WhiteCoat

Healthcare Update — 03-14-2011

Patients gone wild. Patient gets upset at wait and goes “berserk” on emergency department physician, breaking ribs and giving the doc a concussion.

I told you it was cold in here. More patients gone wild. Las Vegas woman sets fire to a trash can in emergency department restroom. Burning plastic from the garbage can filled the emergency department with thick black smoke, forcing the ED to close for several hours. Now patient is charged with arson and six counts of attempted murder.

Why does Reading Hospital want a police officer stationed in the emergency department 4 nights a week? Could it have anything to do with the fact that 54% of all health care violence occurs in the emergency department? The hospital estimates that 4 nights of security from 7PM to 3AM each week will cost an extra $100,000 to $150,000 per year. Security is getting paid between $60 and $90/hour at a hospital? To heck with medicine. I want to know where I can sign up for that job.

Courtroom doors are valued more than emergency medical personnel in Kentucky. In Kentucky it is a felony (.pdf file) for a person to bash one’s head on a courtroom door and break glass, requiring emergency medical treatment. However, beating the crap out of personnel once in the emergency department is only a misdemeanor (.pdf file).

Effects of health reform in Texas. The number of doctors applying to practice in Texas has increased by 60 percent, at least 20 underserved counties now have an emergency physician and 12 counties have an obstetrician for the first time in their history. In short, “we’re seeing medical professionals return to high-risk specialties.” The seven Texas state representative authors of the article are now calling for Texas to create a loser-pays litigation system.
Tort reform doesn’t work. It’s all propaganda. Don’t believe a word of it. All it does is screw the injured and line the pockets of the insurance companies. Those new doctors were planning to move to those counties before tort reform. The Dallas Cowboys football team motivated them to move to Texas, not tort reform. The numbers are skewed because the population in Texas was increasing anyway. The authors of the article can’t be trusted. They have an agenda.
Any arguments from the plaintiff’s bar that I’m forgetting?

Tort reform in North Carolina. Will changing the standard of liability to clear and convincing proof of negligence allow doctors to focus on patient care or should it be considered legislative malpractice?

Pet trauma center modeled after human emergency department. Only a matter of time until … Guess Praney scores get vets fired unless doggie’s tails are always wagging … catnip overdoses start showing up by the boatload and … lawyers sue vets for more than the clinic is worth if the parakeets don’t live to 107 in birdie years.

Other countries taking lead from US. High-value judgments are up 900% in South Africa. A risk services client manager was quoted as saying that the problem has been exacerbated by attorneys actively pursuing medical negligence claims due to their “high earning potential.”

Reducing obstetrical malpractice payouts to zero. As simple as hiring more staff, converting to electronic charting, and getting rid of the dry erase board?

Fairly comprehensive comparison between French and US health care systems. Would US doctors take a 66% cut in pay if they got their educations for free, didn’t have to pay for malpractice insurance, and didn’t have to deal with all the insurance company paperwork hassles?

“911, what’s your emergency?” “Yeah, I was kidnapped. So I broke into this person’s house and decided to take a shower. Now the homeowner is here and I think that they have guns.”

32 Responses to “Healthcare Update — 03-14-2011”

  1. ShortWoman says:

    All things considered, Doc and I will remain in Vegas rather than moving back to Texas!

  2. Hueydoc says:

    Sorry I went on a rampage on Rick Bukata’s article on here – see what he thinks about ER’s and potential.

    • Hueydoc says:

      But I love how the Hospital Administrators are “considering taking steps” after their ER doc is beaten unconcious.
      As said here before- what if this happened to the administrators ? You bet your @ss they would be taking steps !

      • Unuh says:

        There are websites on how to kill with one’s bare hands. I wouldn’t have a problem doing this if a patient attacked me. Self defense?

  3. Anon Doc says:

    I guess Dr. Linquist didn’t show enough empathy.

  4. Matt says:

    Is there less malpractice in Texas now? Or just more money for insurers? I can’t remember which WC supports.

    Also, I like lobbying words like “underserved”. They’re awesome!

    So what’s Texas up to in physicians per capita with all this good fortune? 40th?

    • WhiteCoat says:

      Sorry, Matt. Already beat you to the “line the pockets of the insurance companies” comment.

      Guess that the people of Texas chose “available care” over “perfect care.” I know, no one expects that medical care should be perfect, right? So go ahead and give me a couple of examples of mistakes that result in patient injuries where a doctor shouldn’t be subject to a lawsuit. Can’t wait for your nonresponsive strawman argument to that request.

