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Healthcare Update Satellite — 06-23-2014

Monday, June 23rd, 2014

The right to carry a concealed weapon only exists if your doctor says so. Many states are requiring that physicians certify whether patients are competent to carry a concealed weapon. Some states require mandatory reporting of those deemed not competent to carry a concealed weapon. Of course, the natural extension of such laws is that if the doctors make an inappropriate determination, then the doctors can be held liable if the certifiee does something inappropriate with the weapon.
This New England Journal of Medicine article shows that many doctors aren’t comfortable making that determination.
Then again, I’ve heard colleagues threaten that if they’re required to report people, they’re just going to make anonymous certifications that every police officer they see is not capable of carrying a concealed weapon, then forward them to the state using USPS Delivery Confirmation to prove that the reports were received.
We really shouldn’t stop at physician certifications of competency for gun ownership. We should expand the physician certification to encompass other areas in which people could be potentially harmed. For example, physician determination of competency should be required for positions such as judges, CEOs, prosecutors, and anyone who comes into contact with a child. Dammit, we need to protect the children.

We’ll have to re-publish this study again around November, but for now, keep in mind that using hypertonic saline nebulizers to treat bronchiolitis causes less improvement than just using regular saline.

Many people reportedly complaining of headaches after using Google Glass. Harvard optometrist notes that they aren’t really headaches but a “discomfort in the eye muscles” from looking in strange directions.
Wait. That optometrist said nothing of the sort. Those quotes were taken out of context. Only a few people feel the pain. There are no health risks. Now retract your story or we’ll bury you in the search rankings.
Also see my other post discussing problems using Google Glass for medical applications.

Listen up you administrators and hospital board members … plaintiff lawyers are wising up. Children’s Hospital in New Orleans sued for institutional negligence when deadly fungus spreads through NICU on bed linens and kills five children.
By alleging institutional negligence, the lawyers avoid the $500,000 malpractice cap and also extend the statute of limitations.
No medical providers were named in the lawsuit, either.

This is amazing. Drug trial for arthritis causes interesting side effect. Person with alopecia receiving tofacitinib (Xeljanz) in a clinical trial grows full head of hair.
hair
Our government’s failure to control our borders is now having significant repercussions for the health of our nation’s residents. Deadly diseases such as tuberculosis, dengue fever, and Chagas disease coming into country along with all of the illegal immigrants.
Author of the article describes how President Obama is implementing the Cloward Piven strategy to overwhelm the public health system in order to replace it with a national welfare system to end poverty.
Worked well in Venezuela, didn’t it?

57% of all Italians fear being harmed by physicians. 44% disapprove of their national health care system. The European Commission notes that “Much still remains to be done in terms of patients’ rights, safety, and empowerment to report medical malpractice”within the European Union.

Patient taken to Houston’s St. Joseph Medical Center for an “anxiety attack.” Two hours later, the patient was reportedly discharged. The patient didn’t come home for several days. Finally, the patient was found on the hospital’s fourth floor stairwell. Now the patient’s daughter is “convinced someone from the hospital should pay.”
Hat tip to Scott for the link. Thanks!

When an attorney sued a hospital after mother and twin neonates all die from tuberculosis, he held a news conference stating that “There may have been a motivation to find a cause for her condition other than tuberculosis … If the cause was some other infection, they wouldn’t need the state government in there to investigate … a tuberculosis diagnosis invites oversight and opens up a can of worms.”
Now the hospital is suing the attorney for defamation, alleging that the attorney is implying that the hospital engaged in a cover up.
Paging Barbara Streisand …

Why are we providing better healthcare to those who killed thousands of Americans than we do to the veterans who put their lives on the line to protect us?
“The ratio of patients to doctors in Guantanamo prison is 1.5 to 1. For America’s 9 million veterans receiving VA health care and 267,930 VA employees, the ratio is 35 patients to 1 doctor. Additionally, in late 2008, when Obama was president-elect, he and his staff were warned not to trust the wait times reported by VA health care facilities. But instead of fixing the problem, their focus was closing Guantanamo and improving the comfort of detainees. Even though they already lived under some of the best prison conditions ever seen.”

Another fascinating case. Usually necrotizing fasciitis (a.k.a. “flesh eating bacteria”) causes massive tissue damage, often resulting in death or amputation of limbs. In this case, doctors cured necrotizing fasciitis using a wound vac, antibiotics and irrigation of the wound with an ingredient in household cleaners.

Patient’s pseudoseizure causes doctor to have pseudoseizure when asked to give Ativan and Morphine to treat the pseudoseizure. And I just giggle to myself thinking what would happen if a doctor really did develop a pseudoseizure when a patient went into his or her pseudoseizure.

