• Informed Consent &
  Malpractice
• Employment Litigation
  ADA - Disability - Sexual Misconduct
  Discrimination - Worker's Compensation
• Emotional &
  Physical Damages
  Conscious Pain & Suffering
  Post-Traumatic Stress Disorder (PTSD)
  Neuropsychiatry and Brain Imaging
• Standards for Experts
• Product Liability
  Medical Devices & Pharmaceuticals
  Toxic Tort
• Criminal Justice &
  Public Safety
  Diminished Capacity - Drug Addiction
  Competency to Confess
  Death Penalty Mitigation
  Workplace Safety
• Family & Custody Issues
• Testamentary &
  Contractual Capacity
• Professional &
  Organizational Ethics
  Patient Care - Managed Care - Privacy
• Psychoanalysis &
  Cultural Perspectives

Professional Ethics

Professional ethics, perched on the border between science and humanity, has undergone public scrutiny in modern times. One of the most notable examinations of professional ethics occurred during the Nuremberg trial of Nazi medical atrocities in 1946. In recent years, increasing use of medical technology and the formation of health maintenance organizations have created a new environment in which medical ethics are questioned. "Right to Die" debates and health professionals' sexual misconduct with patients are often in the news.

Administrative bodies struggle with maintaining a balance between protecting the public and liberty interests.

• Protection of Human Subjects. Program Standards Committee for the Department of Veterans Affairs (VA) Human Research Protection Accreditation Program which Dr. Bursztajn helped to formulate has now been endorsed by the Institute of Medicine and is relevant to a drug company's responsibility.
• American Medical Association's web page on ethics.
• AMA Releases Universal Guidelines for Ethics and Medical Privacy
• American Academy of Psychiatry and the Law (AAPL) The AAPL site, base at Emory University in Atlanta showcases resources developed by and for psychiatrists who practice, teach and conduct research in the field of forensic psychiatry.
• American Academy of Psychiatry and the Law Ethical Guidelines for the Practice of Forensic Psychiatry. These guidelines drawn up by a professional body apply specifically to forensic psychiatry.
• Ethics and the Health Professions: Relating the Memory of the Shoah to the New Managed Care Millennium. The parallels between ethics considerations in the Shoah and in today's managed health care organizations.
• The Shoah: A Reflection. Thoughts on professional ethics sparked by the testimony of Dr. Bursztajn's father, a Holocaust survivor.
  • Article: The Holocaust's Arab Heroes. An article on preliminary research into and a short recounting of a number of the Arab heroes during the Holocaust.
  • Article: Why Our Hero Leapt Onto the Tracks and We Might Not. Recent New York Times article on what motivates a rare breed of people to make the leap and put other's lives above their own.
  • For more information on Jewish Lodz, please visit the Lodz ShtetLinks home page.
• Editorial: A day not easily forgotten. Torture and human rights abuses are still ethical affronts in our world.
• Flight: The Eloquence of Silence. In our attempt to arrive at truth, certainty, or at least informed consent in medical procedures, we sometimes forget that our questioning may violate ethical considerations.
• Brain, Mind, Ethics and Society. This site represents a synthesis of the latest developments in neuropsychology with the current themes in ethics.

The Importance of Meaningful Informed Consent for Protecting Patients and Clinical Research Subjects

• Nuremberg Code: The ten principles of ethics governing the use of human subjects.
• Protection of Human Subjects in Research. Home Page of the US Air Force Academy's Institutional Review Board.
• United States Holocaust Museum. The Official Trial Record at Nuremberg.

Employment & Ethics

In the workplace, the forensic psychiatrist may be asked to consider whether a claimed disability (e.g., a chronic general illness, such as Chronic Fatigue Syndrome, a chronic pain syndrome, such as Fibromyalgia, or a mental disorder, such as Depression or Obsessive-Compulsive Disorder) is valid and work stress related. Some other frequently asked employment related examination questions are:

1. "Is a claimed impairment subject to the ADA mandate for accommodation?
2. "What is the appropriate organizational response to a sexual harassment claim?
3. "What is the validity and extent of sexual harassment-related damage claims, such as emotional injury or Post-Traumatic Stress Disorder?

