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Healthcare Updates

Links and commentary to healthcare news around the internet

Healthcare Update — 12-24-2010

Has the pendulum swung too far in the other direction? Texas tort reform is allegedly making it hard for injured patients to find lawyers to represent them. In addition, once they do find representation, it is more difficult to prove a malpractice case against an emergency physician due to heightened pleading standards. One side argues that since tort reform 799 suits were filed with 163 payouts. The other side argues that claims against emergency physicians dropped by 60% during that time and payouts dropped by 33%. Can there be a happy medium in the “perfect care – available care” conundrum? Florida is also considering whether or not to give physicians who treat Medicaid patients sovereign immunity — to the tune of an annual cost of $69 million. Florida woman wins $23 million judgment against University of Florida teaching hospital, but is only able to collect $200,000 of the money since state institutions are already protected by sovereign immunity. You had to know this was going to happen. A vending machine for pain medications and antibiotics outside the emergency department. What? You need a valid prescription and a credit card to get Oxycontin? Curses. Mission creep in the making. CMS is asking for comments on whether it should expand EMTALA to include inpatient care and to increase the responsibilities of hospitals that provide specialized care (link is a .pdf document). Such a requirement would make things easier on small community hospitals and make things more difficult on tertiary care hospitals. Net loss or net gain? By the way, if you want to comment on the issue, go to http://www.regulations.gov and follow the “Submit a comment” instructions. One of those truth is stranger than fiction stories. California man gets locked in his room in the emergency department for five hours when the latch to the door breaks. They tried to use a credit card, an eyeglass screwdriver, and forceps to open the door before calling the fire department to break down the door. But they did give the patient a $3000 discount off his $16,000 bill for his troubles. A nice gesture considering that hospitals routinely discount their charges 50% or more for insurance companies. In other news, hospital CEOs then went around distributing nice shiny new silver dollars to all their employees for Christmas presents. Five ambulances and a hazmat unit descend upon a rehab hospital after pepper spray canister is accidentally discharged in a nursing unit. Twenty people were treated for respiratory irritation, two of whom were transported to the hospital. From pepper spray? What do they staff these places with – canaries? Police SWAT teams couldn’t get that kind of effect using tear gas. Put away your insurance cards – it’s cash only. In the “quick care – quality care – free care” dilemma, patients that can afford it are paying good money to receive faster care in Manhattan. It must have been all a show. Medical malpractice trial ends in mistrial after defendant physician jumps to the aid of a juror who fell ill. Man arrested for swinging a knife at an emergency department employee, then claims that he was suicidal. In other news, as a response to this incident, JCAHO has now ruled that knives in the emergency department are never to be used. No, wait, that was a staff member in danger, not a patient. Scratch that. In other news, as a response to this incident, JCAHO has now cited the employee for improper use of verbal de-escalation techniques and for failing to offer the assailant milk and cookies before he began swinging said knife.

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Healthcare Update — 12-17-2010

See more medical news stories on the Satellite Edition over at ERP’s blog – ER Stories. More violence against emergency department staff. Illinois nurse gets punched in the gut by an intoxicated patient. At least the police and hospital are prosecuting the schmuck. Because health care employees are a protected class of individuals, the criminal is now facing a felony charge. Second Illinois schmuck is arrested for pushing police officers in emergency department, then trying to bite them, then kicking one of them several times, then trying to kick the windows out of a police cruiser. Third Illinois schmuck arrested after “lunging” at physician treating his child then grabbing police officer who tried to restrain him. More medical violence. California psychiatric hospital workers strangled. Another sustains four skull fractures from a patient who had just attacked a custodian. One psychiatrist at the hospital calls it a “culture of violence,” yet hospital police officers are prohibited from carrying firearms or Tasers. Wouldn’t it be interesting if judges and police forces had to live with the same rules imposed upon health care workers? Instead of JCAHO, ENTER JCALEO – the Joint Commission on Accreditation of Law Enforcement Organizations. Sorry, you can’t carry guns. Much too dangerous. First you have to try verbal de-escalation of the whackball who’s running at you with a machete. If milk and cookies don’t calm him down, then – and ONLY then – can you institute the LEAST RESTRICTIVE form of restraint possible. And you have to fill out 17 pieces of paper in triplicate and check on him every 15 minutes to make sure he isn’t hungry, doesn’t need to use the bathroom, and all his other creature comforts are met. $20 million liposuction medical malpractice judgment upheld in Pennsylvania. The University of Chicago is back in the news after having the highest rate of going on ambulance bypass in the state of Illinois. The article states that University of Chicago diverted ambulances for 1,764 hours between Jan 1 and Nov 30 this year, adding up to being on ambulance bypass 22% of all available hours. The runner up was Christ Hospital in the South Chicago suburbs that was on bypass for 706 hours or about 9% of the time. Most of the other Illinois hospitals had bypass rates of less than one percent. The article describes how many patients – even those with insurance – wait 24 hours or more to get a hospital bed. Only two hospitals in NorthWest Illinois went on diversion at all and those hospitals were on diversion for 12 and 17 hours respectively. Excellent article in the Flagler College newspaper about how the health care plan will affect access to care. According to proponents of the Obama plan, such as US Senators Tom Coburn, MD (a family practitioner) and John Barrasso, MD (an orthopedist), patients only go to the ED because federal law requires that they receive treatment there. Insurance expansion will allegedly decrease waiting times and tame overflow.” If these forward-thinking representatives of ours took some time out of their day to actually talk to patients who already have the insurance they’re pushing, they would see that expanding insurance will only increase the strains on the emergency departments because there are few if any community physicians willing to put up with the byzantine rules and low reimbursement from government insurance. The article gives a couple of examples about how the current system has already played out with a couple of patients. Get ready for a ride, folks. Then again, Dr. Barrasso was a rodeo doctor, so he’s had some practice ...