VA tries to hunt down anonymous whistleblowers, demanding that a watchdog group turn over all records it received pertaining to “wait times, access to care, and/or patient scheduling issues” at VA facilities in Phoenix or elsewhere.
First I’d start by “losing” the requests a few times. Then I’d make them fill out all requests in triplicate. Oh wait, did you fax that? I never received it. You’ll have to re-send it. I’ll put you on a waiting list and you’ll get the information as soon as possible.
Oops. Sorry. The hard drive crashed and we lost the e-mails. No back ups, either. Darn.

Healthcare Update Satellite — 06-17-2014

Tuesday, June 17th, 2014

Read more healthcare-related news from around the web on my other blog at DrWhitecoat.com

Oklahoma University Medical Center joins the growing ranks of hospitals that are requiring patients to pay a fee of $200 to be treated for non-emergency complaints. That amounts to an estimated 40% of OU’s emergency department visits. If patients do not want to pay for non-emergent care, they will be referred to nearby urgent care clinics.
This “triage out” protocol will eventually become a standard throughout US emergency departments. Count on it.

Emergency physician writes about how she almost diagnosed Lou Gehrig’s Disease in the emergency department, then learned that the real diagnosis wasn’t quite so ominous.

Holy Cross Hospital puts bowl of Percocet tablets in waiting room. Wait times suddenly decrease to record lows and there hasn’t been a complaint about the ED in months.

Florida emergency physician put on probation, nearly loses license, and has to pay $5000 fine after relying on reports of physician assistant’s assessment of a patient’s finger injury rather than evaluating the patient and making the diagnosis himself. The patient returned the following day and required a finger amputation.
Keep in mind that you may not be covered by your malpractice insurance policy when an injury results from your supervision of other health professionals. Your agreement to supervise could be construed as a contractual agreement or as an administrative duty instead of the practice of medicine – for which malpractice insurance covers you.

Our overuse of antibiotics over the years has caused a crisis of antibiotic resistance. The Telegraph warns us that the golden age of medicine has come to an end.
“Antibiotics are no longer effective. The drugs that have transformed life and longevity and saved countless millions since penicillin was discovered by Sir Alexander Fleming in 1928 now saturate every corner of our environment. We stuff them into ourselves and our animals; we spray them on crops, dump them in rivers, and even – as emerged at a meeting of science ministers from the G8 last year – paint them on the hulls of boats to keep off barnacles. As a result an invisible army of super-resistant bacteria has evolved, one that is increasingly claiming lives – currently more than 25,000 a year in Europe alone.”

Is Vermont State neglecting patients in need of emergency psychiatric care? Currently, only four hospitals in the entire state are capable of providing the highest level of psychiatric care.

As we lose the battle against bacteria in one area, we may have found a weapon to help us win the war. Scientists find protein that will dissolve bacterial biofilm – a substance that some bacteria create in order to protect themselves from the effects of antibiotics. Think of it as if we found a weapon that penetrated the shields on Klingon warships.

Child rushed to emergency department after allegedly drinking nicotine from e-cigarette cartridge. The cartridges are childproof and there is nothing in the article stating that the child actually ingested the liquid, but we should probably just ban nicotine to keep our children safe.

Neat story about a Florida emergency physician and CPR instructor who passed out and died … for 20 minutes … until CPR brought him back to life. Talks about “the light” and how lucky he is to be alive.

More patients in Oregon emergency department – about 600 more per month – after Obamacare took effect.
Most of those patients were “losing access to doctors who’ve cut-back on the number of Medicaid patients because reimbursements don’t cover their costs.” For example, “the Vancouver Clinic announced recently it will no longer accept new Medicaid patients.”
Wait. People with insurance are having problems with access to care? This can’t be. They told us that emergency department visits would decrease. The title of the legislation is the Affordable CARE Act. How can this be happening?

Healthcare Update Satellite — 06-10-2014

Tuesday, June 10th, 2014

See more health-related stories from around the web on my other blog at DrWhitecoat.com.

The doctor will call you now …
Rural health clinics increasingly turning to telemedicine. The story gives an example of a South Dakota clinic physician who used a video feed to get advice on how to insert a chest tube – while a patient was in the room with a hemothorax.

Want to see some of the trick questions that plaintiff attorneys will throw at you during a malpractice trial and see some good responses to those questions? Good examples in this article from Colorado’s Cortez Journal.

Even though your state may have approved medical marijuana, don’t forget that marijuana is still banned by federal law.
DEA cracking down on Massachusetts physicians associated with medical marijuana dispensaries.

Kind of ballsy approach to managing uncomplicated appendicitis in kids. Researchers find that children 7 to 17 years old with pain less than 48 hours, WBC count < 18k, appendix < 1.1 cm on CT or ultrasound, and no evidence of abscess or fecalith can be effectively managed with antibiotics instead of surgery.
I’d be interested in information about relapse rate. If a child has a propensity toward developing “medically managed” appendicitis, it better to just have the appendix removed than to have the patient risk relapses requiring repeat hospital visits for IV antibiotics and CT scans/ultrasounds?

