Archive for the ‘Healthcare Update’ Category
Wednesday, May 29th, 2013
More HealthCare Updates from around the web are at my other blog at http://drwhitecoat.com.
Next on the FDA hit list … sleeping pills. Number of ED visits related to Ambien prescriptions triples between 2005 and 2010.
Connecticut emergency department declares influx of intoxicated patients from nearby concert venue a “scheduled mass-casualty situation” and a public health issue as sometimes more than 90 patients are taken to local emergency departments in various states of drunkenness.
I used to work at a trauma center near a concert venue. The worst concerts during those days were “OzzFest” and Jimmy Buffett. The worst for this Connecticut hospital are reportedly country/western concerts.
How times change.
Unintentional ingestion of medical marijuana sending more children to emergency departments. To make things safer for our children, I’m having trouble deciding whether we should outlaw it, throw doctors in jail for prescribing it, or call it an “assault drug” and wage a media war against it.
Patients Gone Wild goes international. Egyptian doctors go on strike after registered convict beats one doctor and tries to shank an orthopedist while security guards stand down. One Egyptian doctor’s rights group wants people who attack hospitals to be charged with attempted murder.
I have a feeling that attack rates would drop precipitously if that ever happened.
Australian university is trying to figure out why rural adults use the emergency department for dental problems almost 3 times as often as their urban counterparts.
We really need to do a study to figure this out?
Top medical malpractice case in New York for 2012: $8.6 million judgment after ENT doc allegedly misdiagnosed sinus infection for 2 years which allegedly led to pituitary gland infection, which allegedly caused patient to develop diabetes insipidus and seizures.
And I shake my head.
It’s been almost 50 years since JFK was assassinated and now we’re learning what happened to the emergency department where he was treated. Ten years after the incident, workers chopped the room up into little pieces and put it into barrels. Now the Kennedy library reportedly doesn’t even want the material.
Wednesday, May 15th, 2013
More HealthCare Updates from around the web are at my new digs at http://drwhitecoat.com.
“Dear ER staff. Our friend is drunk. Fix him.” Unconscious Arizona college student who was “turning blue” left in hospital lobby with Post-It note stuck to his body after losing “drinking contest” at frat house. Nice friends.
If you decide to follow the link, turn down the volume on your computer. Gannett’s KSKD.com has an auto-start video ad that will blow your ears out.
Irish emergency department so crowded and busy that it has to pull an ambulance up to the front door to act as an extra resuscitation room for a patient. To be fair, there were five patients all needing resuscitation at the same time. I actually think that the doctors were pretty resourceful in coming up with the idea.
Nice article on how University of Michigan is decreasing medical malpractice expenses by disclosing errors and compensating patients before lawsuits are filed. Open claims have declined to 63 from 262. Lawsuits have declined to 0.75 per 100,000 patients per month from 2.13. Claim resolution time also has declined to 0.95 years from 1.36, costs to defend lawsuits have dropped to less than $1 million per year in 2009 from $2.2 million in 2001, and the amount needed for reserves has fallen to less than $16 million in 2009 from $72 million in 2001.
They seem to be on to something.
Nice article in the Atlantic about the decline of emergency care. Emergency department visits have increased by 44% while emergency departments have closed at a rate of 11%. In addition, 339 trauma centers have closed. A 10% increase in the number of African Americans treated correlated with a 41% increased risk of the emergency department closing.
If you’ve got nothing to do for a few hours, you can read the 4951+ comments on Reddit that were posted after an emergency physician offered to answer any questions that the readers might have.
The UnAffordable Care Act may leave cancer patients requiring “specialty drugs” with a hefty bill. Some states will require patients to pay up to 30% of the cost of their medications – which could total thousands of dollars each month.
Wisconsin hospital offers machine that dispenses prescription medications. Bad news is that patients need a credit or debit card to pay for the medications … no cash allowed. In addition, you have to visit the hospital’s own ED or acute care clinic – no other prescriptions work in the machine.
