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Healthcare Updates

Links and commentary to healthcare news around the internet

Healthcare Update — 12-6-2013

A couple of interesting articles on how changing our microbiome may help cure our ills. Fecal transplants have been shown to cure patients suffering from Clostridium difficile infections. Seres Health is testing the first pill containing live bacteria to treat C. difficile and is developing other live bacterial treatments for “inflammatory and metabolic diseases.” Latest battle against antibiotic resistant organisms pits viruses against resistant bacteria. A protein called “0.4” … I’m calling it “.4” to tick off the Joint Commission … was found to kill many of the bacteria resistant to antibiotics such as clostridium difficile, N. gonorrhea, and one of the superbugs called carbapenem resistant Enterobacteriaceae. Now we just need to make sure that the viruses and/or proteins don’t make humans sicker than the bacterial infections. No, it’s not your menstrual period. When woman was involved in car accident, police officer noted that she was bleeding from her vagina. Initially, the woman stated that she was on her period, then an investigation at the jail showed that she had a broken crack pipe and a capped syringe in her hoo hah. She was brought to the ED, evaluated and released. The police actually booked the broken crack pipe into evidence. I’m just going to sit back and smile about all the comments I could make right now, but the winner in the comment section to the article was “Now THAT’s a crack pipe.” Some people would call it a waste of good vodka, but one commenter to a medical column noted that a spray containing half vodka, half water, and a few drops of orange essential oil works well for itchy rashes. I almost erased this this entry after asking myself why the hell I even care about what some random reader thinks will cure itchy rashes, but then I started thinking about a Russian surgery resident who used to smell like vodka and used to harass Mrs. Whitecoat and tell her “You look EXCELLENT” just about every day before I married her and it just made me laugh. So you have to suffer through my word association memories. Sorry about that. And if you decide to spray some diluted Stoli on your pits and it does work, drop me a note. Miracle surgery. First face transplant patient speaks out about his success. Seeing this transformation is remarkable. How many patient harms are associated with hospital care each year? If you believe the Institute of Medicine rhetoric, that number is as high as 98,000. However, this new research says the 98,000 number is a gross underestimate. These authors state that 400,000 patients per year die from “preventable harm” and that 4 million to 8 million patients suffer “serious harm” related to their hospital care. Putting these numbers into perspective, CDC data states that there were 35.1 million discharges in the US in 2010. I’m assuming that there were roughly that many admissions, since you can’t be discharged without being admitted. That would mean that one in every hundred patients discharged from a hospital dies from a “preventable harm” and that up to one in every four patients discharged from a hospital has a preventable “serious harm.” If this is true, then the obvious answer is to outlaw the practice of medicine. It kills too many people. If you’ve ever published a paper with Elsevier, think twice before trying to make it available to others. Elsevier is sending takedown notices to authors who try to make their work available to the public. Read your submission agreements carefully … and consider publishing your papers somewhere other than Elsevier. Some obligatory UnAffordable ...

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Healthcare Update — 11-25-2013

Also see more healthcare related news from around the web at my other blog over on EPMonthly.com American College of Emergency Physicians threatens board certification of any physician who provides medical care in a non-emergency setting. If that fake headline left you scratching your head, so should this one: American College of Obstetricians and Gynecologists threatens board certification of gynecologist who treats men for anal cancer. Even though the diagnosis and treatment of anal cancer in men is similar to the diagnosis and treatment of cervical cancer in women, and even though ACOG’s decision will significantly affect studies on treatment of anal cancer, ACOG sees no “compelling reason” to change its mind. After all, ACOG has been “no Y chromosomes allowed” since 1935. All specialties should be outraged at ACOG’s decision. Most hospitals require board certification of their physicians, so physicians in many cases are forced to be members of the specialty societies in order to practice within hospitals. The more that physicians simply comply with misguided and arbitrary specialty society requirements, the more that we allow those special interests to control the medical care that we provide to our patients. ACOG’s decision not only usurps the determinations of state medical licensing boards, but it also smacks of misandry and homophobia. Did influenza vaccine kill this 19 year old? One day after getting influenza vaccination, the patient developed vomiting, headaches, chills and shaking. A week later he went into a coma and later died from “brain swelling” of undetermined etiology. Patients gone wild in a Long Island emergency department. The brawl in a parking lot wasn’t enough. When the victims were taken to Eastern Long Island Hospital, they went at it again and injured some of the emergency department staff in the process. Philip Howard from Common Good discusses in interview with Medscape how “crazy laws” trap physicians in malpractice system and how current system is not system of justice, but is instead a “system of extortion.” Pensacola Florida Naval Hospital closing its 21,000 visit per year emergency department and turning it into an urgent care center to save money. Will close at night and will no longer accept ambulance runs. Hospital spokesman justifies the move by stating that the emergency department has a “relatively low patient volume”. Tough Mudder race involves obstacle course where often wet and sweaty participants are shocked by live wires up to 10,000 volts. A race in the Philadelphia area resulted in 38 participants going to the emergency department – half of those visits were due to electrical shocks. Doctors at one hospital said that an 18 year old patient “essentially had a heart attack, inflammation of the heart” from receiving 13 shocks during the race. Taking things too far? ACEP’s @DrHowieMell is also quoted in the article. It was recently the 50th anniversary of President Kennedy’s assassination. One of the more captivating accounts of what happened when President Kennedy was brought to the emergency department was written by Jimmy Breslin. As patient volumes increase by 23%, UK’s St. Helier Hospital is telling patients to stay away from the emergency department unless they have a real emergency. Last year, the hospital treated a record number of patients, so it doesn’t look like the warning is going to work. $2.4 million verdict against emergency physician when gastric bypass patient complaining of abdominal and back pain is released from the emergency department and dies the following day from a bowel obstruction. Damages in medical malpractice claims continues to rise. Average payout for medical malpractice cases has increased from $300,000 to $500,000 between 2006 and 2012. Maryland, a ...

