Electronic Records Systems Have Not Reduced Health Costs, Report Says

The conversion to electronic health records has failed so far to produce the hoped-for savings in health care costs and has had mixed results, at best, in improving efficiency and patient care, according to a new analysis by the influential RAND Corporation.

Jim Wilson/The New York Times

Dr. Alvin Rajkomar tracks patient data on a Samsung Galaxy Note. A new report questions whether electronic records reduce health care costs.

Optimistic predictions by RAND in 2005 helped drive explosive growth in the electronic records industry and encouraged the federal government to give billions of dollars in financial incentives to hospitals and doctors that put the systems in place.

“We’ve not achieved the productivity and quality benefits that are unquestionably there for the taking,” said Dr. Arthur L. Kellermann, one of the authors of a reassessment by RAND that was published in this month’s edition of Health Affairs, an academic journal.

RAND’s 2005 report was paid for by a group of companies, including General Electric and Cerner Corporation, that have profited by developing and selling electronic records systems to hospitals and physician practices. Cerner’s revenue has nearly tripled since the report was released, to a projected $3 billion in 2013, from $1 billion in 2005.

The report predicted that widespread use of electronic records could save the United States health care system at least $81 billion a year, a figure RAND now says was overstated. The study was widely praised within the technology industry and helped persuade Congress and the Obama administration to authorize billions of dollars in federal stimulus money in 2009 to help hospitals and doctors pay for the installation of electronic records systems.

“RAND got a lot of attention and a lot of buzz with the original analysis,” said Dr. Kellermann, who was not involved in the 2005 study. “The industry quickly embraced it.”

But evidence of significant savings is scant, and there is increasing concern that electronic records have actually added to costs by making it easier to bill more for some services.

Health care spending has risen $800 billion since the first report was issued, according to federal figures. The reasons are many, from the aging of the baby boomer population, to the cost of medical advances, to higher usage of medical services over all.

Officials at RAND said their new analysis did not try to put a dollar figure on how much electronic record-keeping had helped or hurt efforts to reduce costs. But the firm’s acknowledgment that its earlier analysis was overly optimistic adds to a chorus of concern about the cost of the new systems and the haste with which they have been adopted.

The recent analysis was sharply critical of the commercial systems now in place, many of which are hard to use and do not allow doctors and patients to share medical information across systems. “We could be getting much more if we could take the time to do a little more planning and to set more standards,” said Marc Probst, chief information officer for Intermountain Healthcare, a large health system in Salt Lake City that developed its own electronic records system and is cited by RAND as an example of how the technology can help improve care and reduce costs.

The RAND researchers pointed to a number of other reasons the expected savings had not materialized. The rate of adoption has been slow, they said, and electronic records do not address the fact that doctors and hospitals reap the benefits of high volumes of care.

Many experts say the available systems seem to be aimed more at increasing billing by providers than at improving care or saving money. Federal regulators are investigating whether electronic records make it easier for hospitals and doctors to bill for services they did not provide and whether Medicare and other federal agencies are adequately monitoring the use of electronic records.

Technology “is only a tool,” said Dr. David Blumenthal, who helped oversee the federal push for the adoption of electronic records under President Obama and is now president of the Commonwealth Fund, a nonprofit health group. “Like any tool, it can be used well or poorly.” While there is strong evidence that electronic records can contribute to better care and more efficiency, Dr. Blumenthal said, the systems in place do not always work in ways that help achieve those benefits.

Federal officials say they are drafting new rules to address many of the concerns about the current systems.

This article has been revised to reflect the following correction:

Correction: January 14, 2013

An article on Friday about a new RAND Corporation study that found few savings from electronic health records misstated, in some copies, the name of the city in Florida that is home to a physician practice that is suing a health care technology firm that stopped supporting a system it sold to doctors in the practice. It is in Panama City, not Panama.

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IHT Rendezvous: Breathing in Beijing: Coping With China's Smog

BEIJING — With Beijing’s air pollution soaring to seemingly new, awful records this weekend, the classic parenting dilemma of “What shall we do with the kids?” had a grimly obvious answer: Slap on the antipollution face masks and go shopping for another air purifier.