Interesting social experiment in New Zealand proves the obvious. Patients don’t use the the emergency department because they can’t afford to see a primary care physician – they use the emergency department because it is convenient. Patients were eligible to receive vouchers to obtain free appointments with primary care physicians for non-urgent complaints. Not one voucher has been handed out this year.
There was a wide belief that people used the emergency department because it was free, but the “clinical head” of the ED stated “that’s probably not as strong as a driver as you might think.”
Bullhokey. Institute a $20 co-pay for each emergency department visit and see how quickly ED patient volumes decrease.
Tuesday, May 7th, 2013
More HealthCare Updates from around the web are at my new digs at www.drwhitecoat.com.
Annals study shows clinical signs that necessitate admission in patients with ALTE (when newborns appear to stop breathing): “obvious need for hospitalization (they used persistent hypoxia as one example of this), significant medical history, and more than one ALTE in 24 hours.
Dual energy CT scan can diagnose knee ligament tears more effectively in the emergency department.
Is it necessary to definitively diagnose ligament tears in the emergency department, though?
And how long will it take until government officials blast doctors for ordering these tests?
You know all of those hospitals that advertise their emergency department wait times? Now those ads may end up biting hospitals in the rear. Nevada patient chooses hospital based upon advertised average wait time of 17 minutes, then waits five and a half hours before getting treatment. Newspapers publish statements suggesting that the signs may be “false advertising.”
Will consumer fraud cases against hospitals based on these advertisements be too far behind.
Florida House tries to improve medical malpractice environment by passing bill that would require experts to be in the same specialty as the physicians about whom they are testifying and that would allow ex parte communications between lawyers and a patient’s treating physician.
I still wouldn’t practice medicine in Florida.
Conditions at California’s Contra Costa Regional Medical Center are endangering patients according to the emergency department staff. Examining patients in the lobby and behind screens in the hallways are alleged as the emergency department is seeing twice as many patients as it was designed to accommodate.
So what do hospital administrators do in response? They hire a consultant to tell them the same things that the staff is already telling them.
What? Did you expect rational thinking?
Hospitals finding that they can cut costs by catering to emergency department “superusers”. For example, homeless patient Dennis Manners was treated in the emergency department 337 times in less than two years, amassing charges of more than $626,000. The hospital found him an apartment, assigned him a primary care doctor, and enrolled him in a drug treatment program.
I think that what the hospitals are doing is great, but why should this financial burden fall on the backs of private enterprises when government should be providing the services for its citizens?
Social media strikes again. Picture from Cumberland Infirmary in England shows that the hospital isn’t meeting the government targets for patient throughput.
Tuesday, April 23rd, 2013
More HealthCare Updates from around the web are at my new digs at www.drwhitecoat.com.
Diagnostic errors account for most paid claims in medical malpractice cases. Errors in diagnosis were the most common type of claim and also amounted to the highest proportion of total payments. The total inflation-adjusted amount of diagnosis-related payouts was $38.8 billion over 25 years.
Remember, these statistics represent just the payouts. On average, two of three medical malpractice lawsuits end in no payment to the plaintiff.
And we still wonder why doctors do so many “unnecessary” diagnostic tests?
Missing bamblance. University of Virginia is on the lookout for a stolen ambulance after the driver left the ambulance unlocked with the engine running.
Another missing bamblance. This one was from University of Alabama Birmingham ED ramp. The ambulance company executive said that it “wasn’t clear how or why someone took the vehicle.”
How – The driver obviously left the keys in it.
I agree with him on the “why” part.
Ex-boyfriend kidnaps patient from hospital room. Waited until she was called back to the treatment area from the waiting room, then stuck a gun in her ribs and made her leave.
I can’t make this stuff up.
Another application of federal EMTALA law. Everyone coming to the emergency department must be evaluated and treated – even if they just bombed the Boston Marathon.
Cases like this come up every once in a while and it is very difficult for the emergency department staff to set aside their feelings.
