Researchers at the University of Rochester found that when they injected Brilliant Blue G dye into rats that had suffered spinal cord injuries, the rats were able to walk again. Those that didn’t get the dye never regained their ability to walk.
This blue dye is the same dye used to color Gatorade and blue M&M’s.
Only problem was that the dye had to be administered immediately after the injury or it wouldn’t work. Oh, yeah, and the rats just happened to temporarily turn blue.
Smurftacular! I’d stay blue, don the white hat and white one piece pajama bottoms, and go skipping through town singing the “La LA la LA la la” Smurf tune every day if the stuff kept me ambulatory.
And if anyone is wondering how the researchers chose to inject intravenous grape Gatorade into paralyzed mice, the researchers found that the spinal cord has a molecule called P2X7 which causes cell death. Apparently they found that BBG dye inhibits the function of the molecule.
More research is needed, but this discovery just boggles my mind.
Shadowfax has just posted an interview with ACEP’s President Nick Jouriles. In the interview, Dr. Jouriles explains ACEP’s goals in advocating for emergency physicians and for our patients. Give it a read.
I might even do some guest posts on there if Shadowfax lets me (hint, hint).
In a recent post, I asked the question whether or not people would favor providing some type of immunity to emergency physicians if doing so would increase the availability of emergency medical care.
So far, about 75% of people answering that question voted “yes.”
Some of the attorneys that read this blog were all over me.
A 2005 hospital ED administration survey also lists “malpractice concerns” as the principal factor discouraging specialists from providing ED coverage.
Furthermore, because liability premiums have outpaced payments for their services, some surgeons have concluded that they simply cannot afford the added liability risk for a largely uninsured patient population.
In addition, younger surgeons, who often take the on-call shifts at trauma centers, are leaving states with the most severe liability problems.
For example, according to the Project on Medical Liability in Pennsylvania, funded by the Pew Charitable Trust, “Resident physicians in high-risk fields such as general surgery and emergency medicine named malpractice costs as the reason for leaving the state three times more often than any other factor.”
Further, an American Hospital Association study found that more than 50 percent of hospitals in medical liability crisis states now have trouble recruiting physicians, and 40 percent say the liability situation has resulted in less physician coverage for their EDs.
The crisis has even forced the closure of trauma centers in Florida, Mississippi, Nevada, Pennsylvania, and West Virginia at various times in recent years.
Specialties that have experienced particularly high premium increases—including neurosurgery, orthopaedics, and general surgery—are also among those that provide services emergency patients most frequently require.
According to a report from the General Accounting Office, soaring medical liability premiums have led specialists to reduce or stop on-call services to hospital EDs, seriously inhibiting patient access to emergency surgical services.
Max then responded to the articles I cited by stating that they were biased “surveys and a summary for a hospital lobbying group.”
After all, some of the data were based on surveys of *gasp* doctors.
Max, you lost me, there. If you want to know about doctors’ liability fears or if you want to know why doctors are leaving one state for another state, who are you going to ask? Grocery clerks? School teachers? Attorneys? Would the surveys have been more persuasive if they asked a bunch of nuns what effect they thought that medical malpractice liability would have upon the access to medical care?
Of course the survey participants were doctors. Those are the people whose opinions everyone is seeking.
So I spent about 45 minutes doing some further research on the internet and on some paid medical web sites. I decided to make this a separate post so that if anyone else was searching the internet looking to find out whether malpractice affects access to medical care, you can pick up on the work I’ve done.
Below the fold are some more “nonexistent” studies that support my assertion. Funny, but I haven’t seen one link to any study that asserts the opposite. Oh, and if you do happen to find something … mind you – no surveys from biased lawyers, now.
In court, I believe the term is “uncontroverted evidence.”
This post has absolutely nothing to do with medicine, but you have to take a few minutes to watch the video below. You can’t help but smile and feel good. Watch how the guests start out surprised but within a minute are laughing and clapping. Events like this are what life is all about.
Last Friday, Secretary of Health and Human Services Kathleen Sebelius signed a document that provides vaccine makers immunity when they produce swine flu vaccine.
Many vaccines have a low profit margin. In addition, most vaccines have only one or two manufacturers. If you were a vaccine manufacturer and knew that you could potentially spend tens or hundreds of millions of dollars defending and paying out on one class action lawsuit about a vaccine you produced, would you continue to make the vaccines?
