Patient Safety

Re "Violating the right to a lawyer," Opinion, March 18 I read this piece on inadequate representation for poor criminal defendants with mixed feelings. I have been a deputy public defender in Los Angeles County for nearly 13 years, and during that time I've worked with attorneys whom I believe to be among the country's finest criminal defense attorneys. The nearly 700 attorneys in our office receive special training at the misdemeanor, juvenile delinquency and felony levels; in fact, the Los Angeles County Board of Supervisors recognized our felony training program in 2010.

Re "Battle over 'biosimilars,'" Editorial, March 17 I would like to point out several patient safety concerns with "biosimilars," cheaper versions of biologic drugs that are derived from living cells. Although the U.S. Food and Drug Administration's safety adjudications are important, the FDA has been wrong before. Recent withdrawal of one form of the antidepressant bupropion and safety warnings for virtually all blockbuster drugs have occurred. Such mistakes can be more harmful in biosimilars.

A Los Angeles jury Friday ordered healthcare giant Johnson & Johnson to pay $8 million in damages to a retired prison guard who said he was injured by the company's defective artificial hip. But in a victory for the company, the 12-member jury declined to levy any punitive damages, despite being told by the guard's lawyer that J&J's behavior warranted up to $179 million. This marks the first verdict in more than 8,000 similar suits filed against the world's biggest medical-products maker over this all-metal hip introduced in 2005 by DePuy, the orthopedic division of J&J. In this case, Loren Kransky, a 65-year-old former prison guard in Montana, claimed that he suffered metal poisoning and other health problems from the company's ASR XL hip implant he received in 2007.

Healthcare giant Johnson & Johnson played "Russian roulette" with patient safety by ignoring high failure rates and surgeons' complaints about its once-popular artificial hip, a Los Angeles jury was told during closing arguments at a high-stakes medical trial for the company. Jurors heard arguments from both sides Thursday in a case that pits the world's biggest seller of medical products against Loren Kransky, a 65-year-old former prison guard in Montana who claims he suffered metal poisoning and other health problems from the company's ASR XL hip implant he received in 2007.

California hospitals, under pressure to improve patient safety and cut unnecessary costs, reported a lower rate of early-elective deliveries last year, a new report shows. Hospitals in the state reported that 8.8% of deliveries in 2012 were early by choice, including elective inductions or caesarean sections between 37 and 39 weeks without a medical reason, according to the Leapfrog Group, an employer-backed nonprofit group focused on healthcare quality. That was down from 11.3% among California hospitals reporting data in 2011, and it was less than the 2012 national average of 11.2%, Leapfrog said.

Re "State lacks doctors to fill needs," Feb. 10 Far from a radical idea, the recommendation of state Sen. Ed Hernandez (D-West Covina) to license nurse practitioners to provide the full care they are educated to give is right on the mark. Such measures are already in place in 17 states and in Washington. It is a practice endorsed by many health policy experts, including the Institute of Medicine and the National Governors Assn. California and Nevada are the only Western states that do not already regulate nurse practitioners under these recommendations.

SACRAMENTO - As the state moves to expand healthcare coverage to millions of Californians under President Obama's healthcare law, it faces a major obstacle: There aren't enough doctors to treat a crush of newly insured patients. Some lawmakers want to fill the gap by redefining who can provide healthcare. They are working on proposals that would allow physician assistants to treat more patients and nurse practitioners to set up independent practices. Pharmacists and optometrists could act as primary care providers, diagnosing and managing some chronic illnesses, such as diabetes and high-blood pressure.

Ten California hospitals received fines Thursday for errors that resulted in either serious injury or death to a patient. The California Department of Public Health issued a total of $785,000 in penalties for errors that include removing the wrong kidney, leaving surgical objects behind and failing to call for assistance when a patient began bleeding excessively. The civil fines, ranging from $10,000 to $100,000, were issued to hospitals throughout the state for errors that occurred in 2010 and 2011.

A national report card on patient safety gave a failing grade to Ronald Reagan UCLA Medical Center, one of the country's most prestigious hospitals and one of only 25 nationwide to receive such low marks. In a report issued Wednesday, the Leapfrog Group, an employer-backed nonprofit group focused on healthcare quality, gave a letter grade of F to UCLA Medical Center for performing poorly on several measures tied to preventing medical errors, patient infections and deaths. Leapfrog withheld a failing grade for UCLA in June when it released its first-ever hospital safety scores to give low-performing hospitals time to show improvement.

Hospital chain HCA Holdings Inc., under government scrutiny for allegedly performing unnecessary surgeries and other medical procedures on some Florida patients, has posted healthy profits at its three hospitals in Southern California. The Nashville, Tenn., company said in a securities filing Monday that officials with the U.S. attorney's office in Miami had requested information about medical necessity reviews for certain "cardiology services. " HCA said those reviews had occurred at about 10 of its hospitals, primarily in Florida.