Do you prescribe steroids to patients with acute low back pain? This study found no benefit in doing so. However, note that the study population was limited to patients with a “bending or twisting injury.” Patients were excluded if they had suspected nonmusculoskeletal etiology, direct trauma, motor deficits, or local occupational medicine program visits.
I’m still giving steroids for exacerbations of chronic pain and for radiculopathy.

Potential patients gone wild … Colorado man shot in emergency department parking lot after “confronting” police with a knife.
Lesson #1: Don’t run around in a parking lot wielding a knife
Lesson #2: Don’t use a knife to threaten a man with a gun

Speaking about guns … you know how the incidence of gun-related deaths is increasing over the years? Well it isn’t. A Pew Research study (.pdf link) shows that firearm homicides dropped by 50% and non-fatal firearm crime has dropped 75% between 1993 and 2010. 56% of people think that gun crimes have gone up in the past 20 years.
Wonder why accurate facts like this aren’t being publicized in the evening news?

Woman lays dead in a Paris emergency department for six hours before someone checks on her and realizes that she is cold. Unidentified French official is matter of fact about the death. “People die every day in the emergency room.”

Fortunately, marijuana is a harmless drug … NY Times reporter writes about how she laid in a “hallucinatory state” for eight hours and thought that she had died after eating a pot candy bar in Colorado.

More ideas from people who know little about the effects of the policies they create. Prohibiting people using food stamps from purchasing sugar-sweetened beverages “expected to” improve nutrition and drive down diabetes. And these authors just assume that everyone uses their food stamps legitimately.
I’m not going to pay for the entire study, but I’d wager that they don’t consider how often people misuse food stamps. Therefore the authors are putting invalid data into their calculations. It is not uncommon for people to act as “straw purchasers” of grocery items. I’ve had people offer to do it with me on more than one occasion. You have cash, they’ll purchase all your groceries if you give them half of the total cost in cash. Grocery stores will also purchase food for half of its retail value. I recall reading one article about how bottles of soda were used as a currency of sorts by people in a rural community with people filling up pickup truck beds with cases of soda and bartering the cases for money, cigarettes, and other items – but couldn’t find the article on a web search.
Who cares, though? The authors are now published in a reputable magazine. Their conclusions must be valid.

Chicago files lawsuit against world’s largest narcotics manufacturers accusing the drugmakers of concealing the health risks associated with taking pain medications.
Next up: Suing alcohol companies on behalf of alcoholics and suing fast food restaurants on behalf of overweight people.
Here’s hoping that the drug companies file a counterclaim against the City of Chicago.

Healthcare Update Satellite – 06-04-2014

Wednesday, June 4th, 2014

See more medical news from around the web at my other blog … DrWhiteCoat.com

Car crashes into VA Hospital emergency department in Boston. Elderly driver taken to emergency department … then put on a secret waiting list and will be seen within 2 weeks … if he’s lucky.

What happens when someone calls an ambulance in South L.A.? Same thing that happens in most other places in the country. The stories are the same, only the faces change.
Patient evaluated by EMS for dizziness, hard time breathing, chest pain. Paramedics arrive within 4 minutes. Symptoms resolve. Likely a panic attack. Patient wants ride to hospital anyway. Sits in the hospital with paramedics for up to 3 hours waiting for a bed to open up.
“In many cases people who live in low-to-middle-income neighborhoods like those served by Martin Luther King Jr. Community Hospital choose to take ambulance rides even when deemed unnecessary, all with the public picking up the tab.”
When ambulances are transporting patients with fevers instead of strokes, however, these varying states of crisis weaken the entire system. “They’re not going to a clinic and pay; they’re going to go wherever they can go the fastest, and they use ambulances to get there.”
“The number of people using EMS as a taxi is, not only way to high, it’s alarming,” said Weiss who sees the effects of this first hand as he works in Emergency Departments at various facilities around Los Angeles each day. “We’re using precious resources for a process that isn’t valid.”

Florida Supreme Court decision to invalidate medical malpractice caps may have a ripple effect throughout the nation. Five of seven justices held that there was no malpractice crisis and that the caps don’t hold medical costs down. Of course, when the caps were created, the legislature held differently, but who cares about that.
And if the justices think that there is no malpractice crisis, then why don’t they also rule that the state must provide malpractice insurance to all Florida physicians? Shouldn’t be much of an expense since there isn’t a crisis, right?
Don’t practice medicine in Florida.

Study from Detroit’s Henry Ford Hospital presented at SAEM’s annual meeting shows that 77% of emergency department “super users” have some type of addiction disorder and half were seeking narcotic pain medications. And they still get satisfaction surveys.

Another hospital emergency department closing. Latest victim is Long Island College Hospital in Brooklyn. It is losing about $13 million per month. May get converted into condos. Housing apparently pays better than medical care.

Half of all medical school deans say that their students aren’t competent to treat patients with disabilities. Enlightening article describes how our ignorance about patients with disabilities affects our ability to provide emergency department care. We need to do a better job at this.

