Jung v. Association Of American Medical Colleges: the lawsuit challenging our system of graduate medical education

This article examines the antitrust case in which three physicians have challenged the Match Program and various other aspects of the system of graduate medical education in the United States. After describing the parties to the litigation, the author explains the plaintiffs’ theories of liability. He suggests how the plaintiffs are likely to claim damages in the multibillion dollar range and speculates about the injunctive relief that the plaintiffs are likely to seek. The author then sets forth some of the principal defenses to the case, as well as the basis for the defendants’ position that the plaintiffs have not been injured at all. The author goes on to explore developments that have occurred since the lawsuit was filed on May 7, 2002. These include a motion by the National Residency Matching Program to refer the case to arbitration; motions by certain teaching hospital defendants asserting that they are not subject to suit in the District of Columbia; and motions by the American Medical Association, the Accreditation Council for Graduate Medical Education, and other organization defendants to the effect that the plaintiffs have not alleged conduct by them that violates the antitrust laws. The author then discusses the motion by the plaintiffs to have the case certified as a class action. Finally, he considers legislative initiatives that the litigation has engendered.     

Exclusive hospital-based service agreements: what radiologists need to know

This article provides radiologists with the information that they need to know to participate meaningfully in negotiating or renegotiating an exclusive hospital-based radiology service agreement. It discusses the contract negotiation process, including how to identify and prioritize contract objectives, and how to assess and create bargaining leverage. Options for achieving contract longevity, for resolving “turf” issues and for achieving financial objectives are also addressed. The article further explains the key regulatory issues that shape exclusive hospital-based radiology service agreements, including antitrust, fraud and abuse, Stark Law, HIPAA, tax, and Medicare reimbursement considerations. The author discusses the contract negotiation process from both the radiology group and hospital perspectives. He suggests that successful negotiation will depend on “fitting” the group’s contracting agenda with the hospital’s priorities, organizational structure, culture and resources.     

Immediate shrinkage of optociliary shunt vessels after fractionated external beam radiation for meningioma of the optic nerve sheath

Fractionated stereotactic radiation has become the standard treatment of meningioma of the optic nerve sheath. The mechanism responsible for improvement in visual function is unclear, because neuroimaging after treatment usually shows no discernable change in tumor appearance. We report immediate regression of optociliary shunt vessels in a patient after radiation treatment of an optic nerve sheath meningioma. This observation indicates that radiation treatment can cause rapid reduction of optic nerve compression, even without appreciable reduction in the size of the meningioma.     

The use of iohexol as oral contrast for computed tomography of the abdomen and pelvis

Positive oral contrast agents (high-osmolar iodinated solutions [high-osmolar contrast medium] or barium sulfate suspensions) are used routinely for abdominal computed tomography. However, these agents are not ideal. Patients complain about the taste and, sometimes, refuse to drink the required quantity. Nausea, vomiting, and diarrhea are frequent. In certain clinical indications, either barium suspensions or high-osmolar contrast mediums may be contraindicated. This technical note describes the potential advantages of using low-osmolar iodinated solutions as an oral contrast agent for computed tomography.