WhiteCoat

Healthcare Update — 12-05-2011

Also see more medical news from around the web over at the Satellite Edition of this week’s update at ER Stories.

Whooping cough resurgence in New York. More than double the number of cases than occurred in the next-largest outbreak in 2006.
I renew my assertion that vaccinations should not be mandatory, but that parents who fail to vaccinate their children should be charged with endangering the welfare of a child and should incur civil liability if their children contract preventable communicable diseases or transmit those diseases to others.

Now from the “how else can we justify our existence” department. JCAHO is considering whether to regulate “overuse” of health care treatments, procedures, and tests. That’s right, boys and girls, soon the clipboard brigade will descend upon hospitals and start throwing out citations if too many CT scans or surgeries are performed.
You’ll have to click on the “read more” link at the above site to read about it. I avoided pasting into the story the unique URL that the link generates.
That got me thinking. When is someone going to do a study showing how JCAHO is a threat to patient safety?

Patients gone wild. Illinois man gets a twofer. First he’s arrested for breaking a car door at a bowling alley parking lot. Then he is arrested again after going to the emergency department and attempting to punch out a female emergency physician, hitting her in the ribs.

Who are you freaks and what did you do with Bullwinkle? Flying squirrel gets loose in emergency department, repeatedly jumps from light head-on into glass window.
In other news, PETA is now considering whether to pursue an EMTALA action against the hospital for failing to perform a proper screening exam before releasing the animal into the wild.
And in still other news, JCAHO is considering whether to declare glass windows a threat to patient safety because patients *could* make the same mistake and run head-on into glass, killing or seriously injuring themselves.
Hat tip to hashmd for the story.

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Double double toil and trouble. New York woman criminally charged for “self-abortion” after drinking herbal concoction allegedly intended to cause abortion, then aborting her fetus.

Chicago area hospital system settles birth injury case for $7.5 million.

Navy SEAL dies in hospital from “preventable causes.” Family awarded $4 million. Overdose of painkillers was suspected, but Maricopa Medical Center in Phoenix was able to keep the records secret under Arizona quality assurance law.

The problems with government “insurance.” When federal payments don’t cover the cost of care, states seek to decrease payments to providers … which decreases the number of providers willing to provide medical care at a loss … which decreases access to care.
Arizona hospitals sue to block cuts in Medicaid reimbursement. They argue that the cuts will shift cost of care to insured patients who have to pay more money for their care.
Meanwhile, California is planning to cut Medi-Cal payments to providers by 20%, which will impact the access to medical care for more than 7 million California residents. If the cuts are enacted, “half the state’s hospitals that run skilled-nursing units said they would close them” and “another 35 percent said they would reduce beds or end service to Medi-Cal patients.”

Yet another reason not to practice medicine in Florida — it has three of the top ten “saddest” cities in the US. I’d be sad, too if I could lose my license after three successful malpractice cases, with criminal charges against physicians and pharmacists, with high malpractice rates, if lawyers forced me to sign a contract invalidating statutory contingency fee caps before they took my malpractice case, state investigators cite physicians for failing to save a 13 week old fetus, etc, etc, and so on.

Scary trend. Another patient drives to the hospital emergency department then shoots himself dead.

Missouri hospital tries new tactic to shore up bad debt in the emergency department — holding prescriptions hostage. Patients will all be evaluated in the emergency department, but won’t get their prescriptions on discharge until they either pay their insurance co-pay or pay at least a $40 down payment toward the bill for their care. That policy will end as soon as the first asthma patient dies from no steroids and lack of access to a rescue inhaler after an asthma exacerbation.

You think it’s so easy, then YOU try to meet the guidelines. American College of Cardiology recommends that patients with acute MI be transferred to a hospital capable of performing PCI within 30 minutes. Study in the Annals of Internal Medicine shows that the median time to transfer is double that. Heck, just filling out all the paperwork takes 30 minutes. But just think about how safe that government regulations and lawsuit fears are making all of us …

Does this mean Congress should be held as a bunch of “enemy combatants” for passing that health care law? Secretary of Health and Human Services Kathleen Sebelius said Thursday that America’s health “really is a matter of national security.

The dog must have been an Al Qaeda operative. Kentucky couple comes to emergency department with runny nose, burning skin, dizziness and headache after coming into contact with stray dog. Soon, hospital staff came down with same symptoms. Then hospital goes on lockdown while Haz-Mat crew investigates.

