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Federal Appeals Court Upholds Virginia Abortion Ban
The full U.S. Court of Appeals for the 4th Circuit in a 6-5 decision on Wednesday upheld Virginia"s 2003 law banning what abortion-rights opponents call "partial-birth" abortion, a procedure known medically as intact dilation and extraction, the AP/Hartford Courant reports (O"Dell, AP/Hartford Courant, 6/24). In 2005, a three-judge panel of the U.S. Court of Appeals for the 4th Circuit ruled 2-1 to strike down the Virginia law on the grounds that it does not include adequate exceptions to protect a woman"s health. The U.S. Supreme Court two years ago ordered the appeals court to revisit the issue when it upheld the Partial Birth Abortion Ban Act of 2003, a federal law similar to the Virginia law (White, Washington Post, 6/25). The three-judge appeals panel again struck down the law in 2008 (AP/Hartford Courant, 6/24). The Virginia law permits women to choose various abortion procedures but makes it a crime for providers to perform an intact dilation and extraction, which involves crushing a fetus" skull to ease removal (Washington Post, 6/25). Abortion-rights supporters said that the Virginia law is unconstitutional because its broad definition of intact dilation and extraction could also prohibit standard dilation and extraction, the more common form of second-trimester abortion. Violations of the law would be considered a felony and punishable by up to 10 years in prison. The case is Richmond Medical Center v. Herring (AP/Hartford Courant, 6/24). William Fitzhugh, the Richmond doctor who challenged the Virginia law, said that the banned procedure is necessary to protect the life of the woman in some cases and that the law could prevent abortion providers from performing legal procedures out of fear of prosecution. Stephanie Toti, a Center for Reproductive Rights attorney who represented the plaintiffs, said that the Virginia law is broader than federal law because it punishes abortion providers who accidentally violate the law while performing legal abortion procedures. Judge"s Opinions Judge Paul Niemeyer in the majority opinion wrote that Virginia law protects physicians who are taking needed steps to save a patient"s life and should prevent "a Morton"s fork, where the doctor must choose between criminal liability or care that the doctor believes is not in the best interest of the patient." He added that the circumstances in which doctors could face criminal liability are so limited that they should not invalidate the law in every other case. Judge Blane Michael wrote in the dissenting opinion that the law will create a "real fear of criminal liability" among physicians because it will have the effect of criminalizing the actions of those who seek to perform legal procedures but need to use the banned procedure in rare instances. Michael wrote that the law therefore "places an undue burden on a woman"s right to obtain a pre-viability second trimester abortion -- a constitutional right repeatedly reaffirmed by the Supreme Court" (Washington Post, 6/25).Next StepsToti said that no decision has been made on whether to appeal the decision to the Supreme Court. The Supreme Court"s 2007 decision on the federal law made it clear that abortion bans must include exceptions for the health of the woman, the AP/Hartford Courant reports. Toti said that the appeals court"s decision "just really ignores that precedent." She added, "It"s really insulting to women"s dignity that the court would put so little priority on protecting women"s health and well-being" (AP/Hartford Courant, 6/25). Toti also said, "It puts doctors in a really untenable position because it forces doctors to choose between taking all the steps necessary to protect their patients and committing a felony" (Washington Post, 6/25). Virginia Attorney General Bill Mims said, "While we anticipate that the U.S. Supreme Court may be asked to review the decision, I am confident that the Supreme Court ultimately will uphold the law" (AP/Hartford Courant, 6/25).

Fresenius Endorses PEAK Campaign Efforts To Reduce Dialysis Patient Mortality
Fresenius Medical Care, which operates the nation"s leading network of dialysis clinics, today endorsed the Performance Excellence and Accountability in Kidney Care (PEAK) campaign recently launched by Kidney Care Partners (KCP) - a coalition of patient advocates, dialysis professionals, care providers and manufacturers working together to improve quality of care for individuals with chronic kidney disease (CKD). The PEAK initiative is designed to significantly reduce the mortality rate for patients in their first year of dialysis.
News of the day
Pneumococcal Vaccine Reduces Child Deaths In Developing Countries
A new trial has found that pneumococcal vaccine is effective in preventing severe pneumonia, the leading cause of death among children in developing countries. Co-ordinated by the National Institute for Health and Welfare (THL) between 2000 and 2004, a large scale efficacy trial first of its kind in Asia - was carried out in the Philippines to investigate the effect of an investigational pneumococcal vaccine.
Diagnostics

