WhiteCoat

Healthcare Update — 09-09-2010

Plaintiff’s law firm gets hit with a $1.8 million judgment for screwing up medical malpractice case. Plaintiff was forced to settle for $1 million when she was actually awarded $2.5 million.

AMA gets on Timothy Geithner about tax breaks for plaintiff lawyers.

1 in 4 people can misread a pregnancy test. Who did they poll – preschoolers? Actually, it was 120 females. One company tries to solve the problem by creating a pregnancy test that states either “pregnant” or “not pregnant.” If people can’t tell the difference between “plus” and “minus” on the “old fashioned” pregnancy tests, you think they’re going to be able to understand “pregnant” and “not pregnant”? If you don’t know how to read a pregnancy test, you have NO business getting pregnant. End of story.
Hat tip to NP Odyssey.

Bristol emergency department will lose funding from Medicare. Did a web search and couldn’t find a follow up as to whether this actually went through. If it did, now the hospital is free to patient dump.

Nancy Grace ended up in emergency department for a broken foot. Imagine the fallout on CNN if the docs screwed up her care. There would be four orthopedic surgeons on the TV screen each taking turns badmouthing the emergency physician’s choice of casting material and crutches.

Drunk man charged with disorderly conduct with “persistence” for yelling and swearing in emergency department. If we were able to bring charges against every person who yelled and swore in an emergency department, we’d need to have a full time judge and bailiff in the closet of the psych room.

The Percocet-free emergency department. Saving lives one Darvocet prescription at a time.

Hulk Hogan is brought to emergency department by ambulance for severe back pain, then sends a video message from his emergency department bed.

Another doctor’s view of medical malpractice and defensive medicine.

California voters approve property tax in order to keep emergency department open. Couldn’t really imagine how the department would close, though. California has had tort reform for 40 years and all …

Hint to stabbing perps: After shanking your victims, don’t go to the emergency department to hang out. That’s generally where people go for help after they’ve been stabbed and your victim just might be able to ID you there.

Waits in emergency departments across Ontario average 10-21 hours – and that’s reportedly improved from 2008. One in ten patients waits more than 30 hours for a bed. But at least their care is free.

14 Responses to “Healthcare Update — 09-09-2010”

  1. Matt says:

    I don’t know that whether I could deduct litigation expenses now or later matters that much to whether I take a case, but having the AMA against me doesn’t really worry me too much, given their track record of late.

    That’s really surprising about California. Next you’ll tell me they have access problems, and I know WC said tort reform will definitely improve that.

  2. [...] September 9, 2010 Leave a comment Go to comments This story, via WhiteCoat, deals with a hospital in Tennessee that is slated to lose Medicare payments because of violations [...]

  3. Anonymous says:

    I’m with you 100% and some more with the pregnancy test misreading. Let’s just go Brave New World on these Epsilons and put them in a corner to perform menial tasks.

  4. Storkdoc says:

    The problem with the urine pregnancy test is that as it dries out, the positive line becomes visible. That’s why it is very important to read it at the correct time usually three to five minutes.

    As an OB, I have many patients who come in with a positive home test whose test is negative in the office. On further questioning they all state that they thought is was negative at first, but when they went to throw it out later, they saw the line.

    I wish they could be made so that the line doesn’t become visible as it dries.

  5. “The Percocet-free emergency department”, which means a standard that serious painkillers are inappropriate for an ER (hey, they call it an ER), so they’ll use drugs like acetaminophen, and maybe, if they have to and have no alternative, codeine.

    Wow. Remind me to not go there with a kidney stone. They’ll probably want me to fill out forms in triplicate (while in paralyzing pain) with essay questions to express my justification in going beyond tylenol.

    Certainly writing long scripts for oxycodone makes no sense in an ER, but to have a policy against administering morphine drips for patients with serious injuries? (presumably the most likely place to see compound fractures and ruptured organs is in emergency/trauma ….)

    • throckmorton says:

      I think the point may be missed. In the ED we are swarmed with patients who come in to request narcotic pain medications. These are not true emergency cases such as possible loss of life and limb but rather, “Back pain” and “my fibro” is really bad. First and foremost, these patients do not to be in the emergency department, secondly, they should not be treated with outpatient narcotics.

      This ER is giving those who are seriously ill morphine and other pain medications. They are not serving as a “here is some until you can go somewhere else” Emergency Department.

      At our facilities, we track the number of patients seen by every ED provider. I can tell you that it is easy to tell the prescribing habits of each one. Word gets out in the community, when there is a “candyman” the ED gets packed!

