Physicians Adult Daycare, Inc. Addresses Depression Among the Elderly

“Depression is not a natural function of age,“ states Duane Starkey, CEO of Physicians Adult Daycare, Inc. “It often occurs as circumstances and relationships change for the aging, whether physical or mental.”

More than 6.5 million Americans over age 65, struggle with depression.

Many seniors and their caregivers deal with the problems of depression, dementia and Alzheimer’s on a 24-7 basis. They need to know that help is available in adult day care centers on a daily basis to overcome the struggle for a better life. As part of the company’s series of informative articles celebrating National Adult Day Care Week, Physicians Adult Daycare, Inc. calls for more attention upon the subject of depression among the elderly.

“I applaud KLRU-TV, Austin PBS for their recent program DEPRESSION: Out of the Shadows, which is very informative,” continues Mr. Starkey.

“We need to talk openly about the problem of depression among the Elderly and take action to reduce it. People are living 7 to 10 years longer and are not prepared to deal with the depression that may come with it.

We realize that all too often, families and friends mistake depression for dementia or the onset of Alzheimer’s. At Physicians Adult Daycare Centers, we care for our clients on a daily basis and take the time to help them overcome the bouts of depression that attack the elderly and handicapped. We keep them busy, entertained, and we give them our undivided attention in conversations and listen to their needs.

“We know that aging often means having to depend on others and living with increasing disabilities which often begins depression for seniors. (Learn the symptoms of depression: http://www.webmd.com/depression/symptoms-depression.)

“I further wish to applaud SEC Chairman Christopher Cox, who earlier this week spoke to seniors about the importance of legislators and regulatory agencies assuring the continued smooth operations of the markets—an issue which affects retired person’s who have not the option of a second chance at building a nest egg.”

On Monday, Mr. Cox addressed seniors during the third annual Seniors Summit.

About Physicians Adult Daycare, Inc.

Physicians Adult Daycare provides needed services for an improved and extended quality of life for eldercare and the handicapped. We help seniors preserve their independent living lifestyle and bring relief to their caregivers. For additional information on Physicians Adult Daycare, Inc., please visit the corporate website, http://www.physiciansadultdaycare.com/. The Company has also been featured in recent articles on AudioStocks, Medical News Today, Commercial Property News (CPN) and OTC Reporter.

Forward-Looking Statements:

Certain statements in this news release may contain forward-looking information within the meaning of the Federal securities laws. All statements, other than statements of fact, included in this release may include forward-looking statements that may involve risks and uncertainties. There can be no assurance that such statements will be accurate and actual results and future events could differ materially from those anticipated in such statements. The Company undertakes no obligation to update forward-looking statements to reflect subsequently occurring events or circumstances or to reflect unanticipated events or developments.

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Rhode Island Hospital First in the World to Treat Endometrial Cancer With New Form of Electronic Brachytherapy

Rhode Island Hospital is the first site in the world to treat endometrial cancer using the Axxent Electronic Brachytherapy System. The system, first approved for early stage breast cancer, is now approved by the United States Food & Drug Administration (FDA) for treatment of uterine cancer. The first patient received treatment on September 9 at the Providence, RI hospital.

The Axxent Electronic Brachytherapy System by Xoft uses a miniaturized X-ray source to deliver localized and targeted radiation treatment to reduce the risk of recurrence of the disease. It is inserted into the tumor through a catheter to the tumor site and allows medical staff administering the treatment to be in the room with the patient. The new treatment requires fewer sessions than traditional radiation and eliminates the use of radioactive isotopes, resulting in better outcomes for patients, less exposure to radiation and fewer side effects. The system was designed to improve survival and reduce recurrence of cancer

Rhode Island Hospital, the first in the world to use the Axxent System for the treatment of endometrial cancer, was also among the first in the country to use the system in the treatment of early stage breast cancer, and has seen positive results since it was FDA approved in 2007.

Endometrial cancer is a disease in which malignant cells grow in the lining of a woman's uterus, affecting about 40,000 women each year. It is the most prevalent gynecologic cancer in the United States, and is also the fourth most common invasive cancer. It is estimated that nearly two-thirds of these cases are eligible for treatment with electronic brachytherapy.

The most common treatment is surgery, however, additional types of treatment are often used following surgery to prevent tumor recurrence or if it is considered to be an aggressive form of cancer. These treatments include traditional radiation, chemotherapy or hormone therapy. When radiation therapy is determined to be the most appropriate course of action, women will undergo radiation treatments that can often last up to five weeks and then use vaginal cylinder implant treatment. In some patients we use vaginal cylinder implant treatment alone.

Yakub Puthawala, MD, a radiation oncologist with Rhode Island Hospital, says, "This treatment is revolutionary in the way we provide care to women with endometrial cancers. Vaginal brachytherapy for endometrial cancer is well accepted and we are excited to be the first cancer center to offer this wonderful new electronic treatment option." He also notes, "We believe our patients will find it comforting that we can be in the room with them, unlike other forms of radiation treatment. It allows us to provide more compassionate care."

For more information, call the Rhode Island Hospital Radiation Oncology department at 401-444-8311 or visit the web site at http://www.rhodeislandhospital.org.

Founded in 1863, Rhode Island Hospital (http://www.rhodeislandhospital.org) is a private, not-for-profit hospital and is the largest teaching hospital of The Warren Alpert Medical School of Brown University. A major trauma center for southeastern New England, the hospital is dedicated to being on the cutting edge of medicine and research. Rhode Island Hospital ranks among the country's leading independent hospitals that receive funding from the National Institutes of Health, with research awards of nearly $27 million annually. Many of its physicians are recognized as leaders in their respective fields of cancer, cardiology, diabetes, neurology, orthopedics and minimally invasive surgery and radiation oncology. The hospital's pediatrics division, Hasbro Children's Hospital, has pioneered numerous procedures and is at the forefront of fetal surgery, orthopedics and pediatric neurosurgery. Rhode Island Hospital is a founding member of the Lifespan health system.

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VIDEO from Medialink and P&G

To celebrate in the name of great flavors, Crest Whitening Expressions is hosting the "What's Your Catch Phrase?" contest in search of the new catch phrase that best captures the essence of the flavor experience in Crest Whitening Expressions. Available in Wintergreen Ice, Extreme Herbal Mint, Cinnamon Rush and Vanilla Mint, Crest Whitening Expressions combines great flavors with a bold blast of freshness while brushing.

From Sept. 15, 2008 through Oct. 17, 2008, consumers 18 years of age or older can enter the contest by posting a video of their catch phrase online at crest.com/whatsyourcatchphrase . Submissions must be thirty seconds or less and capture the essence of Crest Whitening Expressions in ten words or less.

On Oct. 24, 2008 up to five finalists will be chosen, and America can vote to determine the winner. The winner will be announced during the week of Nov. 10, 2008 and the winning catch phrase will appear in an upcoming Crest Whitening Expressions TV commercial. In addition, the winner will be invited for an all-expense paid trip to New York for a behind-the-scenes visit to the production of the commercial and receive $5,000!

Registered journalists can access video, audio, text, graphics and photos for free and unrestricted use at http://www.mediaseed.tv .

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US FDA probing deaths in J&J drug study

U.S. health officials said on Friday they were reviewing a higher rate of deaths among patients treated with a Johnson & Johnson (JNJ.N: Quote, Profile, Research, Stock Buzz) anemia drug in a study of stroke patients.

Three months after the German study began, 16 percent of patients who were treated with the drug Eprex had died, compared with 9 percent who got a placebo, the Food and Drug Administration said in a statement.

The study was testing if Eprex could improve brain function in stroke patients, an unapproved use of the drug. The patients were given either relatively high doses of Eprex for three days or a placebo. Most were not anemic, the FDA said.

Eprex is known generically as epoetin alfa. J&J also sells epoetin alfa under the name Procrit. Amgen Inc (AMGN.O: Quote, Profile, Research, Stock Buzz) sells a version under the name Epogen.

The FDA said it was aware of other clinical trials testing the potential neurological effects of epoetin alfa.

