By Carl Hiaasen
chiaasen@MiamiHerald.com
Among South Florida's fearless Medicare rip-offs -- and there are thousands -- is the story of Guillermo Denis Gonzalez.
After serving 14 years in prison for murdering a man with a silencer-equipped handgun, Gonzalez decided in 2006 to try the medical supply business.
For $18,000, the Hialeah resident bought a Medicare-licensed company called DG Medical Equipment and within a year he'd submitted $586,953 in false claims for supplies that were never provided to patients.
Medicare, using federal tax dollars, reimbursed Gonzalez $31,442 before he was tracked down and arrested.
Last summer, after pleading guilty to defrauding the government, Gonzalez was marched over to state court to face another murder charge -- this one for allegedly stabbing and dismembering an acquaintance during a monetary dispute. He is scheduled to go on trial next month.
No one familiar with Florida was surprised to learn that a murderer had been welcomed into the health-care trades. Indeed, the most shocking thing about the Gonzalez case was that Medicare hadn't forked over the full half-a-million bucks in bogus claims that he'd sought.
South Florida remains the Deepwater Horizon of Medicare corruption in the United States, and the gusher is getting worse. No other place even comes close to matching the number of crooked health-care businesses, or the immense dollar amounts that wind up in the pockets of criminals.
While overworked prosecutors crack down on operators like Gonzalez, the latest wave of Medicare cheats is specializing in fictional billing for mental health services, rehab sessions and physical therapy.
As Jay Weaver reported in The Miami Herald last week, mental health clinics in Florida billed Medicare for $421 million in 2009. That's four times more than was billed during the same period by mental health clinics in Texas, and 635 times more than was billed by clinics in Michigan.
As crazy and depressed as Floridians can be, there's no way that we're four times crazier than Texans, or 635 times more depressed than Michiganders.
The only plausible explanation for such a staggering discrepancy in mental-health claims is stealing -- thieves in Florida are simply more adept at fleecing Medicare.
Our dubious distinction as the sleazebag capital of America brought Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius to Miami last week for the first-ever national summit on healthcare fraud.
It wasn't quite as flashy or upbeat as the LeBron James-Chris Bosh-Dwyane Wade summit at the American Airlines Arena, but the mission is nonetheless worthy of attention.
Medicare is the biggest drain on the federal budget, and epidemic fraud is the biggest drain on Medicare. Most older Americans depend on the program to cover many health-care expenses, but the system is sagging and bloated.
Experts say Medicare fraud in South Florida costs U.S. taxpayers between $3 billion and $4 billion annually. It's predictable that Miami-Dade, Broward and Palm Beach counties would be the hotbed, and also the venue for one of every three federal healthcare fraud prosecutions.
Part of the problem is that Medicare pays claims first, then asks questions later. That leaves criminals with a time gap that often allows them to bank the money, shut down their storefronts and scurry on before they get caught.
In 2008, Medicare paid $520 million to home healthcare agencies in Miami-Dade, just for treating diabetic patients. That was more money than the agency spent on that particular illness throughout the rest of the country combined.
The feds then changed the rules and put a cap on claims for homebound patients receiving insulin injections. The scammers simply turned their energies toward other exploitable areas -- in particular, mental health and physical therapy treatments.
Records show that Florida rehabilitation facilities billed $171 million to Medicare last year for physical and occupational services, which was 23 times more than California and 26 times more than New York -- two other states with no shortage of fraud artists.
For years, the Justice Department has been locking up Medicare fraudsters in Florida, yet business is booming. More FBI agents and prosecutors would help, but you'd need an army of them to dismantle all the bogus Medicare operations in South Florida.
Despite all the individuals indicted, including 94 nationwide on Friday, the risk of getting nabbed for Medicare fraud remains relatively small, and the potential profits from the crime remain large.
That's why health-care is such an appealing career move for local felons, even the occasional murderer. Why use a gun when you can make lots more money with a pencil?
Read more: http://www.miamiherald.com/2010/07/17/1735272/medicare-corruption-gusher-worsens.html#ixzz0u38EiK5F
Comment
You want to start hiring people? THIS is the place to start - prosecutors, judges, investigators, prison guards, prison construction people, etc. Billions can be saved by hiring some knowledgable IT guys to discover these scams earlier.
Sunday, July 18, 2010
Wednesday, July 7, 2010
Bang for the Bite - AARP
Seven Foods to Keep You Young
The fountain of youth in your grocery cart
by: Peter Jaret | from: AARP The Magazine | October 2009
Recommend (59) Comments (3)ShareThisPrint
Enlarge
Credit: Julia Sander/Getty Images
Related
50 Healthy Foods That Cost Less Than $1 Per Pound. Read
The Dentist's Preferred Food List. Listen
Grading Aphrodisiacs: Frisky Foods That Get You in the Mood. Read
10 Foods that Fight Off the Flu. Watch
Are Fresh Vegetables Better than Frozen? Read
1. Olive oil
Four decades ago, researchers from the Seven Countries Study concluded that the monounsaturated fats in olive oil were largely responsible for the low rates of heart disease and cancer on the Greek island of Crete. Now we know that olive oil also contains polyphenols, powerful antioxidants that may help prevent age-related diseases.
2. Yogurt
In the 1970s, Soviet Georgia was rumored to have more centenarians per capita than any other country. Reports at the time claimed that the secret of their long lives was yogurt, a food ubiquitous in their diets. While the age-defying powers of yogurt never have been proved directly, yogurt is rich in calcium, which helps stave off osteoporosis and contains "good bacteria" that help maintain gut health and diminish the incidence of age-related intestinal illness.
3. Fish
Thirty years ago, researchers began to study why the native Inuits of Alaska were remarkably free of heart disease. The reason, scientists now think, is the extraordinary amount of fish they consume. Fish is an abundant source of omega-3 fats, which help prevent cholesterol buildup in arteries and protect against abnormal heart rhythms.
4. Chocolate
The Kuna people of the San Blas islands, off the coast of Panama, have a rate of heart disease that is nine times less than that of mainland Panamanians. The reason? The Kuna drink plenty of a beverage made with generous proportions of cocoa, which is unusually rich in flavanols that help preserve the healthy function of blood vessels. Maintaining youthful blood vessels lowers risk of high blood pressure, type 2 diabetes, kidney disease and dementia.
5. Nuts
Studies of Seventh-Day Adventists (a religious denomination that emphasizes healthy living and a vegetarian diet) show that those who eat nuts gain, on average, an extra two and a half years. Nuts are rich sources of unsaturated fats, so they offer benefits similar to those associated with olive oil. They’re also concentrated sources of vitamins, minerals and other phytochemicals, including antioxidants.
6. Wine
Drinking alcohol in moderation protects against heart disease, diabetes and age-related memory loss. Any kind of alcoholic beverage seems to provide such benefits, but red wine has been the focus of much of the research. Red wine contains resveratrol, a compound that likely contributes to its benefits—and, according to animal studies, may activate genes that slow cellular aging.
7. Blueberries
In a landmark study published in 1999, researchers at Tufts University’s Jean Mayer Human Nutrition Research Center on Aging fed rats blueberry extract for a period of time that in "rat lives" is equivalent to 10 human years. These rats outperformed rats fed regular chow on tests of balance and coordination when they reached old age. Compounds in blueberries (and other berries) mitigate inflammation and oxidative damage, which are associated with age-related deficits in memory and motor function.
The fountain of youth in your grocery cart
by: Peter Jaret | from: AARP The Magazine | October 2009
Recommend (59) Comments (3)ShareThisPrint
Enlarge
Credit: Julia Sander/Getty Images
Related
50 Healthy Foods That Cost Less Than $1 Per Pound. Read
The Dentist's Preferred Food List. Listen
Grading Aphrodisiacs: Frisky Foods That Get You in the Mood. Read
10 Foods that Fight Off the Flu. Watch
Are Fresh Vegetables Better than Frozen? Read
1. Olive oil
Four decades ago, researchers from the Seven Countries Study concluded that the monounsaturated fats in olive oil were largely responsible for the low rates of heart disease and cancer on the Greek island of Crete. Now we know that olive oil also contains polyphenols, powerful antioxidants that may help prevent age-related diseases.
2. Yogurt
In the 1970s, Soviet Georgia was rumored to have more centenarians per capita than any other country. Reports at the time claimed that the secret of their long lives was yogurt, a food ubiquitous in their diets. While the age-defying powers of yogurt never have been proved directly, yogurt is rich in calcium, which helps stave off osteoporosis and contains "good bacteria" that help maintain gut health and diminish the incidence of age-related intestinal illness.
3. Fish
Thirty years ago, researchers began to study why the native Inuits of Alaska were remarkably free of heart disease. The reason, scientists now think, is the extraordinary amount of fish they consume. Fish is an abundant source of omega-3 fats, which help prevent cholesterol buildup in arteries and protect against abnormal heart rhythms.
4. Chocolate
The Kuna people of the San Blas islands, off the coast of Panama, have a rate of heart disease that is nine times less than that of mainland Panamanians. The reason? The Kuna drink plenty of a beverage made with generous proportions of cocoa, which is unusually rich in flavanols that help preserve the healthy function of blood vessels. Maintaining youthful blood vessels lowers risk of high blood pressure, type 2 diabetes, kidney disease and dementia.
5. Nuts
Studies of Seventh-Day Adventists (a religious denomination that emphasizes healthy living and a vegetarian diet) show that those who eat nuts gain, on average, an extra two and a half years. Nuts are rich sources of unsaturated fats, so they offer benefits similar to those associated with olive oil. They’re also concentrated sources of vitamins, minerals and other phytochemicals, including antioxidants.
