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28 February, 2009

Australia: Deadbeat State government hospitals

The Auditor-General has damned the financial management of the NSW health system, saying area health services had failed to pay bills on time and had routinely misused trust funds. Peter Achterstraat said the financial audits for 2007-08, which were made public yesterday, showed that some health services had classed bills as "in dispute" to buy time because they did not have the funds to pay small businesses.

His report noted that health services had dipped into trust accounts to pay bills and wages and the worst offender was Northern Sydney and Central Coast, which had 1000 trust accounts that were $9.9 million overdrawn in November 2007. The overdraft coincided with desperate attempts by the former health minister Reba Meagher to improve operations at Royal North Shore Hospital after a patient, Jana Horska, miscarried in a hospital toilet. The incident became the subject of a parliamentary inquiry.

Mr Achterstraat said bills totalling $312 million were outstanding at June 2008, and $75 million of that was more than 45 days overdue. A year earlier $174 million had been owing, none of it more than 45 days late. He found that only two of the eight area health services paid their bills within the benchmark of 45 days. "From a financial point of view this is not a particularly good report card," he said. "They are not paying their bills on time, they're not managing their budgets properly, they didn't get their annual statements in on time and they are using trust fund money for reasons they were not intended."

He recommended that the Treasurer, Eric Roozendaal, or the Health Minister, John Della Bosca, order area health services to pay interest on late bills as an incentive to clean up their act. "I am concerned about the $320 million in trusts and special purpose accounts. They need to make better use of these funds. In some cases these funds have been there for a long time and the department is not clear what they can be used for," Mr Achterstraat said. "Some funds have been used to subsidise overexpenditure in other areas."

Yesterday Mr Della Bosca said he would consider interest payments but pointed out that the data was more than eight months old. "Let me be clear, I want creditors paid on time. No question. But we are getting on top of the problem," he said. "In November last year, more than $15 million was owed to small businesses across the state. That figure has dropped by more than 80 per cent to just $3.4 million this week."

The Premier, Nathan Rees, said there was a plan to reduce all of the debt to creditors "to acceptable levels" by June. "Things are better than reflected in that report, and there is a plan to continue to drive down those creditor issues," he said.

The Opposition spokeswoman on health, Jillian Skinner, said the Government was financially irresponsible and reckless. "We have a $380 million health budget deficit, more than $300 million in unpaid bills on top of that and donated money in trust funds being used for recurrent expenditure instead of the hospital projects they were given to build," she said.

SOURCE





27 February, 2009

British paramedic refused to take man with broken back to hospital 'because he was on his break'

A paramedic refused to help a man in agony with a broken back because he was on his lunchbreak, a tribunal was told. Robert Chambers was approached by the man's desperate friends as he filled his ambulance with fuel. To their horror he told them to wait for another ambulance before driving off. Yesterday the paramedic appeared before the Health Professions Council accused of misconduct and lack of competence. He could be struck off if the case is proved.

The patient, who had been taking part in a fox hunt on the Sussex Downs on Boxing Day 2006, had suffered a jolt to his back, the hearing was told. His friends took him to a Tesco car park in Lewes but could go no further because he was in such pain. 'A friend called the emergency services and he was assessed as a category B patient - which was not life threatening,' Emily Carter, solicitor for the council, told the hearing in South London.

'However at that moment a friend of the patient noticed an ambulance refuelling at a nearby petrol station. 'He approached that crew and spoke to Robert Chambers who was refuelling. He explained that his friend had hurt his back but was told that the crew were off duty.' The ambulance crew, which had been on duty for six hours, had been given their half-hour break at 1pm, the hearing was told. 'This did not prevent him from voluntarily assisting should the need arise,' Miss Carter said.

Mr Chambers was approached for help 16 minutes into his break. But instead of helping the patient, waiting with him until help arrived or clarifying which ambulance was on its way, he simply drove away, the hearing was told. A transcript of a conversation between his ambulance and the control centre was read out. The operator said: 'I know you're off the road at the moment but it looks like you're there - I thought I would let you know in case you were approached.' Chambers is said to have replied: 'I believe it's a gentleman who has hurt his back - I explained there's probably an ambulance on its way.'

However, in another blunder, an ambulance car - which did not have the space or equipment to transport a patient with back injuries - was sent to the scene. It took a further 40 minutes for a proper ambulance to arrive.

Mr Chambers, who works for South East Coast Ambulance Service, admitted his actions were 'wrong' and apologised at a disciplinary hearing in March 2007. At yesterday's hearing he admitted a lack of competence but denied misconduct. The case continues.

SOURCE





26 February, 2009

Huge lawsuit payouts awarded against obstetricians have caused many obstetricians to quit and less qualified doctors are now doing their jobs

Erin Hawe's contractions were five minutes apart when she called Cape Cod Hospital at 11 o'clock on a recent Friday night, wondering whether it was time to head in to deliver her second child. A doctor called her right back, but it wasn't her longtime obstetrician-gynecologist. It was a total stranger - Dr. Luisa Kontoules, one of a new breed of hospital-based physicians who deliver babies for other doctors' patients.

Hawe, a 23-year-old from Dennis, was surprised that Kontoules would be delivering her infant, but immediately relaxed after meeting her at the hospital. Kontoules later sat in Hawe's room answering questions for nearly a half-hour before Hawe was discharged. "I have never spent that much time with any doctor," Hawe said.

Called laborists or OB hospitalists, specialists such as Kontoules are helping fill a void created by the growing number of obstetrician-gynecologists who have stopped delivering babies because of grueling on-call schedules and high malpractice insurance costs. The Boston-based ProMutual Group, the largest malpractice insurer in the state, said about 65 of the 120 obstetrician-gynecologists it insures have quit delivering babies.

For expectant mothers, who traditionally have carefully hand-picked their obstetricians to see them through pregnancy and delivery, the advent of laborists means they typically won't meet the doctor attending the birth until they arrive at the hospital. But some physicians believe the practice will be safer, because laborists can begin caring for pregnant women as soon as they arrive at the hospital. Laborists also work defined shifts, so they generally don't suffer chronic sleep deprivation from repeated on-call shifts. That could lead to fewer mistakes, though there are no data yet.

Nobody tracks how many laborists are employed in hospitals in Massachusetts or nationwide, but the number is clearly rising, particularly in community hospitals. Ob Hospitalist Group, a company based in South Carolina, said it has placed 60 doctors as laborists across the country and is looking for jobs for another 340 physicians interested in being laborists. The new specialty is part of what some doctors said is an unavoidable shift in medicine: Fewer doctors have time to care for their patients when they are in the hospital.

Many primary care doctors - who must squeeze more and more patient appointments into the day to make ends meet - infrequently set foot in the hospital; a growing cadre of hospitalists now care for these patients during hospital stays. In other specialties, like obstetrics, surgery, and orthopedics, physicians no longer want to be on call for emergencies because of the disruption to their practices and personal lives.

Dr. Jim Butterick, chief medical officer of Cape Cod Hospital, said the Hyannis hospital decided to hire Kontoules after four of the hospital's eight obstetrician-gynecologists stopped delivering babies, and those remaining "were getting pulled out of their offices and out of the OR all the time." Kontoules had worked in private practice in Peabody, but when eight obstetrician-gynecologists on Boston's North Shore gave up delivering babies over a two-year period, she had no one to help cover her laboring patients on nights and weekends. For a year, she saw patients in her office all day Monday through Friday and answered pages at all hours to deliver 300 babies and tend to emergencies at two nearby hospitals. Exhausted and burned-out, she, too, gave up delivering babies in October 2007. "I physically could not keep up a private practice," said Kontoules, 50.

But she missed ushering tiny infants into the world and last August she took the job at Cape Cod Hospital, where she works every other weekend, from Friday night to Monday morning, so the hospital's four remaining obstetricians can have a break. Being a laborist has "returned the joy" to delivering babies, Kontoules said, though she worried, at first, about how expectant mothers would react. "I knew what it was like in private practice and how much patients bond to their obstetricians," she said. "I have not had a single woman say, 'I don't want you, I don't know who you are.' They want to feel cared for and have a safe birth and that might overwhelm any disappointment they have." Besides, she said, many pregnant women are prepared for the possibility that another obstetrician in their doctor's practice might deliver their babies - although often women have met those doctors.

Another Massachusetts hospital, Morton Hospital and Medical Center in Taunton, has hired two laborists over the past two years, and Brigham and Women's Hospital in Boston is considering employing them as well. The hospitals pay laborists $125 to $150 an hour and cover their hefty malpractice insurance premiums.

An obstetrician-gynecologist in Massachusetts generally pays between $75,000 and $100,000 a year for malpractice insurance; that amount drops to between $30,000 and $50,000 when a doctor gives up obstetrics and sees patients only for gynecological problems, said Dr. Angela Aslami, chair of the practice committee for the Massachusetts chapter of the American College of Obstetrics and Gynecology. The group plans to survey the state's 900 to 1,000 obstetrician-gynecologists to determine how many have stopped, or plan to, in the next two years.

Dr. Louis Weinstein, chair of obstetrics and gynecology at Thomas Jefferson University in Philadelphia, coined the term laborist five years ago, and promoted the practice as a way to provide safer deliveries. He proposed having four laborists working 10- to 14-hour shifts to cover all of a hospital's deliveries. He believes that employing laborists for entire weekend shifts is dangerous because the doctors may get little rest. But doctors at community hospitals vigorously disagree, saying the number of deliveries is small enough that they get plenty of sleep. Kontoules said that in between delivering two to eight babies per weekend shift and seeing emergency room patients with gynecological problems, she always gets "plenty of sleep."

Overall, said Dr. Robert Barbieri, chair of obstetrics and gynecology at the Brigham, having doctors in the hospital 24 hours a day is a safety improvement, and at smaller hospitals, a weekend-long shift is generally not dangerous. The Brigham, which like most teaching hospitals has obstetricians and physicians in training on-site at all times, is considering hiring laborists for 12-hour weekend shifts to relieve off-site obstetricians of call duty during busy periods.

Dr. Kirti Patel, an OB hospitalist at Morton Hospital who works every other weekend, gave up her traditional practice two years ago because she felt her family life was suffering. Now, the 36-year-old is home with her two young children during the week; her husband cares for them when she's working. Patel - who in addition to delivering one or two babies a day, manages post-operative gynecology patients and provides consultations in the ER - said she feels it's safer for patients because she's less distracted and less exhausted. "I'm really there for just that patient," she said.

SOURCE





25 February, 2009

War hero defeated by NHS after hospital stay left him with three infections and fractured pelvis

He survived the vicious conflict with the Japanese in the jungles of Burma. But veteran Albert Marriott has been reduced to a wheelchair-bound shell by a spell in the care of the NHS. Mr Marriott, 90, was admitted to hospital after a fall at home. He then picked up superbugs Clostridium difficile, E.coli and MRSA - and fractured his pelvis in a fall from a hospital bed.

By the time he was finally released 20 months later and transferred to a nursing home, he was unable to even get dressed without help. There is little chance he will get better. His daughter, Sue Davies, 57, told how the independence her father once cherished had been 'taken away by the inadequate standards of cleanliness and care in the NHS' at two separate hospitals. He must now use his pension and savings - and may have to sell his home - to pay for his weekly 384 pounds care home bill.

Miss Davies said the family had made formal complaints about his care at both Clay Cross Hospital in Derbyshire and the Royal Chesterfield Hospital and may seek compensation. 'It has beaten him. He used to be active, read the papers and have a view on things and now he is a shell and does nothing,' she said. 'Hospital is a place you go in to be looked after, not where you go to get fractures and infections. It's so hard for him, he's a man of dignity and pride and I feel it's all been taken away from him.'

Mr Marriott fought in Burma during the World War II before working as a joiner. A father-of-two, with four grandchildren and three great grandchildren, he has lived alone since his wife Lillian died at 63 in 1981. In June 2007 he was bruised after a fall at home and was admitted for three weeks to Clay Cross community hospital. However, his health began to deteriorate. He developed pancreatitis and had to have a catheter because of other problems. He was then struck by the first of a series of infections and ended up going backwards and forwards between the two hospitals.

According to Miss Davies he had E.coli and C.diff at the same time. After a month of treatment in the Royal he was well enough to return to Clay Cross. But in January 2008 he fractured his pelvis falling from a bed and was sent back to the Royal. The fracture was missed by doctors, who believed he was simply bruised. Miss Davies said: 'He was in so much agony he was crying.' The pensioner was sent back to Clay Cross with morphine to help with the pain and two days later the fracture was diagnosed by another doctor and he was sent back to Chesterfield.

Once on the ward again his condition deteriorated fast. 'He was so poorly I was asked if I wanted him to be resuscitated if anything happened. He became delirious.' Miss Davies said she believes his deterioration was down to the infections. 'He looked like he was dying and we were told more or less that he was,' she added. She claimed he had another bout of C.diff and later had a minor MRSA infection too.

Eventually Mr Marriott was moved to a ward which had just had a 'deep clean' and his health improved. He went back to Clay Cross and after months of looking for a suitable nursing home he was discharged.

Miss Davies said: 'He can't do anything for himself now, apart from feed himself. The NHS hospitals are responsible for this and should pay for his care.' Tracy Allen of Derbyshire Community Health Services said: 'We are very sorry that Mr Marriott and his family feel that we have let him down.' She insisted he only had one episode of C.diff, was known to have E.coli 'on admission' and was 'colonised' with MRSA while in hospital. The Chesterfield Royal Hospital said Miss Davies' complaint would be investigated

SOURCE





24 February, 2009

Creating a real healthcare market

MASSACHUSETTS healthcare costs are a problem. The state has virtually the highest costs in the country and insurance premiums that rise more rapidly than national rates. The state's near-universal health coverage shows that no good deed goes unpunished: As the state lowered the number of uninsured, costs increased.

After the Globe reported that Partners hospital system attained higher prices based primarily on its clout with insurers, Attorney General Martha Coakley began an anti-trust investigation. But the remedies will be a long time coming should she decide to prosecute and then win her case.

To spur more immediate solutions, a memo written last summer by former governor Michael Dukakis urged the return of the halcyon days of the 1970s and 1980s, when Massachusetts regulated hospital fees for services and construction. Although most economic reviews of this regulation had reached negative or uncertain conclusions about its impact, and these regulatory schemes have been mostly dismantled, some argue that the problem may not have been with the regulation per se, but rather in its limitation only to hospitals. The memorandum advocated that the state regulate all health insurance premiums - essentially a single payer system. It concluded that ". . .it should be unmistakably clear by this time that market forces don't work in healthcare."

Nothing could be further from the truth. Real markets, like those for computers or cars, feature many competitors who offer differentiated products, and consumers who search for the best value. Innovators easily enter the market. Consumers separate the good from the bad with readily available information about quality and prices. They use it to reward the good guys and penalize the bad. That is why the Digital Equipment Corporation is no longer among us.

These conditions are absent in the Massachusetts healthcare market. Boston hospitals form an oligopoly, dominated by an almost monopolist Partners Healthcare, which last year earned around half a billion dollars in profits. As for health insurance, many employers offer a choice of one - or a choice of firms with virtually identical policies. And if you need an operation, there's no way to learn about histories and prices of potential surgeons. If this is a market, I am Angelina Jolie.

