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Healthcare Updates

Links and commentary to healthcare news around the internet

Healthcare Update 07-10-2013

New York’s Eliot Spitzer campaigning in Connecticut’s Danbury Hospital emergency department? Nope. Just some slime that backed up from the toilet and leaked down the walls into about 10 treatment rooms requiring partial closure of the ED and requiring the hospital to use a “mobile hospital tent” provided by the state. In a related article, if you ever wanted to know where the term “shit head” comes from, here’s the explanation: Some Oklahoma perv was arrested after he was found in an amusement park septic tank, looking up through the toilet drains while women were using the bathroom. A woman who took her 7 year old to use the toilet saw an eyeball looking up at her. Wrong on so many levels. Speaking about … feces … a parasite in cat feces is now being termed a “significant public health problem.” The immature forms of the parasite, called oocysts, can survive up to 18 months and only one of them is required to cause an infection. Common sources of infection are sandboxes and vegetable patches where cats are more likely to relieve themselves. Toxoplasma gondii has been called a “mind-controlling parasite” (no other puns about our elected officials here, OK?) because when it infects humans, it has been linked to schizophrenia, depression and suicidal behavior in adults and multiple congenital abnormalities including mental retardation in newborns. Oh, and Toxoplasma infections are much more common in France. Draw your own conclusions. Speaking about … infections … there’s a new tick-borne illness which is similar to Lyme disease (Borrelia burgdorferi) but worse. In addition, it doesn’t cause the typical spreading rash, most doctors don’t know the infection exists, and this infection will not show up on tests for Lyme disease. Introducing … Borrelia miyamotoi. Speaking even more about … infections … a pair of studies in the European Spine Journal shows that back pain may be related to pimples – and may be treatable with antibiotics. Propionibacterium acnes, the bacteria commonly associated with acne, was found in discs of 43% of patients undergoing surgery for disc repair. Of those patients with these bacteria present, 80% had inflammatory changes in the adjacent vertebrae. A second study showed significant improvement in disease specific disability, leg pain, and back pain after 100 days of antibiotic treatment. More evidence to me that health is related to proper balance of bacteria in the system. Now we just have to figure out what that balance is. Also makes me wonder whether chronic back pain or even ankylosing spondylitis may have an infectious basis as opposed to an “autoimmune” basis. Another survey out  – this one by the Medicus Firm – shows attitudes of physicians toward practice preferences and the UnAffordable Insurance Act. Out of 2500 doctors surveyed … More than half preferred the East Coast as the region to set up practice More than half of new graduates preferred employment by a hospital or academic center The most common reasons cited for declining physician pay were hospital employment, declining reimbursements, and time wasted entering information into electronic medical records. More than half of physicians rated the “Affordable” “Care” Act as either a “D” or an “F” in terms of being able to decrease health costs, improving the quality of care, improving efficiency of care, and as an “overall grade.” Enforcing the UnAffordable Insurance Act will be the IRS. Yes … that IRS. The IRS will enforce 47 tax provisions under Obamacare and will also collect the penalties … er … um … taxes for noncompliance. What could go wrong? Oh, and under a 253 page Obamacare rule issued ...

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Healthcare Update — 06-26-2013

