Archive for September, 2010
Thursday, September 16th, 2010
Looking for more medical news from around the web? See the satellite edition of this week’s Update over at ER Stories.
Want to get rid of that nasty MRSA infection or that nasty E. coli infection? Try sucking on some cockroach brains. Seriously. You might get a cameo on Fear Factor while you’re at it.
Another emergency department closing – this one near Chattanooga, TN will lose almost $1 million in 2010. Residents of the area will now have to travel between 22 and 41 miles away to the next closest emergency department.
Colorado emergency department shut down for several hours because a patient brought a rock inside. Yes, a rock. He said the rock was radioactive, so men in isolation suits descended on the department, but the rock was described as “a rock that would be found ‘naturally’ in the out-of-doors.”
Wanna run a marathon for a good cause? The Fresh Air Fund is looking for runners and sponsors for the NYC Marathon on November 7, 2010. Go to the fund’s site for more details or to sign up.
Disabled man writes letter to Boston newspaper because EMTs refused to give him water. There was a citywide heat emergency, he’s out tooling around in his motorized wheelchair, and he knows that his body has a “problem regulating its temperature.” He became overheated while talking to a construction worker, couldn’t find anyone to give him enough water, so he called 911 for dehydration. Then he doesn’t get ice water for an hour after the EMTs arrived. Now he blames the EMTs for his predicament because they didn’t have a soda fountain in the back of the ambulance.
Arguing with an insurance company to save a patient’s life. United HealthCare threatens surgeon “If you refuse to talk with us every day, we will tell the patient that we are not paying for her care.”
OK, then, it was Bush’s fault. Kathleen Sebelius writes letter to health insurance lobby warning insurers not to blame health care insurance hikes on ObamaCare. “There will be zero tolerance for this type of misinformation and unjustified rate increases.” What are you going to do if the insurance companies don’t stop the “misinformation” … tax them more? Oooh. I know. Arrest them for disclosing classified federal secrets?
So the government wants to require insurance companies to provide coverage to everyone and prevent them “unjustifiably” raising their rates. Trust us … this whole health reform thing is going to work out juuuuust fine.
See also comments and more links at Overlawyered.com
Democrats are hoping that voters forget about ObamaCare by November. Rod Blagojevich is probably hoping that jurors forget about him trying to sell off the US Senate seat, too. Don’t expect that either one is going to happen.
That lawsuit to stop enforcement of health care reform may not be as crazy as you think. The judge in the matter is “probably” going to let at least part of it proceed past the initial motions.
Budget dust? Cost of medical malpractice is more than $55 billion per year. Rep Tom Price disagrees, claiming the cost is more like $650 billion.
Posted in Healthcare Update | 15 Comments »
Monday, September 13th, 2010
 When I got to work this morning, I had several people tell me that they wished that I was working the day before.
A little five year old girl was brought to the emergency department for suicidal and homicidal ideations – at least according to the social worker who accompanied the patient to the emergency department.
When the patient arrived, she was uncontrollable. Throwing things. Knocking over chairs and garbage cans. Trying to punch or bite anyone who came near her. All the time, the parents were just sitting there playing their little pocket electronic solitaire games and doing nothing to control their kid.
That would have been it for me. You act like an animal, I don’t care how old you are. You’re going in leather restraints. I’m not endangering my staff.
Then the kid went to the bathroom, locked herself inside, and wouldn’t come out. Security had to come with a special key to open the door.
The patient’s actions did get her prompt placement at the children’s psych hospital – where the nurses knew the patient on a first name basis.
Despite being frustrated with the way the child was acting and with how the parents were doing little to intervene, several people were giggling about what happened when the ambulance arrived.
While the EMTs were getting the patient on the stretcher, the kid was actually pretty calm. She looked at the paramedic and whispered something. The paramedic didn’t hear her, so he leaned over to ask the kid what she said.
WHAM! Right hook to the paramedic’s jaw.
I can see the report at the receiving hospital: “We hit a bump in the road construction on the way up here and the IV pole fell over and hit the kid on the head. Really.”
Posted in Patient Encounters | 13 Comments »
Saturday, September 11th, 2010
An article I read in Wired Magazine kind of ticked me off, although technically I should be ticked at myself for not reading the fine print of the software I purchase.
A recent ruling by the 9th Circuit Federal Court of Appeals says that software you purchase is subject to the license agreements contained with the software. Nothing new there. But if the license states that you may not resell or otherwise redistribute the software that you purchased, then you’re stuck with it. Up until this time, there was something called the “First Sale Doctrine” which states that one who purchases a copyrighted work may sell that copy without the copyright owner’s permission.
Autodesk is a software manufacturer that produces a program called AutoCAD. The license agreement for AutoCAD states that the software may not be transferred or leased without Autodesk’s written consent.
When an eBay member tried to sell a copy of Autodesk AutoCAD on eBay, Autodesk demanded that eBay remove the listing, which it did. When the seller then tried to re-list the software, his eBay account was terminated.
The seller, Timothy Verner, filed a lawsuit. The trial court held that the First Sale Doctrine applied. The Appellate Court reversed the trial court (.pdf), stating that someone who possesses a copy of a copyrighted work without owning it (such as a licensee) must abide by the license agreement and cannot transfer it to another person if the licensing agreement does not allow it.
Some parties are now concerned that companies will start creating licensing agreements for all kinds of products – with strict rules of transfer. You can’t sell or give away books you’ve read. Could the sale of a car of home come with a license and licensing agreements in the future?
This case reinforces the need to invest in free software and to encourage those who create free software.
