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Healthcare Updates

Links and commentary to healthcare news around the internet

Healthcare Update — 06-11-2014

See more healthcare-related news from around the web on my other blog: WhiteCoat’s Call Room at EP Monthly.com Could you go for a month without using soap or shampoo? More on the human microbiome and how actions we consider as being “healthy” may be anything but. Interesting theory as to why horses bathe in dirt, also. Amazing investment. Connecticut hospital sees 50% drop in obstetric claims when it standardizes care, implements teamwork protocols, and enhancing oversight of clinical work. Even more impressive is that payouts for malpractice were over $50 million in the five years before the changes were instituted and were less than $3 million after the changes were instituted. Abstract to the article is here. California residents try to save access to health care by petitioning to reopen their small hospital emergency department. Problem is that the costs are excessive. Since 80% of their emergency department visits were more “urgent care levels,” an alternative plan that would have worked would have been to allow the hospital to open as a “free standing” emergency department. But the article notes that California law does not allow free standing emergency departments. California is running a close second in states to avoid when choosing to practice medicine. Congressional Budget Office [2010]: Obamacare will cut the deficit by more than $120 BILLION dollars over the next decade. Congressional Budget Office [2014]: Ummmm. Maybe not. Insurance coverage provisions alone will cost an extra $1.1 trillion during that time. Plus extra $7 billion in government subsidies. Plus … eh, nevermind. Thanks to defendUSA for the link Sparrow Health Systems in Lansing, Michigan misinterprets law and requires that nurses have a “private” [secret?] conversation with 12-17 year old patients before patients or parents can review the patient’s medical records. Then one mom refused to comply, posted the notice, the hospital got called out on its “statist” approach (per one of the commenters) and suddenly the policy disappeared. Good on you Christy Duffy! Thanks to defendUSA for the link British physician loses his license for taking off his socks and washing his feet in front of a patient. Actually, the foot washing incident appears to be the proverbial straw that broke the camel’s back, but it’s still interesting what facts seem to be important in news stories. Wow. In the United States, this was called a “death panel”. In Switzerland – different story. A group that assists patients with their suicides (which is completely legal in Switzerland) has decided that it is going to offer its services to people who are suffering from old age. Before, their services were apparently limited to patients who were terminally ill. Data discrepancies may jeopardize health care coverage for 25% of all patients who signed up for Obamacare. Louisville emergency department seeing a 12 percent rise in emergency department patients since the Unaffordable Insurance Act took effect. Despite what “insiders” and pundits say about Obamacare putting downward pressure on emergency department visits, the opposite effects were predictable. Primary care medicine is drying up – in large part due to government regulations and poor government reimbursement. Most doctors don’t accept Obamacare “insurance” because of low reimbursements. Insurance never equals access. And the emergency department is required by law to provide a screening examination and stabilizing treatment for every patient that requests care. What will happen next: In the coming years, more and more hospitals will implement a “triage out” protocol. If you don’t have an emergency and don’t pay a deposit up front, you’ll be sent home from the emergency department triage desk without further treatment. Many hospitals are already doing this. The closing remark ...

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Healthcare Update — 06-04-2014

