List of designated primary medical care health professional shortage areas (HPSAs); list of withdrawals from primary medical care HPSA designation--HHS. Notice

This notice provides two lists. The first is a list of all areas, population groups, or facilities designated as primary medical care health professional shortage areas (HPSAs) as of August 31, 1993. Second is a list of previously designated primary medical care HPSAs that have been found to no longer meet the HPSA criteria and therefore are being withdrawn from the HPSA list. HPSAs are designated or withdrawn by the Secretary of Health and Human Services (HHS) under the authority of section 332 of the Public Health Service Act.     

List of designated primary medical care health professional shortage areas (HPSAs); list of withdrawals from primary medical care HPSA designation--HRSA. Notice

This notice provides two lists. The first is a list of all areas, population groups, or facilities designated as primary medical care health professional shortage areas (HPSAs) as of June 30, 1992. Second is a list of previously-designated primary medical care HPSAs that have been found to no longer meet the HPSA criteria and therefore are being withdrawn from the HPSA list. HPSAs are designated or withdrawn by the Secretary of Health and Human Services (HHS) under the authority of section 332 of the Public Health Service Act.     

Lists of designated primary medical care, mental health, and dental health professional shortage areas--HRSA. Notice

This notice provides lists of all areas, population groups, and facilities designated as primary medical care, mental health, and dental health professional shortage areas (HPSAs) as of September 30, 1996. HPSAs are designated or withdrawn by the Secretary of Health and Human Services (HHS) under the authority of section 332 of the Public Health Service (PHS) Act.     

Lists of designated primary medical care, mental health, and dental health professional shortage areas--HRSA. Notice

This notice provides lists of all areas, population groups, and facilities designated as primary medical care, mental health, and dental health professional shortage areas (HPSAs) as of June 15, 1995. HPSAs are designated or withdrawn by the Secretary of Health and Human Services (HHS) under the authority of section 332 of the Public Health Service (PHS) Act.     

List of designated primary medical care, mental health, and dental health professional shortage areas--HRSA. Notice

This notice provides lists of all areas, population groups, and facilities designated as primary medical care, mental health, and dental health professional shortage areas (HPSAs) as of March 31, 1997. HPSAs are designated or withdrawn by the Secretary of Health and Human Services (HHS) under the authority of section 322 of the Public Health Service (PHS) Act.     

List of designated primary medical care health manpower shortage areas (HMSAs); list of withdrawals from primary medical care HMSA designation--PHS. Notice

This notice provides two lists. The first is a list of all areas, population groups, or facilities designated as primary medical care health manpower shortage areas (HMSAs) as of December 31, 1989. Second is a list of previously-designated primary medical care HMSAs that have been found to no longer meet the HMSA criteria and are therefore being withdrawn from the HMSA list. HMSAs are designated or withdrawn by the Secretary of Health and Human Services (HHS) under the authority of section 332 of the Public Health Service Act.     

Withdrawals from list of designated primary care health manpower shortage areas--HRSA

This notice provides a list of those areas that have been withdrawn from designation as having primary care health manpower shortages since the most recent list of all designated Health Manpower Shortage Areas ( HMSAs ) was published in the Federal Register on August 19, 1983 (48 FR 37822). Such areas are designated or withdrawn by the Secretary of Health and Human Services under the authority of section 332 of the Public Health Service Act. A forthcoming notice will list those HMSAs that remain designated or have been newly designated.     

Designation of medically underserved populations and health professional shortage areas--HRSA. Proposed rules

The rules proposed below would consolidate the processes for designating medically underserved populations (MUPs) and health professional shortage areas (HPSAs), designations that are used in several DHHS programs. The purpose is to improve the way underserved areas are designated by incorporating up-to-date measures of health status and access barriers and eliminating inconsistencies and duplication of effort. The intended effect is to reduce the effort and data burden on States and communities by simplifying and automating the design process as much as possible, while maximizing the use of technology. The proposed rules involve major changes to both the MUP and the primary care HPSA designation criteria, which have the effect of making primary care HPSAs a subset of the MUPs. No changes are proposed with respect to the criteria for designating dental and mental health HPSAs. Podiatric, vision care, pharmacy, and veterinary care HPSA designations would be abolished under the rules proposed below.     