I’ve been using OpenOffice for almost a year now. The latest version is amazingly simple to use and deals very well with Microsoft Office documents. Companies that are still leasing Microsoft Office products are throwing their money away.
I use GIMP instead of the Adobe Photoshop products. There might not be quite as many bells and whistles, but GIMP is still a comprehensive free product.
If it weren’t for a couple of office programs that I use on a regular basis which are only available in Windows (document scanning and voice recognition), I’d switch all of my computers to the free Linux Ubuntu operation system. Almost all of Ubuntu’s programs are free as well.
I still use Ubuntu on a regular basis, but switch back and forth with Windows depending on what I need to do. I’m currently experimenting with using Sun’s VirtualBox to run the programs inside of a Linux setup so I can dump Windows completely.
There are links to large collections of free software in the “Other Useful Links” page I keep up in the right margin. Take a look at some of the programs. Many of them are similar to commercial products … and you don’t have to worry about being involved in litigation if you dare to transfer the program to someone else.
Wonder if I can license blog posts …
Posted in Computers | 26 Comments »
Thursday, September 9th, 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.
Posted in Healthcare Update | 14 Comments »
Tuesday, September 7th, 2010
Three strange things overheard in the ED during my last shift …
Over the police scanner: “I need an available unit to respond to the corner of 5th Avenue and Clark for report of a black male walking down the street with his pants too low. The complainant says that it looks like something dangerous may be weighing down his pockets.” At least the suspect won’t get away in a foot chase.
On a patient’s past medical history: “Allergies include penicillin which causes rash, sulfa which causes rash, Benadryl which causes dry mouth [a side effect, not an allergy], and mosquito bites which cause … itchy red welts.” The thing that gets me most about this “allergy” is that the docs just dictate it back into the chart with each subsequent admission – like its the real deal. Now we need to keep a can of Deep Woods Off at bedside at all times.
Nurse going off shift to unit secretary: “I can’t wait to go home to watch the new episode of Hoarders.” Sorry, but when the highlight of your day is watching people have nervous breakdowns when garbage is hauled out of their houses, you need to take up a new hobby. Maybe hanging out in the ED waiting room?
Posted in Random Thoughts | 14 Comments »
Monday, September 6th, 2010
 Just found another thing to add to my list of pet peeves.
First, I’ll recap. There are three things that get on my nerves to the point that I have had to rant about them: Cell phones, using the term “emergency room,” and anyone who engages in “baby talk.”
Introducing #4: The “low grade fever”.
This peeve is more about doctors than it is about patients. Most patients don’t and shouldn’t know about medical definitions. I sympathize with patients and families who are inappropriately sent to the emergency department for evaluation of “low grade” fevers. Most of the time, this isn’t your fault. Just don’t go telling everyone else what your doctor said so that the problem gets worse.
The definition of a fever is either a core temperature of more than 100.4 degrees OR an increase of 2.4 degrees or greater above the patient’s basal body temperature. Before you use part B of this definition, you better be showing me some graph paper with temperatures plotted on it. Some experts even state that a temperature isn’t a fever until it hits 101 degrees. Hyperthermia is considered an elevated temperature beyond the body’s normal set points and is generally defined as a temperature of 106 degrees and above. Hyperthermia is bad news and requires immediate medical evaluation.
In 99+% of cases, fever isn’t the enemy. Fever is potentially dangerous in newborns and infants less than 30 days old. Seek immediate medical care. Fever in kids less than 3 months old is still possibly dangerous, but less likely so. Kids older than 3 months are generally safe with fevers. I’ve had several parents come to me concerned that their kid’s brains are going to fry. Your kids aren’t eggs and their skulls aren’t skillets. Brains don’t fry unless you’re in Hannibal Lechter’s kitchen.
If you’re using tympanic thermometers, don’t. There are many studies showing that tympanic thermometers are unreliable or at least less reliable than other methods. Yes, some studies show that tympanic thermometers are reliable. If you had three measuring devices showing that a cup was 8 ounces and six showing that a cup was anywhere between 6 and 12 ounces and couldn’t tell the difference between any of them, which one would you use to bake a cake?
I’m getting off track.
First, don’t try to BS me and tell me that you’ve taken your temperature or your child’s temperature when you haven’t. When parents of an 18 month old bring him in for evaluation of “low grade fever” of “ummmm 99 …. point …. 2 or3,” sorry, but my BS meter has already gone off. No Motrin for you … 1 year!
Second, I don’t care what your doctor told you. Less than 100.4 degrees is not a low grade fever. It isn’t a fever period. I know it’s probably not your fault. I know you’re trying to be a good parent. If your doctor insists that a temperature less than 100.4 degrees requires an emergency department visit, get another doctor.
A temperature of 99.4 is not a low grade fever any more than a blood pressure of 100/60 is low grade hypertension or driving 50 MPH on the highway is low grade speeding.
And no, you don’t need antibiotics for a low grade fever … even if it really is a fever. Amoxicillin doesn’t contain Tylenol and Zithromax isn’t a decongestant. They won’t help.
Posted in Random Thoughts | 30 Comments »
Saturday, September 4th, 2010
After I’ve read through my EP Monthly issue a good dozen or so times, there are a couple of other medical magazines I enjoy. Medical Economics is one of them. I especially like the creativeness of the cartoons.
This cartoon about lack of primary care physicians made me laugh – in an ironic kind of way.
Posted in Funny | 5 Comments »
Thursday, September 2nd, 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.
Posted in Healthcare Update | 15 Comments »
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