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1209717_19610439The focus of this web site is medicine. In this blog, you’ll read about patient stories. The situations have been changed to be HIPAA compliant. Factual statements may or may not be true. I may change ages, gender or presenting complaints about patients. I may even entirely make up complete patient encounters from my fertile imagination. Trust me, if you think I’m writing about you, I’m not. There are billions of people in this world and readers send me stories about patients all the time. It isn’t you.
You’ll also read a lot about health care policy. I may throw in posts about life lessons, computers, and will even throw in family stories once in a while. If you’re looking for articles about politics, sports, or celebrities, you’re in the wrong place – unless the topics have some relationship to medicine.
If you want to add a guest post or to cross-post something from your blog, or if you have a patient story you want me to write about, e-mail me. See more information in the “About Me” page.

Malpractice Reform Shot Down In Illinois

Today, the Illinois Supreme Court agreed with an earlier trial court’s decision to abolish caps on medical malpractice judgments in Illinois, calling the legislation “facially invalid” due to a separation of powers issue with the Illinois Constitution. Apparently only the judicial branch of Illinois government has the ability to reduce verdicts. Because of an inseverability clause contained in the legislation, the entire medical malpractice reform statute was declared invalid. When presented with the number of other states that have enacted noneconomic damage caps and the number of states that have rejected the separation of powers argument under the same circumstances, the Illinois Supreme Court justified its decision by stating “That ‘everybody is doing it’ is hardly a litmus test for the constitutionality of the statute.” The Supreme Court’s opinion is here. Also read an article about the legislation in the Chicago Tribune. Hear all those papers rustling? That’s all the doctors in Illinois flipping through medical journals and newspapers looking for jobs in other states. It will be interesting to see the effect that this decision has upon Illinois citizens’ access to medical care in the coming years. UPDATE Some good insights and additional links to the story from Walter Olson at Point of Law. Interesting to imagine how the Court would back out of its corner if hospitals and doctors required that patients agreed to a limit for damages as a requisite for medical care – contracting around the statute as potential medical malpractice plaintiffs are often requested to do with attorney fee limits in Florida. Also … a picture of young Abigaile Lebron, the child whose birth negligence case sparked the Supreme Court’s decision.

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An ER Doc in Haiti – The Series

I wasn’t aware, but EP Monthly has been publishing Dr. Plaster’s reports from Haiti in real-time. Here’s a link to all his posts. Definitely some things that you don’t read about in the newspapers. He’s coming home now as larger organizations step up their efforts to assist those in need of care.

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Healthcare Update – 02/02/2010

See more news stories from around the web over at ER Stories in the Satellite Edition of this week’s Healthcare Update. When it’s dead and you don’t know what to do with it, send it to pathology. When it’s alive and you don’t know what to do with it, send it to the emergency department — and don’t take it back. Wesley Healthcare Center in Auburn, IN sent a patient to the Angola Hospital emergency department and then wouldn’t take him back after he was cleared for release. Demonstrating an efficient use of resources, Gregory George was forced to stay in the emergency department for a week with around-the-clock care. One former employee of the nursing home stated that the “patient dump” had been planned because the nursing home staff was fed up with the patient’s “excessive complaints” to the State about the nursing home. In other news, the Joint Commission has declared that this incident shows how nursing homes may be a danger to patient safety. All nursing homes must close. Immediately. Here’s a good way to help clear up California’s budget deficit. Start fining hospitals for mistakes. If this takes off, soon they’ll be fining housing contractors for using the wrong pipes, police stations for arresting the wrong people, schools for failing to use the right curriculum, law firms for filing the wrong motions, and legislators for drafting crappy legislation. Instant riches! Ooooh ooooh, I know! Maybe they can fine citizens when they move out of the state. Then California would have a budget surplus in no time. Can’t take the heat? Get out of the kitchen. California city mayor has been to the emergency department five times in past six years suffering from chest pains after getting into arguments at city council meetings. Maybe it’s time for a career in horticulture? Difficult decisionmaking. An elderly patient with multiple organ systems failing goes to the emergency department for an exacerbation of heart failure and decides he wants “everything done”. He is put on a ventilator, goes on dialysis, requires a feeding tube, and dies after six months in the hospital. The patient’s daughter questions whether her father’s decision was the correct one. Attorney wins $3.8 million verdict for client in bad faith medical malpractice insurance claim, then takes $1.7 million in attorneys’ fees. When costs of the suit are paid, the attorneys will likely make more money from the case than their injured clients. Now the attorneys are suing each other about how the attorneys’ fees should split. Ironic how the attorney with the money is now referring to the ones suing him as “bank robbers.” “Now craziness has a name … it’s called CYA.” This editorial in the Chicago Flame about health care reform and defensive medicine is spot on. Interesting paper about defensive medicine and “disappearing doctors.” This 2005 study finds that increasing malpractice premiums generally don’t affect the numbers of physicians practicing in each state, but that increasing premiums do affect the willingness of some specialists to remain in practice – such as rural surgeons who tended to just retire. This study showed that “direct tort reform increases physician supply in the short run by 2.4 percent” and reduces growth of expenditures between 5 and 9 percent. Note that the paper was published shortly after tort reform was enacted in Texas and that there have been significant and sustained increases in physician supply in Texas since tort reform was enacted. A graph in the paper notes that between 1993 and 2001, malpractice insurance premiums for internists in Texas increased by nearly 150%. After tort reform ...

