WhiteCoat

Healthcare Update — 05-10-2010

Coming soon to a hospital near you? Overcrowding and physician shortages at Royal Columbian Hospital in British Columbia having adverse effects on patient care. Volumes are up by 20% from a few years ago and the physician groups estimate they need about 25% more physicians to handle the patients. The result is significant overcrowding. A recent report showed 34 “near misses” where wait times could have affected a patient’s safety or medical outcome – including a man who waited five hours with an intracerebral bleed.
Fire marshals visited the emergency department due to a complaint about overcrowding and issued a notice of fire safety violation. As a result, ambulances are being instructed to hold patients in vehicles in the ambulance bay until there is a bed available. Apparently if you can’t see them, they’re not your problem.
The docs even created a web site to notify the public about how inadequate staffing and overcrowding are limiting their ability to provide “safe and effective care to all patients in a timely and respectful manner.”
In other news, hospital officials are now chastising the emergency personnel for their lower than average Press Ganey scores for the previous quarter.

Should I pack lunch … or lunch and dinner? As emergency department use has increased 32% and wait times have increased 50% over the past 10 years, more emergency departments are posting wait times online. Now if we could only get someone to post wait times for specialist appointments, the Department of Motor Vehicles, and tax refunds.

More on Bret Michael’s experiences in the emergency department. “Am I dying? If I’m dying, I want to see my kids, but if I have a chance, I don’t want them to see me in this condition.”

Former Miami Dolphins receiver O.J. McDuffie wins $11.5 million medical malpractice award after team doctor allegedly misdiagnoses big toe injury.

Parkland Memorial Hospital in Dallas is repeatedly investigated by the Centers for Medicare and Medicaid Services, yet according to this article, CMS found few violations and may have even downplayed or covered up some mistakes.
Another one of those “too big to fail” scenarios?

Obtaining an MRI often requires that the patient remain still for extended periods of time. Kids often don’t want to fit into that category. Pediatric emergency physicians are frequently using propofol – the same drug that allegedly killed Michael Jackson – to sedate children prior to MRIs. In a study of more than 25,000 patients, complication rates with using the drug averaged about 6 percent, with 1.4% of patients needing ventilatory support. No deaths from the drug occurred.

Opting out of Medicare. “Why would you sign up for something that would guarantee to pay you less over time when you’re expected to work harder? We want to be able to spend our time caring for patients instead of assigning codes to them and filling out paperwork.”
Another cardiologist whose practice is comprised of 70% Medicare is considering “opt[ing] out of America,” by moving to and practicing in another country, or retiring early.
Other physicians and patients are considering the “opt out” as well, affecting patients’ access to care.
This is precisely what the government wants – a slow attrition of medical providers so that patients have increasing difficulty accessing care. Those providers that stay with the system will be paid less and less for the services they perform. A win-win situation for government insurance. Pay providers less so you save money on care. Then providers drop out of the system. Patients have to wait longer and longer to access care. When patients can’t access care or have to wait in long lines to do so, then they can’t run up as many charges and the system saves money. Funerals are a lot less expensive than cardiac catheterizations and hemodialysis.
Wasn’t the health care bill supposed to prevent insurers from pulling this type of stuff? Oh. Forgot. That’s only for private insurers.

Statewide narcotic databases going national? Databases that list patient prescriptions only go so far if a patient jumps from state to state. Will a national database improve a provider’s ability to shut down drug seekers or will it intrude even more into a patient’s privacy?

Like something out of a TV sitcom … mistrial called in medical malpractice lawsuit after doctor faints when listening to testimony. Floor throwing in a courtroom? Puh-leese. Are they going to strap him in his chair for the next trial or what?

Ripple effects from St. Vincent’s Hospital closure:
When the hospital goes bankrupt, it doesn’t pay for tail insurance on the medical malpractice insurance policies. Now the doctors have to pay $40,000 per year out of pocket or risk being fully liable for a malpractice lawsuit.
Beth Israel Medical Center is absorbing a lot of the patients that would have gone to St. Vincents. Ambulance runs doubled in the first week after St. Vincent’s closure, walk in patient volumes increased 25% and admissions are at an all time high.
Now the clipboard brigade from New York City is monitoring how quickly the overworked staff is moving at Beth Israel. Go ahead. Shut them down, too. I dare ya.

18 Responses to “Healthcare Update — 05-10-2010”

  1. Sarah says:

    Just a quick comment on the Royal Columbian Hospital article – it’s a political tool for physicians who are negotiating with the province (their employer). The article talks first about RCH and later about Vancouver General – these are two different hospitals in two different health authorities (Fraser Health Authority and Coastal Health Authority). Each health authority has multiple hospitals (Fraser health and Coastal health each have at least a dozen hospitals). So 34 critial incidents spread over 2 dozen or so hospitals over what time period? Use your critical assessment skills before leaping to conclusions.

    Also, note the wait times – an hour on a weekday morning and “much longer” in the evening.

    I used to work at RCH – yes, the emerg needs updating, and who wouldn’t want more staff? This article is a negotiating tactic from a union who’s contract expired. Don’t read too much into it.

    • WhiteCoat says:

      Thanks for the insights.
      One question, though. What’s with the patients waiting in ambulances and the fire marshal citing the hospital. Just politics or is there more to it than that?