The higher death rate in the German study "suggests the need to closely monitor patients enrolled in other ongoing trials for adverse outcomes and to evaluate whether the potential benefits for enrolled patients outweigh the risks in these trials," the FDA said.

J&J reported last week that early data showed Exprex patients in the German study died more frequently than placebo patients, and said it was doing additional analyses to better understand the findings. The company alerted the FDA to the findings, J&J spokesman Mark Wolfe said on Friday.

J&J shares were down 25 cents at $69.11 on Friday on the New York Stock Exchange.

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Continuum Health Care Inc. announces commencement of development of Drayton Valley and Camrose Facilities

Continuum Health Care Inc.is pleased to announce that it and its wholly-owned subsidiary, Continuum Health Care Holdings Ltd. ("Holdings"), have commenced the financing, planning, development and marketing of a 68-unit seniors supportive living facility in Drayton Valley, Alberta (the "Drayton Valley Facility"), together with Vantage West Development Corp. ("Vantage") and Sunrise Village (Drayton) Joint Venture ("Drayton Joint Venture"). Continuum and Holdings have also commenced the financing, planning, development and marketing of a 122-unit designated assisted living and supportive living facility in Camrose, Alberta , together with Vantage and Sunrise Village Joint Venture . Vantage is owned by three of the directors of Continuum, namely Patrick Hovan, Peter Allan and Evan Welbourn. Continuum has received regulatory approval from the TSX Venture Exchange and shareholder approval at Continuum's last annual general meeting held on June 13, 2008 for theses non-arm's length transactions.

The lands to be developed for the Drayton Valley Facility are to be owned by a joint venture between Vantage and Eldercare (Drayton) Limited Partnership. The joint venture is called the Sunrise Village (Drayton) Joint Venture ("Drayton Joint Venture"). The general partner of the Eldercare (Drayton) Limited Partnership is Evan Welbourn, a director of Continuum. The Drayton Joint Venture will own the Drayton Valley Facility through a trustee company, Sunrise Village (Drayton) Holdings Ltd. (the "Trustee") The respective interests of Vantage and Eldercare (Drayton) Limited Partnership, as the joint venturers, will be determined based upon their respective contributions to the Drayton Joint Venture.

The Drayton Valley Facility shall be developed under a Project Management Agreement between Vantage and the Trustee, which covers the planning, design, procurement and construction management services to be completed by Vantage for a specified fee of $236,693.00.

Under an exclusive Option Agreement, Vantage will grant to Holdings an option to acquire Vantage's interest in the Drayton Joint Venture in consideration for a loan of funds made by Holdings to Vantage under a separate Loan Agreement described below. As additional consideration for the Option Agreement, Continuum will provide guarantees on the construction financing for the Drayton Valley Facility. The term of the option will be 48 months. The right of Holdings to exercise the option is contingent upon occupancy of the Drayton Valley Facility being at or above 85% for three consecutive months. The price payable by Holdings for the exercise of the option is the aggregate of the actual cost contributed by Vantage to the Drayton Joint Venture, plus five (5%) percent of the total of all capitalized costs of the Drayton Valley Facility, less the principal amounts advanced to Vantage from Holdings pursuant to the Loan Agreement described below. Should the option be exercised, Holdings would replace Vantage as a participant in the Drayton Joint Venture.

Under a Loan Agreement, an amount up to $1, 396,508.00 is to be advanced by Holdings to Vantage to assist with the capital cost of the Drayton Valley Facility. The loan is to be funded by Holdings from the grant provided to Holdings by the Alberta Government through Alberta Seniors and Community Supports, under the Affordable Supportive Living Initiative ("ASLI"). Interest will accrue under the Loan Agreement at the rate of 6% per annum, and become due on the earlier of four years from the date of the Loan Agreement or thirty days following the date of exercise of the option under the Option Agreement. Should the option be exercised by Holdings, the principal amount owing by Vantage to Holdings under the Loan Agreement would be subtracted from the exercise price of the option and such would constitute repayment by Vantage, and any accrued interest otherwise owing by Vantage under the Loan Agreement would be forgiven.

Under a Facility Management Agreement between Continuum and the Trustee, Continuum shall be the sole and exclusive managing agent of the Drayton Valley Facility and shall also provide marketing and lease-up services. The Trustee will pay to Continuum a fee of $5,666.67 per month until date the first tenant occupies a unit in the Drayton Valley Facility, not to exceed $68,000 in the aggregate. In addition, during the five year term of the Facility Management Agreement, the Trustee will pay Continuum 5% of the total revenue from all of the Drayton Valley Facility's operating departments per month (the "gross revenue"), as well as 5% of net revenue (gross revenue less operating expenses) per year.

As the development of the Drayton Valley Facility proceeds, it is contemplated that further financing will be required by the Drayton Joint Venture and will be guaranteed by the joint venture parties and by Continuum.

The lands to be developed for the Camrose Facility are to be owned by a joint venture between Vantage and Eldercare (Camrose) Limited Partnership. The joint venture is called the Sunrise Village (Camrose) Joint Venture ("Camrose Joint Venture"). The general partner of the Eldercare (Camrose) Limited Partnership is Evan Welbourn, a director of Continuum. The Camrose Joint Venture will own the Camrose Facility through a trustee company, Sunrise Village (Camrose) Holdings Ltd. (the "Trustee"). The respective interests of Vantage and Eldercare (Camrose) Limited Partnership, as the joint venturers, will be determined based upon their respective contributions to the Camrose Joint Venture.

The Camrose Facility shall be developed under a Project Management Agreement between Vantage and the Trustee, which covers the planning, design, procurement and construction management services to be completed by Vantage for a specified fee of $412,250.00.

Under an exclusive Option Agreement, Vantage will grant to Holdings an option to acquire Vantage's interest in the Camrose Joint Venture in consideration for a loan of funds made by Holdings to Vantage under a separate Loan Agreement described below. As additional consideration for the Option Agreement, Continuum will provide guarantees on the construction financing for the Camrose Facility. The term of the option will be 48 months. The right of Holdings to exercise the option is contingent upon occupancy of the Camrose Facility being at or above 85% for three consecutive months. The price payable by Holdings for the exercise of the option is the aggregate of the actual cost contributed by Vantage to the Camrose Joint Venture, plus five (5%) percent of the total of all capitalized costs of the Camrose Facility, less the principal amounts advanced to Vantage from Holdings pursuant to the Loan Agreement described below. Should the option be exercised, Holdings would replace Vantage as a participant in the Camrose Joint Venture.

Under a Loan Agreement, an amount up to $2,444,310.00 is to be advanced by Holdings to Vantage to assist with the capital cost of the Camrose Facility. The loan is to be funded by Holdings from the grant provided to Holdings by the Alberta Government through Alberta Seniors and Community Supports, under the Rural Affordable Supportive Living program ("RASL"). Interest will accrue under the Loan Agreement at the rate of 6% per annum, and become due on the earlier of four years from the date of the Loan Agreement or thirty days following the date of exercise of the option under the Option Agreement. Should the option be exercised by Holdings, the principal amount owing by Vantage to Holdings under the Loan Agreement would be subtracted from the exercise price of the option and such would constitute repayment by Vantage, and any accrued interest otherwise owing by Vantage under the Loan Agreement would be forgiven.

Under a Facility Management Agreement between Continuum and the Trustee, Continuum shall be the sole and exclusive managing agent of the Camrose Facility and shall also provide marketing and lease-up services. The Trustee will pay to Continuum a fee of $8,714.28 per month until date the first tenant occupies a unit in the Camrose Facility, not to exceed $122,000 in the aggregate. In addition, during the five year term of the Facility Management Agreement, the Trustee will pay Continuum 5% of the total revenue from all of the Camrose Facility's operating departments per month (the "gross revenue"), as well as 5% of net revenue (gross revenue less operating expenses) per year.

As the development of the Camrose Facility proceeds, it is contemplated that further financing will be required by the Camrose Joint Venture and will be guaranteed by the joint venture parties and by Continuum.