That’s what we did on Saturday, as the Air Quality Index run by the United States Embassy in Beijing, which uses standards set by the United States Environmental Protection Agency, hit a “jaw-dropping” 755 at 8 p.m., as my colleague Edward Wong wrote. “All of Beijing looked like an airport smokers’ lounge,” Ed wrote.

According to the index, anything above 300 is “Hazardous” and above 500 is “Beyond Index.” This weekend, the readings were Beyond Index for 16 straight hours.

Even the Chinese government’s monitors, which recently have grown more accurate but still tend to measure the pollution as lower than the embassy’s, were recording scary levels of around 500.

Furious, Chinese netizens wrote on their microblog accounts that the pollution had “exploded the index,” or “baobiao.”

They reached for strong adjectives: “postapocalyptic,” “terrifying” and “beyond belief,” Ed wrote.

So it was ironic that on Sunday there was a sense of relief as the index dropped to 319 (still “Hazardous”) then down to 286: a measly “Very Unhealthy.” By Sunday afternoon, it was “Hazardous” again though, at 373.

Ordinary Chinese are appalled. And increasingly, they can say so in public, as the state appears to be relaxing its censorship of reporting on the pollution that everyone can see and smell.

Xinhua, the state-run news agency, reported on Jan. 1 that the environmental authorities were now releasing real-time air quality data from 74 cities in China, at www.cnemc.cn.

On its Weibo, or microblog, feed, CCTV, the state broadcaster, warned early Sunday that “the main air quality monitoring stations in eight city districts will be around 500, which is grade six, heavy pollution, with PM 2.5 and PM 10 the main pollutants,” referring to fine particulates and bigger particulates.

Of course, the problem wasn’t limited to Beijing. As this photograph from NASA appeared to show, pollution was severe across much of eastern China (Beijing is within the blue circle).

And on state media’s lists of the most polluted cities in China on Saturday, Beijing wasn’t even in the top 10. That honor went to Shijiazhuang and other places.

The People’s Daily online was frank, asking in a full-page spread, “What is Going on with our Air?” (Handily cached here by Sinocism, the Beijing-based newsletter.)

The scale of the problem is, quite frankly, overwhelming. A very revealing chart by Edgar, the Emissions Database for Global Atmospheric Research, from the European Commission, estimates that in 2011 China produced 9.7 million kilotons of carbon dioxide, nearly double United States’ 5.42 million kilotons.

Indeed, were the Chinese cement industry a country, it would be the sixth biggest emitter of carbon dioxide in the world, producing 820,000 kilotons in 2011, slightly ahead of Germany’s total carbon dioxide emissions that year of 810,000 kilotons, according to Edgar. Germany was the sixth most polluting nation in the world, with the United States the second and China the first, according to the chart.

But something else stands out here: China’s population of more than 1.3 billion is about 4.5 times that of the United States’ approximately 300 million. So though it leads the world in carbon dioxide emissions, it is still, per capita, far less polluting than the United States.

Unfortunately, that may change. China’s economy may overtake the U.S. economy sometime within the next decade or two, meaning that we may be facing a truly astonishing problem. As Ma Jun, the director of the Chinese Institute of Public and Environmental Affairs told the Hong Kong-based South China Morning Post: “It is no secret that our way of development is not sustainable and the total pollution emissions in the region have far exceeded the maximum ecological capacity.”

How does a family justify living in this? For most people in China’s cities there is no practical alternative to life in the smog, though the appalling environment is a reason cited by most who emigrate (in a recent post I noted how emigration numbers were rising all the time).

To control the risk, we have family rules: above 100, and the air purifiers – all four of them – go on. Above 200, we wear face masks outdoors. Above 300 and no one exercises or plays outside, even with a face mask on. Above 500 and we try not to go out at all. That’s hard, especially for the children.