As a nationally recognized forensic neuropsychiatric expert, Dr. Bursztajn continues to teach via peer review service, publication, and presenting workshops in recognized professional forums. By way of introduction, see American Psychiatric Association workshop abstract on reducing the risk of dual agency complications by performing objective forensic neuropsychiatric evaluations of work impairment claims independent of ongoing subjectively oriented teatment.

Recent Articles in the News

• Drug Approved. Is Disease Real? The pharmaceuticalization of medical diagnosis and disability creation. New York Times, January 14, 2008.
• Ethics Expert says Embryo-Implant Docs Negligent. Dr. Bursztajn often consults and advises clinicians and organizations across the medical and mental health spectrum as well as state and federal agencies on issues at the interface of patient care and clinical ethics. This may include advising the judiciary as an independent or testifying as a plaintiff or defence retained medical and mental health care and ethics expert. Boston Herald, January 16, 2004.
• After Sanctions, Doctors Get Drug Company Pay. Many doctors who were sanctioned by a medical board were later paid for research by drug makers. New York Times, June 3, 2007.
• Health Care as Main Engine: Is that so Bad? Whatever the specifics, executives and economists agree that health care will become a more important part of the economy. New York Times, November 11, 2001
• Prozac Maker Reveals Patient E-Mail Addresses
• Telemedicine Getting a Test in Efforts to Cut Costs of Treating Prisoners
• "Ban Genetic Discrimination" Boston Globe Op-Ed piece by Dr. Harold J. Bursztajn and Dr. Richard Sobel, August 7th, 2000.
• Brave Good World by Martha Nussbaum, The New Republic, December 4th, 2000.
• US Patients Don't Want to Know How Doctor is Paid by Suzanne Rostler, March 6, 2001.

Conflicts of Interest

• Drug Firms accused of biasing doctors' training. Can the pharmaceutical industry be trusted to fund doctors' compulsory education without introducing bias? The issue is dividing Congress, academics and drugs companies. Now, preliminary data have emerged suggesting that industry-sponsored courses skew training material in favour of commercial interests. Published in Nature, November 22, 2007.
• Dr. Bursztajn's recent article with Lisa Cosgrove in the journal of Organizational Ethics, Undoing Undue Industry Influence: Lessons from Psychiatry as Psychopharmacology, details the need for the uncovering of the hidden ties between doctors and drug and medical devices companies and the need for industry critics to be included in the revision and implementation of conflict-of-interest policies.

Recent Articles in the News

• Accusations of Delays in Releasing Drug Results by Alex Berenson, The New York Times, April 1, 2008.

Managed Healthcare

Managed health care organizations are more numerous and pervasive today. As they have grown in influence, many patients and professionals have claimed that medical care, while increasing in sophistication, has declined in quality. At the same time, the large-business and third-party aspects of managed care organizations can make medical decision-making an impersonal process, and increase the need for organizations and clinics to exercise joint responsibility with the treating physician for informed patient care.

• Managed-Health-Care Complications and Clinical Remedies

  More and more clinicians practice both primary medical care and primary psychiatry in the hothouse atmosphere of managed health care. Dr. Bursztajn has been interested in decision making under conditions of uncertainty for many years; one of his earlier books, Medical Choices, Medical Chances, extensively explores this issue in ways that offer direct assistance to physicians across the specialty spectrum as to clinical decisions under conditions of uncertainty. Dr. Bursztajn's article with Archie Brodsky in Primary Psychiatry examines the boundaries between medical and psychiatric fundamentals of clinically-based risk management and provide remedies for the critical pitfalls facing the practitioner in the modern era.

• Responses to a Defective Managed Care Product

  Case: Rush Prudential HMO, Inc. v Moran et al.. In this strong and very important affirmation of patients' rights, the Court ruled that ERISA does not override state laws which require HMOs to provide patients the use of binding independent reviews of the HMOs' "medical necessity" decisions. It may also lead the way to considering "product liability" class action suits viz managed care companies based on a lack of informed consent. Dr Bursztajn's book chapter previewing this implication of the decision is a good introduction to this emerging area. A more complete description of Dr. Bursztajn's recent book chapter can be Responses to a defective managed care product: medical negligence, lack of informed consent, and choicelessness. In: 2000 Wiley Expert Witness Update. New York: Aspen Law Business/Panel Publishers, 2000; 239-264. Bursztajn HJ.

