WhiteCoat

Healthcare Update — 01-16-2012

Also check out the Satellite Edition of this week’s update over at ER Stories.

Florida teen wins a $12.6 million medical malpractice award after being given an expired vaccination and then contracting an infection which developed into sepsis, DIC, and gangrene resulting in amputations of all four limbs.
I’m sure the antivax crowd are having mind cramps over this concept. The vaccines are full of toxic waste and don’t work. The toxic waste is what caused the illness. They should be sued for giving it. Wait. The patient came down with an infection. Infections are good to build the immunity so we don’t need vaccines. That’s what we want. Then why did the teen win all that money? Wait. Maybe expired vaccines cause the infections. That’s it. Yeah. That’s our angle. Hey – will someone get Jenny McCarthy on the phone? Or Dr. Wakefield … does anyone know Dr. Andrew Wakefield’s number?

Speaking about crazy ol’ Florida …man in Naples, FL emergency department waiting room backs a female patient into a wall, gropes her breast, tries to unzip her pants, and then gets a patella to the cha-chas. Hobbles out of the hospital singing tenor and is arrested in the parking lot holding his crotch.

We’re not done yet … New bill requires that any accident victim in Florida must go to the emergency department to be checked out or risk losing personal injury protection benefits from their insurer. Because the emergency departments aren’t crowded enough without having to worry about patients going there because some brainiac legislator creates a law forcing them to do so.
Yet another reason not to live or practice medicine in Florida.
In fact, I just created a new page on my blog: the Top Ten Reasons Not to Practice Medicine in Florida. Permalink to the upper right. Add any reasons that I forgot to the comments section.

GruntDoc commented on this earlier, but I had to mention it now since it was just released as one of the top 10 articles on Medscape. The FDA has given approval to a device called an “Infrascanner” to detect intracranial bleeding. The device can detect “nearly 75%” of hematomas detected by CT scan. Hematomas don’t include deeper bleeding, so I’m assuming that these results don’t include subarachnoid hemorrhages or intraparenchymal bleeds. The device also excludes hematomas 82% of the time, meaning that the unfortunate 18% of patients are going to get a burr hole drilled in their head for bleeding that the Infrascanner says is present when it is really not. Or they’ll just get a CT scan which makes the whole Infrascanner thing a waste of time and money.
However, I am developing a similar device for predicting intracranial hematomas which I will soon seek approval from the FDA. A prototype is pictured at the right.

Greek financial crisis having effect on patient health care. Pharmacists plead manufacturers to ship aspirin. Manufacturers say “show me the money” first.

New strain of bird flu infects twelve people around country – most of whom have been in direct contact with animals. No word yet on the transmissibility of the H3N2 strain (how easily it spreads from person to person) but it was not included in this year’s vaccine, so if the transmissibility is high it is likely to spread quickly.

OK, OK, the previous article was swine flu, not bird flu. I just wanted to get onto Homeland Security’s “watch list.” Big Brother’s Department of Homeland Security is now monitoring and retaining information on a slew of social media sites including Drudge, HuffPo, and other “blogs that cover bird flu; several blogs related to news and activity along U.S. borders.”
Facebook, MySpace, Hulu, Youtube and Flickr also make the list, as do other “publicly available online forums, blogs, public websites and message boards.”
As Glenn Reynolds says on Instapundit, “How’s that Hopey Changey thing woking for ya?”
P.S. Bird flu, bird flu, bird flu, bird flu.

One third of medical costs … in Florida … attributable to defensive medicine costs. 88% of Florida physicians practiced some form of “defensive medicine” in the past 12 months to protect themselves from lawsuits. The other 12% are either teaching or lying.

Defense of frivolous lawsuits is costing the healthcare system a lot of money. It cost an average of $47,000 to defend a malpractice claim in 2010. Almost two thirds of claims against physicians were dropped, withdrawn, or dismissed without payment and cost an average of almost $27,000 to defend – totaling more than one-third of all defense costs for the year.
In addition, physicians are having to pay for larger malpractice policies. The number of policies with limits more than $1 million increased from 28 percent in 2001 to 41 percent in 2010.
If you want to review the actual reports, they are at this link. You have to be a AMA member to access them, though.

