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31 January, 2009

AUSTRALIA'S PUBLIC HOSPITAL MELTDOWN CONTINUES

Three current news reports below

Big deal: NSW hospital death "not from lack of beds or staff"

But it obviously WAS due to insufficient diagnostic testing -- scans etc. There is no reason why diagnostic imaging could not have been done same day. That was once routine and still is in some hospitals

The NSW Government has apologised to the family of a man who died a day after being discharged from hospital, but says his death was not due to a lack of beds or medical staff. Brendan Burns, 24, was discharged from Griffith Base Hospital on Monday with a bad headache and died the following day at Sydney's St Vincent's Hospital from an undiagnosed brain tumour. Greater Southern Area Health Service (GSAHS) Chief Executive Heather Gray yesterday said the matter was being investigated, and would also be referred to the Health Care Complaints Commission.

Health Minister John Della Bosca today apologised to Mr Burns' family but said his death was not linked to staffing levels nor patient capacity at Griffith. "I extend my commiserations to his family, I feel deeply sorry that this has happened," Mr Della Bosca said. "All the evidence I have is that there was a great deal of professional skill involved in the handling of the case. "My advice is there was no bed shortage ... there was no staff shortage."

GSAHS said the man arrived at Hay Hospital on Sunday and was transferred to Griffith Base Hospital on Monday. He was discharged in the early hours of Monday, went home and returned to Hay Hospital that same morning. Later on Monday, the man was flown from Hay Hospital to St Vincent's where he died on Tuesday.

SOURCE

Woman left lying in agony on NSW hospital floor



Tammy Hams thought she was "going to die" when she was offered a blanket and told to lie on a waiting room floor because staff at her local hospital could not find her a bed. Ms Hams was booked in for surgery at Wyong Hospital to remove possible cancerous lesions when doctors discovered a huge abscess causing "agonising pain". The 29-year-old said she spent 3« hours writhing in agony on the waiting room floor of the hospital's surgical ward on Wednesday before she was eventually given a bed. Staff at the hospital "categorically deny" her claims. [But see picture above]

The incident comes amid yet another hospital outrage, in which a 24-year-old man was discharged from Griffith Hospital early on Monday after complaining of sinus pain. The following day he again presented to the hospital and was flown immediately to Sydney's St Vincent's where he died from unknown causes. Greater Southern Health has launched an investigation into why he was discharged. And in Dubbo, doctors are threatening to quit because they routinely run out of basic medications.

Ms Hams said her GP had been trying to get her into hospital since Friday when she began feeling stabbing pains in her stomach. A biopsy four months ago revealed pre-cancerous lesions on her cervix, which if left would turn cancerous. "I thought I was going to die," Ms Hams told The Daily Telegraph yesterday from her hospital bed. "I have never been in that much pain in my life - it was agony."

She was booked-in for a hysterectomy and told to arrive at 9am. Her mother Jenny Leatham said she was "crying and doubled-over in pain" and could not sit on the waiting room chairs or stand, so they pleaded for a bed. "They gave her a blanket and said the best she could do was lie on the floor," Mr Leatham said. "The staff were so nice and you could see they were upset about what was happening. This is just unfair, I'm not rubbishing the staff. There just wasn't enough beds. "The system has to change."

A North Sydney Central Coast Health spokeswoman said an investigation found there was no shortage of beds and Ms Hams was "treated in a caring and timely manner". "It is unacceptable for a patient to be expected to lie on the floor and staff on duty when Ms Hams arrived at the hospital deny making any such recommendation," the spokeswoman said. The hospital argues she was assessed by an anaesthetist at 10.10am and that she asked for the blanket.

Mrs Leatham said by 12.30pm staff found her daughter a bed and she was operated on at 2pm. When surgeons cut her open they discovered a huge abscess pushing on her cervix. Unable to perform the hysterectomy they removed as much of the infection as they could and inserted a tube to drain it over the next seven to 10 days.

"If the abscess had burst while she was in the waiting room she would have died," Mrs Leatham said.

Wyong Hospital is just one of the state's many hospitals plagued with debt, bed shortages and a lack of specialist doctors. Last week its emergency department - one of the busiest in the state - lost all but one of its specialist doctors to Gosford Hospital so it could retain its status as a teaching hospital.

Senior doctors at Dubbo Base Hospital threatened to walk off the job after they ran out of morphine because the hospital could not afford to pay pharmaceutical companies. Patients in intensive care also sweltered for days in record temperatures because contractors could not be paid to fix the air conditioning.

The Greater Western Area Health Service reportedly owes more than $23 million to suppliers. Many are no longer prepared to provide food or medical equipment. The situation across the state is expected to get far worse before it gets any better. A report by auditing firm PriceWaterhouseCoopers last month revealed the state's health budget would blow out by as much as $900 million by March if dramatic changes were not made.

SOURCE

Queensland public hospitals have worst record for killing, maiming patients, botched operations

Queensland Health is a most obnoxious bureaucracy to work for so they are able to attract high quality staff in relatively small numbers only. The rest are often the dregs with nowhere else to go -- and it shows in the quality of their work

QUEENSLAND hospitals have the nation's worst published record for killing or maiming their patients through botched operations, medication errors and other mistakes. And NSW is one of the safest, reporting a third fewer serious errors despite its larger population.

The figures, released in a Productivity Commission report, provide a rare state-by-state breakdown of so-called "sentinel events" - the most preventable and potentially deadly mistakes that occur every year in the nation's hospitals, The Australian reports. Last year, the Australian Commission on Safety and Quality in Health Care reported that sentinel events - ranging from discharging an infant to the wrong family to suicides by admitted patients - more than doubled nationally in 2006-07 compared with a year earlier.

The mistakes accounted for just 10 per cent of serious hospital errors recorded by the states and territories but made public only selectively. But of the 187 deadly or damaging lapses in judgment or procedure made public yesterday, Queensland accounted for over a quarter of the national total.

Its hospitals carried out procedures on the wrong patient or body part an alarming 33 times in 2006-07. They killed another six patients through medication errors, seriously injured or killed four mothers in childbirth, left surgical instruments or material inside three patients, and transfused incompatible blood once.

The next worst offender was Victoria (45), which was slammed by its Auditor-General last year for failing to adequately monitor hospital blunders. Some 135,000 patients - or one in 10 public hospital patients - in that state had endured a medical mistake, with more errors believed to have gone unreported. South Australia, with 36 sentinel events, was next in line, followed by NSW (32), Western Australia (15), the ACT (7), the Northern Territory (2) and Tasmania (1).

"A high number of sentinel events may indicate hospital systems and process deficiencies that compromise the quality and safety of public hospitals," the Productivity Commission said. The willingness to report major mistakes could also influence the totals, it noted.

SOURCE





30 January, 2009

Plan for a green NHS is crazy and dangerous. Britain just need a health service that works

Seemingly oblivious to events in the real world, Whitehall's green crusaders have found themselves another target: the beleaguered NHS. Now, you may have been under the illusion the health service had enough to worry about, saving lives, delivering babies and generally tending to the sick. Wrong! It is responsible for 18million tons of carbon dioxide emissions each year, 3.2 per cent of the total for the whole of Britain. Something must be done! Thus the NHS has dreamt up a strategy, complete with barmy and in some cases apparently dangerous ideas, which will reduce its 2007 emissions by 10 per cent by 2015 and - God help us - 80 per cent by 2050.

So, the next time you are feeling unwell and want to make an appointment with your GP, expect to be asked if you wouldn't settle for some 'telemedicine' instead. Or, sparing the jargon, how about telling your doctor what is wrong over the phone, rather than a face-to-face appointment with stethoscopes and the like, in order to avoid getting in your car, and chugging out carbon dioxide as you cough and splutter over the steering wheel? Sure, you risk misdiagnosis - but think about the good you'll be doing the environment. Feel better already? Thought so.

And what about cutting out the red meat, should you ever be unlucky enough to find yourself hospitalised? Yes, you might be at a low ebb, and in need of a decent meal. But it is very energy intensive to produce a steak, so how about settling for some vegetables? Removing meat from the hospital menu will do the planet good, if not you.

On the nonsense goes. I'm prepared to give them the idea of using tap water instead of bottled. I fell for the fad of lugging dozens of bottles of the stuff home from the supermarket a few years ago and, like most people, have since got over it. But the majority of the green strategy is preposterous, nannying and not without risk. As Michael Summers, of the Patients Association, said: 'I believe this is fraught with danger, and many GPs see it as a dangerous practice. 'There are cases of patients having died after being misdiagnosed over the phone.'

Speaking to your GP over the phone can be reassuring in non-urgent cases - but how can a GP know if it's urgent or not without seeing them?

Even if you accept that Britain must reduce its carbon emissions, in order to lessen the impact of climate change, the NHS is entirely the wrong target. (I'd suggest axing the bureaucrats responsible for thinking up such initiatives. Think of the petrol and light bulbs you could save).

Yes, people have a duty to think about the world we'll bequeath to future generations. But not when they're sick. Nor should those faced with the difficult task of treating the ill, or helping the terminally-ill to die with dignity, have to give a second thought to their carbon footprint. Rather, they should be allowed to concentrate on addressing the failings which - despite the sterling efforts of those on the frontline - remain all too abundantly clear.

Let's take a look at some revelations from the NHS over the past three weeks alone. Two out of three hospitals still have mixed-sex wards, 12 years after Labour promised to get rid of them. Seventy per cent of trusts say men and women are not properly segregated on their wards, where they are often separated by nothing more than a curtain or a flimsy partition. Just 15 per cent of hospitals ensure all patients have fully separate wards and bathroom facilities. Isn't this a little more important than worrying about lightbulbs?

The number of patients killed by hospital blunders has soared by 60 per cent in only two years. Official records show that 3,645 died as a result of outbreaks of infections, botched operations and other mistakes in 2007/08. That was up from 2,275 two years before. Shouldn't the NHS be devoting its time to reducing this figure, rather than keeping beef pie off the hospital menu?

Midwives are more overworked than they have been for at least a decade, and are delivering far more babies per year than stipulated by safety guidelines - putting mothers and babies at risk. Experts believe up to 1,000 babies a year die needlessly because doctors and midwives are too overstretched or poorly-trained to detect warning signs. Do these same poor midwives really need some bureaucrats encouraging them to cycle to work, in order to reduce their carbon footprint?

A Green NHS? The public just wants one that works.

SOURCE





29 January, 2009

THE LATEST ON AUSTRALIA'S PUBLIC HOSPITAL MELTDOWN

Three articles below

Another deadbeat public hospital in NSW

Outstanding bills which have seen a security firm threaten to withdraw its services from a rural NSW hospital will be paid within 24 hours, the state government says. Health Minister John Della Bosca said he had spoken to Greater Western Area Heath Service (GWAHS) chief executive Dr Claire Blizzard, who gave an assurance the bills would be paid imminently.

Heartland Security threatened to halt work at Parkes Hospital if the bills were not paid by today. The firm also has complained about a string of late payments by the health service last year.

"I've been advised by the GWAHS by Dr Blizzard ... that she will be paying within 24 hours the outstanding account to the security firm involved," Mr Della Bosca told reporters in Sydney.

The work performed by the security personnel includes escorting nurses to their cars at the end of a night shift, to offer protection against possibly violent patients. Mr Della Bosca said there were three outstanding bills from the security firm, and only one from November was outside the new benchmark of 43 days in which a bill should be paid. But the latest case of late-payment also follows reports of staff at Mudgee Hospital using petty cash to buy sausages after a butcher refused to supply further meat, and a cancellation of surgery at Orange Base Hospital when it ran out of syringes.

Mr Della Bosca said the outstanding accounts at the GWAHS totalled $60 million when he took on the health portfolio, and they now stood at $23 million. "It has more than halved in four months so that is a very good trend line,'' he said. "I expect that to continue. I expect the GWAHS will achieve the benchmarks that we require for payment of local businesses and suppliers.''

SOURCE




NSW Premier 'too busy' to deal with failing hospitals

Easy interpretation: His brain is so constipated with failed Leftist ideas that he hasn't got a clue what to do

Doctors at Dubbo Base Hospital have not been paid for weeks, nurses at Orange are using their own money to buy batteries for heart monitors and cake trays to dispense pills, and students in Mudgee have bought beds for the emergency department as more reports of the state's credit meltdown come to light. But a spokesman for Nathan Rees said yesterday the Premier was "too busy with other things" to deal with the issue. The Director-General of NSW Health, Debora Picone, refused to comment, saying the Greater Western Area Health Service "managed itself".

The area health service, which covers 56 per cent of the state, is in crisis after more reports that creditors are waiting up to six months to get paid, deliveries of food and medical supplies to hospitals have been cancelled and vital maintenance work, such as fixing blocked pipes and faulty lifts, is not being carried out.

About 12 creditors came forward yesterday, including one owed more than $16,000 for delivering fruit to remote hospitals and a nurse who was angry that several wards at Orange Base Hospital had been without paper towels, vital for infection control, for several weeks because unpaid suppliers had stopped deliveries

Their claims came after the Herald reported a Parkes security firm was threatening to withdraw its services if its $6000 bill was not settled within 24 hours. Its owner, Lindsay Harvey, said he was told yesterday his money would be in his bank account by this morning. Steve Miller, the owner of Country Fruit Distributors in Dubbo, owed $14,000 for three months, was also paid about $7000 yesterday after complaining to the Herald.

The chief executive of the Greater Western Area Health Service, Claire Blizard, said it was "clearly unacceptable that some creditors are facing these delays". "We have made progress in relation to the payment of creditors and in the past couple of months we have made a 50 per cent reduction in creditors owed money. This is not a problem that can be fixed overnight," she said.

Students from Mudgee High School ran car washes, charity balls and raffles to raise $20,000 for emergency department beds last year. "It's a bit of a shame really that in a country like ours, as rich as ours, that our Government's health system has to rely upon local community donations to keep the hospital running," the former school captain, Hannah Kempton, said. Three emergency trolleys were bought by the hospital's auxiliary last week after it raised more than $15,000 in raffles, while a football team paid for carpet in the maternity ward. "It would be nice if we didn't have to buy these things, but we do," the president of the auxiliary, Glenys Goodfellow, said.

The Opposition health spokeswoman, Jillian Skinner, said it was unacceptable. "If people don't pay their speeding fines or taxes on time, then they get taken to court or there's some penalty. Why should the . Government think it's the exception?"

SOURCE




The hugely bureaucratized Queensland Health are such unpleasant people to work for that they have to employ any scum to fill the gaps that their bloodymindedness creates in their workforce

A Pakistan-trained doctor will face a tribunal after allegedly performing an unnecessary vaginal examination on a patient. The Queensland Medical Board referred Naseem Ashraf to the Health Practitioners Tribunal earlier this month, claiming he had engaged in "unsatisfactory professional conduct" that may require disciplinary action.

Ashraf, who is no longer registered as a doctor in Queensland, was working as a senior medical officer and anaesthetist at Mount Isa Base Hospital in October 2004 when the misconduct allegedly took place. It is alleged Ashraf performed an intra-vaginal examination on a woman who had visited him for a pre-anaesthetic consultation. The woman was due to undergo surgery one week later to remove abnormal cells detected during a routine pap smear.

According to a referral notice filed by the Queensland Medical Board in the Brisbane District Court, the vaginal examination was not required for a pre-anaesthetic assessment. The board also is claiming Ashraf did not gain the woman's consent before conducting the examination, or keep adequate medical records. Ashraf will face the tribunal at a later date.

SOURCE





28 January, 2009

Parents' grief as daughter dies after NHS hospital 'forced them to change her treatment'

The father is a very forgiving man. He should sue the pants off the arrogant b*stards. It's the only thing that will get their attention. Arrogance is a hallmark of the NHS

A little girl with a very rare medical condition died after a hospital threatened her parents with a police protection order if they did not comply with a new treatment plan, it has been claimed. Francesca Blair-Robinson, 12, died five months after her father says he and her mother were forced to withdraw their opposition to new treatment.

Father Malcolm, who had taken the lead in his daughter's care, believes the change in treatment led to her death and that Francesca would be alive today if his hand wasn't forced with the threat of police intervention. Last night the devoted father-of-six spoke out about the tragic circumstances of his daughter's death, calling for a change in the way vulnerable children are treated.

Speaking of the hospital's decision to pursue a 'much more aggressive' therapy plan he said: 'I had warned in writing that such a medical approach may prove fatal, based upon the fact that I had been Francesca's full-time carer for almost the whole of her life and had studied her medical condition and her response to treatment 24/7 for 11 years. 'I have conducted significant research into her case since her death and I am entirely satisfied that the treatment killed her and that neither I nor her mother nor Francesca herself would have agreed to this approach but for the intervention of child protection procedures.'

When Francesca was born with a rare congenital syndrome causing a catalogue of symptoms, including being very small and frail, it was feared she would not make it to the age of one. Sent home to die she confounded expectations by surviving under the dedicated care and attention of her family. Her novelist father, 69, became her full-time carer, devising a treatment plan by 'trial and error' but tailored to her needs that included antibiotics, a nebuliser, physiotherapy and a special diet.

