Speaking about JCAHO, they’re now telling patients that they better “speak up” about falls. Are they branching out into the home safety business, too? Do things like keeping lights on in your house all the time. Put non-slip decals on steps so you can catch your foot and trip over them. Avoid getting old so you won’t lose your balance. If you’re in the hospital, make sure you use the call bell every time you want to get out of bed – don’t do that and your fall is your own fault. If you’re at home and you don’t have a call bell … looks like you’re out of luck.
Better watch it or they’ll decredential you as a patient.

We don’t care if you are an emergency department – we’re not stopping. Ambulance service refuses to bring patients to newly-established free standing emergency department because it isn’t attached to a hospital.

Hospital guarantees fast and comprehensive care. Using the “pick any two” theorem, what do you think the cost will be?
With these “see a physician in 5 minutes or less guarantees” – does the public realize what they often involve? I haven’t worked at a hospital with such a guarantee, but one of my friends formerly worked in one (before leaving due to issues that the whole department was having with hospital administration). She told me that they were required to “pop their head in the room” as soon as any patient showed up and say “Glad to meet you. I’m Dr. QuickSee. I’ll be with you as soon as I can.” There. You’ve officially seen a physician. If Dr. QuickSee can’t make it there within five minutes, the patient gets two free discount movie tickets. Other people have different experiences?

Medical devices injure more than 70,000 kids each year. Common problems included puncture wounds from hypodermic needles breaking off in the skin while injecting medicine or illegal drugs; infections in young children with ear tubes; and skin tears from pelvic devices used during gynecological exams in teen girls. You’ll never guess what the most frequent offending medical device is. Hint: Kids frequently put it in their mouth before using it – something that thoroughly grosses me out.

That videotaping patients thing I keep talking about … it’s coming. The report may be biased because the information is coming from the CEO of a company that manufactures such video cameras, but allegedly some insurance companies are considering whether to refuse malpractice coverage for certain high-risk surgical procedures unless doctors videotape the procedure. Alternatively, surgeons who document their surgeries on video may get lower insurance premiums. I found one article in which the Rhode Island Health Department required a hospital to audio and video record all surgeries for one year after several wrong site surgeries occurred. Also see this discussion over at Kevin’s blog about whether surgeons would be willing to operate under these “Big Brotheresque” conditions.
If malpractice insurance companies won’t cover certain high-risk surgical procedures, guess how many physicians will perform these high-risk procedures. All of you that said “none” – pat yourself on the backs. For all of you that think – “I’ll just go to the emergency department and they’ll have to do the procedure,” think again. If the surgical procedures aren’t emergencies, you’ll get sent home with a list of surgeons to contact. If the surgeries are emergencies and the surgeons don’t want to perform those types of procedures, they’ll just drop their hospital privileges for performing those procedures. Like a lot of neurosurgeons drop privileges for performing brain surgery because of increased liability. Then you get to enjoy the ever-increasing waits to get transferred to a hospital that does perform the procedure you need.

I got your package for ya. Man gets vacation in detention center after yelling obscenities at emergency department staff, then partially disrobing and “performing a lewd act“. I can only imagine what that involved.

Also see more news tidbits from around the web on the Satellite Edition over at ER Stories.

Rome, GA woman is arrested after police find her on top of another patient in a dark emergency department room … throwing punches. After being seen yelling profanities at the patient, the perpetrator told law enforcement that she passed out and didn’t know what she was doing. Good answer.

You can only go to the doctor whose next appointment is in six months and the hospital that has a reputation for maiming patients. Otherwise you pay full price. Insurance companies are testing out programs that limit what hospitals and doctors a patient may see. If patients go outside the network, they pay full price for the care. One insurance executive was quoted as saying “We think it’s going to grow to be quite a hit over the next few years.” Just like HMOs were a hit in the 90’s, huh?

The insurance mandate IS NOT a tax … OK, we lied. Last September, Obama was quoted as saying that “For us to say that you’ve got to take a responsibility to get health insurance is absolutely not a tax increase.” In recent court briefs defending the health care law against lawsuits from 20 states, the Obama administration now admits that “the requirement for people to carry insurance or pay the penalty is “a valid exercise” of Congress’s power to impose taxes.” Change you can believe in, baby.

Charity medical care in Utah hospitals drops by 40% in 2008. I’m sure that the numbers are worse in 2009 and 2010.

The Mike Royko approach. Don’t want to pay the overpaid sawbones? “Just have the kid the old-fashioned way. Squat and do it. And if it survives, you can go to the library and find a book on how to give it its shots.” Some people are actually doing that. Only they’re going to YouTube and not to the library to learn how to drain abscesses, remove warts, and … have home births. Only problem is that things don’t always turn out as planned. The article highlights this case in which a 14-year-old girl in Texas was charged in relation to the death of her newborn boy after she and her 11 year old sister learned how to deliver babies on YouTube.