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As more and more state databases come on line, those “patients” who feign pain seeking narcotic pain medications are finding it more and more difficult to find prescribers willing to oblige them. As a result, the patients are adapting by suffering acute injuries for which they need immediate narcotic pain medications to relieve their suffering. Reality check: One or two falls is one thing. When you call around to other hospitals and to the physicians listed on the state databases and find that the patient has “fallen” a half dozen times in the past 10 days, it is quite another. One such unsteady patient was brought by ambulance after falling on the ice. His feet slipped out from under him and he fell flat on his back “like one of those Dudley Doo-Right cartoons.” At least his description was colorful. When the paramedics arrived on the scene, he gave them a hard time. First mistake. Dropping F-bombs, yelling at them, telling them he was hurt all over and not to move him. Well, they decided to look for injuries in the field, and in doing so cut off his clothing – including his down coat. When he arrived, it looked like the Incredible Hulk had been attacked by Angry Birds. There was a trail of goose down wafting to the floor as the stretcher was wheeled into a room. Immediately, the patient began demanding pain medication for his 10 out of 10 pain all over. He stated that he could not move because the pain was so severe. We stated that we needed to assess him for injuries, first. He then threatened to leave the hospital. We told him that was his choice, but he would have to sign out against medical advice. Then he said that his pain was too severe for him to move. He settled on repeatedly demanding that we call the ambulance back to take him to the hospital across town. Sorry, sir, but that isn’t happening. We dutifully began trying to undress him when then the emergency department tech came into the room and asked with a smirk … “Who molted?” That comment must have triggered a release of endorphins from the patient’s pituitary gland. Suddenly he sat up in bed with rage in his eyes. “F–k YOU!” The patient yelled. The tech then walked back out of the room and could be heard down the hall asking … “Anyone got some hot tar?” Yet another release of endorphins. The patient was suddenly able to get up off the cart and rip off his cervical collar. Seeing that he was able to spread goose down with each and every movement of his arms, the patient then stormed out of the emergency department cursing, shrugging his shoulders, and flapping his arms as if he were a reincarnation of some extinct dodo bird attempting his virgin flight. I have to admit that I was laughing while watching him walk out the door flapping his arms. You can’t appreciate it without seeing it. The nursing supervisor happened to witness the patient’s display and his miraculous recovery from whole body pain so severe that he couldn’t move merely minutes before. She casually turned to one of the nurses at the desk and asked … “Jeez. What ruffled his feathers?”

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Too Much Information About AICD Function

A 350+ pound man comes in for evaluation after his cardiac defibrillator discharged. When defibrillators discharge once, there isn’t a lot to do with the patients. The defibrillator did what it was designed to do – sense and terminate an abnormal cardiac rhythm. When there are multiple shocks, that is a different story. Multiple things to worry about including persistent abnormal rhythm, MI where ST changes are being sensed as an abnormal rhythm, lead fractures, loose connections, and electrolyte abnormalities – to name a few. Patients with multiple defibrillator discharges need their defibrillators interrogated and usually need to be admitted to the hospital. By the way – All you docs out there know what to do if you use a magnet to temporarily deactivate an AICD in morbidly obese patients and it doesn’t work because of all the adipose tissue? And what do you do to keep the pacemaker function of an AICD working once the magnet does deactivate the AICD? Check in the comments section for the answers. Fortunately, in this patient there was only one shock and we didn’t have to worry about bad things. We did an EKG just as a screen, but nothing else. Then we let the patient’s cardiologist know what happened and we sent the patient home. Buuut … the thing that was memorable about this patient was how he described what he was doing when his defibrillator discharge. To wit: “I was mounting my old lady when all of a sudden ‘BAM!’ Damn near knocked me off the bed when it went off.” Well, cowboy, thanks to modern technology, you’ll live to ride another rodeo. Yeeehaw!

