See more news stories from around the web over at ER Stories in the Satellite Edition of this week’s Healthcare Update.

When it’s dead and you don’t know what to do with it, send it to pathology. When it’s alive and you don’t know what to do with it, send it to the emergency department — and don’t take it back. Wesley Healthcare Center in Auburn, IN sent a patient to the Angola Hospital emergency department and then wouldn’t take him back after he was cleared for release. Demonstrating an efficient use of resources, Gregory George was forced to stay in the emergency department for a week with around-the-clock care.
One former employee of the nursing home stated that the “patient dump” had been planned because the nursing home staff was fed up with the patient’s “excessive complaints” to the State about the nursing home.
In other news, the Joint Commission has declared that this incident shows how nursing homes may be a danger to patient safety. All nursing homes must close. Immediately.

Here’s a good way to help clear up California’s budget deficit. Start fining hospitals for mistakes.
If this takes off, soon they’ll be fining housing contractors for using the wrong pipes, police stations for arresting the wrong people, schools for failing to use the right curriculum, law firms for filing the wrong motions, and legislators for drafting crappy legislation. Instant riches!
Ooooh ooooh, I know! Maybe they can fine citizens when they move out of the state. Then California would have a budget surplus in no time.

Can’t take the heat? Get out of the kitchen. California city mayor has been to the emergency department five times in past six years suffering from chest pains after getting into arguments at city council meetings. Maybe it’s time for a career in horticulture?

Difficult decisionmaking. An elderly patient with multiple organ systems failing goes to the emergency department for an exacerbation of heart failure and decides he wants “everything done”. He is put on a ventilator, goes on dialysis, requires a feeding tube, and dies after six months in the hospital. The patient’s daughter questions whether her father’s decision was the correct one.

Attorney wins $3.8 million verdict for client in bad faith medical malpractice insurance claim, then takes $1.7 million in attorneys’ fees. When costs of the suit are paid, the attorneys will likely make more money from the case than their injured clients. Now the attorneys are suing each other about how the attorneys’ fees should split. Ironic how the attorney with the money is now referring to the ones suing him as “bank robbers.”

“Now craziness has a name … it’s called CYA.” This editorial in the Chicago Flame about health care reform and defensive medicine is spot on.

Interesting paper about defensive medicine and “disappearing doctors.” This 2005 study finds that increasing malpractice premiums generally don’t affect the numbers of physicians practicing in each state, but that increasing premiums do affect the willingness of some specialists to remain in practice – such as rural surgeons who tended to just retire. This study showed that “direct tort reform increases physician supply in the short run by 2.4 percent” and reduces growth of expenditures between 5 and 9 percent. Note that the paper was published shortly after tort reform was enacted in Texas and that there have been significant and sustained increases in physician supply in Texas since tort reform was enacted.
A graph in the paper notes that between 1993 and 2001, malpractice insurance premiums for internists in Texas increased by nearly 150%. After tort reform was enacted in Texas, medical malpractice premiums dropped by more than 40%.
What else do physicians do when faced with increasing malpractice payouts? Order tests. Significant increases in cardiac catheterizations and CT scans were noted with increased malpractice payouts.
Don’t worry, though. According to the trial lawyers, defensive medicine doesn’t exist.
Hat tip to Ezra Klein

What’s with the bizarre viral infections coming out of Africa? AIDS, ebola virus, now the chikungunya virus. Get bit by a mosquito carrying the disease and you could come down with high fevers, a rash, and severe arthritis for several years. Yes, you can sign me up for the vaccine, thank you. More about the virus from Wikipedia and from the CDC.

Minnesota is the 34th state to begin monitoring the prescription of narcotics. According to this article, 117,000 Minnesota adults abuse prescription drugs each year. Next month, prescription records for patients will be available in a centralized database. The comments section to the article has many anecdotes about people who fear they won’t get needed pain medications and about how people currently abuse the system. One post wonders whether everyone will just begin using aliases and fake addresses. That may work until you have to show a copy of your ID when picking up a prescription. No ID? No Vicodin.