• "More May Not Mean Better in Health Care, Studies Find"

  Dr. Bursztajn's Letter to the Editor of The New York Times (July 26, 2002) in which he states that "Research like that presented is all too often misused as a rationalization for policies that deny access to care and choice of treatments.

• Protecting Patient Care and Public Safety in the Managed-Care Era. General Psychiatric Hospital, Cambridge, MA November 11, 2001 by Harold J. Bursztajn, M.D.
• Preserving the Public Trust. Shaping the Future for Health Participant Programs. The protection of individuals who volunteer to participate in research is essential to the ethical conduct or research.
• Reducing Clinical Research Risks. Dr. Bursztajn's timely letter to The New York Times (August, 2001)alerting sponsors of clinical trials that they are accountable for protecting human subjects from unnecessary risks due to research.
• The Ethics of Social Risk Reduction in the era of the biological Brain

  In keeping with our transdisciplinary orientation, in this article Dr. Bursztajn and co-authors try to do several things at once. They address research on preventing mental illness and its relation to existing conceptions of public health, a topic to which insufficient attention has been paid in the era of the biological brain, while using this case study to illustrate the limits of conventional approaches in bioethics.

• Treatment for Managed Care Pain. Preventing managed health care malpractice.
• HMO Reporting in the Crosshairs, September 25, 2002, JAMA - Poor scoring HMOs more likely to withhold grades
• Protecting Subjects, Preserving Trust, Promoting Progress

  Policy and Guidelines for the Oversight of Individual Financial Interests in Human Subjects Research.

  AAMC Task Force on Financial Conflicts of Interest in Clinical Research, December, 2001.

  In October of 2000, in a speech entitled Trust Us to Make A Difference, Dr. Jordan Cohen, President of the Association of American Medical Colleges (AAMC), announced the formation of a new Task Force on Conflicts of Interest in Clinical Research chaired by Dr. William Danforth, Chancellor Emeritus of Washington University of St. Louis. Core Principles to Guide Policy Development. The first product of these efforts is this report. This document offers guidance to institutions in their efforts to provide responsible and effective oversight of financial interests in human subjects research. Academic institutions share common concerns, yet each retains its own unique culture and mode of self governance.

