Ethics. Research. Community.

Blogging Ethics

Note: blog content is not currently included in EthicShare's Search Results.

11/14/2019 - 1:26pm

By Alexa Richardson

Data has long shown alarming rates of maternal mortality for black women in the United States, with deaths three to four times the rate for white women. Such deaths are not accounted for by differences in education or income, and systemic racism, including racial bias within the healthcare system, is believed to be a significant contributing factor to the problem. In the past year, this issue has finally made it into the policy arena, with a number of serious policy proposals put forth to try to reduce black maternal mortality.

In April, Congresswomen Lauren Underwood and Alma Adams formed the Black Maternal Health Caucus. Democratic primary candidates Senator Elizabeth Warren, Senator Kamala Harris, and Senator Cory Booker have all put forward proposals to address racial disparities in maternal mortality. And in October, California enacted legislation aimed at reducing racism and improving maternal health outcomes in obstetrics.

But what is the content of the policies being proposed? Are some better than others? This post surveys some of the biggest initiatives underway. It turns out that the measures being discussed vary widely–in approach, in scope, and in ambition.

Black Maternal Health Caucus Appropriations Priority Bill

The Black Maternal Health Caucus was formed with the goal of making the problem of black maternal health outcomes a national priority, and to explore the best policy approaches to address it. In June, the Caucus celebrated passage of an appropriations bill allocating funding to initiatives aimed at addressing disparities in maternal mortality. The bulk of the funding went to research efforts–$1.58 billion for the National Institute of Child Health and Human Development, which supports research into maternal health and disparities, $50 million to broadly initiate research, and an increase in funding for the Center of Disease Control Safe Motherhood and Infant Health program’s Maternal Mortality Review Committees, which assess of maternal deaths and identify opportunities for prevention. Funding was also directed toward grants for innovative care approaches, educating more midwives and diversifying maternity care providers, and general funding for coordination of maternity health services.

Much of this funding was already in place and will go to broad federal initiatives of which black maternal health is only a small component. Still, the effort shows the identification by lawmakers of the kinds of initiatives that can impact maternal health disparities, and a commitment to funding them. Funding more research on the matter is critical; we don’t have enough evidence yet to know what policy changes will actually work to close the gap on maternal health disparities. The funding scheme also shows a recognition by lawmakers that better funding of health care all around, particularly in low-income communities, is part of addressing racial health disparities. Finally, the albeit modest efforts to fund diversification of maternity care providers indicates that Congress acknowledges racism in the health care system itself to be a contributing factor to the high rates of death for black women in pregnancy.

Elizabeth Warren’s Proposal to Reduce Maternal Disparities

Democratic primary candidate Senator Warren has proposed potentially sweeping initiatives to address racial disparities in maternity care. Warren’s plan would change the reimbursement system to hold hospitals accountable for black maternal health outcomes. Modeled after the Affordable Care Act “bundled payment” reforms that abandoned payment for particular procedures in favor of reimbursement based on outcomes for an entire “episode” of care, Warren’s model would incentivize hospitals to bring down costs by improving outcomes. Hospitals would receive a “bonus” for reducing racial disparities. If it works, hospitals would have an incentive to fund procedures that evidence shows are effective–like integrated care, support services, and doulas–and to avoid poor outcomes and expensive but unproven interventions where possible. Warren emphasizes that outcomes could be tracked and assessed far out from the birth to reduce dangerous postpartum complications that too often go undetected. Her plan also includes efforts to diversify medical staff.

Warren’s plan is an ambitious, outcome-oriented approach that would transform maternity care as we know it. She recognizes that the plan has risks–sending additional funding to hospitals that are performing well could exacerbate disparities if not carefully managed. Warren’s plan includes measures to avoid such problems by investing in and adding additional oversight for those facilities that are struggling, but unintended consequences could be a risk of this sweeping program. Even so, if it works, Warren’s proposal could lead to dramatic changes in health practices and outcomes, and result in a more rigorous maternity system tailored toward improving outcomes for black women.

Kamala Harris and the CARE Act

Senator Harris, also in the Democratic presidential race, has introduced the Maternal Care Access and Reducing Emergencies (CARE) Act, along with colleagues (Elizabeth Warren and Cory Booker are cosponsors). This is a two-pronged initiative to address racial disparity in maternity care. First, the initiative invests heavily in implicit bias training for health care providers, with an emphasis on obstetric providers. Second, the bill would award grants to ten states to establish “pregnancy medical home programs.” In essence, these programs make integrated care and services part of pregnancy care: social workers, mental health, substance use treatment and support, doulas, home visitors, etc. The programs also hold providers to a variety of evidence-based standards, and requires additional training in cultural competency.