Here’s a news release to slip under the hospital CEO’s door … After several injuries to hospital staff, OSHA fines Danbury Hospital for failing to provide adequate workplace violence safeguards. Does this mean that our 75 year old security guard with the bad back can finally get a TASER? Hat tip to the ageless GruntDoc.

Blacks, Hispanics, and Asians all tend to think that doctors of their same race or ethnicity provide better medical care. Unfortunately if they go to the emergency departments, they have a 4 in 5 chance of being disappointed. 80% of the emergency physicians in the US are white.

It’s a trust fund, not a piggy bank. Wisconsin Supreme Court rules that state has to pay back $200 million it “borrowed” from the trust fund physicians created to compensate medical malpractice victims. With only $45 million left in state budget reserves, the state budget just became a much deeper shade of red.
Here’s an idea. Why don’t Wisconsin residents force the state to sell off its assets to balance the budget? State parks and other state land. State office buildings. State vehicles. If you owe taxes, the state and federal government will force a sale of your assets to pay your debts.
Wisconsin has a projected budget shortfall of $2.5 billion for next fiscal year. I’m sure that the state has more than $2.5 billion in assets. Fork ‘em over.
Anyone want to go in halfsies on a Wisconsin State Police cruiser for those vacations in the Dells?

Dengue … Dengue very much. Dengue Fever getting a foothold in the Florida Keys. One of the first patients to be diagnosed with the disease (after multiple doctor visits) describes her symptoms. “My head hurt so bad that I wouldn’t wish it on my worst enemy.” “Your bones just hurt. That’s why it’s called breakbone disease. It’s indescribable. I can’t even articulate the crazy pain that you’re in. You feel like you’re heavy and out of your body.” Twenty eight cases of Dengue Fever have been confirmed in Key West and about 5 percent of the local population may have been exposed to the disease.

Tennessee emergency department closing after being projected to lose $1 million this year. Urgent care center taking its place. Now patients with emergency conditions will have to add 40 minutes to the trips they take to see a doctor. The local EMS director estimates that each emergency call will now take a total of 2 hours. A major accident in that town will have disastrous consequences.

Press Ganey survey data from them shows that the average time a patient spends in an emergency department visit across the United States was more than 4 hours. Utah patients spent an average of eight hours and 17 minutes per visit while only Iowa and South Dakota were able to break the three hour wait mark.
By the way, did you know that some hospitals/systems pay Press Ganey well more than $100,000 per year to perform these surveys and compile the data? Or that Press Ganey partners with more than 40% of the hospitals in the US?

Some people are starting to get the whole insurance/access disconnect. Arkansas Surgeon General is concerned that adding another 400,000 patients to the ranks of Arkansas’ Medicaid program will worsen the state’s doctor shortage. “We’re going to have to better organize our system so we have access and availability. Otherwise, we’ll have financial coverage but no accessibility.” Exactamundo. Unfortunately, organizing a system won’t do much if you don’t have enough medical personnel providing care.

Also see the Satellite Edition of this week’s update with more news over at ER Stories.

Making an appointment to have an emergency. California emergency department lets patients schedule emergency department appointments online to “alleviate crowded emergency rooms.” Patients who schedule online are guaranteed to be seen within 15 minutes of their appointment time. There’s a catch, though. The service costs $24.99, which pretty much guarantees that the patients using the service aren’t indigent … and also increases the likelihood that the hospital will be compensated for the medical services it provides. Nice marketing idea.
All you patients that can’t afford to fork over $25 for an “emergency appointment” — you just sit and wait in line with all the other poor people.
Fast care, quality care, free care. Pick any two.

Six hour emergency department wait blamed for 25 year old patient’s death from a pulmonary embolism. Now the hospital is being sued for $2 million.
In other news, hospital responds by naming all people in waiting room in a contribution action.

One of eight emergency department visits is for a mental health or substance abuse problem. Of those 12 million patients, 41% are admitted, which is more than twice the national average for medical problems. Half of those patients had either Medicare or Medicaid. Looks like a primary care shortage isn’t the only thing that is going to bankrupt the system.

How fat are you? Pretty soon everyone’s going to know. Federal mandates will require that you Body Mass Index, or BMI, be included on all electronic medical records and uploaded to a national exchange. Next up: How many times have you picked at your ingrown toenail?

