Also see the Satellite Edition of this week’s update over at ER Stories‘ resurrected blog.
Patients gone wild goes international. High patient volumes and lack of adequate staffing cause patients to become “aggressive over lack of service” in Australia. “Five or six” nurses assaulted in one week. Note to patients: Assaulting nurses won’t get you faster care or better care. Trust me.
West Virginia plaintiffs awarded $91.5 million after jury decides that dementia-stricken parent died from lack of sufficient food and water over a span of 3 weeks. Plaintiffs successfully argued that the nursing home was not properly staffed, leading to the patient’s death. Defendant nursing home vows to appeal, alleging that the state’s $500,000 damage caps should apply.
Not really sure what kind of leap of logic required to make this connection, but a man in New Jersey sued his doctor for prescribing him Ambien for insomnia. The patient was *allegedly* inspecting a gun after taking Ambien, woke up to the telephone ringing, the barrel of the gun just happened to be in the patient’s mouth, and the patient just happened to pull the trigger of the gun when he woke up.
Two lower courts said that the case should be thrown out. The New Jersey Supreme Court reinstated the case, giving the plaintiff additional time to find an expert willing to state that his case has merit. So far a psychiatrist and an emergency physician have affirmed the case has merit. Hopefully the family medicine experts will have more common sense.
Personally, I think the injury was caused by the patient’s garden gnome. I just don’t trust those things.
Hurricane Irene is beginning its trek up the East Coast. The damage from the storm is predicted to be horrific.
Any of you self-righteous attorneys from New Orleans want to post a comment prospectively telling all the hospitals everything that they need to do in order to avoid being sued for an “inadequate response” to this natural disaster? Any experts in disaster preparedness want to chime in?
Yet when some patient gets a fleck of dust in their eye from the 120 mile an hour winds after the storm has passed, based on the recent $25 million settlement from Katrina lawsuits, I’m betting that the attorneys will be falling over each other to file lawsuits to retrospectively tell everyone what the hospital did wrong in preventing said speck of dust to become airborne and lodge in the patient’s cornea, though. God forbid that a hospital’s backup generator breaks down. Just sign a check.
While I’m at it …
Any person living east of the Mississippi River is hereby put on notice that a hurricane is coming. You need to take adequate measures to protect yourself from any potential injury or death from the hurricane. This may include moving yourself out of any hospital within 300 miles of the hurricane and relocating yourself in a hospital west of the Mississippi River.
While traveling to Chicago for a class that one of our daughters took earlier in the week, my wife was in the city for a total of about 15 minutes, was stopped at a light using the GPS function on her phone to find an address, was pulled over by a police officer, and was promptly given a $100 ticket for violating some ordinance about using handheld mobile devices without an earpiece.
As if the earpiece would have made any difference in mapping out the address.
Same 15 minute ride into Chicago to drop off my daughter at this class the following day. This time I drove and my daughter brought my camera. During those 15 minutes, my daughter snapped pictures of 10 different police cars, one tow truck on the prowl, and one traffic cop gabbing on her Bluetooth with enough tickets sticking out of her pocket to choke a horse.
Oh, and if you need to park for more than a few hours, it will cost you a cool $37.
In case anyone was wondering, I am a rude racist doctor who discriminates against poor people and who has no idea how to provide medical care for children.
This message was transmitted to the emergency department nurse, the nursing supervisor, the Director of Patient Affairs, and the secretary to the hospital CEO.
Want to know why?
I didn’t write a prescription for over-the-counter antifungal cream to treat a 3 week old case of ringworm on a 13 year old patient.
The caller kept asking “So what, is it a ‘race’ thing, a ‘Medicaid’ thing, or is it just that the doctor doesn’t want the state to pay for the medicine?”
Since most patients are happy to know that they can purchase a $5 tube of cream over the counter to treat their problem, and since the docs don’t know a patient’s insurance status when in the emergency department, I picked “none of the above.”
A patient came in with the following chief complaint:
The FBI told me to come in for evaluation
The patient’s wife followed behind him, telling the nurse that the patient had “lost it.”
OK. Paranoid delusions about the FBI calling him. No problem.
“No,” the wife stated, “the FBI really did tell him to come in for evaluation. I talked to the agent.”
