Novartis's Tekturna shows promise in heart failure

A new type of blood pressure pill from Novartis (NOVN.VX: Quote, Profile, Research) also shows promise as a treatment for heart failure, scientists said on Sunday.

Tekturna, known generically as aliskiren, recently went on sale in the United States and was approved last month in Europe, where is it goes under the name Rasilez.

It is the first of a new type of drug known as a renin inhibitor that experts hope will give extra benefits compared with older medicines.

John McMurray of the University of Glasgow, Scotland, said a 300-patient study of patients with heart failure found Tekturna significantly cut levels of B-type natriuretic peptide (BNP), a biomarker associated with worsening outcomes for patients.

The effect was seen even though patients were already taking other types of blood pressure medications, suggesting Tekturna can offer additional protection to the heart.

"We would hope that a reduction of BNP would translate into a reduction of morbidity and mortality, but that needs to be proved in a large randomised trial, which is the next step," McMurray told reporters at the annual meeting of the European Society of Cardiology.

There was no significant excess of either hypotension -- excessively low blood pressure -- or kidney dysfunction, he added.

Heart failure affects more than 14 million people in Europe alone and is a major killer worldwide, making it a major focus of medical research.

The condition occurs when the heart is unable to maintain adequate circulation of blood in the body's tissues, resulting in shortness of breath, excessive tiredness and fluid build-up.

Tekturna, which was co-developed by Swiss biotech company Speedel (SPPN.S: Quote, Profile, Research), is a key new product for Novartis, which is seeking ways to shore up its hypertension medicine sales.

This business is currently supported by Diovan, Novartis's top-seller with 2006 sales of $4.2 billion, which will lose patent protection in 2012.

Diovan reduces blood pressure by targetting angiotensin receptors, while Tekturna blocks renin, a kidney enzyme that triggers a process in hypertension.
Source :http://www.reuters.com

Acambis up on FDA OK for smallpox vaccine

Acambis was up 9-1/4 pence at 122-3/4 after the US Food and Drug Administration gave the green light to the company's ACAM2000 smallpox vaccine.

Following the approval, Landsbanki reiterated its 'buy' recommendation on the stock, based on its positive outlook for both ACAM2000 and the Japanese Encephalitis vaccine ChimeriVax-JE.

The broker's 164p target price represents an additional 34 pct upside to the current share price. Acambis ACAM2000 and ChimeriVax pipeline contribute 31p and 78p respectively to Landsbanki's aggressively discounted (50 pct premium to cost of capital) sum-of-the-parts based valuation.

Again on the upside, Irvine Energy edged up 0.25 to 3.3750 as the AIM-listed oil and gas exploration company completed the acquisition of the Niobrara oil and gas project in Kansas, US.
Source :http://www.forbes.com/

Medicaid changes assailed

As Washington spends more money to provide health insurance for all its children by 2010, state leaders and child care advocates are blasting the Bush administration over new rules that they say would punish the state for its leadership on the issue.

Dennis Smith, the federal official who oversees state Medicaid programs, recently notified state Medicaid directors that he was setting new standards for states that wanted to increase eligibility for the State Children's Health Insurance Plan, or SCHIP, above 250 percent of the federal poverty level (which is an annual income of $51,625 for a family of four).

The new rules would:

# Require those states to include cost-sharing that includes co-payments and premiums that more closely mirror the cost of private insurance.

# Impose at least a one-year waiting period without insurance for children before receiving coverage.

# Require states to show that they have already insured at least 95 percent of children in families below 200 percent of the poverty level.

# Require states to show that the number of children in the income range covered by Medicaid and SCHIP who are insured through private employers has not decreased by more than 2 percentage points over the past five years.

More than 66,000 children in Washington lack health insurance, according to a Washington State Budget & Policy Center analysis of 2006 data.

Those uninsured children risk their health and incur community costs through treatment of routine medical issues in their aggravated and emergency state, the center's report said.

Under legislation enacted this year, Washington would expand eligibility for children from families with annual incomes of up to 300 percent of the federal poverty level in 2009.

The new federal rules could make the state responsible for providing $5 million more than it had anticipated in federal matching funds.

Last week, Gov. Chris Gregoire said the new federal restrictions would make it harder for Washington to fulfill its commitment to provide all children access to health coverage.

In a letter to Health and Human Services Secretary Mike Leavitt, Gregoire questioned the legality of setting the rules without going through the formal rulemaking process and pointed out that Congress does not support the administration's new policy.