At least some hospitals are getting the idea: Take care of your staff. With the incidence of violence against emergency healthcare workers on the rise, Maine hospitals are creating ways to make their employees safer. One hospital outfits employees with Star Trek-like communicators to summon help immediately when patients become unruly. Another hospital purchased a TASER for the emergency department. As far as I’m concerned, there is no excuse for a hospital administration to put emergency healthcare personnel in a situation where they have to defend themselves against violence without giving them the means to do so.
Police get guns, pepper spray, and bullet proof vests. Emergency personnel get saline flushes, Press Ganey scores, and JCAHO.

If the case goes to court, whatever you do – don’t appeal the ruling. US Supreme Court justice Clarence Thomas’ nephew becomes “emotionally unstable” after emergency physician asks him to put on a hospital gown. When he tries to leave the hospital, he is allegedly beaten and TASERed by New Orleans emergency department security personnel.

What’s with the aversion to hospital gowns? Intoxicated New Jersey dad gets brought to hospital after domestic dispute. When asked to put on a hospital gown, he tried to leave, was restrained, and was sedated. Shortly afterwards, he went into cardiac arrest and died.

University Medical Center internists, family practitioners, and geriatricians stop taking Medicare patients. All the community doctors stopped taking Medicare, so the patients migrated to the university centers. Now the universities are dropping Medicare. Don’t worry, though! The patients have INSURANCE!

The United States isn’t the only country with an emergency department crisis. In the last two years, 235 Japanese hospitals have closed their emergency departments, citing “unprofitablity.” Docs in the emergency departments are only paid 4 Euros per hour. Hospitals routinely refuse to accept patients in ambulances. In 2007, more than 1000 ambulances were turned away by at least 10 hospitals. Now people die in ambulances before they can find care. Funny how Japan’s insurance doesn’t mean much without access to care, either.

Israeli hospitals are getting full, too. Multiple hospitals are at 120 percent or more of capacity. The Israeli Health Ministry routinely closes down different hospital departments to new admissions. One trauma unit was closed for new admissions 90 times in 18 months. Israeli patients spent a total of 70,000 days in hospital hallways due to a lack of available patient beds.

Can you say “amoxicillin for snot noses?” More than half of pediatricians make diagnostic errors “at least once or twice a month” and almost half make errors that cause harm to patients at least once a year – and even those errors are probably under reported.
System-related errors, organizational issues, or communication problems were deemed the most common contributing factors for diagnostic error.
Poor care coordination, lack of teamwork, and lack of communication were rated the most important system-related factors.
Close follow-up of patients was ranked as the provider-based solution most likely to be effective. Access to electronic medical records was ranked as the system process most likely to be effective.
So what if some docs can’t understand that viruses don’t respond to antibiotics. They can sure ban the heck out of childrens’ cold remedies, can’t they?

Bedbug causes closure of New York City emergency department triage room for “fumigation.”
In other news, members of the National Bedbug Association threatened a lawsuit. Chapter president Deborah Peel was quoted as saying “You don’t see them pulling this kind of stuff with mosquitoes or pubic lice, do you? It’s insect profiling. Plain and simple.”

Cleveland should have made this part of its pitch to LeBron James. Dengue fever is making the rounds in the Florida Keys and is expected to spread to the Miami area. Watch out for them skeeters!

Should same sex partner of malpractice victim be entitled to a $2.45 million judgment?

Man walks into Cleveland Clinic-affiliated emergency department and shoots himself in chest.

Think that’s bad? Daytona Beach man walks into hospital emergency department and sets himself on fire.

“Health overhaul may mean longer ER waits, crowding“. Massachusetts Governor Mitt Romney gasps and says “you don’t say!”

Emergency departments seeing an increase in prescription drug overdoses. In 2008 there were almost a million visits for prescription drug abuse – as many as for overdoses of heroin, cocaine, and other illegal drugs combined. That’s a 111% increase in three years.

What father’s day present caused good ol’ dad to end up in the emergency department? From the article, it sounds like the kids probably should have gotten good ol’ dad a different present.

Now that everyone has “insurance,” it’s time for the insurance companies to twist the thumb screws. Insurance companies in Philadelphia area routinely “downcode” short hospital stays costing hospitals millions of dollars per year in revenues. One hospital notes that 10-15% of all its admissions are routinely downcoded by insurance companies — after the patient has received medical care, of course.

LAC/USC Hospital “upgrades” to smaller hospital with 200 less beds in 2008. You already know where this is headed. Now LA County supervisors are concerned because the hospital’s emergency department was deemed “overcrowded” about 80% of the month of May and conditions were considered “severe or dangerous” for half of that month. Supervisors are now looking to re-expand the hospital and have no funding sources to do so. Without extra staffing – which you can’t afford, either – you better just make the expansion one huge waiting room, because patients aren’t going to get care any faster.

