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Tag Archives: News Commentary

Suing Doctors For Patient Addictions

Nevada Senator Tick Segerblom proposes bill that would allow patients addicted to prescription drugs to sue doctors for prescribing the addictive medications and manufacturers for creating the medications. Patients can already sue doctors for prescribing medications if they can prove that writing the prescriptions violated the standard of care and that they have suffered damages as a result. But Tick wants to take the concept a step further. If the patient sues a doctor and wins, the patient should receive payment for rehabilitation, possible punitive damages, and attorney’s fees. It doesn’t matter that “addiction” can be either physical or psychologic and that there is no reliable way to determine when addiction occurs. Tick’s bill doesn’t define addiction. It also doesn’t matter that people can get addicted to pretty much anything … alcohol, illegal drugs, porn, gambling, even collecting Cabbage Patch Kids. Tick’s bill only cares about those evil doctors. Beware internet service providers, you could be next on the list if your subscribers get addicted to the internet. But Tick has good reasons for proposing his bill. Since people lived without drugs before, Pharmacologist Tick doesn’t believe that drugs are the only way to treat pain now. That’s true. Patients in cancer pain could always try incantations and faith healing instead of popping pills. Or patients in pain could bust out some whiskey and a bunch of bullets to bite on … after they take anger management classes so they can purchase the bullets. Oops. That’s Florida. Sorry. Wrong state. Double oops. Alcohol could be addictive. Bad example. Besides, since children are allegedly taught from an early age to do whatever the doctor says, Neuropsychologist Tick says no one has the free choice whether or not to take addictive pain medicines. It’s not so much that, at least according to his Twitter feed, Tick seems just all … well … tickled … about seeing his proposal published in newspapers. The scary thing is that people like Tick Segerblom are elected to public office and may be able to regulate our lives. More comments at Overlawyered.com

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The Nurse Who Denied CPR

I’m in shock about the case where a nurse refused to give CPR to 87 year old Lorraine Bayless in a California senior living facility – a housing setup akin to an apartment complex. Ms. Bayless fell unconscious in the dining room of a senior living facility. Facility members called 911. Ms. Bayless wasn’t breathing and the 911 operator recommended that the facility member perform CPR. The person at the facility would not perform CPR. It took EMTs about 7 minutes to arrive on scene. Ms. Bayless later died from a “massive stroke.” The 7 minute call can be heard HERE in its entirety. A couple of other things made known in the case were that the senior living community did not have any trained medical staff. Remember – the facility was similar to an apartment house. In addition, Ms. Bayless had made known her intentions to “die naturally…without any kind of life-prolonging intervention.” According to the family, Ms. Bayless knew that there were no medical staff when she decided to live at the facility. So why am I in shock? Look at all the whacked out opinions that are being generated from this case. Some people demand criminal charges be filed against the people who wouldn’t help. One person recommends “Depraved Indifference Homicide” Another person notes that if a law says that “you cannot deliberately withhold medical care from a dying person” then ignorance of the law is no excuse for failing to act – applying that hypothetical to this case, of course. Bakersfield California police are looking into whether there was anything criminal and the county Aging and Adult Services Department is determining whether “elder abuse” may have taken place because of the incident. The thing is that if criminal charges were appropriate, then everyone in the dining room of the senior living facility who saw Ms. Bayless collapse would have to be thrown in jail. No one helped her. Let’s just charge everybody with a crime. California can’t pay its bills as it is, so it is unlikely that they will criminally charge a group of elderly patients requiring nursing care and then be required to provide continuing medical care to them. Maybe they’ll all get electronic monitoring bracelets and weekly visits via the wheelchair van to a parole officer, instead. Then the “experts” across the news stations pile on. Virginia Commonwealth professor of geriatrics Dr. Peter Boling stated that without advance directives, patients “wind up sometimes in a very painful and trying situation.” This quote seems to acknowledge that patients may receive unwanted CPR if  there is any question about a patient’s wishes. CBS legal analyst Jack Ford calls the actions “morally reprehensible” but also notes that our society has become much too litigious. Ah, but what about California’s Good Samaritan statute? It exempts people who provide emergency care from liability for civil damages, but it also contains exceptions. Providers have to act in “good faith”. It doesn’t apply to those who are grossly negligent. And it doesn’t apply if the provider is being compensated. Employees of the senior living facility are, by definition, being compensated. So a plaintiff’s attorney may have the ability to circumvent the protections afforded in the Good Samaritan statute just through the “compensation” angle. Other people argued that the 911 operator took all liability for the actions of the nurse. How does such a promise, which is essentially a verbal contract, absolve the nurse from liability when the nurse is the one performing the actions? If a lawsuit was filed, the nurse would still be named regardless of the 911 operator’s ...