Another story on the topic here
Surgical complications good for a hospital’s bottom line. With insured patients, hospitals made an extra $39,000 per patient who had post-surgical complications. Medicare patients with post surgical complications earned the hospital about $1750 more. Hospitals lost money on Medicaid and private pay patients with post-op complications.
Don’t believe people who try to draw the conclusion that “errors” and “complications” are the same thing – they aren’t.
Monday, April 15th, 2013
See more HealthCare Updates from around the web at my new digs at www.drwhitecoat.com.
More of a free market approach to medical care. Australian private hospitals noting a large uptick in emergency department patients as patients opt to pay for emergency services rather than wait for care at the public hospitals. Some emergency departments are recruiting highly regarded specialists to further increase patient demand for services.
Another article about Australian medical care. Patient goes to hospital complaining of the “worst headache of his life.” In many cases, that translates into doctor speak for “order a head CT scan to rule out bleeding”. The patient had a head CT nine days before going to the emergency department which showed the presence of an aneurysm. He was discharged from the emergency department and died the next day.
More arrests for oxycodone prescriptions. In this case, a physician wrote prescriptions for more than 500,000 pills over 2 years. The prescriptions were filled in New Jersey – even though they were written in New York. Other allegations surfaced as well.
The investigation was sparked by an overdose death where a prescription bottle bearing the doctor’s name was found at the scene.
More Unaffordable Care Act follies. Smoking is considered a “pre-existing condition” under the Act and smokers therefore can’t be charged higher rates than non-smokers for insurance. Which means that non-smokers will be charged even more to cover the cost of treating smokers.
I’m getting the impression that the government wants the insurance industry to fail.
Get your healthcare now while you still have insurance, folks.
“Sounds good my man, seeya soon, ill tw …” The University of Northern Colorado student sending this text message never got to finish it. He was driving while texting, drifted into oncoming traffic, jerked the steering wheel, and rolled his car. He died from the resulting injuries.
His parents published pictures of his phone with the message hoping that they can keep others from texting and driving. I hope that every parent prints this article and discusses it with their children.
Monday, April 8th, 2013
Columbus, OH paper compares hospital wait times from 15 different hospitals throughout central Ohio. Metrics include minutes until diagnostic evaluation, minutes until pain medication, minutes until admission decision, and minutes from admission to room placement. I just wonder how accurate the metrics are. It isn’t like self-reported data like this can’t be manipulated.
Evanston Northwestern Hospital in Chicago suburbs also making news because of its wait times – nearly twice the national average.
The problem with providing patients with insurance: When the insurer cuts payments, what happens if providers won’t take your insurance? Government cuts payments to providers so that it costs more for cancer clinics to provide chemotherapy to some Medicare patients than the government reimburses. To stay afloat, some cancer clinics have now begun turning away Medicare patients needing cancer infusions. Now patients go to hospitals where the charges for cancer treatment are higher and the waits for treatment will likely be longer.
But we’re going to be insured! And we can keep our doctors, too!
Patients gone wild. Two brothers in Lebanon “attack” an emergency department, smashing windows and insulting the doctors and nurses on duty. In other words … a normal day in a typical American emergency department. And their Press Ganey scores probably stink for that day, too.
What a great story. Six year old Long Island kid treated in emergency department raises $275 with a fundraiser and uses the money to buy coloring books for other emergency department children.
Remember how CMS promised to give incentive payments for “meaningful use” of electronic medical records? Not so fast. Rules changing. Now it is doing random audits of 5-10% of all applicants to see whether they should actually get their bonus payments. Self-reporting isn’t good enough any more.
Wouldn’t it be interesting to see what would happen if all providers went back to paper records?
Canadian paramedics visiting patients with “non-urgent” issues to keep them out of emergency departments. The only question I have is who determines whether the issues are “non-urgent”?
