Archive for the ‘Healthcare Update’ Category

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 …

Healthcare Update Satellite — 01-07-2014

Tuesday, January 7th, 2014

In Great Britain, the emergency departments are having problems with “superusers” as well. According to a survey of about 60% of the hospital trusts and boards in the UK, almost 12,000 people used the emergency department an average of once a month in 2012 while 150 patients used the emergency department an average of about once a week. At least a couple of patients averaged visits more than 4 times per week for the entire year.
The biggest problem according to the people being interviewed is that the care in emergency departments is more convenient than waiting for an appointment with a GP.

This article alleges that half of all British patients going to the emergency department don’t need treatment, a third only need medical advice, and 13% don’t even need medical advice.
British doctors are now trying to get patients to ante up £10 for using the ED, which one physician says would probably “cut the attendances by half.”
Those against the proposal argue that “you’re never going to get any money out of those drunks, while there is a real risk that patients who need help will not bother because they can’t afford it.”
So what’s the right answer?

Chain of Florida hospitals belonging to Health Management Associates is under investigation for allegedly providing emergency physicians with kickbacks to perform unnecessary testing and inappropriate hospital admissions. Hospital administrators allegedly told emergency physicians that 75% of all Medicare patients should be admitted.

Pennsylvania jury awards $55 million to a patient who was born with cerebral palsy after getting stuck during a vaginal delivery. Lawyers state “If they’d delivered him by C-section, he would have been fine.”

Patients gone wild is back. Texas woman jailed after punching emergency department nurse when nurse told woman to go sit in the waiting room. Woman stated that she “didn’t appreciate” the nurse’s attitude. Now woman faces 2-10 years in the Greybar Motel and a $10,000 fine.

Make it stop. The show, I mean. Latest episode of Sex Sent Me to the ER reportedly involved woman who couldn’t stop having her orgasm after 3 hours.
You can even see part of the episode acted out on a video at the link.
I heard that the ED staff got her orgasm to stop by showing her a picture of Eliot Spitzer. Is that correct?

Answer the questions on medical board applications accurately. Idaho doctor gets publicly reprimanded by Idaho State Medical Board and must pay $500 fine plus $400 Board costs after failing to list a medical malpractice lawsuit on her board renewal application.

Hawaiian prison inmate suffering severe scrotal pain and swelling that made his scrotum appear the “size of a very large grapefruit” sues state and wins almost $1 million when he requires scrotal amputation due to infection. The prison physician reportedly gave him inappropriate antibiotics and the wrong dosage. The judge disagreed that state physicians should be immune from liability.
Since this ruling is the first case of its kind to get to the Appellate level, will medical care in Hawaiian prisons now get better, get worse, or stay the same?

Nice summary article on what to do if your tooth is knocked out. Summary: The best place for the tooth is back in the socket. If you can’t get it back in the socket, put it in some warm water or milk. DON’T scrub the tooth – doing so will damage the periodontal ligament and make it less likely that the tooth will stay reimplanted. Get to a dentist or an emergency department as soon as possible.

Healthcare Update Satellite — 12-30-2013

Monday, December 30th, 2013

More updates on my other blog at DrWhiteCoat.com

North Las Vegas VA Hospital emergency department repeatedly “disrespected and mistreated” a 78 year old diabetic volunteer with more than 5,000 hours of service at local VA facilities. A few weeks after two visits for a colon problem, the patient died in a hospice. When the patient’s friend went to get video of the events from the emergency department, the footage had been erased.

What types of things do Australian emergency departments see on Christmas? Stonefish stings, jet ski accidents, inhaled foreign bodies … not that different from the US, although I had no idea what a stonefish was until I looked it up. Kind of reminds me of my sister.

Back in the US, some emergency physicians are noting “desperate” behavior during the holidays from patients looking to cope with loneliness – manifesting itself in excess drug and alcohol use, excessive sleep, and angry moods.
Other physicians see this behavior every day.

And back to Australia again … Now Press Ganey is “global,” ranking emergency departments in Australia.
Seems like the hospital in the article cut waiting times by doing a lot of things we already do in the US. One thing we aren’t doing, though is seeing patients in order of arrival instead of triaging patients first. Little uneasy with that concept.
“Yes, Mr. Dwyer, you do seem to be having a heart attack, but there was a family of four patients registered ahead of you in the emergency department who have all had runny noses and coughs for the past month and who haven’t had time to get into their family physician.”