Rich doctors? A lot of them are going broke … and leaving practice … and leaving patients with fewer options for medical care.
And I keep going back to that discussion I had with with one of my clinical professors long ago. Boy am I glad that I’m a doctor.

Man … from Florida … runs out of emergency department … naked … and runs into a retirement resort. There he armed himself with knives and waited until he got a smackdown from a security guard.

Patients gone wild. New Jersey tough guy punches emergency department physician in face, breaking his nose. Now awaiting sentencing which may be as long as 18 months in state prison.

Patients gone wild … International Edition. English chap was so drunk he couldn’t stand, but had enough energy to spit at staff and urinate in a consultation area. Tries the same routine with police and is hauled away in a paddy wagon.

“Culture of tolerance” perpetuates violence against health care workers. Sixty six percent of nurses didn’t report physical abuse and 86% of nurses didn’t report verbal abuse. “If a police officer is assaulted, it’s a crime. To a nurse, it’s just part of the job. Don’t get in that mindset. Workplace violence goes up when a culture of tolerance is promoted.” Couldn’t have said it better myself.

That hospital needs an enema. Health Sciences North Hospital in Sudbury, Ontario has 100 patients waiting in limbo for nursing home placement. As a result, elective surgeries are being canceled, the emergency department is packed with 35 patients waiting for beds on the medical floor, and wait times are going up.
But the care is free.

11 Responses to “Healthcare Update — 01-16-2012”

  1. Marilyn B. says:

    I’m sure the antivax crowd are having mind cramps over this concept

    I’m a kinda, sorta anti-vaxer, but not dumb enough to think an expired vaccine caused the kid’s sepsis. More than likely it was failed infection control on the part of someone (I’ve seen some very scary practices from medical care providers over the last year and a half).

    Or the kid already had a smoldering infection somewhere in his body and the sepsis was purely coincidental.

    Patients gone wild. New Jersey tough guy punches emergency department physician in face, breaking his nose.

    There’s an emergency doc in MY town I’d like to punch…errr…infect with bird flu! He put sutures in my finger which unraveled after two days, he rolled his eyes and wrote a vicodin prescription for my niece who went in (following instructions of her regular physician) for severe vertigo from carotid artery obstruction caused by a newly discovered thyroid tumor, and more interesting actions. She threw the prescription and other papers at him and left. Note to drug-seekers: I know an ER that seems to write vicodin fer everyone who walks in the door, seems they think it cures bird flu.

    I don’t blame patients sometimes, for their frustration with doctors.

  2. Steve says:

    Re: 12.6 million award for Florida teen getting expired vaccine

    The article mentions that the mother was deemed 40% at fault- just conjecture but maybe it should have been more like 100%. I’m guessing that the reason was that she was given a portion of the blame is that she didn’t give her child the prescribed daily penicillin prophylaxis that is given to kids this young who get their spleen taken out. That’s probably what resulted in the overwhelming sepsis- not a vaccine that was expired by 4 months. That expiration date was just enough for a payday in a court, but it likely had no clinical effect when it came to whether or not it protected from the bacteria that the child was suspectible to since they didn’t have a spleen.

    There is always a margin of error built into expiration dates- not sure what it is for that vaccine but 4 months is probably in that neighborhood. Once again- conjecture- didn’t read the case but a probable explanation based on the article.

    • Aaron says:

      More than the 40% sounds about right. With the spleen storing and nurturing so many of the heavier hitting white blood cells.

      Still those four months expired could mean quite a bit. With most pharmaceuticals the expiration date correlates roughly to the point where 90% of the active agent remains. I’m not sure about vaccines, but many of those chemicals are in vaccines for a reason and that reason is that vaccines present a terrific growth medium for many microbials. It’s the whole reason for all of those additives.