So this weekend, we breathed at home. Watched a movie. Read. And talked. Told the kids how their generation is going to have to clean up the environmental mess caused by all the previous generations. And watched the incredulity grow on their faces as they contemplated the stupidity of adults.

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Treasury Will Not Mint $1 Trillion Coin to Raise Debt Ceiling

WASHINGTON — The Treasury Department said Saturday that it will not mint a trillion-dollar platinum coin to head off an imminent battle with Congress over raising the government’s borrowing limit.

“Neither the Treasury Department nor the Federal Reserve believes that the law can or should be used to facilitate the production of platinum coins for the purpose of avoiding an increase in the debt limit,” Anthony Coley, a Treasury spokesman, said in a written statement.

The Obama administration has indicated that the only way for the country to avoid a cash-management crisis as soon as next month is for Congress to raise the “debt ceiling,” which is the statutory limit on government borrowing. The cap is $16.4 trillion.

“There are only two options to deal with the debt limit: Congress can pay its bills, or it can fail to act and put the nation into default,” Jay Carney, the White House press secretary, said in a statement. “Congress needs to do its job.”

In recent weeks, some Republicans have indicated that they would not agree to raise the debt limit unless Democrats agreed to make cuts to entitlement programs like Social Security.

The White House has said it would not negotiate spending cuts in exchange for Congressional authority to borrow more, and it has insisted that Congress raise the ceiling as a matter of course, to cover expenses already authorized by Congress. In broader fiscal negotiations, it has said it would not agree to spending cuts without commensurate tax increases.

The idea of minting a trillion-dollar coin drew wide if puzzling attention recently after some bloggers and economic commentators had suggested it as an alternative to involving Congress.

By virtue of an obscure law meant to apply to commemorative coins, the Treasury secretary could order the production of a high-denomination platinum coin and deposit it at the Federal Reserve, where it would count as a government asset and give the country more breathing room under its debt ceiling. Once Congress raised the debt ceiling, the Treasury secretary could then order the coin destroyed.

Mr. Carney, the press secretary, fielded questions about the theoretical tactic at a news conference last week. But the idea is now formally off the table.

The White House has also rejected the idea that it could mount a challenge to the debt ceiling itself, on the strength of the Fourteenth Amendment to the Constitution, which holds that the “validity of the public debt” of the United States “shall not be questioned.”

The Washington Post earlier published a report that the Obama administration had rejected the platinum-coin idea.

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City Room: Cuomo Declares Public Health Emergency Over Flu Outbreak

With the nation in the grip of a severe influenza outbreak that has seen deaths reach epidemic levels, New York State declared a public health emergency on Saturday, making access to vaccines more easily available.

There have been nearly 20,000 cases of flu reported across the state so far this season, officials said. Last season, 4,400 positive laboratory tests were reported.

“We are experiencing the worst flu season since at least 2009, and influenza activity in New York State is widespread, with cases reported in all 57 counties and all five boroughs of New York City,” Gov. Andrew M. Cuomo said in a statement.

Under the order, pharmacists will be allowed to administer flu vaccinations to patients between 6 months and 18 years old, temporarily suspending a state law that prohibits pharmacists from administering immunizations to children.

While children and older people tend to be the most likely to become seriously ill from the flu, Mr. Cuomo urged all New Yorkers to get vaccinated.

On Friday, the Centers for Disease Control and Prevention in Atlanta said that deaths from the flu had reached epidemic levels, with at least 20 children having died nationwide. Officials cautioned that deaths from pneumonia and the flu typically reach epidemic levels for a week or two every year. The severity of the outbreak will be determined by how long the death toll remains high or if it climbs higher.

There was some evidence that caseloads may be peaking, federal officials said on Friday.

In New York City, public health officials announced on Thursday that flu-related illnesses had reached epidemic levels, and they joined the chorus of authorities urging people to get vaccinated.

“It’s a bad year,” the city’s health commissioner, Dr. Thomas A. Farley, told reporters on Thursday. “We’ve got lots of flu, it’s mainly type AH3N2, which tends to be a little more severe. So we’re seeing plenty of cases of flu and plenty of people sick with flu. Our message for any people who are listening to this is it’s still not too late to get your flu shot.”