Oooh. Can’t wait to see this show. [eyeroll] Sex Sent Me to the ER.
Let’s see. I’ll run down the entire season in one sentence: injuries from doing it where you shouldn’t be doing it, foreign bodies where they shouldn’t be, torn female parts, broken male parts, beatdowns after getting caught with someone else’s partner, and diseases. That about covers everything.
Aaaaand I wasn’t too far off. I found this article from the NY Post discussing other cases in this week’s episode. Stroke “mid-shag,” broken penis, painful orgasm, injuries, more injuries.

Want some sex-related medical news stories?
Florida patient has penile implant placed, then sues surgeon and anesthesiologist when he develops post operative infection requiring amputation of his penis, alleging that “doctors should have known that he was not a good candidate for the procedure because of his diabetes and high blood pressure.”
Beware the bad outcome.

Texas man sues manufacturer of a sexual enhancement supplement after man buys supplement at gas station en route to a hotel for a tryst with is “paramour.” During his episode of carnal knowledge, the man states he suddenly had severe penile pain and that his penis then allegedly began spraying blood over the sheets, wall, and mirror like some broken fire extinguisher. He then went to an emergency department where doctors allegedly had to deglove his member (i.e. pull off the skin like removing a glove from the fingers) in order to repair it.
The plaintiff’s treating physician definitively linked the sexual enhancement supplement to the man’s injuries. I’m sure that rough sex had nothing to do with it.
So keep this in mind, dear readers: Taking roadside erection aids may cause your penis to spontaneously snap in two. A treating physician and a plaintiff’s attorney have vouched that it can happen.

Get your flu shots while they’re still around. Latest round of media reports showing that “killer” flu is back in circulation cause increased demand for immunizations. Most of the confirmed cases of influenza are the dreaded H1N1 “swine flu.”
The CDC Influenza Map shows that most of the US has either regional or widespread influenza activity.

Or, if you’re not inclined to have a flu shot, you can just be fired instead. At Pennsylvania’s Horizon Healthcare Services (a group owned by Lancaster General Health, Reading Health System, PinnacleHealth System and Penn State Hershey) a pregnant nurse refused the flu shot for fear of inducing another miscarriage, offers to wear mask instead. Hospital system fires her anyway.

Emergency department in Wigan Infirmary in the UK increasing police presence during the holidays after more than 200 assaults have been reported by staff members increases from 98 last year to 106 this year. That’s twice per week where the staff is actually reporting the violence.

Healthcare Update Satellite — 12-13-2013

Friday, December 13th, 2013

More healthcare news from around the web can also be found on my other blog at DrWhiteCoat.com

Vacancy rate for physicians at hospitals nearly doubles in four years and vacancy rate for nurses at hospitals triples in four years. NPs and PAs also in short supply.
Even though I’m no Obamacare fan, I don’t think the provider shortage can be blamed on the new healthcare law as the Forbes article insinuates.
But if the shortage is because fewer people want to go into the medical field, there are going to be large problems in the future. It takes 11 years of secondary education to train a doctor. That’s a long time to wait if there isn’t enough medical care for all of the newly “insured” patients.

Cook County jury hits University of Chicago Hospital and two doctors with $15.5 million judgment after patient died during childbirth from undiagnosed placenta accreta.

Sticking up for Obamacare twice in a week? I must be falling ill. Kentucky family physician Stephen Kiteck puts ad in paper stating that he is closing his practice “due to the policies of Obamacare.
When he finally granted an interview, Dr. Kiteck said that a requirement to use electronic medical records were the reason he was retiring. The EMR requirement wasn’t part of Obamacare.
There’s still too damn much regulation in medicine anyway, though.

Epic fail? How much does the Epic electronic medical record system suck? Wake Forest Baptist Medical Center reportedly lost $16.8 million in direct expenses and another $53.7 million in indirect expenses just implementing the Epic system.