6. Wine
Drinking alcohol in moderation protects against heart disease, diabetes and age-related memory loss. Any kind of alcoholic beverage seems to provide such benefits, but red wine has been the focus of much of the research. Red wine contains resveratrol, a compound that likely contributes to its benefits—and, according to animal studies, may activate genes that slow cellular aging.
7. Blueberries
In a landmark study published in 1999, researchers at Tufts University’s Jean Mayer Human Nutrition Research Center on Aging fed rats blueberry extract for a period of time that in "rat lives" is equivalent to 10 human years. These rats outperformed rats fed regular chow on tests of balance and coordination when they reached old age. Compounds in blueberries (and other berries) mitigate inflammation and oxidative damage, which are associated with age-related deficits in memory and motor function.
Tuesday, July 6, 2010
Medical records go online, but at what cost to privacy?
Allison Grisham learns how to navigate her medical records with help from Dr. David Seo, a cardiologist at University of Miami Miller School of Medicine.
MARICE COHN BAND / MIAMI HERALD STAFF
In online medical records, worries about privacy breaches
BY FRED TASKER
ftasker@MiamiHerald.com
You're a South Florida resident on vacation in Boise or Bogotá. You suffer stomach pains and visit a local doctor. You whip out your BlackBerry, punch in your access code and show the doctor a list of your medications, allergies, past illnesses, tests, surgeries and advice from your physician back home.
Electronic medical records, or EMRs, are quickly becoming a reality for doctors and hospitals in South Florida and beyond.
If EMRs work, they'll be high-tech marvels -- letting patients access their own medical records on their home computers, helping doctors coordinate tests with each other to avoid duplication, giving medical researchers access to millions of medical records.
Nearly every major South Florida hospital and many doctors are joining a push by the Obama administration to spend $19.2 billion in federal stimulus money to help create a national EMR system by 2014.
Allison Grisham of Miami Beach just got her own EMR from her doctor at University of Miami Hospital, which is spending $100 million on a new Epic brand system. She hopes it can help end medical errors like one she barely avoided a few years ago.
``I was in a hospital once and the nurse tried to give me the wrong medication. We only stopped it because my mother and I refused to let her put it in the IV,'' she said. ``It could have been serious.''
There are drawbacks. Patient advocates worry that EMRs could pose a threat to privacy. Doctors and hospitals say they're not being given enough time to set up the complex electronic systems or enough financial help to pay for them. The systems can cost $50 million to $100 million for hospitals and $15,000 to $50,000 for private doctors.
But the potential pluses outweigh those complaints, many doctors and hospitals believe. The new systems are voluntary, but federal financial incentives for using them and penalties for failing to do so have most medical officials at least resigned to making the change.
Here's what else EMRs will do:
You're a university medical researcher and you suspect a popular diabetes drug is causing heart problems. On your PC, you study the records -- with patient permission, and without their names -- of all the millions of people taking the suspect drug and compare them to those who aren't.
``A researcher could access the records of nearly every patient in the country and solve problems quickly,'' said Dr. Pascal Goldschmidt, dean of the UM Medical School.
Or you're a hospital CEO, and EMRs help you communicate better and faster with other hospitals and doctors around the country -- something most hospitals can't do today even if they have older, simpler electronic medical records.
DUPLICATION
``That would eliminate a lot of duplication,'' said Linda Quick, president of the South Florida Hospital & Healthcare Association. She cited an example: an acquaintance had an EKG from his private doctor, was sent to the hospital next door for follow-up and was given another EKG 90 minutes later.
``Patients will take control of their own records. Exchange of information will be very fluid,'' said Tom Gomez, head of a Florida International University initiative promoting hospital information sharing.
``When we have the whole system, it will be as easy as using an ATM card,'' said Quick.
Still, experts predict years of hard work getting all the new EMR systems -- Epic, Cerner, Seimens and other brands -- to communicate with each other.
``This is going to be complicated,'' says Gomez. ``And we're in the very early stages. It's probably 10 years away.'' There are problems. Private doctors, especially in small practices, say they lack the money and technical staff to implement EMRs -- buying computers, hiring techs to run and repair them, taking time for the training to operate them.
``It's the wave of the future, fortunately or unfortunately,'' says Dr. Tony Prieto, a sole-practitioner family medicine physician in Plantation. ``I agree it's needed. I'm not saying I can afford it.''
Even some big hospitals say the program is moving too fast.
``The goal is noble, but the timeline is unrealistic,'' said Mimi Taylor, Baptist Health South Florida's vice president for IT. ``You have to give hospitals time to do it right.''
Baptist Health's six-hospital, 2,000-doctor system will spend $96 million by 2013 to install a Siemens Soarian system to meet the new federal requirements. An informal Miami Herald survey of 26 South Florida hospitals found every one is putting in a new system or upgrading an old one. In addition to UM Hospital and Baptist Health, hospitals installing new or upgraded systems include Broward's six-hospital Memorial Healthcare System, Tenet's 10-hospital chain, Miami Children's Hospital and Mount Sinai Medical Center.
At UM Hospital, six clinics already have begun offering patients a personal electronic medical record called MyUHealthChart. By July, all clinics on the Miller School campus are to have them. By December, patients will be able to schedule appointments and pay their bills electronically. Even Jackson Health System, with its financial woes, is upgrading its current Cerner EMR system as part of the federal push.
``We have to do it to remain competitive,'' said Fernando Martinez, Jackson's chief information officer.
The Obama administration is using both carrots and sticks to persuade hospitals and doctors to put in EMRs. The president set aside $19.2 billion from the American Recovery and Reinvestment Act of 2009 to subsidize the systems. Doctors who start implementing EMRs by 2011 can get up to $44,000 in extra reimbursements from Medicare or $63,000 from Medicaid.
REIMBURSEMENTS
Hospitals will get bigger reimbursements, although their financial officers can't say how much yet. Local administrators estimate federal subsidies will repay 20 percent to 50 percent of the cost of an EMR system.
The problem, said Prieto, the Plantation physician, is that the expense is up front for the EMR system, but the reimbursement is after the fact.
``I have 26,000 patient charts. I can't imagine what that will cost me.''
The reimbursement ``won't even be close'' to the expense, he said.
``If you're a solo practitioner, you have to go out and buy a new system and educate your staff to use it,'' said Cynthia Peterson, head of the Broward Medical Association. The stick: Doctors and hospitals that don't comply by 2015 will see their Medicare and Medicaid payments reduced by 1 percent in 2015, 2 percent in 2016 and 3 percent in subsequent years.
A Congressional Budget Office report predicts 90 percent of hospitals and doctors will have EMRs by 2019.
Join the discussion
The Miami Herald is pleased to provide this opportunity to share information, experiences and observations about what's in the news. Some of the comments may be reprinted elsewhere in the site or in the newspaper. We encourage lively, open debate on the issues of the day, and ask that you refrain from profanity, hate speech, personal comments and remarks that are off point. In order to post comments, you must be a registered user of MiamiHerald.com. Your username will show along with the comments you post. Thank you for taking the time to offer your thoughts.
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doc77 wrote on 07/06/2010 07:34:25 PM:
who cares? now is too late. EMR's are like HMO's, are here to stay. Did you know that a close friend of our president owns an EMR company in Chicago?
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lenny1 wrote on 07/06/2010 06:40:52 PM:
A friend, who is now retired from medical practise, was also my physician. When he closed down his practice, he had to keep medical files for years. (I think he kept them 10 years, but it was much longer than he required to). When he gave me my medical files, I was advised that most patients are not aware of the actual ownership of those records. They are your records, and if a doctor wants, he can make another copy of them for himself. Still, it is a leap of faith that things will turn out as intended. Wherever there is new technology, there are also opportunities for poorly intended people.
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Vinmoe6878 wrote on 07/06/2010 05:37:11 PM:
I was just informed by my old insurance company that they had two computers stolen and my whole families personal information was on them........
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MedSecurityGuru wrote on 07/06/2010 02:28:34 PM:
Replying to BHarrison (07/06/2010 01:31:53 PM):
"And once yourmedical records go on-line, the insurance companies will wind up (legally or illegally) having the information to decline coverage based upon "prior existing conditions".
As most people are now coming to realize, the NHC - national Health Care program is NOT going to reduce...":@BHarrison....Don't confuse the Electronic Health Care (EHR) issue with NHC...the two are not related.
The correct use of EHR could actually help lower the cost of any healthcare plan.
Putting EHR's on the Internet does not mean that they are open for all to see. That is why I said in my original statement that security of medical records is paramount. You will see a lot of "Mom and Pop" data centers popping up, so doctors need someone to help they work through that quagmire.
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BHarrison wrote on 07/06/2010 01:31:53 PM:
And once yourmedical records go on-line, the insurance companies will wind up (legally or illegally) having the information to decline coverage based upon "prior existing conditions".
As most people are now coming to realize, the NHC - national Health Care program is NOT going to reduce costs; but it IS going to reduce the quality of care. The reality of the NHC is it is a political farce, in an election year, to penalize the vast majority of Americans to subsidize the health care for the poor and indiginat, who wre receing care under government or tax subsidized services (for the services that they received but did not pay for).
The vast, VAST MAJORITY of Americans re NOT going to benefit from the NHC programs ... we're all just going to pay more for health care. Meanwhile the Federal government ahve failed to regulate and to rein in the exorbitant profits of the pharmaceutical and medical insurance industries, who have realized respective profit margins of 25% (Phar. Ind.) and 5% to 6% (insurance ind.). They are allowing these industries to continue to exploit the American people. Where is the common sense in any of this?