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A Link For My Loyal Attorney Readers

As a special thanks for inciting the wrath of everyone favoring tort reform who reads this blog, I present to you a money-saving link. Seriously. http://scholar.google.com/ Back in November, Google Scholar started making case law searches available for free. Now you can type in a case citation or a search topic and can get cases mentioning the topic as well as citations to the cases and links to other related topics. See the screen grab below when I clicked on the first link from a search using the term “tort reform.” Going to the Advanced Search allows you to limit your search to specific jurisdictions. Maybe now you can drop those subscriptions to WestLaw and Lexis. The yacht payments are coming due soon, you know. By the way, the site isn’t just for attorneys. Anyone can use the site to find case law information that has been unavailable or difficult to obtain up until this point. And … the site also does a great job at searching scientific papers as well.

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An ER Doc in Haiti: Day 3

January 27: We’re seeing a stabilization, but what about follow-up? We are right down town in Port-au-Prince today; pretty much every building around us is destroyed. The only thing still standing near us is a church, which is currently housing a local boy scout troop. The effort is starting to see a logical transition right now. At the clinics you’ll get 10 to 20 people walking in with soft tissue injuries – big gaping wounds that are infected – but fewer and fewer people are needing amputations and surgery. I did get a call from a guy in an outlying area who needed a hand surgeon, which we arranged. Other than that, we’re seeing a stabilization. We’re running a clinic today and it’s a typical third-world situation. You announce that you’re available and everybody who has had a backache or a stomach ache for the last five years shows up. As soon as we arrived today, about 200 people queued up. They were very calm and controlled, lots of kids with dehydration and plenty of vague complaints. We’ve got eight treatment stations, 2 or 3 wound treatment stations, a diarrhea station, an upper respiratory station and then whatever else walks up. It’s typical emergency medicine, really. You have to sort through the masses to find the people who are really sick. Haitians can be hypochondriacs just like Americans. They never get to see doctors, so when one shows up who is free, everybody lines up. Generally speaking we’ll run into about a dozen seriously-injured people in a day, but we’ve got to sort through 400 people to find them. We’re going to another place this afternoon where there are supposed to be some very, very sick people. USNS Comfort on diversion? I got my first look at the USNS Comfort, which is off shore a couple miles. We’re next to a landing zone where helicopters are flying in and out, but right now there is no one waiting to go out. The word going around is that the Comfort is basically full and they are now trying to figure out how to bring people back on shore. The army was talking about setting up a 250-bed post-op rehab facility for all of the people coming off of the comfort. They have some tremendous injuries out there, spinal cord injuries and ICU patients, that will really require follow-up care.  It’s going to create a problem on the backside. We’ve heard that the Obama administration has set a timetable for pulling forces out of Haiti – which makes sense – but there is going to be a lot of long-term care that they’ll need to plan for. There are a lot of sick and injured folks here. Heavy on medical supplies, light on water We’ve got medical supplies coming out our ears, but they told us when we left the camp this morning that we had no more water. They said they were going to go try to find water for us. I’ve got a bottle on my back and one in my pack, but that’s the end of my personal stores. I’m assuming we’ll find more – we’ve got a logistics expert tracking it down – but we’re getting a little hungry. I had nothing for breakfast and I have yet to eat my Powerbar for lunch. I’m hoping that I’ll get something for dinner. Surgery Transfers I’ve been taking patients who need surgery to Sacre Coeur (Sacred Heart), where they can receive treatment, since I know the doctors there. I put them in the back of a truck and take ...

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An ER Doc in Haiti: Day 2

January 26: Where there are no doctors Yesterday we just drove down the road and found an open area where we could set up a triage station. We pulled out a tarp, some line to hold everybody back, and just let people come through. We laid out our meds on a table and then just worked through the crowd. Most of the injuries were pretty minor but a couple of them were major, broken bones and such. We probably saw 3 or 4 major cases that morning. Our team is going to places that haven’t had doctors yet. A man told us that a week ago he’d told the UN that they needed help out here but no one had come out yet. To be honest, I had no clue where we were. We drove about a half hour into the heart of Port-au-Prince, a very poor area, people living in tin huts and surviving off of Coleman camp stoves. But I also saw some big, wealthy houses around here. Some of them have fallen down. If it was poorly built it fell down and smashed people. The construction is terrible; they don’t have any construction rebar, they build with cinderblocks and they only have these tiny wires going through them. Even homes that look well made may only have a thin skin of concrete on the outside. One more aftershock and they may come down. I haven’t made contact with the navy yet. We wanted to get a feel for what we needed and how difficult it was going to be. So far it looks relatively simple. Right now we’re just trying to find the people who are most sick. There are a lot of people coming in complaining of back aches that they’ve had forever, but since there is a doctor here they all show up. We had a surgery team show up Sunday and they heard [that there was a need for surgeons]. They went to four different hospitals and all four said that they had all the surgeons they needed and refused to give them any space. Operating space is very limited. These guys are working very hard, 8am to 10 at night. I’m concerned about follow-up. I asked one doc what he was working on and he told me that he was putting on external fixatures. When I asked him who would be taking these fixatures off, he said, “I don’t have any clue.” When I asked him what had happened to the patient he had just put a fixature on, he replied that she “went back out and lay on the ground.” Somebody, someplace is going to have to take that fixature off and they won’t have clear information on when it was put in. We’re talking 4-6 weeks down stream somebody has to take over these cases and they’re not even in the hospital. A lot of them have been lost to follow up. Like the little girl I saw today: the bandage I put on her will probably be the last bandage she gets. …more tomorrow

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