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Healthcare Update — 12-10-2010

Did I tell you how much Google sucks … BLAM! Droid phone explodes in man’s head while he is talking on phone. Emergency department overcrowding takes another life. Short of breath 41 year old Ontario patient dies while sitting in emergency department waiting room for more than 90 minutes. Waits for patients with serious conditions can reach more than 12 hours. Some admitted patients waited more than 26 hours for a hospital bed to open up. Downright scary emails from Alberta, Canada emergency physician to top Canadian political and health care leaders documenting lack of care in emergency departments. Direct link for .pdf download is here. Waits of 5.5 hours for a potential stroke victim to get a bed. No tPA for you! Another potential stroke patient leaves after five hours without seeing a physician. A nine hour wait for a patient experiencing seizures. A man dies because he needed emergency brain surgery and couldn’t get it because of “overwhelming systemic overcrowding”. A suicidal patient leaves without seeing a doctor and then returns by ambulance after overdosing on prescription medications. Another patient boarded in the emergency department for an entire week. Patients in the waiting room threatening triage nurses and “screaming that we are letting people die.” Did I mention that all those patients had national health “insurance”? Oh just cut the damn payments already. Congress staves off physician Medicare payment cuts … again. Because we’re suddenly going to find hundreds of billions of dollars to make the system solvent in the next 12 months. Next time that we have to read about the same brinksmanship and watch Congress kick the can down the road a few more months: January 2012. There’s the French Kiss, then there’s the … Sheboygan Chomp. Sheboygan, Wisconsin man ends up in emergency department after wife bites off half his tongue during kiss. The 79 year old victim noted that his 59 year old wife had been “acting strangely” for several days. No argument there. “911 … please hold.” Louisiana appellate court throws out limit on malpractice awards, stating that the law is discriminatory because lesser-injured patients receive a full payout for damages, while more severely injured patients have their damage awards limited. In this case, a child was awarded $6.2 million, but her award was decreased to the statutory maximum of $500,000. If you were a physician, would this ruling have any effect on your willingness to practice medicine in Louisiana? Georgia hospitals considers “program changes” to deal with unpaid medical care. Charity care at the Medical Center of Central Georgia increased by about $30 million in the latest year reported while uncompensated care statewide was estimated at $1.3 billion. I’ve got a better idea. Let’s just create more regulations. Meanwhile, despite lower patient volumes in 70% of hospitals across the country, according to an American Hospital Association analysis, US community hospitals provided a total of $75 billion in unpaid care in 2009 – a significant increase from prior years. A different AHA survey released the same day showed that hospitals were able to earn a 5% profit margin in 2009. “English only” or just “No Filipinos allowed”? California hospital establishes an “English only” policy for all of its workers, but then allegedly selectively enforces the policy against Filipinos while allowing Hispanic and Indian nurses to speak their native languages on the job. Now the EEOC has filed a lawsuit over the issue. Nurses have more back injuries than truck drivers and more than half of nurses have experienced violence on the job. The article describes how nurses in California have been murdered by ...

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Death Panels and Access to Care

I read an article in the New York Times that underscores my argument that health care insurance does not and never will equal health care access. Our federal and state governments are being crushed by debt. There are many reasons for that debt, and addressing the reasons for the debt are a necessary aspect of decreasing the debt. For example, if a family household had overdrawn its checking account by several thousand dollars and their credit cards were maxed out, most people would consider it foolish for the family to purchase expensive cars, to donate large sums of money to charity, to go out to eat at expensive restaurants, or to continue purchasing large amounts of weapons to stockpile in its basement. When in debt, there are two options – earn more money or reduce spending. Using the example of the family in debt, perhaps they sell their assets and move into a smaller house. Perhaps they eat macaroni and cheese for dinner. You get the picture. But if we assume that the family has cut all of its non-essential spending (and many would argue that this part of the analogy fails when applied to state and federal governments), yet is still in debt, then how can the family further reign in costs? That is the problem with which most governmental entities are now faced. Arizona has taken a drastic step to reduce costs. It is now refusing to pay for expensive medical care to some Medicaid patients in need of organ transplants. According to the article, the decision amounts to “Death by budget cut.” Patients such as a father of six (pictured at the right), a plumber, and a basketball coach all need various types of transplants, but are no longer eligible to receive them. The state estimates it will save $4.5 million per year by not providing these services to roughly 100 Arizona citizens. The state also warns that “there will have to be more difficult cuts looking forward.” Read that as Arizona being poised to cut funding for other types of expensive care. Going back to the analogy about the family – is it morally appropriate to just let family members die because you don’t want to pay for the cost of caring for them? This fairy tale about providing “insurance for all” is the biggest problem with the health care overhaul. We can strive to provide “insurance” for everyone, but “insurance” is only as good as what it insures you for. If you are on Medicare and need expensive care or if you live in Arizona and need a transplant, you still have insurance, but that insurance just doesn’t pay for your medical care. Even though patients pay into the system all of their lives, they get nothing out of it when they actually need the care. Ponzi medicine? If governments were serious about providing medical care for patients, they would create a system similar to the VA Hospital system that is available to every citizen in this country. You walk in the door, you get medical care. Perhaps the care wouldn’t be as good or as fast as care available at private facilities, but care would at least be available. As the implementation of health care reform takes place, it begins to appear that our new health care system may provide the most benefits to the people that use it the least. Don’t get sick and you’ll be just fine.

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