There has been a spike in the number of people going to emergency rooms over the past two weeks with flulike symptoms – including fever, fatigue and coughing – Dr. Farley said.

Mayor Michael R. Bloomberg and Mr. Cuomo made a public display of getting shots this past week.

In a briefing with reporters on Friday, officials from the C.D.C. said that this year’s vaccine was effective in 62 percent of cases.

As officials have stepped up their efforts encouraging vaccinations, there have been scattered reports of shortages. But officials said plenty of the vaccine was available.

According to the C.D.C., makers of the flu vaccine produced about 135 million doses for this year. As of early this month, 128 million doses had been distributed. While that would not be enough for every American, only 37 percent of the population get a flu shot each year.

Federal health officials said they would be happy if that number rose to 50 percent, which would mean that there would be more than enough vaccine for anyone who wanted to be immunized.

Two other diseases – norovirus and whooping cough – are also widespread this winter and are contributing to the number of people getting sick.

The flu can resemble a cold, though the symptoms come on more rapidly and are more severe.

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City Room: Cuomo Declares Public Health Emergency Over Flu Outbreak

With the nation in the grip of a severe influenza outbreak that has seen deaths reach epidemic levels, New York State declared a public health emergency on Saturday, making access to vaccines more easily available.

There have been nearly 20,000 cases of flu reported across the state so far this season, officials said. Last season, 4,400 positive laboratory tests were reported.

“We are experiencing the worst flu season since at least 2009, and influenza activity in New York State is widespread, with cases reported in all 57 counties and all five boroughs of New York City,” Gov. Andrew M. Cuomo said in a statement.

Under the order, pharmacists will be allowed to administer flu vaccinations to patients between 6 months and 18 years old, temporarily suspending a state law that prohibits pharmacists from administering immunizations to children.

While children and older people tend to be the most likely to become seriously ill from the flu, Mr. Cuomo urged all New Yorkers to get vaccinated.

On Friday, the Centers for Disease Control and Prevention in Atlanta said that deaths from the flu had reached epidemic levels, with at least 20 children having died nationwide. Officials cautioned that deaths from pneumonia and the flu typically reach epidemic levels for a week or two every year. The severity of the outbreak will be determined by how long the death toll remains high or if it climbs higher.

There was some evidence that caseloads may be peaking, federal officials said on Friday.

In New York City, public health officials announced on Thursday that flu-related illnesses had reached epidemic levels, and they joined the chorus of authorities urging people to get vaccinated.

“It’s a bad year,” the city’s health commissioner, Dr. Thomas A. Farley, told reporters on Thursday. “We’ve got lots of flu, it’s mainly type AH3N2, which tends to be a little more severe. So we’re seeing plenty of cases of flu and plenty of people sick with flu. Our message for any people who are listening to this is it’s still not too late to get your flu shot.”

There has been a spike in the number of people going to emergency rooms over the past two weeks with flulike symptoms – including fever, fatigue and coughing – Dr. Farley said.

Mayor Michael R. Bloomberg and Mr. Cuomo made a public display of getting shots this past week.

In a briefing with reporters on Friday, officials from the C.D.C. said that this year’s vaccine was effective in 62 percent of cases.

As officials have stepped up their efforts encouraging vaccinations, there have been scattered reports of shortages. But officials said plenty of the vaccine was available.

According to the C.D.C., makers of the flu vaccine produced about 135 million doses for this year. As of early this month, 128 million doses had been distributed. While that would not be enough for every American, only 37 percent of the population get a flu shot each year.

Federal health officials said they would be happy if that number rose to 50 percent, which would mean that there would be more than enough vaccine for anyone who wanted to be immunized.

Two other diseases – norovirus and whooping cough – are also widespread this winter and are contributing to the number of people getting sick.

The flu can resemble a cold, though the symptoms come on more rapidly and are more severe.

Read More..