See more updates at EP Monthly.com In cats they are called hair balls and are considered a bad thing … New fad has fashion models dipping cotton balls in orange juice and eating them in an attempt to suppress their appetites and lose weight. I can’t even come up with a pithy comment for that one. $4 million settlement in New York after mother seeks care for UTI symptoms at 26 weeks gestation, doesn’t receive antibiotics, and child is born 11 days later with neonatal sepsis. Florida Governor Rick Scott is now backing legislation to crack down even further on expert witnesses in medical malpractice cases. The legislation was sparked by one doctor who misrepresented his credentials under oath when testifying as an expert witness. Now plaintiff attorneys are crying foul because the restrictions will “benefit doctors and corporations at the expense of injured patients and consumers.” In other words, “bwwwwaaaaaaaaaah, our contingency fees are going to dry up.” Could Governor Scott’s interest in improving expert witness standards possibly be because Florida is one of the suckiest states in which to practice medicine and he’s trying to make a turd smell a little more like a rose? Chicago-area hospital adding a “Telestroke Program” to its facilities. Now neurologists can view patients over computer cameras to determine whether they need to be transferred to a higher level of care. Will be interesting to see how much benefit the web cams will have. Not like you can do strength testing over the internets. Anyone out there use a video link to neurologists? Not to be outdone, the University of California at San Diego is instituting a study on use of telemedicine for emergency department patients. The principal investigator for the study, Dr. David Guss, states that “underutilized physicians” during lulls in patient volumes are an “unneeded expense.” Ahhhhh, the emergency department of the future … one doctor running around frantically performing procedures on critical patients while a bunch of other doctors write work notes and Norco prescriptions from the comfort of their home offices. New York’s Long Island College Hospital blocks ambulances from bringing patients to emergency department. One neonatologist threatens to “call the cops” if the hospital attempted to move her patients out. Tough to run incubators without electricity. The hospital is losing $1 million per week, but a judge ordered the hospital to maintain staffing levels anyway. Maybe they can use Monopoly money to pay the staff.. One less hospital to care for Brooklyn patients in an emergency. New York isn’t the only place where judges make idiotic rulings. Ontario Court of Appeal rules that obstetrician was negligent for relying on the treatment plan of a consultant specialist who misdiagnosed a patient’s aortic rupture as a pulmonary embolism. Obviously, the obstetrician should know more about medicine than every other specialist. If he agrees with the specialist and there is a bad outcome, he’s liable. If he disagrees with a specialist and there’s a bad outcome, he’s still liable. Ultimate effect of Ontario Court of Appeal’s ruling: Physicians are responsible for knowing everything about medicine and will be liable for misdiagnosis regardless of what a consultant says. Does Canada have a problem with defensive medicine yet? According to a Mayo Clinic study, we are officially The United States of Pill Poppers. Seven in ten people in this country are on at least one prescription medication. Half are on at least two prescription medications. Twenty percent are on 5 or more medications — most of those patients come to my emergency department. Antidepressants and opioids were tied for second place on the ...

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Healthcare Update — 06-17-2013

See more updates over at EP Monthly.com Washington State teen runs from the emergency department and disappears after the po po show up to investigate his gunshot wound. Didn’t see any 15 year old boys in the obituaries, so either he got his treatment or the wound wasn’t life threatening. Vocera hands-free device decreases time spent dealing with interruptions while working in the emergency department by more than half. One of our emergency departments uses Vocera and it is well-liked. Another reason that emergency physicians shouldn’t be doing a coroner’s job. In this CDC study, half of residents surveyed stated that they had reported an inaccurate cause of death. Reasons for doing so included being told to do so by the medical examiner and being told to do so by hospital admissions personnel. Most of the time, the residents put cardiovascular disease as a cause of death when it was not. Only ⅓ of all respondents believed that cause of death reporting is accurate. Interesting study to in mind if one of your loved ones dies under suspicious circumstances. Wait until they send her to collections. El Paso woman receives bills from Providence Memorial Hospital even though she never received care there. Takes a news expose to get action and an apology letter from the hospital. States selling medical data for profit. Medical data mining is a growing industry expected to surpass $10 billion in revenues by 2020. Unfortunately, it’s fairly easy to combine the medical data with, say, news stories to identify the patients. Out of 81 Washington State news stories containing the word “hospitalization,” Bloomberg.com was able to identify 35 patients by their their “anonymous” medical data. One patient’s medical history contained  all his diagnoses and procedures following a major car accident, his doctors, ethnicity and payment information. HIPAA violation? Nope. HIPAA doesn’t apply to states. I’m sure some state employee has somewhere made a trite comment about how patients are giving up some of their liberties and privacy to increase their safety. Then again, we all know what Benjamin Franklin said about liberty and safety Look out North Carolina obstetricians … John Edwards is planning to open a new law firm. He must not be able to stand the constant din of babies’ voices channeling through his head. On one hand there are professional repercussions, lawsuits, and news articles like this if you miss a diagnosis. Diagnostic errors take a serious toll, you know. Missed or delayed diagnoses affect up to 20% of all cases, you know. On the other hand, if doctors do the testing to make the diagnosis and the testing is normal, they’re accused of ordering “unnecessary” testing. Doctors order waaaay to many normal tests, you know. Patients need to learn to say “Whoa” to their doctors, you know. That is, patients need to say “Whoa” until their doctor doesn’t do the test that would have made the diagnosis … then they can point to the other articles about missed and delayed diagnoses. Would be nice to come up with some prospective guidance on what patients should do when their diagnosis is missed by failing to perform an “unnecessary” test, but apparently the media has much more fun just vilifying doctors for bad outcomes regardless of what approach doctors take. Would you do this to lose weight? Surgeons sew a plastic patch (the same material used to make Hula Hoops) onto the surface of the tongue so that it becomes painful to eat solid foods. Then people lose up to a pound a day by following a liquid diet. How much of it comes ...

