Physicians

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.

The Medical Board of California has launched an investigation into a string of 16 fatal overdoses tied to powerful narcotics prescribed by a prominent Orange County physician. Dr. Van Vu, a pain management specialist in Huntington Beach, was featured in a Los Angeles Times article in November that detailed the 16 deaths. A board investigator recently began obtaining signed releases from relatives of the deceased patients, authorizing the board to review their medical records.

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.

A consumer advocacy group Wednesday called for new laws to improve the state's monitoring of doctors who prescribe dangerous narcotics. Consumer Watchdog said reforms were needed to reduce surging prescription drug overdoses and to rein in incompetent and corrupt physicians. "We call upon you to convene hearings immediately to deal with this crisis and consider appropriate solutions," the Santa Monica-based group wrote in a letter to Gov. Jerry Brown and lawmakers. The letter was prompted by Times reports that exposed the role of physicians' prescriptions in overdose deaths.

Every day after work, Sandeep Lehil changes out of her lab coat and blue scrubs and sits cross-legged on a large, black pillow in her airy, quiet Los Feliz apartment. She takes two deep breaths and tries not to think about the patients she so desperately wants to help. She pushes out thoughts of the man with heart problems who left her exam room in an ambulance. And the patient who walked out when she told him his tests indicated he could have HIV. And the woman who Lehil fears is addicted to pain pills.

Though few patients realize it, many doctors receive thousands of dollars from pharmaceutical companies for each patient enrolled in an experimental drug trial. The medication might be the best thing for the patient's condition. The doctor's motives might be pure. But patients should be able to find out about such payments so they can discuss them with their doctors and decide for themselves whether the doctor's participation in an experiment might compromise his medical advice.

It's not surprising that the good folks at NBC decided to give a modernized Dr. Jekyll/Mr. Hyde serial a go. Having made their way through vampires, zombies, werewolves and the occasional ghost/T. rex/space invader, network execs and television writers are banging up against the back wall of the monster cupboard these days, and Robert Louis Stevenson's "case study" of a physician who fatally attempts to isolate the good and bad portions of his personality remains a classic, regularly reprised in a variety of ways.

He was remembered by patients and colleagues as a caring and talented physician, one who followed his father's footsteps into medicine. And his friends spoke of how devout he was in his Jewish faith as well as of his kindness and his zest for life. "He was just a good soul," one colleague and friend said. Now police are trying to determine why someone would walk into the urologist's Newport Beach offices and shoot him to death. Dr. Ronald Gilbert was killed Monday in an exam room of his practice in the heart of a bustling medical community, allegedly gunned down by a 75-year-old retired barber who recently told a neighbor that he had cancer and didn't expect to live much longer.

Re "Healthcare reform's fail-safe," Editorial, Jan. 20 The Times' editorial on the Independent Payment Advisory Board, or IPAB, underestimates the impact of the board's ability to make indiscriminate cuts to Medicare. Physicians are already dealing with a broken Medicare payment formula, which has led to a destabilizing cycle of scheduled cuts, short-term patches and payment rates that have fallen well below the rate of inflation. It is widely agreed that Congress must eliminate this problem; the last thing we need is another arbitrary system that relies solely on payment cuts, rather than improved care delivery, to rein in costs.

FIREBAUGH, Calif. - On a morning in early January, the air is cold and Firebaugh's main street is nearly empty. But the Sablan Medical Clinic is quickly filling up with people eager to see the physicians they affectionately call Dr. Marcia and Dr. Oscar. Lela Burkhart, whose family owns a farm in this remote San Joaquin Valley town surrounded by fields of pistachios and almonds, is one of the first patients of the day. Burkhart, 86, recently had heart surgery, and this morning she's feeling tired and short of breath.