Contesting anticompetitive actions taken in the name of the state: state action immunity and health care markets

The so-called state action doctrine is a judicially created formula for resolving conflicts between federal antitrust policy and state policies that seem to authorize conduct that antitrust law would prohibit. Against the background of recent commentaries by the federal antitrust agencies, this article reviews the doctrine and discusses its application in the health care sector, focusing on the ability of states to immunize anticompetitive actions by state licensing and regulatory boards, hospital medical staffs, and public hospitals, as well as anticompetitive mergers and agreements. Although states are free, as sovereign governments, to restrict competition, the state action doctrine requires that "the state itself" make the decision to do so. Partly on the basis of problems in the political environment, the article criticizes courts for using a mere "foreseeability" test to decide whether a state legislature sufficiently authorized competitors to act in contravention of clear federal policy: "Few things are more foreseeable than that a trade or profession empowered to regulate itself will produce anticompetitive regulations."     

Growth rates of the blowfly, Lucilia sericata, on different body tissues

Estimates of post-mortem interval based on forensic analysis of the age of blowfly larvae on a corpse, are generated from standardised larval development curves. These are derived from studies of the growth of larvae reared, usually, on liver and at a range of temperatures. However, it is possible that the species or organ on which the larvae feed, might significantly alter the rate of growth. The present study therefore compared the development of the blowfly Lucilia sericata (Meigen) (Diptera: Calliphoridae) fed on lung, liver and heart, from both cows and pigs. Half of the tissue samples used were liquidised while half were not, to assess whether structural differences in the food source were important. Larvae grew significantly faster and gave rise to larger adults when reared on pig compared to cow tissue and when reared on lung and heart compared to liver. Larvae completed feeding and wandered from the food source 31h earlier and grew 2mm longer when reared on lung compared to liver. Tissue structure had no or little effect on development. For the forensic entomologist, these results highlight the importance of recording the position of larvae removed from a body and the care that should be used when extrapolating development rates from standard curves based on larvae fed on only a single medium, particularly where that is liver.     

Medication Errors in Family Practice, in Hospitals and After Discharge from the Hospital An Ethical Analysis

Thousands of medical errors are occurring daily in physician's offices, in hospitals, and even upon discharge from the hospital, leading to unnecessary injury and death and costing billions of dollars. We have a systems approach that has been proven to be tried and true in aviation, nuclear energy and many other industrial settings. Being honest when medical mistakes occur, reporting them to national clearing house, objectively searching for root causes, avoiding the fixing of arbitrary blame, and then, where possible, implementing safeguards to minimize the occurrence of future mistakes, is the best way to enhance patient safety. But until the medical establishment takes medical errors and patient safety more seriously, and until the general public rises up in protest, it is up to the state and federal governments to take the lead in protecting the lives of innocent Americans by creating a public policy.     

Suicide by intravenous injection of a veterinary euthanasia agent: report of a case and toxicologic studies

Previously reported cases of suicide by intravenous barbiturates, as well as two other unusual cases [5,6], are compared in Table 2. All decedents were either medical or paramedical personnel and familiar with the drugs and the routes of administration used for their suicides. Lethal is used in veterinary euthanasia at an intravenous dose of 1 ml per 5 kg (10 lbs) body weight. Unconsciousness usually occurs during injection and death supervenes within a matter of seconds. The decedent in the present case weighed 90 kg (200 lbs) and had injected at least 40 ml of the drug, approximately twice the recommended lethal dose. There appears to be little doubt of the victim's suicidal intent, since he had used Lethal in his daily occupational duties. Additionally, the physical configuration of the supports devised to hold the syringe was quite stable, and injection stopped only when the decedent's hand came to rest upon the towels. To our knowledge, the present case represents the only one of its kind in the literature.     

The specificity of electron impact mass spectroscopy for the identification of N-ethyl-1-phenylcyclohexylamine (PCE)

The electron impact mass spectrum of N-ethyl-1-phenylcyclohexylamine (PCE) was studied using both deuterium-labeled compounds and structurally related analogs. The deuterium-labeled compounds used were d2 . PCE with two deuterium atoms on the methylene carbon of the N-ethyl group, d3 . PCE with three deuterium atoms on the methyl carbon of the N-ethyl group, d4 . PCE with four deuterium atoms on the beta carbons of the cyclohexyl rings, and d5 . PCE with five deuterium atoms on the phenyl ring. Structurally related compounds used included the N,N-dimethyl, N-propyl, and cyclopentyl analogs. The identities of some major fragments and possible pathways leading to their formation are shown. Electron impact mass spectroscopy is shown to be a definitive test for the identification of PCE.