Thursday, December 9, 2004
Unreliable System Fails Doctors and Patients
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" "The Washington Post takes a detailed look at a single medical malpractice case--one that began when Dr. Kevin Kearney of Maryland's Eastern Shore urged an 18-year-old mother to have her baby without a Caesarean section. What followed was a complicated delivery resulting in permanent injuries to the child, and a multi-year legal battle, filled with dramatic moments that illustrate how an unreliable system can fail both doctors and patients." "
[Via MedWatch]
Tuesday, December 7, 2004
Laparoscopy and Ambulatory Surgery Centers in PA
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The Pennsylvania Department of Health sent a letter to all Ambulatory Surgery Centers in Pennsylvania reminding them that they are not to perform laparoscopic surgeries which:
" 'require major or prolonged invasion of body cavities.' "
Noting that:
" 'the risk of injury to abdominal and other internal organs and structures is not lessened. In fact, there are some reports that the risk of injury may be increased. (Peter D. Jacobson, Medical Liability and the Culture of Technology, PEW Project on Medical Liability, released 9/22/04). ' "
My reading of the Pew report turns up no data implicating ambulatory surgery centers (ASC's) specifically in injuries from laparoscopic procedures. Nothing to suggest that eliminating most laparoscopic procedures from ASC's will improve patients safety. In an era when 'evidence based medicine' is the watchword for practitioners, this kind of blanket policy by the government is difficult for me to swallow.
I suspect (though cannot prove) that hospitals have brought political pressure to bear on the Governor and/or Department of Health to make this policy change in order to bring a very profitable class of surgery back to the hospital setting. The facility fees collected for laparoscopic surgery are considerable, and hospitals feel they've been missing out.
Another example to suggest hospitals have been active in this area is the requirement by some payors that orthopedic implant surgeries be performed in hospitals rather than free standing ASC's. For example, we used to perform rotator cuff repairs (which use an anchor suture) in the ASC, but they can no longer be done here because the insurance company will only pay for the anchors if placed in a hospital. There is just no reason I can think of for this requirement other than to force surgeries back into hospitals and away from ASC's.
12/8/04 update: it is on the state servers at: http://app2.health.state.pa.us/commonpoc/content/facilityweb/FacMsgBoardDetails.asp?msgid=819&msgindex=2&Selection=ALL
Friday, December 3, 2004
Legalize It
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Froggy Ruminations an excellent argument for why we should Legalize It:
""I’m talking about completely legalizing it and selling it much in the same way as alcohol. I’m not going to trot out statistics about how alcohol is more harmful to the body than pot because you already know that. Besides, that’s not part of my argument either.
"The enforcement of marijuana smuggling is a massive distraction to the interdiction of really dangerous narcotics like cocaine, methamphetamine, and heroin. Smugglers do not care if a 100 lb. weed load is intercepted at a US Port of Entry. They don’t care because it’s the cost of doing business when your actual goal is to cross 5 lbs of heroin or 20kg of coke. The smugglers send some broke migrant farm worker with a green card across in a stolen car with the promise of $500 dollars if the poor sap actually makes it. But when the dope is spread out all around the car, the dogs are sure to catch it, and even if the dogs are taking a nap, any inspector that’s half awake can see the guy’s hand shaking and the beads of sweat forming on his brow. Right after that guy is sent to Secondary Inspection and all of the attention focused on a load car with unknown contents, 10 carloads of real dope crosses. In my two years working dope cases on the Southwest border, I caught a handful of dope loads containing anything but marijuana. Confidential Informants tell us the tactics that the smugglers use, and it is information from them that accounts for 90% of non-marijuana seizures at the Port.""
[Via Froggy Ruminations]
Friday, November 26, 2004
Common Good Promoting Special Health Courts
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Common Good is planning a brochure for mass distribution to 'advance the concept of a special health court.' I've written about this organization before. Their proposal, which has some pretty big names behind it, calls for the creation of special health courts. Some of the details include:
- Full-time judges
- Neutral experts
- Speedy processing at lower cost
- Schedule for non-economic damages
- Liberalized standard for patient recovery
Common Good is accepting donations (tax deductible) to help with the mass distribution of their brochures.
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Thursday, November 18, 2004
Recommended Adult Immunization Schedule
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From the CDC: QuickGuide: Recommended Adult Immunization Schedule --- United States, October 2004--September 2005. (PDF)
Tuesday, November 16, 2004
Would Specter Be Bad News For Tort Reformers?
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There's (another) good reason for physicians to take an interest in who is appointed Chair of the Senate Judiciary Committee--his record suggests Specter would be bad for tort reform.
"" A brief look at Mr. Specter's record makes that clear. In May of 1995, weeks into the new Republican majority, Mr. Specter tried to derail a product-liability reform bill. He voted against limits on attorney fees for medical liability suits and against limiting punitive damages to three times economic damages (not a hard cap, since economic damages would not be capped).
