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Healthcare Updates

Links and commentary to healthcare news around the internet

Healthcare Update 10-04-2012

Violating EMTALA to get “a lot of positive press”? More hospitals using the InQuickER service that preferentially triages patients who register for their emergency department visits online. Florida businessman reportedly had a seizure while driving, rolled his car, and crashed through a fence. When paramedics arrived, the patient was suspended upside down in his car. Paramedics placed a cervical collar and the patient then became combative, got out of the vehicle, and tried to walk away from the scene. If they let him leave, they’re liable for not stabilizing him. So paramedics restrained him. When he arrived at the emergency department, he had been hog-tied and was face down with secretions coming from his mouth. He later died. Prosecutors attempted to file homicide charges against the paramedics, but the grand jury would not indict. Now the paramedics are being sued by the patient’s family. So how should combative trauma patients be managed in order to avoid being charged with murder? 26 people sickened and 4 people die from fungal meningitis after receiving injections of steroids contaminated by Aspergillus fumigatus. Injections were intended to relieve back pain. The pharmacy that bottled the steroids relinquished its business license. Is the answer to this problem more government regulation? Another example of inappropriate journalism? Wall Street Journal publishes article titled “How to Stop Hospitals from Killing Us.” Dr. Wes responds with a great post about the Growing Culture of Hostile Dependency Toward Caregivers. If you haven’t read it, go read it. If you have read it, go read it again.

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By Birdstrike M.D.   I was driving home from a night shift and the scorching sound of Texas guitars flamed out of my car speakers.  The group ZZ Top was old, but the song was new.  It went like this, “25 lighters on my dresser, yessir.  You know I gotsta get paid.”  Mostly, I was shocked that any members of the band ZZ Top were still alive, let alone putting out new music that was actually getting airplay.  Also strange, is that the song is a remake of an old rap song.  The lyric reminded me of a patient who I won’t name.  It would be a safe assumption that he was a gang member.  He wore saggy, baggy pants, and was heavily tattooed and shirtless.  He either spent 8 hours a day in the gym lifting weights, or ate a healthy diet of steroids.  If he had killed half as many people as his tattoos indicated, it was certainly in my best interest to keep him happy.  This was one patient satisfaction score I would ace.  I’ll call him Lighterman. “Yo doc!  You gotta fix my hand, man,” Lighterman said in his gang accent.  He held up his bleeding hand. “What happened?” I asked. “I used my knife to open a bottle of some Robitussin to put in my beer and I slipped,” he said.  “My brother is home right now getting wasted on my stash.” “Robitussin in your beer?” I asked, half amused.  “That could kill you, you know?” “Aw yeah, boy.  It’ll light you up, man.  You should try it.  You a doctor!  You can have all you want, anytime, man.  You got it made,” he said. “Uh, no.  I would never do that.  Let’s take a look.”  He had a 2 cm laceration on the back of his hand.  I prepped, draped, anesthetized and explored it.  “Looks like you’ve got a partial extensor tendon laceration,” I explained.  “It would be best to have it repaired by a hand surgeon.” “No way.  I got deals to make and hearts to break, man.  Ha!” he laughed. “I’ve heard that one before.  I’m not joking, though.  This is serious,” I said. “You got 10 minutes and I’m gone, dog,” he said. Suffice it to say that my best “against medical advice” warnings about limb-threatening bad outcomes and signed paperwork did nothing to dissuade him.  He showed no outward signs of drug or alcohol intoxication and certainly would not have consented to blood or urine testing to prove otherwise.  Although, his judgment was clearly very poor, he understood the risks of not getting the best treatment for his injury.  He just didn’t care. “I don’t got time to go see your specialist, either,” he added.  “I trust you, man.   You look like that TV doctor from back in the day, Doogie Howser, only younger, smarter, with a bigger head and skinnier neck,” he said laughing.  “Sew on, man.  Get on it.  Plus, if you don’t do it, I’ll shoot you.” “What?” I asked. “Just kidding, I’d never shoot a doctor as good as you.  Ha!” said Lighterman.  “Here you go, man,” he said and pulled a handful of cigarette lighters out of his pocket.   “A little somethin’ for the effort.” “No, that’s okay.  I don’t smoke.  I don’t drink or take drugs, either.  Neither should you.  I really don’t need a bunch of cigarette lighters.  Plus, we don’t accept tips here in the Emergency Department,” I answered. “You don’t drink, smoke or take drugs!?  What do you do?  You’re a tough negotiator, boy!  You’re playin’ dumb.  It’s not enough is it?  Here you go.  ...

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Healthcare Update — 09-26-2012

Macabre Monty Python plot? Organ donor network allegedly pressures hospitals to declare severely ill patients as being brain dead – even when the patients showed signs of life. If these allegations are true, should criminal charges be filed? Against whom? Lindsay Lohan goes to the emergency department for an asthma attack … or a “bad lung infection.” Gets discharged with antibiotics and goes back to her hotel room. Asthma … bad lung infection … one of those ZeePacks and she’ll be back to normal. They cure everything, right? Surprised they haven’t tried Z-Packs for her alcohol problems. It will do about as much for alcohol problems as it will in treating asthma or bronchitis. Speaking about criminalizing medicine … Conrad Murray was convicted of involuntary manslaughter for providing inappropriate medications that resulted in Michael Jackson’s death. The working theorem was apparently that inappropriately prescribing medications that result in a patient’s death should result in jail time. Let’s say that Lindsay Lohan develops clostridium difficile colitis, becomes septic, and dies after receiving antibiotics for asthma and/or bronchitis – a use of antibiotics which is medically inappropriate. If we follow the logic under which Conrad Murray was convicted, should Lindsay Lohan’s doctors then be charged with involuntary manslaughter? If not, where do we draw the line? I’d like to see what you all think. “Car surfing” isn’t cool. It kills people.

