Tag: 2022 News

The study, “A Systematic Review of Long-term Clinical and Radiological Outcomes of Arthroscopic and Open/Mini-open Rotator Cuff Repairs,” was published online on February 18, 2022 in The American Journal of Sports Medicine.

In a comparison of long-term outcomes of arthroscopic and open/mini-open rotator cuff repair, a new study shows that both techniques lead to similar long-term outcomes.

“Arthroscopic rotator cuff repair has shown similar midterm functional results and retear rates as open/mini-open rotator cuff repair. A pooled analysis of long-term results of both techniques is yet missing,” the researchers wrote.

The team conducted a systematic review using the CENTRAL (Cochrane), MEDLINE (PubMed), and Embase databases. All studies that reported long-term clinical and radiographic outcomes of full-thickness arthroscopic rotator cuff repair and open/mini-open rotator cuff repair with a minimum follow-up of nine years were included.

Overall, 11 studies met the inclusion criteria: 5 studies on arthroscopic rotator cuff repair and 6 studies on open/mini-open rotator cuff repair. Five hundred and thirty-nine patients with 550 shoulders were analyzed in the review. Mean patient age was 56.3 years (range, 25-77).

The researchers reported that the mean preoperative absolute Constant Score and American Shoulder and Elbow Surgeons (ASES) shoulder score were significant improved postoperatively.

The retear rate was 41% (141 of 342 shoulders) without any between-group difference (arthroscopic Rotator Cuff Repair, 43%; open/mini-open rotator cuff repair, 39%; p = .364). A retear was associated with reduced absolute Constant Score as compared with a healed repair (p = .004).

“No significant differences were found in postoperative functional scores, complications, and retear rates after failed cuff repairs between the arthroscopic and open/mini-open repair groups,” the researchers wrote.

“Pooled analysis of arthroscopic and open rotator cuff repairs demonstrated sustained improvement in long-term shoulder scores and pain with a substantial retear rate in both groups, which was associated with inferior shoulder function. There were no significant differences in long-term functional outcomes, retear rates, and complications. Both surgical techniques may be used on the basis of factors such as patient or surgeon preference and cost. Further studies using a more robust randomized controlled trial or larger cohort design are recommended to ascertain whether one surgical repair technique is superior to the other.”

The San Diego Union Tribune reports that the American College of Surgeons has named Scripps Memorial Hospital La Jolla San Diego’s fourth Level 1 trauma center, formally recognizing the medical center’s efforts around medical education and research.

According to college guidelines, a top-tier rating is reserved for those facilities that can prove they admit at least 1,200 trauma patients per year, at least 240 of which have high injury severity scores as those numbers are “the minimum volume that is believed to be adequate to support the education and research requirements of a Level 1 trauma center.”

During site visits that include reviewing patient charts and other documents, inspectors verify a wide range of factors, including that centers train surgical residents, conduct education and other outreach activities for their communities and participate in ongoing research.

In terms of the range of treatment capabilities they offer, Level 1 and Level 2 centers are identical. Both are required to provide “total care for every aspect of injury, from prevention through rehabilitation.” Some services, such as the reattachment of severed extremities, might only be found at Level 1.

Each must prove through regular inspections that they staff a 24/7 trauma team, including the presence of an attending surgeon round the clock. Both levels must demonstrate that their trauma teams can be fully activated in no more than 15 minutes for the most severe cases that include patients with respiratory difficulties and injuries ranging from penetrating wounds and skull fractures to amputations and “crushed or mangled” extremities.

Scripps La Jolla began working toward Level 1 designation in 2018, hiring Dr. Walter Biffl, previously at Queen’s Medical Center in Honolulu, to serve as its trauma medical director.

Biffl oversaw the gradual introduction of medical residents from Navy Medical Center San Diego. The Navy already had an existing relationship with Scripps Mercy Hospital in Hillcrest, previously the health system’s lone Level 1 center. Already known for trauma research before coming to San Diego, Biffl has worked to expand La Jolla’s scholarly activity.

San Diego County’s trauma system, one of the first and most developed in the nation, assigns specific territories called “catchment areas” to each adult trauma center, with Scripps La Jolla receiving all severe traumatic injuries from the northern shore of Mission Bay north all the way to the Orange County Border.