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MedSecurityGuru wrote on 07/06/2010 01:14:09 PM:
EHR's have been around for several years. Some are good and some not so good. Doctors now have to face the task of deciding which one is right for me AND has it met the requirements set forth by the Department of Health and Human Services? Right now there over 9,000 different makes of EHR software.
Also how does this EHR software handle medical imaging and files from support groups like labs, etc?
Now lets add something else to consider. Does the data center in which I store my medical records have the right level of security to house and share medical records. All Data Centers are not created equal!
Does the data center have redundant engress and egress so that should the need arise the record might be shared with two or more physicians?
If you don't know what to ask and can't decipher what someone tells you, you need to ask someone who knows the answers.
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CooperCity wrote on 07/06/2010 11:53:06 AM:
Information sharing is the way to go. Accessing any sensitive information by mobile devices is a very bad idea. It should only be done with wired computers with great firewalls. You think doctors will spend the money to safeguard your personal info? Think again.
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brainsprain wrote on 07/06/2010 11:07:39 AM:
The positives outweigh the negatives. Yes, it is expensive, but how expensive is it for a nurse, clerk whatever to sit and ask the same questions over and over again because one happens to be in a different doctors office or hospital. Faxing is also quite expensive as is shipping. The conflicts in systems could be easily overcome, look at all the info that is available online because the info is web based in some way or the other.
The medical folk at the top want not only to protect my privacy, they want to hold the information as if were theirs. That is the only reason these various companies cannot set up the systems to interact fluidly. It's the money.
As for privacy, most of our information that should be private is not. Do I really care that the world knows I had a physical or was treated for cancer. Oh, that's right the insurance company may raise my rate or exclude me for a condition. Solution was Obama Care that makes it illegal for them to do so. All one needs to do is check their credit rating and they discover that what we need kept private most (financial info) is available to any Joe or Jill who will pay for it. They don't even need our permission.
We can protect our medical privacy far more easily than we can protect our financial, our tax returns or retirement fund accounts if the system is set up right.
But no system is flawless. At this point anyone who wants can view your medical records just by going into a doctor's office. There is always a way.
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shotman wrote on 07/06/2010 10:15:01 AM:
This won't reduce costs. Take the EKG example, even though it was done 90 minutes earlier in a doctor's office, an EKG is a point in time look at the heart's electrical system and if there is a change in condition, it should be repeated. Plus hospitals won't take the risk of a lawsuit to save the cost of an EKG. They don't know if the doctor's office EKG is calibrated or working correctly. Also do you think that EKG was inputted into the EMR immediately? No doctor's offices take days or even weeks for them to be entered. Same goes for lab work.
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andrejk wrote on 07/06/2010 09:38:55 AM:
Damocles sword. Wow-- few controversies with so many obvious and profound pros and cons at the same time. The potential abuse of privacy is huge. On the other hand, the convenience, efficiencies and research potential and long run savings are fantastic. Obviously, we'll have to take the plunge at some point. Since we are doing this, what dismays me is the shocking fact that there are multiple systems?! I think the AMA and the CDC and the insurance companies should take this transitional opportunnity to MANDATE highly detaile dand STANDARDIZED medical record forms for EVERYTHING. An invoice, report, or record from hospital in Fairbankis should look EXACTLY the same as one from Key West down to the dianosis and billing codes and font type
.
Read more: http://www.miamiherald.com/2010/07/06/v-fullstory/1716657/medical-records-go-online-but.html#ixzz0sxGDhRMo
MARICE COHN BAND / MIAMI HERALD STAFF
In online medical records, worries about privacy breaches
BY FRED TASKER
ftasker@MiamiHerald.com
You're a South Florida resident on vacation in Boise or Bogotá. You suffer stomach pains and visit a local doctor. You whip out your BlackBerry, punch in your access code and show the doctor a list of your medications, allergies, past illnesses, tests, surgeries and advice from your physician back home.
Electronic medical records, or EMRs, are quickly becoming a reality for doctors and hospitals in South Florida and beyond.
If EMRs work, they'll be high-tech marvels -- letting patients access their own medical records on their home computers, helping doctors coordinate tests with each other to avoid duplication, giving medical researchers access to millions of medical records.
Nearly every major South Florida hospital and many doctors are joining a push by the Obama administration to spend $19.2 billion in federal stimulus money to help create a national EMR system by 2014.
Allison Grisham of Miami Beach just got her own EMR from her doctor at University of Miami Hospital, which is spending $100 million on a new Epic brand system. She hopes it can help end medical errors like one she barely avoided a few years ago.
``I was in a hospital once and the nurse tried to give me the wrong medication. We only stopped it because my mother and I refused to let her put it in the IV,'' she said. ``It could have been serious.''
There are drawbacks. Patient advocates worry that EMRs could pose a threat to privacy. Doctors and hospitals say they're not being given enough time to set up the complex electronic systems or enough financial help to pay for them. The systems can cost $50 million to $100 million for hospitals and $15,000 to $50,000 for private doctors.
But the potential pluses outweigh those complaints, many doctors and hospitals believe. The new systems are voluntary, but federal financial incentives for using them and penalties for failing to do so have most medical officials at least resigned to making the change.
Here's what else EMRs will do:
You're a university medical researcher and you suspect a popular diabetes drug is causing heart problems. On your PC, you study the records -- with patient permission, and without their names -- of all the millions of people taking the suspect drug and compare them to those who aren't.
``A researcher could access the records of nearly every patient in the country and solve problems quickly,'' said Dr. Pascal Goldschmidt, dean of the UM Medical School.
Or you're a hospital CEO, and EMRs help you communicate better and faster with other hospitals and doctors around the country -- something most hospitals can't do today even if they have older, simpler electronic medical records.
DUPLICATION
``That would eliminate a lot of duplication,'' said Linda Quick, president of the South Florida Hospital & Healthcare Association. She cited an example: an acquaintance had an EKG from his private doctor, was sent to the hospital next door for follow-up and was given another EKG 90 minutes later.
``Patients will take control of their own records. Exchange of information will be very fluid,'' said Tom Gomez, head of a Florida International University initiative promoting hospital information sharing.
``When we have the whole system, it will be as easy as using an ATM card,'' said Quick.
Still, experts predict years of hard work getting all the new EMR systems -- Epic, Cerner, Seimens and other brands -- to communicate with each other.
``This is going to be complicated,'' says Gomez. ``And we're in the very early stages. It's probably 10 years away.'' There are problems. Private doctors, especially in small practices, say they lack the money and technical staff to implement EMRs -- buying computers, hiring techs to run and repair them, taking time for the training to operate them.
``It's the wave of the future, fortunately or unfortunately,'' says Dr. Tony Prieto, a sole-practitioner family medicine physician in Plantation. ``I agree it's needed. I'm not saying I can afford it.''
Even some big hospitals say the program is moving too fast.
``The goal is noble, but the timeline is unrealistic,'' said Mimi Taylor, Baptist Health South Florida's vice president for IT. ``You have to give hospitals time to do it right.''
Baptist Health's six-hospital, 2,000-doctor system will spend $96 million by 2013 to install a Siemens Soarian system to meet the new federal requirements. An informal Miami Herald survey of 26 South Florida hospitals found every one is putting in a new system or upgrading an old one. In addition to UM Hospital and Baptist Health, hospitals installing new or upgraded systems include Broward's six-hospital Memorial Healthcare System, Tenet's 10-hospital chain, Miami Children's Hospital and Mount Sinai Medical Center.
At UM Hospital, six clinics already have begun offering patients a personal electronic medical record called MyUHealthChart. By July, all clinics on the Miller School campus are to have them. By December, patients will be able to schedule appointments and pay their bills electronically. Even Jackson Health System, with its financial woes, is upgrading its current Cerner EMR system as part of the federal push.
``We have to do it to remain competitive,'' said Fernando Martinez, Jackson's chief information officer.
The Obama administration is using both carrots and sticks to persuade hospitals and doctors to put in EMRs. The president set aside $19.2 billion from the American Recovery and Reinvestment Act of 2009 to subsidize the systems. Doctors who start implementing EMRs by 2011 can get up to $44,000 in extra reimbursements from Medicare or $63,000 from Medicaid.
REIMBURSEMENTS
Hospitals will get bigger reimbursements, although their financial officers can't say how much yet. Local administrators estimate federal subsidies will repay 20 percent to 50 percent of the cost of an EMR system.
The problem, said Prieto, the Plantation physician, is that the expense is up front for the EMR system, but the reimbursement is after the fact.
``I have 26,000 patient charts. I can't imagine what that will cost me.''
The reimbursement ``won't even be close'' to the expense, he said.
``If you're a solo practitioner, you have to go out and buy a new system and educate your staff to use it,'' said Cynthia Peterson, head of the Broward Medical Association. The stick: Doctors and hospitals that don't comply by 2015 will see their Medicare and Medicaid payments reduced by 1 percent in 2015, 2 percent in 2016 and 3 percent in subsequent years.
A Congressional Budget Office report predicts 90 percent of hospitals and doctors will have EMRs by 2019.
Join the discussion
The Miami Herald is pleased to provide this opportunity to share information, experiences and observations about what's in the news. Some of the comments may be reprinted elsewhere in the site or in the newspaper. We encourage lively, open debate on the issues of the day, and ask that you refrain from profanity, hate speech, personal comments and remarks that are off point. In order to post comments, you must be a registered user of MiamiHerald.com. Your username will show along with the comments you post. Thank you for taking the time to offer your thoughts.
