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Healthcare Updates

Updates 180x100Healthcare Updates is something I created to aggregate healthcare-related news from around the web. I’ll usually throw in some snarky commentary and possibly some tired old cliches to try to make things more interesting.
If you’ve seen an interesting medically-related story, I’d be interested in reading it. E-mail a link to me at whitecoatrants [at] g mail dot com with the words “Healthcare Update Link” in the title. The words “Healthcare Update Link” MUST be in the title of the e-mail because I have set up filters on my e-mail account to help streamline the posting process.

Healthcare Update -- 10-21-2014

More healthcare related news from around the web on my other blog at EP Monthly

Let’s call the first part of this post the

Ebola Chronicles

Treating one Ebola patient would wipe out the ICU in an average-sized hospital and may even bankrupt some smaller facilities. Most states won’t even allow disposal of waste from Ebola patients.

Then there’s the Ebola patient in the US you didn’t know about. Doctor infected with Ebola while working for the WHO in Sierra Leone was treated in Emory Hospital’s biocontainment unit for the past 6 weeks. Now is “well on his way to a full recovery.”

Baylor Medical Center in Texas requires that patients knock on glass door and answer Ebola screening questions before being allowed in emergency department.

Clipboard idiot walking alongside Dallas Ebola patient Amber Vinson and directing people in hazmat suits grabs hazmat trash bag and discards it, then boards the flight — with no hazmat gear. Were he and his clipboard quarantined after touching waste from the Ebola patient? Of course not. The only conclusion we can make from this scenario is that clipboards must prevent Ebola.

Vomiting is now an actionable offense. California’s Southwestern College evacuates and institutes quarantine after student who flew on same airplane as Amber Vinson gets sick and vomits in class

But vomiting and dying … not so much. Patient on Nigeria flight to JFK vomits and dies. Officials give corpse a “cursory” exam, declare he does not have Ebola, then whisk him from the airplane. Nothing to see here, folks. Move along. Move along.

Don’t look now … actress Tori Spelling quarantined in hospital with symptoms of Ebola. Well, she did have a fever and an “uncontrollable” cough, but she was hospitalized for bronchitis.
That reminds me. I have symptoms of Ebola, too. My muscles are sore … after I worked out yesterday.
Just wait until flu season hits.

And finally, the lawyers are already figuring out ways to profit from Ebola, suggesting that hospitals may have liability if they miss a diagnosis of Ebola.

Now back to regular news …

Buying insurance on the Obamacare exchange? Last year’s enrollment period began October 1. This year, you can enroll and find out how much your rates have increased … on November 15, 2014 … after the elections.
This strategic timing can only mean that rates are set to skyrocket. If they were trending downward, the elected officials who voted to pass Obamacare would be using that fact in their campaigns.
Want to see the names of the numbskulls who voted for this abominable law?
Roll call of Senators who voted for Obamacare (a party line vote by Democrats)
Roll call of House members who voted for Obamacare (pretty much a party line vote by Democrats as well)
Did I mention that elections are a couple of weeks away and that many of these people want to be re-elected?

More on the microbiome. Stress and shock may really cause a heart attack – by affecting the bacteria present in arterial walls. The stress hormones released during sudden stress may cause the bacterial biofilm over the arterial walls to dissolve, causing placques within the walls to rupture. In the future, managing bacteria within an arterial plaque (carotid arteries typically have Pseudomonas growing inside) may be just as important as managing a patient’s cholesterol.

What happens to all the kids who are sent from schools to the emergency department for psychiatric evaluations? In 92.2% of cases, they’re sent home, and in half of those cases they aren’t even given psychiatric follow up.
The study notes that only 18% of kids receive any evaluation from a school nurse or social worker before being sent to the emergency department, even though the screening decreases the chance of “unnecessary” ED evaluations by 50%.
Even though the study was done in Europe, I suspect that many of the cases of ED referrals were initiated due to liability concerns. If a child acts out and a teacher disciplines the child, the teacher may be accused of inappropriate actions. The safer and easier approach is to call the police or call the ambulance. Disruptive student is removed from the premises, hassle eliminated, no liabilty for having child evaluated by a professional.