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Art Kellermann Rand Rant

One of the posts in my Twitter feed was a re-tweet of something asserted by Dr. Art Kellermann (@ArtKellermannMD). Dr. Kellermann is a distinguished physician. He is the Director and VP of Rand Health. At one point he was a professor at Emory University, but apparently does not practice emergency medicine any more. Dr. Kellermann’s tweet said the following: Dr. Kellermann’s tweet references an editorial article that he wrote in the Annals of Emergency Medicine titled “Waiting Room Medicine: Has It Really Come to This? The article was from 2010, so I’m not sure what prompted him to tweet about it in 2013, but nevertheless, the article at least seemed pertinent … until I read it. The assertion in Dr. Kellermann’s tweet was a quote from his article and was reportedly supported by a 2001 brochure created by the UK Department of Health (.pdf file). The context of Dr. Kellermann’s assertion in the article he wrote is as follows: The ED is more than a clinical setting; it is a “room with a view” of the best and worst of modern health care. In the United Kingdom, a crowded ED is considered a telltale sign of a poorly managed hospital. If that perspective ever takes hold on this side of the Atlantic, things will change. Until then, it is up to us. Things will change if our perspective changes. Until then, change is up to us. What a feel-good nonsensical assertion of nothingness.

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A Physician Tries to Make Sense of Sandy Hook

By Birdstrike M.D.   Since the massacre of innocent school children and those that gave their lives educating and trying to protect them this past Friday at Newtown Connecticut’s Sandy Hook Elementary School, I’ve struggled to make sense of this calamity as much as much as anyone.  As a Physician who has worked to save the lives of sick and injured children, and as a father of children the same age as those massacred in cold blood, I have searched for answers to the questions, “Why?”   “How do we make sure this never happens again?” and “How do I know this won’t happen to my family?”  along with everyone else.  As I’ve read, seen and listened to various explanations and solutions, some better than others, most have rung very hollow.  The arguments and blame fly back and forth, “We need to ban guns,” “We need more guns,” “We need more outpatient mental health treatment,” “We need to re-institutionalize the mentally ill,” and so on.  The more I listen, the less I am convinced that anyone I’ve heard, from the checkout clerk at my local grocery store, to the President of the United States has any real solution to prevent this from happening again, or even make such happenings less frequent. As I dropped my daughter off at school today, and let her get out of the car and walk away from me and out of my sight, I realized that to a certain extent, this was and always has been an act of faith of sorts.  As I’ve thought more and more about this horrible incident, the questions keep coming, but without answers.  I have no good answers to the above questions.  In a nearly post-spiritual world where technology can do practically everything but find answers to the truly important questions in life, I realize there is a word that does perfectly describe this incident, and consolidates all the pain, hurt, chaos, insanity, confusion, murder, blood and tears.  All religion, preaching, atheism, agnosticism and separation of church-and-state arguments aside, the only word I can find that offers any sort of explanation, summary or satisfying consolidation of what we saw last Friday is…..evil. Pure evil. If anyone doubts the existence of true evil, you’ve seen it.  That is the most disturbing and frightening thing about the incident at Newtown’s Sandy Hook Elementary School.  Despite all the good in this world and all the good we may try to achieve with varying levels of success as physicians trying to heal sick and injured children, or trying to protect our own children, we share this world with a certain element of pure unadulterated evil.  Despite all of our necessary efforts to prevent, protect against and deter it, when someone chooses to truly commit an act of pure evil, they can.  When one does so, there is very little any of us can do about it but hurt, mourn the lost, support the living and move forward with acts of good hoping time will offer at the very least, some solace and clarity.  My deepest condolences go out to the victims of this incident, their families and all of those touched in any way.