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Healthcare Update — 11-14-2013

See more updates over at my other blog at EPMonthly.com Jury finds cardiologist and hospital liable for performing unnecessary cardiac stenting in patient. Patient wanted $50 million in damages, jury can’t agree on damage award. Judge throws out case against cardiologist during jury deliberations leaving hospital as only defendant. Veteran’s hospitals paying out record amounts in settlements and court judgments for medical malpractice claims. Some of the claims include – a 20-year Marine Corps veteran paralyzed after a routine tooth extraction – an Air Force veteran who died after a surgeon burned a hole in his heart with a laser – an Army veteran who died after doctors repeatedly failed to diagnose and treat a cancerous growth that was present on the patient’s chest x-rays for more than three years – another veteran who bled to death after being left in a room after a liver biopsy and never re-evaluated The payments for VA negligence come from the Treasury budget … meaning from our pockets. One State rep notes “We focus so much on sending our soldiers to war. But when they’re coming back, we don’t have the same focus on taking care of them.” Another article in the Dayton Daily News gives more details about several of the cases. Association or causation? After drug companies voluntarily withdrew many pediatric cold medications and recommended against using others until patients reach 4 years of age, the percentage of ED visits for adverse events from such medications decreased from 4% to 2.5%. Dr. Melvyn Flye arrested for perjury when he made untrue statements as an expert witness at trial. How often do you see that happen? Actually, I think it should happen more. Arrest incidentally occurred in July, but the article just came across my newsfeed this week. Patients gone wild. Patient upset because emergency physician won’t refill his Norco prescription leaves hospital emergency department and stabs emergency department greeter in the neck on his way out the door. The greeter is in serious condition. Godspeed to her. The patient is in the Greybar Motel. Hope he doesn’t even get Tylenol. Another article on the incident courtesy of Scott DuCharme – thanks! Popular Science calls this a “rare new bacterium.” Tersicoccus phoenicis is found in NASA “cleanrooms” and is resistant to chemical cleaning, ultraviolet rays, and other sterilization procedures. Interesting questions develop in my mind. First, I doubt that the bacterium is “new,” but suspect that it is just that no one has ever looked for or found it yet. Perhaps “newly discovered” would be a better term. Second, if chemicals and sterilization don’t kill it, then what does? If the only thing absent from clean rooms is bacteria, then likely the growth of other bacteria somehow hold the growth of this bacterium in check. Hat tip to Instapundit for the link. Will the Unaffordable Insurance Act (if you were wondering, I refuse to call it the “Affordable Care Act” because it isn’t “affordable” and it doesn’t provide medical “care”) provide more reimbursement for emergency department patients? If Medicaid payments stay the same (which they won’t), then this study suggests that receipts for previously uninsured patients will increase by 17-39%. Great save. Orlando emergency physicians perform needle cricothyrotomy on an infant with a pacifier tightly lodged in his throat. Patient went to surgery and an ENT surgeon had to remove the pacifier in pieces. Why don’t newspapers ever publish the names of the doctors that do great things like this? Seems like almost all of the publicity is for malpractice and other allegations of badness. Alicia Gallegos, former medical legal reporter extraordinaire for the ...

