WhiteCoat

Healthcare Update — 06-27-2011

A different kind of deadly epidemic. Armed robberies at pharmacies rose 81% between 2006 and 2010. Then number of pills stolen now tops 1.3 million. Not surprisingly, the criminals are taking opiates such as oxycontin and Norco. One New York robber walked into a pharmacy and shot without warning – killing the pharmacists and two customers.

Many times it isn’t your negligence that causes the car accident – it’s the other person’s negligence. Here could be one reason why: Eleven percent of day drivers and fourteen percent of night drivers have drugs in their system. Six percent of day drivers and ten percent of night drivers have illegal drugs in their system. Oh, and if you live in California, you’re more likely to see drivers with “medical marijuana” in their system.

Speaking about California … their Medi-Cal Medicaid system is proposing many cost saving measures, including cutting provider pay by 10% and requiring that patients make co-pays for medications, doctor visits, and $50/day for non-emergency ED visits, and up to $200 for hospital stays.
Ratchet up the heat another notch on all us frogs sitting in the pot of hot water called medical care.

A common intestinal infection “powers up” to cause many life threatening infections in Germany.

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Pennsylvania jury awards $21 million to noncompliant diabetic patient who suffers brain damage after leaving the emergency department. Max Kennerly discusses the strange defense strategy – one doctor denied involvement in the case and two other doctors “disputed [his] account. When reading the facts of the case, it I don’t see where the negligence came in. The patient was observed for nearly 4 hours and his blood glucose level was stable, which meets the standard of care. Facts don’t show why the patient suffered brain damage, though. The patient had a complicated history. Was it low glucose, alcohol-related, psychiatric medication related, or some other issue?

Boaz, Alabama Fire and Rescue department debuts $172,000 “ER on wheels.” Now all they need is a “waiting room on wheels” to go with it ….

St. Louis University shuts down emergency department when man with burns to his hand and leg mentions that he has some of his “homemade fireworks” in his car parked outside.

Waiting times in Canadian emergency departments not so good. The manner of reporting wait times is odd, but doesn’t seem to be encouraging. Ninety percent of seriously ill patients at Ontario’s Joseph Brant Memorial Hospital wait “up to” 25 hours before being admitted or discharged from the emergency departments. Many other hospitals are hovering around the 18 hour range. Ninety percent of minor ailments wait “up to” 4-7 hours at the various hospitals in the region.

More issues with wait times in Canadian hospital emergency departments. Windsor Regional Hospital sees delays in evaluation and testing climb substantially because of increased patients, decreased staff, and lack of available beds. But the care is free, though.

Maggie Mahar creates a long post with her take on medical malpractice myths and realities. Are her opinions on the mark or off base?

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Complexity of health care reform bill could make Medicaid open to middle class. Medicaid was supposed to cover only patients at or near the poverty level of $14,710. However, under the health reform law, a retired married couple with total income of $64,000 could still be eligible for Medicaid. Now the administration is promising to find a “fix” to take health care away from the middle class.

Milwaukee area hospital charges $1,771 to remove a tick from a patient’s leg. Patient and commenters to the article are outraged.
To me, this is another argument for transparency in pricing and free market medicine.

South Dakota hospital planning to close unless Indian Health Services coughs up at least half of the nearly $1 million it owes the hospital for emergency care of Pine Ridge Indian Reservation residents. Indian Health Services denies owing the money, stating that it only pays for “priority emergency care” for those patients. In other words, IHS apparently wants the emergency departments to “street” any reservation inhabitants that don’t have “life, limb, or sense” threats.

US Supreme Court decides whether to reconsider the Feres Doctrine which prevents military personnel from suing military doctors for medical malpractice – even in the event of obvious negligence. The case being decided involved a healthy 25 year old who became short of breath while being prepared for an appendectomy and who later died after the nurse anesthetist tried to resuscitate him with children’s breathing equipment and then put the breathing tube in his esophagus instead of his trachea.
The article notes that, according to the Congressional Budget Office estimates, allowing military personnel to sue for medical malpractice lawsuits would cost the government an extra $2.7 billion over 10 years.

Finally, there are several great articles in EP Monthly this month. If you’re involved in emergency medicine and you don’t subscribe, you should. Request a monthly print edition at this link: http://www.epmonthly.com/subscribe/renew-online/

Wild account of an emergency physician who nearly dies after a grease fire in his kitchen.

Greg Henry is mad as hell about violence in the emergency department. Do a search for “patients gone wild” in this blog. You’ll see that he has a good reason for his anger.

