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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.

Healthcare Update Satellite — 04-02-2014

Wednesday, April 2nd, 2014

See other medical news on my other blog at DrWhiteCoat.com

Liberal use of blood transfusions may increase the incidence of serious infections. I don’t have access to the entire article, but wonder if the study also looked at overall mortality. In other words, is the increased risk of developing a serious infection outweighed by preventing more deaths from severe anemia (lower oxygen carrying capacity, increased cardiac demand, etc)

Traumaman … Traumaman goes wherever a trauma can. Sprayable nanofibers may soon replace sutures and may revolutionize trauma care. I imagine it’s only a matter of time until the idea is weaponized. One splat in the face and you’re through.

I’m with Skeptical Scalpel and SurgeryWatch on this one. If patient satisfaction and doctor ratings are of such value to the medical industry, we really need to expand the concept to other industries as well. Enter Airline Pilot Ratings. One of you flyboys hits turbulence and you’re ratings are through. If my ticket price is too high, you’ll be lucky if I give you a single “fair” rating on your whole report card. And if there are any delays, I mean ANY delays … I’ll give you friggin negative numbers. You hear me? NEGATIVE! Oh, by the way, I don’t like how your voice is muffled when you talk on the speaker. You get points off for that, too.
Yep. That’s how all enterprise should work.
Next up: Patient ratings.

Can charm be taught? Meet this generation’s version of (a female) Dale Carnegie and decide. The article is long, but well-written and enjoyable, so grab a cup of coffee before clicking on the link.

Another hospital closes its doors. Hospital board votes to close North Adams Regional Hospital in Massachusetts with only three days’ notice. The hospital had previously been open for 129 years. Nearby Berkshire Medical Center is going to attempt to preserve services at the hospital, but a source for funding has yet to be identified.

Give me the girl. Judge gives permanent custody of a Connecticut girl who is hospitalized in a Massachusetts hospital to the Massachusetts Department of Children and Families. “Closed-door juvenile court hearings late last year” allegedly proved that the parents were unfit to handle their child’s complex needs. It probably didn’t help that the girls dad was being a tool, failing to work with healthcare providers, threatening the social worker assigned to the girl’s case, and calling hospital personnel “Nazis.”
But if these types of things are sufficient to take custody of a child away from the parents, then we’re a few virtual reality computer programs and a holodeck away from the real life Hunger Games.
Another story on this case in the Boston Globe.

Association for Comprehensive Energy Psychology (the “other” ACEP) tries to get Wikipedia to open up its policies to encourage more articles about topics such as Emotional Freedom Techniques, Thought Field Therapy, and the Tapas Acupressure Technique. Wikipedia co-founder responds rather thoughtfully.
“If you can get your work published in respectable scientific journals—that is to say, if you can produce evidence through replicable scientific experiments, then Wikipedia will cover it appropriately. What we won’t do is pretend that the work of lunatic charlatans is the equivalent of “true scientific discourse.” It isn’t.”
Lunatic charlatans, eh? If advancing directives without having work published in reputable scientific journals and without those directives resulting form replicable scientific experiments is what defines the term, then the Joint Commission, Press Ganey, and most of the people who created Hospital Compare fit the definition.

Right on, brother. A leading neuroscientist asserts that ADHD is not a disease, it’s a label that is used to prescribe dangerous medications to children. The medications given to ADHD patients cause long-term changes in the brain and “their rewards systems change.”
Maybe that’s why some people call Ritalin and similar medications “kiddie cocaine.”

Another interesting article about the human microbiome. Certain bacteria in a woman’s vagina may protect against HIV infection. In the study, patients with bacterial vaginosis and taking an antiviral medication had significantly reduced antiviral activity while those patients with healthy vaginal bacteria and treated with the antiviral produced significantly less HIV.

High school teacher forced to resign after taking a 20 year old student (an adult capable of consenting to the actions) to the emergency department for an undisclosed problem and then paying for the cost of the student’s medical treatment.
Huh?