Neat idea for a self-help emergency department kiosk. Hey – they have them in airports and grocery stores. Why not? They are being tried out in New Zealand, but it would be interesting to see whether they would be of benefit in busy US emergency departments. The kiosks collect key data like patients name, date of birth and gender and allow hospitals to check screening questions such as medication allergies and medical history. In addition, the kiosks measure blood pressure, height, weight, heart rate, oxygen saturation, and calculate that useless metric called BMI. It could technically be used to tell patients they need to go see their primary care doctor instead of being in the emergency department as well, but I’m sure someone would get pissed off at the suggestion and break the machine.

The video link of the week is enough to make you yak and make your head itch.
I present you with … a girl with head lice getting her hair combed. Scroll to the end of the video for the retchworthy part.  Just get rid of the comb and get an electric razor, pal.


Healthcare Update -- 10-13-2014

See more medical news from around the web at my other blog at EP Monthly.

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Straight out of Men in Black. UC Davis researchers have discovered that they can erase certain memories in mice by using flashes of light.

China is cracking down on pharmaceutical price fixing. Some company executives received prison sentences of between 2 and 4 years for their actions – although unfortunately those prison sentences were suspended. Government department heads are also being investigated since they are responsible for and must be punished for law violations committed by their subordinates.

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Even the cats were amazed. 18 year old woman who had habit of chewing on her hair goes to doctor with abdominal pain and malnourishment. Rushed to surgery where a 9 pound hairball was removed. Yes, you read that correctly. A nine pound hairball. Like she had a baby Cousin Itt inside of her.

The Limits of Friendship. How many friends can an average person realistically have in their social circle? Based on human brain size … about ….
Oh go on and read the article. The discussion is pretty interesting.

Baylor University Medical Center reportedly at risk of losing all federal funding if it doesn’t submit an acceptable action plan regarding psychiatric patient elopement. CMS inspectors recently found six cases in which psychiatric patients walked away from the hospital’s emergency department before treatment concluded and determined that those “elopements” put patients in “immediate jeopardy” of their health and safety.

The Netherlands has a slightly different way to treat patients with severe psychiatric problems: Euthanization. The rate of death by lethal injection for patients with severe psychiatric problems tripled from 14 cases in 2012 to 42 cases in 2013. Counting “terminal sedation,” euthanasia accounts for one in eight deaths in the Netherlands. But at least the patients in the Netherlands have insurance – just like us.

No more curly fries for me for a while. Woman puts potato in her vagina after being assured by her mother that doing so would be a fail-safe contraceptive method. Turns out mom was right. Guys tend to run the other way when they see roots growing out of your hoo hah. Fortunately, doctors were able to remove the budding spud without surgery.
And if anyone makes any Mr. Potatohead jokes, I’m going to be sick. I just know it.

The hormones from birth control pills found in sewage found to cause feminization of of male minnows. This caused the number of minnows in the Ontario waterways to decrease to 1% of the usual population. As a result, the number of lake trout decreased – lake trout are the minnow’s main predator. Also as a result, the number of insects in the area began increasing – insects are the minnow’s main source of food. When estrogen was removed from the water supplies, all of the changes reversed.
Wait a minute. Obamacare requires that birth control pills be provided at no cost. That must mean that the government wants less fish and more insects in our country.

What effect has the Affordable Care Act had on employment in the US? Mostly negative, according to this paper from the Mercatus Center at George Mason University.
It creates financial incentives for employees to work less. Part time workers receive subsidized coverage, full time workers do not. That equates to about $3000 extra each year that full time workers have to earn just to break even. The effect will be a loss of an additional 4 million full time equivalent workers. Women are more likely to be affected than men.

When antibiotics don’t work for your clostridium difficile infection, there’s always something else you can take: poo pills. Researchers as Massachusetts General Hospital have developed pills made from strained, centrifuged, and frozen human feces. Two days worth of the pills can cure C. difficile infections and are a lot easier to administer than current fecal transplants.

Patients gone wild. West Virginia’s own Misty Crabtree was arrested after she gouges triage nurse’s arm with her fingernails, then tells the nurse that she has hepatitis and hopes that the nurse dies. There goes THAT hospital’s Press Ganey scores.