University Of Maryland Dental School Helps Doctors, Nurses Halt Infant Tooth Decay

Across the state of Maryland, there are now doctors and nurses, freshly trained in pediatric dental health care, who can help stem an alarming number of 3-year-old children who arrive for their first dentist visit with teeth "just melting away." Many children are not seen by a dentist until they are age 3, says Norman Tinanoff, DDS, MS, professor at the University of Maryland Dental School. "And among those in low socioeconomic status, there is also often inadequate dental health education," says Tinanoff. Dental caries disease starts in infants, as the cavity-causing bacteria are transferred from mothers. National surveys from 1988 to 2004 showed a sharp rise in the prevalence of dental decay in U.S. poor children under age 5. More than 400 physicians and nurse practitioners who participate in the Maryland Medicaid Program have received training in infant and toddler dental health care through a program run by the Dental School. The training and Medicaid certification will directly lead to more young children being referred to dentists and introduced early in life to oral health care, says Tinanoff, who is program director of the Dental School"s Department of Pediatric Dentistry. The training allows the physicians and nurse practitioners to be certified by Medicaid and then reimbursed for providing fluoride varnish treatments after conducting oral health assessments for young children and toddlers. The program Maryland"s Mouths Matter: Fluoride Varnish and Oral Health Screening Program for Kids began July 1 and covers children who are Medicaid recipients, ages 9 to 36 months, during their Medicaid scheduled well-child visits. "If [dental caries disease] is not caught early, this is risky business," says Tinanoff. "We have parents come in [to the Dental School public clinic] and say my child"s teeth are just melting away. A child with dental caries is not easy for the parent. It"s not easy for me. It"s not easy for the child." In addition to applying the fluoride varnish--a highly accepted decay prevention tool--physicians and nurses in the program can provide oral health screenings, risk assessments, and oral health guidance for parents or legal custodians. Pediatrician Lisa Horton of Glen Burnie, Md., sent her nurse Tracy Kells, RMA, to the training soon after being trained herself. "There are children who really need this," says Kells. "I"ve seen children with really bad teeth. It"s a pretty good idea. I wish I had this when my children were young." Ayanna Williams, RN, of Total Health Care, Inc., has also completed the training. "A lot of our patients are noncompliant and don"t see what they are supposed to do," she says. "They are the underserved and as Medicaid families have to be impoverished. They waited til the last minute. Mom may be too busy." THC is federally qualified to partner with Medicaid assistance and has eight locations in Baltimore. More than 100 doctors and nurses attended the 10th and final training at the Dental School in June. Tinanoff told them, "The old way was to see these kids at 4 or 5, then it was drilling and filling. ò€¦ So you folks are really going to help with this big problem we have in Baltimore and across Maryland." The Office of Oral Health (OOH), Maryland Department of Health and Mental Hygiene (DHMH), is funding the program, in partnership with the Maryland chapter of the American Academy of Pediatrics. The health department has contracted with the Dental School to administer the program statewide. The training is the latest step, say officials of the School and DHMH, to prevent a repeat of the tragic death two years ago of a 12-year-old Maryland child, Deamonte Driver, from a dental infection that spread to his brain. "This is one of the best things we can be doing," says OOH Director Harry Goodman, DMD, MPH. Goodman is also an adjunct professor at the Dental School. "It works at so many levels. There are only a handful of pediatric dentists in the state. And it"s a population not generally seen by dentists. It gets them in the whole paradigm of care." Jane Casper, RDH, MA, former co-chair of an action committee set up by the DHMH in 2007 after Driver"s death, says, "This is oral health integrity medicine and dentistry as it should be. This is a time when the medical community and the dental community have come together." Pediatrician Balbir Chauhan, MD of Joppatowne, Md., says that when he was in medical school he never thought he would train to do dental work. "Prevention is a very good idea," he says. University of Maryland Baltimore


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