  3. Matt says:

    Wow, what a lot of nonsense in this week’s update.

    1. Wouldn’t the bill requiring that they go to the ED to get PIP benefits be a BOON to EDs? After all, the PIP benefits aren’t health insurance, so the ED can charge full freight on them. It’s thinking like this which indicates how little physicians understand about economics.

    2. 1/3 of medical costs defensive? Because of yet another survey of physicians? At what point do people distinguish between evidence and speculation? Physicians always claim this in support of tort reform, then they get reform and *gasp* healthcare costs never decline. Ever. Where are the Texas savings? How much cheaper is healthcare today in Texas than it was 10 years ago? Or California – which has had it for 30 years? The savings don’t exist. It’s shameful that physicians, who are in the business of analyzing information and making informed judgments, spew nonsense like this.

    3. Defense of frivolous lawsuits doesn’t cost healthcare ANY money. It costs insurers. That money would not otherwise go into the healthcare system, it would go to insurer shareholders and employees. One might foolishly argue that this means premiums have gone up – but we can’t know if they should have without looking at insurer profitability. After all, many if not most insurers operate at a loss if one only looks at premium dollars in v. paid claims/expenses. Why would they do this? Because of the float. Again, WC lacks basic economics knowledge when he argues that insurer expenses = money lost by the healthcare system.

    • Felix Kasza says:

      Matt —

      1. “Self-pay”, these days, means “no pay” more often than not. Charging full freight is useless if the recovery rate is near zero.

      2. Texas? Are we talking about the state with thousands of additional physicians where before there was a wide-spread dearth? The caps are low enough that malpractice insurance has become more affordable again, but not low enough that low-life scum won’t still use it as a lottery.

      3. Those insurers — do they print the money? rob a bank for it? or charge premiums to the doctors they insure? If you picked the third answer, congratulations. Oh, and never mind your straw man argument; we only need to look at premiums. They have gone up far more rapidly than inflation would justify. So the money comes either out of the healthcare pool (which ultimately pays doctors), or out of doctor’s pockets. The second source will dry up when those pockets are empty and need a refill from the first source, so in the end, those premiums all come out of healthcare money.

      I never studied medicine; math and statistics are my thing. How I wish they were yours, too!

      Cheers,
      Felix.

      • Matt says:

        1. That’s the point. The PIP coverage would pay. The lowest PIP coverage is typically $5,000. Often if medical providers know that there may be an insurance claim against a third party they won’t bill Medicare/Medicaid or a health insurer and instead assert a lien on the case because the reimbursement rate is better. That’s smart business.

        2. Texas physicians per capita hasn’t changed materially. As someone who claims that math an statistics are their “thing”, thats a pretty important stat when it comes to availability i wiuld think. If there was a dearth then there is still a dearth. Malpractice rates in states with and without caps rose and fell with the rest of the market. They don’t simply reflect claims paid (which haven’t changed much) because insurance profits largely depend on the skill in investing the float. Interestingly, many states without caps have much higher rates per capita. That may not be a stat that means much to you though.

        As far as a “lottery”, you should ask someone with a malpractice claim large enough and debilitating enough to have a pain and suffering award that large of they feel like a Powerball winner. I’m sure you’d love to trade places with them, just like you would the Powerball guy. They’re so darn lucky.

        3. Premiums have gone up more than justified, I agree. Especially because payouts have been relatively constant. But thats what happens when you underprice the premium dollar to capture market share so you can invest the float and your investments go sour. You need stiff hikes to jump back up. The premiums do not come out of overall healthcare dollars though, for the simple fact that physicians, unlike most professionals, don’t set their rates of pay. Health insurers and the government do. They lack the ability, for the most part, to respond via raising prices.