Bwaaaaaaah. District Court Judge Carter Schildknecht has open and closed door meetings with hospital administrators after her husband had a heart attack in the emergency department at Medical Arts Hospital. Ellis Schildknecht apparently had a gag order imposed by his wife as he remained silent during the meeting … and because of HIPAA laws, the hospital can’t respond publicly to the Judge’s complaint, leaving District Court Judge Schildknecht’s vague question “Is this the reputation that you want our hospital to have in this community?” out there for debate.
Saving the life of a patient suffering from a heart attack? Yes. That’s the reputation we want.
Perhaps you could order that your husbands files be released to the public so everyone could review the care that you deem so deficient and worthy of contempt.

Healthcare Update Satellite — 03-25-2014

Tuesday, March 25th, 2014

Patients gone wild. Really wild. 70 year old Brookdale Hospital nurse Evelyn Lynch gets knocked to the ground by patient Kwincii Jones and has her head stomped. She was knocked unconscious and suffered severe facial fractures. Also underwent brain surgery, so it is likely she suffered a brain bleed or has brain swelling as well.

Congratulations to the antivaccination movement for increasing the worldwide incidence of pertussis and measles. Measles and mumps are now “crushing” the UK. Patients with “religious exemptions” to receiving vaccinations were reportedly the source of one recent California pertussis outbreak.

Rise of the machines. I thought I was pretty good at spotting patients in fake pain. Turns out that most observers are only slightly better than chance at picking out fakers from the real deal. This computer program can achieve 85% accuracy in picking out patients who are truly in pain just by analyzing their facial expressions. Of course, watching the surveillance video of people skipping in the parking lot, then limping into the ED hunched over in “pain” is also a dead giveaway.

Machines are also pretty darn good at sniffing out cancer. A device called BreathLink can detect changes in a woman’s breath that suggest breast cancer and has a diagnostic power similar to mammograms. The device may also be able to test for tuberculosis.
The article also has a neat table about the odors different disease processes cause. Did you know that rubella may cause your sweat to smell like freshly plucked feathers or that schizophrenia may cause your sweat to smell like vinegar? Typhoid fever may cause your skin to smell like fresh-baked bread.

Wrapping that rascal is more and more important lately. The CDC is warning that gonorrhea may soon become untreatable. The “love dart” – otherwise known as an injection of Rocephin – has been a stalwart of treatment and now gonorrhea is showing resistance to this class of medications as well. Another article on the topic in The Verge here.
By the way, do you know what you get when you kiss a parakeet? Chirpes … fortunately that’s still tweetable.
Stop groaning. That thar’s funny and you know it.

What do you do if you’ve been diagnosed with cancer? Take a deep breath. Own it. Don’t run to consult Dr. Google. Dr. Peter Edelstein has some more suggestions here.

Utah Senate passes bill allowing doctors to prescribe Narcan to third parties to administer to patients who may be suffering from opiate overdose.
Initially, I had problems with this idea. Would people be able to inject it IM or assemble the intranasal administration assembly? How would the lay public deal with patients who are suddenly thrown into withdrawals?
Then I thought that it would be better to at least attempt to reverse an opiate overdose and deal with the consequences rather than having a patient die.
So why require a prescription? Shouldn’t Narcan just be made over the counter?

Rhode Island emergency department becomes first in nation to incorporate Google Glass into patient care.

Call of Duty – Dialysis Edition. 14-year-old Norwegian kid drinks 4 LITERS of an energy drink over 16 hours so he could stay awake playing Call of Duty. Ends up in a coma in a hospital for two weeks with “kidney failure” but is expected to respawn and live to fight another day.

Many people in New York contracting rare skin infection called Mycobacterium marinum. All of the 30 cases diagnosed were in people who were handling seafood.

Trying to change the message again. Obamacare architect Dr. Ezekiel Emanuel asserts that “you don’t need a doctor for every part of your health care.” If you like your high school sophomore with a 16 hour course in basic first aid, you can keep your high school sophomore with a 16 hour course in basic first aid.

