Archive for August, 2010
Monday, August 16th, 2010
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The newest national epidemic: Medical malpractice lawyers. Hey – they said it, I didn’t. Bwaaaahahahahahaha.
Getting groped is part of the job. “Violence against nurses and other medical professionals appears to be increasing around the country as the number of drug addicts, alcoholics and psychiatric patients showing up at emergency rooms climbs.” If hospitals can’t make the environments safe for their employees, should OSHA get involved? Federal law gives workers a right to a workplace that is free from known dangers. From all the ED violence in the news lately, I think just treating patients could be considered a “known danger.”
Need one of these five procedures? You might save some money if you look into medical tourism.
Misled on Medicare. Three consecutive years with no independent Medicare trustees to issue a report on Medicare allows Obama administration to put forward an unjustifiably positive outlook for the Medicare program and the impact of the health care legislation. Previous trustees note “many disparities” in this year’s annual Medicare report.
Super Mario Brothers … Boxing. Two dudes playing video games when one dude “invades the other’s space.” Invaded dude then punched invading dude in the jaw, breaking said jaw in two places and sending invader to the emergency department. Reset. Reset. Reset.
One less place for medical access around the country. Archibald, Ohio likely losing its hospital and emergency department next month due to “another poor financial month”.
Emergency department in Pittsburgh closes – to be replaced by a 12 hour urgent care center.
Utah ACEP calls “bullshit” on Press Ganey report about hospital waiting times. Press Ganey states that waiting times in Utah emergency departments average more than 8 hours. Utah ACEP shows that real waiting times are less than 3.5 hours.
“Because Press Ganey has limited access to the not-for-profit hospital system Intermountain Healthcare that serves over 65 percent of all the patients in Utah, they are not able to make an accurate assessment of how long patients are in our emergency departments. By putting forth a report based on incomplete data, Press Ganey diminishes both the accuracy and the impact of their findings.”
93 year old Zsa Zsa Gabor has hip replacement surgery, is discharged home, then suffers a “never event.” Now who will be paying for all the care related to the blood clot in her leg?
What happens when a large state medical insurance plan can’t make ends meet? It cuts payments. What happens next? The medical care system destabilizes. High claims levels, cutting services, lack of access to primary care. If Massachusetts is a litmus test for the entire country, welcome to the future.
I’d like a glass of saline eye wash — on the rocks. Inmate brought to emergency department after becoming upset because he could not see a chaplain and eating another man’s eyeglasses in protest.
$6.2 million verdict against hospital after patient dies during CT scan. The patient had undergone gastric bypass surgery. Shortly after the surgery a CT scan of his lungs was ordered. The patient felt as if he could not breathe while laying flat, but was instructed to lay flat anyway in order to obtain the scan. Reportedly his oxygen level was not checked during the procedure and the radiologist was not notified of the patient’s complaints during the procedure.
Finally, a small non-medical post that made me sad when I read it. One of my friends keeps comparing our country to the great empire of Rome before it fell. Now a poignant post on Salon.com by Glenn Greenwald commenting on this New York Times article about what a modern day crumbling empire looks like.
Posted in Healthcare Update | 11 Comments »
Friday, August 13th, 2010
 A new study released in JAMA shows that the number of annual emergency department visits between 1997 and 2007 increased from 94.9 million to 116.8 million — nearly twice as much as would be expected for population growth.
Also published recently was the Department of Health and Human Services’ 2007 Emergency Department Summary (.pdf file here). Lots of interesting statistics.
Most of the increase in ED visits were due to Medicaid patients. One quarter of the 117 million visits to the emergency department in 2007 were made by patients with Medicaid or SCHIP. Seventeen percent of visits were covered by Medicare. In other words, 42% of hospital ED visits (50 million or so) are paid for by the state or federal government.
The graph to the right from the San Francisco Chronicle shows how emergency department use by Medicaid patients is now more than five times the rate of emergency department use by patients with private insurance – and since they are from 2007, these numbers don’t include the impact from the recession.
Further breakdowns in demographics from the DHHS report include high ED utilization rates for children less than 1 year old (88 visits per 100 US infants), patients older than 75 (62 visits per 100 US persons), homeless persons (72 visits per 100 population), blacks (74.6 visits per 100 black persons), and nursing home residents.
In addition, the number of “safety net” hospitals – defined as those who treat patients regardless of the ability to pay – increased by more than 40% from 2000 to 2007.
Before you start blaming Medicaid patients for health care crisis, think about why there is a disproportionate use of emergency departments by Medicaid patients. If you or your child has a medical problem and few private physicians will accept your insurance, what are you supposed to do? You go to a place where they will accept your insurance and you get relatively timely care (as opposed to an appointment 4 months in the future). Although there are undoubtedly people that abuse the Medicaid system, in general, it isn’t the patient’s fault for having Medicaid. It is the fault of the government for failing to adequately fund and monitor the Medicaid program.