• Program to Cover Psychiatric Help for 9/11 Families by Erica Goode, The New York Times, August 21, 2002. The need to provide mental health care and choices to help 9/11 families given the lack of each in a managed health care dominated American medical landscape.
• American Medical News Letter to the Editor (2.04.02). As managed care pares hospital stays, more need for physicians to advocate on behalf of patients.
• Patients' Rights: What's at Stake? August 16, 2001; The New York Times by Milt Freudenheim. The new law would mean uniformity for the managed care companies but we personally will not see much change.
• Patient Deaths Tied to Lack of Nurses. Managed health care influences on patient care; The New York Times, August 8, 2002
• Kaiser Family Foundation Releases Study on Currently Enacted Managed Care Liability Provisions in State Law. Managed care liability: the need for informed consent as a process.
• Reducing Violence in Severe Mental Illness & Community care does not do well. Why hospitalization is the best hope for reducing mental illness for those prone to violent behavior.
• AMA Principles of Ethics on Managed Health Care
• RICO Ruling May 13, 2001: U.S. District Judge Federico Moreno today issued a major ruling in the racketeering lawsuit brought by the country's physicians against the nation's largest HMOs.
• Captive Patients, Captive Doctors: Clinical Dilemmas and Intervention in Caring for Patients in Managed Health Care by Harold J. Bursztajn, M.D. and Archie Brodsky, B.A.
• Medical Negligence and Informed Consent in the Managed Care Era
• Substituting Alliance for Alienation: Supporting the Human Side in Changing Health Care. The changes in health care, particularly in the doctor-health maintenance organization, can be better handled using skills already in practice in the patient-doctor aspect of the health care relationship.
• Responsibility Without Scapegoating. The physician, patient, and MCO all have different spheres of authority and responsibility.
• A Reflection of My Father's Experiences with Doctors During the Shoah. A portrait of the traditional relationship of care between doctor and patient.
• New Developments in the Role of Post-Traumatic Stress Disorder in Civil and Criminal Law: A Case of Medical Malpractice Illustrates the Growing Importance of Informed Consent.
• Book Review: Managing Care, Not Dollars: The Continuum of Mental Health Services
• Case: Grijalva v. Shalala Federal court rules that Medicare patients are entitled to immediate hearings, when denied treatment by HMOs.
• Case: Failure to Provide Psychiatric Treatment Martino v. Illionis, Cook County Cir. Ct., No. 97 L 874, July 26, 1999.
• Dartmouth Research Project findings in  Research Suggests More Health Care May Not Be Better The New York Times, July 21, 2002.
• Case: Jamie Claborn Drewry v. Phillip Harwell, M.D., et al. The uses of informed consent as a malpractice defense.
• Case: Shannon v. HealthAmerica of Pennsylvania. HMO liability.
• Article: "Report Says Profit-Making Health Plans Damage Care"
• Who's Reaping the Benefits. Transcript of 20/20's program on managed health care.
• Article: "New Report on Doctors & Nurses Experience with Managed Care Denials & Patient Injury"
• When Health Care Goes Lacking. Dr. Bursztajn on consequences of managed health care denial in The New York Times, 8-4-99.
• Article & Editorial: "Group Asking U.S. For New Vigilance in Patient Safety"
• Article: "Medical Insurers Revise Cost-Control Efforts"
• Article: "Under Legal Attack, H.M.O.s Face a Supreme Court Test"
• Article: "Disabled Attorney's Novel Strategy Puts A Civil-Rights Spin on HMO Litigation"
• Excerpt: Hippocrates or Hypocrisy. Professor Illingworth on HMO ethics conflicts: Medical vs. Business.
• Article: "A Price Too High? A Deal to Save Charter Behavioral May Have Hurt It." Managed Care Business and Medical Standards & Ethics.
• Article: "HMO Accused of Underpaying Doctors"
• Case: "HMOs Can Be Vicariously Liable for Their Independent Contractors' Negligence"
• Article: "National Class-Action Filed Against Prudential Health Care"
• Article: "Kaiser Drug Policy Prompts State Inquiry"
• Article: "Doctors Say They Deceive Insurers to Help Patients"
• Article: "Merrill Lynch Cuts Health Costs, Creates a Generous Benefit Plan." Minimizing healthcare costs by maximizing healthcare quality.
• Article: "Supreme Court Shields HMOs From Lawsuits"
• Case: Plocica, et al. v. NYLCare Health Plans, Inc. The case is expected to make managed-care insurers more cautious about overruling doctors, observers say.
• Article: "Health and Disability Costs of Depressive Illness in a Major U.S. Corporation." The cost to employers of failure to treat depression.
• Article: As Technology Improves, More People Breathe With Machines. April 24, 2001 Article in the Science Section of The New York Times with Dr. Bursztajn's response to the editor.

Information on the Commission on Consumer Protection and Quality in the Health Care Industry can be obtained at The President's Advisory Commission on Consumer Protection and Quality

Elder Care

Unfortunately, nutrition tends to be neglected for the elderly receiving home care as well as institutional care. The following provides some relevant information.

• New Food Pyramid to Guide the Elderly
• New Theories Help Plaintiffs In Nursing Home Cases
• Article: "HCFA Publishes Managed Care rule with New Patient Protections"

Benefit Denial

Disabilities, including psychiatric disabilities, are controversial reasons for denial of health benefits or health insurance altogether.

• Dr. Bursztajn's letter to the editors of the New York Review of Books decrying premature denial of care in response to Richard Horton's, the editor of the Lancet, review of "In the Danger Zone" and Dr. Horton's response.
• Avoid Managed Care Benefit Denial
• Appeals Court Rules Health Insurers Can Be Sued Under Disabilities Act

Organizational Responsibility & Ethics

Under some circumstances, managed health care organizations are responsible for liability. The AMA also considers the plan medical director as a "physician first."