An IDC study shows that most docs are dissatisfied with EHRs and that the two most frequent reasons for EHR dissatisfaction involved lost productivity – spending more time on documentation (85 percent) and seeing fewer patients (66 percent).

Autisim symptoms improve with … hot tubs and intestinal parasites?

Seats of horror … infant high chairs responsible for an average of more than one emergency department visit every hour of every day. And the number of visits has increased in the past 10 years. Even worse: Regular chairs which account for four times as many ED visits each year.
How long it will be until the Joint Commission takes definitive actions and bans chairs in hospitals because they are a threat to patient safety? It’s for the children!

President Obama allowed insurers to temporarily keep insurance plans that don’t meet minimum coverage requirements under Obamacare. Aetna says “no way” and refuses to reinstate canceled policies.

Got bad vision? There’s an app for that. iPhone app helps users read letters 1.6 times smaller than they could before they started using the app. Amazing.

Saline, Michigan emergency department converts to an urgent care center effective next spring with about 45 people losing their jobs. In comments section, area residents are upset because the next closest emergency department 9 miles away is overcrowded and wait times are long.

Healthcare Update Satellite — 12-04-2013

Wednesday, December 4th, 2013

What are the busiest hospital emergency departments? An American Hospital Association survey from 2011 published earlier this year is surprising (link to .pdf file). The 25 busiest hospitals in the US see more than 5 million patients per year. Florida Hospital in Orlando is the busiest in the US and sees 407,000 patients per year – an average of 1,100 per day.

Georgia Supreme Court rules that emergency physician’s to diagnose a pulmonary embolism in 15 year old football player who had arthroscopic knee surgery a week prior to ED visit can constitute gross negligence. The patient had pleuritic chest pain, a normal CXR, a normal EKG, normal pulse oximeter, and normal vital signs. He was discharged with a diagnosis of pleurisy. Two weeks later, the patient had chest pain and difficulty breathing. He was transported to another hospital and later died from a pulmonary embolism.
Georgia enacted laws to protect doctors who provide mandatory emergency care by requiring that any malpractice claims must prove by clear and convincing evidence that the physician engaged in “gross negligence” which is defined as failing to “exercise even a slight degree of care” or “lack of the diligence that even careless men are accustomed to exercise.”
The Appellate Court held that the emergency physician had provided some degree of care and therefore the plaintiffs could not meet the statutory burden of proving gross negligence. However, two “nationally recognized specialists” testified that the patient’s symptoms and history “constituted a classic presentation of pulmonary embolism” and that failing to order a chest CT scan and an ultrasound of the patient’s leg therefore must have constituted gross negligence.
Whacked out opinions like this are the problem with any attempts at tort reform. Courts and experts twist definitions to suit their own means, thereby rendering legislative actions moot.
If someone can get me the names of the experts and/or their opinions in this case, I would like to publish the expert’s names and discuss their opinions.

Teenage emergency department visits related to “ecstasy” or “MDMA” have more than doubled between 2005 and 2011. One emergency physician quoted in the article notes that the pills may be mixed with other substances and that taking the pills is “Russian Roulette at its best.”

Reporter on Obamacare describes how personally being in “coverage gap” affects her. According to a Kaiser Family Foundation graphic in the article, patients who earn between $11,490 and $45,960 are eligible for a marketplace subsidy. Patients who earn less than $5400 per year are covered by Medicaid. Patients who earn between $5,400 and $11,490 have no coverage. So what incentive does the law create for patients in the coverage gap who need medical care?

California hospital sued for wrongful termination after secretary fired when she reported sexual harassment against ED Director who allegedly spanked women’s bottoms and stuck his tongue in someone’s ear.

Interesting case. New Jersey statutes require that physicians have malpractice insurance with limits of at least $1 million or that they obtain a “letter of credit” for $500,000 if no such policy exists.
In a malpractice case involving reportedly botched surgery, the surgeon allegedly didn’t meet those requirements and didn’t tell the patients that he had no malpractice insurance. The patient sued and won a judgment for $930,000, but their claims against the surgeon for failing to disclose that he didn’t have malpractice insurance were dismissed.
Now the NJ Supreme Court has taken the case and is going to decide whether failing to disclose lack of malpractice insurance can constitute fraud in New Jersey.