In the long run, the appropriate role for governments in controlling healthcare costs is to use their existing powers to correct these problems through vigorous prosecution of antitrust and the provision of relevant information.

There is a more immediate solution, however. Insurers could require integrated hospital systems to give fixed price bids for providing all the care needed for specific chronic diseases or disabilities, such as Type II diabetes and high-risk pregnancies. Insurers would offer these bids to consumers. They could, for example, choose hospital A's diabetic team in preference to hospital B's, which costs $500 more a year. The effectiveness of such integrated networks is illustrated by Duke Medical Center's congestive heart program. In one year, it lowered costs by an astonishing 40 percent by improving the health of its patients through innovative procedures that decreased the number of hospital visits.

Our oligopolistic hospitals could create these teams. After all, they own all the resources needed to provide this care, and they have sprawled into convenient neighborhood locations. These integrated facilities (which I call focused factories) are feasible even in small areas. For example, if 10 percent of a town is diabetic and the average diabetic costs $10,000 a year, an area of only 50,000 residents could support $50 million of competitive diabetes-focused factories. In addition, transparency about the quality of care for a disease or a disability could be more easily attained from these focused teams eager to demonstrate the competitive excellence of their care. Accordingly, consumers, armed with relevant information, would pick those facilities that give them the best value for their money.

And here's another bonus. Because these teams would effectively and efficiently treat those with chronic illnesses, which normally account for at least 75 percent of healthcare costs, this would give the Commonwealth a shot at finally controlling expenses while improving quality - a potent combination. What do you prefer: giving more power to the state government, which fiddled while Massachusetts healthcare burned, or a transparent consumer-based healthcare system based on real market forces?

SOURCE





23 February, 2009

NHS blunders are behind a spate of 'vaccine overloads'

Children are being given the wrong vaccinations and repeat doses of jabs they have already had due to mix-ups at GPs' surgeries. Nearly 1,000 safety incidents involving child immunisations were reported in a single year. Of those studied in detail, more than a third involved babies and children given a different vaccine to the one they were supposed to have. Other blunders included delays to children having important vaccinations, infants given drugs that were out of date and allergic reactions. It is said all of the incidents could have been avoided if doctors or nurses had checked medical records or drug details thoroughly.

Last night campaigners said these mistakes were the `tip of the iceberg' and expressed fears of a `vaccine overload' from Britain's growing childhood immunisation schedule. A report by the National Patient Safety Agency (NPSA), the watchdog which monitors NHS errors, looked at 949 incidents involving jabs reported in 2007. A detailed study was made of 138 of these cases, picked at random. Eight caused children `moderate harm'.

In 36 per cent of cases a child was given the wrong vaccination. If the sample is representative, it means that hundreds are given the wrong immunisation every year. And, as the reporting of incidents by medical professionals is voluntary, the true number could be much higher.

In 23 per cent of incidents there were errors in documenting the vaccine, while there were delays in 17 per cent of cases. Other problems included incorrect storage of the jabs or out-of-date vaccines having to be thrown away.

GP Dr Richard Halvorsen, of the Babyjabs clinic in Central London, said: `These cases are probably the tip of the iceberg. It's worrying when children are getting the wrong vaccines at the wrong times but it's an inevitable consequence of the vaccination schedule, which is one of the most complex in the world. `Of course things are going to go wrong - it's a recipe for mistakes.'

Children receive 32 immunisations before they reach four. And the Government is now discussing whether also to give chickenpox and flu jabs. The most controversial vaccine is combined measles, mumps and rubella (MMR).

Jackie Fletcher, of campaign group Justice, Action, Basic Support (JABS), said: `Children are sometimes given MMR when they go to get their pre-school booster for diphtheria, tetanus and whooping cough, even if parents have explicitly said they do not want them to have it. To think mistakes occur time and time again is horrendous.'

Previously healthy Jodie Marchant, who is now 17, was left severely brain-damaged and with a gut disorder after being given seven vaccines in a single jab at 14 months. Her parents, Bill and Pat, from Southampton, had requested that she was given only MMR. A claim for damages failed because there was not enough research into the vaccines. The Marchants are now suing their GP practice. Mr Marchant, 68, said: `To think so many other children suffer vaccine mix-ups is appalling.'

The NPSA said new packaging guidelines for jabs would `eradicate' errors. The Department of Health said: `Staff are trained to administer vaccines safely, follow the childhood immunisation schedule and to record it all.'

SOURCE




Nannystate medicrat care

So you want to grant government hegemony over your health, huh? What is it about voters who forever treat politicians like battered wives treat their abusive husbands? "Well, he punched me in the face for the seventeenth time and knocked out four of my teeth but I still love him and he said I can trust him now so I'm going to give him another chance." You actually want government to take over and dictate your personal well-being? You do know, don't you, that you're putting your blind faith in the same politicians who are bankrupting the Social Security and Medicare ponzi schemes and bilking you out of trillions of tax dollars so they can "stimulate" their politically-connected billionaire banking buddies, right?

You know it means becoming completely dependent upon the same kinds of bureaucrats who couldn't get FEMA off its fat, inefficient office chairs after Hurricane Katrina punched New Orleans in the face, right? Knocking out most of her teeth. Have you seen the Queen of the Mississippi lately, over three years after her near death experience? You're talking about trusting your very life to a class of beings responsible for spawning the likes of Rod Blagojevitch, the grafting governor of Illinois, and Eliot Spitzer, the whorehumping governor of New York.

Sort of like begging a mountain lion to rip out your throat to keep the grizzly bear from killing you. Sort of like voting the fascists out of office and replacing them with socialists. Or kicking the big government Republican hacks out the door while holding it wide open for the big government Democrat hacks to waltz right in. Not a very high IQ play, that, swapping one set of power-lusters for another.

Don't you know yet that there's a much better option available to you? How about not being brunch for the bear or lunch for the lion? How about not being the favorite chew toy of fascists or socialists?

"The art of taxation consists in so plucking the goose as to obtain the largest possible amount of feathers with the smallest possible amount of hissing" (Colbert, 1665)

How about not being the goose for the Republican and Democrat feather pluckers? How about owning yourself? How about becoming a libertarian? But wait. That would require internal fortitude and personal integrity. And knowledge. When you find those things please call the libertarians. They'll happily welcome you.

SOURCE





22 February, 2009

NHS now kicking patients out too early

The number of hospital patients being discharged only to be readmitted as emergencies just days later has soared in the last few years, figures reveal. Statistics released by the National Centre for Health Outcomes Development show hundreds of patients are being rushed back to hospital days after being assessed as fit for release. The statistics will fuel criticism of the health service for being too target driven at the expense of providing long-term care.

Roger Goss co-director of Patient Concern, said that hospital trusts were always looking for ways to cut the number of days in hospital for operations. 'Readmissions are the inevitable consequence of so-called "bed-blocking", often a euphemism for high quality care,' he said. 'At the same time, hospital acquired infection rates are so bad that patients want to get out as fast as possible. Better yet, not go in the first place.'

The data reveals that the problem of adult patients having to be brought back to hospital for emergency treatment has risen by almost 20 per cent in the past four years. The figures show that in 2002-03 around 1 in 9 patients aged 75 or over was brought back to hospital as an emergency readmission within 28 days of first being discharged. But by 2006-07 the readmission rate had risen to almost 1 in 7. For adults under 75 the rate has also increased with 8.82 per cent of patients being readmitted in 2006-07, compared with 7.39 per cent in 2002-03. Children's readmission rates have also risen - but not at the same rate - seeing the ratio rise from 1 in 12 patients to 1 in every 11. In total it is estimated that the number of people who are readmitted to hospital as an emergency within 28 days is around 400,000 people per year.

A spokesman for the Department of Health said there were often a number of reasons why patients were readmitted which had nothing to do with poor standards of treatment or care. 'It is in the nature of some conditions, that repeated emergency single admissions will occur,' he said. 'For example, for children a sequence of readmissions is often preferable to a longer stay in hospital. 'Over the last few years patients requiring simple procedures or, in the case of chronic conditions, routine treatment or observation, are increasingly being treated in local and community settings rather than being admitted to hospital.' He added this often made it difficult to interpret readmission rates.

SOURCE




NHS apology over 100-mile birth journey

A woman was forced to give birth more than 100 miles from where she lived because of a lack of suitable cots for premature babies, it has been revealed. Natalie Page, 20, was transferred from hospital in her home town of Leicester to Birmingham, but then from Birmingham to Liverpool where she gave birth prematurely to a daughter on Sunday.

The hospitals involved apologised to Miss Page for the situation which has left her in Liverpool while the rest of her family are in Leicester. David Yeomanson, from Leicester's Hospitals, said: "We are sorry Miss Page had to be transferred via ambulance to Birmingham to deliver her baby, but it was important that she was in the best place to receive the best care for her very premature baby. "The decision to transfer her was made by her consultant as she was about to deliver her baby 11 weeks prematurely due to a pregnancy-related complication. "Unfortunately, we did not have a suitable cot available in our neonatal unit to take her very poorly baby. "We transferred her to Birmingham where they had the specialist neonatal facility for her new baby."

He said they did not have to do it very often, but are part of a neonatal network and transfer babies to a centre able to deliver the level of care and expertise needed for a premature baby. He added: "Whilst this is unfortunate it is not a unique event and all Maternity Units would take the same action in these circumstances."

A spokeswoman for Birmingham Women's Hospital said: "We are very sorry that Natalie Page was unable to give birth in our hospital last week."

SOURCE





21 February, 2009

NHS blunders set schizophrenic patient free to stab woman 21 times

Health workers caring for a paranoid schizophrenic who stabbed a woman in a supermarket 21 times have admitted a series of failings, her family revealed. Samuel Reid-Wentworth was yesterday ordered to remain at Broadmoor high security mental hospital indefinitely for his 'premeditated' and ' frenzied' attack on Lucy Yates, 20.

The news came as it emerged that Sussex Partnership NHS Foundation Trust has implemented stringent changes in its care for mentally ill patients. Senior managers admitted a series of blunders during a tense meeting with Miss Yates's parents, Hugh and Debbie. Although no staff have been sacked, bosses insisted 'lessons have been learned'.

However, Mr Yates said: 'Everyone has been let down by the mental health system, and that includes the attacker and his family. 'The trust might say things have improved, but it doesn't change what has happened. I want better answers but I'm not hopeful.'

He spoke after the frightening psychiatric problems of Reid-Wentworth, 22, were laid bare at Lewes Crown Court yesterday. Reid-Wentworth stabbed Miss Yates repeatedly in the confectionery aisle at Somerfield in Littlehampton, West Sussex, while screaming: 'I'm a ******g psycho!' He later told police: 'I'm a schizo. I did it and I'm proud of it.' And when he discovered that Miss Yates had miraculously survived, he told officers: 'S***, I should have stabbed her more. If they hadn't dragged her away I would have carried on.'

Miss Yates was highly critical of the health chiefs who discharged Reid-Wentworth. She said: 'How was he left free to roam around and stab me and all but kill me? 'I'm disgusted with the people who decided he could be at large. This is partly their fault. 'I hope they can look at me and feel bad about those decisions, then maybe it will stop this happening to someone else in future.'

After the hearing Lisa Rodrigues, the health trust's chief executive, said her staff would learn everything they could from the attack. She added: 'There are always lessons to be learned both for the trust concerned and more widely and I readily acknowledge that the independent review we commissioned after this case offers some clear pointers for care and service improvements in the future. 'We have learned lessons from this case and we will share them with other trusts.'

But warning bells should have sounded when Reid-Wentworth was admitted to the Centurion mental health unit in Chichester, West Sussex, in August 2007 after being given two cautions by police for two random attacks on young women. He told staff he wanted to drink the blood of attractive young women and had been told to kill two people by God, Jesus and MI5. But the trust decided he would be cared for in the community. After a year, he persuaded his carers that his condition had improved and he was discharged. He stabbed Miss Yates six weeks later, having planned the attack by hiding a sword in bushes and slashing a door with a knife 50 times as 'practice'. Before leaving his flat in Bognor Regis, West Sussex, he scrawled 'I'm going to become a killer, ha ha ha' on the wall. Four days before the attack, he wrote to the psychologist who had treated him telling of his plans to 'kill an attractive woman'.

The court heard how Reid-Wentworth took a bus to Littlehampton, where he selected Miss Yates at random after spotting her walking through the town. He followed her into Somerfield where he stabbed her from behind with a 9cm flick knife. When she fell to the ground, he pinned her down and repeatedly plunged the blade into her.

Miss Yates, of Pulborough, West Sussex, received severe spinal damage and a punctured liver, and both her lungs collapsed. As paramedics fought to save her in the ambulance, the sales assistant's heart and breathing stopped three times. But after eight days in intensive care, she pulled through.

Yesterday, Judge Anthony Scott-Gall described the attack as 'horrific and wholly irrational'. 'This terrible attack was premeditated in that you planned for some time to kill a woman,' he said. 'She has been blighted for her whole life. You pose a genuine risk to members of the public, in particular to young women. 'Over some years you have felt the urge and need to drink women's blood. You also have fantasies about decapitating women.'

SOURCE





20 February, 2009

The moral hazard problem of socialized healthcare

Ezra Klein quotes approvingly a section of Michael Pollans In Defense Of Food on the high level of diabetes in those eating a Western-style diet. In response, he almost seems to be suggesting that there's a moral hazard problem of socialized healthcare:

A diagnosis of diabetes subtract roughly twelve years from one's life and living with the condition incurs medical costs of $13,000 a year (compared with $2,500 for someone without diabetes).

This is a global pandemic in the making, but a most unusual one, because it involves no virus or bacteria, no microbe of any kind - just a way of eating. It remains to be seen whether we'll respond by changing our diet or our culture and economy. Although an estimated 80 percent of cases of type 2 diabetes could be prevented by a change of diet and exercise, it looks like the smart money is instead on the creation of a vast new diabetes industry.

I'd just add a question: How many discrete interest groups would save money from a sweeping policy initiative aimed at reducing chronic disease through nutrition, exercise, and other low-cost lifestyle changes? How many discrete interest groups would make money from a sweeping policy initiative aimed at increasing the number of insured Americans able to purchase cutting edge medical care in response to the onset of chronic disease?

The questions asked are quite instructive, and thus I wonder if he is being facetious here.

Undoubtedly Americans would be best served by changing our diets and behavioral patterns to more "sustainable" options. As a libertarian, of course, I favor doing this through the freedom rather than bans of bad foods or mandates of exercise - and certainly support anyone wealthy enough to pay for the medical treatment being willing to abuse their body as much as their bank account can pay for the damage. I'm sure Ezra's "policy initiative" is probably a mix of advertisement, tax policy, and the other sort of "libertarian paternalism" ideas championed by Cass Sunstein.

