WhiteCoat

Healthcare Update — 04-15-2010

When emergency departments close their doors, the patients don’t stop getting sick – they just go to other hospitals. Now that St. Vincent’s Hospital in New York is no longer taking ambulance runs, nearby hospitals are getting a surge in volumes. Bellevue Hospital is now the only level one trauma center in lower Manhattan and is temporarily asking its staff to work longer hours to handle the extra patients.
The remaining city hospitals are now asking for emergency funds to help them treat the patient surges from St. Vincents. What will happen if they don’t get funding and they close?

Hospitals nearby St. Vincents were rumored to have needed to go on “bypass” for ambulance runs due to the volumes, an allegation that is denied by the hospitals. Transport times for ambulances increase from less than five minutes to St. Vincents to nearly 20 minutes to the next closest hospitals. Paramedics believe that it is only a matter of time before there is a bad outcome due to the lack of access to care.

Austrailian emergency department waits top 8 hours for one third of all ED patients, with more than 2500 patients waiting more than 24 hours for care in the last calendar year.
Patient volumes are increasing significantly – by 43% in some cases – and funding is repeatedly lacking. Hospitals are running at 95% capacity instead of the 85% capacity goal. Now Prime Minister Kevin Rudd is pledging $500 million in extra funding … if hospitals sign onto his $50 billion health care overhaul.
Is it me or does this whole scenario sound vaguely familiar?

This iPhone app tells you when you need to go to the emergency department. Dropping your new Percocet prescription in the toilet isn’t on the list.
But … according to this article on KevinMD, if the app gives the wrong advice, the developer could be out a boatload of money. Apple requires that all developers hold Apple harmless from any lawsuits brought against Apple related to the developer’s app. That could mean some heavy duty monetary outlays for app developers. I’m betting that Apple’s lawyers aren’t cheap.

Florida emergency “rooms” – enter at your own risk. So goes the warning from the Florida trial lawyers. If Florida passes a bill extending sovereign immunity to emergency department personnel, the “financial incentives for health care providers to ensure patient safety and high quality care” would be undermined. Rrrrrright.
They’re just upset because they won’t be able to force clients to contract around this tort reform measure like they did with Florida’s cap on attorney contingency fees.

Saudi Arabia bans 16,000 out of 36,000 doctors and other health professionals from practicing medicine and considers whether or not to make medical malpractice a criminal act. The article also notes that nearly half a million Saudis have no access to health care because there are not enough hospitals. Criminalize medicine and see how many people have no access to health care because there are not enough doctors.

After catching another article linked to the article above, I’m betting that the Saudis don’t have much of a problem with illegal drug sales. Saudi officials are seeking the death penalty against a pregnant woman who sold Valium to an undercover officer in a sting operation. The prosecutor told a panel of judges that “This is a crime that poisons our country. It poisons our youth. This criminal wanted to destroy our future. We are asking for the most severe punishment, the death penalty, for this vile crime.”

$10 million verdict against ambulance service when pregnant mother it transported gives birth to child with cerebral palsy.

Man uses circular saw to trim branches from tree. Also uses running wood chipper as sawhorse. Cuts fingers off with circular saw then severed fingers fall in wood chipper. Ooops.
Woman falls in shower after tripping over basketball.
Cases like these are what make emergency medicine so interesting … sometimes.

One quarter of cardiologists order tests due to fear of lawsuits and those tests contribute to significant increases in health care spending. “We need a way for docs to be less afraid of not ordering a test,” said the study’s lead author.
In other news, psssst … defensive medicine doesn’t exist. Pass it on.

Sounds like a script for the next Indiana Jones movie. Benjamin Metanyahu decides to build a new hospital in Gaza on a site where multiple ancient pagan graves were found. Just think, if John Edwards ever travels there, he would be able to channel patients’ medical histories from dead relatives.

California’s newest attempt to fix the budget deficit. Decrease payments to hospitals so they are struggling to provide services, then fine them hundreds of thousands of dollars for safety violations such as failing to follow up with families about abnormal blood testing. Since when did that become a hospital duty?
Shrinking payments to providers. State law ban on balance billing. Hospitals closing. Remind me why anyone would want to practice medicine in California. Oh, yeah, that’s right. I forgot. They have tort reform for the past 30 years.

18 Responses to “Healthcare Update — 04-15-2010”

  1. Matt says:

    “They have tort reform for the past 30 years.”

    I know. It’s amazing. I guess the tort reform pushers were lying when they were talking about how it’s the cure to all that ails medicine! At least no one is claiming tort reform is the key to access anymore. Those guys were sure full of it, eh?

    “defensive medicine doesn’t exist.”

    Who believes this? That’s like believing that tort reform reduces “defensive medicine”. Crazy talk. But you highlighted the wrong part of the article. This is the funny part:

    “Most said they weren’t swayed by such things as financial gain or a patient’s expectations. But about 24 percent of the doctors said they had recommended the test in the previous year because they were worried about malpractice lawsuits. About 27 percent said they did it because they thought their colleagues would do the test.”

  2. Matt says:

    “Just think, if John Edwards ever travels there, he would be able to channel patients’ medical histories from dead relatives.”

    Even better, Bill Frist can diagnose why they died just from looking at the headstone.

  3. KT says:

    Australia’s problem is not enough beds/staff in the ED. It’s not enough beds in the wards.

  4. Matt says:

    “They’re just upset because they won’t be able to force clients to contract around this tort reform measure like they did with Florida’s cap on attorney contingency fees.”

    That’s awesome! You and I can’t pay our attorney whatever we want, but there is no limit on what the insurers can pay their attorneys.

    It’s about fairness, right?

