Home / Healthcare Updates / Healthcare Update — 10-10-2011

Healthcare Update — 10-10-2011

More news at the Satellite Edition of this week’s update over at ER Stories.net.

Admitted drug dealer (who is currently in prison) sues physician (also in prison) for $43 million because the physician prescribed patient the drugs he sold and “caused” patient’s addiction.

Australian patient with shortness of breath and who was “vomiting black stuff” was too big to fit in CT scanner and cannot undergo necessary testing. Later, patient dies from GI hemorrhage.

You have “insurance”? Too bad, you still can’t get care at this hospital, and maybe some others, too. Bayonne Medical Center in New Jersey enters into agreement with Blue Cross Blue Shield that included requirement that it does not accept NJ Health – New Jersey’s Medicaid provider. Agreement may extend to Hoboken University Medical Center once Bayonne group assumes that hospital’s ownership. Meanwhile, if New Jersey hospitals shun Medicaid, state senator Joe Vitale threatens legislation to force all hospitals to take Medicaid.
We should really question the motives of a state or of a state representative who wants to reimburse providers less than the cost of care for providing services and then considers forcing businesses to continue providing those services at a loss. Creating a law that forces companies to engage in an inherently unsustainable business model, Senator? Really?

Same thing is happening in California. Cut payments to Medicaid providers and force the providers to caring for patients at their own cost. This LA Times editorial advocates suing the state to prevent it from cutting payments to providers.

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Now get ready for your federal health “insurance”. Notice how no one is talking about providing medical care to the American public? Everyone just focuses on “insurance” which can be limited, reduced, or withdrawn. Then, when governments make insurance payments so pitiful that no reasonable provider would taken them, the governments paint the providers as “greedy.”
Kind of like calling employees “greedy” for wanting to be paid a minimum wage.

Ooops. Portsmouth Regional Hospital in New Hampshire says that it only meant to charge patient $380 for that antibiotic that was inappropriately prescribed to her and that isn’t much better than several antibiotics on WalMart’s $4 list, not the $1900 that it billed her and that it wouldn’t answer her questions about until she contacted a newspaper.

Girlvet demonstrates how to reduce emergency department care to mathematical equations. For example, “Xanax + ETOH + Lexus +75 mph = airborne driver + multiple fractures”.
Any others we need to know about?

Study of 120,000 patients with migraine headaches shows that 20% of patients with migraines and heart problems were inappropriately prescribed triptans such as Imitrex or Maxalt to treat the headaches. The theory is that triptans constrict blood vessels and that in patients who have heart disease, constricting the blood vessels could precipitate an ischemic event. What the study didn’t show is how many patients actually had a bad outcome from receiving triptans. In other words, are the concerns about giving triptans to cardiac patients justified?
The large study was funded by Merck.
Oh, did I mention that during the above study, Merck had been developing a new drug for migraine headaches called telcagepant that was supposed to be an alternative to triptans? Merck discontinued development of the drug a few months ago (after study data had been collected) when it was determined that the drug caused an elevation in liver enzymes.

Walgreens and ExpressScripts fighting over reimbursement. Now Walgreens decides to take its ball and go home. As of January 1, 2012, Walgreens will no longer fill prescriptions for Anthem Blue Cross.
In other news, Anthem Blue Cross plans to assemble armed vigilantes to attack Walgreens stores … since it knows that Walgreens won’t let its employees fight back and won’t support its employees when they try to protect themselves.

Hospital system ordered to pay $25 million verdict after failing to recognize and report child abuse in a child with two broken bones in his arm. Child brought back to the emergency department unconscious 3 months later with skull fracture and permanent brain damage. Jury awards child $20 million and father $5 million.

Chicken or egg? Study shows that “worst” hospitals in nation treat twice as many poor patients and elderly black patients as “best” hospitals in nation. These “good/bad” ratings will soon affect reimbursement, with “bad” hospitals getting cuts in Medicare payments.
My question is: Are “bad” hospitals “bad” because they just have lousy medical staff or are “bad” hospitals “bad” because they accept more patients who can’t afford their medications, who have no medical follow up, and who therefore have more advanced medical disease, thereby skewing their statistics because the patients are more likely to have bad outcomes and require longer hospitalizations to get better?
And I still don’t see any comparisons between care at VA hospitals and care at any other hospital in the nation. Shouldn’t it tell you something when the government is too embarrassed to publish data about how it fares in meeting its own benchmarks?
This is the problem with statistics and how the government is going to slowly cripple health care in this country in order to save money. Pay progressively less to the smaller hospitals who care for poor patients, force them to go bankrupt, then force the poor patients to go to county hospitals which will ration care based on availability. Fewer patients have access to timely care, more sick patients die, less money spent on caring for them.

