WhiteCoat

Healthcare Update – 09-02-2010

Also see the satellite edition of this week’s update over at ER Stories.

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Work in a health care facility? Get a flu shot or lose your job. That’s the policy that a couple of national health organizations are pushing. We already do it for tuberculosis, measles, mumps, and rubella. Why should influenza be any different? New York is currently creating a permanent regulation for yearly flu vaccination.

The University of Texas Medical Board is losing money. The medical school is getting less funding from the “Legislature” (which I am assuming is the State legislature). How does UTMB make up the shortfall? By cutting charity care. The amount of charity care that the hospital system provides went from 20.6 percent of total patient services in 1999 to 2.6 percent last year. Now the clinics that still care for indigent patients are “busting at the seams” with new patients and patients aren’t getting necessary care for serious medical problems.
Local leaders are claiming that UTMB has a “responsibility” to provide services for those that are economically disadvantaged and that the hospital needs to “do right” for the people of Texas. I disagree. The State of Texas has a responsibility to provide health care to its residents. That “responsibility” can’t be imposed upon private institutions any more than the responsibility to feed the indigent can be imposed on private grocery stores. Since the University of Texas is a state institution, though, the State of Texas also has a responsibility to make sure that its institutions have sufficient funding to provide proper medical care. You can’t cut funding to the institutions and then turn around and blast the institutions for failing to provide care. If the UTMB Board is cracking down on UTMB to be profitable, what is UTMB supposed to do?
Interesting twist to the story is that UTMB is going to have difficulty crying “poverty.” It is reportedly undergoing a $1 billion expansion.

Would you trade a quick ED visit for seeing a nurse practitioner instead of a physician? Journal of Bioethics survey shows that 80% of patients “fully expect to see a physician regardless of acuity or potential for cost savings by seeing another provider.” Patients are more willing to see medical residents than nonphysicians. A little more than half of patients surveyed would agree to see a nurse practitioner or a physician assistant in the emergency department. Additional story from AM News.

Now the citizens get to cast their vote on you. After voting to overturn medical malpractice reform, Illinois Supreme Court Justice is getting a little squeamish about his tenure. Sixty percent of the voters in November have to vote to retain him. More than one group is campaigning against him. The state trial lawyers endorse him. And he gave a speech stating “I didn’t unilaterally make this ruling.” That’s true. Illinois citizens won’t unilaterally vote you out of office, either. Another story on the topic is here.

Patient doesn’t like the only doctor available to treat him, so he calls her a derogatory name … then stabs her in the chest.

39 year old male goes into hospital to visit a patient, takes a dislike to the patient’s 78 year old roommate, then stabs her. Of course, the hospital is going to be held liable since this is considered a never event. How could any responsible hospital not have purchased the technologies available in the Minority Report so that they could prevent crimes before they happen?

Can a football team be sued for medical malpractice? We might find out after the Bengals waived Rashad Jeanty.

Will one physician bankrupt Indiana’s medical malpractice patient compensation fund? With 357 lawsuits pending against him, he might not bankrupt the fund, but he could take a serious chunk out of its reserves.

Nursing assistant gets 2 years in prison for squeezing Fentanyl from 92 year old woman’s pain patches then licking his fingers to get a buzz.

Should hero who saves someone from drowning have to pay his own medical bills after being taken to hospital by ambulance? People on the scene thought he should be “checked out” – which ended up costing him almost $2000. Hero’s family claims “unfairness” for charges. Eventually hospital writes off the bill.

15 Responses to “Healthcare Update – 09-02-2010”

  1. Steve says:

    Amen on the mandatory flu shots- stop whining and get one…don’t like it? Get another job…it’s not about you, it’s about the patient.

    The hero getting the ER bill- I’ve always wondered if there is an ICD code for “get checked out”…I don’t think I’ll ever figure out what that exactly means…it will never happen but there should probably be a lower billing scale for those kinds of “chief complaints”. I think a lot of people get talked into going to the ER for exactly that and they get very little done other than a medical screening exam and get stuck with a big bill.

    • midwest woman says:

      We’re kinda schizoid on this one. We want the staff immunized but frown on people calling in when they’re puking or have fevers. So would you take it a further step and insist hospitals have contigency staff in place during flu season..even vaccinated employees can carry all kinds of junk in when they work sick.