Healthcare Update Satellite — 03-04-2014

Tuesday, March 4th, 2014

Science reporter Miles O’Brien suffers a freak accident while packing equipment after a reporting trip. Case falls onto his arm and causes bruise/injury. The following day, pain and swelling in his arm got worse. The day after that, he was being rushed to the operating room for compartment syndrome. His blood pressure dropped during surgery and the surgeon had to amputate his arm.
Best wishes for a speedy recovery, Miles.

Patients who have had strokes are 50% more likely to have iron deficiency anemia as are control populations. Authors suggest a couple of possible mechanisms for the correlation including decreased oxygen delivery and a secondary thrombocytosis, but no one is quite sure why the risk increases.

Eastern Ontario Children’s Hospital asks patients to stay away unless they have a “true emergency”. The hospital is just too busy.

New Hampshire hospital employee makes “offhanded” comment about strangling and shooting man who was divorcing her daughter. “Antagonistic” co-workers notify police that she was making homicidal threats. Police then come and arrest her and take her to hospital emergency department … where she waits six days before a bed in a psychiatric hospital opens up. She is discharged from the psychiatric hospital the following day. Now she’s suing for false imprisonment and wrongful discharge … from her job, not from the hospital.

The good news is that we have these tests to give us a better idea of your medical “frailty.” The bad news is that if the tests are abnormal, you’re substantially likely to die sooner. Tests include alpha-1-acid glycoprotein, albumin,  very-low-density lipoprotein particle size, and citrate. Those whose tests were in the highest 20% were 19 times more likely to die in the following 5 years than those whose tests were in the lowest 20%. Patients whose tests were in the 99th percentile had a 23% likelihood of dying in the next 12 months and 49% likelihood of dying within the following 5 years.
So … do you still want to have the testing done?

78 year old farmer takes a nap, then wakes up with a bunch of people at a funeral home trying to embalm him. Coroner was called to the house, said the patient had no pulse, and declared him dead. Family surmises that the patient’s pacemaker stopped working.
I’ll say.

Maybe a better title to this article would be “The Way We DON’T Pay Primary-Care Doctors Is Insane”. Some people commenting on the article are advocating use of NPs and PAs to replace the primary care physicians.

Paul Hsieh writes a nice article in Forbes about whether you can trust what’s in your medical records. Uses the case of a Dragonism where “DKA” was transcribed to “BKA” to illustrate the point that sometimes erroneous information can be unintentionally propagated in future medical record entries. Also gives some good advice on patients can minimize errors in their records. Best suggestion: Obtain copies of your medical records and request copies of all testing performed on you.

Louisiana patient sues cardiologist for failure to stent which allegedly resulted in permanent disability when the patient suffered a heart attack a few weeks later.

Should Zohydro be removed from the market? Ten milligrams of hydrocodone in one pill. Opponents are concerned that it will cause further addiction and deaths from drug overdoses. Proponents say that patients may need it for proper pain relief.
Another important issue is whether many doctors will even be willing to prescribe it with the increasing number of criminal actions against physicians whose patients die from drug overdoses.

Healthcare Update Satellite — 02-24-2014

Monday, February 24th, 2014

More medical posts from around the web over on my other blog at DrWhiteCoat.com

Another Pennsylvania hospital closes its obstetrics department, citing clinical and financial viability of the department with only one obstetrician on staff. Interesting point in the article is that in 14 years, more than 40 obstetrics units have closed in Pennsylvania. One site lists about 240 hospitals in the state total. Why all the closures? How does that affect care provided to the pregnant patients?
The article notes that the emergency department is trained to handle emergency births, but if a baby is breach or needs emergent delivery, the outcome is likely not going to be good. Emergency physicians can’t do emergency Caesarian sections and we don’t specialize in high-risk maternity care.

Paramedics frustrated at having to provide care to patients for hours in parking lot at University Hospital Limerick before being able to move patients onto a bed inside the hospital. During that time, the paramedics are unavailable to make other runs to other hospitals.