Senator Harris’ program emphasizes racism in the provision of health care and targets the most vulnerable patients with wraparound services and care. For those patients enrolled in the pregnancy home programs, which have been trialed in North Carolina and shown impressive outcomes, the benefits of this proposal are clear. If the programs prove themselves on the national stage, they could be extended. However, Senator Harris’ plan has limitations. Consensus is forming to show that implicit bias training may not work to change behavior. How far this initiative would go in actually improving outcomes is unclear. The pregnancy home programs are a somewhat narrow intervention–only ten states would receive them and even then the grants only support those specific providers that opt in and receive the funding.

Finally, by bringing state agencies into the homes and lives of poor black women, these types of programs could have unintended consequences. Greater contact with state agencies in the home could increase surveillance of families and the risk of (substantiated or unsubstantiated) reports of substance use, domestic abuse, child neglect or abuse, or social services fraud and the resulting civil or criminal consequences, including actions by child protective services. If such programs led to increased criminalization of black women and their families, they could end up exacerbating the conditions that led to racial disparities in the first place. 

Cory Booker, Ayanna Pressley, and the MOMMIES Act

Senator Booker, another Democratic primary candidate, has joined with Congresswoman Pressley and other colleagues (Kamala Harris and Elizabeth Warren were cosponsors) to introduce the Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services (MOMMIES) Act. This bill emphasizes expanding Medicaid coverage past 60 days postpartum to cover people through 365 days postpartum, and expanding the services Medicaid will cover beyond pregnancy-related services. In addition, much like the CARE Act, it creates a pilot study of the pregnancy home programs in fifteen states. As described above, these programs would provide integrated care ensuring connection to services. Finally, the MOMMIES Act commissions a multiyear study and legislative report on gaps in care for low-income women of color, including the lack of access to doula care and the potential of telemedicine to address disparities.

Booker’s proposal is similar to that introduced by Senator Harris, but it appears to go a little further. The expansion of Medicaid ensures an immediate increase in access and services for all low-income black people during and after pregnancy.  The size of the pilot project of integrated care programs is larger, reaching fifteen rather than ten states. And the addition of a comprehensive study could pave the way for future policy proposals that target maternal mortality in vulnerable communities. It has great potential to begin to address racial disparities in pregnancy outcomes. At the same time, the pregnancy home programs advocated carry the risks of extra state monitoring and surveillance discussed above.

California’s Dignity in Childbirth and Pregnancy Act

California’s bill targeting racial disparities in maternal mortality was signed into law last month. The Act mandates implicit bias and cultural competency training every two years for health care providers that give perinatal care. In addition, it implements more rigorous data collection of maternal deaths, and requires that such data is disaggregated by race.

California’s initiative is modest in scope, but, unlike most of the other proposals, has actually been passed into law. As such, it represents a promising step by lawmakers to prioritize and act on racial disparities in health care. Though the effectiveness of implicit bias training, as discussed above, may be limited, California’s training goes beyond implicit bias to discuss “institutional, structural, and cultural barriers to inclusion,” “power dynamics” in health provision, and the impact of racism on maternal and infant outcomes. The every-two-year training requirement is rigorous. Finally, the data collection could help lay the groundwork for future efforts down the line.

Conclusion

All in all, the rush of proposals to reduce racial disparities in maternity care is cause for celebration.  While recognizing the successes, however, we should ensure that the policies promoted go far enough in tackling disparities. Meanwhile, we should guard against unintended consequences from policies that could harm those they intend to help. As black women continue to die of preventable pregnancy complications at alarming rates, the urgency to find and implement effective solutions could not be greater.

The post Policy Roundup: Improving Maternal Health Outcomes for Black Women appeared first on Bill of Health.

11/14/2019 - 10:50am

By Adrian Gropper

Google’s semi-secret deal with Ascension is testing the limits of HIPAA as society grapples with the future impact of machine learning and artificial intelligence.

I. Glenn Cohen points out that HIPAA may not be keeping up with our methods of consent by patients and society on the ways personal data is used. Is prior consent, particularly consent from vulnerable patients seeking care, a good way to regulate secret commercial deals with their caregivers? The answer to a question is strongly influenced by how you ask the questions.