    • Mama On A Budget says:

      Um, lets see… it’s based on previous strains, not always effective, and people like me who are allergic to eggs/egg white are screwed?

      I had the BEST doctor ever when we lived in another state. She said she didn’t get them ever. So as the only MD reaching out to a rural area a couple times a month, it would be better to not have a doctor for that area at all?

      I think it’s a little crazy.

    • Roberto says:

      I find it laughable that doctors buy into the mandatory vaccination nonsense putting themselves at risk annually of a severe auto-immune disease just ‘to prevent’ a mild, temporary and unpredictable disease (there’s no way to forecast which antigen the virus is going use during the coming season). If old, sick and immunosuppressed people die, let them be, that’s where they belong anyway. Probably you haven’t noticed but there’s way too many people in this world!!. And just in case you haven’t noticed we are in the middle of 2 major oil wars. So give the patients a little help and allow them to go where they belong, and actually you make them a favor by saving them the pain of the next recession or war. Check out this link from an insider .

      Even doctors are sheep.

      • Seriously says:

        Roberto,

        Are you sure you are taking your meds?

      • Chelsea says:

        Roberto, please see this excerpt from the paper
        “Extreme Evolutionary Disparities Seen in Positive Selection across Seven Complex Diseases”

        “Humans have gone from existing solely in Africa to inhabiting every continent on Earth [1]. More recently, humans have begun cultivating specialized food-crop, domesticating animals, and living in towns and cities. Such environmental changes are known to alter common genetic variation via the positive selection of advantageous mutations [2]. As many populations were exposed to new food sources, diseases, and cultural lifestyles, positive selection likely played a major role in shaping the genetic architecture. A positive selection event represents a net gain of fitness, and there is room for the simultaneous selection of harmful mutations if they are linked to a relatively strongly beneficial mutation [3]. This can occur when a locus is in linkage disequilibrium (LD) with a beneficial mutation. Alternatively, the beneficial mutation may simultaneously harbor a harmful component [4]. Positive selection may occur as long as the benefits outweigh the harm. Therefore, increased susceptibility to disease may accompany a fitness-increasing mutation introduced by positive selection.

        Complex diseases contain many distinct associations across the human genome that contribute only slightly to the absolute risk of disease [5]. These disease-associated mutations may undergo positive selection if they are simultaneously associated with relatively strongly beneficial traits. For example, the sickle cell mutation in the Hemoglobin-B (HBB) gene was found to be the target of positive selection due to its properties related to malaria resistance, despite its simultaneous role in introducing sickle cell disease [3]. It has also been recently shown that the variants in the antiviral response gene IFIH1 associated with protection against enterovirus infection simultaneously increase susceptibility to Type 1 Diabetes (T1D) [6]. In this case, the benefits of having variants of the IFIH1 gene that increase susceptibility to T1D depend on the prevalence of enterovirus infection. Having IFIH1 gene variants increasing susceptibility to T1D may be considered advantageous and undergo positive selection if the probability of being exposed to the virus were high.

        Rheumatoid Arthritis (RA) can be detected in human skeletal remains, and likely originated from the Americas and spread to Europe after the pre-Columbian era ended, possibly by a microorganism or allergen that is a necessary trigger for the disease [7]. This paves the way for selection to proceed strongly for potential benefits associated with the genetic-basis of RA. Prior to exposure to microorganisms or allergens required for the onset of RA, there would be no disadvantage to having mutations associated with RA in European populations. Ultimately, the cumulative contribution of such mutations with low effect sizes may play a large role in causing the disease.

        It is currently unknown how much of the genetic-basis of complex disease originates from genetic mutations driven to prevalence by positive selection pressures. Blekhman et al. demonstrated that coding positions within disease associated genes underlying a number of complex human diseases are more rapidly evolving than coding regions of genes not associated with disease [8]. This suggests that evolutionary changes and natural selection may play a role in regions associated with complex disease.”

        To read more, see the full paper at this link:
        http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0012236

  2. Brenda says:

    the $1billion “expansion” at UTMB isn’t really an expansion but rebuilding after hurricane damage.

  3. David says:

    So Mack Brown get $5.1 Million dollars a year to coach the University of Texas football team, it is a public school. So that makes him the highest paid state employee, the Governor only get $150K, and the university chancellor $750K. Where are the priorities when we pay athletes and coaches more than intellectual people who help the world.

