Adoption advice: Canadian physicians are being warned that the medical advice they provide to parents adopting children abroad may be accompanied by legal risk. Over the past decade nearly 20 000 children living overseas have been adopted by Canadians. Prior to adoption, Canadian physicians are sometimes asked to assess the child's incomplete or inadequate medical records and advise parents about possible medical difficulties. This can hold legal risk, states the Canadian Medical Protective Association (CMPA). When adoptive parents' high expectations aren't met, they may blame the physician who advised them, says Dr. James Sproule, CMPA's director of physician consulting services. The CMPA has already dealt with several such cases. The Canadian Paediatric Society advises prospective adoptive parents that “about half” of children adopted abroad will have a medical problem, ranging from rickets to fetal alcohol syndrome, that is not obvious from a physical exam. — Pat Sullivan, Ottawa
Saskatoon ER: A report prepared for the Saskatoon Health Region concludes that 1 patient may have died prematurely because of long delays to see an emergency physician, and 3 other cases were too poorly documented to rule out the possibility. The report, by the College of Physicians and Surgeons of Saskatchewan, found that 76 other deaths were not related to long waits in emergency. The report is vindication for those who raised concern about long waits in the emergency at Royal University Hospital, including Dr. Jon Witt, the former head of emergency services who was demoted when he raised the alarm about long waits in the ED (CMAJ 2004;170[1]: 1653-4). “The report recognizes that patients waited too long to be seen, that there were a few cases that were potentially preventable," he said. The report also made 10 recommendations to improve emergency care at Saskatoon's 3 hospitals. — Amy Jo Ehman, Saskatoon
Smoking treaty: Nearly 90% (167) of WHO-member states, including Canada, had signed the Framework Convention on Tobacco Control by the June 29 deadline. But the treaty won't come into force until at least 40 nations have ratified it. So far 21 nations have done so; Canada is not among them. WHO officials are optimistic the treaty will come into force by year's end. The treaty's myriad requirements include covering at least 30% of packaging with health warnings, tightening advertising restrictions, promoting smoke-free public places and smuggling-prevention measures.
Manitoba pays: Manitoba is now fully funding abortions at Jane's Clinic, the non-profit facility established in Winnipeg 2 decades ago by Dr. Henry Morgentaler (CMAJ 2004; 171 [1]: 25). After years of stormy debate, the Winnipeg Regional Health Authority began to officially cover the cost of therapeutic abortions on July 1. Ultimately, the clinic will function as the abortion arm of a new and expanded Women's Health Clinic. Manitoba's decision to fund abortions at Jane's comes as the Manitoba Court of Queen's Bench reserved judgement on a suit launched by 2 women who were forced to pay for their own abortions at Jane's Clinic because they could not get a procedure at Winnipeg's Health Sciences Centre. — Dan Lett, Winnipeg
Uninsured Americans: The percentage of children in the US without health insurance dropped to the lowest level on record in 2003, according to a report by the US Centers for Disease Control and Prevention. The study, Health Insurance Coverage: Estimates from the National Health Interview Survey, 2003 (www.cdc.gov/nchs/nhis.htm), found that 10.1% of children (7.3 million) were uninsured last year, compared with 13.9% (9.9 million) in 1997. CDC officials attributed the decline to an increase in public coverage for poor and near-poor children. Over the same period, the percentage of working-age adults without coverage rose from 18.9% (30.8 million) to 20.1% (35.9 million). Overall, 15.2% (43.6 million) Americans were uninsured last year, about the same level as in 1997. Dr. Ken Thorpe, chairman of health policy and management at Emory University, in Atlanta, Georgia, called the findings a “mixed bag.” He said it was encouraging that state programs had helped to expand coverage for children but cautioned that “the news for adults was not good.” — Compiled by Barbara Sibbald, CMAJ