Healthcare Update -- 09-22-2014

More health care news from around the web on my other blog at EP Monthly.com

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Woman undergoes colonoscopy and biopsied show that she has rectal cancer. She undergoes four operations to remove parts of her rectum. Five months later, the hospital notifies her that her biopsy specimens actually belonged to another patient and that she never had rectal cancer. Now she’s suing.

Five most common presenting complaints at Kings County Hospital emergency department in Brooklyn: Headache, chest pain, pregnancy, limb pain, back pain.

Vaccines are good? Of the 100 or so children who died from influenza last year, 90% did not receive an influenza vaccination.

Vaccines are bad? 15 Syrian children die and another 50 children sickened after “bungled” measles immunizations occur. Medics may have accidentally used a muscle relaxant to reconstitute the powdered measles vaccine.

Archaeologists uncover 700 year old skeletons in England. They were laid to rest holding hands and their fingers were still entwined together when they were found.

Your children belong to US. Parents remove 5 year old son from British hospital after being refused proton beam treatment for his brain cancer. Take child to Spain to continue treatment in addition to obtaining proton beam therapy. Britain then issues an international arrest warrant against parents based on “explicit medical advice” that the child’s “life was in danger.” Interpol picks the family up in Spain’s Materno Infantile Hospital.

North Carolina’s Fayetteville VA Medical Center converting to an urgent care clinic because the company with which it contracted “failed to staff the emergency department with “an adequate number of well-trained physicians.” Veterans at the facility have reported that there was no medical officer on duty at the facility and that there have been long waits in the emergency departments. And … taking a play from George Bush’s playbook … many veterans were told to just “go to the emergency department” for their health care while they were waiting months for their appointments with primary care physicians.
One 69 year old veteran who was having heart palpitations with a rate in the 150s went to the VA emergency department at 3:30 PM and learned that there was no doctor there to evaluate or treat him. The put him into a monitored bed and left him there until a doctor could see him.
The veteran and his wife were “scared by the lack of care” they received. Let that quote sink in for a second. They have insurance yet they were scared because had no medical care. Another example of how medical insurance doesn’t mean a thing if you don’t have the medical providers willing to provide medical care in exchange for the insurance.
More importantly, the couple noted that nurses in the emergency department were “turning many veterans away and telling many to return at 8 p.m., when a doctor would be on duty.”
If true, the Fayetteville VA Medical Center is violating federal EMTALA requirements. If a patient comes to an emergency department seeking medical care, the patient must receive a medical screening examination to determine whether an emergency medical condition exists.
I won’t hold my breath waiting for news of the investigation of these incidents.

Chinese patients increasingly violent when they are unhappy with the treatment from their doctors.
In September, 2011, a calligrapher in Beijing, dissatisfied with his throat-cancer treatment, stabbed a doctor seventeen times. In May, 2012, a woman attacked a young nurse in Nanjing with a knife because of complications from an operation performed sixteen years earlier. In a two-week period this February, angry patients paralyzed a nurse in Nanjing, cut the throat of a doctor in Hebei, and beat a Heilongjiang doctor to death with a lead pipe. A survey by the China Hospital Management Association found that violence against medical personnel rose an average of twenty-three per cent each year between 2002 and 2012. By then, Chinese hospitals were reporting an average of twenty-seven attacks a year, per hospital.
Hat tip to Overlawyered.com

Ultrasound as good as CT for suspected kidney stones?

More on the microbiome. Drinking diet sodas may cause diabetes … by altering the bacterial flora in your gut. I’m not paying $32 to download the study from Nature, but according to the abstract, the researchers show how there is a link between artificial sweeteners, altered gut flora, and metabolic abnormalities.