Comments (12)
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Comments: 12 Showing: Oldest first Newest first Most-recommended first Least-recommended first
doc77 wrote on 07/06/2010 07:34:25 PM:
who cares? now is too late. EMR's are like HMO's, are here to stay. Did you know that a close friend of our president owns an EMR company in Chicago?
Reply to this Comment Recommend (0) Report abuse
lenny1 wrote on 07/06/2010 06:40:52 PM:
A friend, who is now retired from medical practise, was also my physician. When he closed down his practice, he had to keep medical files for years. (I think he kept them 10 years, but it was much longer than he required to). When he gave me my medical files, I was advised that most patients are not aware of the actual ownership of those records. They are your records, and if a doctor wants, he can make another copy of them for himself. Still, it is a leap of faith that things will turn out as intended. Wherever there is new technology, there are also opportunities for poorly intended people.
Reply to this Comment Recommend (0) Report abuse
Vinmoe6878 wrote on 07/06/2010 05:37:11 PM:
I was just informed by my old insurance company that they had two computers stolen and my whole families personal information was on them........
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MedSecurityGuru wrote on 07/06/2010 02:28:34 PM:
Replying to BHarrison (07/06/2010 01:31:53 PM):
"And once yourmedical records go on-line, the insurance companies will wind up (legally or illegally) having the information to decline coverage based upon "prior existing conditions".
As most people are now coming to realize, the NHC - national Health Care program is NOT going to reduce...":@BHarrison....Don't confuse the Electronic Health Care (EHR) issue with NHC...the two are not related.
The correct use of EHR could actually help lower the cost of any healthcare plan.
Putting EHR's on the Internet does not mean that they are open for all to see. That is why I said in my original statement that security of medical records is paramount. You will see a lot of "Mom and Pop" data centers popping up, so doctors need someone to help they work through that quagmire.
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BHarrison wrote on 07/06/2010 01:31:53 PM:
And once yourmedical records go on-line, the insurance companies will wind up (legally or illegally) having the information to decline coverage based upon "prior existing conditions".
As most people are now coming to realize, the NHC - national Health Care program is NOT going to reduce costs; but it IS going to reduce the quality of care. The reality of the NHC is it is a political farce, in an election year, to penalize the vast majority of Americans to subsidize the health care for the poor and indiginat, who wre receing care under government or tax subsidized services (for the services that they received but did not pay for).
The vast, VAST MAJORITY of Americans re NOT going to benefit from the NHC programs ... we're all just going to pay more for health care. Meanwhile the Federal government ahve failed to regulate and to rein in the exorbitant profits of the pharmaceutical and medical insurance industries, who have realized respective profit margins of 25% (Phar. Ind.) and 5% to 6% (insurance ind.). They are allowing these industries to continue to exploit the American people. Where is the common sense in any of this?
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MedSecurityGuru wrote on 07/06/2010 01:14:09 PM:
EHR's have been around for several years. Some are good and some not so good. Doctors now have to face the task of deciding which one is right for me AND has it met the requirements set forth by the Department of Health and Human Services? Right now there over 9,000 different makes of EHR software.
Also how does this EHR software handle medical imaging and files from support groups like labs, etc?
Now lets add something else to consider. Does the data center in which I store my medical records have the right level of security to house and share medical records. All Data Centers are not created equal!
Does the data center have redundant engress and egress so that should the need arise the record might be shared with two or more physicians?
If you don't know what to ask and can't decipher what someone tells you, you need to ask someone who knows the answers.
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CooperCity wrote on 07/06/2010 11:53:06 AM:
Information sharing is the way to go. Accessing any sensitive information by mobile devices is a very bad idea. It should only be done with wired computers with great firewalls. You think doctors will spend the money to safeguard your personal info? Think again.
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brainsprain wrote on 07/06/2010 11:07:39 AM:
The positives outweigh the negatives. Yes, it is expensive, but how expensive is it for a nurse, clerk whatever to sit and ask the same questions over and over again because one happens to be in a different doctors office or hospital. Faxing is also quite expensive as is shipping. The conflicts in systems could be easily overcome, look at all the info that is available online because the info is web based in some way or the other.
The medical folk at the top want not only to protect my privacy, they want to hold the information as if were theirs. That is the only reason these various companies cannot set up the systems to interact fluidly. It's the money.
As for privacy, most of our information that should be private is not. Do I really care that the world knows I had a physical or was treated for cancer. Oh, that's right the insurance company may raise my rate or exclude me for a condition. Solution was Obama Care that makes it illegal for them to do so. All one needs to do is check their credit rating and they discover that what we need kept private most (financial info) is available to any Joe or Jill who will pay for it. They don't even need our permission.
We can protect our medical privacy far more easily than we can protect our financial, our tax returns or retirement fund accounts if the system is set up right.
But no system is flawless. At this point anyone who wants can view your medical records just by going into a doctor's office. There is always a way.
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shotman wrote on 07/06/2010 10:15:01 AM:
This won't reduce costs. Take the EKG example, even though it was done 90 minutes earlier in a doctor's office, an EKG is a point in time look at the heart's electrical system and if there is a change in condition, it should be repeated. Plus hospitals won't take the risk of a lawsuit to save the cost of an EKG. They don't know if the doctor's office EKG is calibrated or working correctly. Also do you think that EKG was inputted into the EMR immediately? No doctor's offices take days or even weeks for them to be entered. Same goes for lab work.
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andrejk wrote on 07/06/2010 09:38:55 AM:
Damocles sword. Wow-- few controversies with so many obvious and profound pros and cons at the same time. The potential abuse of privacy is huge. On the other hand, the convenience, efficiencies and research potential and long run savings are fantastic. Obviously, we'll have to take the plunge at some point. Since we are doing this, what dismays me is the shocking fact that there are multiple systems?! I think the AMA and the CDC and the insurance companies should take this transitional opportunnity to MANDATE highly detaile dand STANDARDIZED medical record forms for EVERYTHING. An invoice, report, or record from hospital in Fairbankis should look EXACTLY the same as one from Key West down to the dianosis and billing codes and font type
.
Read more: http://www.miamiherald.com/2010/07/06/v-fullstory/1716657/medical-records-go-online-but.html#ixzz0sxGDhRMo
Wednesday, June 30, 2010
Unemployment Benefits Become Fraying Safety Net
Jun 30, 2010 8:41 pm US/Eastern
Reporting
Michael Williams
E-mail MIAMI (CBS4) ―
File: Rashad Ingraham (L-R) William Haselberger, Dietrick Purvis and Carlos Estevez, all unemployed, look for a job at the Diversity Job Fair on Sept. 24, 2009, in Davie, Fla.
Joe Raedle/Getty Images
The unemployment rate hovers around 12 percent in Miami-Dade and Broward. That means misery for tens of thousands of people, and it is now compounded by a cutoff of federal unemployment benefits. The House has approved an extension of those benefits and Senate Democrats vow to press for a vote on the $34 billion dollar proposal Thursday.
Republican deficit hawks may block the way though, and people like Teresa Miranda are not sure what they will do next. She lost her accounting office job last summer in the Miami area, and her $1100 a month unemployment check stopped coming in a few weeks ago.
A tearful Miranda told CBS4 News, "The unemployment quit and I don't know what to do. I have nothing, savings are exhausted, no money for rent in July."
Miranda also has a message for the U.S. Senate, where fierce debate over balancing jobless benefits against budget deficit worries has stalled any extension of unemployment compensation. Miranda argued, "The Senate better open your eyes and realize what you are doing to us. We elected you to help us. I don't see what you are doing for us."
Miranda is single, with two adult sons who are on their own now and facing their own job struggles. She counts on donated food twice a month from a local church to help her get by.
"I'm an American, I was born in this country," she said. "I feel belittled to have to come here to have to get food to live to eat. It is embarrassing to me."
It is embarrassing but necessary, especially when every job Miranda seeks is packed with desperate people. She said, "When you do go, there are 150 applicants."
And so, for now at least, Miranda lives on the charity of others and relies on her faith for a journey she never imagined, and one with no end in sight.
Reporting
Michael Williams
E-mail MIAMI (CBS4) ―
File: Rashad Ingraham (L-R) William Haselberger, Dietrick Purvis and Carlos Estevez, all unemployed, look for a job at the Diversity Job Fair on Sept. 24, 2009, in Davie, Fla.
Joe Raedle/Getty Images
The unemployment rate hovers around 12 percent in Miami-Dade and Broward. That means misery for tens of thousands of people, and it is now compounded by a cutoff of federal unemployment benefits. The House has approved an extension of those benefits and Senate Democrats vow to press for a vote on the $34 billion dollar proposal Thursday.
Republican deficit hawks may block the way though, and people like Teresa Miranda are not sure what they will do next. She lost her accounting office job last summer in the Miami area, and her $1100 a month unemployment check stopped coming in a few weeks ago.
A tearful Miranda told CBS4 News, "The unemployment quit and I don't know what to do. I have nothing, savings are exhausted, no money for rent in July."
Miranda also has a message for the U.S. Senate, where fierce debate over balancing jobless benefits against budget deficit worries has stalled any extension of unemployment compensation. Miranda argued, "The Senate better open your eyes and realize what you are doing to us. We elected you to help us. I don't see what you are doing for us."
Miranda is single, with two adult sons who are on their own now and facing their own job struggles. She counts on donated food twice a month from a local church to help her get by.
