Home / Healthcare Updates / Healthcare Update — 01-09-2012

Healthcare Update — 01-09-2012

Welcome to the New Year! I had a couple hundred e-mails with health care news sitting in my e-mail box and don’t have time to read all the articles, so I decided to declare health care news “bankruptcy,” delete all the messages and start fresh.

So … back to the regularly scheduled updates, and the regularly scheduled update Satellite Edition.

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He should have just called a Bambalance. After running into deer in the road, drunk driver in New York arrested for trying to take deer to the emergency department for medical care.

Is loser pays a solution for frivolous medical malpractice lawsuits? Absolutely.

Speaking about “loser pays,” Glenn Reynolds from Instapundit brings up a very good point regarding using loser pays in criminal cases. Why shouldn’t government attorneys have to pay for defense attorneys’ fees if the jury finds a defendant not guilty? As it stands right now, a defendant can pay hundreds of thousands of dollars in legal fees to defend himself against criminal claims with the only solace being “hey, at least you’re not going to jail.”

Family of 85 year old patient on Coumadin awarded more than $200,000 when radiologist misses a 7mm subdural hematoma after patient fell and hit her head. Emergency physician and hospital were also sued, but were found not liable.

Patients gone wild returns. Florida man refuses to leave emergency department without being fed a meal. When police arrive to escort him out, he whips out his Willy and urinates on the floor. Then he goes to a phone and repeatedly dials 911 to ask for a ride to another hospital. Officer complains because the guy was passing “unbearable” gas when being patted down.

“Permanent hospital residents” costing billions in care because they are illegal immigrants and have no place where they can be discharged. Total cost is several million dollars per year just for one struggling New York hospital.
How should the patients be managed more efficiently? Perhaps being flown to their country’s consulate and dropped off there?
Thanks to DefendUSA for the link.

Teens try to get high overdosing on Coricidin cold medication. Instead end up in hospital. Time for the American Academy of Pediatricians to get out their pitchforks and torches to lobby for removal of another drug from the market. JCAHO would probably be all over it, but unfortunately, the overdoses didn’t occur inside a hospital.

While you’re waiting to see the doctor … would you mind doing chest compressions? Remember last year when Royal Columbian Hospital in British Columbia set up treatment beds in an adjacent coffee shop? This year, overcrowding has forced the same hospital emergency department to set up patient beds in the hospital lobby.
On one hand, I applaud the emergency department staff for having the guts to do what they have to do in order to provide care to patients. On the other hand, what in the heck is wrong with the healthcare system that providers are forced to take such measures?

Are all those rashes that people get when they take medications really “allergies”? This study says that they aren’t. About 25% of the time, the rashes are due to something else. From my experiences, I’d say that 25% is an underestimate.

The government comes up with an updated version of the emergency severity index to determine which patients need immediate care and which do not. Anyone in “severe pain” (can you say “10 out of 10”) or having “emotional outbursts” in triage should be considered for immediate treatment. Does anyone else see a problem with where this is heading?

Texas nurse sues Emerus 24 HR Emergency Room for wrongful discharge after being accused of stealing/diverting drugs from the emergency department and then reporting defamatory information about her to the Texas Board of Nursing.

In Pakistan, one hospital’s emergency department x-ray machine has been broken for 2 months. Patients are upset over the inconvenience of having to go to the outpatient department for x-rays. Oh, by the way, patients have to pay for outpatient x-rays while those obtained in the emergency department are free.

What’s the best medication to treat clostridium difficile colitis? The jury is still out. No antibiotic has been proven superior to the others. However, Flagyl is a heck of a lot cheaper than vancomycin.

Calling all Americans: Blood donations needed. Every two seconds a patient needs a blood transfusion. Pay it forward.

People living in houses near Virginia hospital warned to stay inside after intoxicated patient flees the emergency department. The patient is so dangerous that we have to hide women and children when he’s in public, yet when he gets to the emergency department, staff gets scrutinized if he is restrained and staff gets threatened with job loss if he isn’t satisfied with his visit. Yep, that’s about right.

Medical malpractice reform losing physician support? Give me a break. I work for a hospital. Who in their right mind would suggest I or any other employed physician is any less interested in whether we are named in a frivolous lawsuit? Sure, take my 401k and my house keys. Really. No interest in all. In addition, it seems as if Dr. Kirsch hasn’t heard of the National Practitioner Data Bank.

Some hospitals either close their emergency departments during the holidays, such as these in British Columbia or keep them open with nurses only such as these in Australia.

81 year old Canadian patient has abdominal surgery postponed 4 times in past 18 months. This time, busy emergency department and insufficient ICU beds was cause for cancellation. Wife asks if the government can add a “smidge” more money to hospitals so that sick people can at least have a chance of surviving. But don’t forget – the care is free.

A man after my own heart. And here’s his blog.

18 comments

  1. In the Gummint’s defense, they do make a big deal about severe pain and emotional outbursts requiring CONSIDERATION of immediate treatment. The very next part of the statement talks about how 10/10 toe pain can be triaged as a level 4.

    http://www.ahrq.gov/research/esi/esi3.htm

    That said, the document would be a lot more user-friendly if they’d address the “reported 10/10 pain while laughing, talking on his cell phone, and eating chips” patient.

    • I just foresee the “consideration” of immediate treatment turning into a presumption that the patient should have had immediate treatment unless there is compelling documentation to the contrary. Which will lead to more time writing on the chart. Which will lead to less patient care time. Which will make waits longer. Et cetera, et cetera, and so on.

  2. I am glad you linked to Dr. Doug Farrago’s Authentic Medicine blog at the end of your post. Your blog and his are essential reading that helps me cope with the stuff you both blog about in the practice of medicine. Kindred spirits.

