Monday, April 30, 2012

The Multiple Assassinations of Robert F. Kennedy

Most followers of the assassination of RFK know about two principal arguments that cast doubt on the official version of this event, namely, that Sirhan Bishara Sirhan, as a lone gunman, shot RFK. The first disputable evidence that any of Sirhan's shots could have done the damage is that Sirhan was in front of RFK. The second disputable evidence is that it is still claimed that more than 8 shots were fired -- important because Sirhan's gun was a revolver with a maximum of 8 shots. If there were more than 8 shots, the reasonable assumption would be that there was another shooter. We know that CNN is covering the story and have advised that their reporters study the original autopsy and pathology reports. It is no secret, in fact, it has been known for years, that the kill shot penetrated RFK's skull behind the right ear -- maybe from only inches away. We need to ask if the autopsy showed evidence of a close-up gun shot wound behind the right ear.

We have eyewitness testimony that cannot be accepted without study because so many years have passed since the shooting and since the testimony was originally offered. On the other hand, if it can be shown beyond reasonable doubt that more than 8 shots were fired, the "lone gunman" theory bites the dust and gives rise to a bona fide "conspiracy" theory -- with all of the conspirators having fled the coop, leaving Sirhan holding the bag alone.

That leaves the following question as the critical mass: does the autopsy report and any pathology reports that followed establish with reasonable medical and legal probability that the kill shot was delivered from behind and that the area of penetration was behind RFK's right ear? When the kill shot is fired from close enough, gunshot residue may be present.

If that's correct, not only is the lone gunman theory gone, but so are the other perpetrators and most of those who may've helped to curtail whatever investigation might have been appropriate at the time.

Never mind. It's never too late to learn the truth. We owe that to history.

Wednesday, April 25, 2012


In our post of 4/21/2012 we indicated favorable consideration for two bills that would alter Utilization Review practices. We indicated why we felt that AB 1848 (Atkins) was the stronger of the two bills. We're now informed that the Atkins' bill has been withdrawn. AB 1687 (Fong) now stands alone.

Our take:

In a letter from the Consumer Attorneys of California (CAC), 19 April 2012, the following is stated: "AB 1848 (Atkins) creates unnecessary, but very harmful, hurdles for medical experts seeking to testify on behalf of injured Plaintiffs."

In a not surprising nod to the CAC,  it is understood that Committee Chair Hayashi is not likely to recommend passage of AB 1848. In a nutshell, that means her committee doesn't have the votes to pass it. The bill dies, more likely than not, for the rest of the year (a rules change may be required to revive it).

The Achilles' Heel in the Atkins bill is probably not having limited it to Utilization Review in Workers Comp. Its far reaching effects extend beyond the legislative interests of the California Applicants' Attorneys Association (CAAA) which deals with injured workers and beyond the interests of the California Society of Industrial Medicine and Surgery (CSIMS) which was the chief sponsor of AB 584 (Fong) which Governor Brown vetoed last year.

What is still needed is a requirement that doctors who do Utilization Review (UR) for injured workers in California and who have the power to delay or deny care or even to modify care be obliged to meet the same requirements as the treating doctors who are required in California to be licensed and who are obliged to take a 12 hour pain management course (not required if one doesn't have a California license to begin with). An appropriate amendment could still be added to AB 1687 (Fong) as long as it's clear that the application is for UR for industrial medicine (injured workers) and does not apply to personal injury litigation.

Stay tuned. More to come, for sure!

Tuesday, April 24, 2012


The Hot Ticket for health care on a national basis is the fate of the Affordable Care Act (ACA), also called Obamacare,  and its controversial arm to keep costs in check, namely, the Independent Payment Review Board (IPAB).  Congressional Representative, Anna Eshoo, D-Ca, in a recent exchange with this writer, said that demands to repeal the IPAB were ill considered because we need to control costs.

Medical historians know that the IPAB began life as the IMAB or Independent Medicare Advisory Board. When the Medicare community learned to what extent it was being targeted, cries of "death panels," exaggerated though they were, brought the IMAB to its knees, well, to one knee anyway, because it's now back on its feet as the IPAB in the ACA (Section 10320 thereof).

Meeting now in New Orleans is the American Academy of Neurology (AAN). In an official publication dated 23 March 2012, the following was stated: "The AAN strongly supports both IPAB repeal and medical malpractice reform ... with the addition of the poison pill (italics added) of liability reform, House Republicans were still able to pass IPAB repeal but lost most of the Democratic support."

