WhiteCoat

Healthcare Update — 05-26-2010

Also see the Satellite Edition of this week’s update over at ER Stories – with his new and improved website design and no more rogue ad plugins.

How does a patient break her foot badly enough to require surgery — using a Wii? Click here to find out. Clue: Alcohol was involved.

California’s children not getting needed dental care. Half a million kids missed school in 2007 due to dental problems. Thousands of young children are put under general anesthesia or sedation (with their inherent risks) each year at just one residency program to fix chronic tooth problems. Denti-Cal, the state dental program for low-income children covers the extremely poor, but even those who are eligible for Denti-Cal have difficulty finding care. A survey found that “of 255 California-based pediatric dentists less than half participated in Medi-Cal’s Denti-Cal program, and of those, two-thirds limited the number of patients they accept because of low reimbursement fees and broken appointments. Some parents lucky enough to find a dentist who will see their child often wait months for an appointment.”
In case you were wondering, the new insurance-for-all health care plan doesn’t cover dental services, either.

Final legal challenge to fair payment of physicians in California is settled. Just another reason for doctors not to work in California. By they way, if you want a good explanation of what “balance billing” is all about, head on over to DinoDoc’s blog – and check out her new book while you’re at it.

Seventeen hour waits for care. President of the county medical society quoted as saying “If you want to think you’re in a war-torn third-world country, just [come here] on a Friday afternoon.” Ambulances have to wait in line just to drop off their patients, making them unavailable to respond to other emergencies. When three hospitals in your county close and the number of available beds decreases by one-third, the patients don’t just vanish. They crowd other hospitals. Jamaica Hospital was designed to see 60,000 patients per year. After surrounding hospitals closed, now Jamaica Hospital is seeing 135,000 patients per year.
Some patients are even traveling to different counties for care.
Now New York is considering additional budget cuts. Be interesting to see what happens when the next hospital closes.

This article shows that New York public hospitals are planning to cut 3,700 workers, including a 6% reduction in the physician workforce, over the next 5 years in order to trim a $1.2 billion deficit. As more and more insured patients enter the system, what effect will the cuts have on patients?
“They have to travel further. They have to wait a longer time for an appointment. They might end up in the emergency room for care. We keep hearing people are blamed for going to the emergency room, but if you don’t have other options, you go to the emergency room,” says one of the Public Health officials.

Speaking about books, Eileen Brenner, one of EP Monthly’s regular contributors has a new book out about how to survive a medical malpractice suit. Louise Andrew, a physician/attorney, calls the book a “GPS for Malpractice Litigation.”

A peek at liability issues in government health care for people in custody. Illegal immigrant is arrested for possession of methamphetamine and sentenced to prison. He complains of a lesion on his penis as soon as he arrives in prison. Biopsy was recommended by several physicians, but was deemed “elective” by the US Public Health Service and was not approved. Instead, he was treated with Motrin and antibiotics. The ACLU had to intervene in the case and the patient was released from custody shortly before the procedure “because the government did not want to pay for his treatment.” The biopsy determined that the lesion was cancer and the patient required amputation of his penis. Unfortunately, the cancer had spread and the patient died. When his family tried to sue the federal health officials responsible for the patient’s care, the case was dismissed under the Federal Tort Claims Act which immunizes Public Health personnel who treat immigrants in custody. Hui v. Castaneda.
Will the liability pendulum swing too far in the other direction if a national public health system is implemented?

$36 million Florida judgment in medical malpractice case involving “seemingly erroneous” spinal steroid injection.

$18.5 million New Jersey verdict against Newark Beth Israel Medical Center and obstetrician in medical malpractice case alleging delayed Caesarian section as a cause of patient’s cerebral palsy.

Family of patient who dies from swine flu files lawsuit against hospitals that treated him. “Had he gotten aggressive intravenous treatment for H1N1 early on, he’d be alive today,” the family’s attorney said. Even though the patient had “always been healthy,” and even though CDC guidelines (patient fell ill in September 2009 and link is to December 2009 guidelines – I wasn’t able to find earlier versions, although the recommendations were similar) recommended against treating patients for H1N1 unless they were in one of the “high risk” categories, they required hospitalization, or they had “progressive, severe, or complicated illness,” that “aggressive IV treatment” would definitely have cured him.
When someone dies from an illness, the medical providers must have done something wrong.
I can’t help wondering whether this man got a H1N1 vaccination – if they were available in his area. If he didn’t get an available vaccination, I would absolutely use his failure to vaccinate as a defense in the case.

An act of kindness or a precedent with unintended consequences? StoryTellER Jim describes an interesting dilemma about a patient who feigns a medical problem to get some food in the emergency department. It’s great to be able to help people who are hungry, but at the same time, the patient had unnecessary lab testing performed and she took up a bed in the emergency department for several hours. Obviously not the best use of resources.
Do emergency departments become soup kitchens in addition to trying to provide medical care or do we adopt a “don’t feed the bears” approach? The thinner that we stretch our resources, the less resources we have to offer. I think we need to take the latter approach.

Neat news story on educating kids about emergency medicine. Take them on a tour of the ambulances and emergency department to show them what it’s like to be a patient. I bring blown up pictures of medical items, splints, and fetal monitors (to listen to heartbeats) classes in our kids’ schools. In this story, they strap a kid to a backboard and they put EKG leads on another kid. Everyone looks like they’re having fun.
Of course, to simulate the realism, the kids have to wait 17 hours in a room full of coughing and vomiting people for the tour to start, then they get left alone in the radiology department for three hours, and finally they get poked twelve times with a needle to find a vein. Then when they get back to school they get a student satisfaction survey so they can get the teacher fired. Yep, that about covers it.

7 Responses to “Healthcare Update — 05-26-2010”

  1. DRD says:

    He was an illegal immigrant with drug possession, and his family wanted to sue bc the US didn’t treat him? Also, he complained about the pain as soon as he got to the jail?? Doesn’t sound acute…probably had been going on and he was trying to use it as a get out of jail free card.

    We should stop treating drunks who get into wrecks, drug attacks that cause themselves heart attacks from the drugs, and illegals like this….and we would save a health care dollar or 2! I’m proud of the jail.

  2. Doc99 says:

    Re: the OB case, this statement is incredible:

    “Mazie said medical experts testified that if Morgan had been born eight minutes earlier he would not have the condition.”

    We have met the enemy and they is us.

  3. Matt says:

    “Will the liability pendulum swing too far in the other direction if a national public health system is implemented?”

    Good question, but probably not. Malpractice claims would drop precipitously just based on the fact that one wouldn’t face mountains of medical bills for a debilitating injury. A deeper social safety net lessens the need for the claim, particularly for those without economic damages. And we’d probably go to no-fault workers comp style claims so economics would be limited in exchange for not having to prove liability.

    Another interesting question is what liability carriers do when faced with a national healthcare system.

    • Doc99 says:

      Time will tell.

      • Matt says:

        Yeah, but I think the die has been cast toward national health care and it’s inevitable. Don’t you?

      • throckmorton says:

        Those of us who have worked in or trained in the VA know what it is like to have a national healthcare system. First, it cost more, there was more administration, there was less care and no incentive to be the best. For the patients, it is like going to the DMV and waiting in line in hope to get to see a doc, except you dont know if you will actually get to see one.

  4. Dr. Greenbbs says:

    Do you find it bizarre that the kids from Montana went to a school called “Hellgate and Firing Range Elementary”?

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