Pursuant to each of these transactions, Holdings will provide a loan of funds to Vantage for the development of the facility by a joint venture in which Vantage is one of the two joint venture parties. In return, Holdings will have an exclusive option to buy out Vantage's interest in the joint venture, in certain events. Continuum will provide marketing, lease-up and facility management services for the facilities. This transaction structure is designed to protect Continuum from the majority of risks typically associated with the construction and development of seniors supportive living facilities, while allowing Continuum to maintain an exclusive right to purchase the facilities on favourable terms. Continuum also benefits by receiving a contract to provide the pre-leasing and operations management services for the facility. This structure allows Continuum to focus on its intended role as a seniors facility management company rather than as a development and construction company. The payment rates under all of the agreements will be determined based on current fair market value of the particular asset or service. These transactions are part of the Continuum's strategic plan to improve earnings and returns on common equity, and to enhance total assets by means of expanding its operations in Alberta.

Continuum owns, operates, manages and develops supportive living facilities in Alberta. It currently owns and manages, with its joint venture partners, 167 supportive living facility units in Olds, Lethbridge and Wetaskiwin. Continuum has joint venture interests in another 95 units that are currently under construction at the Wetaskiwin facility and at a project in Ponoka. The facilities under development in Drayton Valley and Camrose will add another 190 units. Continuum and its joint venture partners also plan to commence development of a 120 unit facility in High River, Alberta in the near future. These developments together will bring the total number of units managed by Continuum up to 572 Units.

Continuum is listed on the TSX Venture Exchange (TSXV-CCF) and has a total of 17,854,283 common shares outstanding, 19,529,283 fully diluted.

This press release contains forward-looking statements. More particularly, this press release contains statements concerning anticipated changes in Continuum's financial capital and anticipated development activities.

The forward-looking statements are based on certain key expectations and assumptions made by Continuum, including expectations and assumptions concerning the finalization and execution of the various transaction agreements and the ability and willingness of all of the parties to proceed with the development of the facilities as contemplated.

Although Continuum believes that the expectations and assumptions on which the forward-looking statements are based are reasonable, undue reliance should not be placed on the forward-looking statements because Continuum can give no assurance that they will prove to be correct. Since forward-looking statements address future events and conditions, by their very nature they involve inherent risks and uncertainties. Actual results could differ materially from those currently anticipated due to a number of factors and risks. These include, but are not limited to: (a) risks associated with the assisted and supportive living industry in general, (b) the ability and willingness of operators, tenants, borrowers, joint venture partners and third parties, as applicable, to meet and/or perform their obligations under various contractual arrangements with Continuum, (c) Continuum's ability to successfully implement its business strategy and its ability to identify, finance, consummate and integrate acquisitions or investments, (d) the nature and extent of future competition, (e) the extent of future or pending healthcare and assisted living regulation, (f) increases in the costs of borrowing, (g) the ability of the applicable operators and managers to deliver high quality services and to attract residents, (h) changes in general economic conditions, (i) Continuum's ability to pay down, refinance, restructure and/or extend its indebtedness as it becomes due, and (j) uncertainties resulting from potential delays or changes in plans with respect to facility development, financing or expenditures. Many of these factors are beyond the control of Continuum. Certain of these risks are set out in more detail in Continuum's filings under applicable securities laws and can be accessed at www.sedar.com.

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President Clinton Highlights Hesperian's Commitment to Improve the Lives of Three Million People

Speaking at the Clinton Global Initiative's (CGI) New York summit, President Clinton highlighted Hesperian's commitment to empower communities in overcoming the death and disease that a lack of safe drinking water and sanitation cause. The Hesperian commitment brings together funding and support partners the Kind World Foundation, the Pan American Health Organization (PAHO) and others to arm communities with vital water, health and hygiene education.

The commitment enables Berkeley, CA based Hesperian -- a highly respected non-profit publisher and distributor of easy-to-understand materials that enable communities to recognize, treat, and prevent most common health problems -- to increase the number of local editions of its A Community Guide To Environmental Health, expanding distribution of water and sanitation-related materials while also expanding the circulation of the updated guide Where There Is No Doctor.

Hesperian's life-saving publications are available in over 80 languages, and are currently used in over 100 countries. They are helping to train health workers in violence-torn areas of Colombia, create community-based care for refugees in Thailand, support children affected by HIV/AIDS in Africa, combat toxic poisoning from mining in the Philippines, and answer urgent public health needs worldwide.

"Hesperian works by bringing together community leaders and other partners, and tapping into their local knowledge," noted Sarah Shannon, Hesperian's Executive Director. "That ensures its books are relevant, up-to-date, and community-appropriate. With this commitment, our network can greatly enhance the development and distribution of life-saving information in a powerful, collaborative way that reaches the largest number of people possible."

The commitment reflects CGI's determination to improve global health with existing tools and knowledge. Hesperian is ideally positioned to support this goal through the production and distribution of culturally appropriate, practical and powerful health information via its open copyright publishing model.

Hesperian will work with a partner network to update and test resources in the field, and through a collaborative online portal. It will make seed grants and technical assistance available to over 20 translation partners in Africa, Asia and Latin America. Resources developed will be distributed by PAHO, Populations Services International (PSI), Global Action, and others. http://www.hesperian.org

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Patient-nurse ratio inaccurate mark of success

The National Nurses Organizing Committee, a California-based nurses’ union trying to make inroads elsewhere, is once again calling for higher nurse-to-patient ratios in Texas hospitals.

This isn’t the first time the group has called for lowering the number of patients each nurse is responsible for. In the previous legislative session a bill was introduced but was not voted upon.

Some Texas nurses have taken up the cause, saying patient safety is compromised if nurses have to divide their attention among too many patients. They want a bill submitted in the 81st Texas Legislature, which convenes in January, mandating a 1-to-5 nurse-patient ratio in general hospital wings, with a 1-to-4 ratio in pediatric units and 1-to-2 ratio in intensive care units.

Lawmakers shouldn’t have to be reminded to be skeptical about efforts to mandate more workers made by unions, which gain money and strength when they have more workers to recruit.

They should, however, remember that mandates don’t matter if there aren’t enough people to meet them.

The American Hospital Association released a report in June 2007 that 116,000 existing nursing positions remained unfilled nationwide at the time because there were no nurses to fill them. Several studies have concluded the shortages will only get worse, as an aging population creates ever-growing demands for nurses and other health care professionals. The National Council on Physician and Nurse Supply projects the nationwide nursing shortage could be as great as 800,000 by 2020.

People with medical needs and their families naturally want the best care possible. It’s safe to assume those filling those needs also want to do the best job they can. Those desires, however, don’t magically make nurses appear. Hospitals here and everywhere frequently offer large bonuses to nurses who are willing to sign long-term contracts, just to fill their immediate needs.

It makes no sense to mandate nursing minimums when there is no way those mandates can be met.

Hospitals, nursing homes and other health care facilities deal with such shortages by hiring the nurses they can and using them as supervisors for larger groups of certified nursing assistants. The assistants generally provide most hands-on care, allowing nurses to focus on the more critical cases.

Health care institutions already face periodic reviews and audits that determine how well they are meeting the needs of their communities. Those reviews should be thorough enough to uncover deficiencies; facilities that provide good care with limited resources should not be penalized for their efficiency, just because they might not meet mandated nurse-patient ratios.

Everyone involved should place the priority on quality of care, not on how well a facility meets numbers targets. We trust Texas legislators will see the folly in considering quotas that are impossible to fill.

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Love, hope and loss

Tom Sweitzer was just a boy when doctors told him his mother was dying. An only child, he struggled to cope with the impending loss.

Today, Sweitzer, a professional playwright and director, remembers how hospice care workers lifted his mother's spirits during her last days, while helping to bridge the emotional gaps the experience created between him and his father.

He's drawn from that mix of emotional trauma and redemptive hope to form the basis of his latest production, "Tootleloo."

It tells of a boy's journey toward manhood as he copes with losing his dying mother and the fear of being left behind with his distant father.

The family's life is forever changed when a hospice volunteer begins to visit their home. She brings support, love and most importantly, magic.

Presented by Home Nursing Agency's Foundation, the new musical drama is coming to the Halbritter Center for the Perform-ing Arts at Juniata College in Huntingdon at 7:30 p.m. Oct. 2 and to the Mishler Theatre in Altoona at 8 p.m. Oct. 3.