For the uninitiated, a poison pill in legislation may be an element added as an amendment to a bill that causes a substantial number of legislators to pull away from the bill though they might otherwise support it. In this case, medical malpractice reform is not what the trial lawyers or their legislative allies want. So to them linking repeal of the IPAB to medical malpractice reform is a poison pill that works for their interests since it'll stop medical malpractice reform just as it's emerging again as a force.

In an earlier publication dated 14 July 2011, "Tell Congress to Eliminate the IPAB," AAN stated that the "IPAB effectively removes Medicare spending decisions from Congress  and leaves them up to an unelected, unaccountable board." Actually, the board members will be responsible to the politicians who get them appointed to the board.

If the name of the game, as Eshoo said, is to control costs, the meaning is clear -- cost control gets priority over the medical care that we as individual patients may actually get. It means that treatments favorably reviewed by professional organizations may not be approved for use by the IPAB because of obeisance to cost-control rules and regulations, not yet even codified.  Political considerations, not medical indications, now govern medical care.

In this instance, all it took to slow down IPAB repeal was to link it to medical malpractice reform. That's how poison pills work. Is there palliation for this poison pill? Yes, there could be.

Requiring Congress to be covered by the ACA and the IPAB should it survive could be palliative. Congress, knowing little about the bill, having passed it "to see what's in it," knew enough about it all along to know that they didn't want to be covered by it. So Congress exempted itself from ACA coverage. We should insist they extend the ACA, if it survives court challenge, so that Congress itself is covered by it -- that's when, and only then, will we  know with reasonable medical probability that the IPAB will either be eliminated or will conduct itself equitably.

Repeal of the IPAB or, at the least, modification of the ACA should be a top priority for any organization purportedly devoted to equitable medical care.

Saturday, April 21, 2012


Yes, indeed, asserts this author: here's how. The State of California gives away de facto licensure to practice medicine to out-of-state doctors who are not licensed in California. Since passage of SB 899 in California, insurance companies have had the right to seek utilization review (UR) from doctors who aren't licensed in California and who haven't done the 12-hour pain management course that is required of doctors licensed in California. Non-California licensed doctors are not held accountable for wrong-doing by the Medical Board of California since they're not licensed in this state. Neither are they reponsible to the medical boards of their own states since their own medical state boards don't have jurisdiction in California. This largesse has allowed insurance companies to retain utilization reviewers from out-of-state who are compliant with the interests of insurance and UR companies. These UR doctors don't pay fees to the medical board of California. Wrongful decisions which delay or deny care to injured workers conserve money for the insurance industry and reduce taxable income since providers of care don't have to be paid.  

Protest has evolved. In 2008 Assemblywoman Sally Lieber presented AB 2968 which would have required licensure. The bill passed the legislature but Governor Schwarzenegger vetoed it. That veto is estimated to have caused California to lose about $10,000,000 in fees and taxable revenues that would have gone to the General Fund. Then Assemblyman Paul Fong presented AB 933 to accomplish the same goal. This bill also passed the legislature but Governor  Schwarzenegger vetoed it again. So now the state was down another $10,000,000 for a total of $20,000,000. But Paul Fong got a second chance with AB 584 which also passed the legislature. The surprise came when Governor Brown vetoed it ostensibly because he didn't want piecemeal changes in workers comp legislation (although he approved piecemeal legislation in other areas). Now the state's loss was an estimated $30,000,000. Not to worry, of course, tax payers can always make up the loss.

COMES NOW AB 1687 (Fong) and AB 1848 (Atkins). Both bills offer corrective measures and deserve serious consideration. Fong's bill would require clear and concise language to explain delays or denials of care by utilization reviewers. It would not require California licensure. It would not require the out-of-state non-California licensed doctors to complete the 12-hour pain management course that is a requirement in law for licensed California doctors. All the same it is a step in the right direction. Atkins' bill is the stronger bill since it would require a specified level of certification and would bring the out-of-state doctors under the purview of the medical board of California. Its wording doesn't specify that these doctors would have to comply with the 12-hour pain management requirement. Both bills can still be amended further if the authors want it done.

Cave Canem (beware of the dog) Get it done lest the next time we turn around our state will have lost $40,000,000 -- not to worry, right? We tax payers always make up the difference.