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11 comments

  1. I can imagine the child abuse situation happening. The child was seen in the ER and noted to have a rad/uln fx (I probably see one per shift). Set in the OR (for whatever reason) and CXR taken either in the OR or in recovery. Child being cared for by Ortho (not Peds, who are usually but not always more aware of potential child abuse issues) and they either don’t notice the report about an old fracture OR read the prelim report which doesn’t include anything about the fracture and no one sees the official report as the Pt has already been discharged. Had the Pt been officially admitted and/or on the Pediatric service, someone MAY have been more diligent. But that is by no means a forgone conclusion.

  2. In “Modern Healthcare” magazine there was recently published a list of the top 20 hospitals with the highest readmission rates for CHF. There were at least two or three VA Hospitals on that list.

    • Be vary careful of those ratings. The easiest way to have the best rating is to not report data. If you truly report data, you will be on the bottom. My favorite is the “List of the Best 100 heart hospitals” That you see on road signs. As of last count, there were over 300 hospitals that were in the best “100 heart hospitals.”

  3. Just how heavy do you have to be to not fit “the largest capacity scanner available”?

    Even for those cases, I thought there were even larger scanners available at veterinary hospitals, intended for equines and bovines.

    • Then you get sued for not providing standard of care. Vet scanners are for animals of course!

      • We had a case where there was a bad auto accident on the itnerstate. The Medivac helo was called. Enroute the EMTS called and asked what was load carrying capacity of the helo? They flight crew responded that they could take two patients. The EMTs recalled and asked “what was the weight carrying capacity? End result, patient came in on the back of the ladder truck.

    • Not allowed to take people to vet scanners anymore, it’s not PC. In any case, this patient would have been far too unstable to remove from a hospital to go and use vetinary equipment, if the place where this happened even had a vet clinic with those facilities.

      • Veterinary medicine is such a small market that there is no such thing as a large animal scanner; the gantry used for horses is rated for a higher load but the scanner itself is a human scanner. We vet students and our clinicians would love it if we could stick horses with GI pathology in a CT scanner. The only parts of a horse that you can fit inside the CT scanner are the distal limbs and the head/cranial section of the neck, with the extent of visualization dependent in part on the size of the horse.

        For those interested, in the case of the acute abdomen in the horse, workup usually consists of H+P, rectal palpation, CBC/Chem/electrolytes/lactate, nasogastric intubation, a plain lateral abdominal radiograph, ultrasonography, and abdominocentesis with cytology +/- glucose and lactate. In the case of incomplete information, which is not uncommon, you do an ex-lap or you treat based on what information you do have, based on current information and differential, stability of the patient, finances, and logistics. Endoscopy is used to diagnose gastric and proximal duodenal ulcers but usually after the patient has become more comfortable with supportive care (acute GI bleeds are extremely rare in horses and they usually just present with discomfort).

        – a vet student

      • Like the man said, there is more to be learnt up a cow’s arse than in many an encyclopedia!

  4. The Aussie story is weird, anyway. Since when is a GI bleed diagnosed on CT anyway ? Sure, I get the provisional diagnosis of ? cholecystitis, and CT or U/S to confirm, but a GI bleed producing death produces deteriorating vitals, melena etc etc not in keeping even with sepsis in the setting of cholecytitis. Probably needed a rectal exam for melena instead of a CT…

  5. I’ve commented on Oak Forest Hospital in the past. OFH was a county hospital that was in the same county as Cook County Hospital (the hospital on which the TV show “ER” was based). We would VERY often receive transfers from Cook who died within hours – if that – of arrival, patients who were WAY too sick to be transferred. But they died in OFH’s hands, not Cook County’s.

    And OFH is now closed.

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