Finally, a video to get you feeling all kinds of Christmasy in this holiday season, courtesy of the Drudge Report. Homeless woman, when discussing her 15 children and how she isn’t getting enough social services to care for them all states “Somebody needs to pay for all my children,” and “somebody needs to be held accountable.” The video is apparently several years old, but has resurfaced as a “flashback” and now seems to have gone viral. As the great Glenn Reynolds says on Instapundit … “How’s that Hopey Changey thing working out for ya?”
As an update, this video was being discussed on a radio station in our area and one of the callers made a comment “Ma’am, it’s a uterus, not a clown car.” Ouch.

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22 Responses to “Healthcare Update — 12-05-2011”

  1. Hueydoc says:

    If terrorists were to blow up JCAHO, would anyone care ?

  2. Matt says:

    Despite the claims of Florida’s misery, it still is about middle of the road when it comes to physicians per capita, well ahead of states such as Texas – about 20% more in fact.

    Why? Because Florida is and likely always will be a place with a high number of comparatively wealthy elderly people needing medical services, it will always do just fine in terms of physicians per capita. If you go even deeper, you’ll find that on a county by county basis the wealth-physician population correlation as well.

    Not hard to understand why, and there’s absolutely nothing wrong with it. Any smart physician, or other service provider, will go where the money is. But let’s be honest about the driver of physician movement and growth.

    • doc99 says:

      ME has more actively practicing MD’s per capita than FL. Does that mean folks in ME are wealthier?

      http://www.statehealthfacts.org/comparemaptable.jsp?ind=935&cat=8

      • Matt says:

        Are you really arguing that income of the patient population isn’t the primary driver in access to physicians? If so, what do you think is?

        For all the alleged terrible news for physicians about California and Florida, why are those states not at the bottom of physicians per capita?

    • WhiteCoat says:

      So when there was a sudden surge in physicians applying for licensure in Texas after tort reform passed, was that because a whole bunch of rich people moved to Texas in the years after tort reform passed? Must have been. Smart physicians go where the money is. And obviously, physicians are all just greedy blood suckers whose only motivation is money.
      We’ve gone through this before.

      • Matt says:

        Actually, there wasn’t a surge. Texas physician growth tracked Texas’ overall population growth.

        http://www.politifact.com/truth-o-meter/statements/2011/aug/25/rick-perry/rick-perry-says-texas-added-21000-doctors-because-/

        Read closer – I know you can. All service providers will go where there are more people to pay for their services. You shouldn’t call them bloodsuckers. It’s pretty basic economics.

        But you don’t believe me – believe the head of a physician lobbying organization:

        “Tom Banning, chief executive officer of the Texas Academy of Family Physicians, said that back in the early 1990’s the state began passing laws that made it physician-friendly. Among them, a prompt-pay rule to “to ensure that insurers pay physicians promptly and correctly,” Banning said, “which creates a very good environment for practices.”

        Banning said tort reform was more good news for doctors, a sentiment borne out by opinion surveys from the state’s medical association. But he acknowledges that population growth is the biggest force behind the growing ranks of doctors. “It’s like the Willie Sutton rule,” Banning said, referring to the famous bank robber. “Go where the money is. From a doctor’s standpoint, you go where the patients are.”

        Especially patients who can pay. Banning and other observers in Texas note that most of the new doctors are clustered in the affluent, fast growing suburbs around the state’s biggest cities.”

        The truth will set you free WhiteCoat. No need to run from it.

      • Hueydoc says:

        Then why has our state board in Texas had to set up extra help to handle the influx of physicians from other states applying for a Texas License ?

  3. Anonymous says:

    “but that parents who fail to vaccinate their children should be charged with endangering the welfare of a child ”

    You know what, let’s make it a felony for anyone to come within 10 feet of anyone else….because that would prevent communicable disease too.

    For the record I’m missing half my childhood vaccines and never get a flu shot. And I’m still alive. So clearly vaccines aren’t really “necessary”.

    • Hueydoc says:

      And if you play Russian Roulette 4 times and are still alive, it’s not dangerous to play it, right ?

    • Hannah says:

      My mother and father who both had polio as children would like to disagree with you. Especially my mother who is now suffering from post-polio syndrome.

    • Mad Rocket Scientist says:

      Ever heard of “Herd Immunity”?