"I, and the vast majority of Americans, expect our government to follow the appropriate process when establishing important new policies," Gregoire wrote.

"We also understand the importance of SCHIP to the well-being of our children and hope that the federal government continues to be a partner, rather than a roadblock, to our children's health."

Jon Gould, deputy director of the Children's Alliance, a state child advocacy group, said that even before the new rules, Washington state had been penalized for expanding coverage to poorer children.

When SCHIP was created, it allowed federal funding only to states that implemented new programs or expansions. Washington already had a program in place and was ineligible for most of the federal funding -- in essence penalized for developing its program before most other states, he said.

Gould said Washington has already missed out on $200 million of federal participation.

"And children will continue to miss out unless Congress and President Bush reauthorize SCHIP with a fix for Washington state in September," he said.

California and New York are among 23 other states that have expanded children's health care coverage and stand to lose federal participation because of those policies.

Govs. Arnold Schwarzenegger of California, a Republican, and Elliot Spitzer of New York, a Democrat, have also objected to the new rules.

This year, the Democratic-controlled Legislature in Washington approved $30 million for a children's health care program that:

# Consolidates several health coverage programs into one program of comprehensive benefits, including medical, dental, vision and mental health.

# Adds all children in families up to 250 percent of the federal poverty level into the state's health care budget.

# Opens up public insurance to all families who need it. Families between 200 percent and 300 percent of the federal poverty level will pay monthly premiums on a sliding scale based on income.

Though Washington still qualifies for federal SCHIP dollars, the expansion planned for 2009 would be in question.

Other children's groups said the new waiting period the federal government has added in hopes of preventing an exodus from private insurance would also be harmful.

"It's irresponsible to ask a child with cancer or a pregnant woman to wait one full year for health coverage, even if a parent dies or loses their job," said Bruce Lesley, president of First Focus, a national child advocacy group.

"To protect the health and well-being of our children, this directive should be put to bed and withdrawn."
Source :http://seattlepi.nwsource.com

Indonesia dismisses human transmission on bird flu

Indonesia confirmed that there has been no human-to-human transmission of avian influenza virus in the country, Health Minister Siti Fadilah Syupari said here Monday.

The minister told a press conference that thousands people had been killed should the transmission occurred already in Indonesia.

" There is no human-to-human transmission in Indonesia," she said.

"There has been no virologist report, and it is still zero epidemiologist," said Fadilah at a office here.

She said that the conclusion of the experts from the Fred Hutchinson Cancer Research Center in Seattle, Washington last week could not be used to say that human-to-human transmission had already happened in Indonesia, as the expert only make their calculation mathematically.

The expert found a statistical confirmation that H5N1 virus spread from human-to-human between a small number of people within a family in North Sumatra, Indonesia, where eight people died in April last year.

"That is only a statistical test," said the minister.

In North Sumatra, the cluster contained a chain of infection that involved a ten-year-old boy who probably caught the virus from his 37-year-old aunt, who had been exposed to dead poultry and chicken feces.

The minister said that Indonesian authorities already declared the cluster in North Sumatra as limited human-to-human.

"For example, the father, who has two children, he died. Why was the mother not infected by her child, why only the father was infected?. This still become a big question until now," said Fadilah.

Experts fear that the highly pathogenic H5N1 virus could mutate in a certain level that can make them transmittable among humans that can cause a pandemic where million people can be killed.

The viruses have killed globally 195 out of 322 infected people, most of them in Indonesia with 84 fatalities and 105 cases.

It is rare that the virus was transmitted by human, most of them are passed by birds.

Cluster was rarely happen. Experts worry of the possibility that the H5N1 virus is transmitted by human.

As the number of victims of the virus keeps slowly rising in the country, the health authorities have decided to use the country's own anti-bird flu vaccine after September to stop the virus spread on human, despite the World Health Organization suggestion to stock pile the vaccines.

Huge territory, traditional way of rising chickens on back yardand lack of obedience of provincial administration in implementing the Jakarta decision to stop the virus spread, are among the obstacles in fighting the bird flu in the country.
Source :http://news.xinhuanet.com

Diabetics benefit from lower blood pressure: study

Australian researchers say reducing blood pressure in people with type 2 diabetes can dramatically reduce the risk of death or serious complications.

The scientists say the findings from what is the largest study of treatments for the disease could potentially save several million lives over the next decade.

