• UNAVAILABLE: Southern Paramedic provides ambulance service to Clinton, but rules prevented it from transporting an injured man to Little Rock recently. He died without advanced treatment.

Leslie Newell Peacock reports further on circumstances in the death of a Clinton lawyer following a brief scuffle with a man he tried to bar from his restaurant.

Though it wasn’t mentioned specifically, the incident involving Brett Blakney of Clinton, who died of a head injury May 4 because there was no transport available to take him from the county facility to Little Rock’s advanced care hospitals, prompted much discussion at Tuesday's Trauma Advisory Council meeting about the need for change in transport rules and regulations.

Blakney, 43, the former Clinton city attorney, was taken to Van Buren County Memorial Hospital after a man punched him and knocked him to the ground outside Blakney’s restaurant, the Black Dog Grill around 10 p.m. May 3. Responsive at first, Blakney later became unresponsive at the hospital and an emergency room nurse there told police that unless he was transported, “he’s going to lay here with that head injury and bleed to death.”

By the time the hospital determined that no helicopter would be available because of fog, Southern Paramedic had sent one of its two ambulances in Clinton to Little Rock with another patient and rules didn’t allow the other ambulance to leave the county, CEO Gary Padget said. Blakney died at the hospital around 4 a.m.

Emergency Medical Services rules and regulations currently require that 911 calls take precedence over hospital transport, which meant Southern could not release its one ambulance in Clinton for out-of-county transfers until the second had returned to the county.

Dr. Todd Maxson, the health department’s medical consultant, said the trauma system should create an urgent trauma transfer rule, adding, “The [trauma] patient has to have the same priority as a person calling 911.”

I noted here over the weekend the death of a Clinton lawyer, Brett Blakney, four hours after he struck his head in a scuffle with a man he was trying to bar from his restaurant. He'd been talking with law officers and others before his condition worsened.

Original reporting noted the inability to transfer him from the Van Buren County Hospital to more advanced treatment in Little Rock. Weather conditions made helicopter ambulance use impossible and news reports at the time said a local ambulance service, Southern Paramedics, had only one ambulance on call and it was restricted from leaving Van Buren County.

Much reporting is necessary — ranging from what the hospital says about the patient's condition to the ambulance service's terms of operation and, how, if at all, the statewide trauma system responds in cases such as this.

But there's also pertinent legal background to this case. In brief: a private ambulance service, Vitalinks, had an exclusive city franchise to provide ambulance service in Clinton. Despite that franchise, the county hospital, which sits in the city, allowed Southern Paramedics to provide ambulance service. Vitalinks protested. Legal action ensued, first a criminal action against Southern Paramedics for violation of the franchise ordinance. This turned into a civil suit. A circuit judge ultimately allowed Southern Paramedics to continue to operate, but, by then, Vitalinks had already pulled out. It said it could not operate economically without the exclusive franchise. The case went to the Arkansas Supreme Court. Because Vitalinks was gone, the Supreme Court wouldn't issue an advisory opinion on whether Southern Paramedics qualified for an exemption to operate under the municipal ambulance franchise law. The Arkansas Ambulance Association predicted during the legal action that the lack of an exclusive franchise would be harmful to the "health, welfare and safety of the state."

Another inconvenient fact about Obamacare:

In the first two years after “Obamacare” was signed, Medicare reforms in the law saved seniors a total of $3.4 billion in prescription drug costs by bridging a coverage gap, according to official figures. Over 220,000 beneficiaries have saved an average of $837 in the first three months of 2012, the Medicare agency said Monday. That’s on top of $3.2 billion in savings enjoyed by some 5.1 million seniors in 2010 and 2011 thanks to the Affordable Care Act, according to the advisory on the new figures.

Arkansas Republican legislators were busily Tweeting last night about "taxpayer-funded welfare," otherwise known as Medicaid. If you call something welfare often enough, it becames a hated thing. The implicit message is that the labor of hard-working Americans is going to undeserving poor people, (a photograph of minority recipients is always useful in the effort). If these insurgents take control, they'll eventually have much explaining to do about their victims — elderly people in nursing home (most of whom spent a lifetime in honest toil), children and working poor.

