WhiteCoat

Healthcare Update 10-04-2012

Violating EMTALA to get “a lot of positive press”? More hospitals using the InQuickER service that preferentially triages patients who register for their emergency department visits online.

Florida businessman reportedly had a seizure while driving, rolled his car, and crashed through a fence. When paramedics arrived, the patient was suspended upside down in his car. Paramedics placed a cervical collar and the patient then became combative, got out of the vehicle, and tried to walk away from the scene.
If they let him leave, they’re liable for not stabilizing him.
So paramedics restrained him. When he arrived at the emergency department, he had been hog-tied and was face down with secretions coming from his mouth. He later died.
Prosecutors attempted to file homicide charges against the paramedics, but the grand jury would not indict. Now the paramedics are being sued by the patient’s family.
So how should combative trauma patients be managed in order to avoid being charged with murder?

26 people sickened and 4 people die from fungal meningitis after receiving injections of steroids contaminated by Aspergillus fumigatus. Injections were intended to relieve back pain. The pharmacy that bottled the steroids relinquished its business license. Is the answer to this problem more government regulation?

Another example of inappropriate journalism? Wall Street Journal publishes article titled “How to Stop Hospitals from Killing Us.” Dr. Wes responds with a great post about the Growing Culture of Hostile Dependency Toward Caregivers. If you haven’t read it, go read it. If you have read it, go read it again.

Stop paying hospitals if patients are admitted and stay too long. Now the feds are fining hospitals if patients are readmitted within 30 days. Estimates are that hospitals will be paying about $125,000 in fines this year that will purportedly “improve quality” in health care. How exactly is quality improved when the government is encouraging hospitals to discharge patients early and then fining them if they let patients back in the doors?
I know, let’s compare patients’ medical issues to vehicle warranties for GM and Toyota. Dr. John Santa, director of the Consumer Reports Health Ratings Center, is quoted in the article as saying that “If General Motors and Toyota issue warranties for their vehicles, hospitals should have some similar obligation when a patient gets a new knee or a stent to relieve a blocked artery. People go to the hospital to get their problem solved, not to have to come back.”
Let’s use the warranty analogy a little further. Warranties don’t cover all vehicles for all circumstances. You can’t get a warranty on a vehicle that has 150,000 miles on it because everyone knows that the vehicle is likely to break down. So do we just stop doing procedures on patients older than 40? Warranties don’t cover abnormal use of the vehicles. So do we stop doing procedures on people who smoke or who use drugs?
Maybe we should start fining Consumer Reports if their articles don’t solve all our problems when we read them. I bet that doing so would improve the quality of Consumer Reports’ health experts.
Stick with your administrative duties, Dr. Santa. If you truly believe that people and cars are that similar you shouldn’t be practicing clinical medicine.

Wild story from Johns Hopkins. Patient loses her ear to cancer. Surgeons take cartilage from her ribs and grow a new ear under the skin on her arm. Amazing.
However, all I can think of is those Toy Story movies where Mr. Potatohead can see around corners by pulling his eye out of his head and holding it around the corner. Mom puts her arm around you and you better not whisper something into the phone … she can heeeaaaaar you.

In addition to the taxes from the Affordable Health Care Act, get ready for more taxes to fund Medicare. New taxes looming on home sales, rental real estate, and investment property. The article recommends that “If you’re planning to sell rental real estate or other investment property, run, don’t walk, to a trusted tax expert.”

Not only does it get rid of wrinkles, it also cures depression. Depressed patients receiving Botox treatment for forehead wrinkles allegedly saw a 47% improvement in symptoms after six weeks.

Newest mental illness: Internet addiction. If internet addiction really does become classified as a mental illness, how will the diagnosis be made? Number of hours per week? Subjective feelings of needing to be online? Imagine how such a diagnosis would impact upon job performance and ADA suits. Employers can’t discriminate based on mental illness. What happens if employees are repeatedly caught surfing the internet during work hours? Will there soon be internet addiction treatment centers? Can “television addiction” and “smartphone addiction” be far behind?