''The musical drama is how do you say goodbye to someone you love,'' said Kim Kranz, said the Altoona agency's vice president of operations. ''We all, at one point in our lives, will experience the death of a friend or loved one. (The show) does take you through a journey, and it's also celebrating life.''

It was hospice nurse Connie Shatzer of Williamsburg who inspired the production, Sweitzer, 36, of Middleburg, Va., said.

'''Tootleloo' was created from my memory as a young boy in constant fear of losing my mother, and the powerful impact of Connie's support during my grieving process,'' Sweitzer said. ''Most of all, she allowed me to never say goodbye - hence, the name of the drama is 'Tootleloo.'''

Sweitzer learned of the agency's hospice services as a teenager in the early '90s, after his mother had been diagnosed with a terminal illness and sent home from the hospital, he said. She was given little time to live.

''She was sent home with congestive heart failure,'' he said. ''That's when the team from Home Nursing Agency started helping her with her physical care. Connie had a lot to do with keeping her spirits up.''

Today, Shatzer, 61, serves as a third-party payer specialist for the agency, approving hospice visits with insurance companies.

She was delighted, albeit a bit incredulous, to learn that Sweitzer cited her as the play's main inspiration.

''I was totally overwhelmed,'' she said.

''Whenever I heard that, I thought, 'These are things that hospice nurses in the agency do every day," she said. "I was just lucky enough to be taking care of the mom of a guy who would become famous. But I'm enjoying it.''

Shatzer said she tried to concentrate on the positive things during her time with Sweitzer's mother - things such as her ability to eat, read a book and sit up in a chair.

''That's what she wanted Tom to know - the positive things,'' she said. ''She didn't want him worrying about her, and coming home from school. She wanted him to stay in college.''

Sweitzer made Shatzer promise him that she would let him know when his mother was close to death, so he could be there in her final moments. It wouldn't happen that way.

''It happened too suddenly to notify him,'' she said. ''We told him right after she passed.''

Renowned media personality, Willard Scott, a personal friend of Sweitzer, is very passionate about hospice awareness and has become the spokesman for 'Tootleloo,' Sweitzer said. Scott introduces the play and gives a final monologue at the show's ending via audio recording.

The show includes a cast of eight and is 75 minutes long, he said. On the musical end, it includes one piano and one cello.

"Tom has written a beautiful play, and the music is lovely," said Anne Charlotte Robinson of Upperville, Va., who portrays the dying mother, Kathy. "I'm the mother of a 13-year-old and a 10-year-old, so I could really identify with my role ... I think people will find this show very moving."

Tutti Perricone of Middleburg, Va., plays Kathy's hospice nurse, Marilyn. She, too, could identify with her role.

"I lost my father about a year and a half ago," she said. "We had a hospice nurse take care of him, so I'm kind of taking inspiration from that."

Then there's the boy who's forced to grow up early - 12-year-old Teddy, played by Grant Salley, 12, also of Upperville. The Mishler and Halbritter shows will mark his introduction to full-fledged theatrical productions. He described the play as "very emotional."

"There's some parts, where if you don't understand what's happening, you won't get what's going on later," he said. "You really have to pay attention."

And there's a couple things he wants audiences to pay particular attention to.

"I hope people see that hospice workers do a lot to take care of a dying person," he said. "I also want them to see that the life of a 12-year-old is more complicated than most people take it for."

Proceeds from the show will benefit Home Nursing Agency's Hospice and Healing Patch, A Center for Loss and Hope for Grieving Children and Their Families. The Healing Patch is funded by the agency's Foundation and Highmark Healthy High Five.

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Court trustee to watch over Access Medical Group

A former manager of health clinics will observe the quality of medical care at a Lower Hudson Valley medical practice that filed for protection from creditors in U.S. Bankruptcy Court last month.

Joseph J. Tomaino, a member of the board of directors of the parent company of Westchester Medical Center in Valhalla, was named last week by court Trustee Diana G. Adams to serve as patient care ombudsman in the bankruptcy filing of Access Medical Group.

Access Medical Group is headquartered in White Plains and has offices in Westchester and Orange counties. The practice, with more than 80 employees, filed for bankruptcy shortly after an arbitrator awarded $3.6 million to a medical practice management company with whom Access' principal had feuded bitterly in court for the past three years.

As ombudsman, Tomaino will interview patients and doctors at Access to monitor the quality of patient care and will report to the bankruptcy court no later than every two months on his findings. If he finds that patient care is declining significantly, he will notify the court "immediately," according to bankruptcy court papers.

The role of patient care ombudsman was created as part of the 2005 federal bankruptcy reform bill, said Jack Williams, a professor at the Georgia State University College of Law and a resident scholar at the American Bankruptcy Institute.

In addition to doctors' practices, the ombudsman provision also applies to nursing homes, hospitals and other health care businesses that find themselves in bankruptcy court, Williams said.

"The drafters of this provision were pretty wise in developing a system that works across all those entities," Williams said.

Tomaino is a former chief nursing officer and a director at RSM McGladrey Inc., a Manhattan health care consultancy. He will receive $320 an hour plus expenses for his work. He could not be reached for comment this week.

He said in a court filing that he had no relationships that would conflict with his work overseeing Access.

The medical practice's president and majority owner, Dr. Jeffrey M. Ambinder, stated in a court filing that he hopes to reorganize Access as a smaller business. It employs 15 doctors in offices in White Plains, Yorktown, Carmel, Yonkers and New Windsor.

Access' roots date back to 1982 when it was founded as an oncology service by Ambinder and Dr. Marc Straus, court papers said. Access does specialty work in cancer care and diabetes management. It had 55,000 outpatient visits last year, and revenues of $11.6 million.

But the practice lost $1 million in the first seven months of this year, and $3.5 million over 2006 and 2007, Ambinder's affidavit stated. He blamed the business's financial problems on a range of issues, but chiefly on his legal battles with his former partner Straus.

Ambinder, Straus and other doctors formed MDx Medical Management, a business to manage their medical practice, in 1997, court papers said. Last month MDx obtained an arbitration ruling against Access for $3.6 million. MDx is Access' largest unsecured creditor.

In his affidavit, Ambinder said Access' financial problems also included an unprofitable expansion in Westchester and Orange counties, as well as rising prices for malpractice and other costs, and reduced reimbursements.

Ambinder said his new business plan involved consolidating some offices and shedding unprofitable markets. Ambinder could not be reached for comment. His attorney, Joseph M. Gitto of Nixon Peabody in Manhattan, declined comment.

Williams said nine of 10 medical practices in bankruptcy fail in their attempts to reorganize. Among the problems facing such reorganizations are cash flow difficulties resulting from lengthy waits for insurance reimbursements.

Doctors in such straits must have the "ability to negotiate with a panoply of interests, including secured and unsecured creditors," Williams said. "They all have a different view of how this should go down."

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Westchester Medical Center rejuvenates ICU

Doctors and nurses at Westchester Medical Center yesterday not only transferred patients to a new unit, they took them to a new generation.

With the official opening of the hospital's $2.9 million medical intensive care unit, hospital staff and patients bid farewell to the cramped, 1970s-era space in favor of a bigger, brighter unit equipped with the latest technology and modern furnishings.

The project is part of a long-term, multimillion-dollar renovation to overhaul the medical center's main tower.

The new 11-bed unit - sometimes called the MICU, or "mic-U" - cares for the sickest patients in the hospital and, arguably, in the country. About 400 patients flow through the unit yearly, said the unit's medical director, Dr. Lawrence DeLorenzo.

"We take care of patients with multi-organ system failure," DeLorenzo said. "Folks cared for here are usually critically ill."

That's something Ruth Dapp of Highland, N.Y., already knows.

Dapp has practically lived in the medical intensive care unit since July. Her 27-year-old son, Joshua, who has cancer, struggles to breathe on a respirator in one of the rooms. Ruth Dapp spent most of the past 85 days sleeping on couches and lounge chairs.

"I promised him back when he was diagnosed that I was going to be with him until the cure," Dapp said.