More than 600,000 Australians have type 2 diabetes and around 250 million people worldwide suffer from the disease.

Many will eventually die or become disabled by complications resulting from it.

But researchers from the George Institute for International Health say death rates could be cut by around one-fifth if patients took a combination of two blood pressure lowering drugs.

Dr Bruce Neal is senior director at the George Institute and an associate professor of medicine at the University of Sydney.

He says the study shows that patients get benefits from the blood pressure lowering treatment, irrespective whether the patient has got hypertension or not.

"We got a 10 per cent proportional reduction in the risk of having a serious complication and almost double that reduction in the risk of dying from a serious event like a stroke or a heart attack," he said.

He says that while it is obvious that lowering blood pressure has a number of health benefits, what is not obvious is that people who do not have high blood pressure would get the benefit.

"That's the really novel thing about this study - it's that for a long time we believed that you would get these benefits even if you had normal blood pressure but no one's demonstrated it in this way before," he said.

Preventative therapy

That opens up a new preventative therapy to many, many millions or hundreds of millions of people worldwide with diabetes.

The four year study of 11,000 people with type 2 diabetes in 20 countries, is being published in The Lancet.

It was funded to a large extent by the manufacturer of the drug used.

Dr Neal says that does not comprise the findings.

"Absolutely not - the study was funded almost entirely by a large pharmaceutical company, although there was also funding from the Australian Health and Medical Research Council," he said.

"The reason why this funding doesn't impact upon the validity of the result is that the study was done completely independent to the company.

"They gave us the money, we did the study, and we reported the study independent of sponsor."
Source :http://www.abc.net.au

More Children Being Treated for Bipolar Disorder

The number of American children and adolescents treated for bipolar disorder increased 40-fold from 1994 to 2003, researchers are to report on Tuesday, in the most comprehensive study to look at the controversial diagnosis. And experts say the numbers have almost certainly risen further in the years since.

Most experts believe the jump reflects the fact that doctors are more aggressively applying the diagnosis to children, not that the number of new cases has gone up. But the magnitude of the increase is surprising to many experts, who say it is likely to intensify a debate over the validity of the diagnosis that has shaken the field of child psychiatry in recent years.

Bipolar disorder is characterized by extreme mood swings and, until relatively recently, it was thought to emerge only in adulthood. Some psychiatrists say that the disorder is too often missed in children, and that increased awareness — reflected in the increasing use of the diagnosis — is now allowing youngsters who suffer from it to get the treatment they need. But others argue that bipolar disorder is overdiagnosed. The term, they say, has become a diagnosis du jour, a catch-all now applied to almost any explosive, aggressive child. Once children are labeled, these experts add, they are treated with powerful psychiatric drugs that have few proven benefits in children and potentially serious side-effects, like rapid weight gain.

The spread of the diagnosis has been a boon to drug makers, according to these experts, because treatment typically includes medications that can be three to five times more expensive than those prescribed for other disorders, like depression or anxiety.

“I think the increase shows that the field is maturing when it comes to recognizing pediatric bipolar disorder, but the tremendous controversy reflects the fact that we haven’t matured enough,” said Dr. John March, chief of child and adolescent psychiatry at Duke University’s school of medicine, who was not involved in the research.

“From a developmental point of view, we simply don’t know how accurately we can diagnose bipolar disorder, or whether those diagnosed at age 5 or 6 or 7 will grow up to be adults with the illness,” he said. “The label may or may not reflect reality.”

Most children who qualify for the diagnosis do not go on to develop the classic features of adult bipolar disorder, like mania, researchers have found. They are far more likely to become depressed.

But Dr. Mani Pavuluri, director of the pediatric mood disorders program at the University of Illinois, Chicago, said that label is often better than any of the other diagnoses that difficult children often receive. “These are kids that have rage, anger, bubbling emotions that are just intolerable for them, and it is good that this is finally being recognized as part of a single disorder,” to better tailor treatment, she said.

In the study, researchers from New York, Maryland and Madrid analyzed data from a National Center for Health Statistics survey of office visits, which focused on doctors in private or group practices. The researchers calculated the number of visits in which doctors recorded a diagnosis of bipolar disorder, and found that the numbers went up from roughly 20,000 such diagnoses in 1994 to about 800,000 in 2003

“I have been studying trends in mental health services for some time, and this finding really stands out as one of the most striking increases in this short a time,” said Dr. Mark Olfson of the New York State Psychiatric Institute at Columbia University, the senior author of the study, which appears in the September issue of Archives of General Psychiatry, which is to be published Tuesday.