ProPublica report shows that even though Medicare is able to export its data for the public to review, Medicare officials are still too dumb to actually look at the data themselves. Average “Level 5″ visit billing by physicians is about 4% of patient volume. 1800 health professionals across the country bill that level in 90% of their patients … yet Medicare keeps paying them. Idiots.
Medicare is just as guilty for paying these providers as the providers are for submitting the bills.

“I am so pleased that justice was served.” Now give me my 30%.
Quote from Florida malpractice attorney after winning $7.5 million medical malpractice case against a doctor who failed to evaluate and treat a conduction disorder of a 13-year-old girl’s heart.
Couldn’t find out more about the case during a web search, but did find another recent $7.5 million malpractice judgment in Alabama after patient brought to Brookwood Medical Center and admitted for back pain, then developed incontinence and paralysis of the legs. The patient had developed cauda equina syndrome and wasn’t treated quickly enough. But remember … imaging in patient with back pain (which is the only way to diagnose cauda equina syndrome) is considered “unnecessary” testing according the Choosing Wisely campaign.

Connecticut woman wins $12 million in medical malpractice case after surgeon punctures her colon during routine hernia surgery. Doctors didn’t realize the complication until after patient developed abdominal infection and went into septic shock.
I’m betting that one reason for the large verdict was because defendants started pointing fingers at each other. Surgeon alleges that it was the resident who punctured the colon. Resident denies it. Hospital says it shouldn’t be responsible for the resident’s actions. Patient says she didn’t know a resident would be operating on her.

CPAP machines soon to become an “uncovered benefit” for our country’s veterans. Veteran’s sleep apnea claims have increased by 150% in the past 5 years with total costs more than $1 billion per year. 90% of patients with the disease are rated at 50% disabled, enabling them to receive monthly payments of $822 in addition to their pensions.
But the winds of change are a-blowing. A military budget expert is now on record saying “sleep apnea is not a combat injury, especially if it’s caused by obesity.”

Sasquatch Music Festival overloads local emergency department every year, increasing its volume six- to seven-fold. Them’s the breaks.
I used to work at a trauma center near an outdoor concert ampitheater like this. Same thing used to happen to us. ED and ambulance services were constantly busy with people passed out from unknown drug cocktails or who had drank too much. We would plan our schedules around which bands were playing. Jimmy Buffet and OzzFest used to be the worst. The ampitheater owners were at least somewhat cool about it, though. Every summer, the owners would show up with dozens of free tickets to each concert for the people in the ED who weren’t stuck working.
Or maybe that was a secret plan to have more emergency medical personnel available on scene ….

Pardon me while I pick my jaw up off of the ground. Poll states that there are MORE emergency department visits due to Obamacare? That can’t be. They told us that there would be LESS emergency department utilization once people had insurance.

Healthcare Update Satellite — 05-21-2014

Wednesday, May 21st, 2014

See more healthcare related stories from around the web at my other blog: DrWhiteCoat.com

19 year old Baltimore teen dies in hospital after involved in altercation where 5 security guards were unable to control him, police were called to hospital and used Taser on patient, then left once he had been subdued. Now State’s Attorney is looking into matter.

$25 million lawsuit filed against Las Vegas hospital when pregnant woman enters, has several symptoms and risk factors for tuberculosis on mandated screenings, but hospital does not evaluate or treat her for tuberculosis. She is then allowed to hold her newborn twins in the nursery without wearing a mask. All three patients ultimately die from tuberculosis.
Also of note is that there was a tuberculosis outbreak in the hospital at the time with at least 20 hospital employees contracting the disease.

Feds consider whether to spend billions of extra Medicare dollars to screen former smokers for lung cancer. Doing so could cut a high-risk patient’s chances of dying from cancer by 20%.
I remember someone in a position of leadership once saying that if we can save one life, it’s worth it. Therefore, spending this extra money should be a no-brainer.

At Queen Elizabeth II Hospital in Great Britain, you can only have emergencies between 8 AM and 12 midnight. The emergency department is closed between 12 AM and 8 AM due to staff shortages. To be fair, it seems as if most patients have already gotten the memo on this issue. Severe cases are already referred to Lister Hospital which is 20 minutes away and the QE2 emergency department only sees 5-10 patients per night.

VA Medical Center in Cheyenne, Wyoming busted for “gaming the appointments system” to make it look as if patients are being seen within 14 days of an appointment request when they really weren’t. I’m sure the VA is alleging that this is an isolated incident.
Or maybe not
And if you want a good laugh, watch Jon Stewart’s discussion of the whole debacle.
His summary:”Somehow, we as a country were able to ship 300,000 troops halfway across the world in just a few months to fight a war that cost us $2 trillion.” But it takes veterans hurt in that war longer than that to receive “needed medical care or reimbursement, all while we profess undying love for their service.”
All animals are equal, but some animals are more equal than others.