More and more Kentucky patients dying from heroin overdoses, but benzodiazepines still cause most emergency department visits for overdoses in Kentucky. According to the CDC, the number of patients using heroin nationwide has increased by 80% between 2007 and 2012 and much of that increase is attributed to a clampdown on pain medication prescriptions.

Interesting arguments for NOT treating a child’s fever. Fevers won’t fry a child’s brain. That whole egg on a frying pan comparison only works for drugs. The magnitude of fever is not related to seizure risk. I always believed that high fevers made additional febrile seizures more likely, but was unable to find any literature to support that belief. Fevers may help your body fight infection better. And lowering a fever increases transmissibility of influenza.

More of the Obamacare Chronicles.
Patients who are happy to have “insurance” then overcome with shock when they can’t find a doctor who takes their insurance. “Covered California” leaves many Californians “uncovered” for medical care and the doctor directories that it posts on its web sites are often inaccurate. Consumer fraud, anyone?
Remember my prior post about how doctors would be vilified for refusing to participate in low-paying insurance plans? This article is just one of what I’m sure will be many more to come.
Another article on the same topic is here.
And another.
Receiving healthcare insurance doesn’t guarantee you medical care any more than receiving automobile insurance guarantees you a car.
And California is getting close to Florida as one of the states in which doctors should NEVER consider practicing medicine.

Topeka, Kansas VA Hospital is converting its emergency department into an urgent care clinic. As a result, the hospital no longer has to take ambulance runs. Hospital cites staffing shortages. Kansas Senator Jerry Moran alleges that the VA’s failure to hire appropriate staffing is “causing a … backlog of our nation’s heroes who are not receiving the heath care they need.”

Do doctors need to lie to patients? Is it ethical to tell a patient that everything will be alright when the doctor knows that is not the case?

Another example of selective government “transparency.” Feds want to release payment numbers to physicians for providing medical care, but refused to disclose how much money grocery stores were earning from government food stamps. Government attorneys argued that the data was privileged and exempted from the Freedom of Information Act. The 8th Circuit Court of Appeals shot down that argument.

Healthcare Update Satellite — 02-13-2014

Thursday, February 13th, 2014

More medical news from around the web on my other blog at DrWhiteCoat.com.

No more “putting it on my account.” Due to cuts in payments from Medicare and Medicaid and expenses for treating uninsured patients, Hutchinson Hospital in Kansas will require payment for emergency department services, radiology, and outpatient surgery services before services are rendered.
Emergency department patients will still get screened, but apparently won’t receive non-emergency treatment if a partial payment isn’t made.
Florida Hospital Memorial Medical Center has implemented the same type of system – along with several other hospitals in the area. Hat tip to Scott (@Bnet_bobcast) for the link.
While many people think that emergency departments have to provide patients with medical care, that misconception is only partially true. Federal EMTALA laws only require hospitals to provide care for “emergency” conditions, so chronic back pain, colds, toothaches, and rashes are unlikely to qualify. Many hospitals provide the care anyway, wanting to avoid accusations in the news of “refusing care,” but those winds are changing.
Look for prepayment of nonurgent medical care in the emergency department to become a widespread policy as the Unaffordable Insurance Act ratchets down payments to medical providers. You’ll have insurance, but fewer and fewer doctors will be willing to provide you with care.
Then look for the government to pass more unfunded mandates requiring medical providers to provide care free of charge. Wait. That would never happen … would it?

One of the wildest things I have heard of in a while. Gang busts into Brazilian emergency department and robs patients waiting in the waiting room. Taking “patients gone wild” to a whole new level. Another story about the incident here.

Six ways to avoid “unintentional” Medicare fraud. Usually fraud requires “intent”, but not when dealing with providing medical care to patients on the government’s dime.
The best way to avoid unintentional Medicare fraud is to stop accepting Medicare patients.