By immunizing manufacturers from liability for producing vaccines, the public policy argument is that the public benefits vaccines produce far outweigh the potential public detriment to the point that the government wants to encourage manufacturers to make vaccines.
Several of the attorneys that frequent this blog have stated that legal immunity for physicians is the equivalent of a “license to kill” but they are also quick to defend legal immunity for judges in performance of their duties.
So based on the above, I have two questions related to this immunity topic:
The federal government has immunized manufacturers from liability for making a swine flu vaccine. Will this ruling influence your decision to get the vaccine when it becomes available?
No, I'm getting the vaccine no matter what (81%, 250 Votes)
Yes, I probably won't get the vaccine because manufacturers can't be held liable (11%, 33 Votes)
I don't believe in vaccinations and wouldn't get the vaccine anyway (8%, 26 Votes)
Total Voters: 309
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Using the public policy argument regarding vaccine production, would you support immunizing emergency physicians from liability if doing so would increase the availablity of emergency medical care?
Yes. We need more doctors providing emergency care (74%, 221 Votes)
No way. They're playing with people's lives and should be held liable if there's a mistake (26%, 76 Votes)
The Mayo Clinic – touted by the Obama administration as a system that provides quality care at a reduced cost – turned around and smacked House Democrats in the face over the recent health care reform proposals. A Washington Times article quotes Mayo Clinic officials as stating that the plan will lower quality and increase costs because the outcomes are not patient-focused or results-oriented. “The real losers [with this plan] will be the citizens of the United States.” Ouch.
In other news, President Obama mentioned in a White House press conference that he changed his mind and now thinks that the Mayo Clinic sucks.
Comparing healthcare systems in different countries may help the US come up with a viable alternative to our current system. John Aravosis from America Blog describes a situation in France where his emergency department visit at a specialty hospital cost him a rocking $32. Something doesn’t sound right about that story. If it is really true, insurance companies would spend less money by purchasing an air fleet and sending patients with potentially expensive medical problems to France for emergency care. Anyone else have experience with the French system that could comment more about it?
More violence in the emergency department. An ED admitting clerk was shot three times by her former boyfriend outside the hospital and then stumbles inside full of blood.
I usually don’t believe that the number of malpractice suits against a physician should be used as a measure of a physician’s competence. I know several excellent physicians who have been sued 5-10 times. I have been sued several times myself. Unfortunately, when there’s no reliable way of measuring a desired metric such as physician quality, pencil pushers will take things that can be measured and try to make the argument that the data apply to the metrics. That being said, should an ophthalmologist who has been sued 50 times be subject to discipline just because of the number of lawsuits against him?
The largest medical malpractice verdict in Tennessee history was just handed down against an OB/Gyn physician that allegedly ignored a patient’s complaints about an unusual breast lump, stating that the lump was probably a cyst or a fatty deposit. Instead, the lump was a cancer that later spread to the patient’s liver. The jury awarded almost $24 million to the patient and her husband.
Here’s a WTF moment for you. Two nurses wrote a complaint with the Texas Medical Board after they became concerned with patient safety when a physician kept trying to sell patients herbal medications. Kind of like an IRS agents offering to sell you tickets to the IRS ball just before an audit? The nurses included patient identification numbers, but no names, with the complaint. The story isn’t clear, but apparently medical records were also sent to the Medical Board. When contacted by the county sheriff, none of the patients complained about their care. The District Attorney then filed criminal charges against the nurses after the doctor complained about being “harassed”.
In other news, the Winkler County District Attorney could not be immediately reached for comment, but later was found at home taking a chamomile extract bath with vanilla bean infusion prescribed by the involved physician.
Defensive medicine may not exist, but this doctor does a pretty good job of describing this figment of our imagination. Interesting that Congressional Budget Office statistics show that $30 billion was spent to defend against and pay malpractice claims in 2008, but that money was only 1.5% of the total 2008 healthcare expenditures. Also interesting that hospitals provided more than $35 billion in uncompensated care in 2008.
