WhiteCoat

Healthcare Update — 01-10-2011

See many additional news stories over at the Satellite Edition of this week’s update at ER Stories.

Two year old child loses both feet and one hand to rapidly-progressing infection. Newspapers suggest that 5 hour wait in emergency department waiting room may have played part in the patient’s injuries. Keep in mind that Group A Strep infections are notoriously hard to pick up early in their course and the “rash” only occurs in 10% of GAS sepsis cases. Would the girl have needed amputations even if she received quicker treatment? Tough to tell. But just because there was a bad outcome, doesn’t mean that negligence occurred. See further commentary over at ER Stories and on the Huffington Post about the case as well. To summarize the Huff Po comments: “Sue them all.”

Gripping story from an emergency department nurse who suffered a ruptured brain aneurysm while walking to her car in the hospital parking lot after an ED shift.

“I wouldn’t take my dog to that guy for surgery.” Those words cost Lawnwood Medical Center in Florida a cool $5 million when the surgeon filed a slander case. The case and award were upheld on appeal. Now the surgeon can retire without having to do any more surgery on humans or animals.

Giving patients Medicaid is “a cruel offering of false hope” because few physicians are willing to treat patients with this type of insurance. The doctor writing the article wants to scrap the whole system and start over. I agree.

Montreal hospital emergency departments are operating at 50% more than capacity as patients flood the EDs with “minor ailments.” As a result, “wait times are becoming excessively long for people with real emergencies.” The root of the problem? Patients can’t access primary care physicians. Sound familiar?

Defensive medicine is a fraud. So says the founder of the Center for Justice and Democracy in an article over at Huff Po that is full of talking points from the Trial Lawyers, Inc. I left a few comments on the Huff Po site to respond to some of the issues she raised. I know, some of them are my own talking points, too.

Medicare looking to “reward” hospitals for providing “high quality” care. But it isn’t about the quality. CMS administrator Donald Berwick stated that CMS will “reward hospitals for improving patients’ experiences of care, while making care safer by reducing medical mistakes.” Read that as all medical patients will now get national patient satisfaction scores that determine hospital reimbursement.
Remember that “Hospital Compare” site that has a bunch of “quality indicators” – many of which have no basis in practical medicine? Remember how the site for a while said “quality care” required that all hospitals give heart attack patients immediate beta blockers when the COMMIT trial showed that doing so actually tended to cause worse patient outcomes? They still have “quality indicators” putting time limits on management of medical conditions – one minute over the limit and you’re a “bad doctor.”
Wait to see how much worse medical care in this country becomes once these “rewards” are implemented.

Quality care” at the John Cochran VA Hospital in St. Louis. “Equipment, such as oxygen tubing for respiratory assistance, is chronically broken or unavailable; tools that could provide time-critical diagnoses are unavailable despite more than three years of requests; there are too few rooms in which to isolate people suffering from contagious diseases; there are too few nurses on site; and several patients go days without baths or clean linens.”
Earlier last year, the same VA Hospital was investigated by a House Veterans’ Affair Committee for failing to properly clean dental equipment and potentially exposing up to 1,800 people to hepatitis or HIV.
But don’t forget that the care is free.
Oh, and don’t bother looking for John Cochran or any of the other VA Hospitals on the Hospital Compare web site to see what kind of “high quality” care they are providing. Their statistics are just “NOT AVAILABLE.” The government won’t post its own numbers so that everyone can see how well it cares for its patients. Do as we say, not as we do. We’re here to help.

Drunk Vermont schmuck points gun at a couple leaving a bar, gets into a car and crashes into a telephone pole (knocking out power to the area), then gets brought to the ED and punches out a police officer and a nurse. Hello … Greybar Motel? We need a reservation for one.

How blizzard in the Northeast cost one child his life. 3 month old began having breathing problems, then stops breathing en route to hospital when ambulance gets stuck on unplowed street. Paramedic does heroic job and runs down street with child trying to resuscitate him on the way to the ED. Child dies 6 days later.

Air pollution contributes to heart arrhythmias.
In other news, the Joint Commission has now deemed all motor vehicles as a threat to patient safety. All hospital employees must now walk to work or risk being cited.

A cost of doing business? Pharmaceutical companies paid $14.8 billion in the past 5 years to settle government fraud claims. Then again, spending on prescription drugs was up to $234 billion per year in 2008, so paying the government to leave them alone amounted to only 1% of pharmaceutical company income.

8 Responses to “Healthcare Update — 01-10-2011”

  1. doc99 says:

    Re: Center for Class Action and Litigation, Do a search for autism. You’ll find all you need to know about this group’s raison d’etre.

  2. Hueydoc says:

    I frequent HuffPo out of a perverse sense of bizarre bewilderment at the obviously dysfunctional people on there. The scarey part is that these people are allowed to vote.
    Almost all of their “Medical ” articles are written by a “doctor” who “specializes in quantum healing therapy” or some tripe.
    Take a look at that site- the comments will scare you.

    • DaveyNC says:

      I started going there to see how the other side thinks. I keep going there, and posting there, because it’s more interesting than preaching to the choir.

      I’m pretty many of those people don’t really think more than about 30 seconds on any given issue. I have become enamored of economics in recent years; just try to post anything there from an economic point of view.

      • DefendUSA says:

        Gulp. Go there or to the DU and you will be forced to take an anti-emetic!! Those speaking about the AZ shootings are saying the unthinkable. I like to know the enemy, but there are some unhappy, non thinkers over there.

    • Aaron says:

      I lean left of center, but the consistently abhorrent medical sections at places like HuffPo and Alternet are disgusting. Not that I’m impressed by the rest of their commentary on subjects (I’m biased towards Slate).

  3. Joe says:

    The article about the Montreal ED pointed out that the reason for the crowding (in this case) was a TEMPORARY surge in patients (and lack of doctors) caused by the holidays. I don’t see a way to work around this particular problem under *any* system.

    As for any general shortage of family doctors, the obvious solution seems to be to pay them more.

    • EarlW says:

      Joe doesn’t know about socialized medicine. Montreal is located in Canada, home of Medicare.
      Doctors are all paid the same… by act. If they want to work in the big city, they are looking at a huge cut in pay. That’s assuming that the government will allow them to work at all. They control the number of physicians allowed to work. They control the number of students graduating.
      Until recently, the doctors could not opt out of the public system. Now they are allowed to charge extra for SOME things… a practice coming under a lot of scrutiny. And the government complains when McGill graduates exit the province looking for greener pastures.
      I sell EMR software and I’m saddened every time one of my clients get a call and says: ‘Sorry, we’re not accepting new patients right now’.
      Why the crowding? A Family Doctor CANNOT be found now. The only alternative is to pay thousands of dollars extra to a physician who is not paid by the government. When your kid has a problem, the emergency room is the only alternative.

  4. Matt says:

    “Then again, spending on prescription drugs was up to $234 billion per year in 2008, so paying the government to leave them alone amounted to only 1% of pharmaceutical company income.”

    Don’t forget, the pharmaceutical companies are also included in any federal tort protection efforts. I guess they need it so they can stay in business. . . ?

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