D.

Family Doctors Are the Front Line

Seventy-five to 80% of the cases of depression are diagnosed by family
physicians, internists and other primary care physicians.

Always Voluntary , Always Confidential

Minnesota's mental health system has received increasing attention in
recent years.

About Medica

Medica (www. Headquartered in San Francisco and
available online at www.
"Our findings show that medical treatment for the homeless should not be
based on the preferences of physicians or patients with chronic illness, who,
in general, prefer less aggressive medical care than homeless individuals,"
said Dr.

euthanasia chooses

"Homeless persons are at an increased risk for critical illnesses and
admissions to the intensive care unit.

Health/Medical Writers

LOS ANGELES----Former Oregon Governor
Barbara Roberts, who signed into law that state's historic "Death with
Dignity" law, made the case for a similar law in California today.

rites groundbreaking

"

The Medica initiative is a significant advancement in efforts to identify,
engage and assist people suffering from depression. For more
information about the ACCP, please visit the ACCP Web site at
http: //www.

kubler euthanasia

Homeless participants also were more likely to prefer resuscitative
measures than those with COPD; however, patients with COPD were more likely to
want CPR or mechanical ventilation than physicians ."
Homeless participants also were asked who they would want to make medical
decisions for them if they could not make decisions on their own. The majority
of homeless individuals indicated they had contact with their families and
would want a family member to make medical decisions for them."
"Advance directives are an important part of end-of-life care," said Paul
A. Kvale , MD, FCCP, President of the American College of Chest Physicians."
The bill's authors said those are reasons why California law needs
to be changed.
"I became a public servant to defend the rights of all people to
live with dignity, and I believe that means giving them a choice about
how they die," said Levine.
"There have to be alternatives to the way some people spend their
final days .

infanticide persistent

"I want the option
to hasten my death when life becomes unbearable.

penalty pvs

"With proper
treatment and support, recurrences of mild to moderate depression are
nearly 100 percent preventable," said Dr.unitedbehavioralhealth.
"These findings taken together, suggest that physicians should be involved
in decision-making for homeless patients without surrogate decision-makers,
but that they should be aware of these findings and cautious not to impose
their own preferences on patients ," said Dr.
The governor was joined by Dr. "It is my choice to have no more invasive
treatments and no more hospital stays," she said.

legalization occurs

The program is designed to support the existing
physician /patient relationship, as well as provide information, care
coordination and clinical consultations . Although homeless persons
reported better health status than patients with COPD, current health status
did not affect treatment preferences for either group. In addition,
organizations assisting homeless persons should consider options for
encouraging advance directives for the individuals they serve.

Roberts is urging California legislators to endorse AB 654 by
Assembly members Lloyd Levine and Patty Berg, which would allow
terminally ill people -- with less than six months to live -- to
request prescriptions from their physicians to enable them to choose
how and when to die.

euthanasia psychiatrist

This phone line may be used by a physician for
consultation about any patient, anywhere in the state.

Medica commercial and Medicaid HMO plans have the highest accreditation
status , Excellent, from the National Committee for Quality Assurance
(NCQA). Curtis.
The ACCP's mission is to promote the prevention and treatment of diseases of
the chest through leadership, education , research, and communication.
Joined by local senior, clergy and medical activists, the Governor
said the time has come for California to show compassion by respecting
the right to choice for terminally ill people.
Koons said that physicians of good will, religious conviction and
palliative care expertise exist on all sides of the issue, and called
upon his colleagues to respect the needs and wishes of their patients.

withdrawal promising

m.) for non-crisis level consultations, such
as coordination of care . Medica members can self-refer or be
referred by physicians, behavioral health specialists and employee
assistance counselors for depression/disease management support.com, UBH is part of the
UnitedHealth Group (NYSE: UNH) family of companies. The bill is filled with safeguards to ensure it
can't be abused . "We
are poised at the brink of the most important aid-in-dying legislation
since Oregon's law passed in 1994.

moyers legalization

According to MMHAG, mental health care in Minnesota has long
been characterized by limitations in access, and poor coordination between
physical health and mental health providers . Coordination of care
between medical and behavioral clinicians also reduces the risk of
under -treatment and unwanted side effects from medication.
As a result, homeless persons who must rely on physicians as surrogate
decision makers for medical care may receive less aggressive treatment than
they would choose for themselves.

