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Some medical errors are so egregious that lawmakers in four states now require hospitals to publicly report how often they occur, and to prove that they have taken corrective action. These "never events" laws adopted in Illinois, Minnesota, New Jersey, and Connecticut are based on criteria developed by the National Quality Forum (NQF).

To catch a thief

A 55-year-old African-American man, T.F., presents to your ER with headache, fever (102?F), muscle aches, and cough; his symptoms have rapidly worsened since onset (24 hours). T.F. received the inactivated influenza immunization 10 days earlier but is diagnosed with influenza A. T.F. had a renal transplant several years ago. His current medicines include tacrolimus (Prograf, Astellas Pharma), prednisone, mycophenolate mofetil (MMF) (CellCept, Roche), and furosemide 40 mg daily. T.F.'s SrCr51.8. The resident is considering antiviral therapy and asks your opinion. What do you suggest?

Percutaneous coronary intervention (PCI) encompasses a variety of procedures, including percutaneous transluminal coronary angioplasty (PTCA), intracoronary stenting, and atheroablative technologies used to diagnose and treat patients with coronary artery syndromes such as heart attacks and angina. In the United States, more than one million PCI procedures are performed annually, and it is estimated that about two million procedures are performed annually worldwide. Patients undergoing PCIs are at risk for developing blood clots in the coronary artery, which can result in a variety of complications including heart attack, emergency surgery, and even death.

Hospitals and health systems accredited by the Joint Commission on Accreditation of Healthcare Organizations are getting ready for the first truly unannounced, no-appointment-necessary, on-site surveys. Under the new policy, JCAHO surveyors can show up anytime between Jan. 1, 2006, and Dec. 31, 2006. The only warning facilities will get is a 7:00 a.m. e-mail notification on the morning of the survey.

Confused patients lacking drug plan ID cards, an overwhelmed electronic eligibility system, and excruciatingly long waits on help desk phone calls marred the debut of the Medicare Part D, according to frustrated retail pharmacists reporting from the trenches.

CMS has set up a dedicated telephone help line for pharmacists with Part D problems at 1-(866) 835-7595, available Monday through Friday from 8:00 a.m. to 8:00 p.m.

CMS has set up a dedicated telephone help line for pharmacists with Part D problems at 1-(866) 835-7595, available Monday through Friday from 8:00 A.M. to 8:00 P.M. Officials stressed that pharmacists should not give the phone number to patients or advocacy groups. Pharmacists who have questions about dual eligibles or WellPoint should phone 1-(800) 662-0210, and those trying to check whether a Medicare patient is enrolled in Part D should phone 1-(800) 388-2316.

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Pharmacists trying to help elderly patients find their way through the Medicare Part D maze report that many seniors feel like that old song: "Bewitched, bothered, and bewildered."