I admit that this ACEP article isn’t a “news flash” and leans toward being propaganda. Even if it is propaganda, the article and the story it tells raise a valid point. In some larger cities, ambulance diversion is a huge problem. According to this Washington Post article, diversion happens all the time in Washington, DC. You may not get to go to the closest hospital if you are having an emergency. In addition, the overburdened EMS system may not be able to get to you in a timely manner. Will these problems improve with socialized medicine?
The medical practice climate is tenuous in the Los Angeles region. LA hospitals are reportedly having difficulty finding subspecialists willing to take call for emergency department patients. Big problem. For example, even if patients make it to an emergency department with a life-threatening subdural hematoma, it won’t do them much good if there’s no neurosurgeon there to operate on them. ED physicians can try to stabilize patients, but we can’t do the lifesaving surgery. To maintain coverage, hospitals are paying physicians $250 to $4000 per day to take call and provide patients with care. How long will they be able to continue those payments with massive state budget cuts?
California’s attempts to erase a $26 billion budget deficit by cutting health care will likely push California’s economy further toward bankruptcy according to this LA Times article. Instead of paying for home health care, California will force patients receiving those services to go to nursing homes – at triple the cost. Poison control services and insurance for children of low-income families will be eliminated ending up in more of those “low cost” visits to the emergency department. California’s plan may be as much about cost shifting as it is about cost saving, though. If California cuts payments to the hospitals for emergency services, the hospitals eat the costs of indigent care, not California.
There’s more to the game than direct costs, though. According to the article, a 2006 study tracking similar budget cuts in New York City back in the 1970s found that less than $10 billion in cuts to healthcare, education and law enforcement in New York City over four years led to at least $54 billion in additional costs over a 20-year period. Consequences included higher rates of HIV, a worsened tuberculosis epidemic and a spike in homicides.
Looks like a good trade-off to me, there, Arnold.
New Brunswick, Canada apparently has a poor reputation with Canadian physicians and not too many docs want to work there. ED physicians working in clinics and smaller hospitals are then pulled to work in larger regional emergency departments. Then the clinics and hospitals close. Guess what happens next? All the patients go to other nearby emergency departments and cause an even greater crowding problem. “Then the waits just get longer and longer and there’s more consequences and more possibility, or probability, that something might happen while you’re waiting.” Sound familiar?
When calling an orthopedic specialist regarding a severe leg fracture, the advice I was given was to admit the patient and to “elevate the hell out of it.”
I didn’t think to ask at the time, but exactly how should we accomplish that task?
I can see a patient swinging back and forth in their room, dangling from the ceiling by the affected leg.
My honey and I are starting up a new business venture, so I’ve been very busy with that and haven’t had the time to surf around and read all of my favorite blogs lately.
However, there were a few noteworthy posts that I did catch.
First, the legal equivalent of “Grand Rounds” for medical blogs appears to be the “Blawg Review.” My favorite legal blog – Overlawyered.com – hosted the Blawg Review earlier in the week and was kind enough to mention the saga of my trial as one of the entries. Thanks, Walter! If you are interested in what’s going on in the legal blog world, I encourage you to follow the Blawg Review.
Second, Mark Plaster, the executive editor at Emergency Physician’s Monthly (the publication that is hosting this blog right now) put forth an excellent summary of the Kennedy-Dodd health care bill. Employer-linked insurance and “gatekeeper” concepts haven’t worked thus far, but are apparently going to be pushed further down our throats. I can guarantee they won’t work in this system, either. By the way, speaking about Overlawyered.com, look at the provision some legislators were trying to slip into the health care bill. Fortunately, it was blocked by Republican leaders.
Third is a thought provoking post by Joseph Crea on Bizzyblog.com about healthcare reform. He does a good job at debunking some of the disinformation used to argue against free market reform and for national health care. We have to change our culture before we change our system. Neither is going to happen quickly. My favorite quote: Government-run health care is “akin to treating lung cancer with cough medicine on the advice of Phillip Morris.”
Fourth is an insightful post in the NY Times about health care rationing and why it must happen in the US. The bigger question is how we will decide what gets rationed.
Finally, Kevin wrote an interesting editorial article in USA Today about how many physicians are relying on Wikipedia for information when they do medical research … and how doing so might not be the wisest choice. Congratulations again on taking it to the mainstream media, Kevin.
Kevin’s article got me thinking, though. According to a survey done by Manhattan Research, more than half of physicians report utilizing Wikipedia for medical research.
