WhiteCoat

Healthcare Update Satellite — 12-30-2013

More updates on my other blog at DrWhiteCoat.com

North Las Vegas VA Hospital emergency department repeatedly “disrespected and mistreated” a 78 year old diabetic volunteer with more than 5,000 hours of service at local VA facilities. A few weeks after two visits for a colon problem, the patient died in a hospice. When the patient’s friend went to get video of the events from the emergency department, the footage had been erased.

What types of things do Australian emergency departments see on Christmas? Stonefish stings, jet ski accidents, inhaled foreign bodies … not that different from the US, although I had no idea what a stonefish was until I looked it up. Kind of reminds me of my sister.

Back in the US, some emergency physicians are noting “desperate” behavior during the holidays from patients looking to cope with loneliness – manifesting itself in excess drug and alcohol use, excessive sleep, and angry moods.
Other physicians see this behavior every day.

And back to Australia again … Now Press Ganey is “global,” ranking emergency departments in Australia.
Seems like the hospital in the article cut waiting times by doing a lot of things we already do in the US. One thing we aren’t doing, though is seeing patients in order of arrival instead of triaging patients first. Little uneasy with that concept.
“Yes, Mr. Dwyer, you do seem to be having a heart attack, but there was a family of four patients registered ahead of you in the emergency department who have all had runny noses and coughs for the past month and who haven’t had time to get into their family physician.”

Oooh. Can’t wait to see this show. [eyeroll] Sex Sent Me to the ER.
Let’s see. I’ll run down the entire season in one sentence: injuries from doing it where you shouldn’t be doing it, foreign bodies where they shouldn’t be, torn female parts, broken male parts, beatdowns after getting caught with someone else’s partner, and diseases. That about covers everything.
Aaaaand I wasn’t too far off. I found this article from the NY Post discussing other cases in this week’s episode. Stroke “mid-shag,” broken penis, painful orgasm, injuries, more injuries.

Want some sex-related medical news stories?
Florida patient has penile implant placed, then sues surgeon and anesthesiologist when he develops post operative infection requiring amputation of his penis, alleging that “doctors should have known that he was not a good candidate for the procedure because of his diabetes and high blood pressure.”
Beware the bad outcome.

Texas man sues manufacturer of a sexual enhancement supplement after man buys supplement at gas station en route to a hotel for a tryst with is “paramour.” During his episode of carnal knowledge, the man states he suddenly had severe penile pain and that his penis then allegedly began spraying blood over the sheets, wall, and mirror like some broken fire extinguisher. He then went to an emergency department where doctors allegedly had to deglove his member (i.e. pull off the skin like removing a glove from the fingers) in order to repair it.
The plaintiff’s treating physician definitively linked the sexual enhancement supplement to the man’s injuries. I’m sure that rough sex had nothing to do with it.
So keep this in mind, dear readers: Taking roadside erection aids may cause your penis to spontaneously snap in two. A treating physician and a plaintiff’s attorney have vouched that it can happen.

Get your flu shots while they’re still around. Latest round of media reports showing that “killer” flu is back in circulation cause increased demand for immunizations. Most of the confirmed cases of influenza are the dreaded H1N1 “swine flu.”
The CDC Influenza Map shows that most of the US has either regional or widespread influenza activity.

Or, if you’re not inclined to have a flu shot, you can just be fired instead. At Pennsylvania’s Horizon Healthcare Services (a group owned by Lancaster General Health, Reading Health System, PinnacleHealth System and Penn State Hershey) a pregnant nurse refused the flu shot for fear of inducing another miscarriage, offers to wear mask instead. Hospital system fires her anyway.

Emergency department in Wigan Infirmary in the UK increasing police presence during the holidays after more than 200 assaults have been reported by staff members increases from 98 last year to 106 this year. That’s twice per week where the staff is actually reporting the violence.

5 Responses to “Healthcare Update Satellite — 12-30-2013”

  1. Peter says:

    That nurse deserved to be fired. If you read the article, she has a history of miscarriages, but none of them are linked to being immunized. She created a false link between the shot and having a miscarriage in her mind then made a big stink when no one went along with her false logic.