"I'm an American, I was born in this country," she said. "I feel belittled to have to come here to have to get food to live to eat. It is embarrassing to me."
It is embarrassing but necessary, especially when every job Miranda seeks is packed with desperate people. She said, "When you do go, there are 150 applicants."
And so, for now at least, Miranda lives on the charity of others and relies on her faith for a journey she never imagined, and one with no end in sight.
Want a mansion? Just take one
'Luxury squatters' take over vacant houses and declare themselves owners. In Seattle, one family moved into a $3.3 million place.
Posted by Teresa Mears on Tuesday, June 29, 2010 5:47 PM
For years, the 8,000-square-foot mansion in suburban Seattle sat vacant and for sale, the price gradually coming down from $5.8 million to $3.3 million. One day in June, a 30-year-old woman, a man and two children took down the for-sale signs, changed the locks, moved in and declared it their home.
They didn't actually buy the house, or even rent it. They just moved in and declared it their house.
Jill Lane, who was arrested on a charge of trespassing after two weeks in the house, is not contrite, The Seattle Times' Danny Westneat reports. Not only did she try to take over the mansion, with its wine cellar, home theater, six bedrooms and nine baths, she has staked a claim to 10 other bank-owned houses in the Seattle area.
"Banks do whatever they want and nobody holds them accountable," Lane told Westneat by phone from Disneyland, where she went on vacation after she was released by the police. She and her partner ran a company that pledged to "eliminate mortgages" and help others move into empty foreclosed homes.
"It makes me ill to see what the banks are doing. They aren't using their bailout money to help anyone. So I'm standing up for the people who are being brutalized by banks every day."
And we thought we were making a political statement against the banks by abandoning credit cards and paying cash.
Bing: Squatters in foreclosed homes
You can listen to a radio interview with Lane here and see TV stories here and here.
Lane is one of a number of people nationwide who are taking over other people's vacant homes, some using a quirk in the law called "adverse possession," which dates to 16th-century England, Sally Kestin reported in the Sun-Sentinel of Fort Lauderdale. She wrote:
Adverse possession allows non-owners of a property to eventually take ownership if they pay the taxes, occupy, maintain and improve the land for a period of years -- seven in Florida. The purpose was to prevent abandoned properties from sitting idle with no one paying taxes on them.
It's been used mostly to take over abandoned farmland or settle boundary disputes, such as a fence or building encroaching on a neighbor's property.
In Fort Lauderdale's Broward County and neighboring Palm Beach County, three men were arrested on felony charges and a fourth is under investigation for trying to take over 200 houses.
"We look at this as another con job, another get-rich-quick scheme,'' Don TenBrook, a Broward state prosecutor of economic crimes, told the Sun-Sentinel. "You're starting to see them pop up all over the place.''
Fitzroy Ellis tried to claim 48 properties, Broward officials said, including one worth $1 million. He told police he planned to rent out the houses and condos at a good price "since he didn't have to pay anything for the homes,'' the newspaper reported. He was charged with six counts of grand theft -- allegations, he wrote in court documents, that are "false and an abuse of power.''
Mark Guerette of suburban West Palm Beach filed court papers to take possession of 103 homes. Police say Guerette rented out six of the homes and collected more than $20,000 from tenants before he was arrested and charged with running an organized scheme to defraud.
He pleaded not guilty. His lawyer, Robert Shearin, said Guerette is trying to help people by rescuing blighted homes. "The banks are letting these properties go down the tubes,'' Shearin told the Sen-Sentinel. "Here's a guy trying to help out, and he ends up in jail.''
In Pasco County, north of Tampa, Stephen Bybel drove around scouting for vacant homes. When he found one he wanted, he posted a small notice on the door, citing "adverse possessions" and saying the property "has been found to be vacant, abandoned, open, unsecured and a hazard and a nuisance to the community."
He gave the owners seven days to contact him. If they failed to do so (and certainly out-of-state banks weren't likely to see those signs), Bybel would claim the property. He did that 72 times, The St. Petersburg Times reported.
He rented 31 of those homes to tenants, collecting $16,780 in rents in January alone, the Pasco County Sheriff's Office said. Now all those tenants have to find new places to live.
Bybel, too, told police he was a good guy. He said "he is doing everyone involved a favor, as these vacant properties are being vandalized, burglarized and are a detriment" to neighborhoods, according to a police report.
"This is closer to burglary and grand theft than it is to adverse possession," Pasco County Sheriff Bob White said at a news conference.
Adverse possession isn't the only tactic people have used to move into someone else's luxury home.
Squatters have used bogus deeds to take over luxury homes in Southern California, citing the philosophy of the far-right "sovereign citizens" movement, saying they are beyond the reach of police and the courts. The Southern Poverty Law Center detailed their tactics in a report.
These "luxury squatters" bother the traditional groups that have advocated moving homeless people into homes that truly are abandoned, as detailed in this New York Times story.
"As we've written, squatting in foreclosed properties has become more common as homelessness and foreclosure have gone up. Operation Welcome Home envisions squatting as one part of a larger struggle to end homelessness, not a route to fancy free houses," Natalie Wendt wrote in the End Homelessness blog at Change.org.
"This (Seattle) case isn't really about squatters. It's about two brazen and greedy people (seriously, nine bathrooms?) who tried to steal property and dragged two kids and an entire movement through the mud with them," Wendt said.
Comment
My brother rehabs homes in Broward and came across this scam there. The guy just changed the locks and moved renters in while he collected the rents. My brother paid $3,000 for the guy to sign a quit claim deed so he could sell the property. Its a scam. They arent helping anybody but themselves.
Posted by Teresa Mears on Tuesday, June 29, 2010 5:47 PM
For years, the 8,000-square-foot mansion in suburban Seattle sat vacant and for sale, the price gradually coming down from $5.8 million to $3.3 million. One day in June, a 30-year-old woman, a man and two children took down the for-sale signs, changed the locks, moved in and declared it their home.
They didn't actually buy the house, or even rent it. They just moved in and declared it their house.
Jill Lane, who was arrested on a charge of trespassing after two weeks in the house, is not contrite, The Seattle Times' Danny Westneat reports. Not only did she try to take over the mansion, with its wine cellar, home theater, six bedrooms and nine baths, she has staked a claim to 10 other bank-owned houses in the Seattle area.
"Banks do whatever they want and nobody holds them accountable," Lane told Westneat by phone from Disneyland, where she went on vacation after she was released by the police. She and her partner ran a company that pledged to "eliminate mortgages" and help others move into empty foreclosed homes.
"It makes me ill to see what the banks are doing. They aren't using their bailout money to help anyone. So I'm standing up for the people who are being brutalized by banks every day."
And we thought we were making a political statement against the banks by abandoning credit cards and paying cash.
Bing: Squatters in foreclosed homes
You can listen to a radio interview with Lane here and see TV stories here and here.
Lane is one of a number of people nationwide who are taking over other people's vacant homes, some using a quirk in the law called "adverse possession," which dates to 16th-century England, Sally Kestin reported in the Sun-Sentinel of Fort Lauderdale. She wrote:
Adverse possession allows non-owners of a property to eventually take ownership if they pay the taxes, occupy, maintain and improve the land for a period of years -- seven in Florida. The purpose was to prevent abandoned properties from sitting idle with no one paying taxes on them.
It's been used mostly to take over abandoned farmland or settle boundary disputes, such as a fence or building encroaching on a neighbor's property.
In Fort Lauderdale's Broward County and neighboring Palm Beach County, three men were arrested on felony charges and a fourth is under investigation for trying to take over 200 houses.
"We look at this as another con job, another get-rich-quick scheme,'' Don TenBrook, a Broward state prosecutor of economic crimes, told the Sun-Sentinel. "You're starting to see them pop up all over the place.''
Fitzroy Ellis tried to claim 48 properties, Broward officials said, including one worth $1 million. He told police he planned to rent out the houses and condos at a good price "since he didn't have to pay anything for the homes,'' the newspaper reported. He was charged with six counts of grand theft -- allegations, he wrote in court documents, that are "false and an abuse of power.''
Mark Guerette of suburban West Palm Beach filed court papers to take possession of 103 homes. Police say Guerette rented out six of the homes and collected more than $20,000 from tenants before he was arrested and charged with running an organized scheme to defraud.
He pleaded not guilty. His lawyer, Robert Shearin, said Guerette is trying to help people by rescuing blighted homes. "The banks are letting these properties go down the tubes,'' Shearin told the Sen-Sentinel. "Here's a guy trying to help out, and he ends up in jail.''
In Pasco County, north of Tampa, Stephen Bybel drove around scouting for vacant homes. When he found one he wanted, he posted a small notice on the door, citing "adverse possessions" and saying the property "has been found to be vacant, abandoned, open, unsecured and a hazard and a nuisance to the community."
He gave the owners seven days to contact him. If they failed to do so (and certainly out-of-state banks weren't likely to see those signs), Bybel would claim the property. He did that 72 times, The St. Petersburg Times reported.
He rented 31 of those homes to tenants, collecting $16,780 in rents in January alone, the Pasco County Sheriff's Office said. Now all those tenants have to find new places to live.
Bybel, too, told police he was a good guy. He said "he is doing everyone involved a favor, as these vacant properties are being vandalized, burglarized and are a detriment" to neighborhoods, according to a police report.
"This is closer to burglary and grand theft than it is to adverse possession," Pasco County Sheriff Bob White said at a news conference.
Adverse possession isn't the only tactic people have used to move into someone else's luxury home.