Another successful lawsuit regarding da Vinci robots. This gynecologist was found liable for $110,000 after a da Vinci device reportedly malfunctioned and a plastic sheath was left in the patient’s abdomen after surgery. The foreign bodies were not found in the patient’s abdomen until a CT was performed more than three years after the patient’s surgery.

Patients gone wild. Family member of patient in Philadelphia emergency department punches nurse in the face after alleging that family member was not receiving proper medical care.

Taking patients gone wild to a whole new level. Minnesota obstetrician hunted down and murdered in his home by disgruntled patient who blamed physician for medical issue with which patient was born. The shooter, Ted Hoffstrom, was a 30-year-old attorney.

43 year old Army Veteran wins $8.3 million against St. Louis VA Medical Center in federal court after site from routine cardiac catheterization becomes infected, then “further negligence” caused severe brain injury, then patient’s leg became gangrenous and required amputation.

Interesting statistics about medical malpractice cases in Tennessee. In fiscal year 2013, there were 385 medical malpractice cases filed in Tennessee which was only 0.18% of all trial court filings (one in 555 cases). Despite this, Tennessee trial judges spent nearly 4% of their time on medical malpractice cases — 70% more than first degree murder cases which was the second most time-intensive type of court case.

University of Massachusetts settles malpractice suit for $4.25 million when child born with brain damage after obstetrician mishandled the mother’s labor and did not immediately agree to a mother’s demand for a Caesarian section. Of course, if the doctor had agreed to the mother’s demand for a C-section and there was a bad outcome, the doctor would have been sued for that, too.

Healthcare Update Satellite — 11-25-2013

Monday, November 25th, 2013

See many more medical news stories from around the web over at my other blog at DrWhitecoat.com

Nice synopsis by an Ohio State University emergency physician on how sinusitis can be mistaken for a primary dental problem … and how to use physical examination to help tell the difference between the two. Just don’t expect a sinus infection to get better with antibiotics.

Why one California emergency physician weeps for the future. The patient scenarios that you read about at the link will probably frustrate you as well. Included are patients who come to the ED because they don’t want to wait for referrals or for doctor’s appointments for routine matters and several patients who won’t fill prior prescriptions because someone else isn’t paying for their cost.

Wisconsin emergency department temporarily closes after SUV runs through wall of the department, injuring several people. Driver had to be transported to another hospital for treatment. Here’s a picture of the scene before the truck was removed.

Letter to the editor of a Buffalo, NY area newspaper wonders whether elderly and injured patients will have sufficient access to emergency medical care when Lake Shore Hospital closes, reportedly leaving 4 hospital emergency departments in a 3,000 square mile rural area of western New York.

Canadian Association for Emergency Physicians calls overcrowded emergency departments a public health emergency and warns that more patients could die if the government does not address the problem.

When Prince Edward Island’s Western Hospital staffed its emergency department with nurses and paramedics at night instead of closing the doors … hardly any patients showed up. The emergency department has been seeing less than two patients a night over the two weeks since the change was implemented. What conclusions can be drawn from the lack of patients? One commenter stated that patients are just deciding to drive to the next closest hospital in order to see a physician rather than being triaged and transferred to the other hospital anyway.
Would be interesting to see whether the patient volumes and demographics at the other hospital bear out that theory.

South Dakota jury awards $750,000 to estate of 79 year old patient who died from “unnecessary” spinal fusion surgeries. Award climbs to $933,000 with interest.
The way to prevent such suits in the future is to require second opinions to prove that surgeries are “necessary” prior to performing all non-emergency surgeries.

Hunger Games star Jennifer Lawrence goes to the emergency department for treatment of abdominal pain and is diagnosed with a “fulcer” instead of an “ulcer.” Must be kind of like “fretching” — which happened to be my first post ever in the blogosphere.

Mail order prescriptions decrease the number of diabetic patients visiting emergency departments when compared to patients who pick up their prescriptions at pharmacies. The study only looked at Kaiser Permanente mail order pharmacies, so the results can’t be generalized to mail order pharmacies in general. Being mostly PhDs, the authors have obviously not had to deal much with Medco shenanigans.