Another entry in the “that’s why they call it dope” chronicles. Brainiac in UK went home to visit his mother from college, got high on mephedrone, cut off his woo hoo, and then stabbed his mum.
I was disappointed to see that there wasn’t a comment section to the article.

Canadian “Robin Hood” doctor has license suspended for six months after exaggerating patient’s food allergies so patients could get extra diet allowances from the government – to the tune of $1.8 million over 4 years. In the process, Dr. Roland Wong made $60 per form he completed and earned $718,000 in 2008 alone. Hat tip to Mark for the story.

Study in NEJM shows promise in using an implantable upper airway stimulation device to help control sleep apnea. The abstract doesn’t describe the device, but a small picture on the site makes it appear that the device is similar to a pacemaker and has an electrode implanted under the jaw.

New study in Pediatrics: What’s better for treating children with asthma – oral prednisone/prednisolone or IM dexamethasone?

Hospitals in Ireland so busy and stressful that nurses are checking themselves in to be seen in the emergency department.

Irish patient dies of heart attack while waiting in a “dangerously overcrowded and understaffed” emergency department. Consultants warn that “The risk of our next untimely death remains high while the emergency department overcrowding continues.”
And this is the type of system that we want in the United States?

Not a medical post per se, but may become a bigger issue in the future. A Virginia Court of Appeals held that the rating site Yelp! was required to disclose the identity of “reviewers” who left bad reviews about a carpet cleaning business. The business alleged that the reviewers were not his customers and the court held that there was no “free speech” right to make false statements.
Will the same logic apply to those who anonymously rate physicians and hospitals using Press Ganey? It should.

Healthcare Update Satellite — 02-06-2014

Thursday, February 6th, 2014

More medical news from around the web over at my other blog at DrWhiteCoat.com

Holy feces, Batman! How bad of a marriage do you have to be in for your wife to inject “fecal matter” into your IV line while you’re recovering from a heart procedure in the hospital? Whacked out wifey is a former nurse who will now enjoy an extended stay in Arizona’s Maricopa County jail. Thanks to PJ for the link!

Pennsylvania jury awards a $32 million judgment against two nurses who failed to notify an obstetrician about a change in the fetal heart rate for 13 minutes during the mother’s labor. Child later born with cerebral palsy. Hospital, doctor, and a third nurse were all found not liable for the injuries.

The “Affordable” “Care” Act is keeping costs down alright … by refusing care to sick children. A 2 year old with a neck mass being evaluated for cancer, a child with a chronic severe medical condition, an infant with a skull abnormality – all denied care in Washington.

Patients aged 55 and over in Washington State who sign up for Medicaid aren’t getting “free” care. After their death, the state comes after all the assets in their estates, seeking reimbursement for all the medical expenses it has provided.

Texas patient high on methamphetamines convicted of assault on emergency service personnel and faces up to 10 years in prison in sentencing hearing next month. Lola Thompson reportedly headbutted a family member trying to drop her off at the hospital, breaking his nose, then attacked an emergency department nurse, punching her in the face five times. Thompson required three times the normal dose of sedation to calm her down.

Nurse in Canadian emergency department tells anorexic patient with “mental problems” to “go get some supper and come back.” Patient reportedly felt like cutting herself and wanted to “speak to somebody,” but apparently had no other emergency medical issues. Abuse of the emergency department, uncaring staff, neither, or both?

As Ecuador plans to change its malpractice code to establish a 3-5 year prison term for health professionals who cause death by “unnecessary, dangerous and illegitimate actions,” 150 doctors have resigned. Ecuadorian President Rafael Correa says he has more than 700 doctors from other countries who would be willing to practice in Ecuador if the current physicians leave. Wonder if the foreign docs know about the new malpractice law …

Portland, Oregon emergency physician Dr. Jamie Schlueter is one of the team docs for the US athletes in Russia. Excited to go and “hopes no one needs me” – a comment that, for some reason, pisses off one of the readers.

Feds investigating president of American Academy of Pain Medicine after several of his patients die from medication overdoses. One patient notes that his wife went to the physician’s clinic, was initially seen by the physician and then her care was transitioned to a nurse practitioner with “no oversight.” In 14 months, the patient’s medication dose had increased more than sixfold.