Squatters have used bogus deeds to take over luxury homes in Southern California, citing the philosophy of the far-right "sovereign citizens" movement, saying they are beyond the reach of police and the courts. The Southern Poverty Law Center detailed their tactics in a report.
These "luxury squatters" bother the traditional groups that have advocated moving homeless people into homes that truly are abandoned, as detailed in this New York Times story.
"As we've written, squatting in foreclosed properties has become more common as homelessness and foreclosure have gone up. Operation Welcome Home envisions squatting as one part of a larger struggle to end homelessness, not a route to fancy free houses," Natalie Wendt wrote in the End Homelessness blog at Change.org.
"This (Seattle) case isn't really about squatters. It's about two brazen and greedy people (seriously, nine bathrooms?) who tried to steal property and dragged two kids and an entire movement through the mud with them," Wendt said.
Comment
My brother rehabs homes in Broward and came across this scam there. The guy just changed the locks and moved renters in while he collected the rents. My brother paid $3,000 for the guy to sign a quit claim deed so he could sell the property. Its a scam. They arent helping anybody but themselves.
Tuesday, June 22, 2010
The Universal Question; Does the G-spot Exist?
Does the G-Spot Really Exist?
posted by Lissa Rankin Jun 21, 2010 9:08 am
filed under: Health & Wellness, Relationships & Sexuality, Uncategorized, Women's Health, anatomy, beverly whipple, clitoris, doctor, g-spot, medical school, orgasm, pleasure, vaginal orgasms, what's up down there
When you think of a sonogram, you probably think of some grainy, grey-and-white image of your baby’s hand waving at you, labeled with the caption “Hi Mom!” You probably don’t think about the clitoris. But a couple of French doctors do (leave it to the French).
Is There Really a G-Spot?
A study in Sexual Medicine called “The Clitoral Complex: A Dynamic Sonographic Study” mixes ultrasound, the clitoris, the G-Spot, and vaginal orgasms together into a sexy soup I couldn’t resist writing about. Whether or not the G-Spot exists remains controversial. One of the questions I answered in my upcoming book What’s Up Down There? Questions You’d Only Ask Your Gynecologist If She Was Your Best Friend is “Does the G-Spot really exist?” The answer:
According to the teacher in my Gross Anatomy lab, the answer is no. As we were dissecting the vagina, someone asked, “So where’s the G-Spot, Doc?” My teacher, in his thick Eastern European accent, said, “Zere is no G-Spot in ze human female.” Okay, good to know.
The rest of my medical training pretty much agreed with Professor Von Buzzkill. An expert in the field even told me that every part of the vagina has been examined under the microscope, and there is nothing on the anterior wall of the vagina that looks any different than the rest of the vagina. Therefore, the G-Spot does not exist. Period.
However, as is the case with much I learned in medical school, my patients tell me otherwise. Over the years, thousands of patients have sworn that there is a place felt through the anterior wall of the vagina that hits the oh-oh-oh spot – or, rather, is the spot. I believe in many things I cannot see, so I tend to believe my patients.
Hunting for data to validate their experience, I came across Dr. Beverly Whipple, who famously named the G-Spot after German OB/GYN Dr. Ernst Gräfenburg, who described a zone of erogenous feeling on the anterior wall of the vaginal canal. (A friend of hers suggested she name it the “Whipple Tickle”, but out of respect for Whipples everywhere, she vetoed this idea.) According to Dr. Whipple, the G-Spot definitely exists. When I asked her why some in the medical community vehemently deny its existence, she seemed baffled. She said, “I don’t know. I guess, because they can’t see it under a microscope, they think it doesn’t exist. But my career has been about validating what real women experience. And some — but not all — definitely experience pleasurable feelings when you stimulate the G-Spot area.”
Her belief runs so deep that she went on to conduct hundreds of studies aimed at validating the sexual experiences women relate. For one study in 1981, 400 female volunteers were examined. According to Dr. Whipple, a spot that empirically swells with stimulation was found in each of these women, although she admits that not all women appear to be sensitive to this type of stimulation.
So what is the G-Spot? Dr. Whipple isn’t sure. As Dr. Von Buzzkill said, no specific anatomic differences can be detected in this area. But she suspects a cluster of blood vessels, nerves, glands (including the “female prostate gland”), and part of of the clitoris may all merge to create a sensitive area that hits the spot. She believes the female experience more than the microscope, and I tend to agree with her.
Drs. Foldes and Buisson seem to agree with Dr. Whipple, theorizing that the reason some women can have vaginal orgasms is that the anterior wall of the vagina (in the location of the famed G-Spot) overlies the root of the clitoris, where the crura (legs) come together. So perhaps the reason that nobody can find an anatomic location for the controversial G-Spot is because there’s nothing special about this part of the vagina other than it butts up against a sweet spot of the clitoris.
When you think of a sonogram, you probably think of some grainy, grey-and-white image of your baby’s hand waving at you, labeled with the caption “Hi Mom!” You probably don’t think about the clitoris. But a couple of French doctors do (leave it to the French).
Is There Really a G-Spot?
A study in Sexual Medicine called “The Clitoral Complex: A Dynamic Sonographic Study” mixes ultrasound, the clitoris, the G-Spot, and vaginal orgasms together into a sexy soup I couldn’t resist writing about. Whether or not the G-Spot exists remains controversial. One of the questions I answered in my upcoming book What’s Up Down There? Questions You’d Only Ask Your Gynecologist If She Was Your Best Friend is “Does the G-Spot really exist?” The answer:
According to the teacher in my Gross Anatomy lab, the answer is no. As we were dissecting the vagina, someone asked, “So where’s the G-Spot, Doc?” My teacher, in his thick Eastern European accent, said, “Zere is no G-Spot in ze human female.” Okay, good to know.
The rest of my medical training pretty much agreed with Professor Von Buzzkill. An expert in the field even told me that every part of the vagina has been examined under the microscope, and there is nothing on the anterior wall of the vagina that looks any different than the rest of the vagina. Therefore, the G-Spot does not exist. Period.
However, as is the case with much I learned in medical school, my patients tell me otherwise. Over the years, thousands of patients have sworn that there is a place felt through the anterior wall of the vagina that hits the oh-oh-oh spot – or, rather, is the spot. I believe in many things I cannot see, so I tend to believe my patients.
Hunting for data to validate their experience, I came across Dr. Beverly Whipple, who famously named the G-Spot after German OB/GYN Dr. Ernst Gräfenburg, who described a zone of erogenous feeling on the anterior wall of the vaginal canal. (A friend of hers suggested she name it the “Whipple Tickle”, but out of respect for Whipples everywhere, she vetoed this idea.) According to Dr. Whipple, the G-Spot definitely exists. When I asked her why some in the medical community vehemently deny its existence, she seemed baffled. She said, “I don’t know. I guess, because they can’t see it under a microscope, they think it doesn’t exist. But my career has been about validating what real women experience. And some — but not all — definitely experience pleasurable feelings when you stimulate the G-Spot area.”
Her belief runs so deep that she went on to conduct hundreds of studies aimed at validating the sexual experiences women relate. For one study in 1981, 400 female volunteers were examined. According to Dr. Whipple, a spot that empirically swells with stimulation was found in each of these women, although she admits that not all women appear to be sensitive to this type of stimulation.
So what is the G-Spot? Dr. Whipple isn’t sure. As Dr. Von Buzzkill said, no specific anatomic differences can be detected in this area. But she suspects a cluster of blood vessels, nerves, glands (including the “female prostate gland”), and part of of the clitoris may all merge to create a sensitive area that hits the spot. She believes the female experience more than the microscope, and I tend to agree with her.
Drs. Foldes and Buisson seem to agree with Dr. Whipple, theorizing that the reason some women can have vaginal orgasms is that the anterior wall of the vagina (in the location of the famed G-Spot) overlies the root of the clitoris, where the crura (legs) come together. So perhaps the reason that nobody can find an anatomic location for the controversial G-Spot is because there’s nothing special about this part of the vagina other than it butts up against a sweet spot of the clitoris.
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Marilyn L. says
Jun 22, 2010 5:02 PM
Trudi Gray you are one funny woman.
send
Teresa P. says
Jun 22, 2010 4:50 PM
I don't think I have a G spot. My orgasms are clitoral but they are very good. My vulva is sensitive too. Having orgasms seems a quite healthy thing to do.
Thomas T. says
Jun 22, 2010 4:28 PM
The clitoral glans is homologous to the glans penis in males, and the clitoral body and the clitoral crura are homologous to the corpora cavernosa of the penis. The labia majora, labia minora and clitoral hood are homologous to the scrotum, shaft skin of the penis, and the foreskin, respectively. The vestibular bulbs beneath the skin of the labia minora are homologous to the corpus spongiosum, the tissue of the penis surrounding the urethra. The Bartholin's glands are homologous to Cowper's glands in males.
Then, why would the part the was homologous to the male prostate dissappear? My contention is..it didnt, it IS the G spot.
The science shows that, depending on the hormone balances at the time of differentiaion, (we all start as female), there are variations in the final development of both male and female.
Larger, smaller this and that in both sexes, and, sometimes a complete shamnbles with both this and that in the same person!
That is why some have a larger G spot, some a smaller one, some, one without sensation.
In males, the main source of pleasure at orgasm is at the prostate. The male ejaculation is mainly prostatic fluid. Some women, at orgasm, also ejaculate. From where? I think from the now partly developed prostate, or, the g-spot.
Does the author agree, even though her professor professed otherwise?
Martha Kauppinen says
Jun 22, 2010 3:16 PM
Yes, the G-spot exists! There was no mention in this article of an "ejaculation of water" for lack of a better description. I wonder if anyone else has had this experience along with their G-spot orgasm.
