WhiteCoat

Healthcare Update — 12-31-2012

A brief interview with an emergency physician who is also a health care attorney … defense only. On the right track about the Affordable Care Act, though – it’s all about access, not insurance.

How often have you heard this claim before: Alcohol saved my life! For a man from the UK, the claim was apparently true.

The CDC is warning that this year’s flu season is early and could be “severe.” We already got that picture. Vaccinations probably will help, so get them while you can. Washing your hands and avoiding sick people will definitely help. Antibiotics won’t help, so stop asking for a ZeePack for your cough. It’s like using Raid on dandelions. If you want more information on influenza or want to see the surveillance map, the CDC influenza web site is a good resource. Check it out.

Fear Factor Tunisian style: Man ate 28 raw eggs on a dare … then dropped dead.

Emergency physician sued for failing to report a child who ingested cologne to the Child Protective Services. New Jersey laws require anyone who believes a child is being abused or neglected to contact Child Protective Services and ingestion of any potential poison creates a question as to whether there was abuse … according to the esteemed appellate court justices.
After all, failing to explain who was supervising the child at every second of every day and failing to explain how a 2-year-old child was able to access and consume cologne obviously could mean that in reality there is wanton and reckless abuse going on in the home. How could the doctor not have known that? And do the justices suggest that if the record did contain such explanations, the allegations of abuse would not be reportable?
Hey. I’m in my office typing this while my kids are in the kitchen. And I actually slept 7 hours last night without watching my children to make sure they didn’t get up and eat 2 dozen raw eggs. What an abusive parent I’m being. Good thing I don’t live in New Jersey.
Anyone ever notice how prosecutors and judges always tell you what could be abuse, but they never seem to tell you what isn’t abuse? Why is that?
Hat tip to Overlawyered.com for the link.

Whooping cough rates up 67% in two years in Arizona. Pertussis is definitely reduced by vaccination, yet more parents are choosing not to immunize their children.
If we publish the names and addresses of gun owners under the guise of safety, shouldn’t we also publish the names and addresses of those who haven’t immunized their children so parents can make an informed decision about sending kids to unvaccinated households for play dates?

The “fiscal cliff” has implications for medical care, too. If Congress doesn’t take some action, Medicare reimbursement to health care providers will decrease by 26.5% effective tomorrow. Such cuts will result in tens of millions of our nation’s elderly who still have “insurance” but who will have a lot fewer physicians willing to provide care to them for what the “insurance” pays. Nice for the legislators and the Supreme Court to give everyone “insurance” when the country really needs access to health care, isn’t it?
Don’t worry, Congress doesn’t have the collective gonads to let Medicare cuts happen – at least not for very long.

That’s some damn hot soup. Chinese man eats bowl of extra hot chili soup then begins vomiting blood. Taken to the hospital where doctors were “dumbfounded” to find that the patient had an ulcer. Of course there’s the “association” versus “causation” argument here – did the patient already have an ulcer which was worsened by the soup or did the soup cause the ulcer?
I’m still wondering why the doctors were “dumbfounded” over an ulcer.

Hospital too loud at night. Only 59% of heart failure patients reportedly received discharge instructions. 11% of surgery patients were given the “wrong” antibiotics … as determined by the government. Now the hospital will lose $100,000 in Medicare payments next year.
Hopefully if the hospital goes out of business, the patients will be much more satisfied with hospital noise levels.

Kids misusing common baking ingredients. Games like the Cinnamon Challenge cause violent coughing fits. Stuffing one’s mouth full of marshmallows and then trying to say “Chubby Bunny” has led to the death of at least two children. Snorting nutmeg can get you high. The obvious answer to prevent such tragedies is to create legislation banning all cinnamon, nutmeg, and marshmallows. If it saves one life, it is worth it.

Making us safer by more regulation. Law requiring safe prescription drug disposal method would “reduce prescription drug abuse” according to US Senator Jay Rockefeller.
Because junkies routinely go spelunking through garbage bins and go septic tank diving in search of discarded Percocets. Good reason to create more laws.

A “portable emergency room.” Basically looks like an oversized cardiac monitor and includes ability for voice and video transmission from the field, ECG leads, vital sign monitoring, and a way to access a patient’s medical records if they have been digitized. Oh, and it has been “ruggedized.” Is it worth $20,000 though?

4 Responses to “Healthcare Update — 12-31-2012”

  1. Matt says:

    “Anyone ever notice how prosecutors and judges always tell you what could be abuse, but they never seem to tell you what isn’t abuse?”

    They do, you just don’t read those cases. Courts routinely declare acts do not constitute negligence or rise to the level of criminal sanction. That you don’t know about it doesn’t mean it doesn’t happen. May be a byproduct of your sources for legal news. By the way, you misread the case. The court did not conclude that the alcohol content triggered reporting requirements. The court said that a jury should decide that is all. If the jury finds it was not negligent, then you will have your question answered.

