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In Memoriam
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Last 50 News Postings

 (Click on title to be directed to posting, most recent listed first)

Pulmonary Disease Linked to Vaping
CEO Compensation-One Reason Healthcare Costs So Much
Doctor or Money Shortage in California?
FDA Commissioner Gottlieb Resigns
Physicians Generate an Average $2.4 Million a Year Per Hospital
Drug Prices Continue to Rise
New Center for Physician Rights
CMS Decreases Clinic Visit Payments to Hospital-Employed Physicians
   and Expands Decreases in Drug Payments 340B Cuts
Big Pharma Gives Millions to Congress
Gilbert Hospital and Florence Hospital at Anthem Closed
CMS’ Star Ratings Miscalculated
VA Announces Aggressive New Approach to Produce Rapid Improvements
   in VA Medical Centers
Healthcare Payments Under the Budget Deal: Mostly Good News
   for Physicians
Hospitals Plan to Start Their Own Generic Drug Company
Flu Season and Trehalose
MedPAC Votes to Scrap MIPS
CMS Announces New Payment Model
Varenicline (Chantix®) Associated with Increased Cardiovascular Events
Tax Cuts Could Threaten Physicians
Trump Nominates Former Pharmaceutical Executive as HHS Secretary
Arizona Averages Over 25 Opioid Overdoses Per Day
Maryvale Hospital to Close
California Enacts Drug Pricing Transparency Bill
Senate Health Bill Lacks 50 Votes Needed to Proceed
Medi-Cal Blamed for Poor Care in Lawsuit
Senate Republican Leadership Releases Revised ACA Repeal and Replace Bill
Mortality Rate Will Likely Increase Under Senate Healthcare Bill
University of Arizona-Phoenix Receives Full Accreditation
Limited Choice of Obamacare Insurers in Some Parts of the Southwest
Gottlieb, the FDA and Dumbing Down Medicine
Salary Surveys Report Declines in Pulmonologist, Allergist and Nurse 
CDC Releases Ventilator-Associated Events Criteria
Medicare Bundled Payment Initiative Did Not Reduce COPD Readmissions
Younger Smokers Continue to Smoke as Adults: Implications for Raising the
   Smoking Age to 21
Most Drug Overdose Deaths from Nonprescription Opioids
Lawsuits Allege Price Fixing by Generic Drug Makers
Knox Named Phoenix Associate Dean of Faculty Affairs
Rating the VA Hospitals
Garcia Resigns as Arizona University VP
Combination Influenza Therapy with Clarithromycin-Naproxen-Oseltamivir
   Superior to Oseltamivir Alone
VAP Rates Unchanged
ABIM Overhauling MOC
Substitution of Assistants for Nurses Increases Mortality, Decreases Quality
CMS Releases Data on Drug Spending
Trump Proposes Initial Healthcare Agenda
Election Results of Southwest Ballot Measures Affecting Healthcare
Southwest Ballot Measures Affecting Healthcare
ACGME Proposes Dropping the 16 Hour Resident Shift Limit


For an excel file with complete news listings click here.

A report from Heartwire described a letter written by Peter Wilmshurst to the AHA asking for full disclosure of conflicts of interest in the MIST trial. Wilmshurst was portrayed in SWJPCC on April 27, 2012 in our Profiles of Medical Courage series. We felt the report of the letter might be of interest to the readership of SWJPCC but there was no good section to pass along the Heartwire article. For this reason, a new Section entitled “News” has been started to report developments outside the usual medical journal purview or from other sources which might interest our readers. We encourage bringing news-worthy articles to our attention and would welcome submission of written reports of such articles.



Bipartisan Proposal Calls for SGR Repeal

The Washington Post (11/1, Carey) reports a bipartisan group of legislators has agreed on a framework replacing the “problematic” Medicare payment formula in an attempt to end the annual Sustainable Growth Rate (SGR) or “doc fix” debate. The current system is set to reduce Medicare physician payments by approximately 25% on Jan. 1 without Congressional intervention. Senate Finance Committee Chairman Max Baucus (D-MT) and House Ways and Means Committee Chairman Dave Camp (R-MI) introduced a draft proposal that would “encourage care management services for individuals with complex chronic care needs through the development of new payment codes for such services, as well as leverage physician-developed standard of care guidelines to avoid the unnecessary provision of services”. The Committees value your feedback on this proposal. Please submit written comments to the Finance SGR comments mailbox at and the Ways & Means SGR comments mailbox at by Tuesday, November 12, 2013.