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Healthcare Update 11-04-2013

See more medical news from around the web on my other blog at EP Monthly.com Like a Nazi article touting the benefits of gas chambers. Press Ganey CMO Thomas Lee writes article about current “surge” in “patient experience” published in Health Affairs. Dr. Lee’s definition of “professionalism” that he and his organization apparently expect us to latch onto includes willingness of physicians to work together to “meet[] patients’ needs,” not wasting resources, and being very concerned about data on your performance – even if that data is statistically insignificant and wholly inappropriate to use. So if we don’t “meet a patient’s needs” for large doses of narcotics and if we perform testing that we believe is clinically appropriate but which is then retrospectively deemed to be a “waste of resources” and then we don’t bow down to Press Ganey’s little red, yellow, and green boxes, then according to Dr. Lee, we must now be labeled as “unprofessional.” Another out of touch “physician” who is writing surreptitious articles for his employer. How low will Press Ganey go to make a buck? Meh. Just a flesh wound … or maybe not. Chinese man walks into emergency department with fruit knife sticking out of his head. Occurred when some kind of a “game” got out of hand. Knife actually penetrated his skull and required three hours of surgery to repair. Then the doctors sent him home with the knife. I can just hear him when he gets home and starts playing the “game” again: THIS time I go first! The White House has a brigade of Twitter attack drones just waiting to use your tax dollars for their salaries while they blast anyone who portrays the government and/or the Unaffordable Insurance Act in an unflattering light … for example an elderly survivor of metastatic gallbladder cancer who is now unable to keep her insurance plan because of Obamacare regulations. Some commenters called White House staffer Dan Pfeiffer (@pfeiffer44) a “douchebag” for attacking the patient. I think that’s being degrading to women’s hygiene products. Is that ACEP newsbyte about emergency medicine accounting for only 2% of all healthcare spending really true? Politifact says that it is … mostly. Politifact did cite a 2013 study showing that the cost of emergency care was between 5% and 10% of the total amount of healthcare spending. “Zero tolerance” in some UK hospitals after multiple “high profile” attacks on emergency department staff. Consultants note that emergency department staff deal with violence on a daily basis, yet the only measures they take to curb the violence is to make sure cameras are in place so they can catch the perpetrators after the act. When hospitals refuse to provide adequate security for their employees and are aware of the high potential for violence, perhaps the hospital administrators should be civilly and criminally liable for any injuries sustained by their employees. Michigan House Bill No 4354 (.pdf) would make it much more difficult to sue physicians or hospitals for EMTALA-related care. Requires proof by “BY CLEAR AND CONVINCING EVIDENCE THAT THE LICENSED HEALTH CARE PROFESSIONAL’S ACTIONS CONSTITUTED GROSS NEGLIGENCE.” This is a very high legal hurdle. Article notes that “the liability in such medical situations has many specialists declining to be on call.” A study performed by the Michigan College of Emergency Physicians showed that states such as Georgia and Texas that enacted similar reforms had an increase in physicians. Apparently the concept that we can’t “sue our way to better health care” is beginning to take hold. Notice how all the attorneys in the comment section argue against the legislation. Head of Veterans Affairs writes a letter to US Representative ...

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Healthcare Update 10-28-2013