Dapp appreciates the new unit, and the larger room her son is in, but she said the generosity and concern of the nursing staff are what has helped her through this difficult time. When nurses notice she hasn't eaten, she said, they buy her food, sometimes leaving it on her chair.

"I can't walk down the hall without somebody hugging me," Dapp said.

DeLorenzo said the new unit is meant to be a soothing place for patients and their family members.

Each large, single-occupancy room has a window allowing for more natural light. The halls are wide with earth-tone decor, a trend in hospital design.

It has four more beds than the old unit, which at times couldn't fit the overflow of patients. The larger rooms will help with infection control because bedding and other supplies are contained inside each patient's room, DeLorenzo said.

A broad and centrally located nurses station is flanked by smaller desks outside each of the rooms. Nurses are now able to monitor their patients using closed-circuit cameras affixed above hospital beds.

There is typically one nurse, sometimes two, per patient depending on how critical the patient's condition, nurse manager Kathy Longo said.

Longo said nurses are excited to work in a newer, more modern unit, which she says will be more efficient and help them deliver quality patient care.

Hospital officials plan eventually to renovate all of the hospital's six intensive care units for adults.

They expect four new ICUs will be completed within the next year.

The hospital recently installed a modular addition to its emergency department in order to renovate the original structure. Renovations on seven labor and delivery rooms are also in the works.

The hospital's main tower opened in 1977, and there have been few physical upgrades, said Michael Israel, chief executive officer of the medical center.

"You take a look at the older ICUs, and it is obvious that we need to do something," Israel said.

Hospital officials are in the process of putting together its budget and "don't want to bite off more than we can chew," Israel said in terms of the renovations.

Another challenge is an unfortunate fact of life: The hospital beds are always in use, making it difficult to work around the flow of very ill people, said Tony Mahler, the medical center's senior vice president for strategic planning.

"The demand for critical care is constant," Mahler said.

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8-station dialysis clinic opens at St. Joseph's

With an eye on the increasing number of people experiencing kidney failure, St. Joseph's Hospital on Wednesday officially opened an eight-station, 3,300-square-foot dialysis clinic that can treat up to 16 kidney patients a day.

The opening of the clinic coincides with the observance of the hospital's founding 100 years ago, and Sister Marie Castagnaro, president and CEO of St. Joseph's, said the founding sisters would be pleased to see the new service opening on the historic date.

"This dedication is a lesson in creativity and stubbornness," she said. "The credit has to go to those who worked through the paperwork and the politics to put it all together."

Dialysis is a medical process that filters the blood of a person whose kidneys can no longer perform the function. The risk factors associated with kidney failure include diabetes, hypertension and obesity, said Lisa Perry, the new unit's director.

The unit will be staffed by four registered nurses, two licensed practical nurses and two patient care technicians.

St. Joseph's has been providing dialysis treatments for patients who are already in the hospital since 2005. The new clinic, providing the same services on an outpatient basis, began treating patients on Sept. 10, she said.

Perry was hired by St. Joseph's in 2004 to oversee the clinic's administrative duties. Dr. Luis Tapia and Dr. Fadi Hijazi are in charge of the clinical side of the unit.

Perry said the biggest challenge for creating the new unit was obtaining the state Health Department's approval. There were several times during the process when hospital administrators thought they'd reached the end of the approval process, only to discover there were new requirements that had to be fulfilled, she said.

State approval was finally granted in March.

Castagnaro said 10 patients are in line to be treated in the new clinic, and two have already begun treatments. When the 16-patient capacity is reached, the hospital will seek approval to add dialysis machines.

The state Health Department will allow St. Joseph's to add another eight machines, which will boost the unit's capacity to 96 treatments a week.

Dialysis patients usually require three treatments a week.

Castagnaro also said that with the increasing senior citizen population in the area, opening the outpatient dialysis clinic made sense for the hospital.

"Our clinic will improve access for the many dialysis patients who wish to be dialyzed during the daytime, while at the same time enhancing the quality and continuity of patient care in our community," she said in a prepared statement.

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States, medical groups oppose abortion rule

Several medical associations and 13 state attorneys general voiced their opposition Wednesday to a proposed federal rule that they fear would open the door for hospitals and physicians to deny access to contraception.

In late August, the Bush administration proposed stronger job protections for doctors and other health care workers who refuse to participate in abortions because of religious or moral objections. Abortion foes called it a victory for the First Amendment, but abortion rights supporters said they feared the rule could stretch the definition of abortion to include birth control.

The public comment period for the proposed rule ends Thursday. As the deadline nears, opponents have orchestrated a highly public call for the administration to rescind the rule. While the regulation states that it would not limit access to health care, groups such as the American Psychiatric Association and the American Academy of Pediatrics disagreed.

They said doctors and nurses are already not required to perform abortions or sterilizations. They can refuse to do so. But each health care professional is ethically bound to inform patients about all of their treatment options. If health care professionals cannot or will not provide a certain service, they are ethically obligated to refer patients in a timely manner to someone who can.

"Implementation of this regulation would effectively allow health care providers' personal beliefs to override patients' right to full disclosure of accurate information and available health care resources," the medical associations wrote.

Separately, 13 attorneys general complained the rule was too vague about what health care procedures may be withheld.

"The proposed regulation completely obliterates the rights of patients to legal and medically necessary health care services in favor of a single-minded focus on protecting a health care provider's right to claim a personal moral or religious belief," the attorneys general said in a letter to the Department of Health and Human Services.

HHS spokeswoman Christina Pearson said she would not "speculate" on the department's course of action.

"We have an open comment period, so I'm unable to comment on what will happen beyond here," said Pearson.

Pearson said that Secretary Mike Leavitt has written extensively on his views about the need for the rule in a series of blogs available through the department's Web site. Leavitt has said the rule is directly focused on the protection of practitioner conscience.

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Merck & Co., Inc. and Japan Tobacco Inc. Sign Licensing Agreement for Novel Osteoanabolic Drug Candidate to Treat Osteoporosis

Merck & Co., Inc. and Japan Tobacco Inc. (JT) (TSE: 2914 - News) today announced a worldwide licensing agreement to develop and commercialize JTT-305, an investigational oral osteoanabolic (bone growth stimulating) agent for the treatment of osteoporosis, a disease which reduces bone density and strength and results in an increased risk of bone fractures.

Under the terms of the agreement, Merck gains worldwide rights, except for Japan, to develop and commercialize JTT-305. JT will receive an upfront payment and is eligible to receive additional cash payments upon achievement of certain milestones associated with the development and approval of a drug candidate covered by this agreement. JT will also be eligible to receive undisclosed royalties from sales of any drug candidates that receive marketing approval.

“Through this agreement with Merck, JT is well positioned to maximize the therapeutic potential for JTT-305 as a possible future option for patients with osteoporosis,” said Noriaki Okubo, President of JT’s Pharmaceutical Business.

JTT-305 is an investigational oral calcium sensing receptor (CaSR) antagonist that is currently being evaluated by JT in Phase II clinical trials in Japan for its effect on increasing bone density and is in Phase I clinical trials outside of Japan. Most current available osteoporosis therapies reduce fracture risk by slowing bone loss – or bone resorption. Osteoanabolic drugs, such as JTT-305, may reduce fracture risk by stimulating the growth of new bone and thereby increasing bone density.

"Partnering with JT to develop this novel compound complements Merck's portfolio of musculoskeletal drug candidates," said Alan B. Ezekowitz, MBChB, D.Phil., senior vice president and franchise head, Bone, Respiratory, Immunology, and Endocrine, Merck Research Laboratories. "In the future, we believe that use of antiresorptive and osteoanabolic agents together may provide an effective way to reduce the risk of fractures in patients with osteoporosis."

The effective date of the collaboration agreement is subject to the expiration or earlier termination of the waiting period under the Hart-Scott-Rodino Antitrust Improvements Act.

About osteoporosis

Osteoporosis affects more than 75 million people in the U.S., Europe, South America and Japan. As bones become more porous and fragile, the risk of fracture is greatly increased. The most common fractures associated with osteoporosis occur at the hip, spine and wrist and the risk of having an osteoporosis-related fracture increases with age. One in three women over age 50 will experience an osteoporotic fracture, as will one in five men. According to the International Osteoporosis Foundation (IOF), the worldwide incidence of hip fracture is projected to increase by 240 percent in women and 310 percent in men by 2050.

