Florence Kavaler

The debate over Diagnosis Related Groups

With the advent of the Prospective Payment System (PPS) using Diagnosis Related Groups (DRGs) as a classification method, the pros and cons of that mechanism have been sharply debated. Grouping the comments into categories related to administration/management, DRG system and quality of care, a review of relevant literature highlights the pertinent attitudes and views of professionals and organizations. Points constantly argued include data utilization, meaningful medical classifications, resource use, gaming, profit centers, patient homogenieity, severity of illness, length of stay, technology limitations and the erosion of standards.With the advent of the Prospective Payment System (PPS) using Diagnosis Related Groups (DRGs) as a classification method, the pros and cons of that mechanism have been sharply debated. Grouping the comments into categories related to administration/management, DRG system and quality of care, a review of relevant literature highlights the pertinent attitudes and views of professionals and organizations. Points constantly argued include data utilization, meaningful medical classifications, resource use, gaming, profit centers, patient homogenieity, severity of illness, length of stay, technology limitations and the erosion of standards.

The Differing Views on Insanity of Two Nineteenth Century Forensic Psychiatrists

Dr. Charles H. Nichols and Dr. John P. Gray were the two foremost forensic psychiatrists in the latter half of the nineteenth century in the U.S. However, their rationales differed dramatically. They were involved in four notable murder trials where insanity issues arose: one was a trial for the murderer of a Union officer during the Civil War; in another, a conspirator was tried for the assassination of President Abraham Lincoln; in the third, a temporary insanity plea was supported by a medical expert for the first time in a U.S. courtroom; and the fourth was the trial of the assassin of President James A. Garfield. Pointedly, their differing viewpoints still remain controversial today.

SMALLPOX AND NEW YORK CITY'S SMALLPOX HOSPITAL

Threatened use of the smallpox virus in bioterrorist attacks recently prompted national concerns in the United States. Smallpox, the “speckled monster,” was known in antiquity. In 1856, New York City opened its first hospital devoted to caring for victims of smallpox. Essentially, the hospital isolated and quarantined patients on Blackwell’s Island, located in the East River between Manhattan and Queens. After the hospital closed about 1875, the facility became a training school for female and male nurses. In the mid 1950s, the building was abandoned. Today, the ruins of the smallpox hospital are listed on the National Register of Historic Places. At night, the ruins are illuminated casting an eerie, green aura on the remaining stone walls.

A. Lincoln, Esquire Defends The Murdererof A Physician

After only about a year of law practice, Abraham Lincoln participated in his first murder trial. Dr. Jacob M. Early was shot and killed in a bitter political imbroglio. Lincoln joined a defense team of highly accomplished litigators. Despite his having the least legal experience, he was selected to give the defense summation. In his argument, he spoke to the jury in a conversational tone making his point that Dr. Early had a deadly weapon in his hands, namely an upraised wooden chair, when he was shot. His self-defense plea indicated that Henry B. Truett, the defendant, truly believed that he was in danger of being crushed by the upraised chair. Interestingly, Lincoln knew both the defendant and the murdered physician. He handled litigation for the former and served in the Black Hawk War under the command of the latter. Furthermore Lincoln knew at least five of the jurors.

The Role of Abraham Lincoln in Securing a Charter for a Homeopathic Medical College

In 1854, Abraham Lincoln was retained to prepare a state legislative proposal to charter a homeopathic medical college in Chicago. This was a complex task in view of the deep-seated animosity between allopathic or orthodox medical practitioners and irregular healers. Homeopathy was regarded as a cult by the nascent American Medical Association. In addition, the poor reputation of medical education in the United States in general, further complicated the project. Lincoln and influential individuals in Illinois lobbied legislators and succeeded in securing the charter. Subsequently, the Hahnemann Homeopathic Medical College accepted its first class in 1860 and with its successors remained in existence for almost sixty-five years.

Abraham Lincoln Loses a Medical Malpractice Case, Debates Stephen A. Douglas, and Secures Two Murder Acquittals

An improperly healed fracture was the most common reason for the medical malpractice crisis between the 1830s and 1860s in the United States. As a practicing lawyer in Illinois, Abraham Lincoln defended physicians in medical malpractice law suits. One of these was Dr. Powers Ritchey, who was sued for malpractice in 1855. Lincoln agreed to represent Dr. Ritchey in 1858 as the case was appealed to the supreme court of Illinois. In the interim, Lincoln defended two indicted murderers and won acquittals for both. Between the two murder trials, Lincoln debated Stephen A. Douglas while running for U.S. Senator from Illinois. Lincoln believed that Ritcheys case was poorly represented in the lower court. Ritcheys prior attorneys did not file a bill of exceptions to the testimony of the plaintiffs expert medical witnesses. Lincoln attempted to rebut the allegation of a lack of reasonable medical care and diligence by Ritchey, and he sought to secure a new trial for his client. In its decision, the supreme court of Illinois did not find any error and affirmed the lower courts judgment.

History: James McHenry, MD: Physician, Patriot, Politician and Poet

James McHenry emigrated from Ireland to the American colonies in 1771. He studied medicine with Dr. Benjamin Rush in Philadelphia and immediately volunteered as an Army surgeon when the Revolutionary War began. After serving in the medical department in Massachusetts, New York and at Valley Forge in Pennsylvania, he became an aide to General George Washington and subsequently an aide to the Marquis de Lafayette. President Washington appointed McHenry Secretary of War and he continued in that post under president John Adams. While Secretary, he revised military regulations, established a professional standing Army, pacified the Indians, enlarged the naval forces, organized the armed forces under civilian authority and initiated plans for a military academy. Baltimores Fort Whetstone was renamed Fort McHenry in his honor. During the War of 1812, Fort McHenry gained fame as the birthplace of the national anthem of the United States.