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SCOTUS Ruling Reversing Decision From Sotomayor's Court Not Expected To Affect Nomination
The Supreme Court"s 5-4 reversal of a decision endorsed by a three-judge appellate panel that included Supreme Court nominee Sonia Sotomayor is attracting criticism from the judge"s conservative opponents but is not expected to have a significant effect on delaying her confirmation, the Washington Post reports. The appellate panel in 2008 upheld New Haven, Conn."s decision to discard a promotion test for firefighters after no blacks and only two Hispanics qualified for advancement after taking the test (Markon/Kane, Washington Post, 6/30). The panel"s ruling affirmed a lower court"s decision that the city had a right to discard the test based on a segment of civil rights law involving actions that have a "disparate impact" on minorities. A group of white and Hispanic firefighters who would have received promotions under the test sued, alleging reverse discrimination. Democrats and legal analysts said that Sotomayor was following legal precedent in the 2008 ruling and that it was the Supreme Court, which has the ability to exercise more discretion, that chose to make law by reversing the decision (Friedman, CongressDaily, 6/29). The Supreme Court typically reverses about 75% of the cases it reviews, according to legal experts. The court previously has reversed four of Sotomayor"s rulings and upheld three of her decisions, the Post reports. Tom Goldstein, a lawyer and founder of the SCOTUSblog Web site, said, "I don"t think it will persuade anybody who is inclined one way or another to change their views about Sotomayor" (Washington Post, 6/30). Sen. Charles Schumer (D-N.Y.), a member of the Senate Judiciary Committee, said, "The main charge against Sotomayor is that she will be an activist judge, but this decision clearly shows that she won"t." He said that the results of the case "won"t change things a wit," adding that "in fact, it bolsters (the claim) that she is mainstream" (CongressDaily, 6/29). Sen. Jeff Sessions (R-Ala.), the ranking Republican on the Senate Judiciary Committee, said the New Haven case "sharpens our focus on [Sotomayor"s] troubling speeches and writings" that "indicate ... that personal experiences and political views should influence a judge"s decisions." He added that the issue "will clearly be the subject of questioning" at Sotomayor"s confirmation hearing, which is scheduled to begin on Monday (Phillips, "The Caucus," New York Times, 6/29).
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Health Canada Update About Safety Of Lantus (Insulin Glargine)
Health Canada is informing Canadians of an ongoing safety review of the potential association between the diabetes drug Lantus (insulin glargine) and an increased risk of developing cancer.
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Lambda Legal Files Suit Against Assisted-Living Facility For Allegedly Discriminating Against HIV-Positive Resident
Lambda Legal, a group that represents HIV-positive people, on Tuesday filed a law suit against the Fox Ridge assisted-living facility in North Little Rock, Ark., for allegedly evicting a resident because he is HIV-positive, the Arkansas Democrat-Gazette reports.The Rev. Robert Franke, a retired biology and religion professor who was diagnosed with HIV in 1987, moved into Fox Ridge, which is operated by Parkstone Living Center, in February. The day after he moved into the facility, an unidentified administrator told his daughter, Sara Franke Bowling, that her "superiors" said Franke needed to be discharged from the facility "because of his HIV." Franke disclosed his HIV status on application materials before moving into the facility. The suit alleges that Parkstone violated the Fair Housing Act, the Americans with Disabilities Act and the Arkansas Civil Rights Act and requests a permanent injunction to prevent the facility from denying apartments or services to people living with HIV/AIDS. The suit also seeks compensatory and punitive damages and attorneys" fees and costs. The case was assigned to U.S. District Judge G. Thomas Eisele. The facility declined to comment on the suit. Julie Munsell, a spokesperson for the state Department of Human Services, said Arkansas law allows for people who have been discharged for assisted-living facilities to remain in the facility pending a hearing if the discharge is appealed. Munsell said the department"s Long-Term Care Division received notice that Franke was appealing the discharge but that the appeal was later dismissed without a hearing. According to Munsell, facilities are not permitted to discharge residents based on medical diagnoses but that some facilities have said they do not have the capacity to provide care for certain conditions. Munsell also said that Fox Ridge is "claiming that they did not admit this client so there is no need for a hearing." Scott Schoettes, staff attorney for Lambda"s HIV Project, said that Franke was not seeking medical care from Fox Ridge, although the facility does provide medical services. "He didn"t require any services beyond which they were licensed to provide," Schoettes said. Franke"s eviction is "particularly blatant and egregious, but unfortunately, not all that uncommon," Schoettes said, adding, "This happens all across the country. We want to send a message that this kind of discrimination is not going to be tolerated" (Satter, Arkansas Democrat-Gazette, 5/13).
Medical Devices