About JT

Japan Tobacco Inc. is the world's third largest international manufacturer of tobacco products. Since its privatization in 1985, JT has actively diversified its operations into pharmaceuticals and foods. JT entered into the pharmaceutical business in 1987 and established the Central Pharmaceutical Research Institute in 1993. JT is currently engaged in the research and development of new drugs in various areas such as glucose and lipid metabolism, anti-virus, immune disorders and inflammation, and bone metabolism. The company’s net sales were ¥6.409 trillion in the fiscal year ended March 31, 2008.

About Merck

Merck & Co., Inc. is a global research-driven pharmaceutical company dedicated to putting patients first. Established in 1891, Merck currently discovers, develops, manufactures and markets vaccines and medicines to address unmet medical needs. The company devotes extensive efforts to increase access to medicines through far-reaching programs that not only donate Merck medicines but help deliver them to the people who need them. Merck also publishes unbiased health information as a not-for-profit service. For more information, visit http://www.merck.com.

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MedImpact Appoints New Medical Director

MedImpact has appointed Louis C. Tripoli, M.D., to the position of vice president and medical director. In his new role, Dr. Tripoli will further expand MedImpact’s health services programs, with a focus on innovations that foster new ways to approach complex health problems. He will direct health outcomes research as well as drug management strategy and clinical integration. Dr. Tripoli reports to Dr. Louis Brunetti, senior vice president and chief medical officer for MedImpact Healthcare Systems, Inc.

Dr. Tripoli is a proven leader and brings a wealth of experience and capabilities in many significant areas of medical management,” said Dr. Brunetti. “By looking at the whole health care picture, both medical and pharmacy, MedImpact will continue to be a leader in delivering high quality clinical programs that benefit both the payor and the consumer. I am confident Dr. Tripoli will contribute significantly to our continued accomplishments in the health services arena.”

As medical director for MedImpact, Dr. Tripoli is responsible for all pharmacy and therapeutics activities related to the drug selection process and formulary development, as well as all clinical research. He also oversees the company’s prior authorization and utilization management programs.

Prior to joining MedImpact, Dr. Tripoli was a Captain in the United States Navy and served as senior medical officer for the Navy Personnel Command. He has also served in the United States Marine Corps as group surgeon and chief public health officer for the 4th Civil Affairs Group, First Marine Expeditionary Force.

Preceding his military service, Dr. Tripoli held various civilian positions with health plans and medical groups, including senior vice president of medical affairs and chief medical officer.

Dr. Tripoli earned his undergraduate degree from Harvard University and his doctorate of medicine from the University of Pittsburgh School of Medicine, where he also completed his residency and served as chief resident in internal medicine. He is board certified in internal medicine and continues to practice in his medical specialty.

About MedImpact Healthcare Systems, Inc.

MedImpact Healthcare Systems, Inc. is the nation’s largest pharmacy benefit management (PBM) company that does not sell drugs. Founded in 1979 and based in San Diego, California, the company currently serves more than 30 million individuals nationwide. MedImpact clients include Fortune 500 corporations, unions, managed care organizations, insurance carriers, third-party administrators, as well as local, state and federal employee programs. MedImpact bases its success on delivering innovative products and services designed to lower overall client cost while increasing member satisfaction and quality of care.

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Industry Leader HealthPort Acquires ChartOne

Marking a significant development in its vision to be a leading provider of technology and strategic solutions for the healthcare industry, HealthPort will acquire its closest competitor, ChartOne, officials announced today.

The transaction was completed on Monday, September 22, 2008. Financial details of the transaction will not be disclosed.

“This acquisition combines the strengths of two industry leaders and creates the widest selection of affordable, quality health information products and services available,” says Patrick J. Haynes III, Chairman of HealthPort.

“As the adaptation of technology continues to gain momentum in the healthcare industry, this announcement strongly positions our company to better provide a full spectrum of solutions that can improve business fundamentals and enhance patient care,” continued Haynes.

“In an increasingly complex and highly regulated environment, healthcare companies need customized electronic systems and technology solutions that address -- and improve -- their toughest challenges,” says Michael Labedz, President and CEO of HealthPort.

“We are committed to leveraging these benefits for our existing customers and look forward to pursuing new opportunities as the healthcare information technology sector continues to grow and mature,” said Labedz.

Today, the vast majority of healthcare companies still rely on paper-based systems and processes to manage critical information. Over the next decade, however, the industry is widely expected to shift to paperless, electronic technologies that create greater efficiencies while improving patient care.

SEAMLESS TRANSITIONS FOR EMPLOYEES, CLIENTS

With this acquisition, HealthPort has combined revenues of more than $230 million and serves more than 8,000 healthcare facilities across the United States. The company’s headquarters will be located in Alpharetta, Georgia and will be led by HealthPort CEO Michael Labedz.

Meanwhile, members of the ChartOne management team will work with leadership to continue business as usual while also ensuring a smooth transition for all of ChartOne’s employees and clients.

Combined, the company’s key service line products now include:

* Release-of-information “ROI” technology
* Electronic document and medical records management
* Electronic coding services
* Recovery audit contractor “RAC” services
* Revenue cycle management
* Cancer registry services
* Interim health information management and consulting

FUTURE GROWTH

Future advances in healthcare information technology will enhance these services and generate new solutions. The company’s core and continued focus will remain on access to real-time, online tracking of data, faster turnaround times, and successful transitions to electronic, versus paper, and processing of records.

More information about HealthPort and ChartOne, including a full list of each company’s current offerings, can be found at www.healthport.com and www.chartone.com.

About HealthPort

HealthPort combines technology and strategic solutions to continually improve fragmented business processes for the healthcare community. The company’s financial sponsors are the Thurston Group, a private merchant bank located in Chicago and ABRY Partners, a private equity firm located in Boston. The company offers revenue cycle management, electronic medical record, electronic document management, onsite conversion, practice management, release-of-information, and healthcare consulting services. HealthPort is the one-source provider, offering the widest selection of affordable, quality health information products and services in the industry. For more information, visit www.healthport.com or call 800-737-2585.

About ChartOne

With over a thousand customers, ChartOne is the leading provider of release-of-information (ROI) services and technology to hospitals nationwide. ChartOne has a long-standing reputation for helping hospitals overcome the inefficiencies of managing paper-based medical records to improve hospital productivity, profitability, and patient care. For more information, visit www.chartone.com or call 888.357.7737.

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Carlsbad Dentist Wins $175,000 on Fox's "Are You Smarter Than A 5th Grader?"

Richard Allen, DDS, of Carlsbad's Avia Dental Care, won $175,000 as a contestant on Fox's "Are You Smarter Than A 5th Grader?" on Friday, September 19th.

Dr. Allen was assisted in victory by a class of 5th graders and five colleagues from his office, including Carlsbad residents Diana Lain, Susan Milch, and Jordan Davison as well as Amanda Phillips and Dorothy Davis from Oceanside. He opted to take the money and end the competition after being stumped on a question about the first names of early explorers Lewis and Clark.

"I still don't believe I actually did it!" said Dr. Allen. "I wouldn't have been able to make it without the help of my valuable team."

Team member Diana Lain said, "Being on stage was very nerve-wracking. Being so nervous definitely affected our answers! Dr. Allen did so great, though. He's a risk-taker by nature and was able to win a lot of money!"

When asked what he will do with the winnings, Dr. Allen said, "I will probably donate it to my favorite cause, the education of my two college-age sons!"

About Dr. Allen: Dr. Richard Allen is a 1980 graduate of the University of the Pacific, Arthur A. Dugoni School of Dentistry in San Francisco, CA. Currently practicing at Dr. Mark Nocera's Avia Dental Care in Carlsbad, Allen is the proud father of two sons, one at school at UCSD and one at Cal State San Marcos.