      “What’s Texas up to in physicians per capita with all this good fortune? 40th?”
      I guess you could post a link to one of your misleading graphs of “nonfederal, possibly in residency, we don’t know if they even live in state – much less if they actually take care of patients” doctors to find out …

      • Matt says:

        How exactly do I give you examples of physician mistakes that didn’t result in lawsuits unless I was the victim? Are you saying they don’t exist? Really? Wow!

        Oh, do you have information that says the physicians per capita in Texas has improved? We can count the federal ones if you want, but it doesn’t make much sense to link them to tort reform, since they’ve got immunity.

        Do you have a better way of judging the access besides per capita? I realize statistics may not be your thing, but surely if you’re going to criticize that one you do. . . or did your PR materials not include it? Don’t go thinking for yourself – liable to hurt something that way.

      • WhiteCoat says:

        Ooooh. I must be psychic. Thank you for your nonresponsive strawman argument.

        Over 1 billion physician patient interactions each year in the US and you can’t come up with a single example of a mistake resulting in a patient injury for which physicians should not be liable?
        Thank you for proving my point that many people and most medical malpractice plaintiff attorneys expect doctors to be perfect.

        “The number of doctors applying to practice in Texas has increased by 60 percent, at least 20 underserved counties now have an emergency physician and 12 counties have an obstetrician for the first time in their history.”
        You’re right. That says nothing about “access” to medical care that the patients in those counties have. How silly of me.

      • WhiteCoat says:

        [crickets]
        [crickets]

      • Matt says:

        “Ooooh. I must be psychic. Thank you for your nonresponsive strawman argument.”

        Is that really what you’re reduced to? How sad.

        “Over 1 billion physician patient interactions each year in the US and you can’t come up with a single example of a mistake resulting in a patient injury for which physicians should not be liable?”

        Umm, I’m not sure how familiar you are with privacy laws, or the fact that I’m not a physician, but how would I know.

        I do like your stat though. You’ve often said there are too many med mal lawsuits. Quick question – how many do you expect there to be given that many interactions? (I don’t actually expect a response, since you’ve always refused to answer, but I still hope)

        “That says nothing about “access” to medical care that the patients in those counties have.”

        No, what I said was that says nothing about access in TEXAS. If all those people came from other counties that now have fewer, that really doesn’t tell us much, does it? Or, if they came from rural California and moved to rural Texas, both states with damage caps, how does that prove the efficacy of tort reform? (Again, I realize you’re likely not equipped to answer these basic questions as they would require you to analyze your assumptions, but I’m hopeful)

      • Matt says:

        Did the crickets tell you if there was less malpractice in Texas now? Or is that not something relevant to an insurer shill like yourself?

      • WhiteCoat says:

        Stop trying to change the subject.

        Actually the crickets are telling me that you’re the first ATLA mouthpiece out there screaming about how there should be “less medical malpractice” but you then feign ignorance when you get called out on it.

        So out of hundreds of billions of permutations of hypothetical physician-patient interactions, you can’t come up with a single one where a physician could make a mistake resulting in a patient injury and for which the physician should not be held liable?

        Perhaps you could cite me the section in those “patient privacy laws” that make it verboten to create hypothetical physician-patient interactions.

        I’m just giddy with excitement to learn more about medical law from you.

      • Matt says:

        I think everyone wants less malpractice – don’t you? I didn’t realize that was such a novel idea. Maybe as an insurer shill you’ve become so focused on just paying less money for harm, it never occurred to you to worry about whether not harming at all might be an option.

        In the same way you don’t have the first clue about how to practice law, I don’t have the first clue about how to practice medicine. In fact, you physicians are so sure I don’t, you require expert testimony from other physicians to prove the case against you. Now you’re mad about that? That makes little sense.

        I don’t know why you keep asking lawyers to tell you how to practice medicine. I’d never ask you to practice law – after all, you don’t even know there are court reporters. If you want to know the non-negligent way to practice, ask the experts who testify. They’re the physicians.

      • Matt says:

        Did you figure out the answer to how many malpractice suits you thought there should be out of those billion encounters?

        I’ve only been asking you for a year, so you might not have had time yet to determine it.

        And yes, I readily admit I do not know how you practice medicine in a non-negligent manner. I am not a physician. I am quite confident you could explain it to me, though! But I’m not sure why you’re harping on this though, since all your proposals for “reform” are all about not paying the already injured their full damages.

    • throckmorton says:

      Matt:

      Something else to consider. In Texas, as in many other states, ARNPs are providing more and more care. They are held to a different standard of care and therefore have less exposure to malpractice. This is especially true for independent ARNPs.

      As it has become financially difficult to be a primary care physician and the increased malpractice risk, physicians are shifting out of it.