Dr. John Noseworthy, Mayo Clinic president and CEO, said in a press release he was pleased to see a bipartisan effort to replace the outdated SGR. The release went on to say that the Mayo Clinic will the initiatives and respond to Congress’ request to provide further comments.

Richard A. Robbins MD

Reference as: Robbins RA. Bipartisan proposal calls for SGR repeal. Southwest J Pulm Crit Care. 2013;7(5):278. doi: PDF


Helman Defends Decision to Pull VA Sponsorship of Veterans Day Parade

Sharon Helman, Phoenix VA Director, defended her decision to cancel VA sponsorship of the annual Phoenix Veterans Day Parade in a 4/10/13 email to VA employees. Helman said that VA sponsorship was cancelled because of “…priorities in the organization (specifically access), and heightened awareness over liability concerns which VA Legal Counsel brought forward”. She concluded her letter by warning “… that all media inquiries should be forwarded to Paul Coupaud, Acting Public Affairs Officer”.

VA officials initially said fear of litigation prompted the review of VA support. Last year, a float carrying wounded Veterans in a Midland, Texas, parade collided with a freight train, killing four and injuring 17. Crash victims and their families filed lawsuits in Texas against Union Pacific Railroad and the float owner. The VA was not a defendant, and the VA has not issued any national directives on liability as a result of the tragedy.

In past years, the VA did not contribute cash for the parade. Instead, it served as lead sponsor by providing staging areas at its medical center and allowing Paula Pedene, the former Director of Public Relations at the Phoenix VA, to serve as coordinator. It also provided other support and hosted award events, an essay contest and banquets. Pedene was demoted in the wake of her testimony to the VA Office of Inspector General against former VA administrators. Pedene testified that the Phoenix VA suffered from leadership run amok. She said that agency bosses intimidated employees and created a hostile workplace.

Phoenix VA employees had provided volunteer support on their own time for the Phoenix Veterans Day Parade. No mention has been made of clinical VA employees who participated in parade activities during regular working hours instead of providing care. It is difficult to understand how cancelling sponsorship of the Phoenix Veterans Day Parade will provide increased access to healthcare for Veterans. However, wasting clinical staff time with lengthy and extraneous emails such as the one sent out 4/10/13 or Ms. Helman’s equally lengthy and extraneous weekly e-mails to employees will compromise access. As Helman said in her letter the VA must focus on “bringing additional staff on board” to care for the 81,000 Veterans enrolled at the Phoenix VA. If true, the alleged pattern of abuse, discrimination and retaliation at the Phoenix VA will jeopardize the hiring and retention of the necessary clinical staff to provide Phoenix Veterans access to quality healthcare.

Richard A. Robbins, MD*

*Dr. Robbins was the chief of pulmonary and critical care at the Phoenix VA from 2003-11.

Reference as: Robbins RA. Helman defends decision to pull VA sponsorship of Veterans day parade. Southwest J Pulm Crit Care. 2013;6(4):180. PDF


In Aftermath of Financial Investigation Phoenix VA Employee Demoted after Her Testimony

A previous Southwest Journal of Pulmonary and Critical Care Journal editorial commented on fiscal mismanagement at the Department of Veterans Affairs (VA) Medical Center in Phoenix (1). Now Paula Pedene, the former Phoenix VA public affairs officer, claims she was demoted for testimony she gave to the VA Inspector General’s Office (OIG) regarding that investigation (2). In 2011, the OIG investigated the Phoenix VA for excess spending on private care of patients (3). The report blamed systemic failures for controls so weak that $56 million in medical fees were paid during 2010 without adequate review. The report particularly focused on one clinician assigned by the Chief of Staff to review hundreds of requests per week and the intensive care unit physicians for transferring patients to chronic ventilator units (1,3). After the investigation, the director and one of the associate directors left the VA and the chief of staff was promoted to chief medical officer in one of the VA’s networks. The other associate director was appointed as director of another VA medical center in 2010 before the investigation.

According to the Arizona Republic, Pedene was interviewed in May 2011 by the OIG to probe the misspending along with allegations of sexual harassment and a hostile workplace (2). Pedene testified that the Phoenix VA suffered from “leadership run amok” (2). She said that agency bosses intimidated employees and that then-Director Gabriel Perez threatened her with banishment to a basement workspace, making it clear he did not want a woman — or someone with a service-connected disability — as the VA’s public-affairs officer. The OIG report makes no mention of intimidation, sexual harassment or a hostile workplace in their report (3).