It helps prevent osteoporosis, it improves blood pressure, it makes you more alert, it provides a probiotic effect on the intestines and it’s a heckuva lot cheaper than those prescriptions … and it tastes good, to boot.

Obamacare Summed Up in One Sentence” courtesy of Dr. Barbara Bellar, who is running for Illinois State Senate.
“So let me get this straight … We are going to be gifted with a health care plan that we are forced to purchase, and fined if we don’t, which reportedly covers 10 million more people without adding a single new doctor, but provides for 16,000 new IRS agents, written by a committee whose chairman doesn’t understand it, passed by Congress, that didn’t read it, but exempted themselves from it, and signed by a president who smokes, with funding administered by a treasury chief who didn’t pay his taxes, for which we will be taxed for four years before any benefits take effect, by a government which has bankrupted Social Security and Medicare, all to be overseen by a surgeon general who is obese and financed by a country that is broke. So what the blank could possibly go wrong?”

12 Responses to “Healthcare Update 10-04-2012”

  1. [...] the South Florida Times, with a hat tip to WhiteCoat: Certain portions of a statement given by an emergency room nurse were omitted from the Broward [...]

  2. Mary says:

    I was taught many years ago as a paramedic NEVER to “hog tie” due to respiratory compromise. There are safe ways to restrain patients if appropriate, primarily 4- point restraints. If the patient was truly “hog tied” ( ankles and wrists tied together behind the back, causing extreme lordosis and limiting chest expansion) certainly a review of protocols and/or procedures is in order.

    • Matt says:

      That case is a good one to highlight the usefulness of having a videotape of the incident.

    • Steve says:

      I second that- when I did my EMT class circa 1999 (2 years before this incident) I was taught to never hog tie a patient or transport them face down for exactly that reason. I don’t think this is a great case to highlight the catch-22 that EMS providers face with combative patients because protocols were most likely broken with the hog tie.

      In the past few years there has been much more emphasis on no physical restraint without chemical restraint first (or shortly thereafter). This has made things a lot safer for the patient and the providers- assuming that you have a progressive EMS system with ALS providers with sedative meds available.

  3. Matt says:

    ” How exactly is quality improved when the government is encouraging hospitals to discharge patients early and then fining them if they let patients back in the doors?”

    This is Obamacare, my friend. You want government to solve your “tort problems”, this is how they’re going to solve it. Sure, you’ll have no malpractice liability, but here come the arbitrary rules and regulations regarding “quality of care.”

    Still looking for that physician legislation to roll back the increase of government in medicine. The AMA that hopped on the Obamacare bandwagon certainly isn’t going to propose it. Where are the other physician lobbyists?

  4. NRn says:

    It never fails to zing me when a patient (or family member) starts off an ER visit with:

    I hate this hospital.

    I wouldn’t bring a dog to this hospital.

    Last time we came here I had to be stuck 18 times before they finally got my blood.

    They screwed up and killed my relative here.

    Its really sad. I came out of nursing school taking very seriously a study I’d read stating that nurses are consistently voted the most “trusted” people by profession. This is what I’ve faced daily in many years being an ER nurse in 2 very good hospitals. Its only getting worse, this “you against me” hostile attitude I see in patients.

  5. Chris says:

    We had a case at a local hospital in my area where a mentally ill, combative patient was also hog-tied and placed face down and left alone in an exam room. He pleaded repeatedly that he couldn’t breathe and was told that if he was talking, he was breathing. He stopped talking after a while…..yep, he was dead.

  6. Write-in Candidate says:

    I have no clue what I am supposed to do to address confusion and misinformation. I tried being patient and have been waiting for years now.

    • Write-in Candidate says:

      I do not understand the deliberate non-communication. I have no clue what to do. There is no security issue and never was.

      • Write-in Candidate says:

        It is against everyone’s interests for me to be sitting here waiting. It would have been in everyone’s interests for me to finish the phd and to problem solve years ago.

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