Farm subsidies, direct subsidies to private business in the name of economic development and the many other handouts and preferences given to the corporate and wealthy classes are never described as "taxpayer-financed welfare" in the trickle-down script. They are, rather, incentives to deserving American job creators. A shared commitment to the very least among us gets the scornful "welfare" tag, quite often from politicians who like to loudly proclaim their religious credentials.

Today's verse: Luke 6:20.

Nobody's declaring victory yet, but there are enormous implications in the finding reported today that something may be finally arresting the rise in health care spending.

If doctors and patients really have begun to change their behavior, the savings will be enormous, the benefit to governnment great and political repercussions obvious. Again, nobody's sure about this, but a range of experts spot factors that might help explain the trend. For example:

Finally, and most important, health economists point to a shift toward accountable care, in which providers are paid for the quality of care, not the quantity.

This is the aim, it happens, of the reshaping of Arkansas's government-backed health programs instituted by the Beebe administration. It has been met with skepticism by Republicans. They tend to deride all government health effort because they prefer a system where only those who can afford medical coverage get help. That, it must be said, would be far cheaper in terms of government outlay, but ruinously expensive in terms of illness and death.

The National Park Medical Center and St. Joseph's hospital in Hot Springs will merge under one owner, according to this news release, though details of the combine are in short supply.

Capella Healthcare, parent of National Park, is going to become owner of St. Joseph's Mercy Health Center, which had been operated by Mercy Health, an organization of Catholic hospitals.

The operators have signed an agreement in principle and will negotiate a "definitive agreement." Merging of operations is suggested by the prepared statement from Lynn Britton, CEO of Mercy:

As separate providers in the Hot Springs area, Mercy and Capella face challenges in serving the community. Mercy has deep roots in the region, and it is our intent to continue our ministry here through other ways of meeting community needs. But given the environment, we have come to believe that the region will be better served by a unification of health services under one provider.

St. Joseph's is the larger of the two hospitals.

The University of Arkansas Board of Trustees will meet this afternoon in a called telephone meeting on an important matter — no, not the contract for a new football coach.

They'll be considering a deal to buy the UAMS out of its joint operation with the Central Arkansas Radiation Therapy Institute. A previous price of $10 million may have been bargained down a bit. I expect documents after a while. The campus will then have to spend perhaps $10 million to buy its own radiation equipment to go it alone in that business.

This is viewed a touch nervously in some quarters. $20 million or so isn't small change. The hospital is also talking about $87 million in IT improvements. Nine months into the fiscal year, the hospital remains in the red for the year, though recent months reportedly have edged into the black. If a bond issue is contemplated to pay for these new costs, there'll be questions about the revenue stream to back the bonds. The hospital spent $13 million on a consultant last year who was to map a path to profitability. Critics of the effort believe it has produced no meaningful reduction in payroll. These are potential talking points in today's session.

UPDATE: Here's the proposed deal for UAMS and CARTI to separate, with UAMS paying $9.5 million. It was approved at the evening meeting unanimously. UAMS faculty received this description:

Leslie Newell Peacock reports on the uncertain future of Hope's hospital, a tangled story that includes a recent federal guilty plea by the hospital's owners related to another property in Texas:

• MEDICAL PARK HOSPITAL: Hope employees and officials concerned about its future.

Medical Park Hospital, which is a Level 4 trauma center with 79 beds, is the only hospital between Arkadelphia and Texarkana for people who live along the Interstate 30 corridor. It was purchased in 2008 by James A. Cheek, who was convicted with partner Herschel Breig in February for failure to pay $1.8 million in payroll taxes for employees at a bankrupt hospital they owned at Lubbock, Texas.

The letter was sent to Gov. Mike Beebe, Health Department chief Paul K. Halverson, U.S. Attorney Conner Eldridge, Attorney General Dustin McDaniel, 8th district prosecutor Christy McQeen, Sen. Larry Teague and Ann Roberts, assistant U.S. attorney in Lubbock, Texas. MPH chief of staff Dr. Dale Goins, vice chief and chief of pediatrics Dr. W. Ladell Douglas, chief of radiology Dr. Lawrence Bigongiari, emergency medicine doctor Dr. Paul D. Meredith, director of trauma and chief of medicine Dr. L. Joseph Parker, chief of surgery Dr. Andrew G. Szebenyi and chief of medicine and surgery Dr. Charles A. Vermont signed the letter.