Pedene, the Veterans Day Parade coordinator since 1997, was accused of having her husband take photographs of the Veterans Day Parade. Pedene, who is blind, then allowed her husband to upload the photos onto the VA website using her password (2). Pedene’s legal advisers and VA records indicate the dispute stems from a larger controversy involving years of mismanagement, squandered funds, discrimination, sexual harassment and retaliation at the Phoenix VA. Pedene was notified of her transfer in a Dec. 10 letter from Associate Director Lance Robinson. He wrote that she was the subject of a “very serious” allegation, and he issued a gag order prohibiting public disclosures.  

Former Maricopa County Attorney Rick Romley, who chairs the parade-sponsoring Veterans Commemorative Committee of Phoenix, said he authorized Pedene to hire her husband as a photographer and cannot understand VA administrators’ response to a seemingly minor transgression  (2). “Quite frankly, this is peanuts in the security world,” said Romley, who in 2006 served as special security adviser to the secretary of Veterans Affairs in Washington (2).

Pedene had been called as a witness in the case. The investigation was initiated after complaints by employee Sheila Cain, who in 2010 was assistant chief of the Phoenix VA’s Health Administration Services. Cain had sought to repair problems with the Phoenix VA’s budget and fee-payment systems. According to VA reports, her efforts led to infighting over blame and responsibility. Cain filed a series of grievances alleging that she was subjected to false accusations, denied due process, stripped of authority and isolated in a basement workspace for six months. Cain endured sexual remarks, threats, improper touching, public humiliation and other abuse more than 30 times. In one instance, she alleged that Dr. Christopher Bacorn, then Phoenix VA Associate Director, hit her rear end with a spatula in front of a fellow employee (2).

Documents obtained independently by the Arizona Republic show Cain also was victimized by unlawful access to her medical records (2). An investigation of that patient-confidentiality breach resulted in the discipline of at least nine employees of the health system, some of whom left the VA. Cain remains with the VA but not under the supervision of Phoenix administrators. In the meantime, Pedene became a target of similar treatment under new bosses. Her reassignment to the hospital library, initially set at 30 days, is in its third month.

Employee-relations consultant, Roger French, who at one time represented Pedene and has represented about 40 VA employees in grievances, said he has seen a pattern of abuse, discrimination and retaliation in the Phoenix VA (2). He said Pedene was criticized for her blindness, and administrators dismantled a public-relations program once considered among the nation’s best. Recently, he added, Pedene’s name was redacted from the VA’s online employee directory, and her awards were removed from a display case at the Phoenix VA. “She stood up and told the truth,” French said. “It cost (administrators) their jobs, and they threatened to destroy adversaries and families.”

French has asked Department of Veterans Affairs Secretary Eric Shinseki to launch a new inquiry. French’s Feb. 12 letter accuses the present Phoenix VA administration of nepotism, retaliation and improper downgrading of evaluations. “I have never seen the hostility, cavalier violations of regulations and laws (or) lack of dignity and respect for employees,” French wrote to Shinseki. Shinseki did not respond, French said.

Unfortunately, if Shinseki does act, it will likely be through another investigation by the OIG which inadequately investigated the previous allegations of mismanagement (1). Instead of focusing on the administrators responsible for budget control, the OIG attempted to place the blame on clinicians acting in the best interests of the patients (1). Furthermore, if the Arizona Republic report is correct, the OIG ignored accusations of sexual harassment and a hostile workplace made at the time of their original investigation. If French’s accusations regarding the present Phoenix VA administration are true, a whitewashing with resignation of some and promotion of other present Phoenix VA administrators is likely to result, as it did in the original investigation (1).

Richard A. Robbins, MD*


  1. Robbins RA. Mismanagement at the VA: where's the problem? Southwest J Pulm Crit Care 2011;3:151-3.
  2. Wagner D. VA official in Arizona demoted after her testimony. Arizona Republic. Available at accessed 3/29/13.
  3. (accessed 3/29/13).


*Dr. Robbins was the Chief of Pulmonary and Critical Care at the Phoenix VA from 2003-11.

