WhiteCoat

Healthcare Update Satellite — 07-14-2014

Practicing telemedicine may just get a whole lot easier. Federation of State Medical Boards creating an interstate “compact” that would reduce barriers by providing an “expedited license” to physicians who wish to practice medicine in multiple states. The physician has to establish a state of “principal license” and then may apply to the “Interstate Commission” to receive a license in another state after the “applicable fees” have been paid. The hundreds of dollars per year paid to each state to maintain licensure don’t appear to be one of the barriers that is being reduced.
Most recent draft of the compact can be found at this link (.pdf)

Remember the infant who was “cured” of HIV after receiving high doses of antiretroviral drugs shortly after birth? She was taken off her medications and didn’t have any evidence of HIV in her bloodstream for several years.
Unfortunately, doctors recently announced that the child is now showing signs of HIV infection.
And the hunt for an elusive cure to HIV continues.

Milwaukee woman goes to emergency department with abdominal pain, rapid heart rate and fever. Spent nine hours in the emergency department and was discharged around midnight with instructions to follow up in the morning with her gynecologist for fibroids in her uterus. Later collapses at home and treated for septic shock which caused her to lose both arms and both legs. Sues hospital and plaintiff attorney argues that none of this would have happened if she just got a “$25 antibiotic.” Jury awards $25.3 million, saying that physician assistant and emergency physician who treated her should have provided her with a complete differential diagnosis of her symptoms prior to her discharge.
Attorneys expect that this case will get to Supreme Court as more than $16 million of that judgment would be subject to Wisconsin’s $750,000 medical malpractice cap.

Do you have any Kleenex? I need to blow my … back. Paralyzed woman has stem cells taken from her nose and undergoes stem cell transplant to try to cure her paralysis. Eight years later, she has pain at the surgical site. Undergoes exploratory surgery and doctors find a 3 cm growth of nasal tissue that was secreting mucous which was pressing on the woman’s spine.
Surgeons note that this type of complication is uncommon, occurring in less than 1% of patients.
Case report in the Journal of Neurosurgery is here.

Patients gone wild. Australian police are “investigating” after patient attacks five nurses, a security guard, a paramedic, and an elderly patient. One nurse required hospitalization. No one notified the hospital staff that the patient had previously attacked a nurse.

What are the conversations like in a rural emergency department waiting room with “country folks”? Pretty darn funny column about it by Lauretta Hannon in a suburban Atlanta newspaper. How *did* Aunt Carrie get hooked on them Oxycondoms, anyway?

Kaiser Health reports on newly implemented Dignity Health network policy where emergency department patients can “pay to go to the front of the line.” Hey – Southwest Airlines does it and so many people think that emergency departments should be more like other businesses, right?
But when hospitals start providing preferential treatment to those with money and internet connections, they’re running afoul of EMTALA laws.

Venezuela’s University Hospital of Caracas closes its emergency department in protest for 72 hours after gunmen break into an operating room and kill a patient during a surgery to extract a different bullet. The gunmen also killed the patient’s brother who was waiting in the hospital.

Improving access to health care won’t save money. Nice article in the NY Times about how increased access to medical care increases costs. My favorite quote is a variation of my “Pick Any Two” post:

One of the most important facts about health care overhaul, and one that is often overlooked, is that all changes to the health care system involve trade-offs among access, quality and cost. You can improve one of these – maybe two – but it will almost always result in some other aspect getting worse. You can make the health care system achieve better outcomes. But that will usually cost more or require some change in access. You can make it cheaper, but access or quality may take a hit. And you can expand access, but that will increase cost or result in some change in quality.

And one point on which I differ with the author is his assertion that “The A.C.A. was primarily about access: making it easier for people to get insurance and the care it allows.” The Affordable Care Act was never about access. It was all about insurance. And few if any doctors are willing to accept the miniscule payments offered by government insurance. Health care insurance doesn’t guarantee you health care access any more than auto insurance provides you access to a car.

Occupy Wall Street protester jailed in Rikers Island accuses prison of medical negligence. One inmate with Hepatitis C was reportedly coughing up chunks of her liver before she died in prison.

 

7 Responses to “Healthcare Update Satellite — 07-14-2014”

  1. Greg99 says:

    >Kaiser Health institutes system where emergency department patients can “pay to go to the front of the line.”

    Not quite – *Dignity Health* (previously Catholic Hospitals West) is the healthcare system described in the article as implementing the system.

    Kaiser Health News just reported the story.

  2. markps2 says:

    On the crazy person in the Emergency department story acting violently, you left out “developmental (delayed)” in the mental patient.

    All those mental people are violent and impossible to communicate with.

    If the “patient” doesn’t want to be there and fights for freedom, the violence proves they are mentally ill.
    http://simplelifetogether.com/wp-content/uploads/2014/05/Predict-Your-Future-760×540.jpg

    • WhiteCoat says:

      Point taken. I removed the reference to mental illness and will let readers decide whether the patient’s prior history is relevant.

      However, your assertion that patients who fight for “freedom” must mean that they are mentally ill doesn’t fly. Would you use the same logic if a patient was trying to attack his infant child, only wanted to drink alcohol all day, or didn’t want to stop at red lights while driving?

      At some point someone has to make the call whether the patient is a danger to him/herself or others. The “fighting for freedom” in the emergency department setting almost always occurs after that determination has been made.

  3. TH says:

    Exactly how does a person cough up ‘chunks of liver’ I’ve been in medicine a long time and I’ve never seen that even with the gruesome, horrible trauma cases.

    Nothing like a little, teensy-weensy exaggeration to make headlines. Now, if they had said, “Those chunks of blood from her uncontrolled coagulopathy caused by her untreated Hepatitis C looked like liver when she coughed them up…”

    THAT I would have believed. But then again, accuracy in reporting and space on the news page often have inverse relationships.

  4. PatM says:

    Ah yes. Isn’t Cecily McMillan the woman who had a hysterical crying fit in court when she was forced to wear the same dress two days in a row?

    I guess she was.

    http://nypost.com/2014/05/28/ows-activist-cries-in-court-when-guards-give-her-wrong-outfit/

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