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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 linksparrow-465x620

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 from Kentucky ACEP’s president is classic: “We’ve given people an ATM card in a town with no ATMs.”
I wish I’d thought of that one.

Emergency department visits increasing at the Indiana University emergency department since implementation of the Unaffordable Insurance Act. One commenter to the article notes “how the hell can you afford health insurance when it is so HIGH, tell the jackass president to pay for it.”
They said it would be different. WHY IS THIS HAPPENING?

Should deaths of patients in emergency department waiting rooms be considered homicides? The author mentions a case in Illinois where then-coroner Richard Keller deemed a patient’s death from a heart attack in an emergency department waiting room as “gross deviations from the standard of care” before labeling the death a homicide.
I agree with Dr. Huser, the thought of labeling a death from medical negligence as “homicide” makes my skin crawl.

Durata Therapeutics creates new vancomycin analog to treat MRSA: Dalvance. Will be once weekly dosing. Pricing yet to be determined, but I’m guessing that it won’t be cheap.
And because the FDA chose to fast-track the approval under the new Generating Antibiotic Incentives Now program, Durata gets an additional 5 years of market exclusivity for the product.

California attorney describes why she believes that California’s ballot measure titled the Patient Safety Act will improve safety and save lives. Once again, beware of unintended consequences.
The attorney uses the unfortunate death of her husband to illustrate how the initiative would improve safety by requiring random drug testing of physicians. By passing the initiative, she asserts that no family would ever have to go through what she did. Only problem with her story was that she said her husband died because a resident punctured her husband’s carotid artery during a procedure – in which puncturing the artery is a known complication. There is no indication that the resident was intoxicated or on drugs when he caused the injury, so the initiative would have no effect on the alleged errors that killed her husband.
And if California has all of the information in its databases about patients receiving too many prescriptions for narcotic pain medications, then why doesn’t the state take action directly against the patients? Why put doctors in the middle if patients are lying to get drugs?
Answer: It’s all about reinforcing a negative image of physicians.

If you’re unwise enough to work as a physician in Florida, make sure that you read up on two uncommon diseases that are posing a “serious threat” to Florida residents (and visitors) — dengue fever and chikungunya virus. The threat of an epidemic is the greatest one entomologist has seen in 30 years and the symptoms can be severe and sometimes life-threatening.
Update shows that a patient in Indiana was just diagnosed with chikungunya after traveling to the Caribbean. Looks like we should all probably get a refresher course on these diseases.
Here’s a CDC reference on dengue and here’s one on chikungunya
My wife laughed at me when I told her that chikungunya was a real disease. She thought I was kidding.

I’m screwed. Sleepless nights increase the amount of amyloid beta protein in the brain – which elevates the risk of Alzheimer’s disease. The theory is that sleep cleanses the brain of amyloid beta overnight.


  1. That Patient Safety Act in California is a ruse to gain voter sympathy. The trial lawyers are backing it, to increase malpractice damage caps from $250,000 to 1.1 million

  2. Ah, but Doc, you’re missing the upside:

    Alzheimer’s helps you forget all those sleepless nights!

  3. So a teen spends five minutes alone with the nurse?!?!? Not the doctor??? IMHO creates mistrust between the patient and the physician. I get teens are more likely to open up without a parent there. But in my experience (albeit a terrible one) a nurse in the doctor’s office is more likely to be biased and dismissive. I wouldn’t allow it unless the nurse was male.

  4. Unaffordable healthcare act –> my two cents

    I work fulltime as a pastry chef for a local restaurant my husband by no fault of his own was laid off hence on unemployment and Yikes was on medicaid…… When my salary increased unaffordable care act felt that I no longer qualify for medicaid and that I should cough up 42% of my earnings for a 5k deductible bronze insurance. As of today we don’t have insurance only our boys do. In our current circumstance its either food, diapers, electricity or healh insurance. Guess what choice we made. The two weeks that my husband and I were on medicaid I had an issue that I needed to see a gp. Nearest gp that took medicaid was an hour drive but the doctor (not surprising) was booked out three months. I was put on a waiting list that I was told to call daily, but unfortunately given my work schedule impossible. Rather then continue suffering I called the nearest gp and threatened to go to the ER that worked (btw adding insult to injury the receptionist and nurse announced what kind of “insurance” I had an embarassing and humbling experience.) I can understand the rise in ER non emergency visits.

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