See also the Satellite Edition of this week’s update over at ER Stories.

Hey … she had great Press Ganey scores, so who cares? Spanish woman with no medical training masquerades as emergency department physician for 5 months before being caught. See also a Google Translation of the Spanish newspaper article covering the story.

Drug seeking patients are getting trickier. Patient calls EMS and states that he was beaten with a bat. While in the ambulance, he grabs a syringe “containing a controlled substance” and sticks it in his pocket. When he gets to the hospital, a nurse finds the syringe and calls the po-lice. After an investigation, police determined that the whole call was a “ruse” to gain access to controlled substances in the in the ambulance. Never fear, though. The federal government is cracking down on fraudulent ambulance calls.

Obstetrician ordered to pay $3 million to patient born with cerebral palsy … 18 years ago.

Speaking about obstetrician/gynecologists, the $204,000 malpractice premium they have to pay every year on Long Island is driving many of them out of the baby delivering business. Now some New York counties have no obstetricians to deliver babies. Another example of the dilemma between perfect care and available care. Trying to sue your way to better health care may just leave you with no health care at all.

When you decrease reimbursements and have a bad reputation with malpractice reform, what happens? Just like the story above … doctors leave. New Jersey is expecting an increasing shortage of physicians in the next 9 years due to the poor reimbursement, high tax rates, and its “judicial hellhole” atmosphere.

Should every patient needing a gallbladder removal be required to have an intraoperative cholangiogram just to make sure which one is the hepatic duct and which one is the cystic duct? Doing so would add tremendous costs to every patient’s surgery, but would prevent malpractice lawsuits such as this one in which there was a $250,000 judgment against a surgeon. Issues like these are how defensive medicine is perpetuated. The complication may be quite uncommon (occurring in about 1 in 1000 cases), but if your patient suffers it, you will be sued, you will be made to look like a moron in front of a jury, and you will likely lose the case. What does everyone think? Is an intraoperative cholangiogram one of those “unnecessary” tests that doctors are just performing so that they can make more money?

Medicaid “ripe for slashing” in many states. Governors look to cut Medicaid services and decrease payments to providers in order to shore up state budget gaps. All those patients who are about to get Medicaid “insurance” are soon going to see first hand how Bernie Madoff made all his money.

It doesn’t just happen in the United States and Canada. Woman dies after waiting in an Italian emergency department for eight hours.

Ham on rye, hold the Mayo. Remember that interview President Obama did with Diane Sawyer on how the Mayo Clinic was an example of good care at a lower price? “[At] Mayo Clinic, … people … spend about 20-30 percent less than some other parts of the country, and yet have better outcomes.” Ask the insurers who actually pay for the care and you’ll find out that isn’t always the case. Routine obstetric care costs almost twice as much at Mayo than the median statewide payments in Minnesota. A colonoscopy costs more than double the state median at Mayo. Now insurers are making visits to the Mayo Clinic “out of network” so that the patients have to pay more money to go there.
I think that it is good that consumers must now become more educated about pricing and quality. Do you want to go out of network and pay more for “better quality” care at Mayo or would you rather pay less and go to a hospital that doesn’t have as good “quality” measures?
The problem is that we are spending a heck of a lot more money to purchase insurance policies, will soon be forced to do so, and the policies are likely to cover less and less care – or to make that care “out of network” so that consumers get a “double whammy” of higher insurance premiums and then increased “out of network” charges.

He gets an “A” for effort … and innovation. Insect flies into man’s ear and is flapping around next to his eardrum. First the man tries to get the insect out with a toothpick. Then he puts a vacuum cleaner up to his ear to see if he can suck the critter out. Eventually, he has to go to the emergency department.
Not that you should try to extract insects from your ear at home, but if the buzzing in your ear from the insect’s wings is driving you crazy (and it will), first you have to exterminate the insect. Stabbing it with a toothpick isn’t the way to go, either. When faced with attack, all the insect will do is lay larvae – which will eat their way into the skin in your inner ear and hatch.
Pour water into your ear canal and let the insect drown, first. Then go to your doctor to get it out.
By the way, I was kidding about the “larvae” thing.  How many of you freaked when you read that one?

Welcome to the belated edition of this week’s update and the first post that I have ever made from work — because I have been snowed in at the hospital for the past 2 days.

Shameless plug for songs involving me by name – The ER Blitz. Tex now has over 100 songs in his repertoire. And he still has a damn good blog, too. When is the greatest hits album coming out?

These don’t go in your grandma’s bubble bath. When seasoned drug users state that “this is nasty stuff” and that they “would not be disappointed to see it banned,” you know that states are going to take notice. “Bath salts” are causing psychosis in people that snort them. The active ingredient, methylenedioxypyrovalerone or MDPV, is being outlawed in many states.

Choose one from Column A and one from Column B. House Republicans considering whether to turn Medicare into a fixed payment “voucher” system where the government gives you a voucher to buy a private health insurance plan once you hit “Medicare” age. Democrats rightly note that “privatization will make the cuts previously proposed by either party look tame.”

Put on your snowshoes — and donate blood. Blood supplies are running low due to the bad weather in several areas of the country.

Bureaucracy adds another layer of costs to medical care. Physicians are having a difficult time entering information into the computers to create the electronic medical records that the federal government wants. Now more and more emergency departments are employing “scribes” to enter the information.

Another Pennsylvania emergency department closes due to “consolidation.”

In San Diego, one hospital is expanding its emergency department and laying off almost one quarter of its staff – due to reductions in payments from Medicare and Medicaid

Medicare is “cracking down” on fraudulent ambulance calls. I’m sure that patients like the one in the article who called an ambulance for chest pain then signed out of the hospital 10 minutes later to go to the nearby bar will be dissuaded from defrauding the system in the future when they get a huge ambulance bill.

11,500 patients treated in emergency departments each year for snow shovel-related injuries. More than half have muscle strains. Twenty percent fall, 15% are struck by shovels. About seven percent of patients had cardiac-related issues and those issues resulted in about 100 deaths per year.

Eating fruit can kill you. Man goes to emergency department with muscle spasms and jerking after eating three slices of starfruit. A physician’s assistant in the ED consulted Dr. Google and discovered that patients with kidney problems who eat the fruit could develop seizures and death.

Sometimes waiting in the emergency department can be bonding time with your kids. Read this fun story about a mom who sat in the ED with a child who injured his ankle.

President Obama considers “fixing” the Affordable Healthcare Act but rules out changing issues relating to pre-existing conditions.