Aaron Swartz, Internet Activist, Dies at 26

Aaron Swartz, a wizardly programmer who as a teenager helped develop code that delivered ever-changing Web content to users and who later became a steadfast crusader to make that information freely available, was found dead on Friday in his New York apartment.

An uncle, Michael Wolf, said that Mr. Swartz, 26, had apparently hanged himself, and that a friend of Mr. Swartz’s had discovered the body.

At 14, Mr. Swartz helped create RSS, the nearly ubiquitous tool that allows users to subscribe to online information. He later became an Internet folk hero, pushing to make many Web files free and open to the public. But in July 2011, he was indicted on federal charges of gaining illegal access to JSTOR, a subscription-only service for distributing scientific and literary journals, and downloading 4.8 million articles and documents, nearly the entire library.

Charges in the case, including wire fraud and computer fraud, were pending at the time of Mr. Swartz’s death, carrying potential penalties of up to 35 years in prison and $1 million in fines.

“Aaron built surprising new things that changed the flow of information around the world,” said Susan Crawford, a professor at the Cardozo School of Law in New York who served in the Obama administration as a technology adviser. She called Mr. Swartz “a complicated prodigy” and said “graybeards approached him with awe.”

Mr. Wolf said he would remember his nephew, who had written in the past about battling depression and suicidal thoughts, as a young man who “looked at the world, and had a certain logic in his brain, and the world didn’t necessarily fit in with that logic, and that was sometimes difficult.”

The Tech, a newspaper of the Massachusetts Institute of Technology, reported Mr. Swartz’s death early Saturday.

Mr. Swartz led an often itinerant life that included dropping out of Stanford, forming companies and organizations, and becoming a fellow at Harvard University’s Edmond J. Safra Center for Ethics.

He formed a company that merged with Reddit, the popular news and information site. He also co-founded Demand Progress, a group that promotes online campaigns on social justice issues — including a successful effort, with other groups, to oppose a Hollywood-backed Internet piracy bill.

But he also found trouble when he took part in efforts to release information to the public that he felt should be freely available. In 2008, he took on PACER, or Public Access to Court Electronic Records, the repository for federal judicial documents.

The database charges 10 cents a page for documents; activists like Carl Malamud, the founder of public.resource.org, have long argued that such documents should be free because they are produced at public expense. Joining Mr. Malamud’s efforts to make the documents public by posting legally obtained files to the Internet for free access, Mr. Swartz wrote an elegant little program to download 20 million pages of documents from free library accounts, or roughly 20 percent of the enormous database.

The government shut down the free library program, and Mr. Malamud feared that legal trouble might follow even though he felt they had violated no laws. As he recalled in a newspaper account, “I immediately saw the potential for overreaction by the courts.” He recalled telling Mr. Swartz: “You need to talk to a lawyer. I need to talk to a lawyer.”

Mr. Swartz recalled in a 2009 interview, “I had this vision of the feds crashing down the door, taking everything away.” He said he locked the deadbolt on his door, lay down on the bed for a while and then called his mother.

The federal government investigated but did not prosecute.

In 2011, however, Mr. Swartz went beyond that, according to a federal indictment. In an effort to provide free public access to JSTOR, he broke into computer networks at M.I.T. by means that included gaining entry to a utility closet on campus and leaving a laptop that signed into the university network under a false account, federal officials said.

Mr. Swartz turned over his hard drives with 4.8 million documents, and JSTOR declined to pursue the case. But Carmen M. Ortiz, a United States attorney, pressed on, saying that “stealing is stealing, whether you use a computer command or a crowbar, and whether you take documents, data or dollars.”

Founded in 1995, JSTOR, or Journal Storage, is nonprofit, but institutions can pay tens of thousands of dollars for a subscription that bundles scholarly publications online. JSTOR says it needs the money to collect and to distribute the material and, in some cases, subsidize institutions that cannot afford it. On Wednesday, JSTOR announced that it would open its archives for 1,200 journals to free reading by the public on a limited basis.