Fresno, CA 10 month old found to be under the influence of meth? Mom and dad have some ’splainin’ to do.

Entertaining, but bizarre story about a writer’s imaginary trip to the emergency department. Thought it was true at first, but then the end of the story got a lit-tle weird.

Will Obamacare have positive effect on medical malpractice? Some insurance actuaries think so. “Since hospitals will get penalized if they have a large proportion of re-admissions, this may motivate them to provide better care, which would result in more favorable outcomes and fewer claims.”
OK what will really happen if you pinch hospitals to discharge patients more quickly and also penalize them for re-admissions? The hospitals will find additional diseases while in the hospital that justify prolonged admission. Then, after discharge, if they come back to the emergency department for treatment, hospitals will pressure the emergency departments to treat and release the patients so that hospitals can avoid the penalty … as in daily trips from the nursing home to the emergency department via ambulance for management. Wonder what that will do to overcrowding in the emergency departments.
What happens when hospitals try to reduce costs? They hire more physician extenders “causing less-trained care providers to look at more complicated health issues.”
This whole payment/loophole thing is a mousetrap/mouse issue … and there are some pretty smart mice who will find loopholes to make sure that they are compensated for the services they provide. When the loopholes all vanish, so will many of the providers.
Things are going to get ugly, folks.

Survival skills for the emergency department … a HuffPo journalist laments over his 10 hour emergency department visit in the University of Chicago Hospital.

More temporary closures of Canadian emergency departments as there are insufficient physicians available.

Also see the satellite edition of this update at www.erstories.net.

You’ve heard of GEICO Direct? Now there’s MedMal Direct. A 20 minute call could save you 20% or more on your med mal insurance.

One physician with 350 medical malpractice claims and 22 criminal counts against him. He had an international warrant for his arrest and was finally caught in Italy after he disappeared from his vacation in Greece. Now he gets a long term chateau in the Greybar Motel.

When did Jerry Springer get into the emergency medical business? Two dimwits in Ithaca, NY decided that they hadn’t sufficiently stabbed someone they were involved in a fight with. So they followed him to the emergency department and started hitting and kicking the guy, screaming “bleed, bitch, bleed!”. Victim’s girlfriend then retaliates with a mop handle. Now the attackers are charged with felonies.

More evidence for having TASERs in emergency departments. Drunk emergency patient punches one nurse, scratched the forearm of another nurse, and punched a third nurse in the face. Now she’s been charged with three felonies.

Jerry Springer Part III. Georgia dimwit hits emergency nurse in arm leaving red marks and leaving herself with $1430 less money in the bank.

Jerry Springer Part IV. Florida patient spits in the face of the emergency department nurse. Nurse later gets low Press Ganey scores because she forgot to say “thank you ma’am may I have another!”

Don’t mess with the nurses. Minneapolis nurses set for another strike. At the heart of the matter are fixed nurse-patient staffing ratios, benefits, and increased pay. Hospital executives respond by stating that they can’t maintain profits without having one nurse and two medical assistants staff the entire hospital. Madness isn’t looking forward to a strike, either.

Good advice from Penn State (boo hiss) about how to save your fingers this Fourth of July weekend. Please be safe and keep your kids away from explosives.

The ultimate Ponzi scheme. Hey everyone, let us deduct some money from your paychecks all your working lives and … you’ll have INSURANCE!
Growing number of physicians no longer taking Medicare – just as baby boomers hit Medicare age. Thirteen percent of AAFP family practice physicians don’t take Medicare – more than double the number from 2004. Even those physicians who still accept Medicare assignment don’t accept anyone who wants to see them. Almost a third of AMA primary care physicians restrict the number of Medicare patients they take. Thirty four percent of AOA members either don’t participate in Medicare or don’t accept new Medicare patients and expects that number to double if the Medicare cuts go through. 117 North Carolina doctors have opted out of Medicare since January and 1,100 New York doctors have left Medicare.
But don’t worry. Everything is going well as we integrate 32 million new insured patients to the government insurance plans and as baby boomers begin to turn 65.
By the way … has anyone seen their Medicare A and B deductibles rise significantly?
Yeah. Great system.
Medicare patients: Get health care while you can.

47 governors ask for additional Medicaid funding to stave off massive budget cuts and potential double-dip recession. Pending cuts would cost 300,000 teachers their jobs nationwide. The federal government imposed “maintenance of effort” requirements on state Medicaid programs which prohibit cutbacks in Medicaid eligibility. Now states must make up the costs by cutting other services.