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Fitch Rates Univ Health System of Eastern Carolina's (North Carolina) $246MM VRDBs 'AA-'/Underlying

Fitch Ratings has assigned an underlying 'AA-' rating on approximately $246 million of North Carolina Medical Care Commission (University Health System of Eastern Carolina's (UHSEC) f/k/a Pitt County Memorial Hospital) series 2008 A-1, A-2, B-1 and B-2 variable rate demand bonds (VRDBs). In addition, Fitch affirms UHSEC's outstanding debt at 'AA-'. The Rating Outlook is Stable.

The affirmations are based on UHSEC' dominant market position as a Level I trauma center in Eastern North Carolina, solid operating performance, and manageable pro forma debt burden relative to operations. UHSEC had a dominant 78.8% market share in its primary service area (PSA) in fiscal 2007, up from 74.1% in fiscal 2005. In fiscal 2007, UHSEC generated a 3.9% operating margin ($42.0 million gain), increasing from 2.3% in fiscal 2004, and in line with Fitch's 'AA' median of 4.1%. UHSEC operating profitability has been supported by positive utilization trends, successful negotiation of managed care contracts, and reduced losses associated with the employment of physicians. Two of the System's hospitals have received critical access hospital status (Chowan Hospital in 2004 and Outer Banks Hospital in 2006) which should support revenue growth going forward. Although days in accounts receivables remained somewhat high at 61.6 days at fiscal year-end 2007, it declined from 61.8 days at fiscal year-end 2006 due to favorable revenue cycle initiatives.

In fiscal 2007, UHSEC's pro forma debt burden was manageable with debt to EBITDA of 3.4 times (x), in line with Fitch's 'AA' median. Pro forma MADS coverage by EBITDA was 3.8x in fiscal 2005. Fitch expects UHSEC's debt measures to improve over the medium term as there are no major capital projects expected.

Primary credit concerns center on UHSEC's light liquidity position relative to debt, high Medicaid load, and rising bad debt expense. At Sept. 30, 2007, UHSEC' unrestricted cash of $371 million equated to 157 days cash on hand and 74.8% cash to debt, compared with 161.2 days and 91.9%, respectively, at fiscal year-end 2005. However, Fitch notes that UHSEC's overall unrestricted cash position has grown by nearly $83 million over the same time frame, lending strength to it's overall cash position relative to MADS, reflected in an improved cushion ratio of 13.0x in fiscal 2007, up from 10.1x in FY2005. Fitch had noted that UHSEC's exposure to Medicaid load was high relative to other credits, equating to 17.0% of gross revenues, which results in significant exposure to changes in government reimbursement. However, Fitch notes that UHSEC does receive cost-based reimbursement under the NC Medicaid program for its flagship facility, Pitt County Memorial, due to its affiliation with the Brody School of Medicine at East Carolina University. Medicaid disproportionate share payments have been stable at $12.3 million over the past three years. UHSEC's bad debt expense as a percentage of revenues was high at 10.2% of revenues in fiscal 2007, increasing from 8.5% in fiscal 2004, which management attributes to a rising uninsured population, deductibles, and co-pays.

The Stable Rating Outlook reflects the expectation that UHSEC will continue to benefit from its dominant market position and post strong operating margins, which should be enhanced with the opening of 168-bed patient tower, scheduled to open in January 2009. Growth of UHSEC's liquidity position has been good over the past two fiscal years and should continue to improve as there are no significant capital plans over the next several years. Going forward, Fitch expects UHSEC' strong operating performance to support growth of cash reserves at a moderate rate.

UHSEC is a 1,116-bed hospital system operating six hospitals and several other related health care entities throughout Eastern North Carolina. UHSEC had total operating revenues of $1,065.9 million in fiscal 2007. UHSEC has covenanted to disclose annual audited financial statements to the NRMSIRs and provides Fitch with timely quarterly disclosure (including a balance sheet, income statement, statement of cash flows, and utilization statistics).

Fitch's rating definitions and the terms of use of such ratings are available on the agency's public site, www.fitchratings.com. Published ratings, criteria and methodologies are available from this site, at all times. Fitch's code of conduct, confidentiality, conflicts of interest, affiliate firewall, compliance and other relevant policies and procedures are also available from the 'Code of Conduct' section of this site

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Highmark Inc. Recognized by National Committee for Quality Assurance for Efforts to Reduce Health Care Disparities

By significantly increasing access to exercise programs and expanding its network of participating locations, Highmark Inc. saw membership by African American members in the SilverSneakers® Fitness Program grow from 3.4 percent in 2004 to more than 18 percent in 2008. For its efforts, Highmark was awarded the "Recognizing Innovation in Multicultural Health Care Award" by the National Committee for Quality Assurance (NCQA).

For more than four years, Highmark has partnered with the SilverSneakers Fitness Program, the nation's leading exercise program for older adults, to offer an opportunity for seniors to participate, at no additional cost, in fitness activities and to improve their overall health. To date, more than 68,000 Highmark members have enrolled in SilverSneakers.

"Research has shown that consistent exercise is a key component of a healthy lifestyle for people from all demographics," said Judith Black, MD, medical director of Senior Products at Highmark Inc. "An initial analysis of SilverSneakers Fitness Program enrollment rates by Highmark Medicare Advantage members in 2004 identified a significant disparity in enrollment between African American and White members. It was imperative for Highmark to address the enrollment disparity and provide access to fitness programs for our senior members."

To increase enrollment rates among African American members, six SilverSneakers participating locations were added to the existing network. These centers were located in predominantly minority neighborhoods that were identified as having high concentrations of African American Highmark members: HealthStar Physical Therapy, Penn Hills YMCA, Aliquippa Community Hospital, Homewood-Brushton YMCA, Centre Avenue YMCA (in partnership with the Hill House Association), and the Sarah Heinz House.

In addition, to more fully engage potential program participants, Healthways, the parent company of SilverSneakers, revised its marketing materials to include more diverse images and incorporate a theme of "fitness, fun and friends." SilverSneakers also helped to increase the number of qualified instructors from diverse backgrounds, an important step in building relationships and increasing participation among the African American Highmark membership.

In the fall of 2007, Highmark and SilverSneakers partnered to offer a series of flu vaccine clinics at locations in minority neighborhoods. While the primary goal of these clinics was to increase the vaccination rate within the minority membership, the clinics were located at SilverSneakers sites in predominantly African American neighborhoods in order to increase awareness of the available fitness benefit to that particular population.

With the addition of the new participating locations and other outreach efforts, enrollment by African American members increased from 3.4 percent in July 2004 to 9.6 percent in February 2005 and 18.1 percent in March 2008. This rate is a four-fold increase over the enrollment rate for 2004. In addition, the March 2008 African American enrollment rate of 18.1 percent exceeded the enrollment rate of 17.5 percent for white members in the same time frame.

"Like many seniors, I do have hypertension and it's totally under control. I credit the combination of exercise and the medication I take," said Ann Kenderson, Highmark Medicare Advantage member, who is a SilverSneakers participant at the Kingsley Community Center. "Plus, my exercise routine has definitely helped me to control my weight and my stress. I am so thankful that Highmark understands the value of keeping me healthy by providing such a terrific fitness benefit."

Highmark was recognized at a ceremony in San Francisco, CA, on Sept. 18. The award, sponsored by The California Endowment with support from the Centers for Medicare & Medicaid Services and The Office of Minority Health, is part of NCQA's efforts to improve the quality of health care in the U.S. through development of a truly multicultural health care system.

For information about Highmark's initiatives and strategy to address health care disparities and improve quality of care, visit our Health Care Disparities press kit on http://www.highmark.com in the Newsroom.

About Highmark Inc.

As one of the leading health insurers in Pennsylvania, Highmark Inc.'s mission is to provide access to affordable, quality health care enabling individuals to live longer, healthier lives. Based in Pittsburgh, Highmark serves 4.6 million people through the company's health care benefits business. Highmark contributes millions of dollars to help keep quality health care programs affordable and to support community-based programs that work to improve people's health. Highmark exerts an enormous economic impact throughout Pennsylvania. A recent study states that Highmark's positive impact exceeded $2.5 billion. The company provides the resources to give its members a greater hand in their health.

Highmark Inc. is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. For more information, visit http://www.highmark.com.