Mr. Malamud said that while he did not approve of Mr. Swartz’s actions at M.I.T., “access to knowledge and access to justice have become all about access to money, and Aaron tried to change that. That should never have been considered a criminal activity.”

Mr. Swartz did not talk much about his impending trial, Quinn Norton, a close friend, said on Saturday, but when he did, it was clear that “it pushed him to exhaustion. It pushed him beyond.”

Recent years had been hard for Mr. Swartz, Ms. Norton said, and she characterized him “in turns tough and delicate.” He had “struggled with chronic, painful illness as well as depression,” she said, without specifying the illness, but he was still hopeful “at least about the world.”

Cory Doctorow, a science fiction author and online activist, posted a tribute to Mr. Swartz on BoingBoing.net, a blog he co-edits. In an e-mail, he called Mr. Swartz “uncompromising, principled, smart, flawed, loving, caring, and brilliant.”

 “The world was a better place with him in it,” he said.

Mr. Swartz, he noted, had a habit of turning on those closest to him: “Aaron held the world, his friends, and his mentors to an impossibly high standard — the same standard he set for himself.” Mr. Doctorow added, however, “It’s a testament to his friendship that no one ever seemed to hold it against him (except, maybe, himself).”

In a talk in 2007, Mr. Swartz described having had suicidal thoughts during a low period in his career. He also wrote about his struggle with depression, distinguishing it from sadness.

“Go outside and get some fresh air or cuddle with a loved one and you don’t feel any better, only more upset at being unable to feel the joy that everyone else seems to feel. Everything gets colored by the sadness.”

When the condition gets worse, he wrote, “you feel as if streaks of pain are running through your head, you thrash your body, you search for some escape but find none. And this is one of the more moderate forms.”

Ravi Somaiya contributed reporting.

This article has been revised to reflect the following correction:

Correction: January 12, 2013

An earlier version of this article incorrectly identified the police who arrested Mr. Swartz, and when they did so. The police were from Cambridge, Mass., not the Massachusetts Institute of Technology campus force, and the arrest occurred two years before Mr. Swartz’s suicide, but not two years to the day.

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Thousands of Russians Rally Against Adoption Ban

MOSCOW – Thousands of Russians marched on Sunday in condemnation of the Russian Parliament’s move to ban adoption of Russian children by American families, an event dubbed a “March Against Scoundrels,” where participants chanted, “Take your hands off children,” and carried posters showing the faces of lawmakers stamped with the word “Shame.”

Mr. Putin approved the adoption ban in late December, as part of a broader law retaliating against the United States for the so-called Magnitsky Act, an effort to punish Russian officials accused of human rights violations.

Russian leaders have complained bitterly for years about light sentences handed down in cases where American adoptive parents abused or neglected children adopted from Russia, and named the ban after Dmitri Yakovlev, a toddler who died of heatstroke in Virginia in 2008 after his adoptive father left him in a parked car for nine hours.

But the decision has proven divisive in Russia, even within government circles. More than 650,000 children live in foster care or orphanages in Russia, of whom about 120,000 are eligible for adoption. Many children in orphanages are sick or disabled, and most have little hope of finding permanent homes.

“The authorities thought we would do what we usually do – swallow it and be quiet. They did not expect such a reaction,” said Elena Rostova, 61, who attended the march. “But we had two weeks to consider what awaited these handicapped children.”

A series of high-ranking officials openly expressed their disagreement before the ban was enacted, and figures from the art and entertainment world have recorded emotional messages of dissent and published them on the Internet. Opposition groups have hoped that outrage sparked by the adoption ban would reinvigorate a Moscow-based protest movement that has sagged in recent months, as the government began to prosecute and impose tough sentences on street activists.

A poll released in December by the Public Opinion Foundation showed that 56 percent of Russians approved of the adoption ban. A top official from United Russia, Andrei Isayev, last week described the Sunday protest as a “March of Child-Sellers,” and tried to refocus attention on the Magnitsky Act, which he described as a “public, demonstrative humiliation of the Russian Federation.”

“All the enemies of Russian sovereignty showed themselves the ardent supporters of American adoption,” Mr. Isayev wrote on a party Web site.

