See more health care news at the satellite edition of this update over at ER Stories.net.

Providing free medical care when a mistake occurs. The hospital doesn’t just compensate the patient for his injuries – it writes off the entire hospitalization. I think we ought to do this for every industry. Restaurant screws up my order, I want the whole meal free – including drinks and dessert. And the restaurant owner pays for the waiter’s tip. Grocery store misprices an item, I want my whole order free. Worker comes to work late, employer doesn’t have to pay them for the entire day. Lawyer screws up a motion, the whole case should be free. This is how business ought to be.

Just because the sign says “urgent care center” doesn’t mean that you won’t get billed like you went to the emergency department.

I’ll be back …. Ticked off patient leaves British Columbia emergency department after waiting for 45 minutes then returns and drives his Chevy Blazer through the front door.

Jury awards couple $2 million for delay in cancer diagnosis.

$7 million judgment against hospital and surgeons after delay in diagnosis of postoperative cardiac tamponade.

Note to dimwit would-be robbers: If you beat one of your victims while trying to steal her purse and dislocate your shoulder in the process, it would probably be a good idea NOT to go to the closest emergency department for treatment. The victim just might just go there for treatment and recognize you from the waiting room.

Survival by deception. Parents get their kids labeled with psychiatric disorders and then medicate them so that the parents can make $700 per month in SSI payments. Nice. Parents should have their kids taken away from them and should be permanently banned from public assistance if this happens. And the doctors that create these bogus diagnoses or prescribe medications when the children don’t meet criteria for the diseases should have their licenses stripped.

Government insurance isn’t working so well for West Virginia hospitals. Appalachian Regional Healthcare system is suing the WV Department of Health because Medicaid payments are less than the cost of providing care. Without the added payments, the hospital says that it may not be able to provide services to all its patients.

Should a law requiring that everyone purchase health “insurance” be considered “necessary and proper” for Congress to carry out its responsibilities? That appears to be the $64,000 question in the mounting legal challenge to Obamacare.

Child of star from “16 and Pregnant” ends up in emergency department after hitting her head on fireplace and sustaining a “gash.” Doctors glued her scalp back together. Wait a minute. There’s a TV show that makes “stars” out of 16 year olds who get pregnant? What has our society become?

Remember my post in July (also featured over at Kevin MD) about how Medicare patients are getting stuck with huge bills because they’re being admitted for “observation” status rather than a full admission? Welcome to the newest method by which the feds are pushing hospitals to classify more and more people as “observation” patients. The feds just settled for $3.2 million dollars with a hospital in Pennsylvania after the hospital discovered that it “billed Medicare for more expensive one-day hospital admissions on an unspecified number of occasions when it should have billed for observations or outpatient visits.” From experience, the determination of “observation” versus “inpatient” status is often arbitrary. Now hospitals will be more likely to err on the “observation” status — which means that Medicare patients will get even more of the shaft.

Has the pendulum swung too far in the other direction? Texas tort reform is allegedly making it hard for injured patients to find lawyers to represent them. In addition, once they do find representation, it is more difficult to prove a malpractice case against an emergency physician due to heightened pleading standards.
One side argues that since tort reform 799 suits were filed with 163 payouts. The other side argues that claims against emergency physicians dropped by 60% during that time and payouts dropped by 33%. Can there be a happy medium in the “perfect care – available care” conundrum?

Florida is also considering whether or not to give physicians who treat Medicaid patients sovereign immunity — to the tune of an annual cost of $69 million.

Florida woman wins $23 million judgment against University of Florida teaching hospital, but is only able to collect $200,000 of the money since state institutions are already protected by sovereign immunity.

You had to know this was going to happen. A vending machine for pain medications and antibiotics outside the emergency department. What? You need a valid prescription and a credit card to get Oxycontin? Curses.

Mission creep in the making. CMS is asking for comments on whether it should expand EMTALA to include inpatient care and to increase the responsibilities of hospitals that provide specialized care (link is a .pdf document). Such a requirement would make things easier on small community hospitals and make things more difficult on tertiary care hospitals. Net loss or net gain? By the way, if you want to comment on the issue, go to http://www.regulations.gov and follow the “Submit a comment” instructions.

One of those truth is stranger than fiction stories. California man gets locked in his room in the emergency department for five hours when the latch to the door breaks. They tried to use a credit card, an eyeglass screwdriver, and forceps to open the door before calling the fire department to break down the door. But they did give the patient a $3000 discount off his $16,000 bill for his troubles. A nice gesture considering that hospitals routinely discount their charges 50% or more for insurance companies.
In other news, hospital CEOs then went around distributing nice shiny new silver dollars to all their employees for Christmas presents.

Five ambulances and a hazmat unit descend upon a rehab hospital after pepper spray canister is accidentally discharged in a nursing unit. Twenty people were treated for respiratory irritation, two of whom were transported to the hospital. From pepper spray? What do they staff these places with – canaries? Police SWAT teams couldn’t get that kind of effect using tear gas.