      If you want to improve care and take care of those who are “victims” of “malpractice”. I would be concerned as the what consitutes malpractice is rapidly changing. A doctor may be successfully sued for missing a one in a million case, but ARNPS are not held to the same standard.

      • Hueydoc says:

        They don’t have the “big Bucks” like doctors, so the sharks,,err,,,lawyers don’t go after them as much . (same reason nurses rarely get sued).
        It is ALWAYS about the money !

      • Matt says:

        If they perform a physician’s duties, they’ll be held to that standard of care I would think.

        If I were a physician, I would make sure my professional boards were making sure that the practice of medicine was not being performed by non-physicians.

        A doctor may be successfully sued for missing a one in a million case. I guess that might be true – you got an example of this?

        And yes, Huey is right – it’s about money. You can’t sue to get the damage undone. You doctors like to be paid with money right? So if one of your colleagues negligently injures someone, will you waive payment for their future care?

      • Hueydoc says:

        For lawyers, it’s always about the money. We doctors may or may not get paid for what we do. You still didn’t mention about nurses not being sued.

      • Matt says:

        We lawyers may or may not get paid for what we do either. And unlike physicians, the majority of the income flowing our way doesn’t come from solvent parties like insurers or parties who can print their own money like the US government.

        Stop acting like the world’s highest paid profession got that way by doing nothing but charity care. And when you do work expecting to get paid but the patient/client stiffs you, that’s not charity – it’s a bad debt.

        What about nurses getting sued? Usually their employer is liable under the theory of respondeat superior so they pick up the defense and cost.

        Stop with the “my profession is holier” nonsense. You provide a professional service for a fee. Just like a lawyer does. And you get paid very well for it, as you should. Quit pretending otherwise.

  5. Matt says:

    It is nice to see WC almost understand the basic concept of more people to buy services equaling more providers of those services.

    • WhiteCoat says:

      Is this comment referring to the number of malpractice plaintiff attorneys in South Africa after the number of high-value judgments increased by 900%?
      If so, that’s a pretty sad commentary on your value system.

      • Matt says:

        Look at you, trying to do worldwide comparisons of legal systems when you barely understand our own.

        I note though, that you always seem concerned about how much the victims received, much more than the injury they suffered or quality of care they received, or the fact that much of the money they receive goes back to pay. . . . you guessed it, past and future medical bills. The fact that they are victims of malpractice, and that high judgments typically mean lots of medical bills, past and future, doesn’t bother you much. Tell me, if the responsible party doesn’t pay for the harm they cause – who do you think does? (Two guesses, and the first one doesn’t count)

        You seem to care more about whether your insurer pays a judgment than whether the victim can pay their future medical bills, or the taxpayer has to do so. Wait a minute – have you gone to work for an insurer? Caring more about that than the quality of care would seem to indicate you have.

    • Switchhitter says:

      Matt, are you a plaintiff’s attorney or a defense attorney?

      • Matt says:

        Neither exclusively. I represent both sides in civil lawsuits. If a physicians sued his partners in a dispute over splitting up, I’d be just as likely to represent either side.

        In personal injury claims, about 30% of my practice, I’ve been on the defense side, but for the last 10 years plaintiff – I don’t feel like arguing with insurance companies over literally aspect of my bill anymore – you physicians know what I’m talking about there I bet. No medical malpractice claims in years, and those weren’t complex ones so I wouldn’t dare call myself a med mal attorney.

  6. Pudortu says:

    I wonder what Kevin md would say about that doc getting his ass kicked. NOT THE PATIENT’S FAULT

  7. Matt: What do you think? Night riders bring street justice to the lawyers protecting these violent patients. Beat their asses. To deter.

  8. There are far more victims of lawyer errors of omission and commission than of medical errors. Yet, the lawyer has nearly absolute immunity, all self dealt.

    If liability is a substitute for violence, then logically, the obverse is true. Immunity fully justifies violent self-help.

  9. The fact that most EDs are labelled “weapon-free zones” doesn’t seem to prevent all the violence. It does prevent staff from efficiently protecting themselves from a crazed gunman on the premises. Just wait five or 10 minutes until the police arrive.

  10. ER Jedi says:

    Having gotten my start in medicine by doing emergency room security… I can say we got paid no where close to $60 an hour. More like $15.

    • Hueydoc says:

      Once we had an off duty deputy moonlight his first night as hospital security in the ER.
      His comment was priceless. “You deal with the same @ssholes WE do all the time!”

  11. [...] and good nursing homes, researchers find [US News] Effects of medical liability reform in Texas [White Coat, scroll] New York’s Cuomo caves on medical liability plan [Heritage] Sued if you do, sued if [...]

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