More health news stories from the web can be found on my other blog over at EPMonthly.com. Maternal death rate in the US on the rise. We are currently ranked 31st in the world and our maternal death rate is nine times that in Finland and Sweeden. Is there some sinister reason for the discrepancy, is it just that we track statistics differently, is it that other countries are fudging their numbers, or is it a combination of the above? Kansas legislature votes to increase the malpractice cap on non-economic damages from $250,000 to $350,000. Note that the medical societies in Kansas were in FAVOR of increasing the caps. Patients gone wild. Athens, Alabama’s own Alicia Marie Laughlin arrested for hitting an emergency department nurse then fleeing the scene. Must not have been an emergency after all. Investigation initiated by CMS after patient complained that emergency department did a “visual inspection” of his gangrenous foot then wrapped it up and sent him home. Three days later, the patient returned and needed emergency surgery for debridement. He lost two toes and skin from the top of his foot. Now he’s permanently disabled and it’s all the doctor’s fault. Measles cases in US hit a 20 year high. 100 cases reported in Amish community in Ohio alone – where patients have not been vaccinated. It’s ironic to me that patients avoid vaccinations for religious, personal, or philosophical reasons and then abandon those religious, personal or philosophical reasons and come running for medical assistance when they contract the very illnesses that they were opposed to preventing. Should be automatic insurance denial and full liability for all treatment costs and damages occurred when those without vaccinations contract and/or spread the disease. Texas lawyer “earns” $4.2 million verdict after patient was diagnosed with hydrocephalus in the emergency department, but not properly treated for hydrocephalus by his family physician. Ooooh, and he got featured as litigator of the week in Texas Lawyer Magazine because of the verdict, too. Notice of how there’s no mention of how the money is going to help the client, only finger pointing about what was done wrong and bragging about the amount of money they earned by bringing the “wrongdoers” to justice? Intoxicated patient sets fire to a treatment room in UK’s Monkland’s Hospital. Reportedly, the burning sheets were just a few yards from several full oxygen cylinders. Doubt that the cylinders would have ever exploded, but the situation makes for good headlines. Patient rushed to emergency department with swollen leg. After getting there, mother becomes upset at the wait and begins to complain. Security guard tells mother to leave and then begins “pushing her out of the emergency room.” Son grabs security guard’s arm to try to defend his mother. Police arrest mother and son. You have to admire the staff working in the ED at Lincoln Hospital in the Bronx. It is one of 11 public hospitals in NY City but it handled 15% of all the public hospital emergency department visits. But the quotes from the patients underscore how our system is broken. Patients go to the emergency department not because they have emergencies, but because they “feel they care for me here” or because they want something “taken care of right away.” With no disincentive to obtain emergency medical care … except perhaps the time spent waiting for treatment … why would patients go anywhere else? Australian physicians fighting a government mandated co-pay of $7 for doctor visits, lab tests, and x-rays. Feel it would undermine the principle of universal care and might send them down the path of the American system where people pay for emergency medical care. Pay for emergency medical care? That’s a bad thing? Patient files complaint with ...

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Healthcare Update — 05-21-2014

See more health-related stories from around the web at my other blog at EP Monthly. Say it isn’t so! A detective hired by the VA system in Florida becomes a whistleblower. When controlled substances ended up missing, he reported that the hospital’s Chief of Staff, Dr. Vincent DeGennaro, told him to stop investigating the incidents. A VA patient who died from a cocaine overdose was known to have previously smuggled cocaine into the hospital, but the hospital failed to address the issue. When the patient died, the staff bagged the body up and cleaned the room. Now he’s worried about retaliation. “I can’t begin to explain to you how retaliation works within just the Miami VA. They don’t like people who air their dirty laundry.” “All animals are equal, but some animals are more equal than others.” Apparently revenge isn’t limited to the Miami VA system. The head of the psychiatry department in the St. Louis VA system came forward with stories about how the the system was only treating half of the mental health patients it had the capacity to handle. He was immediately demoted, told not to speak to any of the other psychiatrists in the hospital, and then subjected to harassment from some co-workers. Fears of doctor shortages under Obamacare may have been overblown. Undisclosed surveys of various undisclosed clinics say so. In addition, one patient, an ordained minister, said that Obamacare has “been a blessing for me.” And a former top top official President Obama’s Department of Health and Human Services Department said that the predictions of delays in getting care were “overblown.” That cinches it for me. By the way, did I mention that I “may” have a lease on a New York bridge to sell to someone? This may come as a surprise as well, but Obamacare subsidies are incorrect for more than 15% of all new enrollees. The computers don’t know how to match an enrollee’s stated income with the income on record from the IRS. Is President Obama “ducking” the whole VA scandal? Well he is “madder than hell” that it is occurring. But so far, the President has seemed to say more about the Trayvon Martin case than he has said about policies that have reportedly cost the lives of dozens of our country’s veterans. University of Chicago neurologist is suspended after being seen playing whack-a-mole on himself in a hotel window. A couple of kids saw him doing so and he was arrested for public indecency. He had previous episodes of public displays of autoerotic dermabrasion as well, which likely played a factor in his medical license being suspended. Now this doctor obviously has a problem. But I know lots of doctors who have done worse things and who still have their licenses. Does the punishment of losing hundreds of thousands of dollars in medical education fit the crime? And if you answer “yes,” then how do we reconcile this answer with the fact that police officers, teachers, and politicians can commit worse crimes and still keep their pensions? Speaking about unethical politicians … John Edwards’ first medical malpractice case against a physician ends up with a settlement of $13 million against one defendant and a deadlocked jury on whether the emergency physician should be held liable as well. Dr. Oz warns not to squeeze zits on your face because you may cause “cavernous thrombosis” (which doesn’t even exist). If you’re worried about causing cavernous sinus thrombosis, take solace. There have only been 88 cases of cavernous sinus thrombosis reported in English medical literature between 1940-1988. A boatload more people ...