VA Chief Eric Shinseki grilled about issues in medical care in the Veteran’s system. To his credit, he did put three VA employees on leave after discovering that they may have contributed to the deaths of 40 patients. Of course if that happened in the public sector, the employees would be arrested and charged with murder by now.
All animals are equal, but some animals are more equal than others.

About a third of Australian patients waiting longer than 20 minutes in ambulances once they arrive at hospitals. In some hospitals, more than half of patients wait longer than 20 minutes.
Hopefully they’re not baking their statistics like the governments in some other countries do …

Doctor gets romantically involved with a patient who then commits suicide. Doctor removes medications and suicide note when he finds patient dead in her apartment. Pled guilty to obstruction of justice charge for removing evidence and now is being sued for medical malpractice and wrongful death.

I like this concept. Let’s expand it. If you’re unhappy with a hospital stay or an emergency department visit, do you have to pay? Heck no. If you don’t get perfect medical care, you should demand a refund. Where do these hospitals get off charging us for imperfect care?
If we’re not happy with our state or federal government, we shouldn’t have to pay taxes.
If we’re not getting good gas mileage, we should get a refund on our automobiles.
And if our bosses aren’t happy with our work, they shouldn’t have to pay us.
Others aren’t happy with the way that people on government assistance are utilizing their assistance, they get cut off.
Heck, if everyone just acts pissed at everyone else, everything could be free.

Is non-celiac gluten sensitivity all in your head? Study shows that the effects of having gluten in one’s diet may be due to FODMAPs and not duet just to gluten. Although the sample size is small, it’s an interesting concept. A diet low in FODMAPs has been shown to decrease the amount of gas and, in some cases, the symptoms of irritable bowel syndrome.

This study will give the antivax crowd fits and nightmares. Patients with terminal multiple myeloma injected with enough toxic waste — er, um — measles vaccine to inoculate 10 MILLION people. They didn’t die. They didn’t get sudden onset autism. They didn’t even get Guillian Barre Syndrome.
They got better.
One patient remained relatively disease free at 9 months, the other developed worsening disease after 6 months.
I know. I know. It must be that small doses of toxic waste — er, um — vaccines, are lethal while large doses are curative.

Issues with large medical malpractice judgments in India where the author compared them to the Code of Hammurabi in 2030 BC:
“If the doctor has treated a gentleman with a lancet of bronze and has caused the gentleman to die or has opened an abscess of the eye for a gentleman with a bronze lancet and has caused the loss of the gentleman’s eye, one shall cut off his hands”
Wonder how maiming the healers affected the provision of medical care.

Healthcare Update Satellite — 05-13-2014

Tuesday, May 13th, 2014

Interesting story on how an Indiana hospital discovered the first case of MERS in this country. Patient came in with influenza like symptoms and was placed in negative pressure room immediately. By the time he was admitted to the floor and was interviewed by an ID specialist, everyone coming into contact with him was required to wear full gowns, gloves, and eye protection. MERS was suspected based on his travel history – he was a US resident working in a health care facility in Saudi Arabia.

Don’t ride in a car with pregnant drivers. During a woman’s second trimester, her odds of being in an accident that is bad enough to send her to the emergency department increases by 42%. By the third trimester, the risk is gone.

Obamacare health insurance tax could cost 286,000 Americans their jobs and result in $33 billion in decreased retail sales.
Well of course the right-wingnuts are going to say that. What do you expect?
Wait. The article was written in the official blog of the US Chamber of Commerce? Nevermind. Carry on.

Nice summary article about a physician’s duty to a suicidal patient. Dispels some myths and offers good basic advice. For example, HIPAA doesn’t prevent doctors from disclosing a patient’s psychiatric information if the patient is in imminent risk of self-harm.

Obamacare “MAY” boost hospital emergency department profits. Then again, when you consider that a vast majority of newly “insured” patients under Obamacare have what the article admits are “money-losing Medicaid” patients, that the hospital will have to spend more money to staff the departments to treat the “money-losing” patients, and that the hospital will have to pay more in insurance and consumables to lose this money, Obamacare also “MAY” put more hospitals out of business.
Oh, and I “MAY” have found missing flight 370 in the Sahara Desert.

Since Obamacare was implemented, emergency department visits for the Tenet Healthcare system haven’t seen any decrease in patients. In fact, the number of patients they are seeing in the ED is going up … as their profits go down

OK, I still can’t imagine how this show stays on the air. But this story just has to be repeated. Woman ends up in a hospital emergency department after putting pop rocks in her hoo hah before having sex with her paramour.
All I can do is shake my head and think about all the perfectly good politically incorrect jokes that are going to go unsaid right now.

Why would Americans travel to one of the most dangerous towns in Mexico? To get dental care. The dentist is an American who commutes to Mexico each day and offers care for about 30% of what it would cost in the US. She has low overhead and she has no malpractice insurance, so her costs are less — and she passes those savings on to her patients while still earning a good living.