Mr Blair-Robinson, who split from Francesca's American businesswoman mother in 2004, said: 'Working closely with doctors we not only saved her life but developed therapies through cautious use of drugs which gave Francesca a quality of life, a richness of experience and an inspirational nature that was little short of a modern day miracle.' Although weak, the little girl was able to go to school for short periods, and have a home tutor for the rest of the time. She developed a network of friends on the internet and loved the countryside. But after moving from Surrey to West Sussex in 2006 the doctors overseeing Francesca's care changed.

When she collapsed in May 2007 medical staff at St Richard's Hospital, in Chichester, wanted to change the way she was treated. She made a swift recovery but doctors still advocated 'aggressive use of IV antibiotics' and oxygen therapy, claims Mr Blair-Robinson. He said both he and his ex-wife objected, and within a week were summoned to a meeting where they were confronted without warning by a social worker, police officer and medical staff. 'Her mother and I were threatened that unless we withdrew our opposition to the hospital's medical plans, Francesca, a frail and vulnerable child with a very sharp intellect, would be made the subject of an immediate police protection order.'

Terrified the couple complied and the little girl was referred to Southampton General Hospital which set out the more 'aggressive' programme. Within five months she had died of respiratory failure, a death that Mr Blair-Robinson would not have happened if he had been allowed to continue taking the lead in her care. He believes there should have been a narrative record of her care in her medical notes and a better system of information sharing and is calling for an overhaul of the way the NHS handles complex cases of children with special health needs. 'She knew she was dying, insisted on doing her Christmas shopping early as she feared she would not reach the day herself and confided that she felt the doctors were killing her.'

He said he did not indeed to pursue legal action as he did not think it 'helpful'. 'Doctors do their best but they make mistakes, they are human,' he said. 'They are forgiven but changes need to be made.' He is sending a copy of his proposed reforms to child protection process to Downing Street.

Of Francesca, who he believes could have survived into adulthood, he said: 'She was a completely magic person, everybody who came upon her was enchanted by her, she may have had a wonky body but she had a golden spirit. 'So that the values of her life may be more widely shared, it seems fitting to propose reforms to our approach to helping the vulnerable.' Francesca had congenital varicella syndrome, a condition that is related to the mother being infected with chickenpox early in pregnancy.

SOURCE





27 January, 2009

Medically-caused illness cured by a dedicated British mother

There is no doubt that antibiotics are overused. Sensitivity to them is supposed to be routinely monitored -- but this is the NHS, of course

A baby with a mysterious condition which causes his stomach to swell has been cured by a probiotic drink, his mother says. Riley Anderson, who is 11 months, has struggled with the bloating syndrome since birth. Doctors first noticed the problem when he was just 12 hours old and Riley was taken to a special baby unit. He was fed by a tube and later transferred to a specialist children's hospital, but no one could work out what was wrong with him.

His mother, Anna Anderson, 35, said: 'They didn't know what it was and sent us home. 'They still don't know what it is. He was bloated and his stomach was nearly as big as his body, it was like a balloon.' The problem continued for months. Miss Anderson, who has three other children, added: 'He was bloating up and being sick and if he did need to go to the toilet he was constantly screaming. 'I changed his milk to see if that would help, but it didn't, he was still bloated.'

As doctors could not help her, Miss Anderson decided to do some research herself. When she explored the antibiotics that Riley had been given by doctors, she discovered that one of them kills natural bacteria in the body. As a last resort, she decided to try and reintroduce this bacteria to her son by feeding him bottles of probiotics. 'I gave him Yakult and he was fine within the first couple of days of him having it,' she said. 'He was ten months old, and at his happiest he had been. There was no bloating.'

A few weeks later, Riley had problems with his ears, and was taken to hospital, where he was given more antibiotics. But after just two doses, his stomach began to swell again. Once he was home, his mother, from Aby, Lincolnshire, began to dose him with Yakult and he returned to normal. 'I think there is a bacterial imbalance in his stomach which means he can't digest food, and the Yakult helps get that back,' she said. 'When I give him Yakult, it settles his stomach and he is fine.'

Dr Henry Mulenga, a member of the Royal College of Paediatricians, with a special interest in gastroenterology, said: 'We are beginning to hear more and more of these type of stories. In my view it is very possible. 'There is no doubt that some conditions can be improved by introducing healthy bacteria. 'Many parents may feel that is the case. The difficulty we have with very small babies is whether it is entirely safe to do so.'

A spokesman for Yakult said: 'We are delighted that our product has helped in this circumstance.'

SOURCE

There are pictures at the link above but I found them too distressing to reproduce





26 January, 2009

Australia: Public hospital management and staff pass the buck

A FOUR-YEAR study of NSW hospitals has revealed staff and senior health bureaucrats blame each other for shocking errors, including deaths of patients. The statewide "safety check" found patients were at significant risk of death or injury from falls, medication errors, staffing levels, lax infection control and mistakes in diagnosis and treatment.

Doctors and nurses overwhelmingly agreed that chronic understaffing and heavy reliance on inexperienced junior staff was a major risk - especially after-hours and in complex areas such as emergency and intensive care. But the area health service managers blamed adverse incidents on mistakes made by medical and nursing staff rather than problems with skill mix.

Opposition Health spokeswoman Jillian Skinner said it was "scandalous" that it has been five years since the Walker inquiry into 21 deaths at Campbelltown and Camden hospitals recommended an urgent audit of risks in the health system. Since then internal reports into 85 deaths over two years at western Sydney hospitals revealed that at least 49 of the patients did not receive adequate care.

Most of the avoidable deaths were due to a delay in responding to a rapidly deteriorating patient, the Annual Review of Root Cause Analysis 2006 and 2007 found. But the chief executive of the $55 million Clinical Excellence Commission, Professor Clifford Hughes, defended the Quality Systems Assessment report released today, saying a great deal of developmental work had been done to get an accurate picture of the state's complex health system. Professor Hughes said allowing everyone from the ward staff to hospital managers to top-level administrators to nominate their three highest risks to patient safety showed there was a significant disparity between the issues front-line staff saw as important, and the priorities of management.

The report found dozens of patient safety programs had been implemented since 2004 but very few had been reviewed to assess if they actually worked. Four of the eight area health services, and the Children's Hospital at Westmead, did not have any systems or processes for reviewing deaths. It also found confusion and lack of clear policy in many areas.

The director of the Institute of Health Innovation at the University of NSW, Jeffrey Braithwaite, commended the report but said collecting information was just the first step. "On too many initiatives in NSW we've seen things chopping and changing."

Health Minister John Della Bosca said 89 per cent of respondents felt there had been an improvement in patient safety and quality culture in the past two years. "This rigorous program is a world first for the assessment of quality and safety processes in a health system that will help us achieve ongoing improvements."

SOURCE





25 January, 2009

The fallacy of healthcare reform as economic stimulus

After spending decades trying to reduce health care costs, some commentators and policymakers now argue that health care costs should be increased to stimulate the economy.[1] At the crux of the argument are the notions that increasing spending on health care will create jobs that can be filled by those losing jobs in other areas of the economy--and that implementing long-proposed reforms (such as an increased emphasis on primary care and large-scale deployment of health IT) will reduce health care costs.

These two arguments are fundamentally at odds with each other. Advocates claim simultaneously that (a) it would stimulate economic growth to spend more money on these reforms, and (b) these reforms would reduce total health care costs--that is, result in spending less money. Perhaps one could make an intelligent argument for either proposition, but it is not possible to make both of those claims and be consistent.

Two Sides of the Same Coin

The entire proposal rests on the assumption that one can get a "free lunch" by looking at only one side of the ledger--by counting the benefits of reform but ignoring the costs. Health care jobs are clearly a benefit to workers who would otherwise have worse jobs or no jobs at all, but as long as employees need to be paid, one person's job is also another's cost. Artificially increasing the number of health care jobs also artificially (and wastefully) increases health care costs. On the other hand, reducing total health care spending means there is someone who would otherwise be paid who is either no longer being paid or being paid less--and that person is losing a job or taking a pay cut. Spending money on health care might create jobs in the health care industry but only at the cost of jobs destroyed elsewhere in the economy. In other words, health care reform might reduce health care costs, or it might create new health care jobs, but it cannot do both simultaneously.

Any money the government spends on health care (or anything else) has to come from somewhere--either higher taxes, more borrowing, or inflation--and that means less is available to the economy for private spending. Government spending cannot cause prosperity; it can only reallocate resources from one person or activity to another. Prosperity--economic expansion--can be achieved only by increasing total production, not simply moving it around. For this to occur, entrepreneurial individuals and companies have to find it worthwhile to engage in productive activity and investment. The only way government can induce sustainable economic expansion is to reduce the taxes and regulations that inhibit productive activity.

In the long run, wasteful spending will not stimulate the overall economy or improve health care; it will only divert resources that would be better used elsewhere. Health care reforms are beneficial only if they result in today's health care at lower costs, improved health care at the same or tolerably higher costs, or some combination of the two.

Increasing Spending While Cutting Spending?

Health care expenditures are taking up an ever-larger share of GDP, rising from 13.7 percent in 1993 to 16.0 percent in 2006 and forecasted to grow to almost 20 percent by 2017.[2] Proponents of reform have long argued that this trend is sucking the lifeblood out of our economy, and bound to cause or deepen a recession. And yet, now some of those same experts are arguing that, in order to get the economy out of a recession, health care spending must be increased. In essence, it is as if they are saying, "Our economy is threatened because heath care spending is too high, so to solve the problem we need to make it higher."

For example, MIT economist Jonathan Gruber says that "health care reform can be an engine of job growth," and he cites two main categories of job opportunities. First, he argues that longstanding proposals for reform of primary care would create new jobs for nurse practitioners and physician assistants, which would save money because primary care is cheaper than specialty care. Second, he cites President-elect Barack Obama's proposal to spend $50 billion on health information technology, which would create jobs in the IT sector and save money through more efficient record-keeping.[3]

However, in order for heath care reform to be "an engine of job growth," health care spending must go up, not down. After all, the main reason people like jobs is that they come with paychecks. The goal of reducing health care costs directly contradicts the "logic" of stimulus spending. The idea of stimulus through primary care reform is a contradiction: Spending will be reduced, as higher-paying specialty care jobs are replaced by lower-paying primary care jobs. Furthermore, these jobs--in serious professions requiring real expertise and years of training--would do little to improve the short-term job prospects of people laid off from other industries.

The idea that increased health IT spending will result in a permanent increase in jobs in the IT sector is a red herring. If health IT will reduce health care costs in the long run, then those new jobs in the technology sector will be more than offset by money saved--that is, jobs "lost"--in other sectors. There will be less need for file clerks and office staff and perhaps even nurses.[4] To argue that health IT is both a good stimulus and a way to reduce health care costs is in effect arguing that it is good because it creates (technology) jobs but also good because it destroys even more (health care) jobs.

Medicaid Reform as Stimulus Spending?

Some advocate Medicaid expansion as part of a stimulus package. Medicaid is a complex program in need of reform to provide better health care for the poor at a lower cost, but there is no reason to believe that Medicaid expansion would be a source of stimulus for the overall economy. The argument that it would comes in two forms.

First, some claim that expanding Medicaid eligibility would cause previously uninsured families to spend more on consumer goods, since they would not have to save for unexpected medical expenses. Gruber and Yelowitz find that previously uninsured households that become eligible for Medicaid do indeed spend more.[5] But this does not mean that total consumer spending increases--the money used to fund Medicaid expansion has to come from somewhere; in particular, whoever paid the taxes to fund the expansion had to reduce their own spending. Furthermore, the recessionary effects of taxation mean that the decrease in spending by other taxpayers is greater than the increase in spending by new Medicaid recipients.

Second, others argue that increasing federal funding for Medicaid and SCHIP would free up state money for public works ("roads and bridges"). In fact, it would do no such thing. These are matching fund programs: The states run the programs, and the federal government provides subsidies proportional to the funding provided by the states themselves. If the federal government gave states money to enroll more people in these programs, that would require states to spend less money on public works projects to meet the matching requirements. In fact, under existing law, states could already increase the amount of federal money they receive for Medicaid by choosing to spend more on their own. But they do not, because that would require cutting spending on other programs--for example, public works projects.[6]

No Free Lunch

All of these arguments still neglect the bigger picture: Any money the federal government spends on health care reform, health IT, Medicaid, roads and bridges, or anything else has to come from somewhere. And that "somewhere" is either increased taxes, more borrowing, or inflation of the currency, any combination of which would cancel out any "stimulus" effect of the new spending. Spending money on health care or "roads and bridges" might create jobs in the health care or construction industries, but that is only at the cost of jobs destroyed somewhere else. This is what economists mean when they say, "There is no such thing as a free lunch."

Prosperity cannot be achieved by simply moving resources around from one sector of the economy to another. Rather, it can be achieved only by increasing production, which can be induced not by spending but by reducing the taxes and regulations that inhibit productive activity.

SOURCE




Australia: Victorian Nurses Board approves 103 registrations of criminal nurses

As usual, your regulators will protect you

NURSES guilty of manslaughter, sex offences, arson and torturing animals have been allowed to care for the sick and vulnerable in Victoria. In the past three years the Nurses Board approved registration of 103 nurses who had admitted being found guilty of crimes such as theft, stalking, drug trafficking, possessing child pornography and manslaughter. The board cancelled registration of two nurses because of their criminal pasts, while the results on another three nurses are unclear, the Herald Sun reports.

Patient advocates and the Opposition want an immediate investigation of registration of some nurses, as well as the process, in light of documents obtained by the Herald Sun through Freedom of Information requests.

But the Nurses Board says it is not concerned that at least 103 of Victoria's 86,000 registered nurses have serious criminal records. Its says its investigation processes ensure public safety. In 2006 it became mandatory for nurses to disclose their crimes when renewing their registration each year. Since then the board has been told of:

A NURSE convicted of manslaughter in 1994 whom it re-registered.

THREE nurses guilty of indecent assault who had their registration renewed.

TWO nurses guilty of cruelty to animals.

THREE nurses guilty of recklessly causing serious injury and others who committed serious assault, common assault, unlawful assault, intentionally causing serious injury and negligently causing serious injury.

TWO nurses convicted of stalking.

A NURSE caught with a drug of dependence and taking it into a prison in 2005.

A HOST of theft, fraud and social security offences.

In one instance the board renewed a nurse's registration despite being aware of 19 convictions for arson. Some offences date back many years, but all were disclosed to the board after 2006.

Medical Error Action Group spokeswoman Lorraine Long accused the state's medical authorities of placing the interests of nurses above those of their patients. "The Nurses Board is looking at the rights of nurses, but the patients are part of this equation and where are their rights? Who is protecting them?" she said.

Health Services Commissioner Beth Wilson said she had not urged an investigation because the new disclosure requirements may lead to better processes. "When you get a whole lot of disclosures all at once like this you can't possibly investigate them all, particularly when some of them go back to the 1980s . . . What is more important is the nurse's record. Have they been a good nurse and are they well supervised? "It might be that sometimes people who make mistakes in their life could actually be better nurses."

Opposition health spokeswoman Helen Shardey demanded the board investigate the most serious offences.

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24 January, 2009

FDA madness

#1: FDA experts have voted to ban the drugs Serevent and Foradil for asthma patients. The vote isn't binding, but the FDA generally follows such recommendations. And yet . . . One-third of these experts disagreed with banning these drugs for adult patients. The leading rationale was that many patients used them incorrectly by not pairing them with a steroid. But what about patients who took the drugs responsibly and correctly? The total cost of these drugs plus steroids is still cheaper than that of two other asthma drugs, Advair and Symbicort, which were approved. In other words, the panel voted to limit the clinical options of doctors and increase the costs for patients.

Even so, it could have been worse. Some FDA safety experts wanted to ban all four drugs because they may cause one death in "somewhere between 700 and 4,000 patients." They apparently didn't listen to Dr. Richard Gower, President of the American College of Allergy, Asthma, and Immunology, who said, "We live in an imperfect world. All drugs have potential benefits and side effects."

#2: The FDA has also banned the use of chlorofluorocarbon (CFC) inhalers (MDIs) beginning this year. CFC products are believed to cause ozone depletion, and most of them were banned internationally by the Montreal Protocol of 1987. However, Medically essential products, such as CFC MDIs, have been exempt. Medical products account for, at most, 0.5% of CFC consumption, meaning the ban is not environmentally necessary. Replacement inhalers (HFAs) are still patent-protected, and no generics can be made until 2010. HFA MDIs are 2-3 times the price of CFC MDIs, and require more diligence to clean and maintain.

The poor, who are already more likely to suffer asthma, are paying a tax on their health for the sake of a symbolic environmental gesture. There is no medical justification for banning CFC MDI's....

SOURCE




British cancer victim confronts drugs chiefs

Nothing can hasten the glacial pace of bureaucracy

Seventy-year old David Basey is planning to spend his life savings on a drug that could give him a few months of extra life - in the hope that the NHS will step in before it is too late. And yesterday, he and his wife confronted the group which makes drugs decisions for the NHS to ask why it has taken so long to make up its mind on four life-extending drugs for advanced kidney cancer. Mr and Mrs Basey, from Gorleston, went to the public question time held by the National Institute of Health and Clinical Excellence (Nice), the independent body which provides national health guidance.

The retired bricklayer and electricity board worker was diagnosed last February and was given one to two years to live. He has had his kidney removed but the cancer has spread to his spine. His only hope is one of the latest cancer drugs, Sutent, which could double his life expectancy and his time with his wife Ann, to whom he has been married less than a year.