Flamin’ Hot Cheetos sending many kids to emergency department for a couple of reasons. First, the spicy seasonings are giving kids stomach aches. Also, when kids eat enough of them, the dye causes their stools to become red, making the parents think that the kids have blood in their stool.
Of course I was going to make a snarky remark that we should just ban Flamin’ Hot Cheetos to protect the children … then I read that several schools in New Mexico, California, and Illinois have already done so.
Yet another reason to weep for the future.

Memphis VA Medical Center being investigated after three patients died in its emergency department. One was given a medication despite having a documented allergy to the medication. Another was found unresponsive after receiving multiple sedating medications. A third had “critically high blood pressure that was not aggressively monitored” and died from a brain hemorrhage.

Finally, an Unaffordable Insurance Act quote for the week. A Twitter discussion about how often that Patriots fumbled the football morphs into a new term for fumbling: “Obamacared.” As in “The Patriots just Obamacared on the five yard line.”
The best comment to the thread: “If you like your new verb you can keep your new verb. Period.”

Healthcare Update Satellite — 11-20-2013

Wednesday, November 20th, 2013

How do patients choose their physicians? New survey by the American Osteopathic Association shows that 65% use word of mouth. 50% use their insurance provider directories. 10% use hospital web sites. 9% use consumer review websites such as Yelp. Then 19% who want to gamble with their lives use physician rating sites such as Healthgrades.com. The most important factor in choosing a physician is whether that physician accepts the patient’s insurance plan.

Another example of the difference between “insurance” and “health care.” UnitedHealth cuts thousands of doctors from its networks. You can have the most expensive insurance in the country, but if few doctors accept it as payment or if the company doesn’t have sufficient providers on its network to care for its patients, “health care” will inevitably suffer. One doctor noted that “Fewer practitioners mean longer waits, longer drives, less convenience.” Another oncologist stated that “Patients battling cancer should be focused on their treatment, not on finding another doctor.”

John Edwards will be representing the rights of the disenfranchised once more. I can only wonder if, during all of his “channeling”, his wife tells him what an a-hole he is.

Remember the 2 year old Indonesian kid who was a 2 packs per day chain smoker? Well at 6 years old he’s finally kicked the habit. Now he’s reportedly an overweight junk food addict.

I wonder if there is a study comparing swimmers to non-swimmers … a 1:200 concentration of bleach in water (roughly 2 tsp of bleach per gallon of water), reverses aging of the skin and inflammation from diseases such as eczema. So far, the trials have only been done in mice, but researchers are also looking at whether dilute bleach can improve healing of diabetic ulcers. Stock up on bleach while you can … before it gets labeled as a drug by the FDA and the price goes up to $750/gallon.

Infants often have low body stores of Vitamin K, a vitamin that is needed for blood to clot properly. So infants are usually given a dose of Vitamin K to prevent bleeding. Risks of developing bleeding are 81 times greater in infants that don’t receive the Vitamin K shots.
In Nashville TN, there have been several incidents of intracranial bleeding in infants whose parents have refused to let them receive Vitamin K shots. Of course, the parents initially refused the injections due to fears of their children being exposed to toxins or getting leukemia from the shots, then the parents pled ignorance of the bleeding risks from not receiving the shot after their children had developed brain bleeds.
Jenny McCarthyism is still putting children’s lives at risk.

Police go to residence to investigate a complaint of a pig running around a property. They find an 11 year old boy handcuffed to a porch with a dead chicken tied around his neck. His foster parents? A social services supervisor and an emergency department nurse.

Should the government be prosecuted for creating Healthcare.gov? Andrew Stiles believes so. After all, a commercial venture that is likely mislead consumers violates the Federal Trade Commission Act. The whole premise that people “can keep their healthcare plan” and the “dramatic underestimate[s]” of pricing on the site are just a couple of ways in which consumers have been misled on the site.

Doctor Christine Daniel gets 14 years in prison and a $1.2 million fine for selling snake oil to cancer patients. What she alleged was a herbal concoction to cure cancer was really just a mixture of suntan lotion and beef flavoring. Several patients died when they didn’t seek medical treatment and instead relied on Dr. Daniel’s promises.