EP Monthly executive editor Mark Plaster writes about how a physician reviewing the medical care of a patient who died can be a tremendous emotional benefit to patients’ families — malpractice suits aside.

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22 Responses to “Healthcare Update — 06-27-2011”

  1. Max Kennerly says:

    Per the article, “Duffy said they argued to the jury that because Campbell had visited the emergency room Oct. 11, 2007, due to a severe episode of hypoglycemia, and returned to the emergency room two days later for the same issue, it was a breach of the standard of care to release Campbell without admitting him and investigating why Campbell was repeatedly having hypoglycemic episodes.”

    I would normally understand why the hospital didn’t make big offers on that theory, but for the dispute between the emergency physicians over who treated the patient, apparently leaving open the real possibility that no one at all would take responsibility for the decision. That never goes over well; it’s a hell of a lot harder to argue that a decision was appropriate when no one will own up to it.

    I highly doubt Duffy will try to hold on to that verdict through appeal. It’ll likely settle for something much lower.

    • WhiteCoat says:

      I agree with you.
      If I was one of the defendants in the case, I would have testified that I was solely responsible for the care and that the care was appropriate under the circumstances. From what is described, the care was appropriate and completely defensible.
      Wonder what the issues on appeal are going to involve. Not really seeing appealable issues in the fact pattern.

    • Marilyn says:

      Seems to me that the patient knows he has a problem managing his glucose level and he shouldn’t be using the emergency department to figure it out. He needs to be with his endocrinologist. The responsibility of the ED is to stabilize his dangerous condition. The detective work is up to his regular doc…

  2. Wayne Conrad says:

    Re: Myths about Medical Malpractice: A big deal is made out of medical malpractice cases winning less less often than other personal injury cases, but imagine if medical malpractice cases had better awards, overall, than other personal injury cases. Lawyers on contingency would be more likely to take a marginal case, the larger potential payout making up for the lower odds of winning.

  3. Matt says:

    “The article notes that, according to the Congressional Budget Office estimates, allowing military personnel to sue for medical malpractice lawsuits would cost the government an extra $2.7 billion over 10 years.”

    I wonder if this deducts the cost of the actual care resulting from the injury, which if they’re already eligible for VA care, the government would be paying for regardless.

    • WhiteCoat says:

      Isn’t it a wash?
      Government either pays money to patient in settlement and then patient pays for care or government pays directly for care.
      What’s the difference?

      • Matt says:

        My point exactly. So why add the stat? Whether this changes or not doesn’t change the cost.

  4. hashmd says:

    In California, the Medicaid system only pays a per diem of about $150 per day. So a co-pay of $100 per day would mean the hospital would really only get $50 per day and have to write off the other $100 per day.

  5. Maggie Mahar says:

    Matt,

    You make an excellent point.

    The cost of malpractice settlements includes the cost of medical care needed to treat the patient after the injurty.

    If the injured person is in the military, the government would, as you say, wind up paying for that, “regardless”.

    If the injured patient is not in the military, society (i.e. taxpayers and everyone who buys health insurace) winds up helping to pay for the medical care that the injured patient needs

    The American Enterprise Institute, a conservative non-partisan think tank, points out that if we make it harder for injured patients to sue, “The resulting reduction in insurance payouts and malpractice
    premiums is largely a redistributive transfer, . . . Tort damages transfer wealth from health care providers to injured patients.
    Reducing those awards will transfer wealth in the opposite direction, but does not by itself
    constitute net ‘savings.'”

    When malpractice awards are capped,malpraqctice insurance companies and hospitals responsible for negligent care save money. Patients, and the taxpayers who help indigent patients (through Medicaid) lose money.

    Conservatives generallly support capping malpractice awards, so the AEI is being extremely honest in pointing this out. (Hat tip to the AEI)

    • Matt says:

      Maggie, two things.

      1. The transfer isn’t from providers to patients. It’s from insurers to patients.

      2. You’re correct that “conservatives” generally support tort reform. Which is odd when you consider their anti-government stances in other matters.

      • Hueydoc says:

        The reason that most doctors are “conservative”?
        We worked far too hard to get where we are to be a Liberal. We see the “poor” scamming the system everyday.
        We are against government intrusion because we have seen what the government intrusion has done to our once fine healthcare system.
        And most of all, we usually personally know ( or ourselves have been ) doctors who were sued for no particular reason.

      • throckmorton says:

        Matt:

        Where do the “insurers” get the money?