It seems that Barack Obama was projecting visions of himself into the patient’s brain and was able to communicate with the patient telepathically — a la Obi Wan Kenobi. Mr. Obama was getting jealous of the patient due to the President’s stress and because the patient had so much freedom in his daily life. Therefore, the President telepathically told the patient that he was going to send a hit squad to “get rid of” the patient. The patient then called the Secret Service, the White House, and the FBI, demanding that they arrest Mr. Obama and foil the President’s assassination plot.
Well, Mr. Obama is still at large, and the patient ended up with a nice long wait in the ED while we made reservations for a stint in a psych facility.
I’m thinking that if the fellow just called Rush Limbaugh, or maybe George Noory, none of this would have happened.
In fact, he would probably have gotten some good air time.
While we were playing with a laser light with our dogs, I was reminded of a story about how I was accused of causing a patient’s pneumothorax with a laser light while I was a resident.
During our internal medicine training, senior residents had to run the intensive care unit for several months out of the year. One resident had responsibility during the day on weekdays, several other residents switched off taking call during the nights, and a resident with two interns shared 24 hour call on weekends.
Students often used to jockey for calls based upon which resident was working. Some residents were bears to work with at night, whining about everything and yelling at the medical students. Others did a lot of teaching and let the students assist performing lots of procedures.
So one fateful morning during grand rounds, I happened to notice that one of my fellow residents was falling asleep and doing the head-bobbing thing.
I grabbed a laser light out of my back pack and shined it on his nose. That made everyone around him start giggling. His head bobbing then caused the laser light to hit his eye, which startled him out of sleep and caused him to gasp loudly, let out a muffled yell, and swat his arms around his head as if a killer firefly was attacking his face.
The lecture stopped momentarily while he bent back over and said “Ahhhh. My contact lens!”
When he retrieved his contact lens from the floor, it had been torn and was unusable.
Ooops.
So what does any of this have to do with the pneumothorax?
It just so happens that the sleeping resident was scheduled to be on call that evening. He was one of the residents that the medical students were not especially fond of.
With a ripped contact lens, he wasn’t able to do call, because he couldn’t see without his contact lens.
The only resident that was able to take his call that evening was one of the “nice” residents that liked teaching medical students.
Later that evening, while the “nice” resident was taking call, a patient needed a central line. The resident was teaching one of the interns how to insert the central line and the intern accidentally hit the lung with the needle, causing a pneumothorax – a known complication of central line insertions.
Of course, guess whose “damn laser light” got blamed for screwing up the call schedule and putting the nice resident on call who assisted the intern who caused the pneumothorax.
Florida is back in the news again. After creating legislation to criminalize medicine, creating a three strikes law where doctors lose their license if they lose three malpractice suits, and having some of the highest malpractice premiums in the country, a funny thing seems to be happening. Florida doesn’t have enough doctors. Now Senator Bill Nelson from Florida came out with a press release stating that “Florida desperately needs more doctors” and describing how Florida is increasing the funding for residency training in the state in an attempt to increase the number of doctors in the state.
Without creating a better environment in which to practice medicine, most of the residents will leave once they finish their training.
Remember that whole “perfect care versus available care” dilemma? Why would doctors want to practice in Florida when there are states with much better practice environments?
New York is another state in which medical care is tanking. An Op Ed piece in the NY Post by the creator of health care reform in Texas shows some compelling facts. Nearly 1,300 physicians have left New York for Texas since 2003. The number of physicians in Texas has almost doubled since tort reform was enacted. Total amount for malpractice claims was eight times higher in NY than in Texas. Charity care in Texas is up by $500 million per year. After tort reform was enacted, Texas added more than 2 million patient visits per year.
Perfect care or available care?
What specialties get sued the most? You probably knew the answer – neurosurgery, cardiovascular surgery, and general surgery. By age 65, 99% of physicians in these specialties have been sued. Emergency physicians are sued just a bit more than the average for all physicians. Pediatricians paid out the most per claim, on average forking over $520,000. And only 1 in 5 cases leads to a settlement or other payout. That must mean that 80% of the filed medical malpractice cases are frivolous, right?. Read more findings in this NEJM study.
Sprained ankles straining resources in the emergency department? An article in Clinical Orthopedics says so. The authors want patients with lower extremity injuries to call an emergency phone number to get a visit with a doctor during regular business hours. Is the study another way of saying that emergency departments are taking a bite out of some orthopedists’ bottom lines?