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Business Briefing | Retailing: Best Buy Shares Rally on Improved Holiday Sales

The Best Buy Company had better-than-expected holiday sales, setting off a gain of $2, or 16.4 percent, in its stock price, to $14.21 a share on Friday. The holiday quarter accounted for about a third of Best Buy’s revenue last year. The chain said that revenue at stores open at least a year fell 1.4 percent for the nine weeks ended Jan. 5. The company’s performance in the United States was flat. The chief executive, Hubert Joly, said in a statement that the result was better than the last several quarters. A Morningstar analyst, R. J. Hottovy, said the results showed that some of Best Buy’s initiatives, like more employee training and online price matching helped increase sales.

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Former Lab Technician Denies Faulty DNA Work in Rape Cases

A former New York City laboratory technician whose work on rape cases is now being scrutinized for serious mistakes said on Friday that she had been unaware there were problems in her work and, disputing an earlier report, denied she had resigned under pressure.

The former lab technician, Serrita Mitchell, said any problems must have been someone else’s.

“My work?” Ms. Mitchell said. “No, no, no, not my work.”

Earlier, the city medical examiner’s office, where Ms. Mitchell said she was employed from 2000 to 2011, said it was reviewing 843 rape cases handled by a lab technician who might have missed critical evidence.

So far, it has finished looking over about half the cases, and found 26 in which the technician had missed biological evidence and 19 in which evidence was commingled with evidence from other cases. In seven cases where evidence was missed, the medical examiner’s office was able to extract a DNA profile, raising the possibility that detectives could have caught some suspects sooner.

The office declined to identify the technician. Documents said she quit in November 2011 after the office moved to fire her, once supervisors had begun to discover deficiencies in her work. A city official who declined to be identified said Ms. Mitchell was the technician.

However, Ms. Mitchell, reached at her home in the Bronx on Friday, said she had never been told there were problems. “It couldn’t be me because your work gets checked,” she said. “You have supervisors.”

She also said that she had resigned because of a rotator cuff injury that impeded her movement. “I loved the job so much that I stayed a little longer,” she said, explaining that she had not expected to stay with the medical examiner’s office so long. “Then it was time to leave.”

Also on Friday, the Legal Aid Society, which provides criminal defense lawyers for most of the city’s poor defendants, said it was demanding that the city turn over information about the cases under review.

If needed, Legal Aid will sue the city to gain access to identifying information about the cases, its chief lawyer, Steven Banks, said, noting that New York was one of only 14 states that did not require routine disclosure of criminal evidence before trial.

Disclosure of the faulty examination of the evidence is prompting questions about outside review of the medical examiner’s office. The City Council on Friday announced plans for an emergency oversight committee, and its members spoke with outrage about the likelihood that missed semen stains and “false negatives” might have enabled rapists to go unpunished.

“The mishandling of rape cases is making double victims of women who have already suffered an indescribably horrific event,” said Christine C. Quinn, the Council speaker.

A few more details emerged Friday about a 2001 case involving the rape of a minor in Brooklyn, in which the technician missed biological evidence, the review found. The victim accused an 18-year-old acquaintance of forcing himself on her, and he was questioned by the police but not charged, according to a law enforcement official.

Unrelated to the rape, he pleaded guilty in 2005 to third-degree robbery and served two years in prison. The DNA sample he gave in the robbery case was matched with the one belatedly developed from evidence the technician had overlooked in the 2001 rape, law enforcement officials said. He was recently indicted in the 2001 rape.

Especially alarming to defense lawyers was the possibility that DNA samples were cross-contaminated and led to false convictions, or could do so in the future.

“Up to this point,” Mr. Banks said, “they have not made information available to us, as the primary defender in New York City, to determine whether there’s an injustice that’s been done in past cases, pending cases, or allowing us to be on the lookout in future cases.” He added, “If it could happen with one analyst, how does anyone know that it stops there?”