The doctors wrote that they fear that a pattern they see in Cheek’s other operations — “purchasing, bankrupting and/or closing hospitals shortly after he becomes affiliated with or purchases them” — is being repeated in Hope.
“In recent months, the obstetrical unit was closed, layoffs have occurred, hospital employees have experienced delinquent paychecks or paychecks returned for insufficient funds, premiums on employee health insurance is not being paid, creditors and vendors are not being paid, property taxes have not been paid. In fact, MPH is scheduled to be certified to the State of Arkansas Commissioner of State Lands in May 24, 2012 for failure to pay property taxes. Presently, MPH owes some $3 million in unpaid federal and state employment taxes.”

Hospital executive director Marc Caton, who was hired by Cheek last June and is also the chief executive officer of Carraway Medical Systems, said the company is “working on all those financial issues.” (Carraway purchased MPH last year from Cheek company Shiloh.)

Will the U.S. Supreme Court really rule unconstitutional a law that provides for health care for all Americans, whether they've been sick previously or been too poor to afford insurance premiums but not poor enough for federal assistance? Here's what UCLA law professor Adam Winkler says in the Huffington Post about the court:

... the justices on today's Court have shown little inclination to avoid flexing their muscles on important political issues of the day. There are few stronger trends in the Supreme Court than judicial assertiveness. A Court that could decide a disputed presidential election in Bush v. Gore; unleash Citizens United on our electoral process; and repeatedly wade into presidential war powers can be expected to have no hesitancy deciding the fate of the Patient Protection and Affordable Care Act. So when the justices breezily ignored the plain language of the Anti-Injunction Act on Monday, it was predictable. The Court wants to decide all of the major issues in American politics, including this.

No matter what the ruling, expected this summer, there will be huge political fallout. It could hurt Obama if the Republicans can convince the country that he and the Democrats were pushing a socialist agenda. Or it could hurt the Republicans if the American people, now enjoying certain rights under the Affordable Care Act, lose them. Here's the New York Times on the politics, a Washington Post story on the third day of the Supreme Court hearing and here's a Q and A from the Post on what happens next.

Everything about the argument was outsized. It was, at two hours, twice the usual length. The questioning was, even by the standards of the garrulous current court, unusually intense and pointed. And the atmosphere in the courtroom, which is generally subdued, was electric.

Without the mandate, how will the rest of the health insurance law fare?

Former Times associate editor Gerard Matthews, now communications director for Arkansas Advocates for Children and Families, fills in for Max this week with a guest column on the coming two-year anniversary of President Obama signing the Affordable Care Act into law. The new protections that have gone into effect are having a marked impact on Arkansans' lives, he writes:

Children cannot be denied coverage because of a pre-existing condition. Young people can stay on their parents' health insurance plan until they are 26 years old. Preventive services, which will ultimately help control health care costs, have been added to some plans at no extra charge. Those are real changes — which can have a huge, positive impact on people's lives — that have nothing to do with petty attempts to pin a seemingly unpopular program to the president right before election time.

Take these things away, and folks are likely to notice. A lot of folks. According to the U.S. Department of Health and Human Services, the Affordable Care Act has had the following impact on Arkansans: 865,000 people who already had private insurance no longer have a lifetime limit on their health insurance plans; 439,000 people received added preventive services from their insurance companies without cost-sharing (that's including 110,000 children); 380,845 Medicare recipients have received preventive services; 23,837 young people have acquired health care coverage by staying on their parents' plans.

As part of his Arkansas Advocates for Children and Families gig, Matthews also put together the video interview above with a Clinton School student with a history of mental illness, who's able to attend the public service graduate program thanks to the Affordable Care Act stipulation that allows him to remain on his mother's health plan until he's 26.

This is one the Republican war room won't be retweeting. From Talking Points Memo:

In a development with potentially profound implications — both for Medicare itself and for the broader ideological fight between the two parties over the role of government — researchers writing in the New England Journal of Medicine believe that the growth in per patient Medicare costs has slowed, contra earlier projections that spending would soar at an unsustainable rate. More importantly, the researchers believe this trend will hold over time, thanks largely to the Affordable Care Act’s sweeping cost-control policies.