"Mr. Specter also voted against an amendment to limit non-economic damages to $500,000 and against another to protect OB/GYNs from being sued for problems they didn't cause. Mr. Specter also voted against the final bill. " --Washington Times"
More at NotSpecter.com.
[Via Overlawyered ]
Monday, November 15, 2004
Family Presence--A Really, Really Bad Idea
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There's a movement gaining steam to allow family members of very ill patients to watch resuscitation efforts by the medical team. This Fox News article states: "Better access to information and witnessing for themselves the measures taken, they argue, often help survivors through the grieving process."
I couldn't disagree more. As an anesthesiologist, I frequently find myself in situations where family members want to be present--at cesarean sections, at surgery for their children, etc. I just don't see how being present to witness the invasiveness of a modern 'code' is 'more holistic patient care.' We cram tubes down people throats, stick them with big needles to gain venous access, shock them with lots of electricity. During all of this they are often naked, sometimes vomit and, unfortunately, don't survive a majority of the time. Plus there's frequently chaos. The person 'running the code' is usually a medicine resident whose crisis management skills are, um, developing, shall we say?
Really, really bad idea.
Wednesday, November 10, 2004
Many People Won't Do What They're Told
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The New York Academy of Medicine: News & Publications: Terrorism Response Plans Will Not Protect Many Americans, New Academy Study Finds:
""Called Redefining Readiness: Terrorism Planning Through the Eyes of the Public and funded by the W. K. Kellogg Foundation, this year-long study gave the American people their first opportunity to describe how they would react to two kinds of terrorist attacks: a smallpox outbreak and a dirty bomb explosion. The rigorous study involved in-depth conversations with government and private-sector planners, 14 group discussions with diverse community residents around the country, and a telephone survey of 2,545 randomly selected adults in the continental United States. ""
Bottom Line: only about 40% would actually do as they are told and go to a smallpox vaccination center for fear of a) catching the illness form the crowds there and b) concern over side effects. The public would do worse in dealing with a dirty-bomb (radiation) attack.
[Via The Atlantic Monthly]
Shortage of 200,000 Doctors Predicted in US by 2020
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Annals of Internal Medicine (free): Weighing the Evidence for Expanding Physician Supply
"Summary: "Taken together, this body of information indicates that physician shortages are emerging and that they will probably worsen over the next 2 decades. By 2020 or 2025, the deficit could be as great as 200 000 physicians—20% of the needed workforce..."
...[snip]...
"... the data, forecasts, and signals discussed earlier indicate that physician shortages are upon us and are likely to worsen over time. The picture that emerges is uncomplicated and unambiguous. In simple numeric terms, the number of physicians is no longer keeping up with population growth. The ability to fully service the population is further compromised by the increasing complexity of the care that physicians provide and the decreasing time commitment that many physicians are willing to make. These limitations collide with economic trends that predict a growing demand for physician services. Recruiters, medical leaders, and patients are already experiencing these shortages, and colleagues in other English-speaking countries see a situation in the United States that is all too familiar to them.""
Missing from the article is any mention of 'malpractice', 'tort reform', or 'liability reform'. These issues do effect how long someone chooses to practice and where. If one believes that there's a physician shortage coming, states would be wise to become 'friendlier' to physicians by enacting tort reform in order to insure they remain a viable choice for physicians looking for a place to practice. Of course, Pennsylvania won't be among them, at least not while Ed [trial lawyer] Rendell is governor, as he's already been quoted as saying that malpractice reform is "the next governor's problem."
[Via Medscape]
Thursday, October 28, 2004
NEJM: Health Care Coverage and Drug Costs — The Candidates Speak Out
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The editors asked President George W. Bush and Senator John F. Kerry to respond to two questions regarding health care in the United States. Free full text.
Wednesday, October 27, 2004
Four Myths About Social Security
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Four myths about social security:
- The Pension Myth
- The Transition Cost Myth
- The Baby Boomer Myth
- The Medicare Myth
[Via Marginal Revolution]
Is Kerry Proposing Government Health Care?
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Medpundit opines:
""Any plan that expands Medicaid to include over 50% of the population - which is what the Kerry plan does - is a plan that involves government take-over of the healthcare system. There's just no getting around it.UPDATE: People are asking, "where does Kerry say he's going to put over 50% of the population on Medicaid?" His healthcare plan calls for expanding Medicaid coverage to children families that make up to 300% of the federal poverty level. According to the 2004 Federal Poverty Guidelines, 300% of the federal poverty level for a family of four would be a yearly income of $56,500. And according to the U.S. Census Bureau, the median yearly income in 2003 for family households was $53,991. Assuming that the average family is a family of four, that means that over 50% of families would qualify for Medicaid. And believe me, employers won't foot the bill for healthcare insurance when they know their employees can get Medicaid. So a large segment of the population will be shifted to Medicaid, and that's a government healthcare program.""
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