But what will happen if we do go for a "sweeping policy initiative" aimed at increasing the number of insured Americans able to purchase cutting-edge diabetes treatments? When we offer such "health bailouts", does this not result in a moral hazard where individuals can make bad, risky decisions knowing that they won't feel the full effect? This is no different from the corporate world, where CEO's can embark upon ultra-risky business strategies knowing that the cost of failure will be blunted by federal bailout. Note also that this is a feature of all third-party payment system where the individual care-user is not even charged premiums based upon their risk-profile - it doesn't matter if it's an individual mandate plus a huge push towards company-paid insurance (the Massachusetts model) or a fully socialized system (the British model). The end result will be skyrocketing costs as the individual is not strongly incentivized to avoid poor health.

America, when it comes to "healthcare systems", would be far better off breaking the employer-payment link and moving to a more free system. In this sort of a system, premiums would be somewhat tied to a risk profile (as makes sense for an insurance product), paid individually (so the individual has an incentive to adopt healthy practices), and [probably] would be more tailored to protection from high-cost services rather than pay for day-to-day health care needs. This is post-1930 America, so undoubtedly there'd be a safety net, but I'd rather see the government pay for healthcare for the indigent than for everyone - especially since the system will work better.

In fact, a free market would help bring about Ezra's goal (healthier people who eat better and exercise) while avoiding his worry (a giveaway to the big healthcare corporations subsidizing bad decisions). Maybe someone should tell him that there's an answer outside of government on this one.

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NHS hospitals fail to do routine checks on suspiciously injured children

Two thirds of hospitals fail to conduct routine checks on injured children despite warnings after the death of Baby P, The Times has learnt. A poll of NHS trusts conducted by the Conservative Party suggests that staff at many accident and emergency departments are not able to check whether children are in contact with social services or subject to a child protection plan, even when they have suspicious injuries.

Doctors' failure to detect evidence of non-accidental harm and poor links between health and social services were identified last year as key failings contributing to the death of Baby P in Haringey, North London, in 2007. But few hospitals can check databases of children at risk, while one in ten clinical staff has not had child protection training, the survey suggests.

The Conservatives, who received responses from 120 out of 171 hospital trusts under the Freedom of Information Act, said that problems identified by the independent report into Baby P's death appeared to be systemic. Only one in seven hospitals claimed to be able to make any sort of online check on whether social services were involved in the care of an injured child, the Tories said. Some trusts said that it was not permitted for staff routinely to check whether children were subject to child protection plans.

Last month the Government announced the setting up of a database of 11 million juveniles in England for professionals working with children. The Tories have attacked the œ224 million ContactPoint as "another expensive data disaster waiting to happen". "A far better solution would be to make sure basic checks are maintained in A&E and that other hospitals learn from those that are doing well so that children who are really at risk are identified before it's too late," Andrew Lansley, the Shadow Health Secretary, said. "The NHS is doing its best, but many hospitals are getting incoherent messages about what to do to prevent tragedies like the Baby P case from happening again."

John Heyworth, president of the College of Emergency Medicine, said that although A&E departments could be overwhelmed because of staff shortages or a need to see patients within a government four-hour target, trusts had a "major responsibility to find out whether the child is on a protection plan or in a family that is in contact with social services". "Access to and use of databases varies widely across the country," he said. "In some areas links between A&E and social services are sub-optimal while in other areas there are next to no links at all."

Ben Bradshaw, the Health Minister, said that rules on child protection applied to all trusts, including arrangements for checking if a child was subject to a child-protection plan, and staff training. "The Conservatives are confusing the requirement to check if a child is subject to a child protection plan with accessing details of the plan itself," he added. "That is not a requirement and not something we would expect NHS staff to do."

Rosalyn Proops, child protection officer for the Royal College of Paediatrics, said that all A&E professionals should have an awareness of child protection and be able to check quickly with social services if they had concerns. However, there was a danger that routine checks on child-protection status could override clinical judgment about whether injuries were suspicious. "There has never been a system of routine checks on children coming to A&E and any such system would be at best unhelpful and at worst dangerous to the child," she said. "If children were formally screened, it could provide a false sense of security." The Healthcare Commission, the NHS watchdog, is expected to publish a review of the matter shortly.

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19 February, 2009

UK: Millions opt for DoItYourself dentistry

Millions of people in England have resorted to DIY dentistry, a survey by consumer magazine Which? suggests. The poll, of 2,631 adults, found 8% had tried to fix their own dental problems - and a similar number knew somebody who had tried. Of those who admitted trying the DIY approach, one in four had tried to pull out a tooth using pliers.

Since a new dental contract was introduced in 2006 there has been growing concern over access to care. But the government said the findings of the survey were unreliable, and said access to NHS dentistry was improving. Ministers have announced an independent review of NHS dentistry in England, which will report back later this year.

Which? will be making a submission to this review and is currently carrying out detailed research to build an accurate picture of the state of NHS dentistry. The latest survey found 12% of those who had tried DIY techniques had tried to extract a tooth by using a piece of string tied to a door handle. Some 30% of DIY dentists had tried to whiten their teeth with household cleaning products. Other DIY procedures people admitted to included:

Using household glue to stick down a filling or crown (11%)

Popping an ulcer with a pin (19%)

Trying to mend or alter dentures (8%)

Trying to stick down a loose filling with chewing gum (6%)

Which? health campaigner, Jenny Driscoll, said: "This research shows the desperate measures people will resort to. "Everyone should have access to good quality dental treatment so it's worrying to see so many people resorting to doing it themselves."

Susie Sanderson, of the British Dental Association, said: "While worries about accessing or paying for dental care can clearly be a concern, it really isn't advisable to resort to do-it-yourself care. "We hear too many horror stories about people pulling out the wrong tooth, or causing themselves to have an infection, and urge anyone considering this path to think again. It is all too easy to make the problem worse, rather than solve it. "If you are having trouble accessing NHS dental care then contact your local primary care trust."

Mike Penning, the shadow health minister, said: "It is a scandal that millions of people are resorting to pulling out their own teeth as a result of Labour's disastrous mismanagement of NHS dentistry. "These survey results are a direct consequence of the introduction of Labour's botched dental contract which has left millions without an NHS dentist."

But Barry Cockcroft, the chief dental officer for England, gave the Which? survey very short shrift. He said: "These findings come from an online multiple choice survey that has no statistical credibility. It is ludicrous to suggest that three million people are doing DIY dentistry. "DIY dentistry is dangerous and unnecessary. Thanks to our investment of over 2bn pounds in NHS dentistry, there are now lots of new NHS dental practices expanding and opening around the country."

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18 February, 2009

'We ran out of shavers': Doctors' extraordinary excuses for axing 1,000 NHS operations a week

More than 1,000 NHS operations are being cancelled at the last minute each week because of avoidable mistakes at hospitals. Lost medical records, broken equipment and a lack of beds were among the excuses given to patients whose surgery was called off. But the survey of 110 Health Service trusts also revealed the extraordinary decisions behind some of the cancellations. One hospital claimed it was unable to prepare patients for surgery because it had run out of shavers, while another cancelled an operation because the surgeon had disappeared after a fire alarm. In another case, medics simply forgot about a patient who had been left in a side room awaiting surgery.

The Department of Health figures, revealed by a Freedom of Information request, revealed that the number of operations cancelled for non-clinical reasons in 2007/08 was 57,382 - 10 per cent higher than the year before. Experts now predict that the figures could top 64,000 for the first six months of this financial year.

Leeds Teaching Hospital was the worst trust for cancelling operations at the last moment, closely followed by Plymouth Hospitals Trust (1,346). At the Pennine Acute Trust, which runs hospitals in Oldham, Bury, Rochdale and Manchester, six procedures were cancelled because the surgeon was on holiday. At Plymouth Hospitals Trust, 197 were halted because of a lack of staff in theatre. Two were cancelled at Southampton University Hospitals Trust because of inadequate blood supplies, while at London's St George's Healthcare seven procedures were called off because patients' records had been lost. The Epsom and St Helier Trust was forced to cancel 58 operations because its sterilisation unit was out of action for a week. And at the George Eliot Trust, near Nuneaton, nine were halted because of a chemical spill, three because the surgeons had disappeared in a fire alarm and one because the surgeon refused to use the equipment provided. The Gloucestershire Trust cancelled ten operations because of an infection outbreak on a ward and another 23 because of a flood in the operating theatre. It also halted 53 procedures as a result of a broken lift. At Newham University Hospital Trust in East London, bosses admitted a lack of shavers resulted in operations being cancelled.

Roger Goss, of Patient Concern, said: 'Wasting patients' time and making a stressful experience even worse clearly doesn't matter. 'Contrast this with the complaints from doctors about patients missing appointments. 'Perhaps we should fine hospitals for cancelling operations at the last minute. We are the customers yet only the time of clinicians matters.'

Meanwhile, a report by the Healthcare Commission has revealed that the NHS is failing to respond properly to patients' complaints. Last year, 7,827 complaints were sent to the watchdog for independent review. Half were upheld or sent back to the trust because the initial response was not good enough. One in five of the complaints was about treatment or a wrong diagnosis, while the remainder mainly concerned the behaviour of NHS staff or a lack of information about their care.

Patients were most likely to complain about their GPs. One in eight were about family doctors - double the number complaining about nurses. The commission said the report showed that some trusts were still not responding to complaints effectively. Each year, the NHS delivers 380 million treatments and receives 135,000 complaints. Anna Walker, the commission's chief executive, said: 'It is concerning that complaints raised with us continue to be about the same basic aspects of healthcare, such as poor communication and failure to diagnose conditions.'

SOURCE




Australia: Dentists lash out at socialization plan

If you knew what socialized dentistry is like in Britain -- with people reduced to pulling out their own teeth with pliers -- you would run a mile from this. "Free" dentistry just leads to massive waiting lists -- sometimes even leading to death when serious problems are left untreated. There are in fact "free" dental hospitals in capital cities already but you can wait years to access them

Dentists have condemned a Medicare-style system for free universal dental care being considered by the Rudd Government as impractical, and massively expensive. The Denticare plan is part of the National Health and Hospitals Reform Commission's sweeping makeover in hospital and health services, including for indigenous people, the aged and young people with mental illness. Denticare would be financed by a 0.75 per cent income levy.

In its interim report released yesterday, the commission raised three options for reshaping state and federal governments' running of the health system. The proposals range from an improved version of the existing system, through to the development of a European-style social insurance scheme financed by the Commonwealth under which people could choose from health fund plans which would purchase services on their behalf. The commission is to decide which scheme it would favour in its final report to the Government expected by midyear.

The Health Minister, Nicola Roxon, said the Government was happy to have a debate about the possibility of a new tax to finance Denticare, which she described as a "fairly radical proposal . but we are interested in the community's response to this".

But Dr Neil Hewson, the president of the Australian Dental Association, representing private dentists, slammed the Denticare proposal, saying it could nearly double to $11 billion the cost of dentistry to the government and individual patients. "The recommendation . for a universal Denticare scheme is impractical, nonsensical, overly simplistic and flies in the face of much of the deliberations that have taken place on this issue over the past decade," he said. "It shows no appreciation of the real problems facing dental delivery in Australia."

The association believed the Government should target the 35 per cent of the community who could not access or afford proper dental care and said it would be fiscally irresponsible to introduce a universal scheme for dentistry.

The chief executive of the Australian Health Insurance Association, Dr Michael Armitage, said insurers would consider the dental care proposal and other recommendations and compile a response to the reform commission. "The industry would support any plan to improve access to dental care for Australians but it is about more than that - it's about quality, safety and achieving better health outcomes - not just health financing," he said.

The Opposition's health spokesman, Peter Dutton, said taxpayers would pay billions of dollars in extra taxes for a national Denticare scheme. "Almost 11 million Australians or 50 per cent of the population would pay more than they currently do to meet the costs of the Denticare scheme," he said.

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17 February, 2009

NHS criticised in half of complaints reviewed

One in five NHS complaints sent for independent review relates to poor treatment or a wrong diagnosis.

The Healthcare Commission said that trusts were at fault or could have done more in almost half of the 8,939 complaints it investigated last year. Eleven per cent concerned treatment, 9 per cent delayed or wrong diagnosis and 8 per cent waiting or problems having treatment. Nearly half of complaints were upheld or referred back to trusts. The NHS receives about 135,000 complaints annually. It provides about 380 million treatments. In April unresolved complaints will be passed to the Parliamentary and Health Service Ombudsman, as the Healthcare Commission is replaced by the Care Quality Commission, covering health and social care.

The new system relies on more complaints being resolved locally but the Healthcare Commission said some trusts were still not responding to complaints effectively enough for the new arrangement to work.

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Australian public hospitals have triple the baby deaths of private

Poor people tend to have worse health but the gap here seems too large for that to be the main factor. And the grave problems often reported with public hospital obstetric services leave little room for doubt about where the main fault lies

For every baby that dies soon after birth in an Australian private hospital, three die in the public system, alarming new figures reveal. Women who give birth in public hospitals are also more than twice as likely to suffer tearing, or that their babies will need resuscitation, according to the alarming findings of a new study. Associate Professor Steve Robson and colleagues examined the outcomes of almost 790,000 births which took place over four years, and about a third were in the nation's private hospitals.

Dr Robson said he was shocked not only by the "striking difference" between the two systems, but also by the results that contradict a common criticism of births in private hospitals. "There is often a lot of criticism in the medical press of rates of caesarean birth and rates of the induction of labour - everybody says 'Wow they're so much higher in private hospitals,"' says Dr Robson, of the Australian National University Medical School. "And if you take the literature at face value ... all of those things ought to up the complication rate, (but) it was lower. "We found that quite staggering."

Dr Robson says the study raises questions about the view that some in the medical fraternity hold that "increased rates of obstetric intervention are bad for women and their babies". "Our study suggests these things could be beneficial because the rate of babies dying is about half in the private hospital, and the rate of serious maternal injury is less than half," he said. Dr Robson said differences in the health and socio-economic status of the mothers alone could not explain the performance gap between public and private hospitals, and that further research was needed. "And it's not as though we've taken a small sample, we basically looked at every birth in the country (over four years)," he says.

The study, to be published in the Medical Journal of Australia, reported women giving birth in public hospitals had more than twice the rate of "severe perineal tearing", and their babies were more than twice as likely to require "high-level resuscitation" at birth. The neonatal death rate was one for every 1,000 babies born in private hospitals, compared to three in 1,000 in public hospitals.

The study was also undertaken by Elizabeth Sullivan and Paula Laws from the Perinatal and Reproductive Epidemiology Research Unit, at the University of NSW. Australia's rate of caesarean sections has risen from a single digit per cent in the 1980s to now account for more than 30 per cent of all births.

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16 February, 2009

More medical socialism hidden in the “spendulus” bill

The writer below is one of the alternative medicine crowd but there are a lot of those and they could give the Obama crowd significant opposition. What she says about the authoritarian provisions in the new bill seems correct from any viewpoint, however

I first read Betsy McCaughey’s commentary, Ruin Your Health With the Obama Stimulus Plan a couple of days ago; and again, in not wanting to focus overmuch on federal doings (nor wanting to turn this place into a wall of rantings) I refrained from commenting. But some of the stuff coming down the road is just too outrageous to let it pass by....