Julie F. says
Jun 22, 2010 2:52 PM
The G spot DEFINITELY exists in some way, shape or form. I'm kind of agnostic about it - I know it's there, but I don't really care to define it so. :)
Jun 22, 2010 2:26 PM
Anna W., the G-spot rarely is enough for an orgasm in most women, even if a partner actually finds it! The clitoris is the main source of sexual pleasure for most women. Which is why intercourse is not often satisfying.
Anna W. says
Jun 22, 2010 2:19 PM
Not sure about the G spot. Why do women sometimes get an orgasm and other times they don't? If there is a G spot then it would make sense that every time the G spot is stimulated, they get the orgasm reaction, which is not the case (speaking from my own experience and my friends')
Laurie S. says
Jun 22, 2010 1:43 PM
Thanks for the article Lissa. I figure that as long as we all get our rocks off then it's all good!! :)
Jane H. says
Jun 22, 2010 1:17 PM
Thanks for your open and honest discussion and post!
Juliet D. says
Jun 22, 2010 12:53 PM
@ trudi gray thanks for the laugh! It's so true.. women's magazines have stories about how to please your man in bed, men's magazines have articles about cars.
posted by Lissa Rankin Jun 21, 2010 9:08 am
filed under: Health & Wellness, Relationships & Sexuality, Uncategorized, Women's Health, anatomy, beverly whipple, clitoris, doctor, g-spot, medical school, orgasm, pleasure, vaginal orgasms, what's up down there
When you think of a sonogram, you probably think of some grainy, grey-and-white image of your baby’s hand waving at you, labeled with the caption “Hi Mom!” You probably don’t think about the clitoris. But a couple of French doctors do (leave it to the French).
Is There Really a G-Spot?
A study in Sexual Medicine called “The Clitoral Complex: A Dynamic Sonographic Study” mixes ultrasound, the clitoris, the G-Spot, and vaginal orgasms together into a sexy soup I couldn’t resist writing about. Whether or not the G-Spot exists remains controversial. One of the questions I answered in my upcoming book What’s Up Down There? Questions You’d Only Ask Your Gynecologist If She Was Your Best Friend is “Does the G-Spot really exist?” The answer:
According to the teacher in my Gross Anatomy lab, the answer is no. As we were dissecting the vagina, someone asked, “So where’s the G-Spot, Doc?” My teacher, in his thick Eastern European accent, said, “Zere is no G-Spot in ze human female.” Okay, good to know.
The rest of my medical training pretty much agreed with Professor Von Buzzkill. An expert in the field even told me that every part of the vagina has been examined under the microscope, and there is nothing on the anterior wall of the vagina that looks any different than the rest of the vagina. Therefore, the G-Spot does not exist. Period.
However, as is the case with much I learned in medical school, my patients tell me otherwise. Over the years, thousands of patients have sworn that there is a place felt through the anterior wall of the vagina that hits the oh-oh-oh spot – or, rather, is the spot. I believe in many things I cannot see, so I tend to believe my patients.
Hunting for data to validate their experience, I came across Dr. Beverly Whipple, who famously named the G-Spot after German OB/GYN Dr. Ernst Gräfenburg, who described a zone of erogenous feeling on the anterior wall of the vaginal canal. (A friend of hers suggested she name it the “Whipple Tickle”, but out of respect for Whipples everywhere, she vetoed this idea.) According to Dr. Whipple, the G-Spot definitely exists. When I asked her why some in the medical community vehemently deny its existence, she seemed baffled. She said, “I don’t know. I guess, because they can’t see it under a microscope, they think it doesn’t exist. But my career has been about validating what real women experience. And some — but not all — definitely experience pleasurable feelings when you stimulate the G-Spot area.”
Her belief runs so deep that she went on to conduct hundreds of studies aimed at validating the sexual experiences women relate. For one study in 1981, 400 female volunteers were examined. According to Dr. Whipple, a spot that empirically swells with stimulation was found in each of these women, although she admits that not all women appear to be sensitive to this type of stimulation.
So what is the G-Spot? Dr. Whipple isn’t sure. As Dr. Von Buzzkill said, no specific anatomic differences can be detected in this area. But she suspects a cluster of blood vessels, nerves, glands (including the “female prostate gland”), and part of of the clitoris may all merge to create a sensitive area that hits the spot. She believes the female experience more than the microscope, and I tend to agree with her.
Drs. Foldes and Buisson seem to agree with Dr. Whipple, theorizing that the reason some women can have vaginal orgasms is that the anterior wall of the vagina (in the location of the famed G-Spot) overlies the root of the clitoris, where the crura (legs) come together. So perhaps the reason that nobody can find an anatomic location for the controversial G-Spot is because there’s nothing special about this part of the vagina other than it butts up against a sweet spot of the clitoris.
When you think of a sonogram, you probably think of some grainy, grey-and-white image of your baby’s hand waving at you, labeled with the caption “Hi Mom!” You probably don’t think about the clitoris. But a couple of French doctors do (leave it to the French).
Is There Really a G-Spot?
A study in Sexual Medicine called “The Clitoral Complex: A Dynamic Sonographic Study” mixes ultrasound, the clitoris, the G-Spot, and vaginal orgasms together into a sexy soup I couldn’t resist writing about. Whether or not the G-Spot exists remains controversial. One of the questions I answered in my upcoming book What’s Up Down There? Questions You’d Only Ask Your Gynecologist If She Was Your Best Friend is “Does the G-Spot really exist?” The answer:
According to the teacher in my Gross Anatomy lab, the answer is no. As we were dissecting the vagina, someone asked, “So where’s the G-Spot, Doc?” My teacher, in his thick Eastern European accent, said, “Zere is no G-Spot in ze human female.” Okay, good to know.
The rest of my medical training pretty much agreed with Professor Von Buzzkill. An expert in the field even told me that every part of the vagina has been examined under the microscope, and there is nothing on the anterior wall of the vagina that looks any different than the rest of the vagina. Therefore, the G-Spot does not exist. Period.
However, as is the case with much I learned in medical school, my patients tell me otherwise. Over the years, thousands of patients have sworn that there is a place felt through the anterior wall of the vagina that hits the oh-oh-oh spot – or, rather, is the spot. I believe in many things I cannot see, so I tend to believe my patients.
Hunting for data to validate their experience, I came across Dr. Beverly Whipple, who famously named the G-Spot after German OB/GYN Dr. Ernst Gräfenburg, who described a zone of erogenous feeling on the anterior wall of the vaginal canal. (A friend of hers suggested she name it the “Whipple Tickle”, but out of respect for Whipples everywhere, she vetoed this idea.) According to Dr. Whipple, the G-Spot definitely exists. When I asked her why some in the medical community vehemently deny its existence, she seemed baffled. She said, “I don’t know. I guess, because they can’t see it under a microscope, they think it doesn’t exist. But my career has been about validating what real women experience. And some — but not all — definitely experience pleasurable feelings when you stimulate the G-Spot area.”
Her belief runs so deep that she went on to conduct hundreds of studies aimed at validating the sexual experiences women relate. For one study in 1981, 400 female volunteers were examined. According to Dr. Whipple, a spot that empirically swells with stimulation was found in each of these women, although she admits that not all women appear to be sensitive to this type of stimulation.
So what is the G-Spot? Dr. Whipple isn’t sure. As Dr. Von Buzzkill said, no specific anatomic differences can be detected in this area. But she suspects a cluster of blood vessels, nerves, glands (including the “female prostate gland”), and part of of the clitoris may all merge to create a sensitive area that hits the spot. She believes the female experience more than the microscope, and I tend to agree with her.
Drs. Foldes and Buisson seem to agree with Dr. Whipple, theorizing that the reason some women can have vaginal orgasms is that the anterior wall of the vagina (in the location of the famed G-Spot) overlies the root of the clitoris, where the crura (legs) come together. So perhaps the reason that nobody can find an anatomic location for the controversial G-Spot is because there’s nothing special about this part of the vagina other than it butts up against a sweet spot of the clitoris.
<1 of 2>More on Health & Wellness (1069 articles available)
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Marilyn L. says
Jun 22, 2010 5:02 PM
Trudi Gray you are one funny woman.
send
Teresa P. says
Jun 22, 2010 4:50 PM
I don't think I have a G spot. My orgasms are clitoral but they are very good. My vulva is sensitive too. Having orgasms seems a quite healthy thing to do.
Thomas T. says
Jun 22, 2010 4:28 PM
The clitoral glans is homologous to the glans penis in males, and the clitoral body and the clitoral crura are homologous to the corpora cavernosa of the penis. The labia majora, labia minora and clitoral hood are homologous to the scrotum, shaft skin of the penis, and the foreskin, respectively. The vestibular bulbs beneath the skin of the labia minora are homologous to the corpus spongiosum, the tissue of the penis surrounding the urethra. The Bartholin's glands are homologous to Cowper's glands in males.
Then, why would the part the was homologous to the male prostate dissappear? My contention is..it didnt, it IS the G spot.
The science shows that, depending on the hormone balances at the time of differentiaion, (we all start as female), there are variations in the final development of both male and female.
Larger, smaller this and that in both sexes, and, sometimes a complete shamnbles with both this and that in the same person!
That is why some have a larger G spot, some a smaller one, some, one without sensation.
In males, the main source of pleasure at orgasm is at the prostate. The male ejaculation is mainly prostatic fluid. Some women, at orgasm, also ejaculate. From where? I think from the now partly developed prostate, or, the g-spot.
