WhiteCoat

Healthcare Update 12-05-2009

Obviously biased statistics published in the Metropolitan Corporate Counsel. “Four of ten medical malpractice lawsuits filed in America each year are groundless and overhead costs of malpractice litigation are exorbitant. These costs, of course, are imposed on doctors, hospitals and insurers, and then ultimately passed on to health care consumers.” In addition, “the overall shortage of doctors practicing both primary care and high-risk specialties may grow to nearly 125,000 by 2025.”

Most Americans want curbs on medical malpractice lawsuits.
“In this country, there are just too many people who are just out for a quick buck,” said Christine Vasquez, 67, a retiree from Clarkston, Mich. “I think our insurance costs would go way down if (doctors) didn’t have to be so scared to be sued all the time.”

Connecticut fertility doctor loses NY license after using his own sperm to artificially inseminate a patient. How was he caught? Well, it just so happened that the physician was Caucasian and the intended father was African American. So the doctor’s a weirdo who doesn’t understand genetics. Not sure which would be worse … having his baby or shaking his hand after the office visit.

Walgreens error results in young girl being given amiodarone instead of tamiflu to treat influenza. Family not sure whether there will be heart damage.
A 2003 Auburn University study on pharmacy errors estimated they will occur four times a day at pharmacies filling more than 250 prescriptions daily and that in 1,000 of those errors are a threat to patients’ health. More than 3.6 billion prescriptions were filled in the US in 2008, which adds up to the potential for a lot of errors. This is another area in which humans are expected to behave perfectly.
In other news, as a result of this incident, JCAHO has recommended banning all pharmacies as a patient safety measure.

Eighty five percent of doctors surveyed reported that the threat of malpractice litigation is hampering their ability to practice medicine properly.
Ninety two percent of physicians want medical malpractice reform
. The other 8% are plaintiff experts. Many physicians also supported ending coverage refusals based on pre-existing conditions. Sixty one percent recommended allowing patients to opt out of Medicare, “a government program that underpays doctors so badly in some cases that many Medicare patients have trouble finding doctors who will see them.” Hmmmm. Insurance doesn’t equal access. Wonder where I’ve heard that before. Another interesting statistic – 62% of physicians disagree with the American Medical Association’s endorsement of President Obama’s reform proposal.

Stuck with a hepatitis patient’s bloody needle. Would you take medicine with many side effects that might lessen the chance of you getting HIV or would you forget about it? A difficult decision explained by a new ED nurse who was put in the exact situation.

More emergency department closures in CANADA … not enough doctors are willing to work in Prince Edward Island. The Kings County Memorial emergency department closure during evening hours leaves the entire county without an emergency department during overnight hours. But at least everyone has health insurance, right?

Edwin Leap is spot on. “Healthcare reform that seeks to increase access will not help if physicians aren’t accessible.  Right now, in a time in which increased work can in fact result in increased money, physicians are avoiding call in droves for lifestyle reasons.  Guess what will happen when their pay is cut and they are salaried?  When they make the same amount of money for lots of work or little work?  Are we prepared to force physicians to work under threat of punishment?” The entire article is enlightening.

Got Propofol? Conrad Murray, the doctor implicated in Michael Jackson’s death, has started practicing medicine again — at the Conrad Murray Center for Sleep Pathology … er, um … the Armstrong Medical Clinic in Houston.

See, America? Lawsuits improve patient safety
. Attorney Michael Bryant, president of the Minnesota Association for Justice goes on record as saying “Right now the estimates are that 98,000 people die each year in this country due to medical errors. If you make it harder to bring those cases to court, I don’t see how you’re going to save more lives – you’re going to kill more people.”
In other news, JCAHO and Gerry Spence have both demanded that plaintiff attorneys begin running hospitals as a patient safety measure.

When emergency departments close, the delay in getting patients to the proper hospital may be fatal.

21 Responses to “Healthcare Update 12-05-2009”

  1. PJ says:

    So, should the nurse who violated well-established safety guidelines be eligible for post-exposure prophylaxis and other care related to this incident, all paid for by her employer? This is the same employer who provided the safety equipment (which she didn’t use) to prevent this from happening in the first place.

    • WhiteCoat says:

      I don’t think that the nurse should be refused PEP, but I also don’t think that it is unreasonable that she pay for it out of her own pocket is she wasn’t following the employer’s rules.
      Even so, just like the Woods case, this is another instance of “would it have made a difference”?
      Even if the nurse had been wearing latex gloves, would they have stopped the needle?
      Highly unlikely.

      • DefendUSA says:

        In 1988/1991, they had no such protocol for accidental needle sticks. I was the recipient of two such incidents. A hepatitis positive and a potential HIV. Both times, I did as nurse in the article. Bled the shit out of it in the first 10 seconds of realizing what happened. I was a phlebotomist and wore gloves as well. It did not stop the penetration.