But the drug is not recommended for use on the NHS apart from exceptional cases. Nice is reviewing its guidance and met to make a decision last week, but will not publish it until late March. Until then, Mr Basey has decided to spend his life savings on the 3,000 pounds-a-month drugs in the hope that the NHS will pay for them before his money runs out.

Mrs Basey, 60, asked Nice bosses why there had been such a delay - and chief executive Andrew Dillon admitted that they should have started the process much earlier. She asked: "Bearing in mind that the process has already taken years, can you tell me why there is such a delay between the meeting last week and the announcement in March? Do you realise how many kidney cancer patients are dying for the want of these drugs, or are spending their savings in the hope that it will help them? If the drugs are approved, why do PCTs [primary care trusts] then have three months to implement that guidance?"

Mr Dillon said: "We started work on assessing these drugs far too late. The guilty parties there are Nice and the Department of Health." He said that, once work started, committees had to look at all the evidence, hold a consultation, and look at new evidence. Primary care trusts are given three months to help with financial planning, although some are ready to implement it more quickly. He added: "I know it is tedious, and not just tedious, but distressing. I do sympathise with you."

Nice has been looking at Sutent, Nexavar, Torisel and Avastin since 2007. The drugs could help up to 1,700 people in Britain with advanced kidney cancer each year. It is due to publish its guidance, or final appraisal determination (FAD), in late February, followed by a 28-day chance to appeal, so if there is no appeal it will become official in March. But its new guidance on end-of-life treatments, which was published earlier this month, said it can only publish an appraisal consultation document - in which case the wait will last much longer.

Mr Basey said: "Sutent might double my lifespan. We can afford to pay for it until June and I hope by then the guidance will have changed. I hope something in medicine will come along in the time I have got left. That is my only hope."

Ian Small, deputy head of prescribing for NHS Norfolk, said: "NHS Norfolk welcomes definitive answers on the funding of drugs by Nice. This means that NHS Norfolk would pay for a drug, should it be recommended clinically appropriate for a patient by their consultant. "Nice gives guidance to all primary care trusts to say that processes should be in place to be able to prescribe to appropriate patients within a three-month window and NHS Norfolk would work in line with this."

Fellow kidney cancer sufferer Alan Martin, from Lowestoft, has been campaigning for Sutent to be widely available on the NHS. And David Blackett, from Attleborough, is one of the few to receive Sutent on the NHS as an "exceptional case" after battling to receive it.

Also at the meeting, held at the Norfolk and Norwich University Hospital, was Deborah Browne, the chairman of the N&N's drugs and therapeutics committee. She asked why there had to be a gap between the FAD and the guidance becoming official. She said afterwards: "Once the FAD is published, the patients' expectation is that it will be available. The patients are kept in limbo. That is difficult, when there is a whole group of patients that are waiting."

SOURCE





23 January, 2009

How arthritis sufferers are let down by NHS targets

Thousands of rheumatoid arthritis sufferers are being let down by 'unacceptably wide variations' in care by GPs and hospitals, says a report. It claims the postcode lottery is being made worse by Government targets that are causing delays in appointments to see specialists and receive treatment. Patients already diagnosed with the disease are having to wait longer to be seen - or the NHS ends up paying more than double to treat them as a 'new' patient, says the report from the independent King's Fund think-tank.

Around 420,000 Britons have rheumatoid arthritis, with more women than men affected. It causes pain, swelling and inflammation in the joints and also puts sufferers at higher risk from strokes and heart attacks. The report shows:

Geographical variations in the standards of care for sufferers;

Knock-on effects of the Government's 18-week referral target;

Poor understanding and lack of support among GPs;

Haphazard management of flareups which can cause pain and joint damage unless treated urgently;

Some patients having to wait years for a diagnosis.

The report, commissioned by the Rheumatology Futures Project Group, analysed the views of more than 900 patients and 500 medical professionals and NHS staff. Some patients said they received 'no support' from specialist teams supposed to be co-ordinating their care and were just 'left on the sidelines'. The time between seeing a GP and seeing a specialist ranged from less than six months to more than three years.

But rheumatology experts are most concerned that the Government's 18-week target for referring new patients to specialists is having 'knock-on effects' for existing patients. This can leave those with long-term disease unable to get follow-up appointments because clinics are under pressure to reserve slots for new patients.

Professor David Scott, chief medical adviser of the National Rheumatoid Arthritis Society, said: 'Some GPs end up re-referring existing patients as "new patients" which costs their primary care trusts almost 250 pounds in payment by results instead of 99 as a follow-up appointment.' Professor Scott said he was not talking about his own trust but the experiences of many specialists nationwide. He said: 'Some patients are taking longer to get back to hospital than if they were a new patient, or under the old system. 'One problem is that rheumatoid arthritis is perceived to be a disease of old people and it's not. It can affect patients of any age but they struggle to get the care they need.'

Ailsa Bosworth, joint chairman of the Rheumatology Futures Project Group, said: 'Much needs to be done to raise awareness of the seriousness of this condition with the general public and to address the lack of clinical knowledge about rheumatoid arthritis in primary care.'

SOURCE




Dreamy NHS constitution sets out responsibilities for patients and staff

Any attempt to enforce it would be amusing -- and futile

A written constitution for the NHS - a bill of rights and responsibilities for patients and staff - will be officially signed by Gordon Brown and ministers at Downing Street today. A draft version has already been put out to consultation and the Government has tabled legislation to compel the health service to adhere to the final document. The constitution will effectively become a bill of rights for patients and was introduced by ministers as a major reform - comparable to Mr Brown giving the Bank of England control of interest rates when he was chancellor. The constitution sets out responsibilities linked to people's entitlement to free NHS care, including that they should take some personal responsibility for their own health.

But doctors and campaign groups say that the draft consisted of "optimistic pledges" that would not make any difference to patient care.

Alan Johnson, the Health Secretary, said yesterday that measures to tackle obesity would be included in the document but that it would not threaten to withhold treatment from those who were overweight through over-eating. It would not involve "broccoli police" to check up on people's eating habits. The constitution was intended to be "one concise, clear document that told people what their rights were, what their responsibilities were and what was expected of the staff," he said.

"We never intended this to change the way the NHS works, which is, if you have a health problem we will deal with it. "We have got a section in there on personal responsibilities but it's not something that's backed up by law and [therefore] you'll not have the broccoli police come round if you are having a fry-up. "It was never meant to be something that changed the health service and made it less acceptable to people and made it more problematic. "There are other ways of talking about the dangers of alcohol or getting your nutrition right than stating it in a constitution."

But Katherine Murphy, director of the Patients Association, said "We do not expect this document to make any difference to the care patients are receiving. The time for words like safety, quality, choice and, in this case, constitution to have the meaning they have elsewhere in life is long overdue."

National Voices, an association of charities and patients groups, said that the document had "huge potential". "We need a service that listens and responds to the needs of the people it serves."

SOURCE





22 January, 2009

Health-Care Rationing in Britain

Bruce Hardy probably doesn't have long to live. But he could live longer, if it weren't for the attitude and policies of the British government. As recounted in a New York Times article, Mr. Hardy has kidney cancer that has spread to his lung. His doctor wanted him to take an expensive but effective new drug that has been shown to delay cancer progression for six months.

But Her Majesty's government refused the request. The Times reports: "If the Hardys lived in the United States or just about any European country . . . Mr. Hardy would most likely get the drug, although he might have to pay part of the cost. . . . But at that price, Mr. Hardy's life is not worth prolonging according to a British government agency, the National Institute for Health and Clinical Excellence." (In a supreme irony, the institute's acronym, NICE, is the same acronym C. S. Lewis used for the evil institute in his classic novel, That Hideous Strength.)

The Hardy case highlights many of the problems with socialized medicine: government rationing of health care, a lack of options, and an ultimate devaluation of human life. Remember, in most other countries, Mr. Hardy could have his treatment if he paid for part of it-but Britain isn't even giving him that choice. The government makes the health-care decisions. It's all out of his hands.

And the really scary thing is that other countries are starting to look to Britain as an example of how to manage health care!

Says the Times, "Top health officials in Austria, Brazil, Colombia and Thailand said in interviews that NICE now strongly influences their policies." And even here in the United States, some are calling for the adoption of some of NICE's practices, including officials with Medicare and Medicaid.

Way back during the Clinton era, I predicted that we'd have this kind of debacle here in America if the advocates of socialized health care got their way. As I pointed out then: "The truth is that capping costs will inevitably mean reducing services: Hospitals will have to stop using all the expensive medical technology. In plain English, they will have to stop treating so many people [that] people who are elderly, handicapped, or chronically ill will be pushed to the end of the line." Well, that's exactly what's happening to Bruce Hardy.

Yes, soaring health-care costs are a major problem, and we need solutions. But the great danger of systems like Britain's is that they invariably end up with the government performing a version of the old lifeboat exercise that so many children learn in school now: deciding whose life is worth saving and whose life should be thrown overboard. It doesn't matter how effective or efficient these systems may look on the surface. A government that takes upon itself the right to play God is a government that is not safe for its citizens.

"Everybody should be allowed to have as much life as they can," Bruce Hardy's wife, Joy, told the Times.

As we deal with our health care problems here in America, we would do well to remember her words. The goal of every government should be not to ration life, but to do everything possible to create a system that preserves it.

SOURCE




The Value of Innovation in Health Care

One of the untold stories of the Bush presidency is the progress that has been made over the last eight years on health reform. Though many other domestic and foreign policy issues have grabbed the headlines and many problems remain in our health sector, the administration and the Republican Congress have made notable progress.

In addition to several important policy changes, perhaps the most important accomplishment has been to create a climate friendly to innovation. Instead of offering promises of a sweeping, centralized overhaul of our health sector, President Bush took a step-by-step approach organized around his belief in individual freedom, free markets, competition, and choice. This has resulted in countless innovations from the private sector that have helped to moderate the rise in health insurance cost, create new models for care delivery and financing, and support the movement toward patient-centered health care.

Consider the progress that has been made in moderating costs over the last several years:

In 2007, U.S. health spending grew at its slowest rate since 1998, increasing just 6.1 percent, with year-over-year increases of 6.7 percent and 6.8 percent in 2006 and 2005.1 These increases are still higher than the general inflation rate, but not the double-digit spikes seen over the last several decades.

Premiums for private health insurance also rose by only 6 percent in 2007, the same rate as in 2006, but much lower than the peak of nearly 11 percent in 2002.2 Premiums for new consumer-directed health insurance plans introduced in this decade increased by much smaller amounts - 2.8 percent in 2005 and 2.6 percent in 2006 - helping to moderate costs overall.3

Change is indeed needed

There is a serious problem in our health sector: Health insurance and health care still cost too much. As a result, tens of millions of Americans don't have health insurance, and many more are worried they are one pink slip away from losing their coverage. The costs of Medicare and Medicaid are swallowing up a growing share of federal and state revenues, compromising other functions of government and threatening huge tax increases just to pay for current entitlement commitments. These and other challenges await the Obama administration.

But based upon the experience of this decade, the new president would be well advised to work for solutions that will offer greater choice of private health insurance in a market that continues to deliver innovation and quality of care. Because Americans consistently tell public opinion pollsters they do not want a larger role for government in the health sector, those policies that build on the private sector are much more likely to gain public acceptance.

A climate friendly to innovation

Continued innovation is vital in health care and health care delivery. The medical profession is moving toward patient-centered medicine, with micro-targeting of treatments tailored to the individual genetic code of individual patients. Advances in medical science demand that progress continue without being suffocated by the regulatory obstacles and restrictive payment systems now being considered in Washington. Instead, the government should continue to encourage more private-sector advances.

President Bush has consistently offered policy proposals based upon his belief that Americans should be empowered to make their own decisions about their health needs and that those needs will best be met if they have access to private health coverage that offers choice, flexibility, and incentives for quality health care. "In all we do, we must remember that the best health care decisions are made not by government and insurance companies, but by patients and their doctors," he said in his 2007 State of the Union address.4

A crossroads in the debate

The private sector is much more adept at innovation and evolutionary change than command-and-control public programs. But we are at a crossroads in the policy debate in this country where most of the proposals being offered by political leaders would exert much more centralized government control so that the private health sector would be forced to operate under largely the same rules as the public sector.5

Before we embark on that course, it would be wise to review what innovation has brought us and to assess whether we are ready to cast that aside to put much more control in the hands of public officials.

While the U.S. health sector continues to face many problems, this paper will do what few others have done and focus on the successes during a decade largely friendly to consumer choice and respectful of innovation. It is not possible to begin to describe all of the countless creative ideas, programs, and care delivery innovations in our $2.2-trillion health economy, but this paper will highlight some of the success in the private and public health sectors in this decade.

Two segments of the health sector

The U.S. health economy has two distinct segments - the public and private sectors - and each operates under different sets of rules. About 46 percent of the U.S. health sector is largely financed with tax revenues through government-operated programs, such as Medicare, Medicaid, the State Children's Health Insurance Program, the Veterans Health Administration, community health centers, and others. The rest of health care is financed privately, largely through businesses' contributions to support employment-based health insurance but also through direct purchase of insurance and out-of-pocket payments by patients.

Many analysts refer to our public and private health sectors as a health care system, but we do not have anything approaching a health system in the U.S. Rather, it is made up of conjoined twins, with one run by various government agencies and the other more reliant upon market forces. As health policy analysts attempt to achieve consensus on reforms for our health sector, it is becoming increasingly clear that this operational divide is one reason compromise is so difficult.

The government sector works primarily on a model that provides people eligible for public programs with an entitlement to a government-determined set of benefits within government-determined payment structures. Some patients receive care from physicians employed by the government in government-owned facilities, but most obtain care through private hospitals and physicians paid government-determined rates.

Within the public sector, private health plans also are involved. For example, many states have contracted with private managed care companies to offer care through their Medicaid and SCHIP programs, and Medicare allows participation by private plans in Medicare Advantage and the Part D prescription drug benefit program. But the majority of publicly-financed health care is delivered through the fee-for-service (FFS) model that the private sector largely left behind in the 1980s as unacceptably expensive and inefficient. The response of the public sector to these problems has been to place restrictions on benefits and payments to providers in an effort to restrain costs, which often result in patients having difficulty accessing services and providers.

The private health sector is much more diverse in its range of options and payment systems, representing an alphabet soup of program options from PPOs, POSs, MCOs, and HMOs to HSAs, HRAs, FSAs and even FFS.6 Private health plans, employers, and countless other companies in the health sector are continually innovating to provide options for care and coverage. But they are often constrained by regulation and also by tax policy that is better suited to the last century than to this one. This policy ties private health insurance to the workplace, restricting the market's responsiveness to consumer demands. This gives individual consumers less choice than they would have in a more competitive and open marketplace, as we have written in numerous papers, articles, and our book, Empowering Health Care Consumers through Tax Reform. (For more information see www.galen.org.)

While we do not have a properly functioning private market for health care in the United States, innovative ideas for improvements in the delivery and financing of health care nonetheless come largely from the private sector.

Health care traditionally is not an issue that Republicans have embraced. It is not clear if the issue would have received greater focus from the administration and Congress had the terror threat and the Iraq war not dominated the time and resources of the White House and the country. But the energy, investment, creativity, and responsiveness of the private sector we highlight below show that its engagement will be key to advancing positive change going forward.

Private sector innovation

Entrepreneurs and private investors have been making significant investment in new health care solutions: MinuteClinics, TelaDoc, specialty hospitals, innovative medical practices, and employer plans that empower consumers to engage in their health care and spending decisions are just a few examples in the innovation-friendly climate of this decade.

Here is a summary of some of the other countless private sector initiatives in care, financing, and delivery:

Employer innovations

Employers have taken giant steps to begin to get better value for spending on health care and health insurance for their employees. Some offer employees a variety of health plan options, allowing workers to decide whether they want to pay higher premiums for lower-deductible policies, for example, or agree to more restrictive panels of doctors and/or higher-deductible policies to save on premiums. The new products also give employers flexibility in shaping their health insurance offerings to fit their resources and workforces. A few examples:

Safeway chief executive Steve Burd has become an evangelist for consumer-directed health insurance arrangements. In the first year after the plans were introduced, the company's health costs went down 11 percent. "If you design a health care plan that rewards good behavior, you will drive costs down," he said.7 The company shared its cost savings disproportionately with employees, cutting their costs by 25 percent or more. Safeway also introduced a program called Healthy Measures that encourages employees to get health assessments and provides support and incentives for responsible health behaviors. Safeway also covers the full cost of recommended preventive care.8

Target offers its employees a range of health insurance choices. One Health Savings Account option costs them as little as $20 a month, and Target contributes $400 a year to health spending accounts for individuals and $800 for families.9 "We've seen, and national research supports, that team members make more cost-conscious decisions when they participate in a consumer-based plan," according to John Mulligan, Target's vice president for pay and benefits. "These plans engage our team members in a decision-making process that gives them greater ownership and control of their health care dollars." The company offers its 360,000 employees Decision Guides to help them compare price and quality and estimate their costs, plus access to wellness programs, a nurse hotline, and other support tools.10

Wal-Mart offers dozens of health plan options to its employees, one with premiums as low as $5 a month. For this, employees receive a $100 health care credit, more than 2,400 generic drugs available for $4 a month, and major medical coverage with no lifetime maximum that starts at $2,000 - basically the moment they step into a hospital. Employees can choose to pay higher premiums for lower deductibles and more comprehensive coverage.11 For $62 a month, employees can choose a $500 deductible policy with a $100 health care credit and no lifetime maximum on their insurance coverage.