I missed this little spat when it first came out. National Nurses United erects billboards in Mississippi and Tennessee regarding the high prices charged at Community Health Systems hospitals. Billboards promptly taken down after “complaints”. But the message remains. at CHS’ Biloxi Regional Hospital, charges are set at $674 for every $100 of its total costs, making it the sixth priciest hospital in Mississippi. Nine of the 10 most expensive hospitals in Mississippi are affiliated with either CHS or Florida’s Hospital Management Associates. The co-president of National Nurses United asks “If CHS believes such high charges, and its aggressive collection strategy is justified, why does it want to prevent the public from knowing about its behavior?” I don’t suppose that the disagreement would have anything to do with the fact that NNU is a union trying to get more members from CHS hospitals.
Even so … if statistics are true, I agree with the NNU. As Louis Brandeis once said, “Publicity is justly commended as a remedy for social and industrial diseases. Sunlight is said to be the best of disinfectants; electric light the most efficient policeman.
Biloxi Regional Hospital Price Gouging


Healthcare Update -- 09-12-2014

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40 year old father/husband went to emergency department two days after feeling nauseous when he ate breakfast. Reportedly had cardiac symptoms, including chest pain. Was in the emergency department 4-5 hours, during which time no cardiac enzymes were ever ordered, and then released. Two days later, clutches his chest and dies from heart attack. Jury awards family $4 million.

Good news: Chinese researchers discover new way to kill cancer cells by injecting the metal gallium into the arteries supplying the tumors.
Bad news: In rabbit studies, the metal somehow finds its way into the heart and lungs and forms deposits there.

$62 million medical malpractice award to patient who goes to Winthrop University Hospital for endoscopic removal of an ectopic pregnancy, developed complications from an unnoticed bowel perforation, then developed sepsis that eventually required amputation of both legs. In addition, the high doses of antibiotics she was receiving caused her to lose her hearing.
When a front page story about the patient ran in the newspapers during trial, the hospital’s attorneys requested a mistrial, stating that the plaintiff “should be thankful the doctors were able to save her life.” Not really a good argument to use.
In the end, the plaintiff and her attorney were happy that “justice was served” and someone in the comment section to the article suggests that everyone “remember this case the next time you find yourself asking why a Tylenol in the ER costs you 30 bucks.”

Ohio jury awards patient and husband $1.2 million when patient had persistent pain after undergoing partial hysterectomy and physician didn’t order CT scan to diagnose perforated bowel until the patient was “critically ill.” By the time the complication had been diagnosed, she had developed respiratory distress syndrome and now requires a walker to help her walk.

Remember how the government is making elderly patients pay for more care when they’re admitted as “observation” versus fully admitted? Then they came up with the “two midnight” rule, where providers had to predict whether a patient would need to stay in the hospital for two midnights – and then sign an attestation to that effect. The government won’t give “prior authorizations” for admissions, so providers are left to guess whether the government will retrospectively consider an admission appropriate, and anything deemed as “unnecessary” care is considered fraudulent when the government is billed for it. End result? Community Hospital Systems pays $98 million to settle false claims allegations.
“The United States alleged that from 2005 through 2010, CHS engaged in a deliberate corporate-driven scheme to increase inpatient admissions of Medicare, Medicaid and the Department of Defense’s (DOD) TRICARE program beneficiaries over the age of 65 who originally presented to the emergency departments at 119 CHS hospitals. The government further alleged that the inpatient admission of these beneficiaries was not medically necessary, and that the care needed by, and provided to, these beneficiaries should have been provided in a less costly outpatient or observation setting.”
Several emergency physicians and emergency nurses were “whistleblowers” in the case.
When a hospital wants to admit you as an “observation” status, keep criminal investigations and settlements like this in mind.
One US Attorney was quoted as saying “We will not allow this type of misconduct to compromise the integrity of our health care system.” Widespread fraud in the VA causing death and disability to our veterans? Who cares? Fraud and waste in creating the healthcare.gov site? No problem. Fail to have a crystal ball to determine how long a patient will need to be admitted? Hey! THAT’s not allowed!

Kanye West experiences “excruciating” migraine after playing basketball before a show in Australia and rushes to the emergency department for treatment. One of my son’s friends thinks he was just losing at his basketball game.

Some plaintiff attorneys pretend that “defensive medicine” doesn’t exist and is some creation of [insert the group you want to demonize here - insurance companies/hospitals/attorneys/physicians] to fleece the patients. What about “defensive lawyering”?
“In defensive lawyering, a list is developed of every document having even marginal relevance, every witness who might know something about a subject and every interrogatory that can be propounded. Lawyers practicing defensively live in mortal fear of the smoking gun buried in the pile of documents or the mystery witness who appears out of nowhere to sink our client’s case.”

