose was “to not seek
truth but to seek money.”
He asked jurors not to give smokers
“a large award or bonus” with a
punitive award that pays them on top
o f compensatory awards intended to
make injured smokers financially
whole for their illnesses and lost
income.
rhe six-member jury already has
decided that the industry makes a
d e a d ly , d e fe c tiv e p ro duct and
aw a rd e d
$1 2 .7
m illio n
in
com pensatory dam ages to three
representative smokers.
1 he key tobacco defense is that the
industry has changed its ways since
states began suing in 1994, and that
a $257 billion settlement reached in
th o se la w su its tw o years ago
punishes the companies enough.
Philip Morris, which makes Marlboro
cigarettes and controls almost half
the U .S. m a rk e t, is no longer
“conducting business the way it did
in the ’50s, ’60s and ’70s” and should
n o t be a s s e s s e d any p u n itiv e
damages because o f “enormous”
changes since then, Webb said.
“The world o f Philip Morris has not
stood still,” he said. “Your verdict
has had a profound effect on Philip
Morris and how it does business.”
The companies have argued they
should not be required to pay any
more than their combined net worth
of$ 15.3 billion, the difference between
assets and liabilities on financial
balance sheets. The judge has said
trademark values are not reflected in
that amount and can be considered
by the jury.
Rosenblatt completed the opening
segment o f his final remarks earlier
T u e sd a y , c h a rg in g c ig a re tte
advertising in magazines proves the
industry has not changed.
“They are yelling and shouting from
the rooftops in these ads,” he said.
“That’s why they spend peanuts on
the youth prevention programs and
$6 billion a year on advertising and
promotion.”
As closing arguments began Monday
in the two-year trial, Rosenblatt called
on the jury to punish Big T obacco for
five decades o f “deceit.”
With the jury out o f the courtroom
Tuesday,R.J. Reynolds Tobacco Co.
attorney Ben Reid protested the size
o f Rosenblatt's request, telling the
judge, “He has asked for an amount
that by a matter o f law is an illegal
amount.” Circuit Judge Robert Kaye
c alled the issue som ething for
attorneys to argue in their closing
statements and not a legal issue for
the judge to decide in advance.
The case — the first sm okers’ class-
action law suit to go to trial —
represents what could be the gravest
financial threat to the industry since
it settled the state lawsuits in 1997
and 1998.
Any decision will be appealed and
could take at least two years to move
through Florida’s courts.
The other defendants are Brown &
Williamson TobaccoCorp., Lorillard
Tobacco Co., Liggett Group Inc. and
the industry’s defunct Council for
Tobacco Research and Tobacco
Institute.
FOR THE
FIRST TIME EVER:
$ 2 0 ,0 0 0 CASH BONUS
PLUS $ 5 0 ,0 0 0
FOR COLLEGE.
Choose to serve in one of the Army's top-priority
occupational skills, and you could receive a cash
bonus of up to $20,000, if you qualify. Plus, earn
up to $50,000 in m oney for college through the
M ontgom ery G.I. Bill and the Army College Fund,
if you qualify.
Find out more about these great Army benefits.
Talk to your local Army recru iter today. It could be
one of the m ost rew arding calls you’ve ever made.
284-4005
ARMY. BE www.goarmy.com
ALL YOU CAN BE:
*