Whole Foods' CEO John Mackey toured the country talking to employees about health benefits options. Afterward, employees voted to switch to new account-based health plans with higher-deductible insurance coverage. Whole Foods puts up to $1,800 a year into a spending account for each employee, with Mackey pointing out that this is not charity but part of the employee's compensation package. If they don't spend the money on medical care, it rolls over and the company adds more the next year. Some workers have as much as $8,000 in their accounts.12 Whole Foods saves money and still covers 100 percent of its employees' health insurance premiums.

These companies and many others have worked extraordinarily hard to find the delicate balance between getting health benefit costs under control and continuing to provide coverage that satisfies their workers. There simply is no way that a benefit or cost structure dictated by Washington could achieve these same results. Maintaining ERISA protection is crucial to allowing companies to continue to innovate.

Much more here





21 January, 2009

Arrogant Therapeutic Goods Administration still refusing to cough up for its wrongful actions

The TGA is Australia's version of the FDA. They think that they can get away with destroying hundreds of businesses and creating huge financial losses on the basis of mere speculation. One of the grosser examples of bureaucratic irresponsibility and abuse of power. They are all the more hateful because they have settled with the "big" guy whom they hurt but now seem to think they can stiff all the the little guys by insisting on long drawn out and expensive court action. I have commented on the scum previously. Note that I am no fan of "alternative" medicine. As you can see here I think that there is too much quackery even in conventional medicine. But my attachment to the importance of evidence is obviously not shared by the TGA and the bitches who seem to run it -- depite scrutiny of evidence being their brief

PHIL Alexander has turned to the law for help five years after it was used against his naturopath business in the country's biggest medicines recall. He has become part of a $120 million class action against the commonwealth over its role in the collapse of Pan Pharmaceuticals, which once supplied his multivitamin business. "It was an incredibly harrowing experience," Mr Alexander said, recalling the 12,000 items of stock he was forced to destroy in the recall.

He even received death threats as frightened customers turned against him and bad publicity swamped his sales. "The odd father rang up and said 'If you kill my baby, I'll kill you'," Mr Alexander said.

In 2003, the Therapeutic Goods Administration suspended Pan's licence and progressively recalled 1600 of its products. The TGA accused Australia's then largest complementary medicine maker of substituting ingredients, manipulating test results and running sub-standard production lines after a Pan travel sickness drug was linked to 19 admissions to hospital.

But the decisions the authority made at the time were brought into serious question last year after the commonwealth settled with Pan founder Jim Selim for $55 million over the TGA's handling of the affair.

Now Mr Alexander wants redress, saying his once-thriving Sydney business has never recovered from the TGA's actions. "They pulled all the vitamins and minerals off the shelves, without cause," he said. "After 14 weeks, we were able to get stock made and get it back on the shelves, but of course over 30 per cent of our customers wouldn't come back."

Mr Alexander said the TGA had acted on an "ideological and regulatory whim" in ordering such a massive recall. He said Pan had passed a TGA audit not long before, and no complaints were made or illnesses recorded from the recalled products.

Mr Alexander said he first learned of his business's fate on the 6pm news one Monday in April 2003. "All hell broke loose, and the next day the phones went absolutely mad for 14 days. We spent months returning all the calls. It was bedlam, it was just insane," he said. The TGA refused to even test his multivitamins for contamination, despite ordering the destruction of his stock, Mr Alexander said.

A Health Department spokeswoman said yesterday the TGA was unable to comment because the case was before the courts. But the regulator has publicly refused to concede any of the allegations made in Mr Selim's lawsuit.

Susanna Khouri, investment manager with IMF Australia, which is funding the lawsuit, said Mr Alexander's story of lost revenue and emotional harm was repeated many times over.

SOURCE




Court challenge to NICE over osteoporosis treatment

Typical NHS short-sightedness. They pennypinch on drugs and as a result spend thousands dealing with avoidable fractures

The medicine regulator faces a legal challenge this week over its ruling that thousands of women with thinning bones should be denied effective treatment on the NHS. Draft guidance from the National Institute for Health and Clinical Excellence (NICE) states that doctors should prescribe the cheapest drug available to women with the early signs of osteoporosis, even though up to one in five patients cannot take it. The National Osteoporosis Society and the drug manufacturer Servier say that this is unethical and will do nothing to prevent fragility fractures that contribute to 13,000 premature deaths a year, as well as causing widespread disability and pain.

They will contest the NICE guidance in the High Court, as part of a full judicial review, claiming that the watchdog has not been transparent about its processes and is infringing the human rights of patients by denying them alternative medication on the ground of disability. NICE denies that it has acted illegally. But in a letter to The Times last September, 40 experts called on the watchdog to reconsider its decision, calling it "unethical and short-sighted".

Half of women and one in five men over the age of 50 will develop osteoporosis, in which the spine, wrist and hips become thin and fracture easily. While bone-strengthening drugs are available, the side-effects of alendronate, which costs 50 pounds a year, include crippling stomach pains and indigestion, while the medication is difficult to take - requiring patients to stand or sit for 30 minutes while it is absorbed. The guidelines mean that a woman in her early seventies who cannot tolerate alendronate would have to get up to 60 per cent worse - using a clinical scoring system - to qualify for strontium ranelate, an alternative medication that costs 17 pounds a month.

Nick Rijke, a spokesman for the National Osteoporosis Society, said: "Already there are more than 70,000 hip fractures a year which result in 13,000 deaths and cost the public purse 2.3 billion. "Yet with effective treatment, many of these fractures could be prevented, not only saving lives, but saving the taxpayer money at the same time."

Andrew Dillon, the chief executive of NICE, said that the recommendations on osteoporosis had been "a complex set of guidance to produce", but added that he was confident that NICE had acted lawfully and that the claim would be dismissed.

SOURCE





20 January, 2009

What Medicaid Tells Us About Government Health Care

Why would Obama want to build on a system with poor outcomes?

Medicaid provides coverage to poor and disabled Americans, many of whom face the highest burden of chronic disease owing to cultural and socioeconomic challenges. The program beats being uninsured, but it often relegates the poor to inferior care.

Reimbursement rates are so low, and billing the program so complicated, that it is hard for internists like me to get beneficiaries access to specialized care or timely interventions. For my patients as well, many of whom are uneducated or don't speak English, Medicaid is replete with paperwork, regulations and rejections that make the program hard to navigate.

Now Medicaid is to receive a bolus of federal money, probably as part of the fiscal stimulus plan -- the figure whispered in Washington is $100 billion -- with no obligation that the program does anything to reverse its decline.

Accumulating medical data shows that Medicaid recipients' poor health outcomes aren't just a function of their underlying medical problems, but a more direct consequence of the program's shortcomings. Take the treatment of serious heart conditions, which are among the most closely evaluated Medicaid services.

One study published in the Journal of the American College of Cardiology (2005) found that Medicaid patients were almost 50% more likely to die after coronary artery bypass surgery than patients with private coverage or Medicare. The authors suggest this may be a result of poorer long-term, follow-up care. Like other similar studies, this one tried to control for the other social and medical factors that are believed to influence patients' clinical outcomes.

Another study in the journal Ethnicity and Disease (2006) showed that elderly Medicaid patients with unstable angina had worse care, partly because they were less likely to get timely interventions or be treated at higher quality hospitals. Three other recent studies showed that Medicaid patients presenting with heart attacks or unstable angina received cardiac catheterization less often than Medicare or private paying patients. This procedure to open blocked heart arteries has become standard care, with ample evidence showing it improves outcomes.

The same trends can be observed in other diseases. For example, a study of adults with cancer published in the journal Cancer (2005) found that patients on Medicaid were two to three times more likely to die from the disease even after researchers corrected for differences in the location of the tumor and its stage when diagnosed.

The federal and state governments are equally culpable for the program's troubles. The federal government matches state Medicaid spending, paying an average of 57% of costs. States expand enrollment in order to qualify for more federal aid. Insurance coverage has become the end itself, with states spreading resources widely but thinly -- without enough attention to the quality of care, accessibility, or whether coverage was actually improving health. States have no obligation to rigorously measure health outcomes in order to qualify for more federal money.

A government survey in 2002 for the Medicare Payment Advisory Committee found that "approximately 40% of physicians restricted access for Medicaid patients" because reimbursement rates are so low. Only about half of U.S. physicians accept new Medicaid patients, compared with more than 70% who accept new Medicare patients. Several recent studies trace the difficulty in getting Medicaid patients seen by specialists to low fees and payment delays. Technologies are also restricted. Many expensive but important drugs aren't paid for under various state drug formularies.

There's also a fair degree of fraud in the program. James Mehmet, New York's former chief Medicaid investigator, was quoted in the New York Times as believing that at least 10% of state Medicaid dollars were spent on fraudulent claims, while 20% or 30% more was siphoned off by what he termed "abuse." Even if the federal government wanted to hold states more accountable for peoples' ?185 health, Medicaid claims data is poorly gathered in most states, making meaningful oversight hard.

Barack Obama's team and Democratic leaders plan to change the federal matching rate to reduce the amount of state funding that is required for maintaining a given level of federal Medicaid spending. Mr. Obama would give Medicaid tens of billions more in federal dollars as part of the fiscal stimulus bill. And he wants to extend Medicaid to some unemployed workers, with the federal government paying the entire cost -- a watershed expansion of the program. New money alone won't fix the program's woes. It will simply allow states to siphon off more of what they would have spent on Medicaid to other uses.

For its part, the federal government has often prevented the states from taking steps to fix their own Medicaid programs, such as by devising outcome-based standards for evaluating performance, and de-emphasizing the goal of growing the number of covered people to focus more on improving the health of those served.

Among a handful of states that have received "special permission" from federal regulators to take incremental steps to improve their Medicaid programs, North Carolina has created a primary care-based program that pays doctors more to improve coordination of care, and gives patients more choice by getting new doctors to participate in the program. Indiana is incorporating personal accounts that allow patients greater choice of providers.

Another idea being tried in some states allows patients to choose coverage tailored to specific health needs like pregnancy or certain disabilities. In Louisiana, Gov. Bobby Jindal wants to provide tailored Medicaid services through managed-care networks run by private and competing companies that would be held accountable for showing better health results.

The Centers for Medicare and Medicaid Services, which regulates the program, recently gave states the flexibility to redesign their Medicaid benefits by modeling the programs after popular private-sector plans already being offered in a particular state. But creating enduring incentives for broader state accountability probably means ending Medicaid's open-ended funding. Even the auto makers are being held accountable to certain outcomes as a condition for getting federal loans.

The troubling evidence about the quality of Medicaid patients' services is a cautionary tale for Mr. Obama as he sets about to administer more of our health care inside government agencies. Turning Medicaid around should be the least we demand before turning over more of our private health-care market to similar government management.

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Slow ambulances in Canada too

Very reminiscent of the Australian and British experience

She was so miserable, she prayed she would live. She was so miserable, she prayed she would die. "Couldn't decide," her husband said later. On Jan. 4, three days after her emergency appendectomy, Jessica Baker, the morning traffic reporter for CFRB and EZRock, began experiencing excruciating abdominal pain - far worse than the pain she had in the hours before her appendix was removed - and vomiting repeatedly. At around 7:20 p.m., with Baker in the fetal position, her husband, Adam Dolgin, called 911. The ambulance, he said, arrived at their Toronto apartment more than 30 minutes later.

"It was awful. It was horrible. Probably the worst experience of my life," said Baker, who was hospitalized with a surgery-related infection. "I assume if anybody calls an ambulance, regardless of what it is - because who knows what it could have been, right - that 10, 15 minutes would be the longest it would take."

In all GTA municipalities, ambulances do respond to almost all "Code 4" 911 calls, those classified as the most urgent, within 15 minutes. But responses have become progressively slower over time - nowhere more than in Toronto. In 2007, Toronto responded to 90 per cent of Code 4 calls within 11 minutes, 58 seconds - 3:38 longer than its response time in 1996, according to Ministry of Health figures released upon request. Peel Region's response time increased by 2:38, from 9:32 to 12:10; York Region's increased by 1:26, from 11:38 to 13:04. With the exception of Durham Region, responses slowed throughout the GTA after Ontario downloaded ambulance service to municipalities in 2001.

Responses got faster in 27 of 50 Ontario ambulance jurisdictions between 2001 and 2007. But while numerous small towns and rural areas improved, the most populated urban areas generally regressed. The widespread increase in urban response times, said Emergency Medical Services officials, hospital doctors and the province, is largely the result of systemic problems outside EMS's control. Demand for ambulance care has boomed as cities have both grown and aged, far outpacing increases in EMS budgets.

Increasingly overburdened emergency rooms, unable to quickly find hospital beds for admitted patients, have become slower to take responsibility for people brought in by ambulance, forcing paramedics to continue to provide care instead of returning to the streets to respond to new calls. "Really, the ambulance response time problem is a symptom of the underlying problem: not enough capacity within the whole system. And it's predictable," said Dr. Dante Morra, medical director of the University Health Network's Centre for Innovation in Complex Care.

"The EMS group, and how they respond, is captive to how the hospitals act. The main problem here is that we do not have enough in-patient beds to take care of sick patients. ... These EMS people, who should just walk into the emergency, drop their patient off, and then leave, are frozen in the emerg for a long period of time, because there aren't enough resources there. But the problem isn't even an emerg problem. It's a flow problem."

Growth in the use of cellular and Internet phones, which do not provide automatic location information to ambulance dispatchers, has further contributed to a slower response times. While American cellular companies were forced to adopt location technology by 2005, Canadian regulators only this month imposed a 2010 deadline.

Norm Lambert, Toronto EMS deputy chief, said some of the worsening in Toronto's times - which increased by 44 per cent since 1996, 4 per cent since 2001 - is the result of a change in philosophy that emphasizes "a smarter response" as opposed to just a rapid response. For calls about heart attacks or choking, Toronto ambulances will scream to the scene. For reports of chest pain, however, the city will attempt to dispatch a team of expert paramedics equipped with cardiogram machines, even if that team is minutes farther from the victim than another ambulance. "In the past, we sort of always looked at it that if somebody phones in and it's considered an emergency, we want to run lights-and-siren to the call and get there as quickly as possible," Lambert said. "But that's not always the case. It's not a road race."

As elsewhere, he said, "off-load delay" - the time paramedics spend waiting to hand over patients in emergency rooms - plagues the city's response system. It cost EMS approximately 180 ambulance hours per day in December 2007. The Liberal provincial government has identified emergency room wait times as a priority. The province began in 2008 to provide funding to busy hospitals to devote nurses to the reception of ambulance patients - an "interim solution," the Ministry of Health said in an email. As a result, in December 2008 Toronto EMS lost 60 fewer hours per day to off-load delays. But the demand problem continues to escalate. In York Region, calls for ambulances are up 60 per cent since the municipality took over the service in 2000, said EMS general manager Norm Barrette.

In Toronto, now the 11th-fastest responder in Ontario, calls are up 23 per cent since 2002. Over the same period, Lambert said, the number of paramedics has increased only 1 per cent. "It gets back to resources and vehicle availability ... a 1 per cent increase in paramedics with a 23 per cent increase in demand is quite a difference." Ontario's 50 ambulance providers have been required by provincial law to match their 1996 response time for Code 4 calls - less than a third of which generally turn out to be actual life-threatening emergencies - in 90 per cent of cases. In 2007, only 17 of them met their targets, which the province considers "no longer relevant" to modern realities and which municipal governments have ignored to such an extent that some of them use different targets than the Ministry of Health. Toronto officials, for example, have long used a target of 8:59; the province lists it as 8:20.

As of 2011, municipalities will be permitted to set their own response-time targets for non-life-threatening problems, which will be made public. Municipalities will be urged, but not required, to meet ministry response guidelines for life-threatening problems. Richard Armstrong, director of Durham EMS, and Lambert both said the elimination of legislated targets would not reduce the incentive to improve response times. Voters, Armstrong said, would punish local politicians who set low standards in order to claim success in meeting them. "Through the combined accountability of municipalities to the ministry and to its residents, we believe the risk of such action - the filing of `easy-win' targets - is extremely low," the health ministry said.

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An Alzheimer's patient lies in a grubby hospital bathroom because of a shortage of beds. Will the elderly EVER be treated with dignity in Britain?

This is the picture that shames the NHS. An elderly Alzheimer's patient is treated in a squalid bathroom due to a chronic shortage of beds at a hospital. In what her family describe as 'an affront to human dignity', Gladys Joynes, 79, was shunted into the bathroom for several hours. The grandmother was left next to an overflowing bin, a commode and a foulsmelling walk-in bath. And with no power point in which to plug in her saline drip equipment, she swiftly became dehydrated and unresponsive.

Mrs Joynes was taken to the Royal Liverpool University Hospital last Friday after falling ill with pneumonia-like symptoms at the nursing home where she is a resident. She arrived at the hospital's emergency department in the early hours but was not examined by a doctor until around 7am. Medical staff were unable to find a bed for her and at 10am she was placed in the bathroom. At 2pm her family arrived and were led to the bathroom. One of her three daughters, Sharon Huxley, 55, a company director, said: 'I was so shocked. It was a smelly bathroom with an overflowing bin and we had to put a tray of food on the floor and feed her ourselves from that. 'I just can't believe that staff are so desensitised and complacent that they didn't think it would be a problem.'