Pennsylvania hospital considers closing emergency department

St. Louis psychiatric center definitely closing — due to budget cuts

Decrease in narcotic pain prescriptions equals decrease in patient volume. Dosher Memorial Hospital in North Carolina sees decrease in patient volumes after creating and publicizing policy that it will no longer use or prescribe narcotic prescriptions for chronic pain complaints. Have migraines, back and neck pain, dental pain, fibromyalgia or other chronic pain syndromes? Hope Toradol works because you aren’t getting any codeine, morphine, or oxycodone.

No wait emergency departments. Great business model or way to encourage more abuse of already crowded emergency departments?

Nice shackles. Memphis Med now changes policy so that prisoners wait in the waiting room like everyone else – with police escorts. Problem is that police are now paid to sit in the ED waiting rooms for six hours rather than fight crime on the streets.

Minnesota nurses strike. More than 12,000 nurses walked off the job for one day to protest working conditions and inadequate pay raises. Hospital forced to pay $1600 to $2200 to hire replacements for two days and to cut inpatient volumes.

Tweeting your doctor for advice. Nice in theory, but would you pay 50 bucks for the privilege?

Remember the chatty juror who asked the defendant doctor for medical advice? He got off with a stern warning and no jail time. Probably also got out of future jury duty.

Job security for British emergency physicians … brainiacs in Wales are trying to get drunk by pouring shots of vodka into their eyes. Talk about beer goggles.

Meet the latest member of the “you need an emergent Foley catheter” club. Intoxicated weenie gets brought to hospital emergency department then hits the doctor and nurse.

Check out the new electronic underwear that sends a text message to your nurse when you piss yourself. I’m betting that they probably cost a little bit more than a package of Depends, though. Will the new health plan cover them?

Another Canadian emergency department closing. Two doctors moved from the area leaving only one doctor capable of covering the emergency department at Wakaw Hospital in Saskatoon, Saskatchewan.

Curbing unnecessary trips to the ED. Go to the emergency department too many times for routine care in Utah and you won’t be able to get your prescriptions filled unless you see a primary care physician. Innovative idea – until someone has a bad outcome because they weren’t able to get a timely appointment with the primary care doc. Then again, probably be a little more difficult to sue the state for implementing the policy.

Don’t try this at home. Woman shoots herself in arm so that she can get treatment in the emergency department for pre-existing shoulder pain.

Fill ‘er up. Downtown New York hospitals see spike in emergency department patient visits after St. Vincent’s hospital closure. One emergency physician at Beth Israel Hospital was handling 19 patients at the same time, stating that the scenario was “like a regular day.” Juggling 19 patients at the same time is an invitation to disaster. Try remembering 19 different patient histories, physical examinations, medication lists, sets of allergies, sets of lab tests, and then coming to a rational decision about each patient – all while being interrupted a few dozen times with questions about all the other patients. I work in an ED with 40 beds plus a lot of other hall beds and managing 19 patients – even with the help of residents – is crazy. The AAEM recommends a maximum of 2.5 patients per physician per hour in a moderate acuity emergency department.

Tort reform? Nah. Let’s just charge more for auto insurance and homeowners insurance to keep the only two malpractice insurers in New York from going bankrupt. As the two-year rate freeze on malpractice premiums is set to expire later this month, New York is having difficulty figuring out how to “reduce the bonanza trial lawyers get from the system.”

Bloggers have been screaming about it for years and now all of a sudden it’s on Washington’s mind. Washington spends a whole tenth of a percent of the yearly health care budget to encourage docs to go into primary care medicine, including spending $336,000 per physician to train an additional 500 primary care physicians over the next 5 years. Forget the fact that the American Academy of Family Physicians states that to meet the need for primary care physicians in 2020, the US would have to train 3,725 family physicians and 714 osteopathic physicians per year (or more than 22,000 primary care physicians in 5 years).
Oh and by the time those 500 primary care trainees are ready to see patients (4 years of medical school plus three years of residency), the whole health system will have collapsed.
But it was a nice thought.

Off duty cop storms hospital ICU and takes hostages, then announces “You can leave now. This was just a drill!” Whiskey Tango Foxtrot? Is it OK to point a gun at someone if it is “just a drill”? Last time I checked, that was called “assault with a deadly weapon” and was a crime. Next time why don’t you go try this at the police station … or the courthouse … or the airport … or the firing range? They need to have drills, too. [via GruntDoc]

And last but not least … if you want a positive spin on what’s going on in medicine right now, check out the Positive Medical Blog. Three great bloggers – Lockup Doc, Chrysalis Angel, and SeaSpray – have gotten together to start this new blog and I know that the posts will be a combination of information, inspiration, and fun.