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Healthcare Update — 04-30-2014

Man shoots himself in the head inside New Jersey emergency department. Wanted to commit suicide in front of girlfriend who happened to work at hospital. Second story about incident here. Florida back surgeon and malpractice attorney fighting back and forth with each other. Attorney loses malpractice case, then violates confidentiality order regarding case and is fined $23,400 by the trial court. But it’s not over yet. The attorney had the fine overturned by an appeal court and now the trial court has to re-decide the case. Superior Court Judge John A. Agostini orders the cessation of internationally accepted economic principles by forcing a Massachusetts hospital emergency department to stay open even though the hospital has no funding to continue providing services. Also orders creditors not to take possession of hospital property and utilities not to off power, water, and heat. But he didn’t order his paycheck to be sent to the hospital to fund all of these mandates. Ooooh. A decision written by Agostini said his order was made to “avoid an immediate threat to the health and safety of the residents in the [hospital’s] service area from the abrupt cessation of operations” and to give the parties time “to pursue planning for longer term provision of emergency medical and other services for residents.” In addition, some town residents formed their own “Occupy” movement by camping out in the hospital cafeteria all night even after the hospital was supposed to close. They called it “Occupy Cafeteria” but were later forced to actually eat the hospital food which caused them to scatter like cockroaches under a spotlight. Another Massachusetts hospital decides to merge its psychiatric emergency services with its hospital emergency department. Yeah. What could go wrong there? Where’s this Judge Agostini with his magic orders now? This whole case just makes my skin crawl. A nurse’s ex-boyfriend goes to her home uninvited, then gets mad when she receives text message from another man and strangles her to death. His mug shot shows the scratches all over his face when the nurse was fighting for her life. Then he reportedly uses her stethoscope to listen to her heart to make sure she’s dead. Private patient records from National Health System used by private company to target ads on Twitter and Facebook. Government making money off of the illnesses of patients? Good thing we have HIPAA in the US. Oh. Wait. HIPAA doesn’t apply to the government. Americans’ acceptance of scientific data is haphazard at best. According to this study (.pdf), 80% of people strongly believe that smoking causes cancer, but half of people doubt the Big Bang theory, almost half have doubts about the safety and effectiveness of childhood vaccines, and a third still have doubts that antibiotic overuse causes drug resistant bacteria. In other news, the same researchers expressed surprise at just how easily hospital administrators accept data from patient satisfaction companies when that data is statistically insignificant. One was quoted as saying “Garden slugs have higher IQs than some of the people relying on these satisfaction data points.” ICD 10 implementation has been delayed and issues like this are probably part of the reason. The dumbass(es) creating the codes included codes for events that have never occurred and could never occur in the history of earth. For example, the article notes that ICD 10 code T63813A is for “toxic effect of contact with venomous frog, assault, initial encounter.” The problem is that frogs don’t produce venom, so this could never happen. Or perhaps the patient suffered from V9227XA, meaning that they experienced “drowning and submersion due to being washed ...

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Healthcare Update – 04-08-2014