Reference as: Robbins RA. In aftermath of financial investigation Phoenix VA employee demoted after her testimony. Southwest J Pulm Crit Care. 2013;6(3):151-3. PDF


ATS Joins other Groups in Opposing 2% Medicare Cut

The American Thoracic Society and 124 other medical societies urged lawmakers in a letter yesterday to spare physicians a 2% reduction in Medicare payments.  The cut, mandated by Medicare's sustainable growth rate formula, will affect physicians, hospitals, and other providers, but leave enrollee benefits untouched. It is scheduled to take effect January 1, 2013, unless Congress acts to nullify it. This was discussed by Rep. Schweikert ( during the August 8 Arizona Thoracic Society meeting.

Also released yesterday is a study commissioned by the American Hospital Association estimating that the 2% cut would cost 496,000 jobs in the next year including 9,863 jobs in Arizona and 3,349 in Mexico. This reduction would swell to 766,000 fewer jobs by 2021 including 15,234 in Arizona and 5,173 jobs in New Mexico. The report, produced by Tripp Umbach, a firm specializing in conducting economic impact studies, measures the anticipated effect of these cuts in Medicare payments on health care providers and other industries. Approximately 43% of those lost jobs would reflect the direct effects of sequestration on the healthcare industry. The remaining job losses would stem from indirect and "induced" effects as healthcare organizations reduce their purchases of goods and services from other industries.

Richard A. Robbins, MD

Editor, SWJPCC

Reference as: Robbins RA. ATS joins other groups in opposing 2% medicare cut. Southwest J Pulm Crit Care 2012;5:143. PDF


Wilmshurst Asks AHA and Circulation for Full Disclosure

Dr Peter Wilmshurst alleges in a letter forwarded to Heartwire that the American Heart Association (AHA) and the editors of its journal Circulation have failed to properly disclose conflicts of interest of some of the authors of the infamous Migraine Intervention with STARflex Technology (MIST) trial of the patent foramen ovale (PFO) closure device (1). Wilmshurst was portrayed in SWJPCC on April 27, 2012 in our Profiles of Medical Courage series (2). NMT, the now-defunct company, tried to sue Wilmshurst for alleging that NMT pushed him out of his role as investigator, manipulated some of the data to make the device's performance look better than it really was, and hid the company's relationships to some of the study's authors. Wilmshurst maintains that Circulation, which published the MIST results in 2008 (3), still must acknowledge that NMT employees and investors helped to write the paper and that none of the investigators were allowed full access to all of the MIST data.

Heartwire reports that in a letter to AHA president, Dr Gordon Tomaselli, Wilmshurst alleges "I am concerned that readers of Circulation are deceived into believing that reliance can be placed on what you publish because the American Heart Association and Circulation have rules about ethical publication that you follow….In fact, the events around the correction of the MIST trial paper show that you knowingly break your own rules, giving doctors and patients a false impression of the integrity of the research you publish, when, for example, your organization has colluded in concealment of conflicts of interest.”

Contacted by Heartwire, Tomaselli redirected the request to the AHA press office, which responded: "The American Heart Association categorically rejects Dr Wilmshurst's allegation that the association or Circulation colluded to conceal conflicts of interest.  The association believes it acted appropriately by publishing a detailed correction (published September 1, 2009) to the article on the MIST trial results (published March 3, 2008). The AHA is a publisher of peer-reviewed science, not an investigative body.  We followed our procedure of forwarding Dr Wilmshurst's allegations to the institutions of the involved authors asking them to conduct investigations. We have remained willing to consider any new relevant substantiated information about the situation and to cooperate with any investigating body.  AHA did respond to questions from the General Medical Council of UK in March and April 2011."

Contacted earlier this year on this same issue, the AHA had told Heartwire, "We consider the matter closed from the perspective of AHA's responsibility, but we would cooperate in providing our nonprivileged information if an investigation is undertaken by a university, government entity, or professional society."


  2. Robbins RA. Profiles in medical courage: Peter Wilmshurst, the physician fugitive. Southwest J Pulm Crit Care 2012;4:134-41.
  3. Dowson A, Mullen MJ, Peatfield R, Muir K, Khan AA, Wells C, et al. Migraine intervention with STARFlex Technology (MIST) trial. Circulation 2008;117:1397-404.

Richard A. Robbins, MD

Editor, SWJPCC

Reference as: Robbins RA. Wilmshurst asks AHA and Circulation for full disclosure. Southwest J Pulm Crit Care 2012;5:84-5. (Click here for a PDF version of the aritcle)

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