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Healthcare Update — 08-21-2013

Also check out more updates at my other blog on EPMonthly.com

Nevada Medical Board files a complaint against a Las Vegas doctor … for the actions of a physician’s assistant. That’s right. The PA was allegedly prescribing “unnecessary” drugs and in one instance allegedly prescribed excessive thyroid hormone to a patient. The PA also gave patients expired medications. The PA lost her license to dispense medication. However, the doctor’s medical license is now in jeopardy. The doctor allegedly wasn’t supervising the PA closely enough to prevent the PA from performing these dastardly deeds. In Nevada, doctors must “ensure strict compliance” that the physician’s assistant complies with the rules of the pharmacy board.”
Watch how the tides begin to turn with liability for the actions of PAs and NPs.

Missouri medical malpractice plaintiff attorney complains about the “conspiracy of silence” where he has difficulty finding experts to testify in medical malpractice trials and he has to travel to all parts of the country to find such experts at academic medical centers.
Sure. Conspiracy. Right. All us doctors have a secret medical school course where we all agree never to testify about the wrongdoing of another doctor.
Would be interesting to see how many times Bob Buckley has testified in legal malpractice cases against other attorneys. My guess is that the number is a hypocritical “zero.”

Which specialties are sued the most? This Medscape study says that it is Internal Medicine. Fleas are not even close to being the top sued specialty — according to multiple other studies.
Interesting answers to some questions, though.
74% of docs were surprised to be sued.
One in five cases went to trial.
45% of cases were resolved after a deposition – in 27% the suit was settled and in 18% the suit was dismissed. Deposition preparation is CRITICAL

Nice study in Annals showing that just observing a child in the emergency department will decrease the rate of CT scans without decreasing the incidence of diagnosing significant traumatic brain injuries. How that long wait during observation and the unwillingness of the doctor to do a test to make sure one’s baby is OK will affect Press Ganey scores is another issue.

Affinity Health Plan (in New York State) agrees to $1.2 million settlement with Feds for HIPAA violation when it returned copiers to a leasing agent. The health plan forgot (or didn’t realize) that the copiers had a hard drive inside and had copies of all the patient information that had been copied.

Shasta Regional Medical Center (California) pays Feds $275,000 after senior management sent an e-mail to the entire hospital workforce regarding a patient’s diagnosis and treatment, then met with media to discuss the case, “disclosing PHI to multiple media outlets on at least three separate occasions, without a valid written authorization.”
The nice HHS summary fails to give everyone the whole story, though.
According to this LA Times article, another newspaper published a story about patient Darlene Courtois, alleging that the hospital was overbilling Medicare for the patient’s treatment. The hospital was attempting to defend itself from these potentially criminal allegations when it disseminated the patient’s information. Implicit in the back story is that Darlene Courtois released some of her health records to the newspaper with the intent of making that information public so that it could create its news story.
How crazy is it when patients, newspapers, and/or the government can accuse you of criminal acts in performing your trade and then accuse you of criminal acts for disclosing information to try to defend yourself?

Pushing the envelope. Orlando FLORIDA abortion clinic giving out coupons to save $50 when woman chooses to have an abortion on Sundays. One coupon per patient, of course.

I don’t watch much TV, but now the latest fad is “Bizarre ER”? Really? Isn’t reading the medical blogs enough?

Lower costs or higher radiation?
Study in the Journal of the American College of Cardiology shows that use of CT angiography in triaging chest pain patients from the ED reduces admissions from 40% to 14%, reduces incidence of patients returning to the ED within 30 days by 80%, and decreases the length of stay in the ED by 40%.
But it is one of those unnecessary radiologic tests that we probably shouldn’t be ordering because of the high radiation doses.

A new product was presented to our emergency department … the DisImpactor. A plastic instrument with soft barbs on the end that gets pushed into the stool impaction and then used to pull out the impaction like little Jack Horner pulling out a plum.
The problem I often see in treating patients with an impaction is that the large hard stool bolus has to be broken up in order to make it out through the rectum. Think a hard chunk of modeling clay in consistency. Hooking onto the big one and then trying to yank it out through a small hole intuitively doesn’t seem like it will work.
Novel idea, but I’d have to see this thing in action before I even think about using it.

6 comments

  1. Are you honestly arguing that physicians are forthcoming in testifying and willing to do so even when they believe there is malpractice?

    I don’t know that it’s an organized conspiracy so much, but we all have those “there but for the grace of God go I” moments in our professions. It’s ok to admit that yes, you’re reluctant to testify, unless we’re talking about someone performing surgery while drunk or something like that.

    • Tragically, too many physicians are willing to sell their opinions, and souls, to the highest bidding plaintiffs attorney even when there was no malpractice. This makes your job much easier.

      • And the defense experts do it out of the goodness of their hearts of course. I bet they don’t even charge. Because any time a physician or their insurer doesn’t pay a claim it’s only because the claim has no merit.

        What world do you live in?

    • It’s well known in both sociological and legal circles that members of a group don’t testify against other members of the same group, whether the subset is doctors, lawyers, judges, cops, or plumbers. Nobody likes being a Monday morning quarterback, not last of which because they don’t want their actions to be sharpshot by another Monday morning quarterback.

      Anyone who truthfully claims not to be aware of that documented human phenomenon and is a lawyer is an idiot (but I repeat myself), and anyone who makes the claim falsely with the pretense of obtaining sympathy deserves false sympathy as a quid pro quo.

      All the lawyer jokes in the world fail to live up to the reality of the profession as demonstraed by its practitioners for anything over 4 seconds’ careful examination. The plural of anecdotes isn’t data, but something isn’t a stereotype when it’s true.

  2. Could someone please expand on the comment after the first story? Did you mean to say that more liability will shift from PAs to docs? I don’t get it.

  3. A PA is supposed to work under the direct supervision of a doctor. The liability always was the doctor’s from what I understand. I come from a rural area where doctors are hard to find. There isn’t a hospital in the county, only 2 stop lights as a matter of fact. Statistically the county has a very low birth and death rate (no hospital). The local clinic operates with a few doctors and PAs. Because the area does not have a lot to offer doctors(and spouses) in way of social mobility and it is also poor, the quality of drs suffer and the work loads are great. I don’t think the PAs are supervised very closely. My aunt was being treated for diabetes by the PA, and after a few years, demanded to see the dr. He immediately put her on insulin because she needed it, and is doing much better. He was the dr. that supervised the PA.

    As far as lawyers, The whole health care act was a bunch of lawyers telling another profession how to do their jobs. Lawyers are the biggest bullies in the market.

    Aesop is correct in that no one wants to testify againt someone in their profession. It isn’t just doctors. I don’t like to do business with someone who bad mouths a competitor.

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