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Healthcare Update — 06-06-2013

See more updates over at EP Monthly.com Patients gone really wild. 45 year old patient falls asleep in Harlem Hospital emergency department then wakes to find another patient sexually assaulting her. Assailant then stopped and began to urinate on her. Comments to the article equate the incident to the future of health care in this country. Schools requiring doctor’s notes to apply sunscreen on kids due to “possible–but quite rare–risk of being allergic”? We should probably require doctor’s notes to eat lunch, also. Food allergies are a big problem, you know. It would be amusing to turn the tables on these moronic school officials. “Sunscreen of 30 SPF or higher must be applied exactly 27 minutes prior to anticipated sun exposure. Sunscreen should be applied to all exposed skin areas including scalp and also applied to a 3.5 inch area of skin buffering any and all exposed skin areas. Sunscreen must be reapplied to these same areas every 30 minutes or fraction thereof. Application of sunscreen, times of application, areas of application, and reapplication efforts should all be clearly documented, signed by school officials and returned to this office for filing with the State. Any variation from these directions should be considered medically contraindicated and unauthorized by this practitioner.” Hat tip to Instapundit for the article link. Are US doctors paid too much? When this Forbes article compares US physician salary to physician salary in other countries without comparing the legal atmospheres, the regulatory atmospheres, the costs of training, the costs of malpractice insurance, and the costs of licensure, the article doesn’t effectively answer the question – even though it concludes that US doctors are underpaid. Show me another country where a specialist has to pay $150,000 in malpractice insurance each year and then we’ll talk. Kentucky needs 3,790 more physicians than it currently has – and that’s before Medicaid expansion and the UnAffordable Insurance Act take effect. With 25% of Kentucky’s primary care physicians at risk for retirement in the next 5 years, the problem will only get worse. Now it is looking at allowing nurse practitioners to prescribe non-scheduled medications as one way to combat the problem. Don’t worry, Kentuckians. You’ll still have insurance! Connecticut hospitals have serious problems obtaining psychiatric medical care for children. On many days, more than half of the beds in the Connecticut Children’s Medical Center ED are occupied by behavioral health patients. Many sit in the department for days because there are “no psychiatric beds available in the state of Connecticut.” Chicago’s Roseland Community Hospital threatened to stop taking new patients unless Illinois paid it more than $6 million in back debts. On Wednesday, the hospital recanted and stated that Illinois did not owe it any money – and got $350,000 in funding. Black Disciples gang members protested the possible closing of the hospital, stating that they deserve to be saved and that closing the hospital would amount to “genocide.” Closures of other area hospitals increased the ED volume at Roseland by 40%. Many of those patients were uninsured. I predicted this scenario years ago. When hospitals close, uninsured patients don’t stop getting sick. They find care at other open hospitals. Oh, and don’t forget … the UnAffordable Insurance Act increases the amount of insurance coverage to young healthy adults. The Rand Corporation also commented on the study, stating that “private insurance was acting as it should.” That is until workers are fired or their hours are cut so employers no longer have to pay for coverage to them or their families beginning on January 1, 2014. Don’t worry, though. Our elected representatives ...

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Healthcare Update — 05-29-2013

See more Healthcare Updates on my other blog at EP Monthly.com Cool graphic from Diederich Healthcare regarding 2013 Medical Malpractice Payout Analysis. Among the stats: Medical malpractice payouts have steadily declined since 2003. Five states represent nearly half of all payouts: New York, New Jersey, Pennsylvania, California, and … you guessed it … FLORIDA. Nine of the top ten states in per-capita payouts were in the New England region. Failure to diagnose was the most common allegation and caused the largest percentage of payouts. But don’t forget, everyone, doctors do waaaay too much diagnostic testing. Schools require a doctor’s note for sunscreen? I’m betting that if the schools had to pay for the doctor’s visit, that requirement would vanish. First entry for this week’s Patient’s Gone Wild … Pennsylvania patient grabs emergency department physician and throws her to the floor, injuring her legs and hands. Then head-butts a police officer and urinates in the back of the squad car on his way to the hoosegow. Second story on the incident is here. Study from Pediatrics shows that in Peru, where antibiotics are available without a prescription: 85% of caregivers respected a doctor’s advice not to use antibiotics for diarrhea or a common cold in their children. What conclusions can be drawn from this study? Hmmmmm. I could make a lot of conclusions, but one thing to think about: See how a collaborative relationship is established between doctors and patients when medicine is deregulated? Let patients buy all the medications over the counter that they want. When they don’t get better, then they’ll seek out doctors’ advice rather than viewing them as someone they have to pay in order to get a prescription for inappropriate antibiotics. Well … Grandma’s ashes are still on the mantle. Massachusetts audit discovers that millions of dollars are being paid to dead beneficiaries. 178 people were claiming dead people as dependents. Another lesson in the difference between insurance and health care. Employers being courted by insurance brokers offering barebones plans that barely meet Obamacare requirements but that do not cover surgery, x-rays, prenatal care, or hospitalizations. This way everyone gets “insurance,” employers avoid the Obamacare fines, and employees get stuck with inadequate health care, but everyone can cheer at the news stories describing how many people now have health care “insurance”. Woo hoo! Saw this coming a mile away. Wonder if Uncle Sam will make additional changes in the law in order to force employers to provide additional coverage. Speaking about Obamacare, a majority of Americans say that their health care situation will be worse under the Unaffordable Insurance Act. That number includes 85% of all Republicans and 51% of all independents. Only 24% of Democrats believe that Obamacare will make things worse for them. 56% of those polled want to go back to the old health care system. Let me guess … FoxNews smear campaign against the Demorats. In Taiwan emergency department, a well-known actor punched an emergency department physician in the back of the head for delaying placing the actor’s mother on a ventilator. The Tiawanese Society of Emergency Medicine reported that 80% of emergency personnel have been verbally or physically abused and that 30% have been attacked. Patient satisfaction in Morocco … at 66% favorable, the results are about 2 standard deviations worse than in United States emergency departments. But they’re still way better than that schmuck Press Ganey CEO Patrick Ryan. From the “If You Measure It, Someone Will Study It” Department: Obese patients are 52% more likely to doctor shop and 85% more likely to use the emergency department than are ...