What types of cases come through the emergency department at night in Sydney, Australia? Read this article to find out. Hard to believe that wearing the color black has to do with any of the injuries, though.
Wild story about emergency department director who was convicted of giving drugs to patients for sexual favors. He served a year in prison until the conviction was overturned. As you read the facts of the case in this well-written article, you can see why the doctor is now suing the prosecutor, the police detective, and the local and county governments for falsely accusing and convicting him. Wow. Shows what can happen to seemingly innocent people at the hands of an allegedly corrupt government.
Contrast the Carlisle case with the situation in Canada. This article notes that overcrowding in Canada results in many who need to be admitted waiting on stretchers for up to two days. Most patients are seen by a doctor in 24 hours, though. I think that Pennsylvania’s Health Department would go into convulsions in Canada.
I know the waits are long, but can’t you just read book or watch TV? Guy sitting in a hospital emergency department waiting room decides to flash his “business” to little girls. By the way, the newspaper needs to choose a different headline. “Man with history of exposing himself to children held“? That just conjures up the wrong images in my mind. What exactly was being “held” and who was “holding” it … er, um … him? I mean the guy.
According to a CMS spokesperson, two violations relating to infection control and emergency care issues were “so serious that they triggered ‘immediate jeopardy’” for the hospital. In fact, the reasons for the citation were so heinous that CMS won’t even disclose them to the public until Parkland submits plans on how to fix those super secret problems. That’s the subject of another WTF discussion, but we’ll save that one for later.
The event triggering the CMS investigation involved a schizophrenic psychiatric patient with a heart condition who died while in the emergency department. The report states that the technicians who subdued the man did not have “effective training” and that the patient was not closely monitored before his death.
According to the article and an interview Parkland’s Chief Medical Officer, Parkland was cited for several reasons. Based on what I can gather from the article, two of the hospital’s citations were for:
- Moving patients with less serious symptoms to a separate urgent care center for medical screening
- Staff touching a patient and then touching other surfaces that people would come into contact with
Think about how grave these dangers are.
When a patient is more than 20 weeks pregnant and has abdominal contractions, what happens when she comes to the emergency department? She gets put in a wheelchair and brought directly to the obstetrical department for further evaluation. So by virtue of their presenting complaint, some pregnant women are immediately sent to a different department for medical screening. This process is apparently acceptable for CMS because it happens everywhere in the country.
Suppose the same 20 week pregnant patient has a hangnail instead of being in possible labor. Now, instead of moving the patient to obstetrics for pregnancy evaluation, Parkland was moving the patient to its urgent care department for further medical evaluation.
Both “moves” are made based upon a patient’s presenting symptoms. However, when a patient with one presenting complaint is sent to one area of the hospital for further evaluation, it is entirely acceptable while sending the same patient to a different part of the hospital for a different presenting complaint constitutes a “serious violation” and a “threat to patient safety” that must be stopped immediately.
Makes perfect sense to me.
Then there’s the “let’s have a sterile universe” violation of epic proportions.
Touching a patient and then touching surfaces that other people may contact is a “serious and immediate” health threat? Let’s see this logic. I’m assuming that the government means that it is a serious health threat to potentially transfer germs from one person to another.
What should healthcare providers do in order not to create a “serious and immediate health risk”?
All bathrooms must be completely sterilized between each use. After all, one patient could come into contact with a surface that another patient touched.
Doorknobs to all hospital doors must be sterilized after every person touches them. After all, one patient (or worse … a visitor [gasp]) could come into contact with a surface that another patient touched.
Beds. Walls. Chairs. Everything must be sterile, dammit. Otherwise, we’ll all crumple up and die like those things on War of the Worlds.
Do I think that medical providers need to wash their hands more frequently? Of course.
Could we do a better job at controlling infections all over the world (not just in hospitals)? Sure.
Is there any basis in medical science showing that avoiding contact with surfaces after touching patients will control infections when no other fomites are addressed? Not a shred.
What if a patient touches a surface in a common area directly? What if a patient touches the registration desk? What if a blood pressure cuff is put on the surface after being used on the patient? What if a hospital gown touches the floor after a patient used it? What if the patient was going through the drawers without the medical staff’s knowledge?