Mrs Joynes's eldest daughter, psychologist Kathleen Huxley, 57, said: 'It is a total affront to human dignity for her to be treated this way and the Government should ensure it does not happen again. 'We believe she was cynically chosen because she is an Alzheimer's sufferer and as such would not complain. 'What if an elderly patient or Alzheimer's sufferer hasn't got a family to stand up for them?'

Shadow Health Secretary Andrew Lansley said: 'It is extremely concerning if patients are not being treated with the respect and dignity they deserve. 'I know that the hard-working staff of the NHS will do everything they can to stop this from happening, but unfortunately their hands have been tied by Labour's complacent approach to the extreme pressures placed on our hospitals during winter. Years of bungling by Labour ministers have created a terrible legacy for NHS patients.'

The Daily Mail has consistently highlighted the plight of the older generation through its Dignity for the Elderly campaign. In recent weeks, our readers have also raised tens of thousands of pounds for Alzheimer's sufferers.

Mrs Joynes, 79, ran a milliner's shop in Liverpool before marrying Merchant Navy seaman Frank Huxley. After his death in 2002 she married Stewart Joynes, a musician, who also later died. She developed Alzheimer's symptoms about four years ago.

Last night Tony Bell, chief executive of Royal Liverpool University Hospital, said the hospital was dealing with an ' unprecedented' number of cases and said an extra ward with 17 beds had been opened to cope with the strain. Mr Bell said: 'I would like to offer the patient and her family our sincere apology. It is not acceptable for a patient to be put into a bathroom. 'We are now conducting a full investigation and will identify measures to prevent it happening to other patients.' The hospital denied that Mrs Joynes had been 'earmarked' for the bathroom because her condition meant she was less likely to complain.

Mrs Joynes was last night feeling a lot better and was about to be discharged. She was diagnosed with a chest infection.

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19 January, 2009

New EU working laws will be disaster for NHS

Changes to hospital working hours which come into force this summer under European law will be "disastrous" for patient care and result in "major service failure", Britain's top surgeon has warned.

John Black, president of the Royal College of Surgeons, has issued a dramatic warning that the National Health Service will not be able to cope with the effects of the controversial European Working Time Directive. From August, hospitals face heavy fines if they allow any health care staff, including surgeons, to work more than 48 hours a week, despite warnings from hospitals that they are not able to make the change. In his February newsletter, Mr Black said the new rules were "an impending disaster" which will "devastate" medical training because no surgeon will be able to work a shift long enough to gain proper experience.

The multiple handovers of staff needed to comply with the rules will mean that patients do not see the same doctor for more than a few hours, he said. And he warned there could be "dangerous" lapses in patient care, especially at night. "With nobody able to work more than 48 hours a week from August, the effects on patient care in the NHS are potentially disastrous," Mr Black said. "Out-of-hours cover will be so thin, on occasions non-existent, that major service failure with unplanned reconfiguration of services appears inevitable. "It is well known that dangerous incidents are far more likely to happen at night and weekends, and this will get worse with even fewer doctors available. "This is not to mention the dangers of multiple handovers or the frustration and alarm felt by patients who rarely see the same doctor for more than a few hours. This is all being done under social chapter legislation, supposed to make people's lives better."

Mr Black is meeting Alan Johnson, the Health Secretary, in February to propose a "speciality opt-out" and an upper limit on surgeons' hours of 65 to 70 hours a week. "I have no doubt we will be told that it is impossible to alter or bypass the European law. I do not believe this. All manner of EC law must have been bent or ignored in nationalising a bank in 24 hours. The Government can do it if it has the political will," Mr Black said.

The European Working Time Directive has proved a massive challenge for the NHS since it was introduced in 1998. At first, certain staff were exempt, but a 58-hour limit was introduced in 2004, falling to 56 in 2007 with the final drop to 48 required by August 2009. With time running out to make the changes to rotas needed, a survey of hospital trusts in November last year found that only 18% were hitting the 48 hour limit.

A Department of Health spokesperson said: "A few hospitals have implemented the maximum 48 hour week across all rotas. We are monitoring the situation as some smaller specialities and isolated hospitals may find meeting the deadline more challenging."

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Australia: The "caring" Leftist mania for closing down public hospitals continues

Yesterday it was Queensland. Today it is South Australia. And once again the bureaucrats think they know better than the doctors. They didn't even bother talking to the doctors! My suspicion is that some Leftist hater just didn't like the "Royal" in the name of the existing hospital. They are small-minded enough for that. Witness all their whining about politically correct words

Eminent medical specialists have launched a campaign to save the Royal Adelaide Hospital, saying the city does not need the planned $1.7 billion Marjorie Jackson-Nelson Hospital. A group of respected senior doctors who have spent the past year "brooding and alarmed" have decided to go public with their opposition and have formed a committee dedicated to saving the RAH from being bulldozed. "We want genuine discussion about whether the RAH really needs to be closed," spokesman Dr James Katsaros said yesterday. "We have a responsibility to look at whether we are making a terrible mistake in spending $1.7 billion on something that is not needed while erasing an iconic institution. ". . . as senior members of the medical community we came to the view that if we did not stand up against this lunancy, no one would. "We have been brooding on this for a long time, whispering in corridors and over coffees about the madness of the plan, which was announced without consultation with the medical community."

The "Save the RAH Medical Committee" says the state does not need a new hospital and the RAH's patient accommodation could be upgraded for far less than the Marj's ballooning $1.7bn cost - and the work completed far earlier than the Marj's 12-year time frame. The Save the RAH group includes leading and retired orthopaedic surgeons, cardiologists, plastic surgeons, oncologists and pathologists, as well as people who have held representative positions such as Australian Medical Association office holders. Members so far include Dr Peter Hetzel, Dr John Sangster, Dr Daryl Teague, Dr Francis Ghan, Dr Randall Sach, Dr Peter Malycha, Dr Philip Harding and Dr Katsaros.

The committee is holding a meeting for the medical fraternity at the RAH on March 16 to discuss the issues and see if there is genuine support for the new hospital. If the meeting shows a lack of support for the Marj, the committee will widen the debate to public meetings. The key concerns of the Save the RAH group include:

A LACK of consultation by the State Government with the medical community or the AMA before the plan was announced;

A LACK of convincing arguments in favour of building the Marj;

MISINFORMATION about the state of the RAH, which they say has been substantially upgraded in recent years;

DESTRUCTION of the close working relationship between the RAH, Adelaide University Medical School, Hanson Institute and Institute of Medical and Veterinary Science, which are all on the one city campus;

ABOLITION of the brand name "Royal Adelaide Hospital" - world famous within medical circles.

Dr Katsaros, committee chairman and director of the plastic and reconstructive surgery at the RAH, said the group represented conservative people who otherwise would not want to be caught in a political row. "There was no review to see if it was actually needed, no public debate, just an announcement," he said. "We have been alarmed ever since the announcement was suddenly made and the discussions among doctors have been ones of alarm and incredulity. "Being conservative, it has taken a while to band together and go public, but we have to show leadership and generate genuine discussion about whether we need a new hospital. "While we as senior doctors feel we must stand up, we also have the support of many junior staff as well as nurses and allied health workers who believe the RAH should be retained. "I believe we do not need a new hospital at all; but if the overwhelming view of the medical community after we have discussions is that we do need one, then we will say `so be it' and move on."

Dr Katsaros noted the RAH was world respected, both in facilities and in name that also promoted the city. "The RAH has a brand new emergency (department), which is state-of-the-art, an intensive care area the envy of most hospitals, a world-class burns unit, modern dialysis unit and so on," he said. "Every hospital has to start planning upgrades virtually as soon as they are built, but the RAH right now is at a point where the most urgent thing is a new patient accommodation wing. "That could be built for around $300 million, rather than $1.7 billion, and could be completed in a couple of years rather than waiting 12 years."

The committee will meet AMA officials this week with a request it notify members of the March 16 meeting in the hope of having the largest possible number of the medical fraternity on hand to voice their opinions about whether a new hospital is needed.

Dr Katsaros said the Marj announcement came without any review into whether it was needed. "The existing institution can be refurbished and rejuvenated, as was done in the 1960s when a larger RAH was rebuilt on site without major problems," he said. Dr Katsaros emphasised the RAH name was a respected and valuable brand name for SA. "Can you imagine the folk in Minnesota bulldozing the Mayo Clinic and building the Michael Jordan Hospital 1km away?" he said. "They'd be a laughing stock."

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Australia: And a corrupt hospital system in Victoria too

A SENIOR Victorian doctor will this week use a parliamentary inquiry to blow the whistle on alleged corruption, negligence and bureaucratic bungling in our public health-care system. Peter Lazzari is to release a report that says a "deepening crisis in our hospitals" is costing hundreds of Victorian lives every year. Dr Lazzari, head of an acute unit of medicine at Angliss Hospital and deputy chair of the Victorian State Committee of the Royal Australian College of Physicians, says a deteriorating standard of care and training is responsible for more than 500 deaths each year. In a submission to the Upper House Parliamentary Inquiry Into Public Hospital Performance Data, Dr Lazzari is to:

ACCUSE the Brumby Government and health executives of incompetence and intimidation of doctors, calling medical service directors "doctors of death".

CLAIM nurses are frequently violently and sometimes sexually assaulted by patients and that hospital administrators leave them without protection, "terrified" and "alone" at the bedside.

ACCUSE hospital boards and bosses of deliberate and "widespread cruelty to patients, doctors and nurses".

REVEAL several hospital buildings are putting patients' lives at risk because they are riddled with asbestos, have "crumbling internal walls" and have operating theatres that shake when trucks pass.

In a separate submission, Dr Lazzari will tackle "fraudulent waiting list reporting", claiming many hospitals "fudge" waiting list figures, to avoid penalties and claim government bonuses. He says hospitals tweak elected surgery waiting lists for up to a year, then claim it was the patients' choices. Others keep a second set of waiting lists and only enter them into the system when beds are available. He says it is "sentencing patients to pain, suffering and death". Both reports, expected to be released within days, call for major reforms.

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18 January, 2009

Another reduction of medical services in a socialized medical system

In both Britain and Australia, "caring" Leftist governments have a mania for closing down hospitals and shrinking the number of beds available. The pretext is that they want to combine several hospitals into one to provide bigger, better and brighter services. It is utter crap, of course. It is about cost-cutting and nothing else. Standards decline rather than rise. We see the latest iteration of this "compassionate" Leftist policy in Queensland, Australia, where the government wants to replace two childrens' hospitals with one new one. Result? Everyone is going to be shortchanged. Even the size of consulting rooms has been reduced to the point where they are too small to fit a wheelchair in. And this is a hospital?

One of Queensland's leading doctors sent a disturbing email to nearly 100 colleagues that was leaked to me last week. Dr Brent Masters, a specialist in respiratory medicine at the Royal Children's Hospital asked if anyone was happy with the planned move to the new Queensland Children's Hospital. The planning process was "truly getting out of hand", he wrote. "I recommend you all read the book On Bullshit: you can buy it at the Medical School bookshop for about $15," he said. "It points out that basing decisions on bullshit are (sic) fraught with dire consequences - indeed worse than basing decisions on lies . . .

"The complete lack of intellectual honesty has let pediatrics down badly in this state . . . "I again point out that this hospital should not be about secondary level pediatrics (the bullshit factor) but about tertiary pediatrics: You can not have a world class hospital based on secondary-level pediatrics." Then he gave an ominous warning about underfunded hospitals. "You can cross the road 100 times with your eyes closed and you will get away with it 90 times," he said.

Despite some positive announcements on the new hospital this week, Dr Masters, like many other specialists, remains sceptical. He has to be. He leads a team treating 350 young cystic fibrosis patients. "People come from all over the world to train with them," said a doctor. They are that good." He is backed up by Dr Ann Chang, a leading researcher and devout Catholic who is a world authority on respiratory disease. This week Chang is in Darwin and soon she heads to New York and Miami to present papers to international medical forums.

For Dr Masters it is a demanding clinical load. CF is an unforgiving genetic disease characterised by frequent lung infections. It is incurable. Even lung transplants have only a 50 per cent success rate. Masters and Chang fear the new hospital simply doesn't have enough space to treat existing cases, let alone the 125 new cases who will come onstream in the next five years. And hospital planners neither seem to understand nor care about necessary research. This is a common complaint among specialists, from pathology to neurology.

Gastroenterologists fear they have been sidelined by planners who "stole" some of their space for respiratory medicine. "Gastroenterology is seriously compromised at QCH, with the complete disintegration of our diagnostic unit," said Dr Looi Ee last week.

Doctors practising nuclear medicine and medical imaging fear they, too, have been short-changed, with not enough MRI scanners.

Professor Jenny Batch told colleagues she needed rooms for diabetics and growth hormone therapy and a permanent patient-family education centre. "I share the concerns that there will not be adequate rooms," she said in another email leaked to me.

Space shortages also worried Dr Jane Peake, a pediatric immunologist who deals in allergies, eczema and auto-immune deficiencies. She feared there would not even be enough space to store research papers. She thought she was looking at a "poorly designed rabbit warren" with "small and grossly inadequate consulting rooms".

Dr Kate Sinclair agrees. She says proposed, open-plan office space will be unsuitable. Privacy will be endangered and deeply personal conversations with patients will be difficult.

Several doctors also questioned plans to cut queues at the new hospital by running clinical sessions in a day starting at 7am and finishing at 8pm.

Dr Lynne McKinlay, the director of pediatric rehabilitation at the Royal, noted the apparent lack of large consulting rooms. She said rooms would be "unsuitable" for children who arrived with both parents, siblings and a stroller, "let alone children who come with wheelchairs and walkers".

The proposed research centre remains unfunded and clinicians in allied health, genetics and dentistry believe their patients, too, will suffer in the shift to South Brisbane.

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Socialized health care fundamentally changes the relationship between citizens and state

For most of our nation's history, our approach to economics has favored enterprise, self-reliance and the free market. While the American economy has never been entirely laissez-faire, we have historically cared more about equality of opportunity than equality of results. And while Americans have embraced elements of the New Deal, the Great Society and progressive taxation, we have traditionally viewed welfare as a way to help those in dire need, not as a way of life for the middle class. We have grasped, perhaps more than any other nation, that there is a long-run cost to dependency on the state, including an aversion to risk that eventually enervates the entrepreneurial spirit necessary for innovation and prosperity.

This outlook, once assumed, is now under attack due to a recent series of political and economic events. The first is the unprecedented intervention by the federal government, in the form of a $700 billion relief package intended for our financial institutions after the credit crisis last September. This was followed by extending billions of dollars of federal assistance to America's auto makers in order to prevent their imminent bankruptcy -- the first emergency bailout that went to companies outside the financial sector. We understand why the federal government did this, and even supported legislation that, while hardly perfect, prevented an economic meltdown.

Nonetheless, the consequences of this undertaking are enormous. Not only has the size of the expenditures been staggering -- there is talk of another stimulus package worth an estimated $825 billion -- but we are witnessing a fundamental transformation of government's relationship with the polity and the economy.

The last several months are a foreshadowing of a new era of government activism, rather than an unfortunate but necessary (and anomalous) emergency action. We will soon shift from a market-based economy to a political one in which the government picks winners and losers and extends its reach and power in unprecedented ways.

This shift is exemplified by the desire of President-elect Barack Obama and the Democratic Congress to push us toward government-run health care. For all his talk of allowing consumers to select their own health-care coverage, Mr. Obama's proposal, as he laid it out in his campaign, will provide strong financial incentives for employers and individuals to sign up with a new, Medicare-style government plan for working-age people and their families. This plan will almost certainly use a price-control system similar to the one in place for Medicare, allowing it to charge artificially low premiums by paying fees well below private rates. These low premiums will serve as a magnet for enrollment and will devastate the private companies trying to compete in the health-insurance market. The result will be the nationalization of the health-care sector, which today accounts for 16% of U.S. gross domestic product.

Nationalizing health care will be profoundly detrimental to the quality of American medicine. In the name of cost control, the government would make private investment in medical innovation far riskier, and thus delay the development of potentially lifesaving treatments.

It will also put America on a glide path toward European-style socialism. We need only look to Great Britain and elsewhere to see the effects of socialized health care on the broader economy. Once a large number of citizens get their health care from the state, it dramatically alters their attachment to government. Every time a tax cut is proposed, the guardians of the new medical-welfare state will argue that tax cuts would come at the expense of health care -- an argument that would resonate with middle-class families entirely dependent on the government for access to doctors and hospitals.

Of course, this health-care plan is occurring against our particular fiscal backdrop: Without major reform, our federal entitlement programs will soon double the size of government. The result will be a crushing burden of debt and taxes. In short, we may be approaching a tipping point for democratic capitalism.

While the scope of the challenge should not be underestimated, those of us worried about this fundamental reorientation of politics and economics have several things working in our favor. Among them is that a public accustomed to iTunes, Facebook, Google, eBay, Amazon and WebMD is not clamoring for centralized, bureaucratic government. The strong American instinct for individual initiative and entrepreneurship remains intact. In addition, confidence in government -- from Congress to those responsible for oversight of the financial system -- is quite low.