The increase makes bipolar disorder more common among children than clincial depression, the authors said. The study found that psychiatrists made almost 90 percent of the diagnoses, and that two-thirds of the young patients were boys. About half the patients also had been identified as having other mental difficulties, most often attention-deficit disorder.

The treatment given the children almost always included medication. About half received antipsychotic drugs, like Risperdal from Janssen or Seroquel from Astrazeneca, both developed to treat schizophrenia; a third were prescribed so-called mood stabilizers, most often the epilepsy drug Depakote; and antidepressants and stimulants were also common. Most children were on some combination of two or more drugs, and about four in 10 received some psychotherapy.

Their regimens were very similar to those of a group of adults with bipolar diagnoses, the study found. “You get the sense looking at the data that doctors are generalizing from the adult literature and applying the same principles to children,” Dr. Olfson said.

The rise in bipolar diagnoses in children reflects several factors, experts say. Bipolar symptoms do appear earlier in life than previously thought, in teenagers and young children who later develop the full-blown disorder, recent studies suggest. The label also gives doctors and desperate parents a quick way to try to manage children’s rages and outbursts, in an era when long-term psychotherapy and hospital care are less accessible, they say.

In addition, in recent years drug makers and company-sponsored psychiatrists have been encouraging doctors look for the disorder, ever since several drugs were approved to treat the disorder in adults. Last month the Food and Drug Administration approved one of these medications, Risperdal, to treat bipolar in children — which many experts say they expect will escalate the use of Risperdal and similar drugs in young people.

“We are just inundated with stuff from drug companies, publications, throwaways, that tell us six ways from Sunday that, ‘Omigod, we’re missing bipolar,’ ” said Dr. Gabrielle Carlson, a professor of psychiatry and pediatrics at Stony Brook University School of Medicine on Long Island. “And if you’re a parent with a difficult child, you go online, and there’s a Web site for bipolar, and you think, ‘Thank God I’ve found a diagnosis. I’ve found a home.’ ”

Some parents whose children have received the diagnosis say that, with time, the label led to effective treatment. "It’s been a godsend for us," said Kelly Simons, of Montrose, Colo., whose son Brit, 15, was prone to angry outbursts until given a combination of lithium, a mood-stabilizer and Risperdal several years ago. He is now on lithium alone and he is an honor-roll student.

Others say their children have suffered from side effects of drugs given for bipolar disorder, without getting much benefit.

Ashley Ocampo, 40, of Tallahassee, Fla., the mother of an 8-year-old boy, Nicholas Ryan, who is being treated for bipolar disorder, said that he had tried several antipsychotic drugs and mood stabilizers, and that he had been better lately.

But, she said in an interview, “He has gained weight, to the point where we were struggling find clothes for him; he’s had tremors, and still has some fine motor problems that he’s getting therapy for.”

She added, “But he’s a fabulous kid, and I think, I hope, that we’re close to finding the right combination of medications to help him.”
Source :http://www.nytimes.com

Schizophrenia Could Be Treated with Fewer Side Effects

A new drug that addresses schizophrenia symptoms has shown considerably less side effects than the “traditional” medication, promising more efficient treatments in the future.

Schizophrenia is a severe mental disorder that affects around 1% of the general population, with 2 million men and women being diagnosed every year in the United States as having this disease. It is one of the most mysterious mental illnesses, since the brain of the affected patients is organically “intact”, unlike Alzheimer’s disease or Parkinson’s disease, where the brain shows distinctive signs of degradation (like the deposition of beta-amyloid protein that kills neurons and leads to dementia).

Treatments for schizophrenia’s symptoms are numerous and effective at reducing chances of relapse, however they also have numerous and sometimes very visible side effects. Included in the panoply of treatments are prescription of antipsychotics, antidepressants and psychotherapy, although supplements of glycine (an amino acid), Omega-3 fats (found in fish oils) and antioxidants also help alleviate the manifestations of the chronic disease.

Most side effects quoted by medical reports are related to drowsiness and dizziness in patients receiving treatment, but these are the “easy” ones. Violent tremor (similar to Parkinson tremor) and considerable weight gain are among the worse, along with low blood pressure, rigidity in muscles, severe headaches and different symptoms associated with euphoria.