Palomar Medical Center Escondido, a Level 2 facility, handles cases throughout non-coastal North County east to the Imperial County border with Sharp Memorial Hospital, also Level 2, receiving cases in a wide swath that generally follows Interstate 8. Scripps Mercy and UC San Diego Medical Center, both Level 1, split responsibility for cases from downtown San Diego and Hillcrest south to the border. Rady Children’s Hospital in San Diego, also Level 1, handles all pediatric trauma cases countywide.

Drugmaker Johnson & Johnson and three major distributors finalized nationwide settlements over their role in the opioid addiction crisis Friday, an announcement that clears the way for $26 billion to flow to nearly every state and local government in the U.S.

According to the story published by Fox Business, taken together, the settlements are the largest to date among the many opioid-related cases that have been playing out across the country. They’re expected to provide a significant boost to efforts aimed at reversing the crisis in places that have been devastated by it, including many parts of rural America.

Friday was the deadline for the companies to announce whether they felt enough governments had committed to participate in the settlement and relinquish the right to sue. The four companies notified lawyers for the governments in the case that their thresholds were met.

While none of the settlement money will go directly to victims of opioid addiction or their survivors, the vast majority of it is required to be used to deal with the epidemic. The requirement that most of the money be used to address the opioid crisis contrasts with a series of public health settlements in the 1990s with tobacco companies. In those cases, states used big chunks of the settlement money to fill budget gaps and fund other priorities.

The amount sent to each state under the opioid settlement depends on a formula that takes into account the severity of the crisis and the population. County and local governments also get shares of the money. A handful of states – Alabama, New Hampshire, Oklahoma, Washington and West Virginia – have not joined all or part of the settlement, mostly because they have their own deals or are preparing for trial.

Other companies, including business consultant McKinsey and drugmakers Endo, Mallinckrodt and Teva, have reached national settlements or a series of local ones. OxyContin maker Purdue Pharma and a group of states are in mediation through U.S. Bankruptcy Court to try to reach a nationwide settlement.

California Gov. Gavin Newsom’s proposed budget calls for using $50 million of the state’s expected $86 million share this year for youth opioid education and to train treatment providers, improve data collection and distribute naloxone, a drug that reverses overdoses.

In Florida’s Broward County, home to Fort Lauderdale, the number of beds in a county-run detoxification facility could be expanded from 50 to 70 or 75, said Danielle Wang French, a lawyer for the county. “It’s not enough, but it’s a good start,” she said of the settlement.

With fatal overdoses continuing to rage across the U.S., largely because of the spread of fentanyl and other illicitly produced synthetic opioids, public health experts are urging governments to use the money to ensure access to drug treatment for people with addictions. They also emphasize the need to fund programs that are proven to work, collect data on their efforts and launch prevention efforts aimed at young people, all while focusing on racial equity.

“It shouldn’t be: ready, set spend,” said Joshua Sharfstein, a former secretary of the Maryland Department of Health who is now a vice dean of public health at Johns Hopkins University. “It should be: think, strategize, spend.”

In a separate deal that also is included in the $26 billion, the four companies reached a $590 million settlement with the nation’s federally recognized Native American tribes. About $2 billion is being set aside for fees and expenses for the lawyers who have spent years working on the case.

The companies are not admitting wrongdoing and are continuing to defend themselves against claims that they helped cause the opioid crisis that were brought by entities that are not involved in the settlements.

JPMorgan Chase has sued the state of California on Thursday for $5.9 million in legal fees, resulting from the bank’s intervention to save the state from a dubious purchase of N95 face masks early in the Covid-19 pandemic.

According to the report in Courthouse News, the suit, filed in a Sacramento state court, claims the bank was involved in litigation by the medical supply company purportedly selling the face masks to California, after JPMorgan Chase raised concerns about the more than $456 million transaction.

JPMorgan Chase seeks to recover the legal fees generated defending itself from the medical supplier’s lawsuit.

According to the allegations of the complaint, John Thomas introduced himself to high- level California officials, including the State Controller, and said that his company, Blue Flame Medical LLC, could deliver 100,000,000 N95 masks.Over the next few days, the State Controller’s Office (SCO), the Governor’s Office of Emergency Services (OES), and California Department of General Services (DGS) corresponded with Blue Flame about a potential transaction.