Maybe we should just bug bomb every hospital in the US every hour on the hour.
Got, that, Parkland? Put that in your plan of action. Bug bomb the hospital every hour on the hour and have a steady stream of alcohol sanitizer spraying from sprinkler heads. That’s the only way you’re going to keep your Medicare privileges.
I’m sure that CMS has more infection control violations in its own offices than Parkland has in its hospital. You CMS wonks sterilize your computer keyboards much? Door handles? How about your telephones (when you answer them, of course)?
And what is CMS’s official position on presidential candidates shaking hands during election campaigns? I don’ t see the candidates washing their hands between shakes. Nope. Nary even a squirt of alcohol sanitizer. Those germ infested malevolents are engaging in a serious and immediate risk to the health of every prospective voter at these rallies! They’re like giant bumblebees pollinating the population with deadly germs! GACK! Call off the elections!
Unless CMS is holding back on some other huge bombshell about Parkland’s practices, labeling the above triage policy and infection control violations as “serious and immediate threats to patient safety” is alarmist, capricious, and just plain wrong.
And we wonder why health care in this country is in such a wonderful state of affairs right now …
I’m not going to start political debates on this blog, but I had to post a couple of things relating to how the Republican race is shaping up.
First, is John Stewart’s rant about how the mainstream media is treating Ron Paul like the “13th floor on a hotel”. Paul came in second in the Ames straw poll, but few in the mainstream media seem to be mentioning his name.
Then is Steven Colbert’s discussion about the Ames Straw Poll itself.
Apparently it is common practice for candidates to give away admission tickets to the straw poll. Bachmann’s campaign purchased 6000 admission tickets at $30 apiece and distributed them to her supporters. Unfortunately, only 4823 people voted for her in the straw poll. Paul gave out 4,750 tickets and got 4,671 votes. Colbert notes that “Bachmann got a commanding 80% of the votes she paid for.”
Hey – ERP started posting again on his ER Stories blog. Go take a look for more posts from him and for the satellite edition to this week’s update.
Deadly fungus infection adds insult to injury in Missouri tornado survivors. Thirteen patients were confirmed to have a cutaneous mucormycosis infection, ten required admission to ICUs and five patients died. All patients had open wounds and six required foreign body removal from the wounds. The fungus is typically found in the soil and in decaying wood. Mortality from the infection can be up to 80%!
More patients gone wild. Patient under arrest brought to emergency department and given stitches, then, while being discharged, fights with police officer and tries to take officer’s gun. Nurse, doctor, and EMT jump on patient to assist officer … which will surely end in a JCAHO citation because milk and cookies were not readily available as a “less restrictive” means of subduing the patient before he was able to disarm the police officer and shoot up the emergency department.
Another amazing story about a 31 year old woman who passed out and died in front of her husband — and was then revived by EMTs and emergency personnel. Lots of emotions on her reunion with hospital personnel.
Then there’s the quote in the article about how the ED physician says they “put in a little extra effort with younger patients.”
Hurricane Safety, Part Deux
Saturday, August 27th, 2011Any of you self-righteous attorneys from New Orleans want to post a comment prospectively telling all the hospitals everything that they need to do in order to avoid being sued for an “inadequate response” to this natural disaster? Any experts in disaster preparedness want to chime in?
Anyone?
Bueller?
Bueller?
[crickets]
Yeah. Didn’t think so.
Yet when some patient gets a fleck of dust in their eye from the 120 mile an hour winds after the storm has passed, based on the recent $25 million settlement from Katrina lawsuits, I’m betting that the attorneys will be falling over each other to file lawsuits to retrospectively tell everyone what the hospital did wrong in preventing said speck of dust to become airborne and lodge in the patient’s cornea, though. God forbid that a hospital’s backup generator breaks down. Just sign a check.
While I’m at it …
Any person living east of the Mississippi River is hereby put on notice that a hurricane is coming. You need to take adequate measures to protect yourself from any potential injury or death from the hurricane. This may include moving yourself out of any hospital within 300 miles of the hurricane and relocating yourself in a hospital west of the Mississippi River.
Is that enough to prevent people from suing?
Posted in News Commentary, Random Thoughts, Uncategorized | 3 Comments »