      • DefendUSA says:

        What I know is that eradicating the diseases that can kill is the point of being vaccinated. My cousin also had polio and wears leg braces because of it. My grandmother used to tell me it’s because her sister never let J play in the dirt so her body could build immunity. Not so much.
        As WC points out, it’s simply ridiculous to fall prey to vaccines being dangerous. Every one is not going to be 100% safe from side effects, but it beats the alternative.

        I remember my Aunts having the mumps and the measles, and the only thing I got was Rubeola. Yeah, you can bet that even after that, they got the vaccines because my oldest Aunt was a nurse and told them not to be stupid. (there are 5 aunts)

        My oldest kids have had Chicken pox with me and let me tell you, herpes is no fun as an adult. I got shingles, too, 16 years later.
        The youngest were able to be vaccinated.
        People are allowed to do what they choose, but they cannot put kids in school without these vaccinations.
        And, frankly, these people piss me off, as an educator!!

    • WhiteCoat says:

      What do you have to say to the parents of the unvaccinated children in California who contracted measles?
      http://www.businessweek.com/lifestyle/content/healthday/637218.html

      Or what would you say to the parents of an unvaccinated child in Minnesota who died due to Haemophilus influenza?
      http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58e0123a1.htm

      Would you think it was OK if your significant other had HIV, didn’t tell you, and was having unprotected sex with you? You’d still be “alive” afterwards.

      Your ability to avoid disease because of the immunity of those around you who were responsible enough to get vaccinated in no way reflects whether or not you would be as lucky in an unventilated room full of coughing unvaccinated Darwinists.

    • throckmorton says:

      We have seen a huge rise in Whooping cough here. In many ways the epidemic is under recognized because it is so hard to confirm the infection in someone who had the vaccine as a child that has now lost some of their immunity.

      As to the flu shot, I would rather the flu shot than the ventilator and trach. Every year our ICUs are filled with flu related pneumonia.

  4. DefendUSA says:

    Yeah…here in my area where the UNC elite play, I see mothers giving kids all those “good for you” organics, breastfeeding til age 5, and yet they dis the medical issues of vaccinating while popping the prozac and xananx. Go figure.

  5. Marietta says:

    To the commenter above who hadn’t been vaccinated:

    I’m a therapist specializing in working with children with autism. Despite the reams of research to the contrary, I’m constantly working with families who think vaccines caused their children’s autism so they don’t vaccinate the other siblings and/or refuse future vaccines for the affected child. As a result of which, I contracted whooping cough as a 20-something adult from a young, unvaccinated client. That led to pneumonia and major asthma exacerbations that left me seriously ill and unable to work for weeks until I was no longer contagious. Vaccinations aren’t just for you, they are for the community. Not everyone has a rock solid immune system like you, and those of us with compromised immune systems can get seriously ill when exposed to people who choose not to vaccinate. Unless you want to wear a sign around your neck saying “unvaccinated” so I know not to have any close contact with you, you are putting me and people like me with chronic health conditions in serious jeopardy.

    Note: I was vaccinated against whooping cough as a child and learned after this ordeal that it can wear off by adulthood. They’ve started suggesting a booster which I’ve since gotten, but basically this disease had been mostly eradicated except for among very young infants that hadn’t been vaccinated until parents stopped refusing the vaccine for their children.

  6. Ian Random says:

    Just imagine a 100 years from now, how big the stack of regulations will be. No regulatory organization can justify itself unless it is thinking of something new in the name of safety.

  7. Nurse K says:

    I have to say, you all can crucify me, but I’d be really happy if some of our Greatest Offenders in the world of Big Work-Ups at least had the threat of some sort of consequence for irradiating all these people for no reason. Administration won’t even TALK about inappropriate use of crap with these doctors, but, at least maybe these medical directors will have to manage their doctors if there is some metric in place that makes them watch these sorts of things.

    • joe says:

      I have got an idea Nurse K since you clearly know more than the MD/DO making the call and taking the responsibility, go to med school and residency, then it will be YOUR CALL. It is easy to judge somebody from the sidelines.

  8. DVorah says:

    It’s worth going to the link regarding the new JCAHO gambit — you can take a survey to tell them what you think of it. What I found very interesting in the survey was the astoundingly broad definition of “harm” that they are intending to use. Truly scary!

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