  2. Your posts with these tidbits and referrals are some of my favorties…I think because you hit my interests right on the head. Thanks, bud.

  3. Matt says:

    “This is precisely what the government wants – a slow attrition of medical providers so that patients have increasing difficulty accessing care.”

    True it’s what they want, but maybe for a different reason. Angry patients mean voters who want solutions. Government knows and supports only one solution – more government. That allows this half-measure to become a full takeover of medicine to solve problems created by – wait for it – the initial half measure.

    Providers better start figuring out a way to offer a reasonably priced alternative to compete with the govt or they’ll be employed by the govt. There’s not enough private money to keep all of you afloat if people think the govt. is paying for it.

  4. Matt says:

    This statement is incorrect:

    ” Now the doctors have to pay $40,000 per year out of pocket or risk being fully liable for a malpractice lawsuit.”

    This is the statement from the article:

    “The doctors fear they may have to buy their own medical malpractice coverage for the next several years, policies they say can cost $40,000 a year when purchased …”

    The actual source says “may” and “up to”. Not “have to”. Carry on with your fearmongering.

    • THROCKMORTON says:

      Matt:

      The “may” and “up to” depend on their specialties as they are all different. A surgeon will pay more than a rehab doc. Your tail insurance is all based on your exposure. These folks are very exposed.

      • Matt says:

        Don’t doubt it. But at this point stating it as a fact that everyone is going to pay $40,000 is false. It could be more, it could be less. It’s simply too early to tell. No need to overstate the case.

  5. Classof65 says:

    I’m soooo tired of hearing stories about how the world, especially the USA, is going to hell and we’re all going to die. If it isn’t the climate change, it’s terrorists, if it isn’t swine flu, it’s cigarettes. The sky is falling — and, ya know, there’s not a thing I can do about it. And nothing you can do except try to convince all of us that things are getting worse every day. Lighten up or I’ll quit reading you every day and so will everyone else and then YOUR world will turn to sh##.

    • DefendUSA says:

      Unfortunately for you, Class- I don’t want to pretend that the world isn’t going to hell in a hand-basket. Things are getting worse and the sooner you prepare yourself for the hyperinflation and other things, the better off you will truly be.

      Being willfully ignorant that things are the way they are will make it harder for you to accept reality. Go ahead and put your head in the sand, stop reading WC. I am quite sure the BS he deals with in the ER on a daily basis means that you whining, and stomping your feet..”play nice or I’m leaving” is going to make him howl out loud.
      I did.

    • WhiteCoat says:

      “Lighten up or I’ll quit reading you every day”

      Oh no. Not that. I’ll turn over a new leaf.
      Here is my first new post.

  6. sleepyjosh says:

    A note on the St. Vincent’s closure piece. At one point earlier this year (January-Feb I think), the company that owns/operates Beth Israel Medical Center, the Continuum Group was looking to take over St. Vincent’s. This plan was ultimately shot down by the State in combination with local outcry. Part of Contiuum’s plan was to shift a lot of the inpatient care and ED services over to BI. Odd how it all works out. No idea about the City’s clipboard brigade though….

  7. DefendUSA says:

    WC
    Did you see the article on what it will cost to keep our “adult” children insured will cost us? Heh. My kids will be my dependents as long as I am paying for college.

    And currently, I pay 500/month for a great insurance plan. It will go to hell fairly quickly because according to the Gov’t, I have a cadillac plan!! It means I must be forced to pay almost $190.00 more for care for just one!! She could get her own plan for less than that and have better coverage than I do.

    And it’s a good thing we have less than what is the norm as self-employed people or we’d be losing even more money.

    http://www.breitbart.com/article.php?id=D9FKB4IO0&show_article=1

  8. Classof65 says:

    I’m not hiding from the information — it’s the tone of presentation that bothers me. I know that some things are getting worse and I’m doing my part to try to change those things. However everywhere I look the articles are screaming at us that the sky is falling and imply that we should just stay in bed and hide under the covers instead of suggesting solutions. You know, if you’re not part of the solution then you’re part of the problem…

    And, yes, I know that I have no leverage and that makes it worse. At least when I was demonstrating against the war in VietNam, I felt that I was making a difference…

    • WhiteCoat says:

      You want to hold a rational conversation about it, I’m all for it.
      The sky isn’t falling yet, but I hopefully bring enough news and commentary to the table to show the people who read this blog that things with this health care plan are not and will not be as our legislators have promised us. Believe what you want. Better yet, add some links to show your view. Do you think things are getting better?
      It’s not like I have Instapundit traffic, but the people who read this blog regularly are incredibly insightful and you’ll be surprised how much your voice will be heard if you present a good argument for or against a position.
      As for being part of the solution – I’ve outlined quite a few potential solutions in previous posts. I also present my ideas to legislators (going to DC next week to do just that). Just because I don’t post pictures of myself at Tea Party rallies or shaking hands with legislators doesn’t mean that I’m not involved.

  9. …doctors out….

    For all the fuss I’ve just made about insufficient numbers of physicians (especially primary care physicians) entering the workforce, it’s worth noting that more and more physicians are opting out of Medicare and Medicaid. Via WhiteCoat com…

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