        A classic example of rock/hard place when it comes to protocol now. I have to wonder if the PEP treatments can cause such havoc on a body that perhaps there are factors with recipients that make it so?

        I was also a lab tech in the Army. One of my assignments was doing microbiology for all of the US European theater. Tuberculosis was my thing. I had to wear all kinds of protective clothing, using hepa filtered hoods and the like to decontaminate specimens, etc…My boss swore to me that one day I would show up positive for a tine and PPD, just because of the job. He was. It’s 20 years later, and I am not. Don’t know if that means I was better at aseptic technique, or just happened not to be exposed to TB in the outside world.

  2. GrumpyRN says:

    “In England, some “emergency rooms” close because not enough doctors are willing to work there”.

    Please get your facts correct before you print things – this shows either poor knowledge of geography or poor reading skills. Prince Edward Island is in Canada not England!

  3. SeaSpray says:

    I wouldn’t want to go to Dr Propofol because I would not be looking for that kind of deep ..permanent sleep.

    I’d never trust him ..ever.

    I know of someone who was given the wrong medication by a pharmacy, caught the mistake..*never* took the med.. but called, complained that she got a reaction to the medication… pretended to be distraught. I forget the amount..but she got 2 or 3 thousand out of a local pharmacy for that. She was at lunch in a restaurant with a mutual friend, winked and said watch this. My friend witnessed the whole thing.

    Sometimes I get prescriptions and don’t look in the bottle and just take it… but I can see we should always check.

    I’ve heard this administration won’t do anything about tort reform. If that is true..why in the world won’t they embrace tort reform?

  4. Max Kennerly says:

    “Joyce cites a 2006 Harvard School of Public Health finding “that four out of every 10 medical malpractice lawsuits filed in America each year are groundless, and that the ‘overhead costs of malpractice litigation are exorbitant.”

    Big surprise: spokesperson for the American Tort Reform Association is a big, fat liar.

    Here’s what the study found:

    The reviewers found that almost all of the claims involved a treatment-related injury. More than 90% involved a physical injury, which was generally severe (80% resulted in significant or major disability and 26% resulted in death). The reviewers judged that 63% of the injuries were due to error. The remaining 37% lacked evidence of error, although some were close calls.

    Most claims (72%) that did not involve error did not receive compensation. When they did, the payments were lower, on average, than payments for claims that did involve error ($313,205 vs. $521,560). Among claims that involved error, 73% received compensation. “Overall, the malpractice system appears to be getting it right about three quarters of the time,” said Studdert. “That’s far from a perfect record, but it’s not bad, especially considering that questions of error and negligence can be complex.” The 27% of cases with outcomes that didn’t match their merit included claims that went unpaid even though the injury was caused by an error (16%); claims that were paid but did not involve error (10%); and claims that were paid but did not appear to involve a treatment-related injury (0.4%).

    Read it yourself: http://bit.ly/6OIHr2

    • Fyrdoc says:

      Yes but Max, if you do the math (28% of 37%) means that 1 in 10 of suits filed in the U.S. involved no error and paid out an average of $313,205. 1 in 10! How does this not offend you? My God, if 1 in 10 incarcerated persons was found to be innocent, we’d shut down the Justice System…

      • Max Kennerly says:

        How does it not offend you that a far larger percent of patients who were victims of negligence received no payment at all?

        No system is perfect. You’re apparently deeply troubled that, although the insurance company usually unjustly wins, sometimes individuals unjustly win.

        Comparing paying out an insurance policy to incarceration just shows the absence of any thought given to your policy views. You want the deck stacked against patients, no matter the cost.

      • Fyrdoc says:

        No. I’m offended that I can do my job perfectly well, to the standard of care, everytime. And when I’m sued (for emergency physicians, it is when not if), there is a 1 in 10 chance there will be a large pay out (and a report to the NPDB) even if I do things right! How would lawyers accept the same terms applied to their profession?

  5. Katy says:

    Isn’t there a limit on the amount of prescriptions a pharmacist can fill per day in the US? Another reason why I can’t understand why pills are counted in America rather than just being bought prepacked in boxes. Australian pharmacists are also required by law to scan the barcode of the box of drugs so the computer can compare the drug that was typed in and the drug about to be dispensed (this varies by state, but all dispensing programs have the ability to do it).

    I can’t understand what the proposals are for the healthcare reform, nor do I really care since I don’t live there, but how much are they planning on reducing a doctors pay by? Here, with our univeral healthcare system, doctors still earn $300, 000/year and nurses walk out of university on $64 000 before shift and weekend bonuses. I dunno what’s going on with you guys. =S

  6. DefendUSA says:

    Katy…
    Are those docs specialists? My Neurosurgeon BIL makes decent money as well for 14 years of training. But most general practitioners don’t even come close to 300K!! It seems to me I have read somewhere at less than 200K. And, they work a hell of a lot more than a 40 hour week to get there.