See more healthcare-related news from around the web on my other blog at EPMonthly.com EmCare sues former emergency department medical director for “hundreds of thousands of dollars” for “incompetent and substandard” work. As a result of the physician’s actions, which were not described, the hospital reportedly discontinued its contract with EmCare. What is even more interesting in the article is that EmCare alleged that its losses amounted to “hundreds of thousands of dollars per month” – which is millions of dollars per year just from one hospital system. Why is there this hand print on my butt after I wake up from surgery? Oh, it’s the new dominator/dominatrix surgical technique. Federal investigators accuse a New York orthopedist of insulting anesthetized patients and slapping some patients on the buttocks – sometimes so hard that he left hand prints. Now the hospital faces sanctions for his actions. Interesting that several comments to the news article say that this is a common way that surgeons use to determine whether a patient is under anesthesia. I personally wouldn’t slap a patient’s buttocks, but then what noxious stimuli is appropriate for determining whether a patient is conscious or not? It would be just as easy to write a damaging article about doctors giving patients sternal rubs (which I have done) or pinching a patient (which I have also done). Is this issue dragging us down the rabbit hole of political correctness? Americans hit with sharpest health insurance premiums in years according to Morgan Stanley survey of insurance brokers. This quarter, the average insurance premium increase is 12%. Anyone want to guess why that is? Hint: According to the article, the first word ironically begins with “Affordable”. Welcome to the world’s 20th most populous nation: The country of Medicaid. 72.7 million Americans are on Medicaid, making the number of people on the government program larger than the populations of France, the United Kingdom, and Italy. Add in the 49.4 million patients on Medicare and the resulting 122.1 million people become the 11th most populous “nation” – ahead of Mexico and just behind Japan’s 126 million people. We’re sure to crack the top 10 when the new statistics come out after Obamacare enrollments. With the Unaffordable Insurance Act, you can still see a primary care physician … if you have the right kind of insurance … or you pay cash. When researchers made calls to primary care physicians posing as new patients, 85% of patients with private insurance were able to book appointments. Only 58% of patients with Medicaid got appointments. If you agreed to pay full cash at the time of the visit, 79% got appointments while only 15% got appointments if they couldn’t pay more than $75 at the time of visit. There’s a big difference between “insurance” and “access”. Kings of Leon concert goes viral … literally. Washington State woman contracts measles but treks all over the Seattle area before she becomes symptomatic – including the Pike Place Market and several department stores. Then heads to a Kings of Leon concert. If you’re not vaccinated and have been exposed to the patient (or any of the other unvaccinated individuals who may have caught the disease), you and your family may be in for an unpleasant surprise. People should be free not to vaccinate themselves or their children, but they should not be immune from the legal and financial consequences that occur when they require medical treatment for the diseases they catch and when they spread the diseases to other people. Talk about a downward spiral. Moderate to severe depression increases risk of heart failure ...

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Healthcare Update — 03-30-2014

Didn’t realize how long it’s been. You can see other Updates from the past couple of weeks on my other blog at EP Monthly.com Supplies of liquid nitroglycerin in hospitals are dwindling – not because of medication shortage, but because of packaging issues. Nitroglycerin must be packaged in glass bottles and apparently the only manufacturer, Baxter, is having difficulty finding enough glass bottles to meet demand. Funny. I never remember Coca Cola having such problems. Emergency department visits for dental problems on the rise. Article focuses on New Jersey, but the same problem is occurring everywhere. Oh, and dental care for adults isn’t covered under the Unaffordable Insurance Act. As the CNN article notes, get ready for a “State of Decay.” Study shows that 1 in 25 patients develops a hospital acquired infection. About 721,000 infections were “acquired in hospitals” last year and 75,000 of those patients died, but the study reportedly did not look into whether the infections actually caused the patients’ deaths. I have problems with these statistics. I wasn’t able to find the NHSN criteria they used to determine whether an infection was present before a patient arrived in a hospital or after a patient left a hospital. And if hospitals are such germ-infested dangerous places, why don’t 1 in 25 hospital employees also have these infections? Black Death from Yersinia pestis (“the Plague”) caused the deaths of one third of the European population between 1348 and 1353. For a long time, it was believed that Black Death was spread by rat fleas. New research now says the vector for spread was human to human contact and not rat fleas. Police trying to determine why patient in New York’s Brookdale Hospital beat a nurse unconscious when the nurse tried to remove his catheter. Does it matter what psychiatric diagnosis they come up with? More problems with the cost of emergency department care. Patient upset because emergency department trip after a head injury from a bike accident costs her more than $6000. She had insurance, but it was a high deductible plan, meaning that she had to pay for all the costs out of her pocket. A head CT cost her $4800, calling a doctor in to place the stitches was $460, and the stitches themselves cost $850. The article mentions cost-conscious care … which is fine until something is missed. In this patient’s case, she thought an x-ray should have been done for her head injury instead of a CT scan. Xrays don’t show bleeding, though. Would she still have felt that only an x-ray should have been done if she had bleeding inside her brain and the x-ray missed it? On the other hand, patients can’t be cost conscious about their care if they don’t know the prices. Care and testing performed when a patient has not been advised of the costs in advance should be required to be provided at no cost. More information about how Beth Israel is using Google Glass to enhance medical care in the emergency department. Will be interesting to see a report on their results. You can check in any time you like … but you can never leave. Woman purchases insurance through Obamacare exchange, then gets job and tries to unenroll in her initial plan. Not so easy. She ended up paying premiums on both plans until she could run the gauntlet of unenrollment. 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 ...

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