Mental health care is in a crisis in Colorado. This report says that mental health patients make up almost half of the emergency department patients at Denver Health every weekend. When you cut funding for psychiatric care by 20% and cut the number of psychiatric beds by 30%, the patients with psychiatric problems don’t just disappear. When they can’t get help, they end up in the emergency department, in jail, or even worse. Could the Columbine or Aurora shootings have been prevented by expanding psychiatric care? Probably not. But one emergency department physician noted that for every “high-profile event that everybody knows about, there’s a hundred that were either near misses … or resulted in violence.”

Healthcare Update Satellite — 11-14-2013

Thursday, November 14th, 2013

See more news from around the web over at my other blog at DrWhitecoat.com

An example of the downside to government-run health care. Patients in Venezuela can’t get proper medical care. 300 cancer patients were just sent home when supply shortages and “overtaxed equipment” made it “impossible … to perform non-emergency surgeries.” 70% of the radiation therapy machines are inoperable. Basic supplies such as needles, syringes, medications, operating room equipment, X-ray film, and blood needed for transfusions are all in short supply. There is no anesthesia for elective surgery. Patients can no longer get organ donations or organ transplants.
The most important point in the article is that Venezuela’s constitution guarantees free universal health care to its citizens. They don’t just get government-mandated health “insurance,” they get free health care … and look what happens.
We need to be very careful about what type of health care system we ask for in this country. The government that has the power to give everything to you also has the power to take everything away from you.

Another example of what can happen with “free” medical care. Don’t have a heart attack after 5PM on weekdays or any time on weekends in Kaslo, British Columbia – the ED is closed. If your body doesn’t pay attention to those hours, you’ll have to travel an hour over mountainous terrain to get to the next closest hospital. Hope there’s no snow.

Interesting study in Annals of Emergency Medicine showing that sending daily text messages to poorly controlled diabetic patients improved medicine compliance (.pdf file). There was no statistical change in the HbA1c, but patients receiving text messages used the EDs less than the control population and patients actually liked receiving the messages. Kudos to the investigators for thinking outside the box.

LA County Medical Center board approves $7.5 million settlement to formerly homeless patient after patient was discharged from labor and delivery department at 39 weeks gestation with abdominal pain without being evaluated by obstetrician. Patient returned 12 hours later with ruptured uterus and child born with severe brain damage.

Idaho man suffers broken ribs after being hit by drunk driver … while playing cards in his living room. But there’s more to the story. The man’s dog went missing after the accident. A town resident found the dog wandering … near the emergency department of the hospital where the patient was taken. Happy and amazing reunion.

Entering the emergency department with atrial fibrillation? You have a 69% chance of being admitted according to this American Journal of Cardiology study.

Patients gone wild. Arizona man arrested for being aggressive with emergency department staff and trying to bite a male employee several times. Must have been a full moon.

Patient at Chicago-area Riveredge psychiatric hospital hangs herself with bedsheet. Hospital cited for putting patient in a room with a 7 foot ceiling and having the wrong type of vent covers which placed the patient in danger of “immediate jeopardy” by making it possible for the patient to hang herself.  Beware the bad outcome.

Another reason not to practice medicine in Florida. Predicted medical malpractice loss ratios in Florida for 2014 are highest in the nation – and more than nine times greater than the predicted loss ratios in states such as Indiana and Minnesota. Pennsylvania comes in second highest on the predicted loss ratio list. Check out the link a the top for other reasons not to practice medicine in Florida.

A pair of settlements paid by Iowa State underscore two important points. First, lumbar punctures are not complication-free. One 69 year old patient received $1.75 million after a lumbar puncture left him paralyzed in his lower extremities. In another non-medical case, a patient was awarded $125,000 for a retaliatory discharge from her job after she filed a workplace violence complaint. If hospital administrators take action against ED staff members for complaining about patient violence, there can be liability for doing so.

Popular Authors

  • Greg Henry
  • Rick Bukata
  • Mark Plaster
  • Kevin Klauer
  • Jesse Pines
  • David Newman
  • Rich Levitan
  • Ghazala Sharieff
  • Nicholas Genes
  • Jeannette Wolfe
  • William Sullivan
  • Michael Silverman

Subscribe to EPM