      • midwest woman says:

        so this begs the question..who is the bigger loser?..the pathetic drug seeker or the “candy man” with the medical degree who lacks either a backbone or some integrity to say no.

    • Steve says:

      This policy struck me as strange- it could be due to mis-reporting by the news channel. I don’t think there are any ED docs out there who hand out oxycontin for acute pain or refill chronic prescriptions for the same but the report made it sound like there were doctors doing that previously.

      Keep in mind that allowing schedule III drugs still permits Vicodin but not percocet (schedule II). A lot of ED docs don’t write for percocet and do vicodin instead because you avoid the hassle of the triplicate forms that some states require and in the end, you are still giving a narcotic pain killer.

      Another point- a significant number of people (as high as 30% when you break it down by race) can’t metabolize codeine into its active drug- morphine. So saying “well I’ll just give them codeine instead” is like pissing in the wind for people with legit pain.

      I am all for responsible prescription use but I think not treating real, legit ACUTE pain is horrible. ED docs are pretty good and sniffing out real vs. fake and as long as you write for reasonable doses and limited courses (no more than 15 tablets) of appropriate medications there shouldn’t be a problem. We aren’t there to treat the entire course of your illness- just long enough so you can get to your PCP or specialist.

      If you want to take it one step further, the statewide databases on prescriptions that some have would be a welcome way to curb narcotic abuse. These blanket statements are troubling to me.

      • ThorMD says:

        Most of these policies address CHRONIC pain patients and not ACUTE pain patients. Our ED is formulating a chronic pain policy right now and we’ve referenced policies that other ED’s have implemented, so I’ve reviewed quite a few of them. The policies make a point of saying that docs can still treat acute pain any way they want, and docs can deviate from the chronic pain policy if they feel it’s clinically indicated.

  6. throckmorton says:

    Matt:

    I have heard other attorneys argue that one of the problems with our medical malpractice system is that they have to front so much money for a contingency case. They argue that it is this very fact that encourages then to procede with only cases of merit. The concern is a possible financial incentive to procede with more cases of no mertit.

    It is interesting in that when we look at the possibility of physicians being able to deduct the cost of charitable care or unpaid care, politicians run the other direction. I wonder what ED specialty coverage would be if physicians got a tax break for taking call and seeing these patients.

    I hate to say it but both medicine and law are businesses and both have a business model. Mine is relatively easy, the more patients I see who actually pay the more I make. The more I see who dont pay, the less I make. That is the whole revenue stream. I do not get money from tests or scans. My overhead is constantly increasing. Being able to deduct nonpaid ED call cases is appealing.

    • Matt says:

      “The concern is a possible financial incentive to procede with more cases of no mertit.”

      A loss is a loss. If a case has no merit, you’re still out tens of thousands, not counting your time. Just because you can deduct some of that cost this year as opposed to the year the case resolves really doesn’t change that.

      I don’t mind physician deducting for charity care. But let’s be clear – charity is when you don’t intend to charge up front. Not when you give up on a bad debt.

  7. Laura says:

    I’ll speak up in defense of the pregnancy test reading issue. They specify in the abstract that the test was done on samples with a low hCG level. Under that situation, even reading a test within the specified time frame can lead to uncertainty of whether that damn line is really there or not. You start to go crazy questioning yourself – is it a shadow? Is it a very faint line? Am I imagining things?

    • Roberto says:

      I agree. In a society where believing in miracles is the norm, there’s a chance God can help you in the last minute. And I don’t think the problem is going to be solved by displaying ‘pregnant vs not pregnant’. For a woman wishing to be non-pregnant in her mind there’s still a chance the displayed ‘not’ may have fainted or looked erased. So if there’s a solution it will have to say ‘pregnant’ or ‘mother’, or something like this.

  8. SeaSpray says:

    Someone told me you can get the same pregnancy tests for only a DOLLAR at the dollar store vs paying 15 or more at Walmart. Wow ..wish I knew that! But how the heck can they afford to sell them for 1.00? Maybe they should all go digital ..YES for pregnant/NO for not pregnant… or even better ..PREGNANT!
    *********************************
    Why would Hulk Hogan do that? talk about ruining an image! That kind of wrestling not my thing ..but older son was so into it when he was little.

    I think we still have a hulk Hogan action figure up in the attic.

    I don’t get the point if it’s all fake.
    *********************
    10 – 21 hours in the ED? I almost hit the 10 hr mark once.

    That is too bad for the patients and must drive the ED staff crazy.

    Doesn’t that happen in our city hospitals?

    You’d think if they see it’s not working that they would do something to ease the burden.

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