  3. “Who in their right mind would suggest I or any other employed physician is any less interested in whether we are named in a frivolous lawsuit? Sure, take my 401k and my house keys. Really. No interest in all.”

    Who? Anyone with any actual understanding of the risk involved. The only real risk, and even that is remote, is that maybe, possibly, your rates go up if you pay a judgment. Maybe. When you no longer pay those rates, what are you worried about?

    Anyone with any sense knows your 401K can’t be reached and in every state and in bankruptcy homesteads are protected from judgment. So keep your house keys in your pocket, Chicken Little.

    And if it’s truly “frivolous”, as opposed to what tort “reform” is really about – reducing the damages for the legitimate claims, then exactly how worried are you? None of your “reforms” do much to prohibit truly “frivolous” claims.

    So yeah, it makes sense when you’re not even directly paying the premium, you care less about the supposed “crisis”. Perfect sense.

    To think otherwise is like touting loser pays as a cure for malpractice litigation without mentioning that every other country that uses it has universal healthcare. Talk about making little sense.

    • Matt:

      Why isnt legal malpractice held to the same criteria as medical malpractice?

    • Matt …
      Go to http://www.google.com. Type in “NPDB”. Read about it. There’s one other “real risk.” You could have clicked
      Rates go up for being named in suits. Talk to an insurance underwriter once in a while. Another “real risk.”
      Getting dragged through a malpractice suit for 4.5 years (average per NPDB) having to take time off work for depositions, meetings with attorney, etc. when most cases are thrown out/have no merit. Another “real risk.”
      Did you care to inform everyone of all the exceptions to homestead exemptions in bankruptcy cases, there Bernie Madoff?
      http://www.bankruptcyaction.com/bankruptcyexemptions.htm

      Your last three paragraphs are incoherent.
      Tort reform encompasses more than just the caps which seem to bother you so much. The article is about physicians losing interest in medical malpractice reform because they become employed. Not true. Stay on topic for once, will you? Or next are we going to shift to the pros and cons of Herman Cain dropping out of the presidential race?
      Loser pays wouldn’t stop frivolous claims? Oh, wait. That would work, but it would be unfair to the lawyers, er um, patients.
      The negative connotation to the supposed relationship between loser pays and universal health care escapes me, but I’m sure it makes perfect sense to someone somewhere in a land far far away …

      • “Rates go up for being named in suits. ”

        If you pay, say, $10,000 a year for a decade (a number you would surely argue is low). In one year, you’re named in a suit, dismissed before trial. Let’s say your insurer spent $25,000 on it. Your insurer has made, simply on dollar in v. dollar out basis, $75,000. This doesn’t count where the real money is made – on the float. Why exactly should your rate go up?

        Your complaint about the length of malpractice claims should be directed toward your insurer. The plaintiff has little incentive to delay.

        As to the bankruptcy exceptions: http://www.legalconsumer.com/bankruptcy/laws/
        There they are state by state. But you also forget that most states only allow the primary lender to foreclose on a homestead. I realize that’s a distinction you probably don’t get, but that’s what happens when you practice law without any understanding of it.

        “Tort reform encompasses more than just the caps which seem to bother you so much.”

        Really? Show me a legislative proposal where that is not the centerpiece. Please.

        “The article is about physicians losing interest in medical malpractice reform because they become employed. Not true.”

        Not true because you say so? Again, don’t confuse your opinion with facts.

        “Loser pays wouldn’t stop frivolous claims? Oh, wait. That would work, but it would be unfair to the lawyers, er um, patients.”

        You have actually posted articles with surveys from other countries indicating that it in fact doesn’t work like you dream it will.

        And if you really don’t understand how universal care makes all this moot, your grasp of medical economics, and particularly the relationship between insurance, malpractice, and malpractice claims is even weaker than I thought. I didn’t think that was possible.

  4. I am sure you meant to say Bambi-lance,

  5. What’s the best medication to treat clostridium difficile colitis? The jury is still out.

    There’s probably a “best choice” for each individual; unfortunately I’d vote for the Vancomycin. My daughter-in-law only got sicker when they treated, repeatedly, with Flagyl.

    Vancomycin, “GAPS” (or Specific-Carbohydrate) Diet, and Saccharomyces Boulardii. Triple header saved her intestines.

    Fecal transplant seems very successful too. No worries about drug-resistance there!

    • I have told many people with c. diff and with Crohns about Saccharomyces boulardii. Interesting history and discovery.
      Did you know that Saccharomyces cerevisiae antibodies are present in 70% of people with Crohn’s Disease and that it is commonly used as the yeast to ferment beer and baked goods?

  6. IV vancomycin is surprisingly cheap and can be given PO (instead of the prohibitivly expensive oral form of vancomycin. I’ve used it that way one time when a patient could not tolerate flagyl.

  7. The emergency department computer taught us to tell patients, “Quitting smoking is the most important thing you can do to improve your health.” To what extent are doctors required to give this advice, and to what extent does the profession find it acceptable for them to be in business with the tobacco company with respect to how it should be ethically managed?

    • We aren’t “required” to give the advice. There is a federal “quality indicator” regarding smoking cessation that hospitals are judged as being inferior if they do not offer the advice.

      The tobacco companies provide the advice to avoid lawsuits. [Except if you’re Matt. Then they provide the advice to torment their customers or to disable baby bunny rabbits with floppy ears]

      Not sure what you mean by the doctors “being in business” with the tobacco companies.

      • How would you manage the consequential cognitive dissonance? For example, if presenting as a memory block.

      • Tobacco companies “provide” the advice because they’re required by law to do so. They never did it before they were required to do so.

        Maybe you think that’s a bad thing. As a fan of Philip K. Howard, one of the tobacco industry’s chief lobbyists, I guess that’s not surprising.

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