Some context from McCaughey’s essay first (one link preserved below):

[N]o one from either party is objecting to the health provisions slipped in without discussion. These provisions reflect the handiwork of Tom Daschle, until recently the nominee to head the Health and Human Services Department. Senators should read these provisions and vote against them because they are dangerous to your health. (Page numbers refer to H.R. 1 EH, pdf version [that is not a link to a PDF]).

The bill’s health rules will affect “every individual in the United States” (445, 454, 479). Your medical treatments will be tracked electronically by a federal system. Having electronic medical records at your fingertips, easily transferred to a hospital, is beneficial. It will help avoid duplicate tests and errors.

But the bill goes further. One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions (442, 446). These provisions in the stimulus bill are virtually identical to what Daschle prescribed in his 2008 book, “Critical: What We Can Do About the Health-Care Crisis.” According to Daschle, doctors have to give up autonomy and “learn to operate less like solo practitioners.” Keeping doctors informed of the newest medical findings is important, but enforcing uniformity goes too far.

Yowza! But is McCaughey scare-mongering here? I clicked through to try to find the relevant sections in the bill myself—and in the process, discovered that because it’s still being hammered out, the search results are frequently updated. Thus, I can’t provide a better link than the one in the quoted text above. Anyway, she is not engaging in hyperbole, as the bill stands now. The current form—it has already changed once since I began this post—reads as follows (formatting not retained):

SEC. 3001. OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY.

(a) Establishment- There is established within the Department of Health and Human Services an Office of the National Coordinator for Health Information Technology (referred to in this section as the `Office'). The Office shall be headed by a National Coordinator who shall be appointed by the Secretary and shall report directly to the Secretary.

(b) Purpose- The National Coordinator shall perform the duties under subsection (c) in a manner consistent with the development of a nationwide health information technology infrastructure that allows for the electronic use and exchange of information and that--

(1) ensures that each patient's health information is secure and protected, in accordance with applicable law;

(2) improves health care quality, reduces medical errors, and advances the delivery of patient-centered medical care;

(3) reduces health care costs resulting from inefficiency, medical errors, inappropriate care, duplicative care, and incomplete information;

(4) provides appropriate information to help guide medical decisions at the time and place of care;

(5) ensures the inclusion of meaningful public input in such development of such infrastructure;

(6) improves the coordination of care and information among hospitals, laboratories, physician offices, and other entities through an effective infrastructure for the secure and authorized exchange of health care information;

(7) improves public health activities and facilitates the early identification and rapid response to public health threats and emergencies, including bioterror events and infectious disease outbreaks;

(8) facilitates health and clinical research and health care quality;

(9) promotes early detection, prevention, and management of chronic diseases;

(10) promotes a more effective marketplace, greater competition, greater systems analysis, increased consumer choice, and improved outcomes in health care services; and

(11) improves efforts to reduce health disparities.

(c) Duties of the National Coordinator-

(1) STANDARDS- The National Coordinator shall--

(A) review and determine whether to endorse each standard, implementation specification, and certification criterion for the electronic exchange and use of health information that is recommended by the HIT Standards Committee under section 3003 for purposes of adoption under section 3004;

(B) make such determinations under subparagraph (A), and report to the Secretary such determinations, not later than 45 days after the date the recommendation is received by the Coordinator;

(C) review Federal health information technology investments to ensure that Federal health information technology programs are meeting the objectives of the strategic plan published under paragraph (3); and

(D) provide comments and advice regarding specific Federal health information technology programs, at the request of the Office of Management and Budget.

First, out of all this gobbledygook, the phrase “health disparities” leapt out at me, and I just had to laugh. Given the uniqueness of each of us—uniqueness in health as well as illness—how the f*ck do these healthocrats think they’re going to reduce disparities?

That one phrase is emblematic of the fundamental problem here: their solutions call for systematizing that which cannot be systematized. People are not interchangeable cogs; we do not respond uniformly to most things outside of some basics (such as oxygen or water; and it may be the case that our metabolic pathways may be somewhat unique even here), either in mind or in body. Medicine used to be considered part art and part science precisely for the same reason: helping someone heal requires attending to his unique situation as well as placing it (to some degree) into the broader context of accumulated knowledge.

The art has been undermined for decades, replaced by systems and institutions. And now the science is revealing its cracks, too, as it has narrowed in scope, become politicized and dogmatic, and allowed many of us to think its answers are more solid than they really are. I believe it was my spirited sister Wolfie, who commented recently that for all science’s explorations, relatively few bacteria have been identified, much less understood in the context of human health or unhealth. Yet to read news reports and science mags, one would think this stuff is all figured out. It may be to a high degree, in discrete little units of information, but those bits haven’t become integrated into bytes—there’s too little generalized understanding.

So the fedgov’s effort to herd us into neat little medical categories, and to dictate to doctors and other health care providers how we should be treated, is doomed to fail. It must, given how it’s set up.

But it will cost millions, in dollars wasted, in hours of life and energy to no real purpose, and in lives unnecessarily shortened or snuffed by the medical manufacturers. This is not hyperbole—it is already happening, all around us. Too many of us—myself included, once upon a time—have ceded responsibility for our health to so-called experts who know far less than they let on, and whose biases help keep us in their grip, instead of taking responsibility ourselves. Too many of us have fallen for the seductive promise of definitive answers via scientific methods, requiring that we “understand” how something works before we’ll deign to try it. Tell me, does knowing that a pill is a beta agonist or selective serotonin reuptake inhibitor really tell you what is going on in your body if you swallow it? It sounds like we know what’s going on, when we haven’t a f*cking clue.

I have stated publicly that I will not cooperate with any mandatory health insurance Ponzi scheme. Health insurance is not necessary to obtain health care. It is a wholly unnecessary part of the current medical institution, socializing health care and vastly inflating its cost. In keeping with my desire to keep my health under my control, I will do everything in my power to avoid any health care provider who cooperates with this vast socializing of medical care. In a world that is rapidly stripping away both privacy and dignity, I will resist.

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British hospital let 80-year-old man walk home to his death - because payphone was broken

A hospital has been censured by health watchdogs for letting an elderly man walk home unsupervised to his death after a blood transfusion. Novelist Aplyn Wynn-Jones, 80, was discharged from the hospital after receiving treatment for anaemia. He was found by his daughter Alison the next day at his home in his armchair wrapped in blankets, and died within hours of organ failure and a heart attack. The Healthcare Commission said it would have been 'prudent to have allowed an overnight stay, or at the very least for him to have been collected and taken home with some help and support'.

Alison's husband Patrick Storer, who was with her when she found him, lodged a complaint against Musgrove Park Hospital, in Taunton, Somerset, over the way it had dealt with Mr Wynn-Jones on May 16 last year. Speaking from his home in Blindmoor, near Chard, in Somerset, Mr Storer, 56, assistant headteacher at the Castle School in Taunton, said: 'The hospital didn't organise transport for him; they told him to make a call on a payphone, which wasn't working. 'The walk took him more than an hour, he was forced to sit on low walls to get his breath back. He is a very fit 80-year-old, and walks four miles a day, so this should not have been difficult. 'When we arrived in the morning he was clearly dying. He was conscious, but had no strength and was stone cold. He was shivering by the fire in his study and his chest was rattling.'

Mr Wynn-Jones, a widower and grandfather who was partially deaf and partially sighted, had recently had his first novel published, The Hidden Springs, dealing with the story of Bonnie Prince Charlie.

He went to the hospital as an outpatient for a series of injections but was asked to stay for several hours while being given three pints of blood by transfusion. Unable to call a taxi on the broken hospital payphone, Mr Wynn-Jones walked the one-and-a-half miles to his Taunton home. He spoke to his son-in-law by phone that night, saying he had been sick and was going to bed. The next morning Mr and Mrs Storer found him weak and shivering with his chest rattling. He was taken back to Musgrove Park Hospital where he was pronounced dead that same afternoon.

Mr Storer said: 'My wife and I were both shocked and very upset. He was healthy just two days before. 'Once over the shock, I was just very angry for 10 months. They treated this elderly gentleman terribly. They just chucked him out of the hospital. 'The thing that pained us, that really upset us, was the thought of that walk home. They made no attempt to contact us, we could have picked him up. I'm really quite outraged

Mr Storer said: 'The hospital didn't make sure he understood the procedure and the risks involved. 'We called the emergency doctor who was so appalled by his condition he advised us to make a complaint.' The Healthcare Commission has upheld Mr Storer's complaint and has since made recommendations to Taunton and Somerset NHS Foundation Trust, which runs the hospital. It said in its report that 'the nursing care fell far below the standard expected'.

Mr Storer said he would be discussing possible legal action against the Trust with his solicitor on Monday. A Trust spokeswoman said it was dealing with the recommendations made by the commission 'urgently'. She added: 'The Trust complaints manager has written to Mr Storer. Once the investigation is complete senior medical staff from the trust will meet with Mr Storer to outline the conclusion of the report and the action plan developed as a result.'

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15 February, 2009

A Catholic view of healthcare reform

Reform of the American health care sector is urgent. The current trend of ever increasing health-care spending, superimposed upon technological advancement and an aging demographic, is unsustainable. Approximately 15 percent of Americans lack health insurance and millions are underinsured or struggling with medical bills. Employer based medical care is disintegrating. Well-intentioned leaders often advocate for `comprehensive' or `universal' reform with more government or employer involvement in health care.

Yet our government has a record found wanting in the defense of human dignity. Broad mandates threaten those whose consciences are committed to the sanctity of life. Furthermore, approximately 50 percent of medical spending is already government funded and expenses continue to escalate. Medicare faces insolvency by 2019, or earlier. United States firms struggle to compete in the global marketplace against firms not similarly responsible for medical benefits.

How ought health care be reformed?

Pope John Paul II, in the 1991 encyclical Centesimus Annus, wrote that "the Church offers her social teaching as an indispensable and ideal orientation." These principles of social justice can be considered by all those of good will as guidelines for ethical health care reform.

Catholic social teaching prioritizes the dignity of the human person, created "Imago Dei" (Gen 1:27), in the image and likeness of God. We respect human dignity by recognizing both a duty to care for the sick and personal responsibility for maintaining our own health.

Cognizant of this first principle, we must improve access, affordability and quality of care for all United States citizens. Knowing the second, we are obligated to care for ourselves and family. Patients with stronger incentives to stay healthy could decrease expenditures associated with smoking, obesity, diet-controlled diabetes, atherosclerotic heart and peripheral vessel disease, strokes, alcoholism, and osteoporosis, to name a few.

If patients participated more directly in paying for their care, medical resource consumption would diminish. Patients paying at the point of service are more prudent purchasers of health care than those perceiving health-care benefits as an entitlement. They seek to be more informed. They ask more questions about quality, outcomes, and cost. Patients directly paying insurance premiums would lead to stronger demand for better service. The affluent elderly could bear more financial responsibility.

The Second Vatican Council defined the common good as, "the sum total of social conditions which allow people, either as groups or as individuals, to reach their fulfillment more fully and more easily." This precept contemplates the allocation of scarce resources. The common good would be better served with market-oriented reforms rather than expanding government or employer based health-care. Third-party responsibility for health care promotes resource overconsumption. The $250 billion federal tax subsidy for employer based health-care could be more justly deployed. Increasing insurance industry competition would improve affordability and quality, including allowing insurance purchase from states without expensive mandates.

The principle of subsidiarity places a duty on those closest to a need to provide care: "A community of a higher order should not assume the task belonging to a community of a lower order and deprive it of its authority. It should rather support it in case of need" (Catechism of the Catholic Church). Subsidiarity encourages assistance for those unable to access the health care market. It motivates care by those closer to the sick than government or employer.

Pope Benedict XVI recently stated, "we do not need a state which regulates and controls everything, but a State which .generously acknowledges and supports initiatives arising from the different social forces and combines spontaneity with closeness to those in need." Lower order groups such as community organizations, unions, and churches could help individuals and families purchase insurance at more competitive rates than on the individual market. Insurance obtained outside the workplace would be portable. Workers would be less susceptible to the double jeopardy of income loss and health care loss with layoff or job change. The doctor-patient relationship could be strengthened with less third-party intrusion by government, employer, or insurance carrier. Primary care physicians can assist their patients and families in cost conscious decision making, in addition to encouraging lifestyle and diet changes that can have tremendous impact on preventable or modifiable chronic disease.

Finally, the principle of solidarity concerns responsibility to the less fortunate. Health care reform will be judged by our commitment to the poor and vulnerable. We ought to love our neighbor, feed the poor, cloth the naked, and care for the sick (Mt 25:40). Vouchers or tax credits could facilitate access to the medical marketplace. A safety net for immigrants, the marginalized, and those with chronic disease, is necessary for those who might have still have difficulty obtaining insurance despite market-oriented reform.

Those advocating greater government control of health care ought to reflect on Pope Benedict XVI's 2005 encyclical Deus Caritas Est: "Love-caritas-will always prove necessary. the State which would provide everything, absorbing everything into itself, would ultimately become a mere bureaucracy incapable of guaranteeing the very thing which the suffering person-every person-needs: namely, loving personal concern." These social justice principles provide a foundation for a virtuous and economically sound improvement in medical resource allocation: a Christian prescription for health-care reform.

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14 February, 2009

In digitizing healthcare, patient privacy the battleground

The naifs below have totally missed the real problem: It won't work. The British have been trying to set up a similar computerized system for years but still have not got it to work properly.

The economic stimulus bill before Congress is certain to include billions of dollars to bring electronic record keeping to the healthcare industry, moving patients' records and doctors' prescriptions out of the era of carbon-paper triplicates and undecipherable handwriting. It's an efficiency that's expected to bring down healthcare costs and add jobs. But it's also a way for researchers and others working to improve overall healthcare outcomes to gain access to millions of patients' medical records – and therein lies the rub.

Lawmakers in the House and Senate are currently waging a battle over how to ensure that a patient's very private medical history is protected, even as they allot the money for an information technology (IT) system that makes widespread sharing of that history easier. "The two overarching goals … are to improve the privacy and security of health information, and at the same time, improve research using such information," says Bernard Lo, professor of medical ethics at the University of California at San Francisco at a press conference last week on the current medical privacy law.

For President Obama, the need to spend at least $20 billion over two years for an IT upgrade at clinics and hospitals is clear. "We're still using paper. We're still filing things in triplicate. Nurses can't read prescriptions that doctors have written out," he said Tuesday during a prime-time televised press conference. "Why wouldn't we want to put that on an electronic medical record that will reduce error rates, reduce our long-term costs of healthcare, and create jobs right now?"

Few in the healthcare industry would defend the status quo. In 2001, the Institutes of Medicine called for all healthcare records to be electronic by 2010. Today, only 14 percent of medical practices use electronic health records. The reasons are many: ranging from the high cost of computerizing thousands of offices to the need for staff training to the lack of standards that allow a computer in one office to talk to main frames in another. "Health IT is an important enabler to having a better health care system, but in and of itself it will do very little," says Gail Wilensky, a senior fellow at Project Hope, an international health education foundation. "We also have to be ready to take on some of the very difficult issues with regard to standards, terminology, and ... inter-operability."

