Creating problems as part of the "solution": the JCAHO Sentinel Event Policy, legal issues, and patient safety

The recently reported number of patient deaths attributable to medical errors is staggering. In response to this crisis, the Joint Commission on Accreditation of Healthcare Organizations ("JCAHO") proposed its Sentinel Event Policy. The policy mandates self-reporting by hospitals accredited by the JCAHO. This Article argues that the JCAHO's policy shows an inattention to the legal realities of discovery and absence of immunity. Until the JCAHO addresses these issues, self-reporting will have limited success. This Article suggests that to promote patient safety, self-regulatory reports should go to a neutral, nonsanctioning third party, an approach adopted from aviation's highly successful reporting system.     

Child barbarity and torture: a case report

Penile strangulation with a strand of hair, acting as a tourniquet, and perforation of the eyes with a knife are uncommon accidental injuries in children. In such a situation, a mistreatment must be evoked. We present a case of barbarity and torture involving a young boy 3 years old. He was a victim of penis strangulation and perforation of the eyes, performed on previous surgical and infectious lesions. The mistreatment was performed by his mother's boyfriend. The perpetrator used the previous lesions to hide his misdeed. This amazing case of mistreatment points out the violence of the wounds and their being performed on previous lesions.     

The role of competition in health care: a Western European perspective

The Federal Trade Commission and Department of Justice 2004 report Improving Health Care: A Dose of Competition expresses a clear allegiance to competition as the organizing principle for health care. In Europe, by contrast, the key organizing principle of health care systems is solidarity. Solidarity means that all have access to health care based on medical needs, regardless of ability to pay. This is not to say that competition is not important in Europe, but competition must take place within the context of solidarity. This article critiques the report from a European perspective, describes the role of competition in Europe (focusing in particular on European Union law), and suggests that the United States could learn from the European perspective.     

Out on the town: an evaluation of brief motivational interventions to address the risks associated with problematic alcohol use

Alcohol has long been identified as a significant contributory factor in crime and anti social behaviour, yet there is a dearth of effective treatment available for those individuals whose drinking contributes significantly to their criminality, and subsequently the health risks and the economic and wider social implications associated with it. The literature on treatment programmes is drawn almost exclusively from medical experience but indicates that brief interventions are at least as effective as more intensive programmes in reducing alcohol consumption in at-risk groups. This research was undertaken to evaluate projects based in the West Midlands, United Kingdom, providing brief motivational interventions to offenders arrested for offences where alcohol is identified as a significant contributory factor. The evaluation indicates that an arrest referral scheme as developed in the West Midlands can achieve good levels of identification and referral, acceptable attendance, retention rates, and effective outcomes in terms of attitude and behaviour change.     

DNA evidence in rape cases and the Debbie Smith Act: forensic practice and criminal justice implications

The Debbie Smith or "Justice for All" Act was passed on November 1, 2004. The act addresses the problem of collecting and analyzing DNA evidence from backlogged rape kits sitting in crime laboratories around the country. Presently, no empirical data exist by which to assess the soundness of the legislation. However, the act clearly affects discrete operations within the forensic and criminal justice systems. This article explores the relative merits of the Debbie Smith law, highlighting changes in Sexual Assault Nurse Examiner (SANE) programs, law enforcement, court administration, correctional treatment, and juvenile justice practices. Concerns linked to the likely impact of the "Justice for All" Act raise significant questions about its overall programmatic utility and treatment efficacy.     

U.S. policy on health inequities: the interplay of politics and research

What is the relationship between scientific research and government action in addressing health inequalities in the United States? What factors increase the impact of scientific research on public policy? To answer these questions, we focus on racial and ethnic disparities in health status and health care in the United States. We first review the history of the disparities issue to elucidate how the continual and persistent interplay between political action and scientific research drives government policy. We then analyze two recent government-sponsored reports about racial and ethnic disparities to understand the strategic consequences of issue framing. We draw lessons about how disparities research can have a greater impact on public policy.     

Reframing the racial disparities issue for state governments

Although racial and ethnic disparities in health have been on the federal government's agenda since 1985, no policy reforms have significantly reduced disparities. The question arises whether states can effectively address this issue without waiting for solutions from the national government. The purpose of this article is to propose ways of reframing the disparities issue that might give state policy makers more leverage and might strengthen political will to address the issue. I suggest a moral frame based on a concept of distributive justice in which medical care must be distributed according to need. I explain the rationales for such a frame and consider its strategic advantages and disadvantages. In the last section, I suggest some policies based on this framing that are within the power of state legislatures.     

Computerized craniofacial reconstruction using CT-derived implicit surface representations

In forensic craniofacial reconstruction, facial features of an unknown individual are estimated from an unidentified skull, based on a mixture of experimentally obtained guidelines on the relationship between soft tissues and the underlying skeleton. In this paper, we investigate the possibility of using full 3D cross-sectional CT images for establishing a reference database of densely sampled distances between the external surfaces of the skull and head for automated craniofacial reconstruction. For each CT image in the reference database, the hard tissue (skull) and soft tissue (head) volumes are automatically segmented and transformed into signed distance transform (sDT) images, representing for each voxel in this image the Euclidean distance to the closest point on the skull and head surface, respectively, distances being positive (negative) for voxels inside (outside) the skull/head. Multiple craniofacial reconstructions are obtained by first warping each reference skull sDT maps to the target skull sDT using a B-spline based free form deformation algorithm and subsequently applying these warps to the reference head sDT maps. A single reconstruction of the target head surface is defined as the zero level set of the arithmetic average of all warped reference head sDT maps, but other reconstructions are possible, biasing the result to subject specific attributes (age, BMI, gender). Both qualitative and quantitative tests (measuring the similarity between the 3D reconstructed and corresponding original head surface) on a small (N = 20) database are presented to proof the validity of the concept.