WhiteCoat

Healthcare Update Satellite — 07-2-2014

Ve have vays of keeping you qviet. Halt den mund! Government-contracted security force who actually call themselves the “Brown Shirts” … threatens to arrest medical providers if they leak any information to media about all of the medical illnesses that are being seen at an illegal alien refugee camp in Lackland Air Force Base.
By the way, this story is from FoxNews, so everyone should just ignore it until you or your family members sit next to one of them on a bus or in a movie theater. Combine these kids on playgrounds with anti-vax kids? What could go wrong?
Nothing to worry about. Nothing at all.

New York City urologist and surgeon father/son team up to serve the needs of the city’s hungover partiers. For a mere $250, they will send a nurse to your home or office, insert an IV, and give you IV Zofran, IV Pepcid, and IV Toradol. It’s called a “revive” package.
When people start spending more on the morning after recovery than they do on the night out, they have serious issues.
Oh, and don’t mind that you can get the same or similar medications and a bottle of Perrier for about $10.

60 year old Alaska emergency department patient gets arrested after trying to walk out with bed sheets, latex gloves and a bloody syringe, oxygen tubing, medical wrap, a pulse oximeter
Items reportedly worth $300. Patient goes to Greybar Motel where bail is set at $2500. What was he going to do with oxygen tubing and a pulse oximeter? Guess there’s always eBay.

Nice article in Annals of Emergency Medicine about how to Effectively Use Online Resources in Emergency Medicine. Article gives lots of resources with links. Included in the recommendations are: 1. Use an RSS reader. I posted about RSS readers on DrWhiteCoat.com after Feedly temporarily tried to steal bloggers’ content. Theoldreader.com and taptu.com were a couple of the favorites other than Feedly.
2. Use a PodCast Application. I don’t listen to podcasts. Popular with anyone else?
3. Find compilations of content (also suggested that residency directors post lists of compilations)
4. Use social networking to connect with content producers and peers.
5. Use custom search engines for material (such as GoogleFOAM.com – which happened to be a dead link at the time I wrote this post)

$5.2 million verdict in lawsuit filed against Maryland’s St. Agnes Healthcare, EMCARE, emergency physician, and physician assistant. Patient injured knee in a gate at loading dock. PA who evaluated patient noted paresthesias, difficulty moving his foot, and pain in the leg then diagnoses patient with knee sprain. Physician overseeing PA reportedly performed an exam, but did not write a note in the chart and did not co-sign the chart until 10 days later. Patient returned two days after initial visit and found to have torn all ligaments and tendons in his knee and suffered injury to popliteal artery. Because of the initial misdiagnosis, the patient required an above-knee amputation.
The article doesn’t say whether there was a judgment against the emergency physician, but recall that insurance policies may not cover physicians for claims involving failure to properly supervise other medical practitioners. Make sure that your contracts include coverage for such claims.
Copy of the original complaint can be downloaded here.

Arizona Supreme Court rules that “vulnerable or incapacitated adults” are able to sue for all the attorney’s fees and expert witness fees under Arizona’s Adult Protective Services Act. I couldn’t find the fee-shifting portion of the statute, but am worried about the unintended consequences.
What happens when hospitals know that there is potential for increased liability when caring for “vulnerable or incapacitated adults”?
What will lawyers do when they know that they’ll get paid more for filing such claims?

WhiteHouse pressuring states to join Obamascare’s Medicaid conglomerate, claiming that if they don’t, the states will deprive 5.7 million Americans of health coverage in 2016. The report is “based primarily on careful analysis of the effects of past policy decisions” which also brought you such conclusions as “if you like your doctor you can keep your doctor” and implied that emergency department use will decrease under the Affordable Care Act, so take the conclusions for what they’re worth.

Pennsylvania state medical board suspends license of anesthesiologist for sending nearly 250 text messages with sexual innuendos while overseeing surgeries. During a stomach surgery, he sent 45 text messages alone. Not good. Hopefully none of the patients were injured.

Now that we’re discovering about 2.2 million Obamacare enrollees may lose coverage due to unresolved discrepancies in their data and that 6 million Obamacare enrollees ended up enrolling in their new Obamacare plans because they were kicked off of their previous plans, the department of Health and Human Services has stopped providing updates in enrollment data. A net negative number of enrollments probably wouldn’t fare well for the law’s future.
Megan McArdle asks “Where Did the Obamacare Data Go?”

Patient goes to emergency department with a cough. Doctor ordered x-ray to rule out pneumonia. Radiologist read chest x-ray as normal. More than a year later, patient returns to emergency department with worsening cough. CT is performed and shows metastatic lung cancer. When lawyers go back and look at prior chest x-ray, a 1.5 centimeter nodule was reportedly missed. The patient later died. Her daughter filed a lawsuit and the jury just awarded her $16.7 million dollars.
Wonder why radiology reports are sometimes so “comprehensive”?
To wit: Master Radiologist able to hedge on every possible medical condition. Report of 7 pages and 10,000 words contained interpretation gems such as “The intestine is mildly dilated and collapsed with thick or thin walls and most organs have areas of abnormal or normal enhancement, so small bowel obstruction and organ pathology must be considered. And tuberculosis. Also, cancer. Could be cancer.”

6 Responses to “Healthcare Update Satellite — 07-2-2014”

  1. Peter Schildhause says:

    Yeah, those brownshirts won’t let me talk about my patient’s conditions either. I wish my doctor could tell the whole world about my problems.

    • WhiteCoat says:

      First, “brownshirts” was what they wanted to be called and what they called themselves, not a pejorative term I came up with.

      Next, your doctor could tell the whole world about your problems with your permission.

      Third, you confuse dissemination of aggregate and deidentified information with patient specific information.
      It is entirely acceptable and perfectly legal for any medical provider to make statements such as “there is a disproportionate incidence of drug resistant tuberculosis being seen at the Air Force Base right now” or “one of my patients had cholera.”
      It is generally not acceptable for a doctor to state that “John Smith has drug resistant tuberculosis, watch out for him.” However, there are even exceptions to this rule. Many states and the CDC have mandatory reporting laws for certain communicable diseases and if the providers did not report to the state under threat of arrest, then that is another cause for concern.

      But don’t worry. Everything will be just fine.

      • Peter Schildhause says:

        Do you recall the problems when being from Haiti was suggested as a risk factor for HIV? With a universal group of one “race” or ethnicity, it is problematic to suggest to the public that there is some sort of infestation of disease prevalent. These people are probably not mixing with the general population, so there is not risk to the general public unless we count the risk to Hispanics who will be viewed as Lepers as a result of misinterpretation of this data.

  2. Mary says:

    I had a 3cm lt. apical mass missed on a chest radiograph (by radiologists I work with). Same lesion found two years later on a CAP CT for trauma. Good thing it was benign. Strange thing is, they also did not mention it in the pre-surgical chest radiograph for removal of said lesion. I was amazed, and pointed it out to my primary care as I am hoping it doesn’t happen to someone else with a cancerous lesion. Upon review of the original image with the chief radiologist, although he agreed the lesion was subtle, it should not have been missed.

    • B.RAD says:

      Glad it turned out OK for you. Recognizing these lesions can be very difficult especially if they are overlapped by normal structures. That’s why the apical regions on a chest x-ray are referred to as “lawyer zones”. It’s always pretty easy to find things with the retrospectoscope. In reality, radiology is one big book of “where’s Waldo”, but 70 to 80 % of the time, Waldo is not there.

  3. Teresa Chan (@TChanMD) says:

    GoogleFOAM.com is working… weird.
    Dunno what you’re talking about. :D

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