Doctor and US Vet warns other veterans that their lives are in danger from the care being provided at VA Hospitals.
The medical chief of staff is Dr. Darren Geering. He is a physician but it appears he had no function for protecting the VA patients from this egregious action causing the death of at least 40 patients who were on a “secret waiting list” from which these patients died, waiting for any kind of medical care.

A couple of tangentially medically-related articles.

Jail starts doing body scans on inmates entering the facility. Finds dark object on scan of one perp’s lower abdomen. Turns out that he had a cell phone inside his rectum. The comment section to this article is a riot … must have had crappy reception … taking butt dialing to a whole new level … ring tone set to “”pbthpbthpbth”.

Survey shows that 1 in 9 people want an android child like the kid in the movie “A.I.” and that 20% of people would have sex with an “android.” One of the comments to the article downplayed the results, noting that 20% of the population would probably have sex with a baked chicken.
Now I can’t decide whether I’m hungry or want to watch some crappy Steven Spielberg movie.

 

Healthcare Update Satellite — 05-07-2014

Wednesday, May 7th, 2014

They’ve got “insurance” but they still can’t find anyone to provide them with dental care. In Oregon, dental problems are the second most common emergency department discharge diagnosis in patients 20 to 40 years of age and have a 25% repeat visit rate, costing the State more than $8 million annually — just in hospital costs. Problem is that Obamacare’s coverage doesn’t include adult dental care. Even if patients have Medicaid coverage, the reimbursements are so low that dentists won’t treat patients with that type of “insurance.” But don’t worry, everyone, 7.1 million more people now have health “insurance.” Full report can be found here (.pdf)

Belfast emergency department has 100 patients in its waiting room with one patient reportedly waiting 11 hours just to be evaluated. Strain on resources indeed …

New Jersey Supreme Court throws out a malpractice case against an emergency physician who failed to report suspected child abuse when child brought in for ingesting cologne. Child was discharged to parents who later abused the child. Placed in foster care and foster parents sued physician for failing to report suspected abuse as required by New Jersey statutes. The Appellate Court agreed with the parents. Fortunately, the Supreme Court had some common sense and noted that upholding such a decision, every accidental ingestion case presenting at a hospital’s emergency department give rise to a mandatory child abuse reporting obligation. New Jersey medical providers dodged a bullet with that case.

San Francisco General Hospital in the midst of a “culture of chaos” because hospital is failing to provide enough staff to care for the patients. Because the emergency department is short 23 nursing positions, the remaining nurses are often doing clerical and other work instead of caring for patients.
And I’m sure some member of the clipboard brigade will cite one of the remaining nurses for failing to make sure that patients were screened for domestic violence, tuberculosis, wearing seat belts, substance abuse, and guns in the house. Oh, and making sure that there are safety caps on all medication bottles, too.
Decreased staffing in the food services department has decreased quality of meals and resulted in long waits for patients to get meals because no one is available to deliver meals to patient rooms.
Another example of getting what you pay for in health care.

Patient wins $1.9 million judgment in malpractice case where Massachusetts oncologist diagnoses him with non-Hodgkin’s lymphoma then order several rounds of chemotherapy and a stem cell transplant. The patient never had lymphoma, but instead had an “immunodeficiency” that mimicked cancer.
Doctor claims his treatment was based on a pathology report. Pathologist found not negligent.

How often should you shower? Daily showering may not be as healthy as you’d think. Frequent showering may wash away the natural body oils that protect the skin from drying out and from bacteria. Then again, I imagine that most active people would rather sacrifice a little health to avoid smelling like a used tube sock.

Megan McArdle writes about the “ugly spike” in healthcare spending. Is the spike due to the effects of Obamacare or is it that there was a transient slowdown in spending related to the recession – which is now resolving … or neither … or both?

With healthcare reform and increasing “insurance” coverage comes more emergency department use. Happened in Massachusetts with RomneyCare and it is already happening in the US with Obamacare – regardless of what statistics you see.

Elderly patient sent to nursing home. Lives there three weeks before dying. Jury awards $90 million verdict against nursing home, agreeing with plaintiff’s attorneys that patient’s death was due to inadequate staffing in the nursing home and failure to provide patient with food and water.
Now verdict is under review by the West Virginia Supreme Court to determine whether medical malpractice caps apply to the verdict, which would reduce the award to $500,000 for non-economic (pain and suffering) damages. I wonder if the administrators were named in the suit.

Healthcare Update Satellite 04-24-2014

Thursday, April 24th, 2014

Kudos to staff at Blessing Hospital in Quincy, IL for its excellent management of a rollover bus accident with 27 kids. You all do us proud!

Stock up on your Norco pills now, folks. This study shows there’s no difference in pain relief when compared with codeine, and when the DEA changes hydrocodone to a Schedule II drug, the supplies will dry up quickly.