Our sense is that at the moment, the public is not thinking in terms of "big government" or "small government." Instead, Americans want efficient government -- one that is modern, responsive and adaptive. People want government to act as a fair referee, providing guardrails that allow individuals to rise without intrusively dictating individual decisions.

If conservatives hope to win converts to our cause, we need to understand this new moment and put forward an agenda that reforms key institutions in a way that advances individual freedom, without creating an unacceptable level of insecurity. This is no easy task, and it must begin with providing a compelling alternative to what contemporary liberalism and Mr. Obama are about to offer. This especially includes health care, where we must start by recalling that our current health-insurance system was designed to meet the needs of a 20th century economy and World War II-era employment laws. It is hopelessly outdated, yet the Obama plan would make the system even more sclerotic.

The core of our message needs to be a commitment to creating a health-care plan that meets the demands of the modern economy. We need to convince concerned citizens that we can help the uninsured find coverage in the private sector and use market incentives to contain costs. The result will be a system that makes it possible for everyone to afford health insurance, including those with pre-existing conditions. Tax credits, high-risk pools, insurance choice and regulatory reform can form the basis of a transformation from today's enormously costly and inefficient third-party system into one driven by ownership, choice and competition. And at the nucleus of this redesigned system will be the patient-doctor relationship.

If we hope to succeed in making our case, it will require a concerted education campaign that relies on hard data and facts, rigorous and accessible public arguments, and persuasive public advocates. This is quite a tall order. But if we do not succeed in resisting greater state involvement in the economy -- and health care is meant to be the beachhead of this effort -- we will move from a limited welfare state into a full-blown one. This will reshape, in deep and enduring ways, our nation's historic sensibilities. It will lead here, as it has elsewhere, to passivity and dependence on the state. Such habits, once acquired, are hard to shake. Between now and the end of this decade may be one of those rare moments in which among other things will turn decisively one way or the other. The stakes could hardly be higher for our way of life.

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Embryo screening funding is 'postcode lottery' in Britain, researchers say

Handicapped children are a better deal, apparently. Amazingly short-sighted thinking. But that's governments for you

More than half of couples seeking embryo screening to protect their offspring from inherited genetic diseases such as breast cancer are being prevented from doing so, researchers say. Evidence from one of the country's leading gene-screening clinics suggests that local health authorities frequently refuse to fund treatment for patients who wish to avoid passing defective genes to their children.

Scientists predict an increase in demand for the technique, known as preimplantation genetic diagnosis (PGD), after the start of a pilot programme screening an entire adult community for faulty genes. The Times revealed last week that the London community of Ashkenazi Jews is being offered screening for BRCA genes that raise risks of breast, ovarian and prostate cancers. Britain's first baby screened to ensure that it was free of a genetic risk of breast cancer carried by a parent was born last week, and hailed as an important advance in the fight against genetic disease. The girl was born after embryos created through IVF treatment were screened to exclude the faulty BRCA1 gene.

PGD, which costs between 5,000 and 20,000 pounds, depending on the number of IVF cycles required, is available to dozens of selected couples each year who wish to have children but do not want to run the risk of passing on potentially fatal disorders to their offspring. It is licensed for more than 60 different conditions, including cystic fibrosis, Huntington's disease and some forms of cancer, which are triggered when a child inherits a key genetic mutation from one of its parents.

Joy Delhanty, Professor of Human Genetics at the University College London PGD centre, said that many couples were being refused NHS funding because the technique had not been considered by the National Institute for Health and Clinical Excellence (NICE), the value-for-money watchdog. "Funding for the procedure is a postcode lottery. More than 100 couples a year are referred to us from all over the country but more than 50 per cent have problems with funding in the absence of guidelines from NICE. "If local PCTs [primary care trusts] do not see this as a priority then they do not provide funding, it is as simple as that, but they do not consider the potential money they save by ensuring a child will be free of a disease."

Professor Delhanty declined to name individual trusts but said that couples living in the North of England seemed to have a greater chance of PGD applications being funded by their local PCT, while those living in London and the South East may be forced to pay thousands of pounds for private treatment.

Only a few hundred couples a year are eligible for PGD. To benefit from the technique, families must first know that they have a defective gene, usually discovered through a recurring family history of illness. Once the risk is confirmed by a clinical geneticist, embryos generated and fertilised through IVF treatment can then be screened and implanted in the womb if they are free of the faulty gene.

The Department of Health said last night: "PGD is available on the NHS but is considered on a case by case basis."

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17 January, 2009

SCHIP & The States: Another Bailout Boondoggle

It’s a typical Washington elixir. When bad press for multi-billion dollar bailouts has got you down, there’s nothing quite like a government program “for the children” to put things right again – particularly when the new President needs a quick victory to get his “Era of Bigger Government” of to a successful start. Such is the drama surrounding the “reauthorization” of SCHIP, the State Children’s Health Insurance Program, which passed in 1997 ostensibly in lieu of socialized national health care and will be “re-upped” after President-elect Barack Obama takes office this month. The House just reauthorized the legislation yesterday by a vote of 289 to 139. Now, it heads to the Senate.

Never mind that the program is unsustainable. And bankrupting the states. And not insuring who it claims to be insuring – all those are things that can be worked out later, right? After all, we’re only $10 trillion dollars in the hole, with another $10 trillion pledged over the last four months alone to help us avoid an “economic Pearl Harbor.” If money grows on trees, as our leaders evidently believe that it does, why not blow billions more of it on a program that’s not only failing its mission, but doing something government shouldn’t even be doing in the first place.

Since its inception, SCHIP has been a case study in everything that’s wrong with government – another example of feel-good rhetoric and lofty promises paid for with your money, except the rhetoric never matches the reality and the promises are always too good to be true. Although its proponents are quick to throw up pictures of starving inner city children, the fact is that SCHIP has insured millions of adults, and middle class families over the past decade. In some cases, SCHIP recipients were earning 300% of the poverty level.

This was famously exposed in 2007, when Democrats selected a middle school student named Graeme Frost to deliver the rebuttal to President George W. Bush’s veto of SCHIP reauthorization, only to discover later that the boy attended a $20,000 a year school and his family lived in a 3,000 square foot home valued at over $400,000.

And who pays the most for SCHIP? A disproportionately high number of poor smokers – the very people the program is supposed to be serving. And on top of that, a recent Heritage Foundation report recently showed that 22 million people will have to take up smoking in America over the next decade or else the program will go bankrupt. How many of those people will be classified as low-income?

Then there’s the biggest fraud of them all – the fact that SCHIP is cannibalizing the private sector to the tune of 6 out of 10 beneficiary recipients. That’s right, evidence shows that only 40% of SCHIP recipients are actually uninsured – a pretty amazing number when you stop and think about it. Frankly, this defeats the whole purpose of the program, unless of course we want to start subsidizing this expense for people who can already afford it.

Not surprisingly, the 60% figure is higher than the government will admit, but not by much. Even the Congressional Budget Office acknowledges that “for every 100 children who gain coverage as a result of SCHIP, there is a corresponding reduction in private coverage of between 25 and 50 children.”

Why is this relevant now? Well, government simply can’t afford to continue unsustainably spending money on non-core functions, like providing health insurance to people who already have it. Nor can it afford to bail out the states on SCHIP to the tune of tens of billions of dollars, which is what numerous governors are currently asking for. Government must return to its core functions and get out of the business of subsidizing everything that comes along with a “for the children” sign on it.

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Any excuse to refuse medical care to those who have paid for it

British woman with deadly virus denied free NHS care... because she moved to Turkey to retire

A grandmother who moved to Turkey when she retired was billed for NHS treatment - despite making National Insurance contributions throughout her life. Joyce McDonald, 66, almost died when she was struck down with heart and liver damage and spent her entire life savings on an emergency medical flight to Britain. She was rushed to Addenbrooke's Hospital in Cambridge where she spent two weeks undergoing treatment for a deadly virus attacking her organs.

But after she returned to Turkey, Mrs McDonald was stunned to receive a bill for 367 pounds from Cambridgeshire Primary Care Trust for her initial consultation. She was also slapped with another 800 bill for the three mile ambulance ride from the airport in Cambridge to the hospital.

Mrs McDonald, who moved to Turkey with her husband in 2004, was told she was not entitled to free state health care because she is no longer a British citizen. But her husband Ronald McDonald, 71, has blasted the NHS for its 'disgraceful' stance after the couple made more than 50 years' National Insurance contributions. He now fears they could be left financially crippled if they are forced to pay an estimated 10,000 for future treatments themselves. He said: 'It was touch and go as to whether I might lose my wife on the flight home. She was very weak. 'Then when I got to the airport in Cambridge we were taken by ambulance from the airport to the hospital - I have since been given a bill for 800 for a five minute ambulance ride.

Mrs McDonald was struck down with a deadly virus and will need more treatment in the UK 'I'm still waiting for the bill for the two week hospital stay. It's utterly disgraceful. 'My wife and I are still British citizens and have paid taxes for the best part of 50 years before we moved to Turkey. 'We only moved because our pensions didn't cover the cost of living.' The couple left their home in St Ives, Cambridgeshire, for Turkey, five years ago to enjoy their retirements in the sun.

But Mrs McDonald was struck down with a severe virus in November and the pair were forced to spend 26,000 on medical evacuation flights to the UK. She was discharged two weeks later and returned to Turkey, but was told she needed to return to the UK next month for further tests. The couple are both still British passport holders but have been told they will have to pay for all future treatments because they had been out of Britain for more than three months.

Mr McDonald, who still pays tax in Britain on a small private pension, is prepared to go to court over the issue. He said: 'I refuse to be blackmailed by the NHS. 'I don't mind having to pay for the emergency air ambulance and treatment in Turkey but it's ridiculous to have to pay for treatment in my own country. 'What have I been paying for all these years? 'I have already been given a bill of nearly 400 for the initial consultation when we arrived at the hospital and my wife still has four tests in February for her heart and her liver. 'Obviously I've spent my life savings to save my wife and now I'm totally wiped out. 'It's probably going to cost us at least 10,000.'

Mr McDonald also claims Cambridge NHS trust had threatened to contact the Foreign Office and stop him having his British visa renewed. He said: 'I don't even need a British visa - I'm a British passport holder 'We are being treated worse than immigrants who come across to Britain and get free health care and don't pay taxes.' 'Thousands of immigrants, both legal and illegal from both the EU, and the rest of the world, are entitled to free housing and medical treatment, but as British citizens, my wife and I are excluded from similar treatment.'

A spokesman from the Department of Health said the regulations on payment for services had been in place since 1989. He said: 'The NHS is first and foremost for the benefit of people who live in this country. 'People who are not ordinarily resident here are not automatically entitled to access free NHS hospital treatment. 'UK state pension holders living overseas are exempt from charges if they need treatment during their visit to the UK. This does not include pre-planned treatment.'

John Leslie, Director of Finance at NHS Cambridgeshire said: 'While NHS Cambridgeshire cannot comment on individual cases,the Department of Health gives very clear guidance on the provision of NHS services to people in Cambridgeshire. 'Anyone who is normally a resident of the UK is entitled to free NHS hospital treatment.' 'However, anyone who has been living outside of the UK for more than 3 months would not be automatically eligible for free hospital treatment.'

SOURCE




Amazing emergency room incompetence in Australian public hospital

A pensioner [senior citizen] who claims a doctor at Wynnum Hospital was unable to administer an insulin shot has become embroiled in a dispute over the emergency department's level of care. Richard Supranowicz, an insulin-dependent diabetic, said the doctor told him he would need technical advice from either the Redlands or Princess Alexandra hospitals on how to administer the insulin needle. "He also explained his experience was very limited, and his main duties were to supervise admitted patients," Mr Supranowicz said. Mr Supranowicz, directed to Wynnum after phoning a Queensland Health hotline, said he had to be transferred to Princess Alexandra Hospital to be treated for high sugar levels.

A spokeswoman for Health Minister Stephen Robertson said he had ordered a full investigation into the issues raised by Mr Supranowicz. Mr Robertson said: "Doctors at Wynnum Hospital are qualified and registered medical practitioners who can handle emergencies and provide resuscitation and stabilisation of emergencies until transfer or retrieval to a higher level service. "A doctor is rostered on and is on site at all times."

Mr Supranowicz, however, described the situation as "absolutely disgraceful". Wynnum specialist physician Dr Brian Senewiratne said Wynnum Hospital was a ``write-off''. ``It has been a write-off for a long time because it doesn't have the beds, the trained staff or the facilities, so everyone is referred to the PA which doesn't have the beds either,'' he said. ``There is the obstinate refusal of the administration to admit there is a problem.''

Queensland Health's website lists the facility's hospital services as being ``acute medical'' and ``emergency services''.

Dr Senewiratne said Wynnum deserved better because patients especially those who were elderly needed practical and emotional support from nearby family and friends.

Opposition health spokesman Mark McArdle said: ``I think it is a reasonable expectation that a hospital that is described as offering acute medical and emergency services on the Queensland Health website should actually do this.''

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16 January, 2009

NHS patients face indignity of mixed-sex hospital wards

Men and women in hospital are still being treated on mixed-sex wards with little or no segregation, despite government promises to improve privacy for patients, the Conservative Party says. In April ministers claimed that they were close to abolishing mixed-sex accommodation in the National Health Service. Figures obtained by the Conservatives suggest that 15 per cent of hospitals in England still use mixed, open-plan "Nightingale" wards, while a similar proportion (16 per cent) have wards where patients are segregated only by curtains. The party said that nearly a third of trusts did not have separate bathrooms for men and women.

There were 997 complaints about lack of privacy and dignity in hospital trusts and 135 complaints in mental health trusts in the past year, a poll of 132 acute trusts and 55 mental health trusts showed.

Andrew Lansley, the Shadow Health Secretary, accused the Government of breaking its promises on the issue. "Patients have enough to worry about when they go into hospital without having to suffer the indignity of being placed in accommodation that affords them too little privacy at such a sensitive time," he said.

Alan Johnson, the Health Secretary, told a nurses' conference last year that there was a "bit of a political distinction" between the terms mixed-sex accommodation - where men and women are in separate rooms or bays and have their own bathrooms and lavatories - and the larger, mixed-sex wards.

The Department of Health responded: "We are reducing mixed-sex accommodation to an absolute minimum and have made significant progress. Some hospitals and local NHS areas still have more to do and they are now required to publish and implement ambitious plans to improve." A spokesman added that only 2 per cent of patients complained about lack of privacy in the latest official audit.

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Midwives' workload surges under Labour - putting mothers and babies at risk

The decline of maternity care under Labour was highlighted last night by figures showing that midwives are more overworked than they have been for at least a decade. NHS midwives are delivering far more babies per year than stipulated by safety guidelines - putting mothers and babies at risk. For the sixth year running, the number of births each midwife handles has risen, and it is now higher than at any time since records began in 1997.

The workload being heaped on maternity wards was blamed for the recent doubling in the number of payouts for medical blunders - and for the fact that rising numbers of women are being left alone and terrified during labour. Experts believe up to 1,000 babies a year die needlessly because doctors and midwives are too overstretched or poorly-trained to detect warning signs.

Safety guidelines, laid down by the Royal College of Midwives, say that midwives should deliver an average of 27.5 babies a year - one every 13 days or so - to ensure mother and child have the best quality of care. But figures obtained by the Liberal Democrats from a parliamentary question show that in 2007, the average midwife in England delivered 34.0 babies - one every ten or 11 days, and almost 25 per cent more than they should under the safety standard. This was up on 2006, when the midwife to baby ratio was 33.7, despite the launch of a major maternity strategy designed to turn things round and even offer all women onetoone care with a midwife. The number of babies delivered is 10 per cent higher than in 2001, and is higher than at any time since records began in 1997, when the ratio was 33.7.

Critics blame a continuing shortage of midwives and ministers' failure to anticipate a soaring birthrate. More babies are now born in England than at any time in the past 26 years; largely the result of immigration. They say the figures prove the Government has no chance of honouring its pledge that all women should have one to one care from a named midwife during the entire pregnancy by the end of this year. The number of babies a midwife is expected to deliver is less than one a week because the job is much wider than dealing with the birth: they look after women over the whole pregnancy and afterwards.

Liberal Democrat health spokesman Norman Lamb said: 'After 12 years of empty promises the Labour party will have left maternity care in a state of near crisis. 'Last year it was revealed that hundreds of thousands of women are being left alone during their labour causing worry and distress to many. We also know that the number of safety incidents is on the rise and that millions are being paid out in compensation for medical blunders. 'To find now that midwives are at their most over-stretched since records began, adds to the shameful failure of the Government. 'We must increase the number of midwives and cut back on managers so the health service can cope, especially with a birth rate set to rise.'

Last year, the Healthcare Commission watchdog found that more than a quarter of women were left worried and alone during labour or shortly after birth. Other figures showed that the numbers of medical blunders on NHS maternity wards has doubled in two years. In 2007, 70,108 cases of blunders or abuse of mothers on neonatal units were passed to the National Patient Safety Agency, compared with 35,428 in 2005.

A spokesman for the Department of Health said: 'The UK is one of the safest countries in the world to have a baby. 'There is no evidence to suggest a lower ratio of births to midwives is needed. The number of midwives is actually increasing.'