        Math and statistics are great I agree. But you need to know the basic numbers. Doesn’t sound like you do. You might also study how insurance works. I strongly recommend any of the Berkshire Hathaway letters to shareholders as a start. That empire is largely built on the profits from the underwriting float of all kinds of insurers. Including med-mal, of which they own one of the largest. One of the things you’ll learn is that most property and casualty insurers write insurance at a loss, yet the industry as a whole is generally quite profitable. But maybe you know something about insurance that Buffett doesn’t.

        Cheers!

    • WhiteCoat says:

      1. Go back to Google and type in the words “unfunded mandate.”
      Again, you present half the picture. The ED can “charge full freight” for the visits? The bigger issue is how much the ED will collect. Do tell us all how often insurers gladly fork over “full freight” payments for bills. And what if the settlement doesn’t cover the bills? And what if there is a judgment against the claimant? What if the injured person was hit by an uninsured driver?
      Want to create a bill that requires “full freight” payments when services are provided, they’ll probably get more support. I’m betting that ultimately the insurers will find a way not to pay for the visit and the law will add another 400,000+ visits to the emergency departments each year in Florida alone. Then we can throw in increased wait times, delays in care, bad outcomes, increased malpractice suits, etc.

      2. You must make the same arguments so often that you forget you make them. Who do you propose that we survey about defensive medicine to determine its prevalence? Gerry Spence? From your previous arguments on the same topic, you will now go off on a tangent about how to define defensive medicine and will never answer the question.
      Funny thing about life … *gasp* … college tuition never declines either. Neither do gas prices *gasp* or a loaf of bread *gasp* or attorneys fees *gasp*. What’s your point? That because medical costs are higher in California than they were 30 years ago you have now created irrefutable proof that medical tort reform is hogwash? Strong argument.
      Would be interesting to look at systems that do control lawsuits and compare the costs in those systems with the costs in the US.

      3. This is rich. The insurers are the ones on the hook for all the frivolous lawsuits. Of course. Why didn’t I know that working in the medical field. Got a question for you there, Socrates: Where do the insurers get their money? If you said “from the health care system” … ding ding ding YOU’RE RIGHT! Tell us what else he has won, Johnny!
      Well, WhiteCoat, Matt has also won a short course in medical economics. Here goes, Matt.
      Health care entities pay premiums to insurers to protect the health care entities from going bankrupt from malpractice lawsuits. In fact, many larger health care entities even insure themselves now in order to save money, so they assume all the risk for frivolous lawsuits. When the premiums go up or there is a judgment against self-insured trust, that money is taken out of the health care entity’s operating expenses. So, yes, WhiteCoat, frivolous lawsuits cost health care entities lots of money.
      And there’s still more! Insurers won’t continue engaging in ventures where there is a loss. Funny thing about insurers is that if there is a lack of profit, they usually pull out of the market. Got to ACEP’s EM Report Card http://www.emreportcard.org/ and look at states that have poor malpractice environments. Florida, New York, Pennsylvania all have significantly fewer insurers writing medical liability policies per 1000 physicians than the national average. Coincidence? You be the judge.
      Float that.

      • Matt says:

        “Again, you present half the picture. The ED can “charge full freight” for the visits? The bigger issue is how much the ED will collect.”

        AGAIN, they will collect the full amount of the PIP benefits, at a minimum of up to $5000 (in most states). The average ER visit cost is $2000

        http://www.consumerhealthratings.com/index.php?action=showSubCats&cat_id=274

        Correct me if I’m wrong, but if Medicare/Medicaid or a health insurer pays it, that invoice will be cut by at least 25%. PIP coverage won’t (can’t) do that. You get paid MORE.

        PIP coverage is not a settlement. It’s on your own auto policy. You, WhiteCoat, have it. If you’re in wreck, no matter who is at fault – YOUR PIP coverage can be used to pay your bills up to your limit. They may subrogate if you recover against a third party – but that doesn’t matter to the provider.