Put away your insurance cards – it’s cash only. In the “quick care – quality care – free care” dilemma, patients that can afford it are paying good money to receive faster care in Manhattan.

It must have been all a show. Medical malpractice trial ends in mistrial after defendant physician jumps to the aid of a juror who fell ill.

Man arrested for swinging a knife at an emergency department employee, then claims that he was suicidal.
In other news, as a response to this incident, JCAHO has now ruled that knives in the emergency department are never to be used. No, wait, that was a staff member in danger, not a patient. Scratch that.
In other news, as a response to this incident, JCAHO has now cited the employee for improper use of verbal de-escalation techniques and for failing to offer the assailant milk and cookies before he began swinging said knife.

See more medical news stories on the Satellite Edition over at ERP’s blog – ER Stories.

More violence against emergency department staff. Illinois nurse gets punched in the gut by an intoxicated patient. At least the police and hospital are prosecuting the schmuck. Because health care employees are a protected class of individuals, the criminal is now facing a felony charge.

Second Illinois schmuck is arrested for pushing police officers in emergency department, then trying to bite them, then kicking one of them several times, then trying to kick the windows out of a police cruiser.

Third Illinois schmuck arrested after “lunging” at physician treating his child then grabbing police officer who tried to restrain him.

More medical violence. California psychiatric hospital workers strangled. Another sustains four skull fractures from a patient who had just attacked a custodian. One psychiatrist at the hospital calls it a “culture of violence,” yet hospital police officers are prohibited from carrying firearms or Tasers. Wouldn’t it be interesting if judges and police forces had to live with the same rules imposed upon health care workers? Instead of JCAHO, ENTER JCALEO – the Joint Commission on Accreditation of Law Enforcement Organizations. Sorry, you can’t carry guns. Much too dangerous. First you have to try verbal de-escalation of the whackball who’s running at you with a machete. If milk and cookies don’t calm him down, then – and ONLY then – can you institute the LEAST RESTRICTIVE form of restraint possible. And you have to fill out 17 pieces of paper in triplicate and check on him every 15 minutes to make sure he isn’t hungry, doesn’t need to use the bathroom, and all his other creature comforts are met.

$20 million liposuction medical malpractice judgment upheld in Pennsylvania.

The University of Chicago is back in the news after having the highest rate of going on ambulance bypass in the state of Illinois. The article states that University of Chicago diverted ambulances for 1,764 hours between Jan 1 and Nov 30 this year, adding up to being on ambulance bypass 22% of all available hours. The runner up was Christ Hospital in the South Chicago suburbs that was on bypass for 706 hours or about 9% of the time. Most of the other Illinois hospitals had bypass rates of less than one percent. The article describes how many patients – even those with insurance – wait 24 hours or more to get a hospital bed.
Only two hospitals in NorthWest Illinois went on diversion at all and those hospitals were on diversion for 12 and 17 hours respectively.

Excellent article in the Flagler College newspaper about how the health care plan will affect access to care. According to proponents of the Obama plan, such as US Senators Tom Coburn, MD (a family practitioner) and John Barrasso, MD (an orthopedist), patients only go to the ED because federal law requires that they receive treatment there. Insurance expansion will allegedly decrease waiting times and tame overflow.” If these forward-thinking representatives of ours took some time out of their day to actually talk to patients who already have the insurance they’re pushing, they would see that expanding insurance will only increase the strains on the emergency departments because there are few if any community physicians willing to put up with the byzantine rules and low reimbursement from government insurance. The article gives a couple of examples about how the current system has already played out with a couple of patients.
Get ready for a ride, folks. Then again, Dr. Barrasso was a rodeo doctor, so he’s had some practice already.

Patient pens letter of complaint to newspaper because some “barely understandable … foreign doctor” comes to take care of his wife after a knee operation rather than their own family physician. Medical care is becoming “too impersonal,” he writes.
Sorry to burst your bubble, sir, but the Marcus Welby days are long gone. Patients now drop their physicians like they drop garbage in the trash any time their insurance changes. If you go to a university hospital, the doctor that spends the most time with you will probably be a resident. Once that resident graduates, you’ll get a different doctor. And the insurance that you have pays a pittance for providing care to patients in hospitals and it doesn’t compensate your doctor for time away from his practice or for all the phone calls he gets in the middle of the night. Office-based physicians have less and less incentive to take care of their patients in the hospital.
We reap what we sow.

Let the patient die or you will no longer be considered a Catholic hospital. A pregnant woman at St. Joseph’s Hospital in Phoenix was diagnosed with pulmonary hypertension. Pregnancy makes the condition worse, and may cause maternal death. Physicians consulted a member of the hospital’s ethics committee and then terminated the pregnancy. Bishop Thomas Olmstead demanded that the hospital repent for this “grave scandal to the Christian faithful,” and if it did not meet his many other demands, threatened to suspend his endorsement of the hospital and warn the members of the diocese that the hospital no longer qualifies as a “Catholic” hospital.