    • throckmorton says:

      Matt:

      For what’s it worth. The only neurosurgeons in our area will not see any non-ED patient unless they have signed an arbitration agreement. They got the agreement and amended it for their practice from the states trial lawyers org.

      • Matt says:

        I have no problem with two parties freely negotiating contract terms. If a patient chooses arbitration so be it. I don’t know why the physicians think it’s so much better though. It’s only slightly less expensive, which they’re not paying anyway.

  5. Anonymous says:

    Really do any kids going into premed/med school think about these things (I have a point, I promise)? So WC the question is, if you had all the info of the problems of today (liability, abuse, et al), would you still have done medical school? Will the fresh supply keep up with the tired and fed up current generation of doctors?

  6. Wow…my sympathies to Bellevue…I can only imagine if one of our local hospitals stopped and we picked up their ER patients!

  7. Matt says:

    ” If Florida passes a bill extending sovereign immunity to emergency department personnel, the “financial incentives for health care providers to ensure patient safety and high quality care” would be undermined. Rrrrrright.”

    This quote illustrates the dichotomy between WC’s stated positions on “free market” medicine, yet his willingness to go to the government for all the protection he can get. Less government when it most benefits him, it appears.

    He wants the government to protect him from the claims of the consumers in the free market, yet he wants to be more “free” to contract with the same consumer.

    WC, do you really think that once the government extends its sovereign immunity shield over you, that it’s going to relinquish control over you in other areas? If you do, I admire your optimism in the face of all evidence to the contrary.

    • WhiteCoat says:

      Matt, you’re losing it.

      First of all, I don’t believe that being covered under a state or federal tort claims act is necessarily a good thing. What happens if the government chooses not to extend protection to you? What happens if the government settles a frivolous case without your consent and then you get put on the national practitioner databank?

      You babble on about me seeking protections in the “free market”. The medical market isn’t even close to being “free” right now. In fact, there will never be a completely free market in medicine because some people could never afford even basic health care yet we still have to provide care for them.

      I don’t go running to the government for protection. I’m happy to pay for malpractice insurance, but can’t pay for the premiums if patients don’t pay me.

      So if we operated in a truly free market, I would get paid by each patient, I would pay my malpractice premiums, college loans, medical school loans, Supreme Court Justice school loans, Ferrari payments, etc., and I wouldn’t have to worry about whether the next insurance payment cut would affect my ability to pay my bills.
      In the real world, 40% of patients pay me 10 cents on the dollar, 25% of patients pay me closer to nothing, and 30% of patients pay me a little more than the cost of providing care.
      Now how does the “non-free” market entice medical providers to stay in the market under those conditions? Decreasing expenses for the provider would be one way. Loan repayment programs. Cover malpractice insurance costs. Ooooh yeah, 30 years of tort reform!
      However the market will entice providers, it better do so quickly. The next round of Medicare cuts isn’t going to make things any better. And all the new technology requirement, audits, JCAHO regulations, and increased patient populations will likely cause more experienced physicians to hang up their stethoscope.

      I await your Spock-like logical retorts on how we can provide complete medical care to everyone using only the change found between couch cushions, while increasing the take-home pay for malpractice plaintiff attorneys – based on your extensive experience in the field, of course.

      • Matt says:

        I find all of the above quite humorous. Particularly because it’s quite clear you didn’t read what I said. What’s funny is that you and I probably agree on the solution – eliminating third party payers.

        But you, on the front lines of this issue, whose life is directly affected by it EVERY DAY, have done next to nothing to further that. I must have asked you three times what legislation we should support that brings you the “free market” you claim to want. Yet you have nothing. Zip. Zero.

        “I don’t go running to the government for protection.”

        What do you think all your cries for malpractice “reform” are? You’re asking the govt to protect you from the public.

        “In the real world, 40% of patients pay me 10 cents on the dollar, 25% of patients pay me closer to nothing, and 30% of patients pay me a little more than the cost of providing care.”

        If all this is true, how is the average ED physicians salary $180,000? Are the remaining 5% paying you 200x the cost of providing care? And 10 cents on what dollar?

        Your math makes no sense.

      • Dave says:

        Matt, why don’t you take your own solution and eliminate your own third party payer, and go bare of insurance? I’m sure you can find a doctor who will take care of you cash on the barrelhead. If you get sick and wind up with a serious illness, such as lymphoma, you might find out why the third party payer system exists.

      • Matt says:

        My deductible is so high I pretty much do anyway. I’d go with just a catastrophic policy over $20,000 if one was offered. Really I’d rather pay for professional services by the hour and have more transparency.

  8. Matt says:

    “I await your Spock-like logical retorts on how we can provide complete medical care”

    I love the strawman, by the way.

  9. NormD says:

    Matt is a troll who detracts from the conversation. Could you limit him to one comment per thread with a word limit?

    Lawsuits are extremely flawed in that they make future recipients of a service pay for past misconduct. How does this fix anything?

    I keep hearing doctors complain that they are being underpaid, but the gross amount spent on healthcare keeps rising. Something does not add up.

    I am so tired of the current healthcare system. I would love to pay a reasonable amount to doc at time of service and be done with it.

    Have you seen discussion of vouchers to purchase health insurance as opposed to the current top-down plan?

    • Matt says:

      Your complaint about lawsuits makes little sense. But they definitely should be the last choice for dispute resolution.

  10. [...] I mentioned this case in a previous Healthcare Update. [...]

Leave a Reply


six + = 11

Popular Authors

  • Greg Henry
  • Rick Bukata
  • Mark Plaster
  • Kevin Klauer
  • Jesse Pines
  • David Newman
  • Rich Levitan
  • Ghazala Sharieff
  • Nicholas Genes
  • Jeannette Wolfe
  • William Sullivan
  • Michael Silverman

Subscribe to EPM