What Dr Sandeep Patil and colleagues, from drug firm Eli Lilly, have tried to do with their new "LY2140023" treatment is to address both the problem of the side effects and the efficiency of the overall medication, by taking a different path. As a side note, Eli Lilly is renowned for its other drug called Zyprexa, introduced in 1996, whose side effects were ironically downplayed by the company from fear that it would hurt sales.

This time, Patil, who continued the breakthrough work of Dr. Darryle D. Schoepp, a toxicologist and pharmacologist who joined Lilly in 1988, worked on the relationship between glutamate receptors in the brain and the symptoms of schizophrenia.

Current anti-psychotic drugs block the uptake of a naturally occurring chemical called dopamine, which is both a hormone and a very important neurotransmitter. Excessive levels of dopamine are thought to trigger psychotic episodes in patients suffering from schizophrenia, which is why anti-psychotics’ main purpose is to inhibit the influence of dopamine.

However, Patil’s team avoided the “dopamine-filled brain” path and concentrated instead on another neurotransmitter, called glutamate, whose involvement in psychotic episodes has been a long debate among scientists. The debate started when psychiatrists noticed that the use of a drug called PCP, also known as angel dust, induced symptoms similar to schizophrenic episodes in consumers, by blocking glutamate’s receptors.

Glutamate is the major excitatory neurotransmitter in the mammalian central nervous system (CNS), including humans of course. Its receptors and associated proteins are likely to be located on every neuron in the brain. Thus, glutamatergic transmission may affect every central neuron and is critical to all mental, sensory, motor, and affective function. For this reason alone, the glutamatergic transmitter system has received attention in examinations of schizophrenia.

In the brains of individuals with schizophrenia, glutamatergic signaling may well contribute to the functional changes in neural networks that account for the progression of the disease through its various stages, as well as for temporal variations in the severity of symptoms at each stage.

Since glutamatergic signaling inside the brain plays such an important role in the development of neural circuitry and in schizophrenia, altered glutamate function, either primarily or as a downstream consequence of some other event, may be part of the pathogenic mechanism leading to psychosis.

Psychotic episodes are characterized by a general loss of contact with reality, involving hallucinations, delusional beliefs, disorganized thinking and an alteration of personality. Because of the fact that these symptoms involve superior cognitive functions, Schoepp and Patil have narrowed their research domain to the study of pre-frontal cortex (PFC), the anterior part of the frontal lobes of the brain, lying in front of the motor and premotor areas.

This part of the brain is mainly involved in the so-called executive function, which gives us the ability to decide between conflicting thoughts, determine good or bad or anticipated different consequences of our current actions. Many authors have indicated an integral link between a person's personality and the functions of the prefrontal cortex.

“This is a system that is so fundamental to the function of your brain that it is quite powerful,” said Dr. Schoepp.

During the evaluation period, which lasted for four weeks, LY2140023 was administered to 97 patients alongside smaller groups given placebos or olanzipine, a commonly prescribed anti-psychotic medication. The results show that Russian olanzipine-treated patients (the experiment took place in Russia between August 2005 to June 2006) and those who received LY2140023 showed roughly the same encouraging effects. LY2140023 matched the effectiveness of olanzipine for both "positive" symptoms such as hallucinations as well as "negative" ones, including withdrawal.

Of course, results need further confirmation, and a new trial, involving 870 patients, is expected to be complete in January 2009. Eli Lilly will re-evaluate the findings from this second phase of the clinical tests, and if things turn out as expected a larger phase III will commence, with more than 2,000 patients.

“We have to confirm safety and efficacy with multiple studies,” Dr. Steven Paul, the president of Lilly Research Laboratories said. “We are very actively working on this target and related targets because we believe that this mechanism is now validated,” he added.
Source :http://www.efluxmedia.com

Video Game Overuse May Be an Addiction

Millions of U.S. children and adults obsessed with video games may suffer from a real addiction, according to a proposal up for debate by top U.S. doctors.

Delegates attending the American Medical Association conference in Chicago, which starts Saturday, will discuss the proposed addition of video game addiction to a list of "formal disorders," where it would join other problem behaviors such as pathological gambling.

Dr. Martin Wasserman, executive director of MedChi, the Maryland State Medical Society, helped spearhead the new proposal, which has resulted in a 10-page report submitted to the AMA by the group's Council on Science and Public Health.

"The concern came up because one of our psychiatrists here in Maryland was seeing older people who were losing their social contacts," specifically because of their overuse of video games, Wasserman said. "It was ruining their family life. So, it was not unlike gambling addictions or alcohol, where it was having a profound impact on the lives of individuals."