dying terminally

The National Institute of Mental Health (NIMH) estimates 12 percent of
adult American women (about one in eight) and six percent of men, have a
depressive disorder. Participants were asked whether they
would want intubation and mechanical ventilation and whether they would want
cardiopulmonary resuscitation (CPR) in four health scenarios: current health ,
permanent coma, dementia unable to recognize family or friends, or bed-bound,
dependent on others for care. When
given the choice between a physician and court-appointed guardian to make
decisions , the majority of homeless individuals chose a physician.

persistent promising

, chief medical
officer for Medica. It responds to action
called for during 2004 by the Minnesota Mental Health Action Group (MMHAG),
which includes prominent government, academic, consumer and health care
organizations.

According to the AMA , although depression is very treatable, in many cases
it is not diagnosed correctly, is under diagnosed , or is not treated
appropriately. A coalition of public and private organizations formed the
Minnesota Mental Health Action Group in 2003 to press for change.

Homeless Prefer Aggressive Medical Treatment

A
new study published in the June issue of CHEST, the peer-reviewed journal of
the American College of Chest Physicians, reports that homeless persons are
more likely than physicians to want lifesaving procedures performed on them. Consequently, homeless individuals are at an
increased risk of having life-support decisions made that do not reflect their
wishes. Of the homeless
persons who did not have contact with family or did not want family members to
make decisions for them, the majority indicated they would want their primary
care physician or hospital physician to make medical decisions for them.org .

chooses complicating

It also provides Medica members with business hour access
(Monday-Friday , 8 a.medica.com) is Minnesota's largest HMO, largest PPO and leading
non-profit and independent provider of health plans.

Compared to physicians, homeless individuals
were more likely to want CPR and mechanical ventilation in coma and dementia
scenarios.

responding brinkley

Medica is reaching out to physicians and
mental health professionals with a unique new program to help Medica
members with depression get faster access to treatment. UBH is a leader in providing
evidence-based behavioral health care management services designed to help
improve and sustain the health and performance of individuals , workplaces
and communities. "Hospitals that serve
homeless individuals should consider developing policies to ensure that
ethical and consistent decisions are made that are in the best interests of
the patients who do not have surrogate decision-makers."
Mrs.

dignity palliative

One of the distinctive features of the new program, Health Advantage by
Medica(SM), is a specific physician-to-psychiatrist consult line that is
open to all physicians regardless of whether or not they are part of
Medica 's network. The call
center's clinicians work with the member and the member's primary care
physician or other health care professionals to support the individual
action plans and to arrange for periodic reassessment. Randall Curtis, MD, MPH, FCCP,
Division of Pulmonary and Critical Care Medicine, Harborview Medical Center,
University of Washington, Seattle, WA. It is available
online each month at http: //www. C. Ronald Koons, Chair of Medical
Staff Ethics Committee at the UC Irvine Medical Center, and Polly
Crouch, who is terminally ill with lung cancer.

vegetative euthanasia

PRESS RELEASE Medica Initiative Makes It Easier to Receive Care for Depression

Curtis.chestnet.

moyers withdrawal

The program encourages Medica members to work proactively with physicians,
behavioral health professionals, and other health care professionals , and
to follow treatment plans. Medica also offers
national network coverage to employers who also have employees outside the
Medica regional network. UBH's comprehensive range of products and
services are customized to meet the needs of the nation's employers, health
plans and public sector organizations."
CHEST is a peer-reviewed journal published by the ACCP.org .

vegetative psychiatrist

As with many other illnesses, the earlier and more effective the
intervention, the sooner people can see improved results. Fazio. Medica has 1., Homeless persons prefer more
aggressive medical care than the physicians making decisions for them, which
may result in treatment preferences of homeless persons being overlooked . Right now, many patients go without food or water for
weeks to hasten their deaths.

palliative brinkley

Untreated and under-treated depression leads to higher
medical and mental health care costs. Health Advantage
by Medica is designed to bridge the gap between physicians and mental
health professionals so that the patient gets the right care from the right
clinician, and soon.