About the Healthways SilverSneakers® Fitness Program

The SilverSneakers® Fitness Program is offered by Healthways, an industry leader providing specialized, comprehensive Health and Care Support(SM) solutions to help people maintain or improve their health. Founded in 1992, SilverSneakers is the nation's leading exercise program designed exclusively for Medicare members and offers an innovative blend of physical activity, healthy lifestyle and socially-oriented programming that allows older adults to take greater control of their health. The unique program is available at no additional cost (other than any medical plan premium) to eligible Medicare members and is currently offered in 49 states, Puerto Rico and the District of Columbia at nearly 3,000 participating locations. For more information on SilverSneakers, call 480-783-9555 or visit http://www.silversneakers.com.

About NCQA

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and recognizes physicians in key clinical areas. NCQA's Healthcare Effectiveness Data and Information Set (HEDIS) is the most widely used performance measurement tool in health care. NCQA is committed to providing health care quality information through the Web, media and data licensing agreements in order to help consumers, employers and others make more informed health care choices. For more information, visit http://www.ncqa.org.

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U.S. Pet Owners can Double the Impact of Vaccinations to Help Reduce Rabies in Africa, Save Lives

American pet owners and their animals can help save lives in Africa through vaccinations administered in the U.S. between now and December 31, 2008. Pet owners are invited to double the impact of the annual veterinary visit and give a global dimension to rabies prevention through the Afya Serengeti project.

Afya Serengeti, "Health for Serengeti" in Swahili, is seeking to control rabies in this region of Tanzania by vaccinating domestic dogs, responsible for more than 8 out of 10 cases of the deadly disease, with children suffering the greatest impact. To support this lifesaving work, Intervet/Schering-Plough Animal Health, a global animal health company, is donating a dose of its rabies vaccine for every dose of its Continuum® canine or feline vaccine given to pets through the end of 2008. Intervet/Schering-Plough Animal Health has committed up to 250,000 doses to the project. The company is also a sponsor of World Rabies Day on September 28, 2008, a global initiative to address rabies prevention and control.

In Africa, around 25,000 people die from the disease each year, most of them children. Kept as both pets and working animals, domestic dogs are an essential part of everyday life in the Serengeti yet they account for 84.2% of rabies cases. Controlling the disease in household dogs means reducing deaths from rabies in children. Afya Serengeti is a highly successful rabies control project that ensures widespread vaccination of domestic dogs in regions where many people cannot afford an annual rabies shot. A vaccination zone has been set up around the Serengeti National Park with regular clinics where dog owners can bring their pets to be registered, vaccinated and marked with a plastic collar to signify their protection from rabies.

Afya Serengeti has already had a massive impact in the Serengeti region of Tanzania. In its second year of operation, the number of people needing hospital care for bites from rabid dogs dropped by 82% and the control of rabies in domestic dogs has prompted the resurgence of the once-endangered African wild dogs in the park--a major attraction for wildlife tourists.

This year, Intervet/Schering-Plough Animal Health has increased its support in the fight to eradicate rabies by providing a new Land Rover to help with rabies vaccine distribution to the Afya Serengeti team. The company will also host events featuring African food at a number of its U.S. locations to raise awareness of the company's support of World Rabies Day and its commitment to rabies eradication.

Dr. Sarah Cleaveland from the Centre of Tropical Medicine at the University of Edinburgh, UK, who founded and leads the Afya Serengeti project says, "We are immensely proud of the success of our initiative in Tanzania. This is a campaign that has let people get on with their everyday lives by helping to eradicate one of the everyday threats. It's not about famine or war or any kind of disaster, it's about making everyday life safer in the Serengeti, especially for children."

Pet lovers who want to do more for the project can also visit the project Web site, www.afya.org, to make a donation, learn more about the issue and view videos about the impact of the project on the Serengeti region.

Pet owners are invited to contact their veterinary practice to ask about support for this lifesaving initiative.

About Intervet/Schering-Plough Animal Health

Intervet/Schering-Plough Animal Health is a leader in research and dedicated to the development, production and marketing of innovative, high-quality animal-health products, such as Continuum®, Galaxy®, Eclipse®, Zubrin®, Vetsulin®, Panacur®, Tri-Heart® Plus, and Leventa®. For more information visit the following Web sites: www.continuum3.com, www.vetsulin.com, www.triheartplus.com and www.leventa.com.

Continuum, Eclipse, Galaxy, Leventa, Panacur, Tri-Heart, Vetsulin, and Zubrin are registered trademarks of Intervet Inc., Schering-Plough Animal Health, or an affiliate.

In addition to animal-health products, Intervet/Schering-Plough Animal Health provides services through its wholly-owned subsidiary HomeAgain®, a leader in companion animal identification and lost pet recovery.

For more information about Intervet/Schering-Plough Animal Health visit the following Web sites: www.intervetusa.com, www.spah.com and www.homeagain.com.

About Schering-Plough Corporation

Schering-Plough (NYSE: SGP - News) is an innovation-driven, science-centered global health care company. Through its own biopharmaceutical research and collaborations with partners, Schering-Plough creates therapies that help save and improve lives around the world. The company applies its research-and-development platform to human prescription and consumer products as well as to animal health products. Schering-Plough's vision is to "Earn Trust, Every Day" with doctors, patients, customers and other stakeholders served by its colleagues around the world. The company is based in Kenilworth, N.J., and its Web site is www.schering-plough.com.

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New Medicare Website Provides Customized "Aetna Answers" for Consumers

Aetna announced today that it has launched a redesigned Medicare website, www.aetnamedicare.com. The site gives people a single online resource where they can go through the entire enrollment process, from researching and comparing plan options to receiving price estimates to submitting an enrollment form.

In addition to general information on Medicare, individuals can find and compare Aetna plans available in their geographic area. Each comparison is customized and unique, with users selecting the aspects of the plan that are most important to them, such as prescription drug coverage or making sure their primary care physician participates in Aetna’s network. Individuals can also estimate the cost for each plan before actually applying and even enroll online, a process that can be completed in about 10 minutes.

“This website gives consumers access to the same information they would receive from an Aetna Medicare specialist and allows them to simply walk through the various plan options to help them make an informed decision,” said Frank McCauley, head of Aetna’s Consumer Business Segment. “Choosing a plan that best fits their individual needs is an important way for people with Medicare to protect their health and financial well-being, and the Aetna Medicare website (www.aetnamedicare.com) can help with that process.”

Easy-to-Find Information

Through extensive consumer research, Aetna determined that the majority of Medicare consumers who were searching for information fell into one of three categories. These individuals were:

* Just becoming eligible for the Medicare program and starting their research;
* Looking for a specific piece of information on plan coverage for doctors, hospitals, pharmacies and prescription drugs; or
* Done with their research, aware of what they wanted, and trying to find the plan that best met their needs.

Based on these findings, the new Aetna Medicare website (www.aetnamedicare.com) provides targeted information to individuals in each of these situations – making it quick and easy for them to access relevant information. In addition, there is a fourth section specifically for individuals who may have Aetna Medicare coverage available through a current or former employer.

No matter what section individuals choose, they will have access to a number of different tools and resources. This includes a list of dates to remember, such as when individuals will start to receive marketing materials and when the actual Open Enrollment period takes place; a tool that allows individuals to find scheduled Aetna Medicare informational meetings in their area; important documents such as enrollment and claim forms, as well as the Summary of Benefits for plans; and additional contact information for general Medicare questions.

Designed for Medicare Consumers

Aetna’s research also influenced the new design of the Aetna Medicare website in a number of different ways. The site was simplified with a significant amount of white space and less scrolling on pages, for ease of navigation. There is also a strong contrast in the different colors used in the site and the option of increasing the text size, making the information easier to read.

In addition, the enrollment section of the website has the same format and design as the rest of the site, giving individuals the convenience of searching for information and enrolling in a plan in the same location.

“We are confident that this new website will help anybody looking for information on Aetna Medicare plans find what they need easily, and also smoothly transition to the application process,” McCauley said.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving approximately 37.2 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities and health care management services for Medicaid plans. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, governmental units, government-sponsored plans, labor groups and expatriates. www.aetna.com

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