With the increase in visits, there are longer waits and less availability of medical care.
Because the JAMA study was based in California, I did a little searching and found that 61 California hospitals closed between 1998 and 2008 and 14 more California hospitals closed their emergency departments. That’s a loss of 75 emergency departments in 10 years.
The San Francisco Chronicle article notes that California hospitals are facing an additional $17 billion in payment reductions over the next 10 years. I’m sure that will translate into many more hospital closures.
Oh. And health care reform will add between 11 and 22 million additional patients to Medicaid – you know … that good insurance that all the doctors’ offices take. Then what?
I know this is another “sky is falling” post. But I think that it is important to show how health care policy changes are affecting access to medical care in this country.
Posted in Access to Care, Medicare, Policy | 26 Comments »
Thursday, August 12th, 2010
 Catching up on the news and saw an article about a construction crew in Flint, Michigan that was expanding the hospital emergency department when they came upon two time capsules buried deep within Hurley Hospital.
At least one of the time capsules is more than 100 years old.
I had a bunch of humorous ideas for what I thought they’d find inside.
What do you think will be in there?
Posted in Medical History | 13 Comments »
Wednesday, August 11th, 2010
Just finished a string of shifts and finally have a few days to breathe and put all the posts I have in my head into writing.
One short thing that happened to me last night …
I was busy writing admission orders when I saw my phone light up.
A call from home. Eight year old Junior WhiteCoat is on the other end. Usually they call Mrs. WhiteCoat, but she was at her office and daughter WhiteCoat was watching the kids.
Me: “Everything OK, buddy? Kind of busy in the hospital right now.”
Junior: “Yeah.”
Me: “So what’s up?”
Junior: “Where is the drill and the soldering iron?”
Me: “Ummmm. Let me talk to your sister.”
Junior: “Oh, she’s outside.”
Was then going to call the fire department and send them to my house, but opted to call a neighbor to go and hide all combustible items, electric tools, and sharp objects from our garage immediately. Fortunately, Mrs. WhiteCoat was on her way home.
Reminded me of one of those Calvin and Hobbes cartoons.
Posted in Uncategorized | 9 Comments »
Friday, August 6th, 2010
More stories from around the web at the Satellite Edition of this week’s update over at ER Stories.
Hmmmm. I’ve already fulfilled my life’s dream to jump on someone’s car at a gas station while waving a gun. What to do next? I know! I’ll run to the hospital and hold a nurse hostage in the emergency department.
Please wear helmets. Seventeen year old dies from brain injuries after falling while riding skateboard. Probably didn’t help matters that he was being pulled on a rope by a car when the incident happened.
Average four hour wait for emergency services in the US? That’s nothing. Ontario patients with minor conditions wait an average of 4.3 hours and the average wait time for patients with complex conditions is 11 hours.
That’s not a wait … now THAAAT’S a wait (remember Crocodile Dundee?) AVERAGE wait times for admitted patients at USC-LA County Hospital to get a bed in the hospital are 15 hours. And USC-LAC’s overcrowding is getting worse not better. Almost 50% of the time the ED is “severely overcrowded” and 15% of the time the ED is “dangerously overcrowded” (is there a difference?). In other words, surge capacity at USC-LAC is essentially nil and any type of disaster in that area will result in unbelievable chaos and death.
The feds closed down King-Harbor Hospital when a patient died of a bowel perforation while “writhing on the floor in the waiting room” and after failing a federal inspection. It would seem like dangerous overcrowding is a direct threat to patient care, as well. Why doesn’t the LA County close this hospital, too? Dangerous conditions are OK when there aren’t any other hospitals in the area to accept patients?
The wheels are starting to fall off the medical care buggy in the Los Angeles area. Get ready for a big crash.
Just be careful out there. One hundred degree heat and football practice amount to a set-up for heat exhaustion.
One way to get a ride home … or to jail: Steal an ambulance from the emergency department parking lot.
“It was an inmates-running-the-asylum kind of thing.” According to a Dallas Morning News expose, surgery residents at UT Southwestern Medical Center and Parkland Hospital performed surgeries without attending physicians knowing about them. Then injuries occurred or were missed. Faculty members were quoted as saying that it is “OK for residents to make mistakes” like that because ”that’s how people learn.” The article explores just how much autonomy is needed to properly train residents and what kinds of bad outcomes can occur if residents are given too much autonomy.
One of the attending physicians filed a whistleblower claim against UT Southwestern and was promptly stripped of his academic chair positions. Here is the latest ruling in his lawsuit.
Another story about the situation here.
The high cost of emergency medical bills. Ambulance rides $327 to $560 plus $10/mile. Helicopter trips $11,000 plus $114 per mile. After seeing the bill for the services, you need the services again.