Here’s a short review of this current and related scandals. It also links to a recent deal between Mayo and Google, also semi-secret. A scholarly investigative journalism report of the Google AI scandal with London NHS Foundation Trust in 2016 might be summarized as: the core issue is not consent; it is a conflict of interest at the very foundation of the information governance process. The foxes are guarding the patient data henhouse. When the secrecy of a deal is broken, a scandal ensues.

The parts of the Google-Ascension deal that are secret are likely designed to misdirect attention away from the intellectual property value of the business relationship.

HIPAA grants the hospital, the “covered entity,” the right to delegate certain functions to “business associates” that are presumed to be outsourced services that might otherwise be done by the covered entity itself. A good example of that would be a transcription service that converts a doctor’s dictation into text and just sends it back to the hospital. The assumption there, and core to the provider-centered HIPAA privacy model, is that the transcription service does not use the content of the patient record they are transcribing for their own purposes, such as selling the data to a third party. Sounds reasonable, but HIPAA is ancient in modern network and artificial intelligence computing terms.

Over more than two decades, the practices of business associates justified under HIPAA have drifted to seriously undermine the privacy interests of individual patients as well as society as a whole. One drift, about ten years ago, treats health information exchanges as HIPAA business associates. Now, a business associate can use the patient data in a way that was not entirely under the control of the covered entity or obvious to the patient. A recent example is the dispute between Surescripts as the HIPAA business associate and Amazon PillPack pharmacy as a HIPAA covered entity. The privacy issue in this case is that the patient has an open consented relationship with PillPack as their pharmacy but has no knowledge of how or why Surescripts is using their data for their own business reasons. Surescripts business practices are now under federal investigation, but their use of patient data without consent continues and the privacy aspect of this scandal will play out in the courts.

The next stage of HIPAA drift is machine learning for the benefit of the business associate, Google, in this case. This benefit might be monetized by selling trade secret medical advice to various hospitals and their patients. The privacy impact in this case is not to the individual patient of an Ascension hospital but to society as a whole. Until now, medicine has not been licensed as a trade secret. The advent of proprietary silos of medical science branded Mayo or Google is new and its impact on health care is hard to predict. What we do know is that patients, when asked, are reluctant to let their personal data to be used for profit. Ascension is a nonprofit entity but Google is not. HIPAA is now being used to avoid informed consent for corporate data uses well beyond the patient’s relationship with their Ascension hospital. The public misdirection is driven by conflict of interest since all parties to the secret deal benefit and neither physicians nor patients are consulted.

The Ascension-Google deal bundles simple HIPAA business associate services like cloud computer hosting with less obvious machine learning technology that Google can sell outside of the Ascension relationship. Is Ascension getting a discount on the cloud hosting because of their contribution of patient data to Google’s future business? How much will Google charge a non-Ascension doctor or me as a patient for their medical record summary service? Will Google merge the machine learning from Ascension patients with the machine learning from Mayo patients? One thing seems sure, we’re expected to trust Google to not be evil because we’re certainly not being asked.

The post What Google Isn’t Saying About Your Health Records appeared first on Bill of Health.

11/14/2019 - 8:23am

This week, New Zealand MPs voted 69-51 to approve David Seymour's End of Life Choice bill, sending the issue to a public referendum next year.

11/14/2019 - 8:23am

This week, New Zealand MPs voted 69-51 to approve David Seymour's End of Life Choice bill, sending the issue to a public referendum next year.

End of Life Choice Bill - Third Reading - Video 1 from New Zealand Parliament on Vimeo.

11/13/2019 - 12:46pm

By I. Glenn Cohen

As has been well reported in the media, there is a controversy brewing over nonprofit hospital chain Ascension sharing millions of patient records with Google for their project codenamed “Nightingale.” (very Batman, if you ask me!) Most of the discussion so far, and the answers have not yet become pellucid, concerns whether the hospital and Google complied with HIPAA.

 

This is important, don’t get me wrong, but it is important that conversation not ignore a more important question: Is the existing HIPAA regime adequate to do what we want it to do in an era of big data? As Michelle Mello and I argued in JAMA in August concerning a lawsuit relating to the sharing of medical records between the University of Chicago and Google, these stories expose a “US health data regulatory regime that is showing its age.” In particular, the reliance on patient authorization (especially more blanket front door versions) that have often been the basis for justifying data sharing are not an ethically sufficient way forward. Patients “are rarely given the information and opportunity to ask questions needed to give meaningful informed consent to future uses of their data. Even if those problems could be overcome, it is asking a great deal of patients to imagine and assess how their information may be used and what the risk of reidentification maybe.” Moreover, what happens when the risks and benefits change over time but the authorization remains in place?