Does the author agree, even though her professor professed otherwise?
Martha Kauppinen says
Jun 22, 2010 3:16 PM
Yes, the G-spot exists! There was no mention in this article of an "ejaculation of water" for lack of a better description. I wonder if anyone else has had this experience along with their G-spot orgasm.
Julie F. says
Jun 22, 2010 2:52 PM
The G spot DEFINITELY exists in some way, shape or form. I'm kind of agnostic about it - I know it's there, but I don't really care to define it so. :)
Jun 22, 2010 2:26 PM
Anna W., the G-spot rarely is enough for an orgasm in most women, even if a partner actually finds it! The clitoris is the main source of sexual pleasure for most women. Which is why intercourse is not often satisfying.
Anna W. says
Jun 22, 2010 2:19 PM
Not sure about the G spot. Why do women sometimes get an orgasm and other times they don't? If there is a G spot then it would make sense that every time the G spot is stimulated, they get the orgasm reaction, which is not the case (speaking from my own experience and my friends')
Laurie S. says
Jun 22, 2010 1:43 PM
Thanks for the article Lissa. I figure that as long as we all get our rocks off then it's all good!! :)
Jane H. says
Jun 22, 2010 1:17 PM
Thanks for your open and honest discussion and post!
Juliet D. says
Jun 22, 2010 12:53 PM
@ trudi gray thanks for the laugh! It's so true.. women's magazines have stories about how to please your man in bed, men's magazines have articles about cars.
Sunday, June 20, 2010
Payback Time
In Budget Crisis, States Take Aim at Pension Costs
By MARY WILLIAMS WALSH
Published: June 19, 2010
Many states are acknowledging this year that they have promised pensions they cannot afford and are cutting once-sacrosanct benefits, to appease taxpayers and attack budget deficits.
Gov. Pat Quinn said an overhaul would save Illinois’s pension system $300 million in its first year. But the fund is weakened.
Payback Time
Untouchable Benefits
Articles in this series are examining the consequences of, and efforts to deal with, growing public and private debts.
Previous Articles in the Series »Illinois raised its retirement age to 67, the highest of any state, and capped public pensions at $106,800 a year. Arizona, New York, Missouri and Mississippi will make people work more years to earn pensions. Virginia is requiring employees to pay into the state pension fund for the first time. New Jersey will not give anyone pension credit unless they work at least 32 hours a week.
“We can’t afford to deny reality or delay action any longer,” said Gov. Pat Quinn of Illinois, adding that his state’s pension cuts, enacted in March, will save some $300 million in the first year alone.
But there is a catch: Nearly all of the cuts so far apply only to workers not yet hired. Though heralded as breakthrough reforms by state officials, the cuts phase in so slowly they are unlikely to save the weakest funds and keep them from running out of money. Some new rules may even hasten the demise of the funds they were meant to protect.
Lawmakers wanted to avoid legal battles or fights with unions, whose members can be influential voters. So they are allowing most public workers across the country to keep building up their pensions at the same rate as ever. The tens of thousands of workers now on Illinois’s payrolls, for instance, will still get to retire at 60 — and some will as young as 55.
One striking exception is Colorado, which has imposed cuts on its current workers, not just future hires, and even on people who have already retired. The retirees have sued to block the reduction.
Other states with shrinking funds and deep fiscal distress may be pushed in this direction and tempted to follow Colorado’s example in the coming years. Though most state officials believe they are legally bound to shield current workers from pension cuts, a Colorado victory could embolden them to be more aggressive.
Colorado pruned a 3.5 percent annual pension increase to 2 percent, concluding that was the fastest way to revive its pension fund, which was projected to run out of money by 2029. The cut may sound small, but it produces big results because it goes into effect immediately. State plans vary widely, but many have other costly features, like subsidized early-retirement benefits, which could likewise be trimmed for existing workers.
Despite its pension reform, Illinois is still in deep trouble. That vaunted $300 million in immediate savings? The state produced it by giving itself credit now for the much smaller checks it will send retirees many years in the future — people who must first be hired and then, for full benefits, work until age 67.
By recognizing those far-off savings right away, Illinois is letting itself put less money into its pension fund now, starting with $300 million this year.
That saves the state money, but it also weakens the pension fund, actually a family of funds, raising the risk of a collapse long before the real savings start to materialize.
“We’re within a few years of having some of the pension funds run out of money,” said R. Eden Martin, president of the Commercial Club of Chicago, a business group that has been warning of a “financial implosion” for several years. “Funding for the schools is going to be cut radically. Funding for Medicaid. As these things all mount up, there’s going to be a lot of outrage.”
Joshua D. Rauh, an associate professor of finance at Northwestern University who studies public pension funds, predicts that at the current rate, Illinois’s pension system could run out of money by 2018. He believes the funds of other troubled states — including New Jersey, Indiana and Connecticut — are also on track to run out of money in less than a decade, unless they make meaningful changes.
If a state pension fund ran out of money, the state would be legally bound to make good on retirees’ benefits. But paying public pensions straight out of general revenue would be ruinous. In Illinois’s case, it would consume about half the state’s cash every year, bringing other vital state services to a standstill.
Mr. Rauh said he thinks any state caught in that trap would have little choice but to seek a federal bailout. Bigger pension contributions and higher taxes can go only so far.
Many state officials, hoping for a huge recovery in the markets, say that such projections are too pessimistic, and that cutting benefits for future workers must suffice, given laws and provisions in state constitutions that make membership in a state pension fund a contractual relationship that cannot be breached.
Lawyers, though, are raising the possibility that those laws are being misinterpreted.
By MARY WILLIAMS WALSH
Published: June 19, 2010
Many states are acknowledging this year that they have promised pensions they cannot afford and are cutting once-sacrosanct benefits, to appease taxpayers and attack budget deficits.
Gov. Pat Quinn said an overhaul would save Illinois’s pension system $300 million in its first year. But the fund is weakened.
Payback Time
Untouchable Benefits
Articles in this series are examining the consequences of, and efforts to deal with, growing public and private debts.
Previous Articles in the Series »Illinois raised its retirement age to 67, the highest of any state, and capped public pensions at $106,800 a year. Arizona, New York, Missouri and Mississippi will make people work more years to earn pensions. Virginia is requiring employees to pay into the state pension fund for the first time. New Jersey will not give anyone pension credit unless they work at least 32 hours a week.
“We can’t afford to deny reality or delay action any longer,” said Gov. Pat Quinn of Illinois, adding that his state’s pension cuts, enacted in March, will save some $300 million in the first year alone.
But there is a catch: Nearly all of the cuts so far apply only to workers not yet hired. Though heralded as breakthrough reforms by state officials, the cuts phase in so slowly they are unlikely to save the weakest funds and keep them from running out of money. Some new rules may even hasten the demise of the funds they were meant to protect.
Lawmakers wanted to avoid legal battles or fights with unions, whose members can be influential voters. So they are allowing most public workers across the country to keep building up their pensions at the same rate as ever. The tens of thousands of workers now on Illinois’s payrolls, for instance, will still get to retire at 60 — and some will as young as 55.
One striking exception is Colorado, which has imposed cuts on its current workers, not just future hires, and even on people who have already retired. The retirees have sued to block the reduction.
Other states with shrinking funds and deep fiscal distress may be pushed in this direction and tempted to follow Colorado’s example in the coming years. Though most state officials believe they are legally bound to shield current workers from pension cuts, a Colorado victory could embolden them to be more aggressive.
Colorado pruned a 3.5 percent annual pension increase to 2 percent, concluding that was the fastest way to revive its pension fund, which was projected to run out of money by 2029. The cut may sound small, but it produces big results because it goes into effect immediately. State plans vary widely, but many have other costly features, like subsidized early-retirement benefits, which could likewise be trimmed for existing workers.
Despite its pension reform, Illinois is still in deep trouble. That vaunted $300 million in immediate savings? The state produced it by giving itself credit now for the much smaller checks it will send retirees many years in the future — people who must first be hired and then, for full benefits, work until age 67.
By recognizing those far-off savings right away, Illinois is letting itself put less money into its pension fund now, starting with $300 million this year.
That saves the state money, but it also weakens the pension fund, actually a family of funds, raising the risk of a collapse long before the real savings start to materialize.
“We’re within a few years of having some of the pension funds run out of money,” said R. Eden Martin, president of the Commercial Club of Chicago, a business group that has been warning of a “financial implosion” for several years. “Funding for the schools is going to be cut radically. Funding for Medicaid. As these things all mount up, there’s going to be a lot of outrage.”
Joshua D. Rauh, an associate professor of finance at Northwestern University who studies public pension funds, predicts that at the current rate, Illinois’s pension system could run out of money by 2018. He believes the funds of other troubled states — including New Jersey, Indiana and Connecticut — are also on track to run out of money in less than a decade, unless they make meaningful changes.
If a state pension fund ran out of money, the state would be legally bound to make good on retirees’ benefits. But paying public pensions straight out of general revenue would be ruinous. In Illinois’s case, it would consume about half the state’s cash every year, bringing other vital state services to a standstill.
Mr. Rauh said he thinks any state caught in that trap would have little choice but to seek a federal bailout. Bigger pension contributions and higher taxes can go only so far.
Many state officials, hoping for a huge recovery in the markets, say that such projections are too pessimistic, and that cutting benefits for future workers must suffice, given laws and provisions in state constitutions that make membership in a state pension fund a contractual relationship that cannot be breached.
Lawyers, though, are raising the possibility that those laws are being misinterpreted.
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