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Tag Archives: News Commentary

Anna Brown And Appropriate Emergency Medical Care

I’m surprised that this case hasn’t gotten more press. A patient named Anna Brown was unhappy with the care she received at several hospital emergency departments. When she was discharged from the last emergency department, she refused to leave. Police were called and the patient was carried to a police car. She said that she couldn’t walk. Police took her to jail, carried her into the cell and left her laying on the floor. About an hour later, she was still laying there … dead. From the public’s point of view, the case appears outrageous. But as I read through the description of what happened and thought about what could have been done different, from a physician’s point of view, I’m not sure what else could have been done. Christine Byers wrote an excellent article describing events that took place, and then wrote a follow up article in which the hospital defended its care. I’m hoping that the St. Louis Post-Dispatch commends her for her work. She did a great job with the stories. Background A summary taken from Ms. Byers’ article shows that Anna Brown was admitted to the hospital for spraining her ankle while walking near a ditch. EKGs, blood tests, and lab work were performed. Ms. Brown was in the hospital from Sept 13 to Sept 15 and then discharged. She walked on crutches after her discharge.

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Drug Shortages

Just got word that several additional medications have been added to the national list of “drug shortages”. Doctors better start learning more about wilderness medicine at this rate. I can see the management of our next unstable patient now … [Call comes in on telemetry line] “We’re coming to you with a 44 year old male hypotensive and unresponsive. Short transport time.” [15 minutes later, the crew arrives] “Sorry it took so long, our ambulance ran out of gas because we couldn’t afford to fill the tank due to the high gas prices and low Medicare/Medicaid reimbursements. We had to call for assist with transport from the Amish Ambulance Service with its horse and buggy. By the way, do you know where I can get a broom and a very large shovel?” [Patient is hooked up to the monitor. Wide complex bradycardia. Pressure 60/40. Dialysis graft is noticed in his arm.] “Dialysis patient. He may be acidotic and hyperkalemic. Give him an amp of bicarb STAT.” “Sorry doc, we’re out. There’s a national shortage.” “Keep that fluid bolus going. Let’s start some Levophed on him to raise his blood pressure.” “Sorry, doc. We don’t have any of that either. National shortage.” “Well let’s at least give him some Vancomycin in case he’s septic.” “I’d like to, but I can’t. That’s on national shortage, too.” “Well, he’s not responding very well. At least let’s get him intubated. Can someone push some Rocuronium?” “Don’t have that, either. National shortage.” “Vecuronium?” “Nope. That’s out, too.” “Pavulon” “Nope. National shortage.” [patient now loses his pulse] “He’s CODING! Start CPR. Give him an amp of epinephrine, STAT.” “Sorry, doc. National shortage. Don’t have any.” “OoooKayyy. Give him an amp of atropine, then.” “Don’t you know that atropine isn’t part of ACLS protocol any more? Besides, we don’t have any and there’s a national shortage of atropine, too.” [patient is unable to be resuscitated and dies] Six weeks later, the doctor receives a letter from the Arizona State Nursing Board [for those who don’t regularly follow this blog, this is parody — background here] informing him that he is being investigated for failure to properly manage the patient and failure to properly look out for the patient’s best interests, too. He must submit to a psychiatric evaluation, must submit to a genetic test to assess his future intellectual capacity, and must submit to a hearing in front of the whole nursing board to explain himself or else his name will be posted somewhere on the Arizona State Nursing Board’s web site and he will never be allowed to be a nurse in Arizona. “I think I’m going to be sick.” “Hope not. We’re out of Zofran, too. National shortage.” [fade to black] UPDATE Good thing I had extra coffee and some old jumper cables laying around to jolt my heart back into a normal rhythm after seeing the Instalanche! Thanks, Glenn!