We instead recommend seeing authorization as merely one of several possible “governance technologies” and we recommend looking at different approaches. One important one more downstream (at the time of a particular use rather than at the time of collection) and group rather than individual based. We explain how such patient data use committees that have real meaningful patient input can operate.

While the media focuses on whether Google and Ascension have complied with the law, we must also ask the more important question: is that current law working or should it be reformed?

The post The Right Lesson from the Google-Ascension Patient Privacy Story appeared first on Bill of Health.

11/13/2019 - 12:28pm

By Adriana Krasniansky

Over the past several days, technology players Google, Apple, and Facebook have each reported health-related business news. In this blog post, we examine their announcements and identify emerging ethical questions in the digital health space.

On Nov. 1, Google announced plans to acquire smartwatch maker Fitbit for $2.1 billion in 2020, subject to regulatory approval. The purchase is expected to jumpstart the production of Google’s own health wearables; the company has already invested at least $40 million in wearable research, absorbing watchmaker Fossil’s R&D technology in January 2019.

In another corner of the wearables market, Apple beat earnings expectations, largely driven by 54% year-over-year growth of its “Wearables, Home, and Accessories” group. The category now accounts for more revenue than Apple’s iPads, and there are indications that Apple is developing its wearables with health in mind. Since 2014, Apple has filed patents for in-ear technology to monitor heart activity, stress levels, and temperature.

Facebook is working with health organizations to develop its Preventive Health tool, which allows users to opt-in for checkup reminders, such as cholesterol tests or mammograms, based on their age and gender. In addition to receiving notifications, users can locate health centers and mark when tests are completed.

Together, these announcements unveil emergent ethical considerations in personal digital health.

Health as a newsfeed

Google and Apple’s announcements emphasize investment in continuous health monitoring, where individuals can track their health outside of the hospital—creating a personal health newsfeed that mimics our social platforms.

While continuous monitoring offers important benefits (e.g., simplifying disease management, encouraging healthy habits, or catching undiagnosed conditions), it also surfaces ethical concerns. These include a possible increase in health anxiety (exacerbated by social reminders on Facebook) that fuels overmedication or unnecessary treatment. Conversely, some of the population may experience alarm fatigue and ignore otherwise important indicators.

“There will be a day in the future that we look back and Apple’s greatest contribution will be to people’s health.”

– Apple CEO Tim Cook, Q4 2019 earnings call 

Data sales & advertising

Google and Facebook have stated that health data will not be used for advertising. However, subsequent activities—such as purchasing a blood pressure monitor or joining a digital health support group—are fair game. As Facebook writes:

We don’t show ads based on the information you provide in Preventive Health…As always, other actions that you take on Facebook could inform the ads you see, for example, liking the Facebook page of a health organization or visiting an external website linked to from Preventive Health.

Increased health awareness suggests that our digital browsing and buying behaviors will be more indicative of our health states; thus, while not explicitly sharing data, our digital ecosystems are likely to result in more health-based advertising in the near future.

Health industry partnerships

While technology players won’t sell health data, there are other lucrative opportunities, particularly partnerships with insurance partners and employers. For example, Fitbit’s corporate wellness initiative has been one of the business’s most effective growth strategies, and the company even launched a separate device for corporate partners.

In health monitoring programs, individuals are incentivized to participate with reduced health premiums, copayment reimbursements, or cash. In exchange, participants’ health data is shared with their employers, wellness plan administrators, or health insurers to inform plan structure and pricing. According to the Kaiser Family Foundation, 21% of large employers who offered health insurance collected data from employee wearables in 2018.

Corporate-device relationships are increasingly common; Aetna and Apple and Fitbit and United Healthcare are just two examples. However, concern exists that these relationships could eventually favor healthy employees or act upon unhealthy employee behavior outside of the office. Subconsciously, these programs may also impose a dimension of health surveillance that amplifies the power dynamic between employer and employee.

A shadow health record

Largely in response to public concern, Facebook, Google, and Apple have taken precautions to guard user health data. Existing Fitbit and Apple device partnerships exhibit HIPAA compliance under business associate agreements (read more about BAAs and consumer technology in a previous Bill of Health post), and Facebook has gone to great lengths to emphasize its protection of Preventative Health behavior.