    • WhiteCoat says:

      Hey – it’s the lawyer who doesn’t know what damages are.

      Welcome back. Good to see that your waning legal acumen is still going strong.

      Of course courts decide on a case-by-case basis what does and does not constitute abuse, but I’ve yet to see or hear of a decision stating that “in this jurisdiction a parent’s decision to do X, Y, and Z does not constitute abuse.” You aware of any such cases, counselor? Perhaps you could go log onto WestLaw and provide us all with some citations.

      When you’re finished, why don’t you re-read my commentary to the decision. You’ll see that I said “ingestion of any potential poison creates a question as to whether there was abuse.” So what the court was implicitly ruling is that any time a physician in New Jersey contacts the Poison Center regarding a child, that physician better also be filing a report with the state, lest … in the event of a bad outcome … the physician be held liable for medical malpractice for failing to report. That reasoning should probably extend to all childhood injuries as well. Who is a doctor to say whether the parents were lying about how a child cut their finger?

      And if you read down to the end of the linked opinion, the justices believed that because the record failed to explain who was supervising the child at every second of every day and failed to explain how a 2-year-old child was able to access and consume cologne, a finding of reckless conduct could be reasonably inferred.

      Fear the bad outcome.

      Nowhere did I say that “the alcohol content triggered reporting requirements”.

      Finally, unlike the poorly reasoned appellate opinion, jury decisions about whether failure to keep track of kids every moment of the day and failure to explain how a kid got ahold of a bottle of cologne constitute recklessness (not “negligence” as you suggest) are not binding legal precedent. Hopefully the NJ Supreme Court sees how silly this opinion was and reverses it.

      Hoping the new year affords you some better legal analysis skills,

      Cordially,
      WC

      • Matt says:

        I think it’s funny when you lecture on the law based on your close reading of Overlawyered.

        “Of course courts decide on a case-by-case basis what does and does not constitute abuse, but I’ve yet to see or hear of a decision stating that “in this jurisdiction a parent’s decision to do X, Y, and Z does not constitute abuse.””

        You asked do prosecutors and judges ever tell you what is NOT abuse. The answer is all the time. Prosecutors when they don’t charge cases, and judges when they rule on summary judgment. Courts when juries render verdicts of not guilty in criminal cases or don’t find negligence in civil. In each of those cases the conduct has not risen to the level of criminal or civil liability, thus you know those acts don’t constitute abuse. It happens every day. Again, that you don’t know about it doesn’t mean it doesn’t happen.

        “So what the court was implicitly ruling is that any time a physician in New Jersey contacts the Poison Center regarding a child, that physician better also be filing a report with the state, lest … in the event of a bad outcome … the physician be held liable for medical malpractice for failing to report.”

        This is incorrect. The explicit, and only, ruling, was that the court said that as a matter of law this is a factual dispute which is appropriate for the jury to decide. Your “bad outcome” language is a red herring, and irrelevant to this particular ruling, although not the case. The jury may well decide that there was no duty of the physician to report. That’s what juries do – decide questions of fact. Again, that you don’t know this doesn’t mean it’s not true.

        “, the justices believed that because the record failed to explain who was supervising the child at every second of every day and failed to explain how a 2-year-old child was able to access and consume cologne, a finding of reckless conduct could be reasonably inferred.”

        The reason you believe this is because you don’t understand the standard for summary judgment. There is a bias in the law for the jury to hear the case – what with us fighting the Revolutionary War to preserve the right and enshrining it in the Constitution. Thus when a court reviews a motion for summary judgment it does so by assuming all facts in favor of the non-moving party and resolving all inferences in favor of the non-moving party. Therefore when an appellate court analyzes the case, it analyzes it based on that standard as well. If the case goes back down, the jury finds in favor of the physician, and it’s appealed again, the appellate court will give deference to the finding of the jury.

        You are right – jury decisions themselves are not binding precedent. When they are appealed they are. This decision is a very limited one related to an appeal of a summary judgment decisions. It is not at all uncommon for trial court summary judgment decisions to be overturned. All that means is that there is a question of fact for the jury to decide.

        I realize it’s all pretty boring Rules of Civil and Appellate Procedure stuff, and I wouldn’t expect you to know it, or anyone who doesn’t practice law. Not because they’re dumb, but because most people have never even cracked open the Rules of Civil Procedure. However, you would think you might know what you don’t know and not be so cavalier in criticizing those who do understand what they’re talking about. But then, humility isn’t really your way, is it? Must be your curse, being an expert on everything.

  2. Matt says:

    PS – Happy New Year! Enjoy ObamaCare implementation. Hope it was worth ignoring to fight for your liability carrier’s profit margin!

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