The medical examiner’s office has said that the risk of cross-contamination was extremely low and that it does not appear that anyone was wrongly convicted in the cases that have been reviewed so far. And officials in at least two of the city’s district attorneys’ offices — for Brooklyn and Manhattan — said they had not found any erroneous convictions.

But Mr. Banks said the authorities needed to do more, and that their statements thus far were the equivalent of “trust us.”

“Given what’s happened,” he said, “that’s cold comfort.”

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Former Lab Technician Denies Faulty DNA Work in Rape Cases

A former New York City laboratory technician whose work on rape cases is now being scrutinized for serious mistakes said on Friday that she had been unaware there were problems in her work and, disputing an earlier report, denied she had resigned under pressure.

The former lab technician, Serrita Mitchell, said any problems must have been someone else’s.

“My work?” Ms. Mitchell said. “No, no, no, not my work.”

Earlier, the city medical examiner’s office, where Ms. Mitchell said she was employed from 2000 to 2011, said it was reviewing 843 rape cases handled by a lab technician who might have missed critical evidence.

So far, it has finished looking over about half the cases, and found 26 in which the technician had missed biological evidence and 19 in which evidence was commingled with evidence from other cases. In seven cases where evidence was missed, the medical examiner’s office was able to extract a DNA profile, raising the possibility that detectives could have caught some suspects sooner.

The office declined to identify the technician. Documents said she quit in November 2011 after the office moved to fire her, once supervisors had begun to discover deficiencies in her work. A city official who declined to be identified said Ms. Mitchell was the technician.

However, Ms. Mitchell, reached at her home in the Bronx on Friday, said she had never been told there were problems. “It couldn’t be me because your work gets checked,” she said. “You have supervisors.”

She also said that she had resigned because of a rotator cuff injury that impeded her movement. “I loved the job so much that I stayed a little longer,” she said, explaining that she had not expected to stay with the medical examiner’s office so long. “Then it was time to leave.”

Also on Friday, the Legal Aid Society, which provides criminal defense lawyers for most of the city’s poor defendants, said it was demanding that the city turn over information about the cases under review.

If needed, Legal Aid will sue the city to gain access to identifying information about the cases, its chief lawyer, Steven Banks, said, noting that New York was one of only 14 states that did not require routine disclosure of criminal evidence before trial.

Disclosure of the faulty examination of the evidence is prompting questions about outside review of the medical examiner’s office. The City Council on Friday announced plans for an emergency oversight committee, and its members spoke with outrage about the likelihood that missed semen stains and “false negatives” might have enabled rapists to go unpunished.

“The mishandling of rape cases is making double victims of women who have already suffered an indescribably horrific event,” said Christine C. Quinn, the Council speaker.

A few more details emerged Friday about a 2001 case involving the rape of a minor in Brooklyn, in which the technician missed biological evidence, the review found. The victim accused an 18-year-old acquaintance of forcing himself on her, and he was questioned by the police but not charged, according to a law enforcement official.

Unrelated to the rape, he pleaded guilty in 2005 to third-degree robbery and served two years in prison. The DNA sample he gave in the robbery case was matched with the one belatedly developed from evidence the technician had overlooked in the 2001 rape, law enforcement officials said. He was recently indicted in the 2001 rape.

Especially alarming to defense lawyers was the possibility that DNA samples were cross-contaminated and led to false convictions, or could do so in the future.

“Up to this point,” Mr. Banks said, “they have not made information available to us, as the primary defender in New York City, to determine whether there’s an injustice that’s been done in past cases, pending cases, or allowing us to be on the lookout in future cases.” He added, “If it could happen with one analyst, how does anyone know that it stops there?”

The medical examiner’s office has said that the risk of cross-contamination was extremely low and that it does not appear that anyone was wrongly convicted in the cases that have been reviewed so far. And officials in at least two of the city’s district attorneys’ offices — for Brooklyn and Manhattan — said they had not found any erroneous convictions.

But Mr. Banks said the authorities needed to do more, and that their statements thus far were the equivalent of “trust us.”

“Given what’s happened,” he said, “that’s cold comfort.”

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