The 'Other' Cruciate Ligament: Newer Treatments For PCL Tears

While major advances have been made in the understanding of posterior cruciate ligament (PCL) anatomy and reconstruction, a literature review published in the July 2009 issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS) finds that there must be continued advances in basic science research in order to determine the best course of treatment for those with PCL injuries. "An ACL (anterior cruciate ligament ) tear is an injury of instability; a PCL tear is an injury of disability," said study author Matthew Matava, MD, Associate Professor, Department of Orthopedic Surgery, Washington University School of Medicine, in Chesterfield, Missouri. "With a PCL injury, your knee won"t buckle on you tomorrow, but in a few months or years it may become painful and not as strong or stable as it was prior to the injury. PCL tears are less frequently discussed because they are often left undiagnosed and the patient does not seek treatment for what they assumed was a mild injury." PCL injuries are assessed by grades: - Grade 1: Partial tear (non-surgical treatment options recommended) - Grade 2: Isolated, near complete tear (non-surgical treatment options recommended) - Grade 3: Complete PCL torn, with other ligament injuries (surgery often recommended, but not always) Two newer surgical options, along with one traditional method, are currently used to treat Grade 3 injuries: - Traditional: One-bundle bone graft passed through a tunnel in the tibia (shin bone). One-bundle grafts are made thicker than two-bundle grafts, but may not be as effective because they attach at a single point. - Newer: Two-bundle graft (studied for the past 10 years). Two-bundle grafts use thinner individual grafts, but their total graft volume is thicker. They may be more effective than one-bundle grafts because they attach at two different points. - Newer: Inlay reconstruction is an approach whereby a graft is screwed into the back of the tibia avoiding a tunnel through the front of the tibia. According to Dr. Matava, basic science data suggests that it is favorable to use a two-bundle graft over a one-bundle graft, and that an inlay reconstruction is preferable to a graft passing through a tibial tunnel. Inlay reconstruction is different, he says, because the graft does not get stretched around the tibial tunnel and is prevented from stretching out and/or fraying. "I like this procedure because I have had improved results compared to prior patients of mine that underwent the traditional method with the graft placed through the tibial tunnel," said Dr. Matava. "Additionally, there is biomechanical evidence that the benefits I have noticed are real." There have not been any randomized prospective studies to date, however, comparing the two methods. Some orthopaedic surgeons, however, believe these procedures are more complicated and therefore more risky; they also disagree on how much tension to use on the graft. If a patient has a PCL injury, the orthopaedic surgeon should first determine the level of injury in order to decide on the best treatment option. Because PCL surgery is technically challenging, a patient needing surgery should seek out an orthopaedic surgeon with experience performing PCL reconstructions. "Although we believe the newer treatments are better, we still must prove it," said Dr. Matava. "In order to do that, we must continue with our research, and follow patients over the course of several years to determine whether their treatments were successful." About the PCL The PCL is a ligament that prevents the shin bone from moving backwards, and PCL injuries occur most frequently in individuals involved in motor vehicle accidents when the knee is bent and the shin forcefully strikes the dashboard. Athletes also experience PCL tears when they fall on the front of their knee, causing it to bend back. Injuries to the PCL should not be confused with ACL injuries. Nearly 200,000 ACL surgeries are performed in the U.S. each year; PCL surgeries are estimated to be approximately 20 times less common. Disclosure: Matthew Matava, MD or a member of his immediate family serves as a paid consultant to or is an employee of ISTO Technologies and Schwartz Biomedical, and has received research or institutional support from Breg. Neither of the other authors of the study or a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Evan Ellis, MD and Brian Gruber, MD. JAAOS AAOS


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