Interesting side note is that deaths from drug overdoses in women increased fivefold between 1999 and 2010. In 2010, more than 15,000 women died from drug overdoses and nearly 1 million women visited the emergency department for drug abuse or misuse.

Even more interesting side note is that the fivefold increase in drug overdose deaths in women seemed to start shortly after the Joint Commission declared pain as a “fifth vital sign” and made pain management a “standard.
Has anyone ever considered that the Joint Commission edicts may be responsible for increasing patient deaths?

Should we be doing pelvic exams in the emergency department? In 94% of patients, the results of the exam had no effect on the clinical plan. Good discussion in the comments at ALiEM.

Healthcare Update Satellite – 01-30-2014

Thursday, January 30th, 2014

More medical news from around the web over on my other blog at DrWhitecoat.com

St. Barnabas Hospital in Bronx, NY registers a patient in emergency department to be seen for a rash. Told to go sit in the emergency department. Was called several times over the loudspeaker but didn’t answer. Found “stiff, cold, and blue” 8 hours later.
An unnamed hospital employee told news that the man died because there is “not enough staff to take care of the number of patients we see each day.”
Comment sections of both articles about the story have created a crowd of people with torches and pitchforks relating their own ED horror stories and demanding to know how hospital staff could be so stupid not to know that rashes could be deadly.

Virginia emergency department closed four hours due to … bedbugs. I’m guessing that they aren’t just in the ED, but that’s another story.

Repeal and replace. Republicans offer framework for a health care plan to replace ObamaCare. Will it work? I wonder if telling everyone “you have to pass it to find out what’s in it” would suffice.

Go to one San Jose, CA hospital emergency department without insurance and you’ll get someone offering to sign you up for ObamaCare while you’re sitting in the waiting room.

Doctors Medical Center, the largest emergency department in California’s West County with more than 41,000 visits per year at risk of closing – due to lack of funding.
Doctors Medical Center handles 79% of the region’s hospital admissions, 62% of the region’s ambulance traffic and 59% of the region’s emergency room care, yet 75% of the patients have government “insurance” – which is being cut – and another 11% of patients have no insurance at all. Only 12% have private insurance with who knows how high of deductibles.
“Hospitals are facing $23 billion in government payment cuts through 2020, so independent safety net hospitals that don’t have the large number of private payers face a huge challenge.”
Who’s left to pick up the tab? Taxpayers. The county has already passed two prior property tax increases to help keep the hospital open and is considering a third in November.

And then we wonder why patients with insurance are charged $89,000 for going to the emergency department with a snake bite. Different state, private hospital, same issue.

In Sweden where the government is trying to “guarantee patient care,” patients are purchasing health care insurance so that they can get timely care. Even then, the waits are longer than we would be accustomed to in the United States. “It’s quicker to get a colleague back to work if you have an operation in two weeks’ time rather than having to wait for a year.”
Remember the Engineer’s Triangle: Fast Care, Cheap Care, Quality Care – Pick any Two.

Hospital orderly finds patient’s purse in emergency department and turns it over to a hospital security guard. Security guard then rifles through purse, takes patient’s debit card, leaves work, goes down the street to a fried chicken joint, and withdraws $1,400 – all while patient was still in the emergency department.
When security guard gets back to hospital and sees patient speaking with police officer, he tries to give money back to the patient.
Now the security guard is under arrest and the bail is $5,000. No, he didn’t put down a $1,400 deposit.

Obese preschoolers are four times as likely to become obese teenagers.
Dr. Wikipedia beating out Dr. Google for health care searches. Wikipedia is reportedly the leading source of health care information for both patients AND physicians.
My guess is that the reason for Wikipedia’s dominance has something to do with Wikipedia entries appearing at the top of the search results when someone seeks out a topic.