DGS prepared a purchase order for 100,000,000 N95 masks, and Blue Flame prepared an invoice. The total purchase price was $609,161,000 and 75% prepayment was required. It then tried to issue a $456,888,600 wire (constituting approximately 75% prepayment) to Blue Flame on March 25.

During its “diligence in reviewing the transaction,” the bank alerted the state to concerns stemming from its internal investigation of the wire transfer. The complaint claims that JPMorgan Chase learned from Blue Flame’s bank that “Blue Flame’s account was new, that the account had been opened by a political lobbyist and that the size of the wire was unusual for this client.”

Made aware of the concerns about Blue Flame, California reversed course on the wire transfer. JPMorgan Chase claims the funds were returned to the state the same day the wire was initially approved.

The complaint cites multiple statements from the involved state officials at a California Assembly oversight hearing in May 2020 in which they credited JPMorgan Chase for helping retrieve the funds and alerting them to some of the concerns regarding Blue Flame.

In September 2021, a federal judge in Virginia granted summary judgment to Blue Flame’s bank, compelling JPMorgan Chase to indemnify the bank for their losses in the transaction between Blue Flame and California. JPMorgan Chase settled with the bank, agreeing to pay $5.9 million in attorneys’ fees and expenses.

It now seeks to recover that sum from the State of California after the state declined to reimburse the bank.

Blue Flame has faced multiple probes into its financial dealings, including allegations that it failed to deliver products to state governments who purchased masks and other personal protective equipment. These include a criminal inquiry by the U.S. Department of Justice and a congressional committee investigation.

On February 7, 2018, Steven Brow, sustained industrial injury to his left thumb while employed as a machinist by Sepragen Corporation, insured by The Hartford.

Mr. Brow’s case-in-chief was never the subject of a Stipulated Award or Compromise and Release, and the case was administratively closed by The Hartford.

Medical treatment and a surgery was provided by the United States Department of Veterans Affairs. The hearing was initiated by the V.A. for reimbursement of treatment provided for the injured employee’s left thumb injury, including for an outpatient nerve repair procedure.

The defendant partially reimbursed the V.A., the V.A. claimed additional reimbursement.

The WCJ found that an extensive body of federal or state case law, and statutory law, supports preemption of Labor Code section 5307.1 and the California Official Medical Fee Schedule (OMFS) with respect to the V.A.’s billings. And that section 5307.1 and the OMFS are preempted by federal law, and that the applicable federal billing schedules, and not the OMFS, apply to the V.A.’s billings in this case.

The Hartford petition for reconsideration of the Findings, Award and Order. Reconsideration was denied in the panel decision of Brow v. Sepragen Corporation (Feb 2022 – ADJ12210104).

Defendant contends, in substance, that there is nothing to trigger federal preemption of state law because there is no conflict between state and federal law, which both hold that a standard of reasonableness applies to the medical treatment charges incurred by the V.A.

The panel noted that “although defendant states it does not contend that the California OMFS applies to the V.A.’s billings for medical treatment, defendant nevertheless contends that the V.A.’s billings are subject to a standard of reasonableness under California state law.” ….”As such, defendant’s contention indirectly attacks part of the WCJ’s seventh Finding, wherein the WCJ found that ‘applicable federal billing schedules’ apply to the V.A.’s billings in this case.”

The WCJ stated on page five of his Opinion on Decision that federal law expressly preempts state law on the question of the extent of the V.A.’s entitlement to reasonable reimbursement. That is, there are various kinds of preemption, but here defendant erroneously relies upon conflict preemption, which is not on point given the facts of this case. (See People v. Hamilton (2018) 30 Cal.App.5th 673 [The four species of preemption include express, conflict, obstacle, and field preemption].)

The V.A. still has the burden of establishing the reasonableness of its charges in accordance with the billing applicable to V.A. cases, as well as establishing all other applicable elements justifying the payment sought.

In conclusion the panel “affirm[ed] the WCJ’s finding that the V.A.’s medical treatment charges are not governed by California state law, but rather are subject to the ‘applicable federal billing schedules.’ ”