According to the AMA report, one soon-to-be-released British study polled 7,000 "gamers" and found that 12 percent of them met World Health Organization criteria for addictive behaviors.

Statistics released in 2005 by the Entertainment Software Association (ESA), an industry group, estimated that 70 percent to 90 percent of American children play video games. The typical gamer is a 30-year-old male who spends about seven or eight hours a week gaming.

The ESA survey also found that video game overuse was most prevalent among the approximately 9 percent of video game users who play against others online in Internet-based "massive multiplayer online role playing games."

The new AMA report defines "heavy game use" as two or more hours a day, but Wasserman, a pediatrician, said addictions are best defined by their impact on an individual's life and psyche.

"Basically, you're using a disproportionate amount of time on the video game, and it's what you are thinking about even when you're not on the video game," he said. "And even though it's having negative consequences for you in school or your family situation, or it's taking a disproportionate amount of your money, you still continue to do it. You spend less time with your friends or in other social things."

One theory why certain individuals spend so much time on online games is that they prefer the experience to real-world interaction. According to the report's authors, the "current theory is that these individuals achieve more control of their social relationships and more success in social relationships in the virtual reality realm than in real relationships."

But that sense of control may come at a price, Wasserman said, especially for children and adults obsessed with games loaded with violent imagery.

"The violent aspects of this, in particular, have got to be a threat to the normal growth and development that we'd like to see in young people," he said. "People have observed more aggressive behaviors [linked to gaming], and if you do subjective testing, there are studies which have shown aggressive behaviors in young people and less supportive behaviors."

Wasserman wonders, as well, about the sedentary aspects of hours of video game use. "I can't tell you if this is associated with our current epidemic of child obesity," he said, "but too much time in front of a video tube -- and much of that time spent watching violent interactions -- can't be good for our kids."

That's a sentiment shared by a majority of the American public, according to a survey of more than 1,000 parents of children aged 2 to 17 that was released Tuesday by the nonprofit Kaiser Family Foundation. According to the Associated Press, two-thirds of parents responding to the survey said they were "very concerned" about the amount of sex and violence their children are exposed to in various media.

But the AMA report remains merely a starting point for discussion among doctors gathering in Chicago. It is far from certain that the physicians' group will, in fact, move to label excessive gaming an addiction.

The report's authors are urging that the AMA pressure the American Psychiatric Association (APA) to include "Internet/video game addiction" in the next edition of the Diagnostic and Statistical Manual of Mental Disorders, the standard diagnostic text used by psychiatrists worldwide.

But Dr. James Scully, medical director at the APA, said any decision on the matter is a long way off.

Right now, "we don't agree or disagree" with the idea, he said. "As a diagnostic issue, it is going to be several years before we make a determination of that. It's clearly something that we want to consider."

In the meantime, he said, it's up to parents to limit their child's exposure to video games, especially the more violent ones. Both the AMA and the APA support current recommendations from the American Academy of Pediatrics that limit children's exposure to all "screen time" -- TV, computers and video games -- to a total of two hours a day.

Wasserman believes this simple rule can minimize media's potentially harmful effects. Media, in itself, isn't always bad, he said, but "everything needs to be done in moderation."

"That's what we taught our kids -- if they didn't do it in moderation in our home, we moderated it for them," he said. "It didn't hurt them."
Source :http://www.forbes.com

Patient's death jeopardizes hospital

When Edith Isabel Rodriguez showed up in the emergency room of an inner-city hospital complaining of severe stomach pain, the staff was already familiar with her.

It was at least her third visit to Los Angeles County's public Martin Luther King Jr.-Harbor Hospital in as many days. "You have already been seen, and there is nothing we can do," a nurse told her.

Minutes later, the 43-year-old mother of three collapsed on the floor screaming in pain and began vomiting blood. Employees ignored her, and she was soon dead.

Now state and federal regulators are threatening to close the hospital or pull its funding unless it can be improved, and Rodriguez has become a symbol of everything wrong with the facility derisively known as "Killer King."

After she collapsed, surveillance cameras show that Rodriguez was left for dead on the floor.

Nurses walked past her. A janitor cleaned up around her. No one did anything until police were called to cart her away. They didn't get far before she went into cardiac arrest and died.