Both sides preparing for battle as they take positions on California’s Proposition 46 ballot vote to quadruple limits on noneconomic damages in medical malpractice cases and to require drug and alcohol testing of physicians. This article by a local city council member notes that in voter guide information, attorneys are trying to downplay the increase in damages and the benefit it would have to the malpractice attorneys. The article also notes that many parts of the state already have physician shortages and that passing the proposition would likely worsen those shortages.
“Paving the way for more malpractice lawsuits is not a way to improve health care coverage nor will it help slow the rapidly growing cost of health insurance premiums. But it will certainly be good for the lawyers behind Prop. 46. Unfortunately, getting this message to the voters will surely be more difficult due to some deceptive official voter guide information.”
We can’t sue our way to better health care.

Dog waits outside emergency department as elderly owner undergoing surgical procedure. A lot of people commenting on these pictures express disgust that a dog would be allowed inside of a hospital. On one hand, I suppose there would be a risk of contamination from the animal, but I’m not sure that risk has ever been proven. On the other hand, it would light up my day to see my dogs there with my family if I was in a hospital recuperating from surgery.

Instapundit posts a link regarding how health care costs are taking a bigger bite out of Americans’ budgets, asking “How’s that Hopey-Changey stuff workin’ out for ya?” The commenters to the articles are full of insight. One of my favorites is from a commenter named Carl who initially noted that a large percentage of health care costs are in response to government regulations and liability protection and then stated “the parasites [referring to the government] all think the host should get much more efficient at using what little blood is left to it — so there’s more for them!


Healthcare Update -- 07-28-2014

Patients with “insurance” wonder why they can’t find access to medical care? Here’s a good example of why: Wisconsin pays a pittance to those who care for its Medicaid patients. As in 71% lower for office visits than private insurance payment rates, 76% to 78% lower for hospital care than private insurance rates, and 91% lower for emergency care than private insurance rates. According to the article:

One result of Medicaid’s low payment rates for physicians is a shortage of primary care clinics in low-income neighborhoods in Milwaukee.
That contributes to many people seeking care in high-cost hospital emergency departments. Wheaton Franciscan-St. Joseph estimates that roughly half of the patients in its emergency department — the busiest in the state — could be treated elsewhere.

Letter to the editor about the article from an emergency physician notes that the abysmal payment rates make it difficult to recruit and maintain emergency physicians in Wisconsin.

Oregon hospital notes “record breaking” increases in emergency department visits after Obamacare implemented. Average daily patient volumes in the 60s increased to the mid-70s with some spikes up to 100 patients per day. Wait times also increasing.

BMJ investigation shows that drug manufacturer Boehringer Ingelheim reportedly hid data from regulators regarding safety of Pradaxa [dabigatran].

Some Life Pro Tips from Reddit contributors on how to speak to people who have hearing impairment. Not scientific, but I’ve found that I tend to speak slower and enunciate each word when a patient initially says that he or she cannot hear me. After going back and forth once or twice, I’m usually able to speak in a normal or near-normal voice. Any ENT experts care to chime in? Slowly, of course.
And for all you young whippersnappers out there, here are two related sitcom videos related to auditory issues from Monty Python and Taxi.

More on the $190 million Johns Hopkins settlement after gynecologist found to have taken secret pictures of up to 8000 patients. Hopkins joined an insurance collective with other universities such as Yale, Cornell, Columbia, and the University of Rochester. Now money will be coming out of the pockets of several institutions that had nothing to do with the Hopkins incidents.

Recently-published CDC study based on 2012 data shows that children covered by Medicaid use the emergency departments at a rate nearly double that of patients with private insurance.

Pregnant California woman in labor is unable to cross street to get into hospital for 30 minutes because President Obama’s motorcade was passing through at the time.

Pakistani town organizes protest of 100 people calling for a doctor to be arrested when patient under doctor’s care dies of stroke. Protestors laid patient’s body in road in front of the clinic and initially refuse to leave.