The battle in Congress is over what kind of rules should guide that change – especially over ensuring privacy while striving for efficiency. A patient's medical history is vital to a healthcare provider's ability to provide high quality, efficient care. But privacy advocates contend that individuals should be able to control who can see their medical record and when. There is concern the information could be used by insurance companies or employers to discriminate, or that companies would mine the medical data for profit.

The need for patient confidentiality could conflict with the effort to improve overall outcomes. To understand which medical interventions work best, researchers need access to large databases that include the outcomes of particular treatments for various diagnoses. "The key depends in the long run on who owns and controls the patient record," says Marc Roberts, a professor of political economy and health policy at Harvard's School of Public Health. "Many healthcare systems are now intentionally building medical record systems that are nonstandardized and noncompatible so they can own and control the data." ....

More here




Australia: Private hospital emergency rooms soon to be covered by health insurance

Medical insurance in Australia normally covers hospitalization only -- with some ancillary benefits

THE nation's largest health insurer is planning to operate its own private emergency care centres, ending the up to 10-hour waits patients face for treatment in a public hospital, Medibank Private, which insures three million Australians, wants to set up the emergency centres staffed by specialised emergency doctors to serve its own members as well as other members of the public. Health insurers currently don't provide rebates for treatment in the 30 private hospital emergency centres operating around the country. And patients who use these private services often face bills of $200-$300. The situation has left health fund members with minor ailments such as broken bones with no option but to use a public hospital.

Medibank Private chief George Saviddes told The Daily Telegraph his fund was considering importing a system used in Ireland where private clinics have been set up to deal with the minor sprains, bone breaks and cuts that make up 80 per cent of public emergency work. All patients could use the centres but Medibank Private members would get most of their costs, estimated to average about $400 per patient, covered by their health fund. The fund is also looking at whether private hospitals would want to tender to provide the services.

The nation's choked public hospital emergency departments treated 6.7 million patients in 2007 but about 35 per cent of urgent and semi-urgent patients had to wait longer than recommended for care. It is estimated 40 per cent of emergency department beds are taken up by patients waiting for a bed in a hospital ward. The privately run and privately subsidised emergency care centres would help relieve some of the pressure on public hospitals.

Medibank will also later this year extend to NSW a program offering a free midwife to new mothers for the first month after the baby's birth. Health funds are also questioning why they cannot buy generic brands of hip and knee replacements that could help cut the cost of surgery for their members. These joints will cost one third less than newer branded prostheses and result in less complications and follow-up surgery.

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13 February, 2009

Authoritarian British medicine being evaded

Women should be allowed to have some say in their own risks but in Britain you are just expected to obey commands from on high. The vast majority of IVF births are fine with or without Britain's draconian restrictions

CHILDLESS British women who travel abroad to have up to four embryos implanted in their wombs have been given an official warning about the health risks. The "embryo tourists" are going overseas to circumvent rules on multiple IVF births. Some women return expecting triplets or quadruplets.

Professor Lisa Jardine, who chairs the Human Fertilisation and Embryology Authority (HFEA), says women are damaging their health and exposing their babies to harm. The authority says the women are also burdening the NHS by becoming pregnant with more than one baby. The watchdog is now investigating how to tackle the practice. Jardine said: "It is our job to make sure that this deeply felt need [for a child] does not result in people putting their health at risk. "People who seek treatment outside the UK often do so because they believe this will allow them to make choices about their treatment which are not available in the UK. These might include selecting the sex of their baby for nonmedical reasons, or having a higher number of embryos transferred, in spite of the widely recognised risks associated with multiple pregnancy. "My deep concern is that, in the belief that they are widening their choices, such people are also removing themselves from the help and protection that responsible regulation provides [That's a laugh1]. We are looking closely at whether there is more we could do to protect and inform those who choose to travel abroad for fertility treatment."

In the past few weeks, one woman has returned to Britain with quadruplets after fertility treatment in Israel, while last year a woman who returned to Leeds with triplets after fertility treatment in India lost all three babies.

Professor Alan Cameron, past president of the British Maternal Fetal Medicine Society and a consultant obstetrician at the Queen Mother's hospital in Glasgow, said: "I see the impact of this almost weekly. My colleagues in the neonatal units are going to hate me when I make that call to say we have triplets who look like they are going to appear early, and that has an impact on neonatal units and neonatal costs."

In Britain, a maximum of two embryos can be transferred to a woman below the age of 40. Women aged above 40 are allowed three embryos. The HFEA has, however, introduced quotas on the percentage of multiple births permitted at each clinic to make single embryo transfer the norm. From last month, only 24% of births at each clinic are permitted to be multiple births including twins, triplets and quadruplets. The percentage must drop to 10% in three years' time.

Adam Balen, professor of reproductive medicine and surgery at Leeds general infirmary, said: "[Multiple births] result in women coming into hospital, sometimes for many weeks on end because of threatened premature labour." Balen, who is also a spokesman for the Royal College of Obstetricians and Gynaecologists, said: "The reality of a premature delivery is babies born who need neonatal intensive care and run the risk of either sadly dying or being left with a significant handicap such as cerebral palsy."

The Medical Board of California is investigating the fertility treatment given to Nadya Suleman who gave birth to octuplets last month. Suleman, 33, who has six other children through fertility treatment, had six embryos transferred at a clinic in California. Two of them split to create the octuplets. American Society for Reproductive Medicine guidelines say only one or two embryos should be implanted in a women of Suleman's age. The octuplets, although apparently healthy, were born nine weeks prematurely by caesarian section and are expected to remain in hospital for several more weeks.

Mandy Allwood, the British mother who became pregnant with octuplets in 1996 after taking fertility drugs without medical supervision, lost all eight babies. Allwood, who has since attempted to take her own life, has spoken of her mixed emotions at the safe birth of the American octuplets.

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12 February, 2009

'Too Old' for Hip Surgery

As the USA inches towards nationalized health care, important lessons from north of the border.

President Obama and Congressional Democrats are inching the U.S. toward government-run health insurance. Last week's expansion of Schip -- the State Children's Health Insurance Program -- is a first step. Before proceeding further, here's a suggestion: Look at Canada's experience. Health-care resources are not unlimited in any country, even rich ones like Canada and the U.S., and must be rationed either by price or time.

When individuals bear no direct responsibility for paying for their care, as in Canada, that care is rationed by waiting. Canadians often wait months or even years for necessary care. For some, the status quo has become so dire that they have turned to the courts for recourse. Several cases currently before provincial courts provide studies in what Americans could expect from government-run health insurance.

In Ontario, Lindsay McCreith was suffering from headaches and seizures yet faced a four and a half month wait for an MRI scan in January of 2006. Deciding that the wait was untenable, Mr. McCreith did what a lot of Canadians do: He went south, and paid for an MRI scan across the border in Buffalo. The MRI revealed a malignant brain tumor.

Ontario's government system still refused to provide timely treatment, offering instead a months-long wait for surgery. In the end, Mr. McCreith returned to Buffalo and paid for surgery that may have saved his life. He's challenging Ontario's government-run monopoly health-insurance system, claiming it violates the right to life and security of the person guaranteed by the Canadian Charter of Rights and Freedoms.

Shona Holmes, another Ontario court challenger, endured a similarly harrowing struggle. In March of 2005, Ms. Holmes began losing her vision and experienced headaches, anxiety attacks, extreme fatigue and weight gain. Despite an MRI scan showing a brain tumor, Ms. Holmes was told she would have to wait months to see a specialist. In June, her vision deteriorating rapidly, Ms. Holmes went to the Mayo Clinic in Arizona, where she found that immediate surgery was required to prevent permanent vision loss and potentially death. Again, the government system in Ontario required more appointments and more tests along with more wait times. Ms. Holmes returned to the Mayo Clinic and paid for her surgery.

On the other side of the country in Alberta, Bill Murray waited in pain for more than a year to see a specialist for his arthritic hip. The specialist recommended a "Birmingham" hip resurfacing surgery (a state-of-the-art procedure that gives better results than basic hip replacement) as the best medical option. But government bureaucrats determined that Mr. Murray, who was 57, was "too old" to enjoy the benefits of this procedure and said no. In the end, he was also denied the opportunity to pay for the procedure himself in Alberta. He's heading to court claiming a violation of Charter rights as well.

These constitutional challenges, along with one launched in British Columbia last month, share a common goal: to win Canadians the freedom to spend their own money to protect themselves from the inadequacies of the government health-insurance system.

The cases find their footing in a landmark ruling on Quebec health insurance in 2005. The Supreme Court of Canada found that Canadians suffer physically and psychologically while waiting for treatment in the public health-care system, and that the government monopoly on essential health services imposes a risk of death and irreparable harm. The Supreme Court ruled that Quebec's prohibition on private health insurance violates citizen rights as guaranteed by that province's Charter of Human Rights and Freedoms.

The experiences of these Canadians -- along with the untold stories of the 750,794 citizens waiting a median of 17.3 weeks from mandatory general-practitioner referrals to treatment in 2008 -- show how miserable things can get when government is put in charge of managing health insurance.

In the wake of the 2005 ruling, Canada's federal and provincial governments have tried unsuccessfully to fix the long wait times by introducing selective benchmarks and guarantees along with large increases in funding. The benchmarks and the guarantees aren't ambitious: four to eight weeks for radiation therapy; 16 to 26 weeks for cataract surgery; 26 weeks for hip and knee replacements and lower-urgency cardiac bypass surgery.

Canada's system comes at the cost of pain and suffering for patients who find themselves stuck on waiting lists with nowhere to go. Americans can only hope that Barack Obama heeds the lessons that can be learned from Canadian hardships.

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11 February, 2009

Rough NHS dentists kill little girl

Careless and arrogant treatment all along the line here. You are just cattle to government employees

An eight-year-old girl starved to death after developing an extreme phobia of dentists and refusing to open her mouth, an inquest has been told. Sophie Waller, from Cornwall, England, was so traumatised by a visit to the dentist that she refused to open her mouth to talk or eat.

Sophie’s extraordinary fear first developed when, at age four, a dentist accidentally cut her tongue during a check-up. Her fear became so extreme that when she needed a tooth removed four years later, she was taken to hospital. But doctors made the situation even worse by removing eight of her milk teeth. She was so traumatised by that procedure she had to be fed through a tube.

“She had blood running all down her face... It was very scary for her," her mother Janet told The Daily Mail. "She soon needed a feeding tube because she stopped eating and drinking.” “I signed a form to consent to have one tooth being removed, but not eight."

Despite her refusal to eat, Sophie was discharged from hospital. Her parent’s pleas for her to be readmitted reportedly fell on deaf ears. Doctors referred her to child psychologist Kerry Davison, who allegedly told them “not to worry”. Two weeks after leaving the hospital Sophie weighed less than 25kg. She died of acute kidney failure in December 2005, a post mortem examination revealed.

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10 February, 2009

NHS boss Lynda Hamlyn angry at organs for foreigners

Special treatment for the rich -- exactly what the NHS was founded to eliminate

A LEADING National Health Service hospital has come under attack from the government's transplant authority for giving livers from dead Britons to overseas European Union patients in private operations. More than 40 procedures using organs from British donors have been carried out on foreigners at King's College hospital, London, over two years. According to NHS Blood and Transplant (NHSBT), the trade undermines Gordon Brown's œ4.5m attempt to increase organ donations and creates an "obvious potential conflict of interest". It accused King's of "a persistent lack of clarity" over the trade. The criticisms appear in correspondence released to The Sunday Times under the Freedom of Information Act.

Lynda Hamlyn, chief executive of NHSBT, wrote in one letter to the hospital: "This is the third specific issue of concern raised by UK Transplant [part of NHSBT] over the past four years about the transplantation of livers from deceased UK donors into nonUK residents undertaken on a private basis at King's. "People joining the organ donor register and families giving consent for organ donation need to be completely confident that UK residents . . . are treated fairly."

In one week following publication in The Sunday Times last month of figures on private transplants given to foreigners at King's, 22 people withdrew their names from the organ donor register in protest. Tim Smart, chief executive, denied King's College Hospital NHS Foundation Trust had failed to give clarity. He said EU patients had the same legal entitlement as British patients to receive donated organs.

SOURCE




Australia: Queensland public hospital system employed a doctor who was 'unemployable in US'

There were obviously zero checks made on his application. Queensland Health is such a noxious bureaucracy to work for that they will take anyone willing to work for them. The Queensland "free" hospital system was established in 1944 so it shows where such a bureaucracy ends up. It is a slowly metastasizing social cancer -- now with three bureaucrats for every clinical employee

Surgeon Jayant Patel was virtually unemployable in the US and lied to gain employment in Australia where he now faces criminal charges. The Magistrates Court in Brisbane heard Patel had a long history of disciplinary hearings in New York and Oregon before he was recruited as the director of surgery at Bundaberg Base Hospital. Patel, 58, who worked at the hospital between 2003 and 2005, is facing a committal hearing on 14 charges including the manslaughter of James Phillips, Mervyn Morris and Gerardus Kemps. He also faces fraud and grevious bodily harm charges.

Prosecutor Ross Martin SC recounted a history of disciplinary actions taken by American medical bodies against Patel dating back to 1984. The actions included a stayed suspension of his licence to practise and restrictions on his ability to perform certain surgery. Mr Martin said by 2001 Patel also needed to get second opinions on difficult surgery.

He said Patel had resigned from a major hospital in the American state of Oregon in September, 2001. Mr Martin said authorties in New York also reviewed Patel's status and he eventually surrendered his licence to perform surgery in New York. Patel applied for a job in a small town named Harney, Oregon, which had a hospital with just 25 beds. Patel failed to get the job.

Mr Martin then detailed how Patel was put in contact with Queensland Health authorities through a recruiting company. It was alleged Patel failed to tell the truth about his hisory in the US when gaining the necessary clearance to work in Australia. Mr Martin said it was further alleged Patel lied again when his registration in Australia was extended until he left in March 2005.

In the case of the manslaugher charge involving Mr Phillips, it was alleged Patel had not consulted a speciaist, Patel was restricted in the US on performing that type of operation, the operation was un-necessary and it was badly performed. Mr Martin said in the second manslaughter charge of Mr Morrs, Patel performed surgery when he was under USA restrictions, there had been an incorrect diagnosis, it was the wrong procedure, and there were mistakes in post operative procedures. Patel had also performed the wrong operation in the third manslaughter charge involving Mr Keeps, it was again under USA restrictions, and it had been inappropriate to perform the operation in the Bundaberg Hospital.

Mr Martin said one of the two operations on Mr Keeps had been performed in a negligent manner as Patel had not acted to stop internal bleeding. The court heard Patel had removed the bowel of a patient Ian Volwles when there was no need for the operation. Mr Martin said Patel had treated Mr Vowles for cancer but a later biopsy showed no signs of cancer. Patel faces a charge of grevious bodily harm for his operation on Mr Vowles.

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9 February, 2009

Equipment shortage at major NHS children's hospital killed baby

The parents of the five-week-old baby who died from a suspected hospital blunder believe her death may have been caused by a lack of equipment at London's world-famous Great Ormond Street Hospital. Poppy Davies was admitted for a minor operation on Friday, January 9, but was left brain-damaged and paralysed after a junior nurse administered an overdose of glucose. She died last Sunday after her parents had her life-support machine switched off.