Mammography may be diagnosing too many cancers. The idea is that some of the tiny cancers found on mammography would never progress or threaten a patient’s life. Overdiagnosis and overtreatment is expensive and potentially dangerous. So the question becomes: Why are radiologists overcharging patients and insurance companies for reading these unnecessary exams and why are surgeons performing these unnecessary surgeries?
Hey ACR – kind of sucks when your own dumbass logic is used against you, doesn’t it?

Catholic Health Initiatives settles lawsuits relating to unnecessary heart stenting procedures performed by Dr. Mark Midei. Total payouts will be $37 million, with each patient receiving payment of at least $134,000.

Patient with potential measles left sitting with other patients at Rhode Island Hospital. Rhode Island Department of Health descends upon hospital and demands immediate action to prevent “potential harm to the public.” Hospital now must re-educate and re-train staff regarding “care and treatment, including emergency room assignments and required precautions, for patients presenting with contagious or potentially contagious conditions.” The patient presented with “flu like symptoms with fever (which is a symptom of the flu).” Given that every snot nose is a potentially contagious condition, there are going to be a lot of cases of “potential harm to the public” regardless of what training takes place.
All because some brainiac decided not to get immunized.
And the patient didn’t even have measles. Sheesh.

California malpractice cap could be raised from $250,000 to $1.1 million during November ballot vote.
Notice now: If you practice in California, get licensed in other states and start working on hospital privileges. California has officially become runner up to Florida for states in which you don’t want to practice medicine.

Florida Supreme Court rejects medical malpractice caps.

Kansas also planning to raise the limits on non-economic damages – from $250,000 to $350,000.

Pennsylvania considering increasing the standard for malpractice in emergency settings from simple negligence to gross negligence and increasing the standard of proof to “clear and convincing” as opposed to a preponderance of the evidence.
Cue plaintiff attorney wailing and gnashing of teeth in … 3 … 2 … 1 …

You have your robot’s lawyer call my robot’s lawyer and we’ll just see about that. How do human laws apply to robots performing surgeries?

Cleveland Clinic neurosurgeon wins $7.7 million malpractice judgment against Cleveland Clinic. The neurosurgeon was using a saw during surgery when a bone chip flew into his eye. During surgery to repair the damage, the Cleveland Clinic ophthalmologist damaged the neurosurgeon’s iris, making it impossible for him to ever practice neurosurgery again.
The big question in the comments section was whether the neurosurgeon was wearing protective glasses.

California family files malpractice suit after elderly family member declared dead of heart attack, placed in morgue, but allegedly was still alive. Morticians who received her body several days later found her face down in the body bag with broken nose and disfiguring cuts and bruises to her face.
Video about the incident here.

Healthcare Update Satellite — 04-16-2014

Wednesday, April 16th, 2014

Ouch. Tree trimmer using chainsaw mistakes his neck for a branch and shows up in the ED with the chainsaw embedded into his neck and shoulder. Trauma surgeons removed the saw and the patient is expected to make a full recovery.

You think eating all of that nasty salad and tofu is doing you any good? Think again. Vegetarians may have lower Body Mass Index, but they’re twice as likely to have allergies and they are 50% more likely to have heart attacks and cancer. The silver lining is that vegetarians also have a higher socioeconomic status. Does that mean that meat costs too much or that eating vegetables will make you rich?

It is both scary and disappointing that this story is even in the news at this point in civilization. Measles is spreading rapidly across New York City’s Lower East Side. Health officials are urging people to get vaccinated since unvaccinated patients who are exposed to the virus have a 90% chance of getting the disease and up to 33% of infected patients can suffer some type of complication such as pneumonia or encephalitis … which is why civil and potentially criminal liability should attach to those who refuse to vaccinate themselves or their children.

A Canadian hospital emergency department so overwhelmed that an elderly patient allegedly develops bedsores while waiting five days for a hospital bed after being admitted. As horrible as it sounds, it is unlikely that five days laying in a bed would cause bedsores “full of pus” and “almost down to the bone”. Those had to be there before the patient arrived.
But a wait of 5 days for a general medical hospital bed is still pathetic.
More hospital closures and more ED patients in the US every year. Is this a look into the future of US healthcare?

California’s Palm Drive Hospital goes bankrupt and plans to close its doors. Board members base the decision on falling Medicare/Medi-Cal reimbursements, competition from other hospitals, significant loss of patients and the general costs of health care. Community members “pleaded with the board to reject the proposal to close the emergency room.”
Unfortunately, many people are learning the hard way that health care insurance and timely health care access are two very different things. Create a hostile environment to services and you won’t have those services any more.

Louisiana’s Governor Bobby Jindal is shooting for a big fat “F” on the next ACEP report card. Louisiana got a D in the latest ACEP report card due to high rates of uninsured and lack of access to primary care. Now Governor Jindal is proposing a flat-rate triage fee for emergency departments that is “significantly less than the cost of providing care.” Look for such a plan to increase the number of “triage out” patients in the emergency department.