A second interesting Medical Economics article. What are the tech trends that will affect how doctors practice medicine in the future? Interesting to consider. Remote patient monitoring. Personal health records with biometric security. Cool stuff.
More than 25% of Oklahoma patients enrolled in Medicaid. Of those, about a quarter used the emergency department a total of 528,000 times at a cost of $170 million. Oklahoma is now trying to determine how to deal with the high utilizers – those who use the ED more than 15 times every 3 months.
Speaking about Oklahoma … Oklahoma Dentistry Board officials are deciding whether to pursue criminal charges against a dentist. Officials found rusty instruments, “potentially contaminated drug vials” and “improper use of a machine designed to sterilize tools” in the dentist’s office.
The Oklahoma Dentistry Board accused the dentist of re-inserting needles in drug vials after their initial use and using the same drug vials on multiple patients. This happens often in medicine. The dentistry board also stated that a sterilization machine hadn’t undergone monthly testing in six years. Concerning, but when the Board officials tested the machine was it not properly sterilizing equipment? They did test the machine, right? Were the rusty instruments used on patients? Where was the rust located – on the handles or on the surfaces that come into contact with patients?
In addition, the dentist allegedly allowed dental assistants to administer IV sedation when only dentists are allowed to perform such acts.
For each charge, the dentist could face up to four years in prison and a $10,000 fine.
Are the alleged actions above worth throwing someone in jail for 8 years over?
Rhode Island emergency department reportedly one of few in country to have an MRI available in the department. Wonder how MRI use at this hospital compares to national averages.
Remember … fast care, quality care, free care – pick any two. Patient upset because she was treated quickly in a freestanding emergency department, but her bill was too high and included a $1,500 “facility fee” typically used by hospitals. Some of those costs to go complying with governmental regulations.
One British Columbia hospital emergency department is in a “state of emergency” due to understaffing and high patient volumes.
Emergency department personnel don’t routinely ask suicidal patients about availability of firearms in the home. Will patients admit to having guns and if so, will intervention make any difference in suicide rates?
Woman with double uterus told not to have any more children due to possibility of dying from complications. Goes for abortion and learns several days later that the abortion was unsuccessful. Instead of going for repeat procedure, keeps pregnancy. Now, after delivering healthy 6 pound girl, woman sues abortion clinic for the pain, suffering, and emotional distress of having undergone an improperly performed abortion.
Monday, April 1st, 2013
This case report is entirely bizarre. Patient gets awarded more than $800,000 after visit to doctor resulted in incorrect diagnosis of cancer when the patient really had pneumonia and caused patient to have amputation of her foot. A trial was held on the case four years ago with a verdict in favor of the doctor, but the judge declared a mistrial because Washington State jurors were referring to the plaintiff’s Japanese attorney as “Mr. Miyagi” and were making other racist comments against him.
Then, the article notes that the doctor had been disciplined by state regulators for making “erroneous diagnoses” and for prescribing methadone to drug-addicted patients. So now Washington State physicians’ licenses can be on the line for failing to perfectly diagnose patient symptoms and for prescribing medication for one of its intended uses.
I admit we don’t have all the information behind the license actions, but the article makes the Washington State Medical Board sound a little overeager to discipline physicians.
Congratulations! You delivered a healthy 6 month old! 15 lb 7 oz baby delivered vaginally in UK. More than 20 doctors reportedly assisted in the delivery.
Curing patients gone wild? Australian hospital emergency department guards petitioning to carry guns at work. Medical workers claim that it will make emergency departments more dangerous.
Australian patient held four days in emergency department waiting for psychiatric bed to open up. Shortage of beds creates high demand. Patient’s mother alleges that his condition worsened because of the long wait.
Not that anything like this could happen in the US. Oh wait. What a coincidence. LSU is closing their mental health emergency department, resulting in other hospital emergency departments having to care for “an additional 2,000 people who are a danger to themselves or others, who are desperately in need of stabilization and potential further hospitalization.”
When medical services are curtailed, the patients needing those services don’t just disappear.