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Healthcare Update — 09-24-2012

Which is exactly why they’re going to cut reimbursement even more … Medicare requires providers to use electronic medical records to avoid being “penalized”. Now they discover that computerized medical records are better at billing and that Medicare had to pay $1 billion more in reimbursements in 2010 than it did five years earlier. Goodbye toothbrush? Japanese scientists developing tooth “patch” that could prevent decay, whiten teeth. It is made from hydroxyapatite – the same mineral that forms most of the tooth structure. Still not sure I’d be making out with someone who didn’t brush regularly, though. White teeth with a mouth that smells like tennis shoe insoles isn’t a particularly desirable combination, either.I was a little put off by Mitt Romney’s response to the question recently posed to him on 60 Minutes. “Does the government have a responsibility to provide health care to the 50 million Americans who don’t have it today?” Mr. Romney’s response was “Well, we do provide care for people who don’t have insurance … If someone has a heart attack, they don’t sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care. And different states have different ways of providing for that care.” First of all the “we” who provide the care isn’t the government, in a vast majority of cases it is private businesses that provide that care. When states “provide” for that care by paying private businesses pennies on the dollar to provide that care under the threat of large sanctions if they don’t provide that care, to me, it’s a stretch to say that the government is providing the care. The government is relying on private entities to provide that care. Big difference. I’ll take Holy Pillpoppers for $1,000 Alex. Answer: 4 billion.

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Healthcare Update — 09-13-2012

Kentucky man goes into surgery for a circumcision, leaves surgery without a penis. The urologist stated that the patient’s genitals were “cancer ridden”, that no living tissue was present, and the patient consented to additional procedures at the doctor’s discretion. The patient claims the doctor should have delayed the procedure and allowed the patient to get a second opinion.Another problem with digital medical records … Hackers break into surgical practice’s EMR, encrypt all records, then leave ransom note demanding money for the password. Is this considered a HIPAA violation? After all, the records are secure. Washington DC patient settles $20 million lawsuit after he was mistakenly diagnosed with HIV. Appellate court ruled that patients who are given incorrect information about a life-threatening illness from their doctors can sue for emotional distress. 17 year old Staten Island, NY teen wins $100 million judgment against hospital where she was delivered at 1 pound 12 ounces and now suffers from cerebral palsy. Jurors believed that the hospital failed to prevent the patient’s pre-term delivery.

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Obama vs. Romney vs. Honey Boo Boo

By Birdstrike M.D.   Once again, our upcoming election will have great impact on future health care policy.  Obamacare will either be kept intact, repealed or altered.  This will have great impact on patients, physicians in general, and especially Emergency Physicians.  By whom they choose to lead us, the electorate will decide whether treatments are rationed or not, and if so, to what extent, by whom and on what basis.  They will decide whether doctors are free to choose what tests to order, and if so which ones, how many and for what reasons.  Also, they will influence physician salaries, by choosing the leaders who will determine Medicare and Medicaid reimbursement, which generally lead with reimbursement cuts that private insurers follow.  Our electorate will determine our malpractice liability by choosing our leaders who will either, strengthen, weaken or ignore tort reform.  They will influence which charting systems we are required, or not required to use, given that Obamacare has already written into law penalties for failure to implement electronic health record use.  By whom they choose to lead us, the electorate will influence how much we are, or are not burdened by regulations, and whether these regulations will be logic based, or cumbersome and irrational. The choice of the electorate will affect which pay for performance measures we and our salaries are subject to.  Likely, they will also influence which form of patient satisfaction surveys we are or are not subject to.  Also influenced, will be our overall workload depending on whether patients are adequately insured, by which doctors and in which settings.  This will influence who is most, or the least burdened by the overall shortage of healthcare providers, and whether or not the millions of newly insured will end up in primary care physicians’ offices, shunted to emergency departments with growing wait times, seen in specialists’ offices or remain uncared for.  How informed, or uninformed our electorate is, particularly as it relates to health care policy, will affect the health of our patients, our livelihoods as physicians, not to mention the health of our families and ourselves as patients. Since the end our nation’s two major party conventions, it caught the attention of several major news organizations that on any given night of the week of either the Republican or Democratic National Conventions, that both parties faced stiff competition for viewers from the new and controversial TV show on TLC called “Here Comes Honey Boo Boo,”  which TLC describes on its website as a show where a “six-year-old pageant sensation proves that she is more than just a beauty queen.” As said by the child’s own mother, June Shannon on ABC News, “We are a little redneckish, and we live in Georgia and that’s what people do in the country — get muddy and have fun with the family.”  In the first episode they take part in the “Redneck Games,” bob for pigs feet and take part in a “mud pit belly flop.”  Although fortunately the overall viewership of the conventions was greater according to ABC News, this show did draw more viewers than Fox News’s coverage of the Republican National Convention on at least one night and tied the ratings of the Democratic National Convention during Bill Clinton’s speech.  Does anyone know where Honey Boo Boo stands on health care? Apparently, a large part of our electorate would prefer to watch a show like TLC’s “Here Comes Honey Boo Boo” over either convention.  Whether this is more of a reflection on our political parties, our electorate, our “Democracy” or (hopefully) none of the above, I am not sure.  However, two months before an election where we will choose a ...

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