List of primary care health manpower shortage areas designated under Section 332 of the Public Health Service Act

This notice provides a list, updated as of September 30, 1984, of primary care health manpower shortage areas designated by the Secretary of Health and Human Services under the authority of section 332 of the Public Health Service Act.     

List of primary care and dental health manpower shortage areas designated under section 332 of the Public Health Service Act

This notice provides a list, updated as of March 31, 1982, of primary care and dental health manpower shortage areas designated by the Secretary of Health and Human Services under the authority of section 332 of the Public Health Service Act. (At a later date, an update of the lists of psychiatric, vision care, podiatric, pharmacy, and veterinary health manpower shortage areas will be published).     

List of primary care, dental and psychiatric health manpower shortage areas designated under Section 332 of the Public Health Service Act

This notice provides a list, updated as of December 31, 1982, of primary care, dental, and psychiatric health manpower shortage areas designated by the Secretary of Health and Human Services under the authority of section 332 of the Public Health Service Act.     

Criteria for designation of mental health professional shortage areas--PHS. Final rule

This final rule amends the existing regulations governing the criteria for designation of health manpower shortage areas, or HMSAs (now health professional shortage areas, or HPSAs; name changed by Public Law 101-597, the National Health Service Corps Revitalization Amendments of 1990) under section 332 of the Public Health Service Act. Specifically, this amendment revises the existing criteria for designation of HMSAs having shortages of psychiatric manpower, transforming them into criteria for designation of HPSAs having shortages of mental health professionals, to take into account not only psychiatrists but also mental health service providers other than psychiatrists. The intended effect of this amendment is to more accurately assess the supply of mental health service providers when making shortage area determinations. This notice also summarizes the comments received by the Department on the Notice of Proposed Rulemaking published on August 8, 1989, which set forth the proposed methodology for making this and other changes to the HMSA criteria. It also formally changes "HMSA" to "HPSA" throughout the regulation, to conform with Public Law 101-597.     

Validation of main notions of flaws in medical care

The authors define the notions of defects in medical care (DMC) in accordance with the new Criminal Code and Regulations for Estimating Harm to Health (Order No. 407 of Ministry of Health of the Russian Federation of December 10, 1996). Definitions of DMC, flaws in organization, diagnosis, and treatment, etc., at the prehospital and hospital stage of medical care are defined. List of the main components of DMC and their causes is presented.     

Waiver of the two-year home country physical presence requirement for certain foreign medical graduates--INS. Interim rule with request for comments

This rule amends the Immigration and Naturalization Service (Service) regulations by allowing certain foreign medical graduates who entered the United States in J-1 status, or who acquired J-1 status after arrival in the United States, to obtain a waiver of the 2-year home country residence and physical presence requirement under section 212(e)(iii) of the Immigration and Nationality Act (Act) pursuant to a request by a State Department of Public Health, or its equivalent. The waiver is intended to permit these foreign medical graduates to work at a health care facility in an area designated by the Secretary, Health and Human Services (HHS), as having a shortage of health care professionals ("HHS-designated shortage area"). This interim rule also contains provisions which will permit these foreign medical graduates to change their nonimmigrant status in the United States from J-1 exchange visitor to H-1B specialty occupation worker.     