Don’t go parking in the emergency department patient’s lot if you work at the University of Iowa. They’ll fire you quicker than their clerks take insurance information. News just broke of a third employee fired for the offense (and denied unemployment benefits). Husband and wife employees were fired for the same thing a couple of months ago.

Healthcare Update Satellite — 01-19-2014

Monday, January 20th, 2014

Hospital administrators may be sabotaging their own satisfaction scores by boarding patients in the emergency department.
New study in Journal of Emergency Medicine shows that 6 out of 7 patients prefer inpatient boarding to boarding in the emergency department because inpatient hallways are deemed safer, more confidential, more comfortable, quieter, more private, and as having higher staff availability.

Interesting article in Medium about how physician inventors have created new products out of necessity – and why some products are more likely to go to market than others.

I have a funny feeling that this will be the most clicked-on article this week. Porn star’s health is reportedly in jeopardy from her O-cup breast implants. She can’t perform activities like getting dressed and alleges that the implants diminish her blood flow to her body and may cause blood clots. Doctors recommended double mastectomies, but the patient refuses, saying that it would ruin her career.

Usually we get those little baby roaches. This thing must have been huge. Australian man has inch-long cockroach pulled from his ear. When he first developed pain in his ear and figured out that it was a roach, he tried using a vacuum to get the critter out of there. When that didn’t work, he went to the emergency department and the doctors removed the roach with tweezers.
What should you do to keep cockroaches out of your ears? You can sleep with cotton in your ears or use earplugs. Once they’re in there, they usually can’t get out – either because of the wax in the ear or the tight fit of the ear canal (I’ve heard that roaches can’t crawl backwards, and with the angle of their legs, that makes sense, but I’ve never seen that confirmed by an entomologist). To get them out, first they have to be killed, then usually you have to use alligator forceps to grab them.

Midterm ads blasting Democrats by name for supporting Obamacare.
Vote them out. Then repeal the law just like they repealed prohibition.

Plaintiff allowed to proceed with her malpractice case against orthopedist who diagnosed her with lymphedema when patient develops a blood clot a year later and requires an amputation. Orthopedist recommended that she follow up with neurologist for numbness in her foot rather than a vascular specialist for her lymphedema.
The patient had symptoms for a year, didn’t seek further care, and it is the orthopedist’s fault?

University of Iowa fires employee for parking in the emergency department patient parking lot. The sign in the lot said that violators could be fined or towed. Administrative law judge rules that the firing was justified anyway – “she received a benefit intended for employer patients.”

California having lots of success enrolling patients in Obamacare … by enrolling patients in the emergency departments. Many of those patients are enrolled into Medicaid which will only strain the insurers and states even further.

Should doctors be Googling their patients? The article author, who is a physician, thinks not – it may cause the doctors to have inappropriate preconceived notions about patients. I think that if the information is available, the doctors should have the option to review it. It isn’t like patients don’t Google doctors and get misleading statistics from hack sites like Healthgrades.com.

Get your flu shot. Influenza is widespread throughout the US right now.

Don’t get your flu shot. It could cause you to develop narcolepsy.

Have chronic pelvic pain? The good news is that a doctor has developed a device that may cure it. The bad news is that men have to insert a hammer-shaped probe up their rectums in order for it to work.
Hat tip to Instapundit.

Exciting research by scientists at Cornell. By coating leukocytes with special proteins, they were able to form “unnatural killer cells” that would find and kill cancer cells floating in the circulation. You need an advanced degree to understand the paper, but if they can get the process to work reliably on humans, it will be a huge breakthrough for cancer treatment.

Abusing the system? Patient gets airlifted from Galapagos Islands by an Ecuadorian navy helicopter and then takes jet to US in order to receive treatment for a kidney stone.
If your name is Jeff Bezos and you’re paying the tab, you can get whatever treatment you want.

Australian emergency departments trying to cope with inappropriate emergency department use are considering charging patients a co-payment. Detractors argue that patients will avoid accessing care that they need if they have to pay for it.
They’ll probably avoid accessing care that they don’t need as well …

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