"This needs to stop," state Health Services Director Sandra Shewry said Thursday as the agency moved to revoke the hospital's license. "We're doing this in response to the egregious incidents that have come to light in the last six weeks."

The hospital, formerly known as Martin Luther King Jr.-Drew Medical Center, was built after the 1965 Watts riot to bring health care to poor, minority communities in south Los Angeles.

But it had been plagued by patient deaths blamed on sloppy nursing care, among other things. The county attempted over the last few years to correct the problems with a multimillion dollar rescue effort, disciplining workers, reorganizing management, closing the trauma unit and reducing the number of beds from 200 to 48.

After Rodriguez's death, federal reports showed those efforts were failing and patients were in "immediate jeopardy." Of the 60 cases reviewed between February and June, more than a quarter received substandard care, according to the U.S. Centers for Medicare and Medicaid Services.

In February, a brain tumor patient languished in the emergency room for four days before his family drove him to another hospital for emergency surgery. A pregnant woman who complained of bleeding was given a pregnancy test and left, only to return three days later and have a miscarriage after waiting more than four hours to see a doctor.

The findings have sent county officials scrambling to improve care before a federal inspection due by Aug. 15 that could determine whether the hospital keeps its federal funding. The county might close the facility without that money.

The hospital, meanwhile, could contest the state allegations in a hearing before a Department of Health Services administrative law judge.

"I'm losing hope," Zev Yaroslavsky, member of the county Board of Supervisors that oversees King-Harbor, told hospital managers earlier this week. "We need to be prepared for the worst-case scenario."

On Friday, the county's Department of Health Services released a contingency plan to deal with closing hospital departments and relocating patients if they must. The plan, which also lays out how the hospital could eventually be reopened if a private partner is found, will be presented to the Board of Supervisors on Tuesday, said Bruce Chernof, director of the department.

Even though hospitals nationwide struggle with too many patients and not enough staff, the scope and severity of King-Harbor's problems are rare.

"Most hospitals in America have long waits, they have crowded ERs," said Dr. Bruce Siegel, former chief of New York City's public hospitals and a George Washington University professor. "But they don't let people die in the waiting room after they call 911. This is a whole new level here."

Rodriguez, who struggled with drug addiction over the years, had visited King-Harbor several times for stomach pain in the days before she died. Each time, she was sent home, in some cases with pain medication, after doctors said she suffered from gallstones.

"They discharged me, but I don't feel good. I feel sick," she told her sister, Marcela Sanchez.

At the urging of her sister, Rodriguez returned to the hospital.

Early on May 9, she was wheeled into the ER by county police officers.

"Thanks a lot, officers, she's a regular here," a nurse said. "She has already been seen and was discharged."

After the nurse again refused to help, Rodriguez slid off her wheelchair and onto her knees in a fetal position, screaming in pain, according to a federal report based in part on surveillance videotape.

Over the next half hour, hospital staff walked past her. Soon, her boyfriend, Jose Prado, who had left for about an hour, returned to the hospital.

"When I came back, I found her lying on the floor with blood coming out of her mouth," Prado said. "She said, 'Honey, help me! Nobody will help me here!'"

He pleaded with medical staff and then a county police sergeant to intervene, but no one did.

"I told him she had blood in her mouth," Prado says he told the sergeant. "But he told me, 'Don't worry, she just has chocolate in her mouth."

Then he called 911.

"My wife is dying and the nurses don't want to help her out," he said in Spanish through an interpreter

"What's wrong with her?" a dispatcher asked.

"She's vomiting blood," Prado said.

When the dispatcher refused assistance, he hung up and frantically ran back to Rodriguez.

"I just hugged her. I didn't know what else to do. I couldn't think of anything else," he said.

Eventually, officers arrested her on a parole violation.

Police wheeled her out of the ER, then returned minutes later after Rodriguez's heart had stopped. Autopsy results revealed she died of a perforated bowel that probably developed in the previous 24 hours, a condition that is often treatable if caught early enough.

"They took her outside to die like an animal," Prado said.

After her death, a triage nurse was put on leave, resigned and was reported to the state Nursing Board for investigation. Six others — a nurse, two nursing assistants, and three hospital finance workers — were disciplined. Sheriff's detectives, meanwhile, have opened a homicide investigation.

Rodriguez's family said little will ease their grief. They plan to sue and are seeking copies of the video surveillance tapes, which are being held as part of a criminal investigation.

"They took my sister," Sanchez said. "It wasn't time for her to go."
Source :http://www.chron.com