Poppy's father, David Daly, 21, has now told The Mail on Sunday: 'Staff told us someone was using the wrong piece of equipment because the right one wasn't available.'

An inquest was opened and adjourned last Thursday, and Mr Daly and his partner, Carly Davies, 22, must wait until May to find out exactly how their daughter died. Carly, from Grays, Essex, said: ' It's Great Ormond Street and knowing they've helped so many other children makes it difficult to be too angry. Mistakes can be made but you can't afford to make mistakes in circumstances like this.'

Poppy was born prematurely at Basildon Hospital, Essex, but moved to Great Ormond Street for surgery to close a blood vessel in her heart. The operation went well but the next day she was allegedly given up to 75 times the recommended dose of glucose solution.

Her father, a fireplace fitter, said: 'We want to find out what happened but nothing's going to bring her back.' Last night a spokesman for Great Ormond Street said: 'We're investigating a number of possibilities as to what went wrong.'

SOURCE




Australia: New South Wales public hospital's $75m in unpaid bills

NSW public hospitals have officially hit rock bottom, producing their worst financial results on record. The NSW Health annual report, to be tabled in Parliament next month, reveals all the State's health services blew their budgets during 2007-08, plunging them into unprecedented debt. In total, health services overspent by $159.4 million - a result 500 per cent worse than in the previous year. Despite this, patients are being forced to wait longer for beds and more medical mistakes are being made.

The disastrous results have prompted the State Government to declare a crackdown on spending and tighter monitoring of budgets. But staff cutbacks [not including "essential" personnel such as clerks, managers and "administrators", of course] are likely to have a detrimental impact on services to patients this financial year. The Northern Sydney and Central Coast regions sank deepest into the red, racking up debts of $63.3 million - more than double the total health service overspend in 2006-07. The debt-laden Greater Western and North Coast area health services each went over budget by about $30 million.

Unpaid bills also reached new highs, leaving businesses that supply hospitals struggling to stay afloat. The value of accounts not paid within a benchmark of 45 days skyrocketed from zero in 2007 to $75.1 million in 2008. South Eastern Sydney Illawarra was the worst offender, owing creditors $24.3 million. Greater Western had not paid $20.9 million and Greater Southern accumulated bills of $12.7 million. This is the worst level of creditor payment on record -- and the figure has increased since results were compiled. Last week, NSW Health admitted the total amount owed to creditors was now at $117.5 million.

The report also revealed worrying slumps in key performance indicators. One in four patients waited more than 30 minutes to be offloaded from an ambulance at emergency departments. This transfer, described as "a challenge", is supposed to be as quick as possible to improve a patient's chance of survival and ambulance efficiency. Nearly a quarter of emergency department patients waited more than eight hours for an inpatient bed.

Mistakes are also on the rise. There were 583 serious safety incidents "in which death or serious harm to a patient has occurred", the highest figure in at least five years. NSW Health claimed, however, this was because of a change of definitions and better reporting. There were also more incorrect procedures, including surgery mistakes, and more deaths of hospital patients in falls.

Overall, NSW Health's expenses amounted to a record $13.12 billion in 2007-08 - nearly $36 million a day.

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8 February, 2009

Lives put at risk by lack of new X-ray facilities, claims senior British doctor

Patients are being denied a life-saving X-ray treatment because of the way NHS funding works, claims the country's most senior radiologist.

Interventional radiology can be used in a range of procedures from destroying cancerous tumours to stemming blood loss in women after childbirth. But the head of the Royal College of Radiologists said many hospitals are unable to offer an adequate service. "The irony is that this would save money by preventing more costly and complicated surgical interventions being carried out," said Professor Andy Adam who is calling for an urgent review of funding for the technique. He claims that because the treatment, known as IR, comes out of the relatively small radiology budget and not the larger surgical one, it means that the technique is not being employed enough. He is calling for an increase in the number of designated posts for trained IR professionals.

IR - sometimes known as "pinhole surgery" - uses images from X-ray or ultrasound to guide the doctor to the exact site of the problem. The blood supply to tumours can then be cut off and radio frequency heat used to effectively "cook" the growth. Arteries can also be blocked to stop internal bleeding after an accident, or a haemorrhage in women caused by childbirth.

"At the moment there is a genuine postcode lottery when it comes to accessing this service - and it could genuinely save lives," Professor Adam said. "Surgery to stop internal bleeding in someone who has had a major accident is much riskier than using interventional radiology."

Virginia Beckett, a spokesman for the Royal College of Obstetricians and Gynaecologists, agreed that interventional radiology "was not available as it should be". "It may not be possible for every hospital - and it's not always practical in an emergency - but there should at the very least be regional centres where such treatment can be obtained - it shouldn't be the struggle to organise which is currently is."

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7 February, 2009

British man pulls out 13 of his own teeth with pliers 'because he couldn't find an NHS dentist'



A former soldier pulled his own teeth out with a pair of pliers because he could not find a dentist to take on NHS patients. Iraq War veteran Ian Boynton could not afford to go private for treatment so instead took the drastic action to remove 13 of his teeth that were giving him severe pain. The 42-year-old, from Beverley, East Yorkshire, had not had his teeth looked at since seeing the army dentist in 2003. He had not been registered with a dentist of his own since 2001.

He said: 'I've tried to get in at 30 dentists over the last eight years but have never been able to find one to take on NHS patients.' But when Mr Boynton started suffering from toothache in 2006 he decided to take drastic action. He said: 'I started having pain in a front tooth, which protruded slightly more than the others. I was constantly fiddling with it and wiggling it because it hurt so much. 'In the end I knew it had to come out and had to use the pliers to pull it. Amazingly, it did not hurt as much as you might think. 'I think I'd been prising it that much in the meantime that I'd been killing the nerve.'

In the last two years Mr Boynton has pulled out 13 top teeth including molars, incisors and canines. He now only has two teeth left in the roof of his mouth. He served as a medic in Iraq in 2003, but six months after leaving the Territorial Army had an accident while working as a paint sprayer that aggravated an old back injury.

Unemployed Mr Boynton, who is single, said: 'It's a horrible situation to be in when you can't afford to go to the dentist when your teeth were so bad.' In a stroke of ill-timed luck he has now finally found a dentist to take him on. Mr Boynton said: 'I think the situation has improved slightly because of all the uproar. Unfortunately it came too late for me. 'I desperately needed a dentist because, although I'm no longer in pain, I need to have false teeth as I'm finding it difficult to eat. 'Unfortunately I can't make false teeth myself.'

SOURCE




Australia: Bundaberg Hospital inquiry 'ignored' central witness

In my post yesterday I ridiculed on principle the internal "Inquiry" that had dismissed the complaints about Bundaberg hospital. We see now below that I was exactly right to do that

QUEENSLAND Health dismissed serious allegations of assault and negligence at Bundaberg Hospital without speaking to the key witness, it is alleged. In The Courier-Mail yesterday, Health Minister Stephen Robertson said allegations a baby had been assaulted and an elderly man left to die on a trolley in a hallway had been investigated by the Queensland Health Ethical Standards Unit and "found not to have been sustained".

However, the nurse at the centre of the controversy claims she has not been contacted by the unit. "No one from the ethical standards unit has ever contacted me - not ever. Not by phone or letter or in person," she said. "And never once did a manager at Bundaberg come back to me and say, 'Let's look at your evidence'." The highly qualified nurse has made a series of startling allegations against the hospital, including the falsifying of records, understaffing, bullying, and gross medical neglect.

Following pressure from Rob Messenger (LNP, Burnett), Mr Robertson confirmed he had referred the case to the Health Quality and Complaints Commission. He also said 3000 complaints logged at the hospital in the past three years would be reviewed by Queensland Health's patient safety centre. As well, Dr Stephen Ayre, executive medical director of Prince Charles Hospital, will investigate the 100 complaints by the whistleblower.

Mr Robertson said claims of falsified triage times would be investigated after the Crime and Misconduct Commission and the Queensland Health Ethical Standards Unit, and investigations into emergency department and triage times would be completed by February 23, with the report to be released publicly. Mr Robertson rejected the hospital was understaffed and said 33 extra doctors, 114 extra nurses and 127 extra allied health professions had been appointed since 2005.

The controversy took another strange twist yesterday when the Director-General of Health, Mick Reid, was reported to his own ethical unit for allegedly using explicit language. Mr Messenger, the MLA who raised the allegations, claimed Mr Reid used the unsavoury language during a meeting in Bundaberg with the whistleblower. Mr Messenger said in a reply to a comment about the whistleblower's career prospects, the Director-General said "If you want to say to me f*** off I'm going to go and do something else, that's great". Mr Reid apologised last night for his choice of language. "I'm not aware that the nurse or her partner were offended by the language I used, but I reiterate that I am sorry for any offence I may have inadvertently caused," Mr Reid said.

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6 February, 2009

AUSTRALIA: THE PUBLIC HOSPITAL MELTDOWN CONTINUES

Brisbane hospitals turn away emergency patients

The lack of public hospital capacity has caused overflows at private hospitals too

The emergency room meltdown that created chaos across Brisbane hospitals yesterday looks set to continue today with two hospitals already in strife. Shortly before 7.30am Wesley Hospital was placed on bypass until further notice and Caboolture Hospital has issued a capacity alert. The situation is expected to continue to midday, meaning paramedics can expect lengthy delays at the hospital and should take patients elsewhere. Yesterday half a dozen emergency rooms at major hospitals were forced to turn away patients on the same day because they were full. Six hospitals around the city issued capacity alerts as a flood of high priority patients threatened to overwhelm services stretched to the limits.

The chaos left stressed ambulance officers trying to care for people in their vans. The drama began at 8.30am when Queensland Ambulance Service was advised the Royal Brisbane and Women's Hospital was on "patient bypass", with all except for trauma or critically ill patients being redirected to other hospitals. Twenty minutes later, QAS was advised Redland Hospital was also experiencing significant delays and paramedics were told to use other facilities. At noon, the RBWH was able to accept patients again, but then The Wesley Hospital was put on complete bypass until midnight, meaning it could accept no emergency patients. Then for varying periods during the day the Princess Alexandra, Logan and Redcliffe hospitals were all placed on high-capacity alert.

A Queensland Health spokeswoman said the peak in demand could not be put down to any particular event, but rather was due to a coincidence of a large number of high priority patients presenting at once.

A frazzled nurse from the Wesley, who withheld her name for fear of losing her job, described the situation as "meltdown". "Today is out of control, our departments are in complete meltdown," the nurse said. "What is scary is that there is no good reason for it - it isn't a terribly hot day, it isn't flu season, there is no outbreak of disease, we just don't have enough resources."

Ambulance union spokesman Kroy Day said the lack of hospital resources meant it was "only a matter of time before someone dies in a van". He warned that having multiple hospitals on capacity alerts meant paramedics could be left caring for patients in their vans for up to four hours. "If this is what we are seeing on a mild summer's day, I hate to imagine the trouble we'll be in when flu season rolls around," he said.

When asked about the RBWH being on bypass, Health Minister Stephen Robertson blamed a record amount of elective surgery patients.

SOURCE

Angry doctor throws baby at Qld. public Hospital

A baby at a Queensland hospital was assaulted by a doctor who lost his temper when the child wouldn't stop wriggling, and an elderly patient was left to die in a hallway after being denied proper treatment, according to allegations made to the Crime and Misconduct Commission. Three hospital staff have sought whistleblower protection after detailing allegations of gross medical neglect and incompetence, overcrowding, bullying, intimidation and cover-ups at the Bundaberg Hospital.

A highly qualified nurse who spoke to The Courier-Mail told how she was repeatedly made to falsify records to hide lengthy waiting times in the emergency department. She said triage cases were improperly and dangerously downgraded because of understaffing. She said a troubled teenager who waited five hours without seeing a doctor ran away and slashed her wrists. And a doctor said he was too busy to see a boy who had been stabbed in the leg in a suspected child abuse case. The cases are among 100 serious and minor procedural errors on the hospital's prime reporting database.

Dismissed as a troublemaker and frustrated at the lack of response, the nurse and two others took complaints to Burnett MP Rob Messenger, who first raised allegations against the hospital in Parliament in 2005. "They have made allegations which lead me to reasonably suspect misconduct by a number of public officials," Mr Messenger said. He called for an inquiry, saying it was clear patients and employees of Bundaberg Hospital were "in continuing danger of physical and psychological danger".

The CMC was told the doctor threw the baby on its back and twisted its arm after angrily shouting, "Keep him still". It is believed the child suffered bruising but was not seriously hurt. The elderly man who died on the trolley was refused acute care after his triage rating was downgraded.

"Good nurses and doctors and administration officers who work miracles every day are being placed under unbelievable pressure by a government that won't properly resource staff," Mr Messenger said. He said the $41.1 million upgrade promised by the Beattie-Bligh governments had not happened. "They have spent $8.6 million and instead of the 30 extra beds promised, we got five. There is clear evidence of understaffing and underfunding." Mr Messenger said there were more beds at Bundaberg hospital in 1969 than there were now.

The nurse making the allegations said she believed nothing much had changed at Bundaberg since events that sparked a royal commission. "Patients are still abused and refused proper treatment, and they still have the gall to smooth the whole disgusting mess over with half-truths and convenient forgetfulness," she said.

SOURCE

Clerks 'given nurses' duties' at notorious Bundaberg Hospital

Lots of covering up going on but some whistleblowers are coming out. An independent enquiry is needed

CLERKS with no medical training were allegedly made to bandage wounds and assess patients at Bundaberg Hospital's emergency department. The clerks were also asked to perform other nursing duties such as putting ice on patients suffering strains, the Crime and Misconduct Commission has been told.

The Courier-Mail reported yesterday that staff at the hospital sought official whistleblower protection after detailing allegations of gross medical neglect and incompetence, overcrowding, bullying, intimidation and cover-ups. The couple at the centre of the latest allegations successfully sued the hospital, said Julie Bignall, state secretary of the Australian Services Union clerical division. "We pursued work cover claims for stress and psychological injury," she said. "Their WorkCover claims got up. They are now keen to go back to work." Ms Bignall said she was annoyed the allegations against the hospital had been made public by Member for Burnett Rob Messenger.

He took detailed accounts of hospital shortcomings to the CMC. There were allegations a doctor had cruelly mistreated a baby and at least one elderly patient had been left to die on a trolley. Mr Messenger said it was his duty to expose misconduct and accused the union of pressuring whistleblowers to withdraw their statements to the CMC.

Ms Bignall denied this. "We didn't put pressure on them," she said. "We just don't recommend they go to politicians."

The controversy widened yesterday when more nurses came forward with specific allegations against the hospital. There were also fresh claims that staff complaints and patient records had been manipulated to hide hospital shortcomings.

Mr Messenger said he spoke to another nurse who claimed she was denied promotion because she gave evidence at an earlier inquiry. "It's payback time for her," he said.