Arizona patient gives multiple names to emergency department staff in attempt to obtain pain medications. Now 27 year old Emily Ingerick … or is it Deborah Peel … or is it Jim Dwyer? Whatever her name is, she’s spending the night in the Greybar Motel … sans pain medications.

FedEx employee is exposed to nontoxic food additive powder at home, but develops breathing problems and vomiting. Goes to Methodist University Hospital emergency department where hazmat crews unnecessarily shut down hospital emergency department for three hours to decontaminate it from a substance that was “not hazardous in any way.”
What a waste of time and taxpayer money.

Is Chicago the gun death capital of the US? Last weekend four people were killed and 37 people were wounded in Chicago gun violence … which makes no sense at all because Chicago has such strict gun laws.

Good news and bad news. If you’re looking for a new job and have a scienctifically-oriented mind, going into medical laboratory science may be something to look into. At least according to this article, there is a desparate need for lab techs in Northeastern Louisiana, and one of the people interviewed for the article notes that there is a shortage of lab techs nationwide.
The bad news is that if the University of Louisiana can’t find more students to fill its spots, the program may disappear, which would have a negative impact on health care in the area – including emergency departments that depend on quick turnaround for lab tests.

Why isn’t this show off the air yet? Sex sent me to the ER turns to “sexism” sent me to the ER when doctor passively watches patient get beaten by wife in the ED after patient thrown out of third story window by prostitute when he tries to write her a check.

Healthcare Update Satellite – 04-08-2014

Tuesday, April 8th, 2014

See more healthcare-related news from around the web on my other blog at DrWhitecoat.com

Emergency physicians more likely to miss signs of strokes in young patients – often headaches with dizziness. Those misdisgnoses may account for 40,000 to 80,000 preventable deaths each year.
Of course, the answer to save lives is to perform MRIs/MRAs on everyone with those symptoms.
Until some beancounter tells you that the MRIs and MRAs are “unnecessary”. Then you’re a bad doctor for ordering the tests. So you don’t order as many tests.
Then you miss a stroke and the news media references a journal article about missing strokes with those same symptoms, points to your care and tells everyone what a bad doctor you are.
Then some administrator tells you that your failure to order a test that missed the uncommon presentation of a disease cost them a million dollar settlement.
Then you order more tests to keep from missing another case of a stroke.
Then the beancounters tell you that your testing is unnecessary …

Kansas City area pain clinic gets hit with $2.88 million verdict when patient commits suicide due to pain from MRSA meningitis. Clinic physicians allegedly performed spinal injections through an abscess that had formed on the patient’s back and seeded his spinal canal.

Speaking about pain, the American College of Medical Toxicology meeting had research showing that there was a 65% increase in opioid prescribing for headaches. For hydromorphone (Dilaudid), the increase was 450%. Investigators noted that “we are concerned that providers are prescribing these medications, despite guidelines recommending against their routine use” but also noted that patient satisfaction scores and regulatory requirements (pain is the fifth vital sign, right Joint Commission?) are likely driving these prescribing trends. These types of unintended consequences are exactly what happens when you have clueless people trying to regulate health care.

Physicians finding it more and more difficult to deal with online trolls. “Because the Health Insurance Portability and Accountability Act (HIPAA) of 1996 prevents doctors from discussing patients, disgruntled and anonymous individuals can pick fights over their quality of medical care with little chance of being successfully hit back, leaving physicians almost powerless to defend themselves. In some instances, aggravated patients use that advantage to mount calculated attacks with the intention of inflicting irreparable damage to careers and reputations.”
Anyone willing to donate to a Kickstarter campaign to create a HIPAA compliant web site for doctors to rate patients?

Physician describes how he prescribes more Adderall and Dexedrine to increase his satisfaction scores on Yelp. He also notes how he “hasn’t advised a single patient to exercise regularly or maintain a healthy diet since 2011, saying he learned his lesson after receiving a devastating one-star review.” Courtesy of the Onion – America’s Finest News Source.

Former nurse jailed for 20 years for killing her infant … by breastfeeding. The woman was taking morphine for chronic pain due to a car crash and prosecutors convinced a jury that there was sufficient morphine secreted in the woman’s breast milk to kill the infant. A pathologist testified that there was enough morphine in the infant’s system to kill an adult.
Yet the American Academy of Pediatrics actually recommends using morphine over other pain medications when breastfeeding.

How can you spot a psychopath? This article gives 20 psychopathic traits and also gives a good discussion of what makes a psychopath. “These people lack remorse and empathy and feel emotion only shallowly … it’s like colour-blind people trying to understand the colour red, but in this case ‘red’ is other people’s emotions.”

Breath-actuated nebulizers and traditional handheld nebulizers showed no difference in clinical effectiveness when compared in the emergency department. Guess which one is more expensive.

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