Monday, March 25th, 2013
Another medical issue with overweight patients: Intramuscular injections. An Epi-Pen may not work in patients who are obese since the distance through the subcutaneous fat to the muscle is greater than the length of the needle. This study showed that in more than 4 of 5 obese children, the subcutaneous fat layer was too thick for an IM injection one quarter of the way down the thigh. In nearly 1 of 5 obese children, the subcutaneous fat layer was too thick three quarters of the way down the thigh. In those patients, the study suggested injecting the calf.
I suppose the manufacturer could be forced to make autoinjectors with longer needles, but then non-obese patients would theoretically risk getting a bone marrow injection of epinephrine.
How good are emergency physicians at dispositioning psychiatric patients when compared to psychiatrists? Not horrible, not great.
95% of patients assessed as “definitely admit” were admitted by the psychiatrist. For other emergency department psychiatric patients, there was an 87-90% concordance rate.
Sugary drinks may kill 25,000 people each year. That’s nothing. SALT [allegedly] causes one out of 10 deaths in this country each year and more than 2.3 million deaths worldwide in 2010.
Wonder what that sphincter Michael Bloomberg is going to do with this information. Salt tax? Force NY City hospitals to draw serum sodium levels on all patients? Outlaw salt shakers in restaurants? Or maybe he could just go after the salt shakers with the larger holes and call them “asSALT” weapons.
Bwaaaaaahahaha. Sometimes I crack myself up.
Another nice article by Alicia Gallegos at AM News. Liability involving patients who overdose on medications is increasing. Families of suicidal patients who overdose on medications are blaming physicians who prescribe the medications … and winning.
According to the article, physicians are having also disciplinary actions taken against them if they prescribe medications to a “doctor shopper”.
This is getting ridiculous.
When pain patients complain that they are treated like “drug seekers,” this is part of the problem why.
Maybe the next step should be forcing all patients to sign a statement requiring them to list any doctors that have prescribed them medications, any medication that they have at home or have access to at home, and any medications or street drugs they are using or have used in the past 12 months. (more…)
Monday, March 18th, 2013
The Veteran’s Administration intentionally changed and hid data to avoid providing costly yet critical medical care to soldiers from the Gulf War? A head VA epidemiologist alleges that more than two thousand veterans responding to a study felt like they would be “better off dead”. In 95% of those cases, the VA did nothing to assist those veterans with follow up care. In a subsequent study when the same epidemiologist attempted to ensure follow up care for potentially suicidal veterans, he allegedly had disciplinary actions instituted against him. If that’s true, I wonder how everyone else will be treated once they have medical insurance under the UnAffordable Care Act.
American College of Obstetricians and Gynecologists advises against using the da Vinci robots for hysterectomies. Robotic surgery adds about $2000 to the cost of surgery and “there is no good data proving that robotic hysterectomy is even as good as, let alone better than, existing and far less costly minimally invasive alternatives.”
I hope that other specialty societies have the integrity to make similar inquiries.
All those hospitals that spent millions of dollars on these machines to keep up with the Joneses may just be in for a big surprise.
Insurance companies expect health insurance premiums to rise 20% to 100% once the UnAffordable Care Act is implemented next year. Department of Health and Human Services responds that it is misleading to look at the one provision of the UnAffordable Care Act because “taken together, the law will reduce costs.” Well, gee, that broad unsubstantiated assertion sure convinced me.
You know all those things your hospital does to stop the spread of clostridium difficile infections? Yeah. They don’t work (.pdf file). 42% of hospitals implementing such policies noted decrease in c. difficile rates while 43% of facilities noted an increase in c.difficile rates.
Can’t wait to see the spin that the Joint Commission puts on this one.
Monday, March 11th, 2013
Doctor treats child born to HIV positive mother with full three-drug regimen of HIV drugs one day after birth instead of one or two drug regimen typically used until an HIV infection can be confirmed. Treatment continued for 18 months, then the patient’s mother stopped bringing the patient to appointments.