      • Matt says:

        For all their alleged conservatism, I don’t see the docs rushing to get away from a healthcare system that has the government paying 50% of all expenditures, and growing.

        Nor is there anything “conservative” about tort reform.

        Throck, insurers make money primarily from their investments.

    • throckmorton says:

      matt:

      Where do they get the money to invest?

      • Matt says:

        Premiums, but that’s not where they make their money. Many write premiums at a loss just to get the investment funds. Which works until the market crashes – then we’ve got ourselves a “crisis” and the AMA maps come out.

  6. doc99 says:

    Disclosure, NY Judge McKeon’s early settlement conference, and Health Courts would go far to reform the present system without depriving anyone the opportunity for his day in court.

    • Matt says:

      Depends on what you mean by “health courts”. Every version I’ve seen is just back door damage caps, and shifts a lot more costs onto the taxpayer.

  7. Steve says:

    Found this on CNN.com today…patients billing doctors for their lost time…

    http://www.cnn.com/2011/HEALTH/06/30/time.worth.money.cohen/index.html

    I think its pretty ludicrous…while a bottle of lotion or soap- something of token value- may be appropriate getting a check for 100 bucks is jaw dropping. While other service industries may do something similar by providing “satisfaction guaranteed” or something of token value, if you asked them to reimburse your lost time at that rate, they would laugh in your face.

    100 bucks to keep one patient happy? I know that losing 1 patient usually means losing more due to word of mouth but if this was a primary care appointment you probably just paid her more than you got reimbursed for that visit.

    And it would be nice to say that this won’t happen in the ED but it already is…

  8. Maggie Mahar says:

    Matt, throckmorton & White Coat

    Throckmorton makes a good point. The insurers get the money from hospitals and doctors who pay premiums.

    Matt– You’re absolutely right about the high cost of bringing a mapractice claim. The lawyer who brings the claim usually pays these costs upfront. They include: hiring expert witnesses (in some states, he needs another physician willing to testify that the provider was negligient just to file a claim. Normally, that doctor is paid as an expert witness. And they are very expensive.) He also must pay the costs of “discovery”–huge–sorting through the thoudands of documents the hospital will send him when he asks for evidence of “what happened.” Litigators explain that the goal is to “bury the other guy in paper.” Then there are the depositions, and finally if the case goes to trial, the costs of the trial itself.

    When independenet physicians at Harvard reviewed thousands of claims in their own speicalties, they found that juries favor doctors and physicians over plaintiffs. In 16% of cases where the physician investigators thought there was negligence, the
    plaintiff received no reward. Overall, plaintiffs win significanctly less then half of all cases.
    Then the plaintiff’s attorney receives nothing and must “eat” the expenses.”

    Awards of $1 million or more are rare. But they make the headlines and lead people to think that plaintiff’s attornies make a fortune.

    White Coat — the median award varies widely depending on the severity of the injury. When the patient is left “brain damaged, paraplegic, in need of care for the rest of his life” the average award is over $600,000. That is the most expensive category (numbers from practioners’ data base.)

    When the patient dies as a result of negligence, the median award is less than $200,000. (Often these patients are over 65 and no longer working, so their is no compensation for lost wages.) When the injury is “major and permanent” the award is somewhere north of $350,000. After expenses, It’s very hard for a plaintiff’s attorney to break even on an award of less than $250,000.

    When the injury is not major patients can rarely find a lawyer to take the case. Evidence shows that plaintiff’s attorneys turn away many more cases then they accept. In reality, very, very few frivlous claims are brought (though patients may threaten to sue.)

    The average malpractice claimtakes 4 1/2 years.
    from injury to settlement. This demands a huge amount of time and expense for the plaintiff’s attorney. This is in no way comparable to a lawsuit over an auto accident

    See part 2 of my malpractice post on http://www.healtheatblog.org. I should be posting it late today or tomorrow. Many suprising facts.

    I think our current system is “inhumane” both to
    plaintiffs and to doctors. In part 3 of the post, (which will go up next week) I talk about solutions that would be much more humane, fairer to both parties, cost society far less, and actually reduce medical mistakes. There is much that hospitals could do to increase patient safety.

    I also quote heavily from an excellent working paper that was written for the conservative American Enterprise Institute and published just two months ago.

  9. Hueydoc says:

    Whitecoat-
    You seem to have quite an infestation of lawyers on here lately.
    I recommend spraying a concentrated solution of “Loser Pays” quite vigorously.

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