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Pressure to Admit

We were away for the weekend, but in a restaurant, I caught glimpses of this segment on 60 Minutes called “The Cost of Admission.” Couldn’t hear the conversations in the restaurant, but luckily CBS posted the entire report online. If you didn’t see it, you really need to watch the video and/or read the transcript. In summary, 60 Minutes spent a year investigating irregularities in hospital admissions. Administrators at Health Management Associates and at EMCARE (one of the national emergency medicine contract groups) were accused of putting pressure on emergency physicians to admit at least 20% of patients that came to hospital emergency departments.  For Medicare patients, the “benchmark” for admissions at one hospital was allegedly 50%. The 60 Minutes expose also included spreadsheets showing comparisons of different physicians’ admission practices and text from e-mails saying such things as “I have been told to replace you if your numbers do not improve.” HMA held a conference call disputing the allegations and stating that they “take all allegations regarding compliance very seriously.” HMA allegedly had outside experts review the data (not the medical records?) and the experts determined that “the data simply do not support the allegations.” Now HMA is being investigated by the US Department of Justice for Medicare fraud. I predict that HMA will make a large settlement with the government to drop all charges (without admitting wrongdoing, of course) and that things will return to business as usual shortly thereafter. With things like this, I can’t really blame patients for thinking that medical care is “all about the Benjamins.” Patient satisfaction metrics are creating quite similar incentives with physicians. How long will it be before people wake up and see how much fraud that the satisfaction scores are causing?

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Stretching the Definition of “Quality”

It seems as if some members of the American Academy of Pediatrics have determined that emergency physicians aren’t performing enough useless tests on teenage girls. According to a study presented at this year’s AAP conference, only 19 percent of the 77 million girls between ages 14 and 21 that were examined in emergency departments between 2000 and 2009 received pregnancy testing. Subgroup analysis showed that only 42% of those patients complaining of abdominal pain received pregnancy testing and only 28% of those patients exposed to radiation that could cause birth defects received a pregnancy test. In an American Academy of Pediatrics news release, the researchers, including study author Dr. Monika Goyal, found it “particularly concerning” that rates of pregnancy testing were low even among females with potential reproductive health complaints or with exposure to “potentially teratogenic” radiation (i.e. may cause birth defects) such as chest x-rays or CT scans. First, note how Dr. Goyal and company mention nothing about the indications for performing pregnancy testing in the emergency department. In other words, they’re bashing emergency physicians for failing to order a test when they haven’t even described when the test should be ordered. I’m sure that Dr. Goyal’s study didn’t look at repeat visits or specific patient histories. If they’re reporting on 77 million patient visits, they must be using aggregate data. Another problem with the study is that aggregate data doesn’t take into account all of the instances in which a pregnancy test may not be indicated in a female teen. If the patient had a negative pregnancy test in the doctor’s office two days prior to her current visit, another pregnancy test probably isn’t warranted. If a patient who is known to be pregnant is also having abdominal pain, a pregnancy test is probably a waste of time and money. Patients with epigastric pain or “heartburn” probably don’t need pregnancy tests. Should we get pregnancy tests on every patient with classic UTI symptoms? I don’t. It’s pretty ridiculous to call the lack of pregnancy testing “particularly concerning” without saying what the “concerns” were. Did the researchers find any cases of bad outcomes due to lack of pregnancy testing in the 77 million cases that they reviewed? I’m sure there will be a few, but then a thorough researcher would then analyze thoses cases to determine whether the bad outcome was due to a failure to perform a pregnancy test. This study did nothing of the sort. I was also surprised by the specious logic that patients having a chest x-ray performed should have pregnancy testing performed because chest x-rays “may” cause birth defects. The amount of radiation in a chest x-ray is equivalent to the amount of background atmospheric radiation people experience just being alive for 10 days. It is also equivalent to the amount of radiation that someone taking two roundtrip flights from Washington DC to Los Angeles would absorb. Read more about it on Wikipedia if you’re interested. Calling for more pregnancy testing because chest x-rays may be “teratogenic” is like demanding that all women take a pregnancy test before taking a cross-country flight on an airplane because the increased radiation exposure in the upper atmosphere may be just as “teratogenic.” Whoops. Better not give the TSA any ideas. Another practical issue is that lead aprons block x-ray radiation. Often x-ray techs and/or doctors will just have a potentially pregnant patient put a lead apron over her abdomen while an x-ray is performed rather than obtaining a pregnancy test. Of course such actions would be “particularly concerning” because no pregnancy test was done. In the AAP news release, the ...

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