In addition to the physician -to-psychiatrist consult line that is open to
any physician in the state, a special call center is available specifically
for Medica members. The program also provides education and support
to help members and family members better understand the disease of
depression. Physicians must never abandon our patients," he said.

moyers occurs

In
addition, improving mental health services for people enrolled in
MinnesotaCare (MNCare), Medical Assistance (MA) and General Assistance
Medical Care (GAMC) is a 2006-2007 budget recommendation for the Minnesota
Department of Human Services.

Health Advantage by Medica's depression/disease management is available to
people who are 18 years of age and older. Medica's vision is to become the community's health plan of
choice, trusted for its integrity , respected for its service, and admired
for its commitment to innovation and efficiency. "Previous research indicates that
physicians who make medical decisions independently may make these decisions
based on their own preferences. ACCP represents 16,000
members who provide clinical respiratory , sleep, critical care, and
cardiothoracic patient care in the United States and throughout the world .
"Physicians should be aware of these perspectives and encourage our
colleagues to respect the dilemmas faced by patients at the end of
their lives. Crouch, 78, said she is grateful for the hospice care she is
now receiving and for the continuing love and support of her husband,
children and grandchildren.

decisions terminally

Some suffer from depression,
others from depression and a chronic disease such as diabetes or cancer. For example, the NIMH estimates that
about 40 percent of adults with dysthymic disorder (chronic, mild
depression lasting at least two years) also meet criteria for major
depressive disorder or bipolar disorder.

The professionals not only take calls from Medica members, but in some
cases, they make regularly scheduled phone calls to the member.

Medica developed its depression disease management program in collaboration
with United Behavioral Health (UBH). Physician Preferences May Influence Medical Care for Homeless

NORTHBROOK, Ill. I think there needs to be an alternative
to that," said Berg.

dying responding

"I don't know of a
program like this anywhere else," said Charles Fazio, M. "The reasons behind our findings are not clear, but it may be
because homeless people generally do not have good access to medical care and
other societal benefits, therefore , they may be more reluctant to have
potential medical benefits withheld from them.

complicating withdrawal

Medica estimates that more than 90,000 of its members experience some
degree of depressive disorder in a given year. This call center is a key resource in Medica's
depression management program for Medica members (866-658-4662) and
provides 24-hour crisis-level access to licensed behavioral health
professionals . to 5 p.2 million
members and 27,000 providers in a regional health care network service area
that includes 98 percent of Minnesotans and a growing number of adjoining
counties in Wisconsin, North Dakota and South Dakota.

About United Behavioral Health (UBH)

Through its emphasis on evidence-based consumer-focused behavioral health
benefit management services, UBH helps improve the health and well-being of
people at home and at work.
"Physicians should encourage all patients to make their treatment preferences
known to family members, friends, or health-care professionals .

End of Life issues in society have to do with whether death occurs 'naturally,' the quality of life near death, and who determines and who chooses among the alternatives for living or dying near the end of one's life.

dying promising

"It makes resources available to the entire community. This includes Medica members who
are MNCare, MA or GAMC recipients. Nationwide, UBH's services reach more than 22 million
people . From cost-effective behavioral
health benefit management services to complete work/wellness/life programs,
UBH meets the diverse needs of its members while helping its customers to
achieve long -term growth and success."
Using a cross-sectional survey, researchers from the University of
Washington compared treatment preferences of 229 homeless individuals with
preferences of 236 physicians and 111 patients with oxygen-dependent chronic
obstructive pulmonary disease (COPD). In regard to gender and
race, homeless men were more likely than homeless women to want CPR or
mechanical ventilation in the coma and dementia scenarios and nonwhite
homeless participants were more likely than white homeless to want
resuscitation.chestjournal.

dignity occurs

m. They also are less likely to have
family or friends to be surrogate decision makers, leaving physicians to make
the decisions for them," said study author J.

L.A. Advocates Oregon Governor Kick Off Drive to Win 'Compassionate Choices' for Terminally -Ill Californians

"I have learned that
more than costs and more than pain, the biggest issue for the
terminally ill is loss of choice," Roberts said.