Philadelphia psychiatrist pulls out gun and shoots armed patient who had just shot his case worker. Police admit that the doctor’s actions stopped the patient from going on a rampage and killing others, but police are also “investigating” why the doctor had a gun at work since “bringing guns to work is against the rules at the hospital.”
Those “no gun” zones work so well. Obviously the patient in the incident was playing close attention to the rules. And Chicago is a shining example of how properly implemented gun-free zones save lives.

You know all those fitness wristbands and fitness apps for your phone? They’re a gold mine for advertisers and identity thieves.

Almost 75% of the apps studied sent data to third parties; nearly half shared personal information with advertisers — all without the user’s knowledge. Another analysis found that the top 20 health-related apps transmitted information to as many as 70 third-party organizations.

And the article notes that since the application makers aren’t “covered entities” under HIPAA laws, there is no protection of the information collected in the applications. Your weight, medical problems, and any other information you allow the apps to harvest could be posted anywhere in the universe and you have no say about it once you opt in.


Healthcare Update -- 07-18-2014

More patients gone wild. Texas woman gets trip to the hoosegow after running a red light and colliding with another vehicle, then attacking the emergency department nurse who was trying to help her.

Adding pelvic exercises to a workout may help men as much as it helps women. Kegel exercises for men *may* improve incontinence and erectile dysfunction, and one company actually created a little weight lifting system that fits over the male genitalia. Gives new meaning to the phrase “pump you up.”

Not to be outdone, you can also see this article on weight training with a women’s genitalia using a jade egg. Who wouldn’t want a pelvic floor like a trampoline? Then again, just reading the article makes me think about getting one of these things for Mrs. WhiteCoat.
Hat tip to Instapundit for the link

North Carolina patient with chronic pain experiences an increase in pain for 2-3 weeks then waits until 3PM on a Friday afternoon to seek medical care in the emergency department rather than seeing their primary care physician in the prior 14-21 days. Given two pain shots and a prescription for pain medications but wife is still upset because he “was not adequately treated for his episode of pain,” so she writes letter to the editor of the newspaper.

Speaking about chronic pain … Salix gets approval for its new drug Relistor for treatment of chronic pain in non-cancer patients. Initially approved for opioid induced constipation and is an isomer of the drug naltrexone which is used to treat alcohol dependence and occasionally used to treat opioid dependence.

California’s Grant Union High School in the midst of a tuberculosis outbreak. 116 of 450 students and staff have latent TB while 5 students developed active TB including one who spread the disease to some family members.

New Jersey’s University Hospital cuts emergency department beds and opens “observation unit” to ease emergency department overcrowding. Kind of interesting how state hospitals work that numbers game. Will be interesting to see how much crowding increases in both the ED and the observation unit.

Naval Hospital Bremerton closing its emergency department and ICU and opening an urgent care facility

April 15, 2014 article in Huffington Post by Alexander Kjerulf titled “Top 5 Reasons Why ‘The Customer Is Always Right’ Is Wrong.”
Companies that exhibit this attitude create unhappy employees: “You can’t treat your employees like serfs. You have to value them … If they think that you won’t support them when a customer is out of line, even the smallest problem can cause resentment.”
The “customer is always right” sentiment also creates perverse incentives where “abusive people get better treatment and conditions than nice people.”
When companies enforce this culture, employees feel less valued, feel as if they have no right to respect, and gradually learn to provide “fake” good service where the courtesy is “on the surface only.” One expert noted that “when you put the employees first, they put the customers first.”
The article ends by noting
The fact is that some customers are just plain wrong, that businesses are better of without them, and that managers siding with unreasonable customers over employees is a very bad idea, that results in worse customer service.

FDA trying to regulate tweets. Maybe it should spend more time reviewing the safety profile of drugs so that it doesn’t recall medications for safety concerns after it has approved them for 30+ years … not that something like that would ever happen. Twice. Or more.
Oh, and by the way. Stare at my avatar for 30 seconds 3-4 times per day. I’ve created a pixel pattern so that doing so over the course of several weeks will significantly improve hydrangopenic neurolitis. If you do notice improvement, please send a PayPal payment to my e-mail address. Nice doing business with you!


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