SOURCE




Maggots in Australian public hospital ICU

This must be about as charming as it gets. Maggots breed in garbage or dead bodies. But the NHS got there before us, of course

Maggots have been found falling from the ceiling of the Royal Hobart Hospital's intensive care unit. The maggots were discovered on Tuesday in a male staff toilet not accessible to the general public. The hospital attempted to play down the grubby find yesterday, saying only a small number of larvae were found by a staff member, who reported them immediately.

Spokeswoman Pene Snashall said patient hygiene was never at risk. "The Environmental Services Team and the Infection and Prevention Control Team responded immediately with a thorough clean-up and investigation," Ms Snashall said. "Patient safety and care was always our top priority." But even after virtually gutting the toilet block, the source of the infestation remains a mystery. The hygiene team ripped out ceiling tiles looking for possible sources of the maggots, including dead rodents in the air-conditioning vents, but found nothing. "There have not been any further discoveries [of maggots] as of today and we are confident we have eliminated the problem," Ms Snashall said.

Maggots are sometimes used in medicine to eat dead flesh and speed up the healing of wounds -- but not in this case. Ms Snashall said the hospital had a year-round pest control program to control spiders, ants and cockroaches.

Australian Nursing Federation Neroli Ellis said the incident showed the ageing hospital was virtually rotting. "I do think it is a one-off -- the cleaning staff are vigilant," she said. "But it is reflective of the state of the building and the age of the building that these issues are occurring and there needs to be strong monitoring and a review of maintenance to ensure this situation doesn't happen again." Ms Ellis said building a new hospital would not fix the problems at the old facility in the short term. "Whatever is decided politically about building a new hospital, there must be an ongoing upgrade of the current building in the meantime because it is falling down around them," she said.

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15 January, 2009

Incompetent Indian doctor kills woman in NHS hospital

A doctor killed a patient being treated for an infected bunion by injecting her with adrenaline against the advice of colleagues, a court heard yesterday. Priya Ramnath ignored two doctors' and a nursing sister's express instructions and failed to speak to a consultant anaesthetist before administering the fatal dose to 51-year-old Patricia Leighton in 1998, a jury was told. Mother-of-two Ramnath moved to America soon after. She denies the manslaughter of Mrs Leighton by gross negligence.

Ramnath, now 40, was working as a registrar in the intensive therapy unit at Stafford District General Hospital where Mrs Leighton was being treated for septic shock from the infection on her left foot. Ramnath, who was on a seven-week placement at the hospital, became concerned about Mrs Leighton's weak pulse and low blood pressure. She says she thought adrenaline was necessary because she believed the patient was about to go into cardiac arrest, the court heard.

Her colleagues advised her not to use adrenaline as they believed Mrs Leighton's condition could have been controlled without it. But Ramnath gave her a 3ml injection of it, Birmingham Crown Court was told. Prosecutor Michael Burrows QC, said: 'The effects of adrenaline are unpredictable and can be fatal. In the case of Mrs Leighton, they were fatal. 'Within moments of the injection, Mrs Leighton jerked forward and sat bolt upright in her bed. She shouted out "What's happening to me? I am going to die".' Mrs Leighton, of Burntwood, Staffordshire, then lost consciousness, her heart stopped and she died despite attempts to resucitate her.

Mr Burrows said: 'Mrs Leighton was not in cardiac arrest, the injection of a bolus of adrenaline was not necessary and should not have been given. 'She owed Mrs Leighton a duty of care, that duty was breached by giving her the adrenaline. There was no clinical indication that such treatment was necessary.' Mr Burrows said the Crown would call an expert witness who believed that Ramnath's alleged decision to ignore advice was arrogant and reckless.

He added that when writing up her notes Ramnath said she injected the adrenaline after Mrs Leighton went into cardiac arrest. He said: 'When someone does something wrong they may seek to conceal what they have done wrong. 'This is a case where you will have to consider whether Dr Ramnath sought to conceal what she has done and whether others helped her.'

Ramnath handed in her resignation less than a week after Mrs Leighton's death stating she had been planning to move to the US with her husband. Mr Burrows told the jury: 'You will have to consider whether she fled the country in order to hinder or escape the investigation into Mrs Leighton's death.' Ramnath, whose address cannot be published for legal reasons, came back to Britain in February last year after dropping her opposition to extradition proceedings.

SOURCE




Britain worse off for hospital beds than Macedonia

The provision of hospital beds in Britain has plunged in the past eight years to one of the lowest levels in Europe. The number of beds per person has dropped 14 per cent since 2000 - to below the rate for Latvia, Estonia and Macedonia. The UK has only 389 hospital beds per 100,000 inhabitants, even when taking into account both private and NHS beds. This is well below the EU average of 590 beds per 100,000 inhabitants.

The UK is ranked 25th out of 32 European countries. Only Cyprus, Portugal, Denmark, Spain, Sweden, Turkey and Malta perform worse. In 2000/01 the NHS had 186,091 beds, falling to 160,297 in 2007/08. Maternity beds have almost halved in number in some parts of the UK. In 2000/01 the NHS had 186,091 beds, falling to 160,297 in 2007/08. Maternity beds have almost halved in number in some parts of the UK.

Tory health spokesman Andrew Lansley, who obtained the figures from the European Commission, said: 'The objective of the NHS is to deliver world-class healthcare, not to maintain a certain number of hospital beds. 'It is madness to cut beds when wards are overcrowded, there aren't enough isolation rooms to control hospital infections and patients are still in mixed-sex accommodation. 'In 2000 Labour said that bed numbers needed to increase but these figures demonstrate again how badly they have failed.'

Health Minister Ben Bradshaw said: 'Given that the Conservatives are pledged to cut NHS funding, we await with interest a commitment by Andrew Lansley to increase expenditure on this or any other aspect of the work of the NHS that he frequently criticises.'

A Department of Health spokesman said: 'Bed numbers have fallen because people are being treated much more quickly - spending less time in hospital - and for many conditions medical advances mean they do not need to go to hospital at all. 'Detailed analysis of the past three years' MRSA and bed occupancy rates has shown no correlation between the two.'

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US Surgeon Shortage Pushes Hospitals to Hire Temps

With miserly Medicare payments being a big part of the problem

When someone doubles over from stomach pain, the general surgeon is the one who performs an appendectomy. Gallstones? The general surgeon removes the gallbladder. Breast and colon tumors and hernias are also matters for the surgeon's scalpel. Now the economic and cultural forces reshaping U.S. medicine are prompting an exodus from this once venerable field, creating a growing market for temporary surgeons-for-hire.

As a general surgeon in her hometown of Franklin, Tenn., Jennifer Peppers could no longer keep her practice going after eight years in business. Faced with rising overhead costs and declines in reimbursements, she and her partners stopped drawing salaries last winter. To pay her home mortgage, Dr. Peppers had to borrow from a credit line.

So the surgeons shuttered their practice, and Dr. Peppers, 42 years old, hit the road. Her typical month might now include a weekend in Springfield, Ore., removing ruptured spleens or repairing obstructed bowels, followed by two weeks at a rural Kentucky or New Hampshire hospital. Though she misses her husband, she earns double her old salary and has paid off a big chunk of her medical-school debt. "I'd much prefer to be in my hospital in my little town," says Dr. Peppers, who is now licensed in five states. "But I don't see how that's possible."

The shift toward temporary assignments comes as the traditional way of practicing general surgery is fading in many parts of the country. For decades, general surgeons have been the backbone and economic engine of the community hospital. While maintaining their own private practices, they staff trauma and critical-care units and perform most common abdominal procedures. Without them, hospitals couldn't provide many emergency-room services. In rural areas, their backup is necessary for everything from complicated births to inserting chest tubes.

But the increasingly grueling schedules, shrinking payments and the temptation of more profitable surgical niches have made the field less attractive. Over the past 25 years, the number of general surgeons per capita has declined 25%, according to a study published in the Archives of Surgery earlier this year. Other specialties are also seeing shortages as their ranks grow more slowly than the overall population, but the decline in general surgery is steeper than most. And while the number of physicians overall isn't in decline, general surgery is one of the few fields where the absolute number of surgeons is actually shrinking.

It's possible that the implosion of Wall Street will rekindle an interest in medicine as a career, but future medical-school graduates could continue to flock to specialties that pay more than general surgery. Nearly three-quarters of surgeons-in-training already are opting for lucrative subspecialties with more predictable hours, such as cardiovascular surgery and neurosurgery, the American College of Surgeons says. That's left community hospitals around the U.S. struggling to provide some of their most basic services.

Some are turning to temporary physicians to fill the void. General surgery is now among the fastest-growing areas of a temporary-medical-staffing industry that's expected to double to $2.1 billion in 2009 from five years ago, according to Locumtenens.com, a staffing agency. The company, which takes its name from the Latin phrase meaning "to stand in another's place," matches hospitals with what the medical field calls locum tenens doctors. Rising demand for these services, in turn, is prompting more of the remaining general surgeons to choose a life on the road and in hotels.

Staffing agencies estimate that at least 1 in 20 of America's 17,000 general surgeons now work on a temporary basis some or all of the time. Full-time temporary surgeons can earn $250,000 or more a year, in some cases nearly twice as much as in private practice. That's largely because they don't have to pay overhead costs anymore.

Critics of the practice worry that it carries potential safety risks. A new surgeon arriving in town may not be familiar with a hospital's staff, for example, or with surgical patients coming in for follow-up visits. "That continuity of care in surgical diseases is really important," says Phillip Burns, chairman of the University of Tennessee's surgical department. As the one who performs the surgery, "you are the best one to handle [any problems] because you were the one inside."

Some who've switched to temporary work say patients often fare better with a surgeon who can focus entirely on providing care instead of the administrative hassles of a private practice. "I don't pay a penny of overhead now and I feel better than I have in years," says Kenneth Lawson, 55. Dr. Lawson left his practice in Roseburg, Ore., in 2005 to travel as a temporary surgeon.

While in private practice, Dr. Lawson says he would often spend five nights in a row on call, "bleary eyed," performing emergency surgeries. Increasingly, he says, these patients had no insurance. Hospitals typically have the means to pursue debts from patients or write the losses off as charity care, but doctors don't always have the manpower to collect on their portion of the bill. "We got to the point we wouldn't waste a stamp trying to get that money," says Dr. Lawson.

Locum tenens isn't a bargain for hospitals or a health-care system that is already the world's costliest and accounts for nearly 17% of the U.S. economy, according to federal government data. A temporary surgeon who comes in to perform scheduled procedures and emergency operations can cost a hospital about $1,500 a day -- between $650 and $900 for the physician and about the same for the staffing agency, according to Staff Care, a temporary-medical-placement firm. That's in addition to travel and lodging expenses. In traditional practice, hospitals don't pay surgeons directly: They give them "privileges" to use their operating rooms in exchange for sharing in emergency-call duty.

Yet, without the ability to perform surgeries, "we lose the business," says Karen Hendren, chief operating officer of Stillwater Medical Center in Oklahoma. The hospital plans to hire temporary surgeons this spring, when one of its three local general surgeons leaves. Ms. Hendren is bracing for a hit to the bottom line. In 2007, it cost the hospital $1.2 million to cover the departure of a few anesthesiologists by hiring temporary replacements, contributing to a $4 million drop in operating income. Hiring temporary doctors adds "a lot of cost to the health-care system, and it's almost certainly going to get worse," says Richard Reynolds, president of MidMichigan Health, which operates four hospitals in the heart of the state. He estimates it costs the company twice as much to hire a temporary doctor than a permanent one. MidMichigan tries to pass on some of these costs in contract negotiations with insurers, says Mr. Reynolds, but it doesn't always succeed.

Steven Bengelsdorf, a 41-year-old doctor from Nashville, formed his own group of temporary surgeons to contract directly with hospitals so they avoid the extra cost of a staffing agency. Spending days or a week at a time away from his wife and three children is tough, Dr. Bengelsdorf says, but, "when I'm home, I'm home. I can participate in their lives and take them to birthday parties." If he were in traditional practice working 12- to 14-hour days, he adds, "I wouldn't get to see my kids."

The American College of Surgeons has long condemned the practice of "itinerant surgery," where doctors operate on patients and leave follow-up care to a family physician. But it has refrained from issuing guidelines on locum tenens. Paul Collicott, a director of the ACS, says it's "a necessary part of surgical practice today," given the overall shortage in the field. He says it's the responsibility of each temporary surgeon to make sure patients are handed off to another surgeon for postoperative care. The ACS also advises doctors who primarily work in urban hospitals, where the work is more specialized, not to do stints in small, rural hospitals, where they typically need to be jacks-of-all-trades.

In 2007, Marlene Tymchuk of Reedsport, Ore., learned she needed a large pool of blood called a hematoma removed from her groin. The hospital in her small coastal town was staffed by a temporary surgeon; the nearest hospital with a full-time surgeon was 45 minutes away. "I talked it over with my family," she says, debating whether it would be smarter to go to the bigger hospital and have consistent care. She decided to stay in Reedsport, in the hospital she knew well and near her family doctor. Though she saw another surgeon for her follow-up care, she says it felt better to be close to home.

Temporary surgeons used to be mostly older physicians who wanted a lighter workload, or those fresh out of training, still deciding where to put down roots. But today, more are midcareer people like Dr. Peppers, who had originally mapped out a more traditional path. Born in the same Franklin hospital she later operated in, she knew by age 10 she wanted to be a surgeon. She told her future husband -- a childhood friend -- she wanted to marry him so she could take his name and be "Dr. Peppers." After medical school, residency and a fellowship in laparoscopic surgery, she came back to her hometown to practice in 2000, saddled with $250,000 in debt. Paying it back turned out to be harder than she thought.

While Dr. Peppers was in training during the 1990s, the federal Medicare program was cutting back what it pays surgeons for many common procedures. For instance, in 2008, Medicare paid a general surgeon $562 for an appendectomy, compared with $580 in 1997. For a complex hemorrhoid removal, a general surgeon got $390 in 2008, compared with $574 in 1997. Private insurers followed suit.

Meanwhile, higher-priced procedures increasingly fell under the purview of more specialized fields. And, reflecting a steady rise in the number of uninsured and underinsured Americans, more of the patients whom surgeons would operate on in the emergency room had limited means to pay for treatment.

By 2007, Dr. Peppers says, she was making roughly $135,000 annually and her practice was struggling to pay its overhead and malpractice insurance. Since shuttering her practice last spring and becoming a full-time surgeon-for-hire, Dr. Peppers says she's earned enough money to whittle her medical-school debt to below $100,000. For the first time, she adds, she can focus exclusively on surgery and patients. "When I had a practice, it was like running a small business," she says. "It's like a huge weight has been lifted."

Dr. Peppers says she is careful to take assignments where she knows the surgeon she'll be handing cases off to and often follows up with a phone call. "I'm very conscientious about telling the patient, 'I'm here until 7 o'clock Monday morning. If there are any problems, after that you need to talk to Dr. so-and-so,'" she says. "I put a lot of responsibility onto patients."

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14 January, 2009

NHS squanders millions on agency staff - with some nurses earning up to $200 an HOUR

Millions of pounds of health service funds are being wasted employing agency nurses on up to 128 pounds an hour. This is almost ten times the amount paid to an experienced staff nurse - and equates to a salary of 250,000. Overall, the health service spent almost 800million on agency doctors, nurses and consultants in 2006-07, according to the figures uncovered in a Freedom of Information request. That could fund around ten hospitals or employ 30,000 full- time experienced nurses. Agency staff are plugging the holes left by the 11,000 nurses who left to work overseas last year, seeking better pay and conditions.

The yawning gap between rates for NHS workers and agency locums exists at every level including managers and even prison GPs, who have been paid up to 158 an hour. The figures also show that much of the money goes into the pockets of agency bosses rather than to the workers, who can earn less than two-thirds of what the NHS pays out.

The Department of Health insists that the amount spent on agency staff is falling, year on year. But critics say it must do more to prevent agencies 'creaming off' millions meant to improve the standards of care. Dr Peter Carter, the chief executive and general secretary of the Royal College of Nursing, said: 'We are concerned and we want the Government to tackle this as a matter of urgency. 'If the NHS made more effort attracting and retaining permanent staff, it would obviate the need for many agency nurses. 'It's understandable that members of the public seeing these huge rates wonder whether nurses really are underpaid, but the reality is that individuals working for agencies get much less than the NHS is charged. There are private companies that are making a killing out of the NHS.'

He said many nurses were emigrating, partly because the NHS could not help with high housing costs in many areas. He said: 'There has been a huge surge in UK nurses wanting to work abroad and they have employment opportunities in the U.S., Australia, South Africa and other countries. Almost 11,000 went last year.'

Tory health spokesman Andrew Lansley, who obtained the figures, said: 'For years the Government have been telling us how many extra staff they have hired for the NHS. So surely we should have reached a situation by now where we no longer need to keep paying out millions each year to agencies and their staff? 'It is a dreadful waste of taxpayers' money at a time when we can least afford it.'

All NHS trusts were asked to provide details of the highest amount they paid to an agency worker between May and October 2008 and there was a response rate of more than 70 per cent. An agency nurse employed at Great Western Hospitals NHS Foundation Trust in Swindon was paid 128 an hour. An experienced nurse on Band 5 pay in the NHS gets 13 an hour or 26,000 a year - almost ten times less. Whipps Cross University Hospitals NHS Trust said it paid 188 an hour for an anaesthetics medical consultant, equivalent to a salary of 366,000.