However, it’s unclear how well these initiatives will integrate with medical records. Many similar health applications—from fertility trackers to running apps—are not HIPAA compliant and do not integrate with medical records. The explosion of (good and bad) direct-to-consumer health technology stands to create shadow health records that are neither protected nor clinically considered. While digital health tools may lead individuals to feel empowered by data, current practices indicate that resulting health profiles are likely to be fragmented, under-protected, and, in some cases, beyond individuals’ control.

The post Reviewing Health Announcements at Google, Facebook, and Apple appeared first on Bill of Health.

11/13/2019 - 12:25pm

By Nicolas Terry

There’s an old saying, credited to Will Rogers, “If you find yourself in a hole, stop digging!” When it comes to Medicaid work requirements there has been mounting evidence that excavation cessation would be good advice for states considering this misguided attempt at social engineering. After all, work requirement waivers face unrelenting legal challenges, an obdurate CMS apparently unable to fashion a lawful waiver, mountains of bad data, and increasingly poor optics. Two weeks ago Arizona, which had yet to implement its program, jumped ship notifying CMS that it was postponing implementation. This week Indiana, which began implementation at the beginning of the year, announced a similar postponement.

According to the KFF Medicaid Waiver Tracker, CMS has approved applications from nine states for Section 1115 work requirement (or “community engagement”) waivers. Nine more are pending. Of the nine states with approvals, three (Arkansas, Kentucky, and New Hampshire) have had them overturned by D.C. Circuit Judge Boasberg. Work requirement poster state Kentucky even had a second, revised waiver overturned. Of the six other approved states, five (Arizona, Michigan, Ohio, Utah, and Wisconsin) have yet to implement their work requirements. Until this week, the sixth, Indiana, had been performing a slow and litigation-free roll out. However, with its work requirement sanctions about to get serious, a few weeks ago Indiana also found itself on Judge Boasberg’s docket.

In the four decided cases, plaintiffs argued that the work requirement waivers fundamentally altered the design and purpose of Medicaid, while the Secretary neither offered his own estimates of the number of Medicaid-covered persons who would lose coverage nor dealt with the estimates in the record. The Secretary’s silence on the issue is not surprising. Back in 2017, CMS Administrator Seema Verma and then-HHS Secretary Tom Price wrote to the country’s governors announcing the acceptability of work requirement waivers, making clear they were seeking to reframe Medicaid as welfare rather than health insurance. However, as Judge Boasberg said in the New Hampshire case, “the Secretary needed to consider whether the demonstration project would be likely to cause recipients to lose coverage and whether it could cause others to gain coverage.” Even a cursory listen to the oral arguments before the D.C. Circuit is enough to inform a guess that Judge Boasberg’s judgments will be upheld and that any possible resolution in the Administration’s favor will have to await the Supreme Court.

Data analysis of the impact of work requirements has not been helpful to CMS, making the Secretary’s failure to engage on the numbers even more damning. First, analysis of Indiana’s HIP 2.0 (prior to work requirements, but involving skin-in-the-game features), cast doubt on behavioral economics nudges leading to successful social engineering; almost 60 percent of non-expansion persons never enrolled or were dis-enrolled for failing to pay premiums, while 51 percent of expansion persons never enrolled or lost coverage. Research pointed to enrollment affordability and enrollee confusion about the payment process as the primary reasons for non-enrollment or loss of enrollment. Second, before it was shut down by Judge Boasberg, the “Arkansas Works” program had been up and running for about nine months and generated similar disturbing data. In the first six months, approximately 12 percent of those with Arkansas Medicaid lost coverage without moving any employment or community engagement needles. As with the study of Indiana’s HIP 2.0 program, enrollees were confused about the changes and faced difficulty reporting and other administrative barriers. A later study found that over 18,000 persons lost their health insurance for failing to meet the Arkansas requirements. Another study estimated that between 589,000 and 811,000 people would lose Medicaid coverage after 12 months if work requirements were implemented in all states that have received waivers.

The bad data confirmed that work requirements are a bad idea. Tying Medicaid eligibility to employment is based on several false premises. The first is that adults on Medicaid are not working, when in fact most are employed. The second is that rather than work improving health and well-being, health makes it more likely that persons will seek work. Third, many Medicaid-covered persons live in areas with high unemployment and few jobs or lack the education or credentialing to qualify for employment. Fourth, many Medicaid-covered persons have serious medical conditions or disabilities that create serious barriers to employment.

