Malpractice environment in Texas improves, doctors flock to state. In the three years after tort reform took place in Texas, 7000 doctors applied for Texas medical licenses. Malpractice environment in Illinois stays bad, doctors leave. According to a recent Northwestern University study (.pdf file, see story here), 70% of medical students who planned to leave Illinois after graduation cited Illinois’ “anti-doctor liability environment” as playing a role in their decision. The study predicts that rural communities in Illinois will remain underserved due to lack of physicians. So which is more important, perfect care or available care?

St. Joseph Hospital in Baltimore pays $22 million to settle claims that it was performing unnecessary cardiac stenting procedures in patients. Three cardiologists who blew the whistle on the hospital get a cut of the settlement. That leaves the hospital with only 101 more lawsuits to defend due to the allegations.

Can computers help curb “unnecessary tests”? According to the Institute for Clinical Systems Improvement, a computer program has reportedly saved Minnesota $28 million per year by “eliminating thousands of unnecessary tests.” The project in Minnesota discovered that physicians chose clinically unuseful testing approximately 10% of the time, so insurers agreed to forgo prior authorizations for testing if doctors used the program. Two problems with the system and the article mentions them: Defensive medicine and patient satisfaction. If doctors perceive that they are going to reduce liability by ordering the test, they’re going to order the test, and if doctors are getting graded by how happy they make patients, when patients want the test, doctors are going to order the test. Despite the shortcomings, the program has been so successful that the federal government is considering whether or not to implement it on a national basis.

New York woman wins $3.5 million in a jury trial after requiring lower leg amputation due to “emergency room delays” in treating a knee dislocation.

Team Health, one of several national emergency department staffing companies, had third-quarter profit that was up 30% due to recent acquisitions and improved contract volume.

University of Minnesota’s medical malpractice cases going down, but costs remain stable. The University spent $4.3 million to defend 42 claims filed against the University since 2005. It spent almost $740,000 to get 16 cases dismissed before trial and spent another $2.5 million settling and defending 15 other cases. Four cases went to trial and the University won all of them. The numbers in the article don’t add up, but do give at least an idea of what it costs to defend malpractice cases.

Good way for insurers to make lots of money: Collect premiums, insure patients, don’t pay (or underpay) claims for a few years, then go bankrupt. California insurer La Vida did just that, sticking many emergency medical providers with years of unpaid bills.

Some people go to the emergency department and get treatment for bedbug bites … some people go to the emergency department and get bedbug bites. Bedbug infestation found in two rooms at a Milwaukee emergency department. Ewwwwww. How many people started itching after reading this? I can only imagine what the Medical Marijuana Advocates are going say about that one.

Interesting factoid from across the pond. In Great Britain, 23% of all cancer cases, including up to 50% of leukemia and brain tumor patients, are initially diagnosed in the emergency department.

New Yorkers have drinking problems? Emergency department visits for alcohol-related issues in New York increase 250% from 2003 to 2009.

Identity theft ring hits Florida emergency departments. Employee accessed more than 1,500 files and printed patient information which was later sold to other criminals who used the data to obtain fraudulent credit cards and debit cards. With criminal charges that range from 10 to 20 years per count, these citizens can expect a permanent room at the Greybar Motel.
Reading through the archives, another man, Ruben Rodriguez, was sentenced to 11 years in prison for selling patient information this past October.

Ya think? Researchers discovered that “differences in hospital surveillance methods affect the quality of public reporting of bloodstream infections on hospital report cards.” In fact, in this study, the hospital that reported the lowest overall infection rates had the highest infection rates when surveillance methods were standardized. The researchers could have saved their troubles by looking at some real investigative blogging on the topic.

Some people think that there is a trick to getting seen in emergency departments more quickly by arriving in an ambulance. Not necessarily so. When the emergency department is full, ambulance runs are routinely triaged to the waiting room if the patients do not have an urgent complaint. In Canada, paramedics share the pain. They get stuck waiting along with the patients until a bed opens up. Edmonton paramedics are forced to wait an average of an hour and 22 minutes with a patient in the emergency department waiting room every time they bring a patient to the hospital. What happens when all the paramedics are sitting in the hospital and they get another 911 call?