The problem is that anyone can create or edit a post on Wikipedia, so the information being disseminated should be taken with a grain of salt. Pharmaceutical companies have been caught deleting information about adverse effects from the medications they produce (I’m not calling those reactions allergies). There are even cases of editing wars between “Wikifiddlers” who change an entry only to have it immediately changed back by someone with a contrary view. Not too long ago the Church of Scientology was banned from editing any entries on Wikipedia due to the repeated editing wars. Want to get Tom Cruise pissed off? Post an entry on the Scientology Wikipedia entry saying that vitamin therapy is for looney birds.
As I transcribed the next several posts about my trial (coming out soon) concerning expert witness testimony, I thought that medical expert testimony is similar to a post on Wikipedia. Heck, any expert testimony is similar to a Wikipedia post.
A jury has to depend on the information given by the expert to make a decision, but the jury has no idea about the bona fides or the biases of the person making the statements. The expert’s statements can be completely erroneous opinions supported by little or no fact, and the jury doesn’t get to ask the expert questions to follow up on the expert’s statements. Despite all this, the jury has to take the expert testimony at face value and base their verdict on that information.
Interesting system, huh?
I’ve got a couple of dozen other news articles and sites that I have bookmarked over the past few weeks, so I’ll try to start doing the Healthcare Roundup again next week.
A 13 year old boy comes in after being thrown from an ATV while riding in a field. His arm is painful and deformed at the elbow. He has numbness in his thumb, index, and middle fingers.
What is the diagnosis? What problems do you have to worry about? What should you monitor? What is his prognosis?
Scroll down for the answer.
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Answer: Type III Supracondylar Elbow Fracture
With sensory deficit in the first three fingers of the hand, the patient likely has a median nerve injury. Also note the darker grey fat pad immediately posterior to the distal fracture segment.
Gartland Classification of Supracondylar Fractures includes
Type I: non-displaced
Type II: displaced, but with intact posterior cortex
Type III: displaced with complete dissociation of fracture segments
Vascular compromise occurs in up to 20% of children with supracondylar fractures. If missed, can develop compartment syndrome or ischemic contractures.
Compartment syndrome occurs infrequently and may be difficult to diagnose in presence of an associated median nerve palsy since the pain associated with compartment syndrome is diminished. May consider applying a continuous pulse oximeter to help monitor perfusion.
Median nerve injury can occur in up to half of patients with Type III supracondylar fractures.
Radial nerve injury can occur in up to 25% of patients with Type III supracondylar fractures.
Supracondylar fractures can often be fixed by percutaneous pinning, but may require open reduction and/or exploration if vascular injuries or if unable to achieve satisfactory reduction using closed manipulation.
Neurologic deficits often, but not always, resolve in 3-6 months.
Range of motion in joint may not return for up to 12 months.
OK, make that $40 million for the plaintiff and $20 million for the attorney.
Sorry, but even if the doctor royally screwed up, no one’s labium is worth that much. Just as an aside, don’t click the “labium” link at work or around children. It’s a Wikipedia entry, but there are pictures there that might be difficult to explain to your boss or to your child.
But it’s good to have juries deciding cases like this, right?
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Healthcare Policy Roundup 7/22/09
Wednesday, July 22nd, 2009The Mayo Clinic – touted by the Obama administration as a system that provides quality care at a reduced cost – turned around and smacked House Democrats in the face over the recent health care reform proposals. A Washington Times article quotes Mayo Clinic officials as stating that the plan will lower quality and increase costs because the outcomes are not patient-focused or results-oriented. “The real losers [with this plan] will be the citizens of the United States.” Ouch.
In other news, President Obama mentioned in a White House press conference that he changed his mind and now thinks that the Mayo Clinic sucks.
Comparing healthcare systems in different countries may help the US come up with a viable alternative to our current system. John Aravosis from America Blog describes a situation in France where his emergency department visit at a specialty hospital cost him a rocking $32. Something doesn’t sound right about that story. If it is really true, insurance companies would spend less money by purchasing an air fleet and sending patients with potentially expensive medical problems to France for emergency care. Anyone else have experience with the French system that could comment more about it?
More violence in the emergency department. An ED admitting clerk was shot three times by her former boyfriend outside the hospital and then stumbles inside full of blood.