    And our nurses typically, a two year degree, start out at roughly 35-39k depending on geographics.

  7. ERP says:

    Holy moly, where is Matt? Your post was dominated by articles about malpractise reform and he has not yet chimed in with his usual cheerful, supportive comments.

  8. Social comments and analytics for this post…

    This post was mentioned on Twitter by USHealthcareIT: Healthcare Update 12-05-2009 | WhiteCoat’s Call Room: Obviously biased statistics published in the Metropolitan Cor… http://bit.ly/5RsEjm

  9. Canuck says:

    A hospital in PEI had to close at night. So what? It happens. It’s not the direct result of “socialized medicine”….christ, I hate that term! And it’s not directly related to the fact that “everyone has health care” -as if that is the sole reason there aren’t enough doctors. PEI is a small province with a small population, and hospital closures at night (I don’t recall reading that the entire hospital shut down) are cyclic in nature.

    What’s the excuse for US hospitals that close? I could say “they went bankrupt” or “the JC shut them down” but those are simplistic (and closed-minded) answers. King-Harbor was a huge, busy hospital in a large, populated city. It closed (and much more completely too). These things happen.

    Enough with the comparisons between Canada and US, as if they are contiguous systems. It’s a bit like comparing apples to oranges. And it really is insulting to constantly read that one system is so much better than the other, when each have their problems. Let us criticize and compliment our own system. It might not be perfect, and we do complain (who doesn’t?!?!) but we do appreciate what we have. Especially when we’re making minimum wage, have an MI and don’t go deeply into debt to pay for our quadruple bypass.

  10. Canuck says:

    P.S. I used to work in the US. Kept paying my CAD taxes though, and kept my OHIP (provincial health coverage) up to date. I always said if I got really sick, I’d hop on a plane and head back to Ontario as fast as I could.

    When you’re sick, money should be one of the last thing on your mind. Convincing your insurance company to cover your treatments so you don’t die shouldn’t be on your “to do” list either.

    Here, it isn’t.

  11. Mark Baird says:

    “Web-based survey sampled 1,978 physicians across America in major medical and surgical specialties”

    I would be interested in seeing the survey and how they controlled their population sampling.

    Maybe if someone had sued earlier…

    http://www.youtube.com/watch?v=4PMdBkNv3Vs

    It is real easy to use anecdotal evidence. I could through up cases all day long such as these.

    Doctors should know better. Where is the empirical evidence supporting all of this talk about tort reform and defensive medicine. Doctors should know better. Please where is the evidence.

  12. Mark Baird says:

    “Though commonsense Americans repeatedly raised the issue of tort reform ”

    So let me straight, a majority of Americans want tort reform, and yet is it not these very same people that are on juries or is that a different crowd from another planet.

    • DensityDuck says:

      In general, no. The jury-selection process ensure that the jury is made up of twelve people who’ve never been sued, are not and never were and don’t know any doctors, no involvement in the medical or pharmaceutical industry, no knowledge of medical procedure or treatment processes, no awareness of the split between attorney fees and actual patient awards…

  13. Sandy says:

    More emergency department closures in CANADA … not enough doctors are willing to work in Prince Edward Island. The Kings County Memorial emergency department closure during evening hours leaves the entire county without an emergency department during overnight hours. But at least everyone has health insurance, right?

    Montague where the hospital is is 29 miles from Charlottetown PEI, the capital of PEI. The 2006 pop stats for Montague are: within city limits 1,800, within the surrounding area 16,000.

    Canada is the 2nd largest country in the world with 1/10th the population of the USA – of course there will be areas without immediate medical care. Please use reality when considering the differences between us. Other than the most obvious fact – all our citizens and permanent residents have health care.

  14. burned out says:

    I was sued. did nothing wrong and was cleared both by the hospital peer review and the state medical board. Sued by a plaintiffs atty, and insurance settled for half a mil, just because it was cheaper than defending and risking a loss. I had no say in the choice to settle.

    What is fair about that? I did nothing wrong, was cleared by my peers, and yet still had to settle just because a lawyer sued and the business model said settlement was cheaper than defending it and risking the loss.

    Of course, now I have my sights set on a new business model. the hell with medicine, I am going to exploit the lawsuit industry, and apply the same standards that get applied in medicine to the rest of my life.

    Did you fix my car and now it does not work. I am suing you.
    did you fix my plumbing and now I have a leak. lawsuit!
    did you offend me in public by doing or not doing something that I alone deemed inappropriate or offensive. Sic em Law school grad!

    the way I figure it, I can hire a lawyer, and we can get rich suing everybody else for not meeting standards that we alone set for society. It seems to be where this country is headed.

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