The “Kind of an Emergency” Department: Fountain Valley Regional Hospital in California and two Memphis, TN hospitals jump on the growing bandwagon allowing patients to reserve an appointment in the emergency department so they don’t have to wait. The catch is that patients have to pay $14.99 for the privilege. The fee is refunded if you aren’t seen within 15 minutes of your arrival. I think that the idea has good and bad points. Patients need to realize that medicine is a business that costs money. When you think of the old idea about “fast care, quality care, free care — pick any two”, the idea of patients paying extra money to receive an added benefit makes sense – like paying more to fly “business class” as opposed to “coach.” On the other hand, a requirement that people have some type of credit or debit card and then use it to pay a $14.99 fee online for an appointment makes it more likely that indigent patients or those on fixed incomes won’t be able to use the service. Acceptable?

Taking “trick or treat” way too far. Four year old in Lubbock, TX begins acting strange and then seizing after eating Halloween candy. A trip to the emergency department showed that he had methamphetamines in his system. Police suspect that someone may have laced his candy with meth. Yes, I asked the same question, too. Police investigated the child’s home and didn’t find a meth lab there.

It will adversely affect doctors, patients, taxpayers, attorneys, farmers, college students, people living in rural communities, retirees, the military and federal employees. Yup, the latest deficit reduction plan will officially piss off just about everyone.

Very thought provoking blog post about judging others written by a social worker working in an emergency department when a drunk driver causes a five car accident that killed four of five family members in another vehicle.

Man wins $4 million in medical malpractice case against hospital but surgeon gets a defense verdict. It appears that the patient had surgery for a gall bladder removal. He was later rushed to the emergency department for pain and fever. A CT scan showed that his gallbladder was still there … and that a surgical sponge had been left inside the patient. The surgeon was cleared of negligence by blaming the nurses for not counting the sponges correctly. The article doesn’t explain all the facts in the case, but I found myself needing to know: Did the jury just think the gall badder regenerated like some freaky salamander tail after the surgeon allegedly removed it?

Canadian police are launching a full criminal investigation into the death of Brian Sinclair, a double amputee who died after sitting in an emergency department waiting room for 34 hours. Criminal prosecution of medical care is a very bad idea. Starting a precedent where medical staff can be sent to jail for making patients wait will have one and only one effect: A lot of providers will leave the profession fairly rapidly. Then the waits will go up. Then more medical staff will go to jail. Oh well. At least the inmates will have good medical care. Hey … wait a minute … if the police are investigating … and the prisons need doctors and nurses … maybe … naaaahhh.

Texas considering whether or not to drop Medicaid. “This system is bankrupting our state. We need to get out of it.” The state figures that it can save $60 billion from 2013 to 2019 by leaving Medicare and CHIP patients to fend for themselves.
Meanwhile, South Carolina plans to stop paying doctors for treatment of Medicaid patients effective March 4. Oh, they still expect the doctors to see Medicaid patients “in hopes that they will eventually be paid.” The state’s Medicaid population has grown from 100,000 to 975,000 since 2007 – which means that more than 20% of the state’s population now has Medicaid as their primary insurance.
With 30 million patients getting brand new insurance cards in the next few years, a whole lot of people are going to learn the difference between “insurance” and “access”.

That’s it. Your satisfaction scores are TOAST! Interesting court battle brewing in Chicago. Northwestern Memorial Hospital has been trying to discharge an 86 year old patient with inoperable pancreatic cancer who has been stable for discharge for almost a month. The patient doesn’t want to go home from the hospital and her daughter is worried that “she is unable to adequately care for her frail, terminally ill mother at home.” Medicare deemed the extended stay medically unnecessary and won’t pay for her inpatient bills any more. The patient’s daughter, a who is power of attorney, states that Northwestern should make special accommodations for her mother since Northwestern allegedly delayed diagnosis of the pancreatic cancer. Now Northwestern is going to court to have the daughter’s power of attorney revoked.
Three simple letters would probably go a long way toward resolving this problem: ABN.

Last but not least is the WTF story of the week: Woman charged with aggravated assault for threatening to batter a police officer with a “rigid female pleasure device.” Whaaaat? First, I can’t believe that an officer wrote that in a report. Bet it will make for some interesting looks in the evidence room. Second, if someone busts into your house, it a “pleasure device” the first thing you’d grab to defend yourself? Third …. ah nevermind. This is a family blog run by medical professionals.