Why is defensive medicine so prevalent? Physicians are afraid of lawsuits. Why are physicians so afraid of lawsuits? Because they’re going to get sued, that’s why. AMA survey (download .pdf file here) shows that there is a high likelihood of a physician being sued in his or her career. Overall, there were 95 claims filed for every 100 physicians during a physician’s career. General surgeons and obstetricians had more than 200 claims filed against them for every 100 physicians and 70% of physicians in those specialties had been sued at some point in their career. More than half had been sued twice. Pediatricians and psychiatrists had the lowest incidents of claims with less than 30% of physicians in those specialties reporting lawsuits against them and about 40 claims per 100 physicians being filed.
Oh, and to save all the plaintiff attorneys who would type a response to this article from developing repetitive stress injuries … the survey is from a biased organization, juries get cases right when they go to trial, it is a legal right to file a lawsuit in this country, and stop trying to screw the injured by writing about stuff like this.
Tennessee hospital losing specialist coverage … which translates into losing patients … which translates into less physician coverage. “Low patient counts make it hard to recruit new specialists, and a lack of specialists, in turn, makes it harder to attract patients and referrals.” Another hospital closure on the horizon?
They’re just ticked because they can’t bill him for the procedure. Swedish man gets tired of waiting for someone in emergency department to sew up his leg laceration. So he takes the needle and thread that the nurses set out on the table and he sewed up the laceration himself. The hospital is now filing charges against the man for “criminal dispossession” of the suture material.
Posted in Healthcare Update | 15 Comments »
Thursday, August 5th, 2010
 For a few hours, our emergency department was Octogenarian Central.
It seemed like every patient that registered to be seen was in their 80′s. Weakness. Dizziness. Constipation. Chest pain. More weakness. Hip pain. Eight out of ten patients were octogenarians. Family members accompanied all of the patients and helped us piece together the multiple medical problems. After my second disimpaction of the afternoon, I longed for a kid with an ear infection.
Then we got an ambulance call. Patient down. Full arrest. Family trying to perform CPR. Yup … he was 81.
The story was especially difficult. The patient was sitting in his living room watching TV with his wife. He suddenly had trouble breathing. He told his family to call the ambulance because he felt like he was going to die.
When the ambulance got there, the patient had arrested. Paramedics did a great job getting back a pulse, but it was short-lived. When the patient hit our doors, he had no pulse.
We tried to revive him, but to no avail. Another angel gets some wings.
Informing the family was difficult. I’ve always said that telling families that a patient has died is one of the most difficult things in medicine. Hasn’t changed in all these years.
But there was a bit of a funny twist to the sad situation.
We called the coroner after the patient dies. He has to come to investigate and release the body. The coroner for this town is a great guy. Probably early 70′s himself. Every once in a while, he just randomly stops in with popcorn or ice cream for the emergency department staff.
He came in wearing a baseball cap with his trademark smile. He patted me on the back and asked me what room the deceased patient was in. I was on the phone, so I pointed to the patient’s room and kept talking.
The coroner walked over to the room, pulled open the curtain to the room, looked at the patient, and screamed out loud. Then the patient screamed out loud. He came back out of the room sweating and looking a bit peaked about the gills.
“I thought you said that the patient was in Room 12!”
“No. I pointed to Room 11.”
“Holy crap, you almost gave me a heart attack. I walked into the room expecting to see a dead person and then she rolls over on the bed. My heart’s still palpitating!”
The daughter of the patient in Room 12 then walks out of the room laughing nervously. “How do you think I felt … seeing the coroner walk into my mom’s room when she isn’t even that sick?”
Posted in Patient Encounters | 4 Comments »
Sunday, August 1st, 2010
I don’t use the iPhone and don’t want one, but for those who do use them … look at how much data it stores about you.
This guy even teaches people how to recover information from the iPhone – including keystrokes, pictures, address book entries, call history, image maps, browser cache, and deleted voicemails.
Moral of the story – if you plan to crank call the president, use a disposable phone.
Posted in Computers | 4 Comments »
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Stay Away From That Oxygen Stuff – It’ll Kill Ya
Monday, August 2nd, 2010Researchers found that patients who were admitted to the intensive care unit after suffering a cardiac arrest were almost twice as likely to die if they had “hyperoxia” – which was defined as a PaO2 of 300 mmHg or more.
Hyperoxia patients died 63% of the time, hypoxia patients (PaO2 < 60 mmHg) died 57% of the time, and normoxia patients (PaO2 between 60 and 300) died 45% of the time.
Common thinking with the docs I know is that more oxygen is better – except with COPD patients.
Don’t have full access to the JAMA article, so am not sure what percentage of each group ended up actually walking out of the hospital. It is entirely possible that the patients who survived ended up in chronic vegetative states.
Nevertheless, this study plus the work of Gordon Ewy in advocating “chest compression only” CPR (no mouth-to-mouth) really bring the current “standard of care” for resuscitation of cardiac arrest into question.
Posted in Medical Studies, News Commentary | 15 Comments »