• Dr. Bursztajn's book Psychiatric Ethics and the Rights of Persons with Mental Disabilities in Institutions and the Community, co-written with with Michael Perlin, Kris Gledhill and Eva Szeli with many case studies contributed by several of his mentees who nominated him for the Barger Award below, was published on February 25, 2008 and is available for download at the UNESCO and the International Center for Health Law and Ethics at the University of Haifa websites. Physical copies of the book may be purchased by contacting the editor Amnon Carmi. All purchased copies will benefit the work of the International Center for Health Law and Ethics at the University of Haifa and will help them to continue their work in this vital area.
• Case: Petrovich v. Share Health Plan of Illinois Inc.
• Case: Tallahassee Memorial v. Cook "Medical Necessity Defined in Medicaid Case"
• Article: "Examples of Liability Claims Against Healthcare Organizations"Piam Quarterly Newsletter For Group Practices; Issue: Winter 1999
• Article: "Group Sues to Halt Kaiser Permanente Ads"
• Case: Nealy v. US Healthcare HMO: "Beyond ERISA: N.Y. Court Allows Negligent-Delay Suits Against HMOs." Medical Malpractice, April 1999.
• Article: "Physicians Awarded $22.8 Million After Losing Privilege"
• Article: "Troubled Adolescents Need A Double Safety Net"
• Mismanaged Care & Suicide CNN program which aired June 20 & 21, 1999.
• Article: "Series of Rulings Eases Constraints on Suing HMOs"
• Article: "HMO Charged with Racketeering"
• Article: "Medical Directors Are Physicians First"
• Article: "Justices Skeptical Over Suits Against H.M.O.'s and Bonuses" The Supreme Court considers fiduciary duties in managed care malpractice litigation: Beyond the skepticism regarding plaintiff's undue influence arguments there are the substantial separate issues of whether there is a duty by health care organizations to provide the insured with informed choices regarding potential conflicts as to their health care.
• Article: "Trends in the Prescribing of Psychotropic Medications to Preschoolers" Overmedication of preschoolers?
• Doe v. Doe. "Does an Organizational Merger Create A Potential Unmanageable Conflict of Interest?"

Organizational Influences on Clinical Decision Making

• Beautiful Minds Can Be Reclaimed offers hope and indicates the importance of early recognition of and treatment perseverance for those suffering from major mental illness. Dr. Bursztajn's Letter to the Editor, The New York Times, March 12, 2002.
• A Beautiful Mind. The Nobel Prize acceptance speech of the mathematician, John Nash, the protagonist of "A Beautiful Mind", is a good reminder that the lives of people suffering chronic mental illness are of value.
• Patient Choices "A New Health Plan May Raise Expenses for Sickest Workers", by Milt Freudenheim, The New York Times, 12.5.01. Possible health plan that would significantly change the way employees are reimbursed for ordinary medical expenses.
• Article: "Alleged HMO Control of Practice Through Deselection Process in Managed Health Care"
• Report: A Tale of Two Stories: Contrasting Views of Patient Safety
• Article: Dr. Bursztajn's article on Ethics and the Triage Model in Managed Care Hospital Psychiatry published in the Psychiatric Times, 1998.
• Medical Choices, Medical Chances: How Patients, Families, and Physicians Can Cope with Uncertainty

  A book written by Dr. Bursztajn and colleagues. A must-read for all who are interested in medicine and where it is headed in the new millennium; a practical guide for medical professionals. Ordering Information.

  • For a recent article dealing with several similar issues to Medical Choices, see this New York Times article, "Sleights of Mind." Links to the Basketball/Gorilla video and some clips from Association for the Scientific Study of Consciousness annual meeting mentioned in the article.
• Diabetes: Caring for Your Emotions as Well as Your Health. A book written by Jerry Edelwich and Archie Brodsky
• The Influence of MCO Formulary Restrictions on Clinical Practice: Written by Dr. Harold Bursztajn
• Article: "Major Mental Illness & Violence: Quick Fix vs. Commitment to Care"
• Article: "Toward Evidence-Based Medical Statistics. 1: The P Value Fallacy" Bayesian statistics in medical research and practice. Annals of Internal Medicine, 6-15-99.
• Article: "Managed Care Can Color Patient Advice"
• Editorial: Standing Statistics Right Side Up. An editorial which explains how all physicians are Bayesians. See also Dr. Bursztajn's classic text: Medical Choices, Medical Chances: How Patients, Families, and Physicians Can Cope With Uncertainty. Ordering Information
• Article: "Medical Directors Are Physicians First"
• Article: "UnitedHealth Move on Reviews Is Seen as Industry Watershed"
• Article: HMO Influence on Medical Decision Making: Creating Conflicts of Interest?