It’s not yet clear whether the trend will be permanent — one key reason cost growth has slowed has nothing to do with policy or innovation, but rather that the economy has been depressed for years. But the ACA expanded on provider payment savings policies from the 2000s and adopted a plethora of new measures, some of which are already proving successful at reducing spending. On top of that, U.S. medical cost growth, long having exceeded other areas of the economy, is currently at a five-decade low and more closely in line with GDP.

Hard to sell the Republican plan for privatization, with its sure increases for profits, against this record, TPM suggests.

I read about this over the weekend in the Austin newspaper and couldn't believe it.

The costs, of course, will be enormous in pain, undiagnosed illness and higher treatment costs for those problems that are missed, along with unintended pregnancies.

You'll remember that Sen. Jason Rapert made a brief bit of noise about money in Arkansas that goes to Planned Parenthood for family planning disease prevention, including condom distribution. (Also more here.) At the moment, the General Assembly isn't ready to have a vote on choosing women's health over hatred for an organization that serves women well. But this year's elections could very well be about exactly that proposition and family planning in general.

Nationally, the newest target is Title X, the main federal family planning program. All four Republican presidential candidates support eliminating Title X, which was created in 1970 with Republican support from President Nixon and the elder George Bush, then a congressman.

Like other federal financing, Title X does not pay for abortions. Only some of it covers birth control. Title X also provides money for cervical and breast cancer screening, testing for H.I.V. and other sexually transmitted diseases, adolescent abstinence counseling, infertility counseling and other services.

Planned Parenthood receives about a quarter of Title X’s $300 million budget and sees about a third of Title X patients. The remaining money goes to clinics, community health centers, hospitals and state agencies.

Mitt Romney’s fiscal plan proposes eliminating Title X because it “subsidizes family planning programs that benefit abortion groups like Planned Parenthood.”

Rick Santorum, in a recent debate, acknowledged, to boos, that in Congress he voted for appropriations bills that included Title X money. He pledged to rectify that if elected, saying, “I’ve always opposed Title X funding.”

President Obama supports Title X, which serves five million low-income people.

The war on contraception is neither a figment of the imagination nor a joking matter.

NOTE CORRECTION: Rapert targeted federal pass-through money on combatting sexual diseases, particularly to get at its use for condoms.

UPDATE FROM THE REPUBLICAN SEX POSSE WATCH: Utah has become the first state to pass law banning mention of birth control in sex education for either pregnancy or disease prevention and also bars mention of homosexuality. The only thing you can say about sex in Utah classrooms is NO. This, too, could easily represent Arkansas's future depending on 2012 elections.

• KEYNOTE: Former President Bill Clinton was among those speaking at the Arkansas Children's Hospital centennial observance.

Arkansas Children's Hospital, marking its 100th birthday today with an event including former President Bill Clinton among the speakers, said it had raised $100 million already toward a $160 milion goal to apply to pediatric care, research, education and prevention. The fund drive will run through 2014. The hospital said about 20 percent of the money raised so far came from "family" — board members, employees, physicians and faculty.

The money will partially fund the South Wing of the sprawling facility, one of the country's largest of its type. The South Wing is to open in July.

Gov. Mike Beebe was also among the speakers. No word just yet on whether discussions today included the perils facing the state in Medicaid funding and the pressures a static budget — not to mention a growing anti-tax legislative contingent — place on an institution like Children's. It receives a huge portion of its revenue from government insurance and other programs.

Here's an explainer on a current fight in the House by Republicans to kill a key part of the Obama health care reform legislation, a board aimed at curbing costs. The article explains why Republicans would fight cost containment. They favor a different approach — an end to a defined benefit, government health insurance plan for all under Medicare. They want privatization. As Talking Points Memo details, this could be a key fight before it's over in the battle to preserve Medicare as it's always been understood.

Arkansas's Republican congressmen will be backing a plan that keeps the business — and the costly profits — with private insurance companies and leaves those for whom a government voucher isn't enough s*** out of luck.