State Health Minister Stephen Robertson said the allegations were being taken seriously. He said two cases, that an elderly man had been left to die and a doctor had assaulted a baby, were both investigated 12 months ago. "They were investigated at the time they were made by the Queensland Health Ethical Standards Unit [The notoriously corrupt Queensland Health bureaucracy investigating itself! What a laugh!] and they were found not to have been sustained," he said. But heads would roll if health investigators found there had been cover-ups, he said

Opposition Leader Lawrence Springborg questioned how Mr Robertson as the minister did not know of the claims when they came up. "They of course are troubling allegations and the CMC needs to investigate them," he said.

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5 February, 2009

Little girl lost both legs because of careless, lazy and incompetent NHS doctors

Jodie Cross looked on in despair as her daughter Lydia was violently sick again. She knew the two-year-old was seriously ill, but she was facing an uphill battle to prove it. Lydia had appeared unwell three days earlier, on a Friday evening. When her father Tony, a policeman, took her to see an out-of-hours doctor, he diagnosed a virus and said there was nothing to worry about. By Sunday, the little girl's condition had deteriorated. This time, a different doctor diagnosed an ear infection. 'He prescribed antibiotics, even though I said Lydia wouldn't be able to keep them down as she was vomiting repeatedly,' says Jodie. 'He said: "Yes, but they will make you feel better" - as if I was being neurotic.'

Now it was Monday morning. Lydia's temperature had soared and she was hallucinating - she thought spiders were crawling all over her body. Jodie was particularly concerned because Lydia's baby sister Millie, then seven months, had just spent two weeks in hospital, critically ill with septicaemia and suspected meningitis, although the latter was never confirmed. Jodie was terrified Lydia had caught it, too.

At 10am, she rang the Gable House Surgery in Malmesbury, near the family home in Wiltshire. 'I asked for a home visit and was told matter-of-factly: "That's not our policy." 'I was really shocked. Lydia was far too ill to go out, and I expected a doctor to be sent to such a young child straight away. I know doctors are reluctant to do home visits these days, but I wouldn't have requested one if it wasn't urgent.'

Jodie, now 39, insisted on speaking to a doctor. When a doctor she didn't know called back, she explained what had happened over the weekend. 'He was very arrogant and reluctant to come out - he wanted me to take Lydia to the surgery. I explained that her sister had just been critically ill with blood poisoning and suspected meningitis, and said that Lydia had been hallucinating and vomiting. 'But he was certain it was only a virus, and told me to call back if I was still worried.'

They struggled to keep Lydia cool with a fan and Calpol. Then, when Jodie tried to bath her, she became even more concerned. 'Lydia didn't seem able to sit up,' she says. By 2.30pm, frantic with worry, Jodie called the GP practice again and asked for an emergency appointment. There wasn't one until 4.45pm - but when Tony took Lydia, a passing nurse saw how ill she was and fetched the doctor straight away. He took one look at her and called an ambulance.

'Tony rang from the ambulance to say Lydia was really poorly. I was shaking all over because I'd told the doctors this, but they'd said it was just a virus.' In fact, Lydia had meningitis and septicaemia, and was fighting for her life. Five weeks after becoming ill, both her legs were amputated below the knee because blood poisoning had killed the soft tissue. One of the effects of blood poisoning is that blood flow is diverted away from the extremities to the vital organs, so the arms, legs, hands and feet can be starved of blood and the tissue can die. Incredibly, doctors discovered that the bacteria responsible was a different strain from the one her sister had.

What is worrying is that too often meningitis is missed: Lydia's story is one of a number of similar misdiagnoses that have made news over the past few years. Only two weeks ago, the Mail reported the case of an 11-year-old, Colette Smith, who was sent home from A&E by a doctor who dismissed her symptoms, only for her to be rushed back the next day in an ambulance. In fact, research funded by the Meningitis Research Foundation has found 49 per cent of children taken to a doctor with potentially fatal meningitis and septicaemia were sent home because the signs were missed. Now the charity has produced booklets and a CD-ROM to help doctors diagnose and treat bacterial meningitis and septicaemia earlier.

Some experts believe the poor quality of cover provided by GP out-of-hours services is partly to blame, Lydia's case also highlights the terrible consequences of the decline in the GP home visits. Although there are no official statistics, anecdotally the number of home visits is declining, admits Dr Richard Vautrey, deputy chairman of the British Medical Association's GP committee. 'Fewer patients ask for visits these days,' he says. 'They tend to get an urgent appointment instead. 'We want to see patients as quickly as possible, and the best way is often to encourage them to come to the health centre. It's much easier to examine patients properly there, because you have all the right equipment.'

The fact is, doctors often don't want to make home visits, explains Michael Summers, vice-chairman of The Patients' Association. 'Although most doctors still do home visits when needed, you do get some who are no longer interested.'

Dr Vautrey admits there are pitfalls in giving advice over the phone. 'Meningitis is notoriously difficult to diagnose in the early stages,' he says. 'It will look like a simple virus at first, but can develop dramatically within hours. If people are concerned, they should not hesitate to call a doctor back repeatedly.' As the Cross family did - but to no avail.

'When I was a child, my GP knew my parents weren't neurotic and only asked for a home visit if something was seriously wrong,' says Jodie. 'The same is true of me and Tony.' The consequences of their GP's refusal to make a home visit were horrifying. When Jodie arrived at Bristol Royal Infirmary, where Lydia had been taken, she was told her daughter had stopped breathing in the ambulance. Lydia was by now so ill that her mother wasn't allowed to see her. Her parents were told that even if their daughter survived - at this stage, the doctors were fighting desperately to save her life - she might lose not only her legs but her arms.

'My first thought was of Lydia's favourite cuddly toy, a cow called Woosie,' recalls Jodie. 'When she was tired, she held Woosie against her cheek. What would she do if she couldn't hold Woosie? How could she do anything she loved?

'When we saw her, we barely recognised her because her nose, cheeks, lips, arms and legs were dark purple and swollen. A plastic surgeon had to make slits in the skin on her legs and feet because otherwise the skin would have split, and we were warned she might lose the tip of her nose, cheeks and lips, as well as her limbs. 'It was horrific. I just held her poor, bruised hand and cried. I couldn't bear to think about what might happen to my beautiful little girl.'

Jodie visited the hospital chapel daily. 'I would sit and cry and pray. I even wrote a letter to God saying he'd let us keep one daughter, please do the same with the other.' Mercifully, on her twelfth day in hospital, Lydia was well enough to come off life support. 'Of course, we were distraught - more than Lydia herself was - when we were told she'd lose her legs,' says Jodie. 'But she was lucky to be alive.'

Five years after Lydia's illness, her family, who now live in Braunton, Devon, won a fight for compensation. The High Court heard that if a doctor had seen Lydia when Jodie first called, and sent her to hospital just an hour-and-a-half earlier, her legs could have been saved. The court ruled that given her age, deterioration and her parents' ongoing concern, Lydia should have been seen at home. The GP - Dr John Harrison - admitted that, in the circumstances, he should have visited the two-year-old, although he disputed whether it would have made a difference to the outcome.

His medical insurers agreed to settle the case on the basis of 85 per cent liability, and the family was awarded a six-figure compensation sum. This money is being held in a court trust fund to provide for Lydia's needs, including prosthetic legs. Her first pair were provided by the NHS.

However, life is still far from easy for Lydia. Now aged seven, she has to have surgery every year because the bones in the stumps below her knees still grow, forming points that have to be trimmed, otherwise they cause pain and infection. This means that every year she spends three months in a wheelchair. 'Lydia's very positive, but there are times she wishes her legs were real. A few months ago, she asked to wear her legs in bed so she could be "a real little girl" in the morning, like Millie. When she woke up in the night uncomfortable, she cried because she wouldn't be a "real little girl" after all.'

In the meantime, the couple are campaigning for more paediatric training, so healthcare workers can diagnose devastating illnesses such as meningitis and septicaemia immediately. And they are adamant about what parents should do. 'My advice is if you're worried about your child, don't assume the doctor knows best,' says Jodie. 'Pester your GP for a home visit, and if they won't come, dial 999.'

A spokeswoman for Dr Harrison said: 'He would again like to apologise to Lydia and her family for the distressing time they have had to endure over the past four years. Although he did the best he could for Lydia at the time, he now realises that he could have done more for her.' A Department of Health spokeswoman said: 'Health services locally are under a legal obligation to provide home visits for those who need them. What happened in this case is clearly unacceptable.'

SOURCE





4 February, 2009

Take control, public hospital patients urged

The article below is from Australia but there is no doubt that it could equally well apply to Britain

Don't expect Mohamed Khadra's new book to be comforting reading if you're about to go into hospital. The author of the acclaimed Making the Cut and a professor of surgery at the University of Sydney, he is about to publish a follow-up that makes crystal clear the fact that unappealing food is the smallest of the many hazards facing patients admitted onto public wards. The new book, called The Patient, is being published next week. It tells the story of a fictional male professional, Jonathan Brewster, who discovers mid-career that he has a bladder cancer. The book follows him through the various stages of his treatment, noting in pitiless detail along the way the impersonality of the health system, the strains it places on the legions of dedicated yet sleep-deprived staff, and also the unprofessional attitudes of some doctors and nurses.

It also documents the cavalcade of cock-ups, major and minor, that go on behind the scenes. But while the story is fictionalised -- like Brewster, the Victoria Hospital in which it is set does not exist -- The Patient is not fiction. Khadra, the book's sole real character, says most of the things that happen to the unfortunate Brewster and to others within the hospital are drawn from real-life experience.

The book confronts head-on the "corruption" of the health system: the fact that patients handed a cancer diagnosis who need an urgent specialist's appointment can effectively jump the queue, simply by having the right social connections -- while other patients without strings to pull have to wait weeks or months.

It spells out the extreme patient-unfriendliness of a system that can bandy about terms such as "triage" that barely a handful of people understand. It scores in painful detail the rudeness of some doctors, nurses and other staff; the clock-watching, officious culture of the newer breed of nurses, and the madness of a health bureaucracy that alienates its own permanent nursing and medical staff by paying double rates to last-minute agency fill-ins.

Perhaps most tellingly, the book exposes the extraordinary lack of compassion that can be found in every corner of the system -- from the receptionist who keeps a pain-wracked patient on his feet while she slowly fills in a form, to the haughty consultant whose aloof arrogance scarcely conceals his disdain for public patients, who he believes contribute less to his income and prestige than those paying privately.

Khadra -- who received a huge response to the criticisms of the health system in his previous book -- says a prime motivation for writing The Patient was to help patients understand better what a spell in hospital involves. "Day in, day out, I sit across the desk from people who are planning their next holiday, they've just been married, they've just bought a house, they've just started a new job -- and I look down at a piece of paper that has words on it or numbers on it that are radically going to change their life for the worse over the next couple of years, or even curtail their life," Khadra says. "And I find people just aren't prepared. They have this sense that the health system is a benevolent creation of the government that will look after them; they aren't prepared spiritually, they aren't prepared physically and financially."

But it's also a call to arms. Khadra himself has been a patient, after being diagnosed 10 years ago -- just as he and his wife had bought a new house, were raising two boys, and as their careers were taking off -- with a thyroid cancer that had already spread to his chest and neck. "I had an extensive period of treatment," he recalls. "And what I saw of the health system then, and what continues -- if anything -- to get worse over the ensuing 10 years, is a health system that ... doesn't deliver compassionate health care to people most in need. "And my basic feeling is that what has occurred in the 20-year period since the 1980s, when I trained, is a cancerous growth in the bureaucracy of health. "The basic aim of the bureaucracy is to avoid making mistakes. And what that creates is a paralysis of decision-making throughout the system that now has kneecapped every single hospital general manager, health leader, and nursing leader."

Such a critique could not come at a more poignant time: NSW Health and its minister, John Della Bosca, have been deeply embarrassed this week by further revelations of chronic late payment of debts -- to the extent that some tradesmen and suppliers of drugs, food and other consumables are refusing to deal with hospitals in the west of the state. It chimes with Khadra's own experience. He tells of a general manager of one hospital he worked at who was unable to spend just $55 on a medical textbook without getting clearance from the central health department.

At the ward level, Khadra says the solution is to take the power away from the bureaucrats and give it instead to the clinicians and managers within each hospital who would then once again have the power, and incentive, to ensure their own units ran efficiently.

In a different way, power should be claimed by the patients themselves. "There wasn't a ward I could walk into 20 years ago, in any hospital, where I couldn't go to the nursing unit manager and say 'How's Mr Jones', and that nurse would be able to tell me that his cousin visited yesterday, that his toenails have been clipped today, and that he's been moved six times overnight to help with his pressure sores," Khadra says, echoing a criticism that earned him widespread public support following the publication of his previous book. "Now, even from the nurse looking after the patient, I'd struggle to get any sense of what's going on with the patient.

"What has happened? What has happened is that local single-point accountability has been taken away from the hospital, so there isn't that opportunity for someone to say this needs to be changed. "If the ward is unclean, who do I go to? The boss of that cleaner is somewhere in town, because it's all outsourced. If the food that I'm putting in front of the patient is unappetising, who do you go to? It's all outsourced somewhere, and there are policies upon policies that obstruct any sort of feedback on that."

Khadra -- who says he received overwhelming backing from his peers after the publication of Making the Cut in 2007 -- urges patients to ditch the passive role they suffered 50 years ago and claim a greater responsibility for their own care. He accepts he might receive a "cold shoulder" from one or two doctors who take umbrage at the portrayal of their profession in the character of David Johnson, an arrogant, glib and dismissive consultant urologist who regards patients as stupid and their questions as irritants to be discouraged. But he stresses the book also portrays "a number of heroic doctors ... who really are compassionate, who really are competent".

"The point that I make in The Patient -- if you are dealing with a doctor who isn't communicative, who isn't able to sit down and really go through the benefits and risks of a particular procedure, who isn't transparent about why they are doing it and involves you in a shared decision-making capacity -- perhaps you are going to the wrong doctor," he says. "I welcome it when my patients are questioning about every step of the way. Why am I having a PSA test? Why am I having a prostatectomy? What are the alternatives? What are the risks of this, what are the benefits?

"Gee, I love those questions, truly -- it shows an involved, informed patient. And we know now there's some evidence to suggest that the outcomes for that type of patient are actually much better, because they are involved in their healthcare, they feel empowered in their own health care. "Are there doctors out there who avoid that glare of light on their own practice? The answer is yes. But I can tell you the vast majority of competent doctors would welcome that type of questioning."

SOURCE





3 February, 2009

Does SCHIP Work?

An expansion of State Children's Health Insurance Program has just passed both houses of Congress. Its perverse effects are noted below

Obama wants to expand the program, but eliminating it would be best for all involved. Pres. Barack Obama proclaimed in his inaugural address, "The question we ask today is not whether our government is too big or too small, but whether it works." If he was serious, he should veto the $115 billion expansion of the State Children's Health Insurance Program that is soon to reach his desk-and insist that Congress eliminate the program entirely.

For two years, SCHIP has been mired in an ideological standoff. Republicans described the Democrats' proposed expansions-which were more moderate than those in the current bill-as "socialized medicine." SCHIP supporters, like Nobel Prize-winning economist Paul Krugman and columnist E.J. Dionne, claim the program works

Researchers who actually study the program find that SCHIP does help uninsured children find coverage, but at great expense. They find no evidence that SCHIP actually improves health outcomes, or that the program addresses the systemic quality problems that confront even insured children.