ERISA

According to the Pocket Guide to Managed Care, "The Employee Retirement Income Security Act (ERISA) is a federal law that governs the rights of employees to employer-sponsored pension and health benefits. It is supposed to protect patients by preempting state laws that regulate or tax employee benefits provided by employers. In theory, ERISA can protect managed care organizations that are sued for (a) Malpractice, (b) Refusal to pre authorize care, and (c) Denying payment through their utilization management process. In practice, ERISA's actual protection of MCOs is variable." (La Puma, J and D Schiedermayer, McGraw Hill,1996. pp 24-25)

• Article: ERISA Sidestepped in HMO Lawsuits = the trend for 1999!
• Article: "No ERISA Preemption for PA HMO"
• Article: "HMO Can Be Sued For Incentive Plan; No ERISA Preemption"

Political activity has also recently increased to address the need for patient protection.

• Article: "Patient Protection Resonates in State Legislatures"

Biotechnology

• Genetic Aspects in Personality Washington Post SCIENCE, July 22, 2002
• Case: Summary of the case, A.Z. vs. B.Z. Informed consent and in vitro fertilization.
• Article: Genes, Risk, and Managed Care Medicine
• Article: "Stressful Life Events, Genetic Liabiltiy, and Onset of an Episode of Major Depression in Women"
• Article: "Medicine's Rude Awakening to the Commercial World" Freedom of Information vs. Freedom of Innovation
• Article: "Celera Says It Is Willing to Share Publication of Gene-Mapping Data" Freedom of Information vs. Freedom of Innovation
• Article: "Back to the Future: Medicine and Our Genes"

  Genes & medical choices - on the importance of having the time to formulate a differential diagnosis, analyze in terms of probabilities rather than certainties, and to engage in an informed consent process rather than pro forma pro forma informed consent.

• Article: "Even Techies Are Getting Nervous About Technology" Unintended but forseeable consequences?
• Article: "Genes, Environment, and Mental Health Wellness" Genetics and behavior.
• Article: "Science, Medicine, and the Future: Genetic Epidemiology"
• Article: "Case at VCU Brings Ethics to Forefront" Genetics researchers who elicit family medical histories cautioned about informed consent
• Dr. Bursztajn's letter to the The New York Times: "Genes, Medicine, & Managed Care."
• Article: "Promotion of the Fittest"

  The new science of genetic screening is so precise that it might just give workplace discrimination a good name.

• Article: "Massachusetts Poised to OK Genetic Privacy Bill"
• Article: "Do the Dimensions of the Temperament and Character Inventory Map a Simple Genetic Architecture?" Evidence from Molecular Genetics and Factor Analysis.

Care for the Dying

Terminally ill patients are often denied certain kinds of medical treatment. While the process of dying is often depressing, such depression is rarely treated. Often, this depression leads to giving up on life rather than the desire to make one's last months feel worthwhile. There are serious ethical and medical considerations in regard to best practice treatment for the terminally ill.

Please read Reflections on My Father's Experiences with Doctors during the Shoah

• Harvard Medical Alumni Bulletin issue from Autumn 2006 titled "Sparks of Inspiration" includes the article "Presciptions for Hope". Lessons from the Holocaust in how doctors can heal through hope, an adaptation of Dr. Bursztajn's original article above.