  4. Anonymous says:

    “Local leaders are claiming that UTMB has a “responsibility” to provide services for those that are economically disadvantaged and that the hospital needs to “do right” for the people of Texas.”

    Democrats would disagree. They love to give to help humanity…so long as it’s done with other people’s money.

  5. Pattie, RN says:

    Why DO so many educated health care workers refuse to get the flu vaccine? I mean, heck, even the truly needlephobic could use FluMist and take several days in a row off while they are shedding virus. Personally, I take every vaccination that is available. Being sick is no fun, and if there is something I can prevent….sign me up!

    My only concern at the ED is getting appropriate treatment. Midlevel providers can treat the basic stuff fine….I only want an MD if there is some fancy diagnosing needed.

  6. Glern says:

    UTMB refers to the medical school in Galveston, Texas. Many of the buildings, materials, records and equipment were destroyed by Hurricane Ike in 2008. This includes a state prison hospital, local hospitals, Shriner’s Childrens hospital and extensive research facilities.

    The initial idea was to remove UTMB from Galveston. For various reasons, some legal and some political, it was decided to rebuild in Galveston.

    Little of the property loss was covered by insurance. Facilities have been slowly reopened, but much remains to be done.

    UTMB has received massive funding over the years from Galveston based charities (not so much from the city itself). Facilities built with some of these dontated funds were to specifically serve the needs of Galveston residents.

    Facilities and services built up over the last 120 years are now being rebuilt. There is an understandable problem now with determine priorities for rebuilding and restoring programs. One major issue is: should the programs originally funded by local donations be restored before teaching/research programs that had other funding sorces?

    These issues are so large they make the ED funding almost a moot point.

    UTMP is at least $250,000,000 short of funds needeed to completely restore all facilities to pre-Ike levels.

    Obviously, any comparison with pre-Ike level of service have no real meaning.

    Glen in Texas

  7. rn says:

    Last looked, this WAS America w/ freedom of choice….next it will be a chip in the neck is mandatory for your job.
    The’flu” vaccine is a speculation as to WHICH of the bazillion viruses will be on the Number One list this year. The people it’s supposed to be “saving” are the same per cent of the population that will always be at risk for some contagious respiratory event that will make them ill. It is only surprising that for years humanity was able to continue on w/out the flu vaccine.

  8. DensityDuck says:

    You know what’s 100% effective at preventing flu infection? Maintaining a sterile barrier. Isn’t that what doctors are already supposed to do?

    • Nancy says:

      There is a difference between an “clean” procedure and a “sterile” procedures. The procedures for handwashing, gloving, gowning, wearing of masks or not, all depend on what procedure is being done, and on the infection or immunosuppressed status of the patient. No, all doctors and nurses are not supposed to be sterile,for various reasons such as development of superstrains of bacteria, or effectiveness of antibiotics. Yes, handwashing, ‘contact’ precautions and various other infection prevention measures are in place and should be adhered to by healthcare professionals AND patient and familiies. There is a huge body of research about this. For example, the basic mask used to in isolation rooms is only effective for about 20 minutes. After that, moisture from breathing and force of the air from breathing permeates the mask, rendering it ineffective. But the presence of the mask gives the illusion that we are preventing infection. To make a long story short, no, doctors and nurses are NOT supposed to maintain sterile barriers except in certain situations. Flu shots have some limited effects on healthcare workers getting and transmitting the flu. It is also linked to Guillan-Barre syndrome, and severe allergies have been noted. The formulation of flu shots changes in strain from year to year, not so with MMR, Hep C and other vaccines. So it in not such a simple thing.

  9. DensityDuck says:

    “The State of Texas has a responsibility to provide health care to its residents. That “responsibility” can’t be imposed upon private institutions any more than the responsibility to feed the indigent can be imposed on private grocery stores. ”

    Actually, private grocery stores can be required to accept food stamps (or whatever the Texas version is called.)

    Of course, this is “customer turns in food stamp and the store is reimbursed by the state, and the food stamps are only good for certain things, and there’s a limited number each customer can use in a month.”

    If food stamps worked like health insurance, then any random person could walk into a store, take as much as they liked of anything they wanted (including beer and cigarettes), waltz out the door yelling “I’m poor, can’t pay”, and the store would get ten cents on the dollar from the state if they got anything at all.

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