I usually don’t believe that the number of malpractice suits against a physician should be used as a measure of a physician’s competence. I know several excellent physicians who have been sued 5-10 times. I have been sued several times myself. Unfortunately, when there’s no reliable way of measuring a desired metric such as physician quality, pencil pushers will take things that can be measured and try to make the argument that the data apply to the metrics. That being said, should an ophthalmologist who has been sued 50 times be subject to discipline just because of the number of lawsuits against him?
The largest medical malpractice verdict in Tennessee history was just handed down against an OB/Gyn physician that allegedly ignored a patient’s complaints about an unusual breast lump, stating that the lump was probably a cyst or a fatty deposit. Instead, the lump was a cancer that later spread to the patient’s liver. The jury awarded almost $24 million to the patient and her husband.
Here’s a WTF moment for you. Two nurses wrote a complaint with the Texas Medical Board after they became concerned with patient safety when a physician kept trying to sell patients herbal medications. Kind of like an IRS agents offering to sell you tickets to the IRS ball just before an audit? The nurses included patient identification numbers, but no names, with the complaint. The story isn’t clear, but apparently medical records were also sent to the Medical Board. When contacted by the county sheriff, none of the patients complained about their care. The District Attorney then filed criminal charges against the nurses after the doctor complained about being “harassed”.
In other news, the Winkler County District Attorney could not be immediately reached for comment, but later was found at home taking a chamomile extract bath with vanilla bean infusion prescribed by the involved physician.
Defensive medicine may not exist, but this doctor does a pretty good job of describing this figment of our imagination. Interesting that Congressional Budget Office statistics show that $30 billion was spent to defend against and pay malpractice claims in 2008, but that money was only 1.5% of the total 2008 healthcare expenditures. Also interesting that hospitals provided more than $35 billion in uncompensated care in 2008.
I admit that this ACEP article isn’t a “news flash” and leans toward being propaganda. Even if it is propaganda, the article and the story it tells raise a valid point. In some larger cities, ambulance diversion is a huge problem. According to this Washington Post article, diversion happens all the time in Washington, DC. You may not get to go to the closest hospital if you are having an emergency. In addition, the overburdened EMS system may not be able to get to you in a timely manner. Will these problems improve with socialized medicine?
The medical practice climate is tenuous in the Los Angeles region. LA hospitals are reportedly having difficulty finding subspecialists willing to take call for emergency department patients. Big problem. For example, even if patients make it to an emergency department with a life-threatening subdural hematoma, it won’t do them much good if there’s no neurosurgeon there to operate on them. ED physicians can try to stabilize patients, but we can’t do the lifesaving surgery. To maintain coverage, hospitals are paying physicians $250 to $4000 per day to take call and provide patients with care. How long will they be able to continue those payments with massive state budget cuts?
California’s attempts to erase a $26 billion budget deficit by cutting health care will likely push California’s economy further toward bankruptcy according to this LA Times article. Instead of paying for home health care, California will force patients receiving those services to go to nursing homes – at triple the cost. Poison control services and insurance for children of low-income families will be eliminated ending up in more of those “low cost” visits to the emergency department. California’s plan may be as much about cost shifting as it is about cost saving, though. If California cuts payments to the hospitals for emergency services, the hospitals eat the costs of indigent care, not California.
There’s more to the game than direct costs, though. According to the article, a 2006 study tracking similar budget cuts in New York City back in the 1970s found that less than $10 billion in cuts to healthcare, education and law enforcement in New York City over four years led to at least $54 billion in additional costs over a 20-year period. Consequences included higher rates of HIV, a worsened tuberculosis epidemic and a spike in homicides.
Looks like a good trade-off to me, there, Arnold.
New Brunswick, Canada apparently has a poor reputation with Canadian physicians and not too many docs want to work there. ED physicians working in clinics and smaller hospitals are then pulled to work in larger regional emergency departments. Then the clinics and hospitals close. Guess what happens next? All the patients go to other nearby emergency departments and cause an even greater crowding problem. “Then the waits just get longer and longer and there’s more consequences and more possibility, or probability, that something might happen while you’re waiting.” Sound familiar?
Posted in Access to Care, Funding Crisis, News Commentary, Policy | 19 Comments »