Other articles by Dr. Bursztajn that are of interest in this area are:

• From PSDA to PTSD: The Patient Self-Determination Act and Post-Traumatic Stress Disorder, Journal of Clinical Ethics. 1993, Vol. 4 pp71-74.
• Authenticity and Autonomy in the Managed Care Era: Forensic Psychiatric Perspectives, Journal of Clinical Ethics. 1994, Vol. 5 pp237-242.
• Clear, Convincing, and Authentic Advance Directives in the Context of Managed Care? Journal of Clinical Ethics. 1994, Vol. 5 pp364-366

Privacy & Confidentiality

• Article: Protecting Privacy in the Behavioral Genetics Era. In view of the recent 97-0 vote in the Senate to protect genetic privacy and the timeliness of the issues around genetic privacy, Dr. Bursztajn's article published by the American Bar Association, Commission on Mental and Physical Disability Law, 2003 is of great interest and value.
• Article: "Sacred Secrets; The Privacy of Medical Records" by Charles A. Welch, M.D., Massachusetts General Hospital, Boston. Personal Medical Information is far from private in the United States. Published in New England Journal of Medicine, August, 2001.
• Article: "The Limits of State Laws to Protect Genetic Information" by George J. Annas, J.D., M.P.H. Protecting Personal DNA Information. Published in New England Journal of Medicine, August, 2001.
• Article: "Air Force Tracks Dumped Records" Dr. Bursztajn quoted in the The Tampa Tribune, July 16, 1999.
• Article: The Logic of Privacy. From The Economist print edition comes a new way to think about computing and personal information
• Article: "Long Reach Into Patients' Privacy"
• Article: "New Proposals for Privacy Laws Don't Protect Patients, Groups"
• Article: "State to Adopt Privacy Rules on Information From Insurers"
• The President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry
• Accountability without Health-Care Data Banks Letter to the Editor of Health Affairs regarding patient confidentiality and health-care databanks.
• "Threats to the Confidentiality of Medical Records: No Place to Hide"
• Article: "Uses and Abuses of Prescription Drug Information in Pharmacy Benefits Management Programs"
• Notice of Proposed Rule Making for Standards for Privacy of Individually Identifiable Health Information
• Case: Jaffee v. Redmond (95-266), 518 U.S. 1 (1996).
• Article: "Kaiser E-Mail Glitch Highlights Pitfalls of Placing Personal-Health Data Online"
• Free Prozac in the Junk Mail Draws a Lawsuit Ft. Lauderdale, FL, July 3, 2002 The New York Times. How privacy law applies to medical records used in marketing is an open question.
• Press Release: Health and Human Services Proposes Administrative Simplification Standards for Health Care Transactions

Some questions concerning a national healthcare database:

• How do we leave control in the hands of patients and allow for informed consent when data is entered into data bases?
• How do we prevent Managed Care Organizations (MCOs) from using databases for enrolling and disenrolling high quality health care providers [predatory profiling]?
• How do we protect patient confidentiality from employers, Americans with Disabilities Act (ADA) aside?
• Can patients access their own data?
• Can patients opt out from being included in data bases?
• How do we inform patients about the experimental nature of health care data bases in terms of potential negative impacts on patient health care?

Telemedicine

• The United States Department of Health and Human Services HIPAA website.
• Guidelines for Telemedicine, Confidentiality, & Informed Consent
• Dr. Bursztajn's Consultation to the American Psychiatric Association on Telemedicine
• The Forensic Psychiatric Home Page on the Web: The Intrapsychic, Interpersonal and Professional Dimensions
• Telepsychiatry: The Vision Emerges
• MedicineNet.com Since 1996, the MedicineNet.com Web site has provided in-depth, physician-reviewed medical information for consumers.

Interesting articles on Telemedicine:

• Article: Telemedicine Getting a Test in Efforts to Cut Costs of Treating Prisoners
• Article: Telemedicine : A State-Based Answer To Health Care in America
• Article: "Panel Examines Privacy Issues"
• Article: "Viagra Prescription Over the Internet"
• Article: "A Guide for Patients Who Turn to the Web"
• Report of the Board of Trustees Regarding Clinical Practice Guidelines and Clinical Quality Improvement Activities Resolution
• Article: "What To Look for in Web Privacy Practices"
• Article: "Physicians Now Face a Wealth of Clinical Information Online"

To obtain Telemedicine: An Overview of Applications and Barriers, contact: Physician Insurers Association of America, 2275 Research Boulevard, Suite 250, Rockville, MD 20850. (301) 947-9000.

Dr. Bursztajn has an active patient care practice and consults to physicians, institutions, judges, and plantiff and defense counsel nationally.