Unsurprisingly, the Arizona and Indiana postponement statements failed to acknowledge these fundamental flaws. The Arizona announcement merely referenced an “evolving national landscape” and “ongoing litigation.” The Indiana announcement was similar, although it reiterated the state’s commitment to its “Gateway to Work” program and promised its resumption (with “substantial advance notice”) after the litigation was resolved.

The Indiana suspension was particularly interesting because the state had tried to learn from the prior litigation and the bad optics of thousands of persons losing their health insurance. First, it tried to thread the needle between a work requirement and job training, connecting “HIP members with ways to look for work, train for jobs, finish school and volunteer.” Second, it implemented the program with a kindler, gentler roll-out that required no reported hours of work or engagement for the first six months (or bad headlines), slowly building to eighty hours per month after July 2020. Indiana’s Medicaid Director reportedly went so far as to vow that no current beneficiaries would lose benefits. Yet, the program web site states “Gateway to Work was designed with a requirement for some members to do Gateway to Work activities to keep their HIP benefits.”

Notwithstanding the assumption that final approval of work requirements will have to await a 2020 Supreme Court appeal from the assumed D.C. Circuit decision (though cert. den. may be a better bet), the Administration continues to defend its position in public. In an October 2019 speech Administrator Verma noted “it is so important that we support state innovation designed to help lift people from poverty rather than trap them there” — code for work requirements. However, in all likelihood, the Administration has already moved on as it launches its newest plan to dismember Medicaid, suggesting states use the waiver process to request a block grant model of financing, as previewed by Tennessee’s recent request.

As to the future of work “requirements,” states perhaps should look to Pennsylvania. There, those who are Medicaid eligible can request job training which is facilitated by the state’s Medicaid MCOs. In the words of the Keystone state’s human services secretary, “I worry that, with its reporting rules, work requirements result in fewer people covered by Medicaid, and that is not our goal… Our goal is to try to get people out of poverty. If you take access to health care away for people not working, I’m not sure how that helps people get a job.” That seems to be an approach to work “requirements” we could all get behind.

Addendum, Nov. 12, 2019

Montana, which has applied for but not yet been granted a work requirement waiver, has announced a delay in implementation because of the need to write administrative rules and build the necessary software. Meanwhile, the results in some recent state elections are likely to change the work requirements map; in Kentucky, Democrat Governor-elect Beshear, ran on a promise to rescind work requirements, while the Democratic party’s takeover of both houses may lead Governor Northam to cancel that state’s waiver application.

The post Are Work Requirements Sinking as Arizona and Indiana Abandon Ship? appeared first on Bill of Health.

11/13/2019 - 3:00am

In this famous scene from Sesame Street, the characters explain to Big Bird that "when people die, they don't come back." This seems simple enough.

This common error was recently colorfully illustrated by Benjamin Schreiber, an Iowa inmate. Schreiber claimed that he served his "life" sentence when he "died" during surgery. He asserts that he “died” on March 30, 2015 and as a result of such “death” he has now served the life sentence and should be released from custody....

11/13/2019 - 3:00am

In this famous scene from Sesame Street, the characters explain to Big Bird that "when people die, they don't come back." This seems simple enough.

Nevertheless, people commonly refer to cardiac arrest as "death." This is wrong. Death requires more than the cessation of circulatory and respiratory functions. It requires the "irreversible" cessation of circulatory and respiratory functions.

This common error was recently colorfully illustrated by Benjamin Schreiber, an Iowa inmate. Schreiber claimed that he served his "life" sentence when he "died" during surgery. He asserts that he “died” on March 30, 2015 and as a result of such “death” he has now served the life sentence and should be released from custody.

Both the District Court and the Iowa Court of Appeals rightly denied the claim. "Schreiber is either alive, in which case he must remain in prison, or he is dead, in which case this appeal is moot."

On the other hand, Screiber was resuscitated despite his DNR order. He may have a civil claim for damages against the hospital and its clinicians.

11/12/2019 - 9:21am

by Jay Behel Burnout, provider dissatisfaction, and attrition remain at near-epidemic proportions among healthcare providers. A 2017 survey found that 39% of physicians reported significant burnout, and nearly a third of physicians were contemplating leaving practice in a 2012 survey.  Nurses seemed to be faring better in a survey released earlier this year with only […]