Finally … Now you can catch updates both here and on my other blog at EP Monthly.com If you like your insurance, you can keep your insurance … that is until the insurance company cancels the policy because it doesn’t meet the Obamacare requirements. Florida Blue is canceling about 80% of its individual policies and Blue shield of California is canceling 60% of its individual policies. Most of those cancellations will see their insurance premiums rise in new policies – if they can afford to purchase them. Now there are reports that POTUS knew that whole “keep your insurance” statement was untrue from the start. How sad. Want to know how much you’re going to pay once your insurance coverage gets dropped? Don’t go to healthcare.gov. According to this article, the prices quoted on the healthcare.gov site are wildly inaccurate. One patient found that the cost for a policy was 50% more than quoted on the site. Another patient reportedly was quoted a price of $394 on the government site when the actual cost of the policy was $634. If private companies did this, it would be considered consumer fraud. How export limitations and drug shortages affect executions. Interesting story. Sodium thiopental supply has dried up. Then prison officials began to look at using propofol for lethal injections. That was the drug that reportedly killed Michael Jackson. However, most propofol is made and exported by a German company which is subject to EU regulations limiting export of drugs for use in capital punishment. If misused in the US, the EU could deny further exports of the drug. According to the article, US regulations “make propofol difficult to manufacture in the US.” Now prisons are looking at using midazolam (Versed) as a substitute in lethal injections. The drug is made in the US, but it isn’t tested for executions. During one lethal injection, the prisoner was reportedly awake and blinking during his execution. Do we go back to firing squads? Speaking about Michael Jackson’s death … Conrad Murray was released from jail today after serving half of his four year sentence. I was going to link to the story on ABCnews.com, but they have an annoying autostart video when you click on the story. So F them. New research shows promise for hair growth. Researchers grow human hair papilla on a culture medium, then inject them into hairless areas. New hair follicles form. They know this because they were able to get hair to grow onto grafts of human foreskin. No, men aren’t going to have to shave their woo hoos … foreskin is hairless and they wanted to make sure that the procedure grew new hair follicles instead of affecting existing hair follicles. University of Michigan study shows that 77% of parents want to be able to e-mail doctors about children’s health care problems. However, half of the parents think that they shouldn’t have to pay for e-mail medical consults. In other words, the parents want doctors to spend hundreds of thousands of dollars on a medical education, pay tens of thousands of dollars each year in licensing and insurance fees and then provide services at no cost. Sounds like a sustainable business plan to me. Study in the American Journal of Emergency Medicine shows that obese patients may not receive proper medication dose when using EpiPens. The needle length on the EpiPen is only 1.6 cm while the amount of fatty tissue in obese patient thighs was much more than that. About a third of patients were failure risks. Women were 6.4 times as likely to receive inadequate medication doses ...

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Healthcare Update — 09-25-2013

Also see more medical news from around the web over at my other blog on EPMonthly.com. As we rely more and more upon computers to improve our health, some downsides emerge. How many of you would ever have thought that there would be medical device hackers? Hackers have the ability to wirelessly reprogram an implanted cardiac defibrillator and can instruct it to deliver a shock to a patient’s heart or to inappropriately drain its battery. To combat the hackers, researchers at Rice University have created a device that must be in contact with a patient’s body and measuring a patient’s heartbeat before the defibrillator could be wirelessly accessed. Interesting concept, but then come the “what if’s.” The security is obviously only as good as the encryption, though. And then what happens if the device has difficulty reading the heart rate? Probably not applicable for ventricular fibrillation since AICD data won’t be very useful in that case. Approval of the device is still “years” away. In the meantime, maybe pacemaker patients need to begin wearing tin foil over their chests? Whooping cough reaching epidemic levels in Texas. Many of the new infections are attributed to new vaccine that is safer but less effective and to decline in number of children being vaccinated. Of course, if you’re in the anti-vax crowd, then the increase in cases must mean that there is an increase in filthy living environments … or that Jenny McCarthy has put a curse on the entire state of Texas. I still believe that parents who don’t vaccinate their children should be held legally responsible if their children either become infected with a preventable disease or if their children infect someone else. Although it reads like an informercial for a certain soap manufacturer and cites a study from 2011, this recently-published article still made me do a double take. The liquid soap in those public bathroom soap dispensers is sometimes so laden with bacteria that you may be better off washing your hands in toilet water. The article noted how some soap dispensers left people’s hands with “25 times more (potentially harmful) gram-negative bacteria AFTER washing than before washing with contaminated soap” That’s it. From now on, I’m holding it until I get home. No. Wait … I’m not using the bathroom until I get home. Seattle Times guest columnist asks whether it is time to get rid of the FDA. Normally, I’d say “yes” and move on to the next question. But the author bolsters his argument by noting many scandals in the DEA (which seem present in many government agencies nowadays), the DEA’s data collection practices (ditto), the failure of the DEA to reschedule marijuana as a “safe” drug, and the assertion that the DEA is losing the battle on the “war on drugs”. So let’s say we merge the DEA with the FBI as the author suggests. Will these problems get better? Movement to cut Obamacare subsidies to lawmakers and aides gains momentum. Mitch McConnell quoted as saying “I’m totally opposed to any preferential or special treatments for members of Congress when it comes to Obamacare.” Watch this become a hotbutton issue over the next few weeks. One more Obamacare article. Feds state that the Unaffordable Insurance Act will provide insurance to only half as many people as initially projected in 2014. Obamacare is expected to account for more than ⅔ of the increase in healthcare spending next year – which will total more than 3 TRILLION dollars. CDC report acknowledges that agricultural antibiotics play a role in drug resistance. According to the FDA, there are more ...

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