        You should stop arguing with me – I’m pointing out how this BENEFITS YOU FINANCIALLY!!!! IT HELPS YOU FINANCIALLY!!! THAT IS A GOOD THING!! You’re reflexively arguing with me about something that you clearly do not understand.

        2. “Who do you propose that we survey about defensive medicine to determine its prevalence?”

        I don’t care who you survey – it’s pointless. It’s like surveying the employee of a drug company about whether their drug is better than their competitor. Would you then prescribe it based on the results of that survey? It’s meaningless as a data point. This is illustrated by the fact that all the solutions physician propose for this “problem” identified by their surveys NEVER WORK. EVER. After literally decades of trying them. Health costs increase pretty much at the same rates across every state.

        3. ” Where do the insurers get their money? If you said “from the health care system””

        No, they don’t. Insurers make their money from investments primarily. A physician’s income is not a significant part of health care costs, as you’ve stated many times when arguing against cutting physician salaries. And you don’t get to pass costs on. It’s not like the guy who owns your building, where if his fire insurance premium goes up, when you renew your lease he can raise the rent. You, as a physician, lack that power. I’m not saying that’s a good thing – it’s just the product of our payment model.

        4. ” Got to ACEP’s EM Report Card http://www.emreportcard.org/ and look at states that have poor malpractice environments. Florida, New York, Pennsylvania all have significantly fewer insurers writing medical liability policies per 1000 physicians than the national average. Coincidence?”

        I don’t see where it lists the number of carriers? However I did see that overall California got a D+ and has had your malpractice reform for literally decades. New York and Florida, incidentally, had Cs, like Texas. So I’m not seeing your point. Insurers are more likely to be driven by the state insurance commission’s willingness to raise rates.

        Interestingly, in the pdf of the report on that site, Texas, your tort reform “miracle” and California, who has long had it, both had Fs for ED access. I guess there goes your “perfect or available care” strawman!

        Your own links refuted your claims.

        5. “Would be interesting to look at systems that do control lawsuits and compare the costs in those systems with the costs in the US.”

        It certainly would PROVIDED you also point out that those nations have universal care. Not to mention that their physicians make much, much less than US ones. On that point, I agree with you – if we go to universal care medical malpractice litigation will be basically wiped out in terms of a jury trial. It’ll be some byzantine bureacracy where a physician has far less chance to defend themselves, and physicians will make significantly less money.

      • Matt says:

        Forgot one thing:

        “Float that.”

        That’s a cute saying, but trying to mask your ignorance of how insurance works with things like that don’t help you. At all. You should know and care how insurance works, particularly since so much of the money flowing into the healthcare system comes from insurers. Insurers who are always trying to reduce the rate they reimburse you.

        If you truly believe that it’s a matter of premium dollar in – paid claim = profit, and that’s how premiums are calculated, then you should support mandatory health insurance coverage since that increases the amount of money available to pay you!

        But I think you’re smarter than that.

  4. Pattie, RN says:

    I thought Matt the “bambulance” chaser went away? Oh well, such is life on the net!

    For your Florida file (not a doc, but RN DOWN THERE for fifteen LONG years until I got back to God’s country here where there are mountains, snow, and sanity!)

    *If you cannot communicate with your illegal alien/visiting Disney World/ staying with relatived foreign language speaker who speaks NO English, then it is “A” your fault for not having an interpreter who speaks Serbo-Croation/ Thai/Mandarin/Spanish and “B” you liability if their treatment is delayed in any way, they don’t give full and informned consent, and you don’t have WRITTEN d/c instuctions in their language.

    *If the same patient needs 9 months of rehab and a wound vac for the bug even the ID guys can’t name, they will stay in your hospital, sometimes for years, because you can’t discharge them until they are 100 % healthy and btw they will NEVER be 100 % healthy

    *No one actually has auto insurance AND it is legal to ride a motorcycle without a helmet, Wanna guess who pays for the hospital stay AND the nursing home AND endures the lawsuits from the relatives of the self-injured idiots??? BINGO!

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