SCHIP's great expense stems from the fact that in many cases, it simply enrolls children who were already insured privately. Economists Jonathan Gruber and Kosali Simon estimate that out of every ten children added to the SCHIP rolls, six already had private coverage. Only in government is a program deemed to "work" when it covers four uninsured children for the price of ten. The current proposal will only exacerbate this problem. Congressional Democrats want to expand SCHIP to children in families of four earning up to $80,000 per year. The Congressional Budget Office reports that 77 percent of such children already have private health insurance.

In terms of actually improving health outcomes, SCHIP looks even worse. Economist Robert Kaestner and his colleagues conclude, "The proposition that health insurance is the cure for adverse health outcomes among poor and near-poor children has not been adequately demonstrated." About SCHIP specifically, they write, "It is remarkable that there is so little empirical evidence to support so large an expenditure." Economists Helen Levy and David Meltzer write that there is "no evidence" that SCHIP and similar programs are a cost-effective way of improving children's health. They observe that targeted health programs, policies that increase incomes, or even improved educational opportunities could deliver greater health improvements per dollar spent.

It's not even clear that SCHIP's method for improving children's health-expanding insurance coverage-is the right one. The New England Journal of Medicine reports large gaps between the quality of care children receive and what they should receive, even if the children have insurance. That study's authors conclude, "Expansion of access to care through insurance coverage, which is the focus of national health care policy related to children, will not, by itself, eliminate the deficits in the quality of care."

One thing SCHIP does accomplish is to discourage work. SCHIP and similar programs create enormous disincentives to climb the economic ladder. A single mother of two earning minimum wage in New Mexico who increased her earnings by $30,000 would find no change in her net income: She would pay an additional $4,000 in taxes and lose $26,000 in SCHIP and other government benefits, according to data compiled by the Urban Institute for the federal government. Expanding SCHIP would pull even more families into that low-wage trap. Since income is an important determinant of health outcomes, expanding SCHIP could actually harm many children's health.

The one positive thing that can be said of SCHIP is that, for all the inefficiencies and perverse incentives it creates, it does insure some children who wouldn't have had coverage otherwise. But oddly enough, eliminating SCHIP could have this effect to an even greater degree. When Congress eliminated Medicaid benefits for non-citizen immigrants in 1996, opponents predicted an explosion in the number of uninsured immigrants. But according to Harvard economist George Borjas, that didn't happen: Immigrants sought out jobs that provided benefits, and were so successful that the employer-provided insurance completely offset the loss in government benefits. In fact, in the states that offered the fewest benefits, the immigrant insurance rate rose.

SCHIP families, which are more affluent than the families affected by the 1996 policy, would likely fare even better. If President Obama wants to cover more uninsured children, he should set ideology aside and repeal SCHIP. After all, you can't argue with what works.

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2 February, 2009

Elderly people will have to care for disabled grown-up children as Labour ‘rushes’ to close NHS homes

Fancy words can't hide the fact that it's just cost-cutting and that disabled people are going to be left to fend for themselves regardless of whether they can or not

Thousands of elderly couples fear their final years could be spent caring for disabled grown-up children as a result of Government plans to close down NHS residential homes. Under proposals that echo ‘care in the community’, Labour wants to move around 10,000 adults with serious learning difficulties out of state-run institutions so they can live by themselves. Ministers have been pressing for the changes since 2001 in a series of White and Green Papers that aim to prevent the disabled from becoming ‘institutionalised’.

But while the idea has been welcomed by some, few believe that council-run social services departments will pay for the expensive additional support that the disabled adults would need, and many fear the true burden will be met by ageing parents, who may themselves be struggling with illness.

And even though the proposals have not been put into law by Parliament, health authorities across the country are preparing to have them in place by March 31 next year. David Congdon, head of campaigns and policy at the disability charity Mencap, said: ‘There’s a danger in the rush to move people out of NHS provision that you simply make them go anywhere that suits your plan. ‘Seriously disabled adults need to have enough support where they’re living. You cannot do this on the cheap.’

The potentially devastating results were uncovered in an investigation to be screened at 8pm tomorrow on Channel 4’s More 4 News, which highlights the case of 44-year-old Tracy Butt from Norfolk. Tracy has cerebral palsy and epilepsy. She cannot speak, has very limited understanding, is incontinent and wheelchair-bound. Yet, despite this, she faced being uprooted from her NHS residential home. Tracy’s parents, both in their 60s, cared for her at home until they both suffered serious ill health. Her mother Jean was diagnosed with cancer and her father Bill underwent a heart by-pass operation.

‘Our illnesses brought home our own mortality – we realised we had to make provision for the future, and the decision that Tracy should go into long-term care,’ said Bill. They managed to find Tracy a place in a set of NHS bungalows in King’s Lynn, with round-the-clock care and access to an on-site day centre. But, two years ago, the couple were told that the local NHS trust in Norfolk intended to close the bungalows and move the disabled residents into homes in the community – because it had been ‘decreed’ by the Government. Jean was distraught. ‘How dare they do this, when Tracy’s happy and has the warmth and care she needs?’ she said. Bill was worried about what help Tracy would get in the future. ‘One plan was that Tracy would become a tenant in her own house, with care provided through social services,’ he said. ‘Supported living is a very good thing for many people – we just didn’t think it was suitable for Tracy.’

Social workers assessed Tracy in preparation for the move. But Bill said the subsequent report underestimated the difficulties she would face. ‘The report said things like “preparing meals and cooking: I cannot do this yet,” ’ he added. The implication was that Tracy may be able to cook some time in the future. Bill said: ‘It was ridiculous. Tracy’s now 44, and she’ll never be able to make a cup of tea. They said, “using the telephone: I cannot do this yet.” She’ll never be able to use the telephone. She can’t speak.’

The couple put their concerns to Norfolk Primary Care Trust and, according to Bill, were simply told the plans were ‘in a Government White Paper’. ‘We just didn’t think this was right,’ he said. The Butts sought legal advice and, when London barrister John Friel looked at the case, he was in no doubt that the Norfolk Primary Care Trust was wrong. ‘A White Paper isn’t the law, so for the Trust to suggest it was, was legally without foundation,’ he said. ‘The Trust’s attitude was aggressive. Effectively their words were, “You will get out of your accommodation, there’s no choice, we’re going to move you whether you like it or not.” ‘This case wasn’t picked up by local politicians, or the legal departments of local authorities, who accepted what was said. So the implications for the whole system are very serious. If Norfolk could get away with it, others could.’

The barrister took the case to the High Court and, following a court order, this week, the chief executive of Norfolk Primary Care Trust will write an admission to the Butts that the proposal of moving disabled people into the community, as outlined in a Government White Paper, ‘did not create a mandatory duty’ to close Tracy’s home. Norfolk Primary Care Trust maintains it is committed to moving disabled adults into homes in the community and that the Butt family will be ‘actively involved’ in this process. A spokesman for Norfolk social services said: ‘Following resettlement, we believe that everyone will benefit from better levels of support, and will have more choice and control over their lives than NHS campuses could ever offer.’

A spokeswoman from the Department of Health said the Government was funding a three-year programme costing 175million pounds. She added: ‘The Government is committed to increasing the housing options available to people with learning disabilities.

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1 February, 2009

ANOTHER DAY OF THE AUSTRALIAN MEDI-MELTDOWN

Three more current news reports below

Amazing public hospital negligence kills man

I reported the bare bones of this story yesterday but now that we have the details below, the case is even more unforgivable

He was a devoted father who loved the outdoors, but in the final days of his life the pain in his head was so great it reduced him to tears. Yesterday the distraught family of 24-year-old Brendan Burns said he had been handed a "death sentence" by an unnamed doctor at Griffith Base Hospital, who discharged him last week after refusing to order a CT scan that might have saved his life.

Mr Burns, a road worker from Hay in the Riverina, had been experiencing debilitating headaches for about a week when he was taken to the local hospital by ambulance on Saturday. A doctor who examined him ordered his transfer from Hay to Griffith Base Hospital for an emergency CT scan. But at 11.30pm that night, Mr Burns' partner Liz Newman received a call to say he had been discharged and that she should pick him up. When she and a friend arrived at the hospital, they were horrified to find him barely conscious. "Brendan didn't even know who we were. He couldn't move. Not even the doctor could wake him - I had to get an orderly to sit him up. He had no control over his bodily functions," Ms Newman said yesterday.

Despite her friend's pleas that he be allowed to stay in hospital, the pair were told to take him home. But just hours after Ms Newman put him to bed, she heard a "horrific noise". "I rushed in and started screaming. I saw this stuff coming out of his mouth. I rolled him on to his side so he wouldn't choke." Mr Burns was rushed back to Griffith Base Hospital and was then flown to Sydney's St Vincent's Hospital, where a CT scan revealed a growth on his spinal cord. "He had hydrocephalitis and the pressure had been so great that it shifted parts of his brain," Ms Newman said. He underwent surgery, but died on Tuesday surrounded by family.

Ms Newman said she had no idea how to explain to the couple's daughter Nadia, 3, that her father wouldn't be coming home. "Brendan never got to say his goodbyes and it's their fault. "My daughter has been robbed of her father. Those doctors can get on with their lives. They don't have to live with a little girl screaming for her dad."

SOURCE

Ambulance could not find man two minutes drive away

They were so bureaucratized that they apparently did not even think of looking up one of those silly old-fashioned paper maps of the locality. And once upon a time, firemen, police and ambulance officers were supposed to a have a good knowledge of their local geography. More silly, oldfashioned ideas, I guess

A heartbroken Brisbane mother has launched legal action over the death of her partner after paramedics took an hour to find him because the address - which had existed for four years - was not in the state's road database. Kylie Bacon, 33, of Chermside, is suing the State Government, Moreton Bay Regional Council and the body corporate of Spinnaker Beach One Community Titles Scheme for unspecified damages for herself, daughter Letitia, 13, and son Owen, who turns three tomorrow. Her partner of seven years Adam Foks, 30, a landscape gardener, died from an asthma attack at a Bribie Island bus stop after dialling 000 on January 25, 2006. Their son, Owen, was born a week later - the day after his father's funeral.

Ms Bacon's claim, filed in the Queensland Supreme Court, states Mr Foks had caught a bus to visit his mother, Sandra Major, in the Sandpiper Court estate on Spinnaker Drive, when he had an attack. Mr Foks called 000 at 5.47pm and gave his mother's address. He collapsed on the nearby footpath, where his mother found him and called another ambulance at 6.06pm. Paramedics arrived at 6.45pm but Mr Foks had died. The claim states the nearest Queensland Ambulance Service station was about two minutes' drive from Spinnaker Drive and Sandpiper Court, which has existed since 2002.

Ms Bacon alleged the Government failed to ensure the State Digital Road Network, administered by the Department of Main Roads and used by the QAS, was kept up to date and accurate. She also alleged the council failed to keep up-to-date records of local roads and inform Main Roads of the existence of Sandpiper Court, and that the estate's body corporate should have also ensured its details were on the network.

Yesterday, Ms Bacon said the family was "broken" and still struggled to deal with their grief and find "stability". "Our lives have been turned upside down and we still haven't found our footing," the sole parent pensioner said. "Owen is the spitting image of his dad. Every night we go out and talk to the stars, where he knows Daddy is watching from heaven. "I stress every day about raising a son without a strong male role model and not being able to teach him things about being a man that a father could." Lawyers for the State Government and regional council declined to comment. Representatives for Spinnaker Beach said the matter was with their solicitors.

SOURCE

Unbelievable public hospital inefficiency

And all because of the Leftist love of centralization and horror at any hint of competition. Only a government could be this insane and wasteful

The Queensland Children's Hospital will deliver just 23 extra overnight beds at a cost of $1.1 billion. That's $47.8 million a bed. Of course I haven't factored in the new building that goes with the beds. And the hospital plan includes 100 or so recliner chairs or "same day" and "short stay" beds not counted in my calculation. Nevertheless, the revelation the new hospital will get 23 extra overnight beds for such an extraordinary pool of money will come as a shock to clinicians and patients - if not Health Minister Stephen Robertson himself.

The details are contained in the latest official figures released by Queensland Health showing there will be 248 overnight beds in the new hospital compared with a combined 225 overnight beds available now at Royal Children's and Mater Children's hospitals. The new hospital will come about with the closure of the Royal Children's and the Mater Children's and the pledge of a "world class" children's hospital adjoining the Mater in the South Brisbane electorate of Premier Anna Bligh.

Specialists already complain the new hospital will have inadequate beds and inadequate space for key departments like gastroenterology and respiratory medicine. Pediatricians have complained that consulting rooms may be too small for patients in wheelchairs. And vital research facilities are in limbo, with no space allocated in the main hospital site. Unless there are research and training facilities, the new "world class" hospital will not attract quality staff. Then there is the problem of an $80 million energy plant - unfunded in the hospital plan.

However, the chief executive of the Queensland Children's Hospital does not believe these problems are insurmountable. Peter Steer believes enhanced pediatric services at other hospitals in the southeast corner will take the heat off the QCH. [Thus defeating the point of the excercise?]

Good luck to Dr Steer. The world needs more optimists. He said the proposed Gold Coast University Hospital and the Sunshine Coast University Hospital would have emergency pediatric and inpatient specialty services. And pediatric services in other hospitals would be increased, he said. "The impact of these enhanced services will reduce the level of secondary service demand at the QCH so that it can operate as a truly tertiary level hospital," he said in response to questions I sent to Mr Robertson. Dr Steer added: "The current proposed total bed numbers at the QCH are considered appropriate to meet the projected demands for the hospital in conjunction with the enhancements to services in surrounding hospitals." Dr Steer said he was too busy to be interviewed face-to-face.

Dr Steer was also quoted as saying: "In addition to the services proposed for the QCH, there is currently work being undertaken to increase pediatric bed numbers for less complex patients who it is envisaged will access services in their local area." He said despite the closure of Royal Children's, Brisbane northside families would have adequate emergency pediatric cover. But he couldn't say where it would be or how much it would cost. "The proposed specialist pediatric emergency department on the northside of Brisbane will include a short-stay unit," he said. "The location of the specialist pediatric emergency department on the northside is being finalised in consultation with clinicians." The new short-stay facility would likely have 20 same-day beds. Dr Steer said funding was still to be announced.

Despite his assurances, Queensland Health bureaucrats say it is a "potentially high-risk strategy" to believe outer-Brisbane hospitals can pick up the slack. An internal report last year warned: "If further beds for QCH cannot be afforded, the only option will be to have strategies in place to enhance secondary level pediatric services at Logan, Redlands, Ipswich and Prince Charles hospitals. "This will require additional capital and recurrent funding for those hospitals and a reprioritisation within the Area Health Service Plans."

Then came the bombshell: "There is currently no capital planning under way for enhancements to emergency departments or pediatric in-patient capacity within the planning time frame for the QCH. The worst-case scenario for QCH is that it is built with too few beds and too small an emergency department on the assumption that these services will be provided elsewhere, and then the required capacity elsewhere is not delivered."

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