Psychiatric correlates of medical care costs among veterans receiving mental health care

Research on increased medical care costs associated with posttraumatic sequelae has focused on posttraumatic stress disorder (PTSD). However, the provisional diagnosis of Disorders of Extreme Stress Not Otherwise Specified (DESNOS) encompasses broader trauma-related difficulties and may be uniquely related to medical costs. We investigated whether DESNOS severity was associated with greater nonmental health medical care costs in veterans receiving mental health care. Participants were 106 men and 105 women receiving VA outpatient mental health treatment. A standardized interview assessed DESNOS severity. The dependent variables consisted of primary and specialty medical treatment costs. Sequential zero-inflated negative binomial regression was used to evaluate the variance in medical costs accounted for by DESNOS severity, controlling for PTSD severity and established predisposing, enabling, and need-based health care factors. Contrary to our hypothesis, in fully adjusted models, DESNOS severity independently added a significant amount of variance to lower specialty medical care costs, whereas PTSD did not consistently account for significant variance in medical care costs. Greater DESNOS severity appears to be associated with lower specialty medical care costs but not primary care costs. These findings may indicate that patients with DESNOS symptoms are at risk for being underreferred for specialty care.     

Hospital care and medical services in non-VA facilities--VA. Final rule and regulation

Department of Veterans Affairs (VA) is amending regulations which pertain to the authorization for contract non-VA hospital care and medical services for veterans. The Veterans Health Care Act of 1992 provides that veterans with a total disability permanent in nature from a service-connected disability may be authorized contract non-VA hospital care and medical services. Contract care may be authorized only if the VA facility is not capable of furnishing the care required, or is not capable of furnishing economical care or services because of geographical inaccessibility. This amendment will make the regulations consistent with the law.     

The standard of care and expert evidence of accepted practice in medical negligence

The topic of this article is the perennial issue in medical negligence litigation of various kinds of the extent to which it is a defence to a charge of lack of reasonable care that the defendant's conduct complied with accepted professional practice. Recent English interpretations of the controversial Bolam principle are considered, before the current approach of the courts and the Health and Disability Commissioner in New Zealand is described, using case illustrations. In New Zealand expert medical opinion of accepted practice is relevant to, but not conclusive of, the standard of care. There is, however, more freedom than pursuant to the current English approach for a decision-maker to reject expert opinion of accepted practice, because he or she is able to examine not just the logical defensibility of the practice but its overall reasonableness, including where the practice involved a risk assessment on a matter of clinical judgment. A decision to reject expert opinion of accepted practice is more readily made in areas which do not involve assessment, diagnosis and treatment.     

Establishment of criteria for determining priorities among designated health professional shortage areas--HRA. Notice

In accordance with the requirement of section 333A(c) of the Public Health Service Act, as amended by Public Law 101-597 (the National Health Service Corps Revitalization Amendments of 1990), this Notice establishes the criteria which the Secretary will use to make determinations under section 333A(a)(1)(A) of the health professional shortage areas (HPSAs) with the greatest shortages, using the exclusive factors specified in section 333A(b).     

Designation of medically underserved areas; list of final deletions--Health Resources and Services Administration. Notice

This notice is to advise all interested individuals and organizations, particularly Health Systems Agencies and State Health Planning and Development Agencies, of the final deletions from the list of areas that have been designated as medically underserved areas (MUAs). The final deletions result from analysis of comments received since the publication on October 28, 1981, in the Federal Register [46 FR 53320] of areas proposed for deletion.     

Retail medical clinics: increasing access to low cost medical care amongst a developing legal environment

Retail medical clinics are an innovation in health care with the potential to increase access to low-cost basic health care services while changing the delivery model for routine, non-urgent medical care. However, the few states that attempted to directly regulate retail medical clinics have been met with criticism by the FTC due to the proposed legislations' anticompetitive undertones. The relationship between retail medical clinics and the host stores or pharmacies that house them has the potential to spark fraud and abuse concerns. Retail medical clinics must abide by state-specific regulation on scope of practice of the various mid-level practitioners who work for the clinics, particularly to minimize exposure to litigation and keep within the clinics' intended purpose of a supplement to primary care physician offices. The author concludes that the consumer benefits of cost and convenience, combined with the potential for growth and expanded consumer base from a retailers' perspective, make the legal challenge inherent in running a retail medical clinic well worth the effort.