Special report on reimbursement. HCFA enacts new enforcement remedies covering nursing facilities

While the regulations are revolutionary in their use of "substantial compliance," the interpretation and application of HCFA's new remedial scheme are still uncertain, as states are given broad discretion in defining important terms and in applying and interpreting the criteria to select remedies. Further complicating the issue is the fact that some states, including California, intend to seek waivers from HCFA to substitute their own state enforcement systems for most, if not all, of the new federal system. Based upon these uncertainties, the enforcement of nursing facility standards will likely be in a state of flux for some time to come.     

Fatal decompression sickness following therapeutic hyperbaric environment (author's transl)

In Hannover/Germany in 1976 a so called "Society for Regenerative Hyperbaric Therapy" (Gesellschaft für Regenerative Uberdruck-Therapie) subjected 20 patients within two coupled multi-place chambers to a simulated hyperbaric environment, equivalent to a maximum of 4 ata, followed usually by gradual reductions of the pressure. The patients were of an average age of 67.2 years and were afflicted by various disorders. During one of the "dives" a patient developed air embolism of the central nervous system. During ensuing confusion of the chamber was opened suddenly, with resultant explosive reduction of the high pressure. This resulted in five letal accidents of decompression sickness. Post mortem examination revealed diffuse distribution of gas bubbles throughout the entire body. By elecronmicroscopy each bubble was covered by an osmiophilic coat. Post mortem findings are discussed and correlated with well-known and new clinical symptomes. These observations present for the first time fatal accidents of decompression sickness in humans, associated with hyperbaric air-therapy.     

Oral contraceptives and breach of warranty under the Uniform Commercial Code

This is a discussion of the issue as to whether a woman who either becomes pregnant while on pills or suffers side effects as a result of taking birth control pills has a breach of warranty cause of action under the Uniform Commercial Code. It is concluded that the woman has no cause for action against her doctor. In fact, it is unlikely that the woman will be able to support a claim of breach of warranty against anyone in the chain of supply, either the pharmaceutical company or the distributor. Previously decided cases offer no precedent as to when a breach of warranty can be found as a result of side effects produced by pills. Warnings which presently accompany oral contraceptives are insufficient. However, a woman claiming damages must prove that the side effects she suffered were directly caused from use of oral contraceptives. There is the assumption of risk issue, whether the woman assumes the risk by reading the information booklet and deciding to take the pills anyway. Revised warnings should certainly be included with pills.