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Healthcare Update — 05-15-2013

Also see more Healthcare Updates on my other blog at EP Monthly.com Pain pills make you impotent. Well, the study doesn’t quite say that but the headline sure catches your attention, doesn’t it? The study did note a 45% increased likelihood of using testosterone replacement or medications for erectile dysfunction when patients were taking long-term opioids. You think YOU’ve got it bad? In Pakistan, four children share the same ICU bed and machines such as MRIs have been out of order for more than 3 years – forcing patients to go to private hospitals and pay out of pocket to have the tests done. The Medical Marijuana Associates would have a conniption just thinking about this happening in the US, but the government that provides everything to you has the power to take everything away from you. Don’t worry. Nothing like this would ever happen in this country. On the other hand, according to the article, the tests cost about 20,000 Rupees – about $200 US Dollars – which is a fraction of the cost for the same tests in the US. Another bamblance stolen – this time the driver was still inside. Tennessee’s John Shanks jumped in the driver’s seat of an ambulance in Erlanger Hospital’s parking lot and drove away while the driver was in the back of the ambulance cleaning it. Driver tried to subdue thief who when jumped out of the ambulance and ran away in a serpentine pattern. He was later caught and charged with multiple crimes. Patients gone wild episode of the week. Intoxicated male “causing trouble” in Newfoundland ED. Police called to scene and patient now faces charges of causing a disturbance and assaulting a police officer. Remember the story about the brawl in the Georgia ED waiting room a few weeks ago? Now police have released pictures from surveillance video that shows the alleged perps and are looking for information identifying them. Identified so far include Quantavious Cortez Thomas, Altravious Antwan Thomas, Montravious Monque Gibson, and Cedrick Octavious Marshall. Tragic story. Twelve year old girl dies after taking grandmother’s used Fentanyl patch out of the garbage and putting it on her leg – possibly to help with a stomach ache. Richard Epstein eloquently explains how the Affordable Care Act is unraveling before our eyes. Insurance isn’t worth much if no one can afford it. How much will individual health insurance premiums increase under Obamacare? Estimates from 17 of the country’s largest health insurance providers expect 100-400% increases. In other words, 90% of individuals will be dropping their health insurance policies. Businesses will see a 50-100% increase in their premiums. Instead of calling it the UnAffordable Care Act, maybe I’ll start calling it the UnAffordable Insurance Act. Indiana man goes to hospital and shoots himself in hospital emergency department after shooting his former boyfriend at boyfriend’s place of employment. More “unnecessary” spending in medicine. Urologists at Henry Ford Hospital allege that emergency department treatment for UTIs alone cost $4 billion per year in “unnecessary” health care costs. I need to start publishing retrospective studies about wasteful procedures in other specialties. Irish emergency department so crowded and busy that it has to pull an ambulance up to the front door to act as an extra resuscitation room for a patient. To be fair, there were five patients all needing resuscitation at the same time. I actually think that the doctors were pretty resourceful in coming up with the idea. South Carolina parents sue hospital for performing corrective surgery on young child with ambiguous genitalia, stating that the doctors picked the wrong sex. Doctors created ...

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