    • WhiteCoat says:

      A couple of points:

      First of all, there is conflicting evidence on whether influenza vaccines have any effect on decreasing the spread of influenza.
      This Cochrane review showed that there was no evidence to support vaccinating healthcare workers to prevent influenza in nursing home residents.
      http://www.ncbi.nlm.nih.gov/pubmed/21735402
      This Cochrane review showed that there was significant bias in reporting safety outcomes of live vaccines and that there was no data showing that immunization has any effect on transmissibility of influenza. The authors noted that “reliable evidence on influenza vaccines is thin but there is evidence of widespread manipulation of conclusions and spurious notoriety of the studies.”
      http://www.ncbi.nlm.nih.gov/pubmed/22895945
      This Cochrane review showed that hand washing and masks are most effective at reducing spread of respiratory viruses, so a rational policy would require firing of employees who do not use masks or who do not wash hands.
      http://www.ncbi.nlm.nih.gov/pubmed/21735402

      You assert that the nurse should be fired because she used false logic in saying that the vaccine may cause miscarriages. I agree that there is no known link between influenza vaccinations and miscarriages. But aren’t the hospital administrators also using false logic if they require vaccinations because they believe that influenza vaccines decrease transmission of influenza – even if there aren’t conclusive studies to support those assertions?
      Don’t get me wrong. I still advocate vaccinations. I’m just beginning to re-consider my unwavering support of influenza vaccinations in light of additional data.

      Second, if the nurse is forced to receive an immunization in order to keep her job and then she has an adverse outcome from the immunization, should the hospital administrators be liable for any damages that are caused?

      • Peter says:

        We do a lot of things in the hospital that aren’t supported by conclusive studies. However, I think we can agree that the worst case scenario with a flu shot is a rare adverse reaction. Still there is the possibility that illness can be prevented. The flu shot is inactivated so your article about attenuated vaccines is not applicable.

        The nurse went on record saying she didn’t want to have a miscarriage so she refused the shot. That’s the same line of logic as I don’t want my kids to have autism so I don’t get them vaccinated. She made a stand on an issue that doesn’t exist and she got fired.

        She knew the rules of the workplace when she signed on and should follow them. She’s not being forced to take the shot. She can always resign.

  2. Dina says:

    Most of us who did residencies in the US did part of them in VA hospitals. Did any of us ever think the Vets routinely got anything approaching good care? I know that even 25 years ago when I did most of my internship year at a VA, I was horrified. What I don’t understand is why Vets are so adamant that the VA system remain intact. Why not close them all and provide then with health insurance that covers private/public facilities, with as high rates of pay as the best insurance or better? Surely, that would be cheaper than keeping the VA system intact, and provide better care for our veterans. Of course, I understand that current EDs are already overwhelmed, but with this new influx of good insurance pts, wouldn’t that also help EDs make money and stay open/reopen new ones?

    • WhiteCoat says:

      I’ve long advocated for opening up all VA/state/county hospitals up to provide free medical care to any US citizen.
      That’s one of my biggest gripes with Obamacare – it doesn’t provide “care” – only “insurance.” IF the feds really wanted to provide “Affordable CARE” – they’d open up the VA system to everyone.

      The most important point of your comment is that someone has to pay for the care.
      We can say that facilities should be paid “high” rates, but that it exactly the opposite of what is happening. Payors (especially governments) are cutting payments which is why people with government “insurance” are having such a hard time finding providers who are willing to accept that “insurance” as payment. The last time I checked, our State reimbursed emergency departments $17.50 for a “routine” visit that could have been seen in a doctor’s office. Between staffing, malpractice, and other operating expenses, the hospitals lose money on each Medicaid patient for whom they provide such routine care. Consider getting a job where it cost you 2 hours in commuting, $25 in gas, $40 in parking each day and you got paid $50/day. How long would you keep that job?

      The influx of new Medicaid patients isn’t going to be a windfall for the hospitals – that’s a big fallacy. Instead, many hospitals will become worse off by providing care to patients with Medicaid. Lines in the ED will be longer. Waits will be longer. Waiting rooms will be more crowded. Patients who need ongoing or specialty care still will have difficulty finding it. Delays in payment in many states will turn low reimbursements into essentially no reimbursements.

      If the government thought that it would be such a financial windfall to provide care to patients with Medicaid “insurance,” don’t you think that it would have taken over the business by now?

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