The child is now 30 months old, has been off HIV medications for a year, and has no HIV infection according to ultrasensitive testing performed at Johns Hopkins.
Now the doctor’s colleagues are planning a celebration.
Of course, if the child did poorly or had a bad reaction to the medications, the doctor would likely have been arrested, lost her license, and sued for millions.
More warnings about superbugs. MRSA is bad enough, but what happens when the organisms living in all of our intestines become resistant to antibiotics?
Patients gone wild returns. Minnesota goof screams profanities and disrupts medical care. Tied down in four point restraints until police arrive. Will likely be charged with disorderly conduct. Wow. If every patient that did this kind of thing was charged with disorderly conduct and whisked off to jail, our ED volumes would drop by a good percentage.
Electronic medical records are supposed to improve care, right? In this study, alert fatigue caused 30% of VA doctors to miss important alerts. 87% of doctors said that the number of alerts they received was excessive and more than half blamed the design of the EMR for the problem.
Quite possibly better than the lollipop story. Police find loaded gun in woman’s hoo hah during search. Also had crystal meth in her butt crack. And THAT, dear readers, is why they call it “dope.”
You think your wait in the emergency department is long? Try going to LA County Medical Center where the wait averages 12 hours at some points.
In the past, certain people have equated high wait times to a poorly run hospital, but we won’t go there.
Spider bites may be a common complaint when coming to the emergency department, but the complaint often turns out to be a MRSA infection. As the Milwaukee Brewers General Manager discovered, bites from other arachnids may also require an emergency department visit when you try to squish them up in a tissue.
British Columbia emergency physicians describe horror stories in their emergency departments allegedly due to funding issues and overcrowding. Performing CPR on the waiting room floor? Even I haven’t heard of that one before.
Nurse in New York caught stealing medications from nursing home patients.
Not sure how to take the wording in this article. Polish man walks into emergency department with screwdriver sticking two inches into his forehead, article reports that there was no damage to the patient’s brain.
South Carolina inmate grabs an officer’s gun during emergency department visit. Second officer “fires shot to subdue him” – inside the emergency department. Inmate then gets taken back to jail. What happened to the gunshot wound?
Did medical malpractice kill Bruce Springsteen’s saxophonist? Clarence Clemons’ brother, an attorney, pursues malpractice litigation against doctors for Clemons’ stroke.
Could medical malpractice climate in Florida be changing? Bill working its way through Florida House would increase burden of proof on medical malpractice claimants and would limit who can serve as an expert witness. Also protects hospitals from liability for actions of their contracted health providers.
Florida Medical Association attorney notes that Florida’s current malpractice laws are “doing a disservice to our state and are a driving force in a physician’s decision to leave critical-need specialities, retire prematurely and even leave to practice in another state.”
We’re watching you …California wants $10 million in funding to create a prescription-tracking database so that it can find doctors who overprescribe narcotics. Once the system was up and running, doctors and pharmacists would be REQUIRED to check it to look for signs of narcotic abuse. Of course, the definition of “signs of narcotic” abuse is purposely not included. That way the state could just attack at will any physicians who prescribe any narcotics. The database would be paid, in part, by raising physician licensing fees.
Interesting statistic. Top 25% of Medicare beneficiaries account for 85% of total Medicare spending. Prime targets for “death panels,” huh?
Seriously, though the article has several good points about how to improve the medical system, even though it is written by someone with no apparent experience in the medical system.
One point in which I disagree with the author is that “guidelines” should be used both as a shield and as a sword. We all saw what happened when NY Times reporter Jim Dwyer misused guidelines. In general, guidelines are situation specific and failure to follow them to the letter shouldn’t be considered malpractice.
Obese patients eligible for special seating at the 2014 World Cup in Brazil. Just need a medical certificate stating that your body mass index is 30 or more, which apparently qualifies people as being disabled under Brazilian law.