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Joanne Doroshow At It Again

Why does the Huffington Post allow Joanne Doroshow to keep posting misinformation? For those of you who didn’t know, Ms. Doroshow is an attorney who is the executive director for New York Law School’s Center for Justice and Democracy. Attorney Doroshow’s latest blog post on HuffPo alleges that medical malpractice caps are an “attack on women” and therefore any Republican who votes for medical malpractice caps is risks alienating himself (or herself) from half of all the voters in the United States. Yeah. Half of Attorney Doroshow’s post cites opinions from others that the Republican party is engaging in “mass misogyny.” When she finally tries to justify her kindergarten logic, Attorney Doroshow quotes University of Buffalo law professor Lucinda Finley, stating that “[C]ertain injuries that happen primarily to women are compensated predominantly or almost exclusively through non-economic loss damages. These injuries include sexual or reproductive harm, pregnancy loss, and sexual assault injuries.” Let’s look at the legal arguments that Attorney Doroshow has adopted. Sexual or reproductive harm happens primarily to women. Is Attorney Doroshow attempting to argue that there are so many fewer lawsuits relating to testicular/prostate cancer, male urologic injuries, testicular torsion, and hernia-related injuries such that malpractice caps would be de facto misogynistic? I notice a deafening lack of statistics to support her assertions. Professor Finley’s article didn’t address the issue, either, but Professor Finley’s article wasn’t limited to medical malpractice caps — it discussed general caps on noneconomic damages. Pregnancy loss happens primarily to women. True. Women are the ones who get pregnant. But is Attorney Doroshow attempting to argue that only one parent is allowed to file a lawsuit on behalf of the child when there is a pregnancy-related loss? As an attorney, what is her legal basis for such a claim? How are malpractice caps on a “pregnancy loss” lawsuit discriminatory toward women? Sexual assault injuries happen primarily to women and are compensated predominantly or almost exclusively through non-economic loss damages. I agree that sexual assault injuries primarily happen to women. However, sexual assault injuries have little to do with medical malpractice caps. Sexual assault is a criminal issue. Often, victims of crimes receive compensation from a Crime Victims Compensation Fund. Caps on medical malpractice have nothing to do with sexual assault injuries – unless the physician is the one assaulting the patient. And even if a physician did sexually assault a patient, the litigation wouldn’t be a “medical malpractice” issue subject to malpractice caps, it would be a civil tort issue where malpractice caps do not apply. As further justification for how noneconomic medical malpractice damage caps are discriminatory toward women, Ms. Doroshow again cites Professor Finley, stating “[J]uries consistently award women more in noneconomic loss damages than men … [A]ny cap on noneconomic loss damages will deprive women of a much greater proportion and amount of a jury award than men.” There is no comment from Attorney Doroshow on why it is acceptable for juries to discriminate against men in awarding noneconomic damages. However, if legislatures take some action that would potentially neutralize the “discrimination,” Attorney Dorshow alleges the action would constitutes a sleight so severe to the female gender as to amount to instant political suicide. That is simple pig pen effluent. I agree that $250,000 caps on noneconomic damages are not fair to patients. I also think that we need to find some middle ground where patients can be fairly compensated for their injuries but where medical providers are not subject to bankruptcy from “super losses“. Joanne Doroshow’s attempts to scare people into opposing H.R. 5 through a campaign of misinformation is ...

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Medicaid Recipients Twice as Likely to be ED Patients

A study just published in the Annals of Emergency Medicine shows something that many people suspected: Patients with Medicaid (i.e. government “insurance”) tend to use the emergency department much more often than patients with private insurance. After studying 230,000 participants in the National Health Interview Survey, the researchers found that Medicaid patients were more than twice as likely to use the emergency department as their privately-insured counterparts. When barriers to timely primary care were added into the picture (including difficulty reaching doctor on telephone, difficulty obtaining timely appointment, long waits in the physician’s office, limited clinic hours, and lack of transportation), emergency department utilization increased significantly. 40% of Medicaid patients had used the emergency department more than once in the prior year. 51% of Medicaid patients with one barrier had more than one ED visit in the prior year and 61% of patients with two or more barriers had more than one ED visit in the prior year. I’m sure that there are other reasons for the higher than normal emergency department utilization, the biggest one being lack of a disincentive for using emergency departments versus primary care physicians. The article concluded that “Expansion of Medicaid eligibility alone may not be sufficient to improve health care access.” Insurance doesn’t equal access. Wonder where I’ve heard that before ….

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Pay Up or Leave

Want non-emergency care in the emergency department? Pay up first. After performing a federally-mandated screening exam, many hospitals are now charging an up-front fee of $100 to $150 to be treated for non-urgent complaints. Don’t want to pay? You’ll get a list of other health care resources and can leave. And it is happening … all … over … the … country. ACEP is against such a policy, arguing that 2 to 7 percent of patients determined to have “nonemergency” conditions are admitted to a hospital within 24 hours and that a vast majority of patients have conditions requiring urgent treatment. I don’t think the policy is a bad idea, provided that patients have an alternative source for routine care. Medical care costs money … a lot of money. The problem is that when the practice becomes commonplace and a public outcry occurs, I can only imagine what new laws that will be created to force hospitals/providers to provide treatment to all emergency department patients.

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Gender Equality in Unnecessary Testing

I admire this lady’s chutzpah. If Virginia wants to make an unnecessary ultrasound necessary before a woman can have an abortion, Virginia Senator Janet Howell wants to make unnecessary rectal exams and stress tests a prerequisite before men can receive Viagra prescriptions. I bookmarked this link from Instapundit which is one of my favorite news aggregator blogs. However, I disagree with Glenn Reynolds’ opinion that the Virginia senator’s rider to the initial bill is “kindergarten payback” and that it is “sad” that Senator Howell is being lauded for her cleverness. OK. Maybe it is kindergarten payback. The bottom line is that the state wants to make an expensive and unnecessary medical procedure a prerequsite to a woman being able to obtain an abortion. The proposed bill stated that the ultrasound is required to determine the gestational age of the fetus. Why? If a woman appears to be past her first trimester or near fetal viability, then I can possibly see the utility in obtaining an ultrasound. But requiring the test on every pregnant patient seeking an abortion? I don’t agree with abortion, and I have harsh feelings toward women who use serial abortions as a form of birth control. However, I still believe that a woman has a right to choose what happens to her body. To me, it seems like the intent of the law is to put an additional financial burden on women seeking an abortion. Can’t pay for the ultrasound? The doctor is prohibited from performing the abortion. Glenn Reynolds stated that “presumably the reason for an ultrasound is to let women see what they’re aborting.” That reason doesn’t meet medical necessity. What other reason would a legislature require a useless medical test in order to have a procedure performed? Eventually, the bill was passed in the Virginia House with a modification requiring that the physician offer to perform an ultrasound prior to performing an abortion. This version has no teeth, but I believe it tees up the matter for further debate in another “addendum” to the law somewhere down the road. The initial bill was just another example of an unfunded mandate and I am one of those that applaud Senator Howell for standing up to it. Now it appears that they could use Senator Howell’s help in Kansas. Lawmakers there are proposing a law that provides malpractice immunity to physicians if they hide information from patients in order to prevent an abortion. The law also forces doctors to tell women that abortions potentially increase the risk of breast cancer. Maybe they can also create an addendum to the law requiring that doctors tell the husbands of pregnant women seeking an abortion that touching their woo-hoo while thinking impure thoughts will grow hair on their palms. Have the legislators been drinking on the job? Utah is probably beyond Senator Howell’s help now. Recently, the Utah Supreme Court ruled that “unborn children” and “minor children” are legally the same for the purposes of wrongful death lawsuits. Great concept. Extending the definition further, under that logic, pregnant women in Utah now need to purchase two plane tickets – one for them and one for their “minor child.” They also need two movie tickets. Ohmigod. What if there are triplets? What if Octomom wanted to board a plane in Utah while she was still pregnant? If pregnant women drink alcohol, using the Utah Supreme Court’s logic, they must be endangering the welfare of a child by force feeding their “minor children” alcohol. If they smoke, they must be breaking federal law by providing cigarettes to minor children. Child protective ...

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