The resulting data did not show whether the workers came from privately-run agencies or from NHS Professionals, a non-profit agency set up by the Government to provide flexible staff. Some agencies-were taking large cuts. Somerset Partnership NHS Foundation Trust paid 116 per hour for a nurse but the agency took 50 (43 per cent).

Matthew Elliott of the TaxPayers' Alliance said: 'Agencies have creamed off millions of pounds of taxpayers' money, whilst patients continue to receive below-par care.' A Department of Health spokesman said: 'Temporary staff have, and continue to have, a key role in helping the NHS to respond to fluctuations in demand for services and in staff availability. 'The total pay bill spent on agency staff has reduced from 5.5 per cent in 2003-04, to 4.2 per cent in 2004-05 to 3.5 per cent in 2005-06, 2.7 per cent in 2006-07 and 3.2 per cent in 2007-08.'

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Australia: More "caring" socialist medicine

Mother charged $500 to park at hospital but media exposure brings a backdown

THE Children's Hospital, Westmead has told a mother about to donate a kidney to her daughter she will have to pay $500 in parking fees. The case of South Granville mother Kristy Hite has exposed the confusion and heartlessness of the hospital's new parking policy. The Daily Telegraph this week revealed the State Government's plan to privatise hospital car parks and Westmead's proposal to increase fees at its car park.

Ms Hite's daughter Lily, 4, has been sick since she was born and the struggling family was entitled to free parking. Last month a hospital social worker said the free parking would be revoked and Ms Hite would have to pay for parking for at least two months until the hospital could consider her case. If Ms Hite parks at the hospital - which is now charging $16 a day, up from $12 - during visits before and after her daughter's operation she would pay about $512.

When The Daily Telegraph alerted the hospital to Ms Hite's plight yesterday, a spokeswoman said there had been a miscommunication and the family would continue to be allowed to park free. "She (the social worker) said she was looking into what we could do further down the track," Ms Hite said yesterday. "She said I would have to pay for a couple of months until they worked something out, it was a very vague conversation we had. "It is the worst time for them to cancel that card, we're going to live here for at least a month."

Ms Hite has moved from Nowra to South Granville and borrowed money to stay afloat. Before the hospital returned her parking privileges, she said she would have to park blocks from the hospital and walk to see her daughter despite undergoing serious surgery to have her kidney removed. "That cost isn't even an option . . . I am in debt up to my eyeballs," she said. "I am amazed you have to pay at all and the price is ridiculous."

Health Minister John Della Bosca said yesterday he had called the hospital to ensure families were given proper consideration. A spokeswoman for the hospital said Ms Hite would be provided with free parking.

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13 January, 2009

The GOP Should Fight Health-Care Rationing

Obama's HMO deserves principled opposition

Perhaps the greatest missed opportunity of the past eight years was the chance for Republicans to fundamentally reform the terribly broken American health-care system. Access to quality health care has long been a professed priority, yet Republicans have been reluctant to tackle the issue.

As a physician, this is deeply disappointing to me because patient-centered health care is, at its core, conservative. Health care is fundamentally a personal relationship between patients and doctors. To honor this relationship -- consistent with Republican ideals -- our goal should be to provide a system that allows access to affordable, quality health care for all Americans, in a way that ensures medical decisions are made in doctors' offices, not Washington.

Republican unwillingness to address the issue, however, has left us facing an emboldened Democratic Party well equipped to push a government-centered health-care agenda. While Democrats are still dangerously misguided in their policies, this time they are prepared to avoid the political mistakes of the Clinton administration.

For a preview, look no further than "What We Can Do About the Health-Care Crisis," a book published this year by former Sen. Tom Daschle, President-elect Barack Obama's choice for secretary of Health and Human Services. Atop the list of worrisome ideas proposed by Mr. Daschle is the creation of an innocently termed "Federal Health Advisory Board."

This board would offer recommendations to private insurers and create a single standard of care for all public programs, including which procedures doctors may perform, which drugs patients may take, and how many diagnostic machines hospitals really need. As with Medicare, for any care provided outside the board's guidelines, patients and physicians would not be reimbursed.

Mr. Daschle is quick to note the board's standards would serve only as a suggestion to the private market. Yet to ensure that there are no rogue private insurers, he has proposed making the employer tax deduction for providing health insurance dependent on compliance with the board's standards. In an overtly political ruse, Democrats will claim they are dictating nothing to private providers, while whipping noncompliant insurers in place through the tax code.

To be sure, this strategy seeks to eliminate private providers completely. Forced into accepting rigid Washington rules and unsustainable financing mechanisms under Mr. Daschle's plan, most private insurers would be quickly eradicated. Or, as Mr. Daschle soberly predicts in his book, "the health-care industry would have to reconsider its business plan."

If we fail to recognize the scope and scale of Democratic ambition on this issue, we will find ourselves with a permanent Washington bureaucracy prescribing patient care. Our goal, however, must not be confined to defeating a Democratic proposal. Instead, we must advocate for a positive approach to health-care reform that does not sacrifice patient care to achieve its goals. This patient-centered approach must be built upon two pillars: access to coverage for all Americans and coverage that is truly owned by patients.

First, we must fundamentally reform the tax code so that it makes sense for all people to have health insurance. This may be readily accomplished through the adoption of tax equity for the purchase of insurance, active pooling mechanisms for increased purchasing power, and focused use of tax deductions and credits. Through positive changes in the tax code we can make health-care cost effective and create incentives so there is no reason to be uninsured. This way, care is purchased without government interference between you and your doctor.

Secondly, we must transform our health-care model to one that is owned and controlled by patients. Currently, most Americans receive coverage through a third party, leaving health-care decisions to an employer or the government. By creating a new system in which Americans are provided the opportunity to purchase whichever health-coverage product fits their personal needs, insurers would be forced to focus on patients. Not until patients truly own their own health plans will we see the accountability and flexibility needed to ensure quality care and necessary cost-lowering efficiencies.

A historic debate about American health care is fast approaching. We are not doomed to a Washington-run bureaucratic health-care system, so long as Republicans push for the right remedy for health care and return to being the party of solutions.

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Four-hour wait for a lifesaving British ambulance trip

They actually keep ambulances out of action for bureaucratic reasons!

Patients with life --threatening conditions are waiting up to four hours for an ambulance. One man with suspected poisoning had to wait three hours 47 minutes for an ambulance to drive less than a mile to treat him. Others suffering from severe breathing difficulties have had to wait two hours for medical help to arrive. Government targets say ambulance trusts should reach such 'category-A' patients within eight minutes in 75 per cent of cases. But the lack of a maximum time means some are waiting hours.

The cases were uncovered in Freedom of Information requests. The figures, from 2007/08, also showed that some 'category-B' patients - those with illnesses that need urgent hospital treatment but are not life-threatening - are waiting as long as nine hours before help arrives, even though trusts are supposed to attend 95 per cent of such calls within 19 minutes.

A patient with severe back pain waited nine hours 11 minutes for paramedics to show up in London. The ambulance trust blamed a lack of vehicles. Many of the slowest responses occurred over the 2007/08 New Year period, when paramedics had to deal with thousands of drunken revellers and an upsurge in flu and breathing problems.

There was massive variation across the country in the slowest response time for a category-A case. In the North West it was just 38 minutes, but in the East Midlands, the longest response took two hours and 34 minutes, and in Wales, three hours 47 minutes - the suspected poisoning case.

Critics blamed the failures on Labour's strict four-hour maximum waiting time for hospital accident and emergency units. As this is only counted from when the patient steps through the casualty department doors, ambulances often queue outside hospitals, dropping off patients only when they are certain to be seen within the allotted time.

A Department of Health spokesman said: 'We often see an increase in demand for ambulances during the winter season and this year is no different. 'The NHS is coping well with this increased demand. We have done a lot of work in recent years across the country to share best practice. Our staff are working hard and doing great work to respond to the extra demand.'

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12 January, 2009

NHS Trust where 270 died of superbug STILL making 'serious' hygiene breaches

Undercover inspectors have found continued hygiene failings at the NHS trust where 270 people died of the superbug C. diff. Spot checks revealed evidence of 'serious' breaches of hygiene on a specialist ward where internal body cameras were not being properly decontaminated before being inserted into another patient. The Healthcare Commission said there was still a shortage of nurses at the trust and on one ward staff could not wash their hands because there was no accessible basin.

At least 90 people died as a direct result of C. diff, and a further 180 deaths were hastened by two outbreaks at three hospitals covered by the Maidstone and Tunbridge Wells trust in 2006 and 2007. The trust's chief executive, Rose Gibb, resigned after being offered a 250,000 payout. It was later reduced to 75,000 - half her annual salary. Miss Gibb is appealing the reduced payoff through the High Court.

Now a follow-up investigation by the Healthcare Commission has said the trust - which runs the Kent and Sussex Hospital, Pembury Hospital and Maidstone Hospital - still needs to do better. A spot check in October found several breaches of the Government's-hygiene code.

The most serious related to decontamination of equipment in the endoscopy unit at Kent and Sussex Hospital in Tunbridge Wells. A special double sink for washing the internal camera equipment has now been ordered.

It was also found that although regular audits were being carried out on the effectiveness of infection control facilities, the recommendations were not being followed up across the trust. But specific wards have been allocated for the isolation of infected patients and there are better standards of cleaning and improved staff training. The latest C. diff figures were the lowest for three years.

Healthcare Commission head of investigations Nigel Ellis said: 'The trust's infection control system still needs further improvement.' Inspectors will visit the trust in July to check on progress. Geoff Martin of pressure group Health Emergency said: 'This was the biggest corporate failure in the history of the NHS. It is shocking that there are still problems this far on.'

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Australia: Public hospital delays killing cancer patients

CANCER campaigners are developing a hospital waiting lists shame file in an attempt to cut treatment delays they say could be killing patients. People who have faced hold-ups in the state's health system are being urged to contact Cancer Council Queensland's hotline, from tomorrow, to report their experiences. Chief executive officer Professor Jeff Dunn said the calls would be logged and presented to Health Minister Stephen Robertson.

The move follows the release of Queensland Health figures showing more than 250 Category 2 patients had been waiting more than two years for elective surgery. People in that group - including cancer and heart disease patients - should be operated on within 90 days, according to State Government guidelines.

"We are very concerned that some cancer patients might have experienced a two-year wait for treatment," said Prof Dunn. "We have a moral responsibility to ensure that Queenslanders with cancer are receiving timely treatment."

The Cancer Council says hold-ups in getting access to treatment could cost lives. "A two-year delay in treatment for most types of cancer is too long and could have an impact on patient survival and quality of life. "With timely treatment, effective care and support, people have a much better chance of surviving and thriving after a cancer diagnosis," Prof Dunn said.

Long waits could also cause additional pain and distress for patients and their loved ones, he said. "The diagnosis and treatment of cancer is a major life stress for most people and brings with it a range of psychological challenges, including anxiety, depression and - for some - feelings of loneliness, confusion and fear of the future. "Over one-third of people diagnosed with cancer experience persistent, clinically significant distress, and carers often experience even higher distress than patients.

"A two-year waiting time could significantly exacerbate their distress, with adverse effects on the patient's treatment and recovery process."

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11 January, 2009

NHS not equipped to handle triplets

Multiple births are often of low birthweight and premature but that still seems to come as a surprise to the NHS. It essentially took the whole of England's medical resources to handle this lot. Reminscent of the Canadian lady recently who was having quads. Nowhere in Canada could she be accomodated so she was transferred to a small American city in Montana that "just happened" to have four humidicribs available. See here

A couple have been making a marathon journey to visit their premature triplets in three separate hospitals. The children, two girls and a boy, were born on December 6, 14 weeks early, at Derriford Hospital in Plymouth. Martha, Evie and Harry were born to Sam and Andrew Paciuszko, who live in Truro, but Martha needed an operation on her stomach and was sent to a specialist hospital in Bristol. A shortage of incubation units meant that Harry was transferred to the Royal Cornwall Hospital in Treliske, near the couple's home, while Evie was kept at Derriford.

This week Harry and Evie have been reunited in Truro, but they are still waiting to hear when Martha can be moved. All three are doing well and their mother and father have been allowed to pick them up for the first time. Mrs Paciuszko, 31, said: "Over Christmas the only available neonatal beds were in Liverpool so we were lucky that our three babies were in three hospitals in the West Country. Speaking of their 400-mile round trips to visit the children, she said: "We have been very lucky with our families and friends ferrying us about. After a Caesarean I cannot drive, so we have been extremely lucky. "I would not wish this on anyone. Every day we take two steps forward and one backwards but we are heading in the right direction."

The new mother had been receiving fertility treatment but it was still a surprise when three babies arrived at once. She said: "Andrew and I took the gamble but never really thought we would have more than twins. We are very grateful and happy with our three bundles of joy and miracles but that will be our lot. They will be our first and last children."

The babies were delivered by Caesarean section within four minutes of each other, Harry arriving first, weighing 1lb 12oz, then Martha at 2lb 2oz and finally Evie at 1lb 13oz. Mrs Paciuszko said: "They were all put in Tesco freezer bags to keep them warm and then in a Bubble Wrap covering. The Bubble Wrap was later replaced with woolly blankets. I thought they would be put in medical bags but they were Tesco bags - I suppose every little helps, as the advert says."

Mr Paciuszko, a 37-year-old postman, has remained in Bristol with Martha for much of the time. Julian Eason, the clinical director for neonatal services at Plymouth Hospitals NHS Trust, said that the triplets had been moved to different units because they needed specialist care, not because of a lack of resources. "The triplets were born 14 weeks early at Derriford Hospital, all requiring intensive care treatment," he said. "The most premature and sickest will be looked after in Plymouth. We are delighted to reunite Evie with Harry in Treliske Hospital to be closer to mum and home. Hopefully, Martha will be able to return soon." The neonatal intensive care unit at Derriford Hospital had its busiest year on record in 2008 with more than 850 admissions.

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Australia: Bureaucratic brilliance kills public hospital patients

A Westmead Hospital scheme designed to slash costs and improve performance statistics by getting patients out of ambulances more quickly contributed to the deaths of two patients, who received sub-standard care in the emergency department, internal investigations claim. Patients were placed on trolley beds in a corridor, under the care of a nurse and without supervision by a doctor or even basic resuscitation equipment, under the scheme, which continued for seven months after the first death and despite the written objections of the hospital's emergency chief.

Internal investigations into the deaths of a 64-year-old man in February 2007, and of 85-year-old Mary Redfern in October the same year, pointed to inherent dangers in the so-called Nurse Ambulance Release Team (NART) arrangements as significant contributors to both. A report into the death of the man - admitted with a lung infection, low blood pressure and low oxygen levels - concluded, "the geographical location of NART beds and the absence of allocated [doctors] to the NART beds were a contributory factor". It recommended the relocation of the release team to "a defined clinical space", with emergency equipment and medical supervision.

But the hospital's administration did not act on the advice until Mrs Redfern's death, which occurred after nurses missed the seriousness of her falling blood pressure. The hospital's investigation again blamed the release team initiative in part, concluding, "There is an inability to [recognise] critical illness ... in the NART area."

Internal emails, seen by the Herald, show hospital management rejected a demand by the director of emergency medicine, Matthew Vukasovic, for the immediate cessation of the release team system six weeks before Mrs Redfern's death. "I feel that the minimal advantages that are obtained from offloading patients on to a NART trolley are overshadowed by the patient safety issues," Dr Vukasovic wrote on September 12 to Maureen Berry, the director of clinical operations for a group of western Sydney hospitals including Westmead.

Ms Berry responded by forbidding Dr Vukasovic from ending the release team arrangements without her permission, saying this would inflate costs and off-stretcher times and would not ease crowding in the corridor - which she said would still be occupied by ambulance trolley teams. The initiative was finally ended days after Mrs Redfern's death.

Under the scheme, patients arriving at a crowded emergency department could be transferred into the care of a registered nurse - typically a part-time or casual employee on an extra shift - who worked without formal supervision by a doctor, allowing the ambulance team to return to the road. This replaced a more expensive measure in which ambulance paramedics, paid overtime rates, were based at the emergency department to offload ambulance patients. An internal memo shows the hospital expected to save more than $200,000 a year by having nurses take charge of patients - half the $400,000 cost of ambulance officers managing the equivalent service.

According to a 2006 synopsis of the policy, written by hospital administrators when they entered it for a health-care industry award, the proportion of people waiting longer than 30 minutes to be off-loaded from an ambulance fell from 30 per cent to about 10 per cent - the NSW Health Department benchmark - immediately after its introduction.

In a written response to questions, a spokeswoman for Sydney West Area Health Service, which administers Westmead Hospital, said the initiative was intended as "a way of improving patient care by providing a better, safer and cheaper alternative [to hospital-based ambulance officers]". Despite the damning conclusions of the internal reports, she said the two deaths were due to "multiple factors but not a direct result of the NART model of care".

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10 January, 2009

Starved to death in an NHS hospital: Damning inquiry highlights case of patient left without food for 26 days

Nobody gives a stuff when you are in the hands of the government

A vulnerable patient starved to death in an NHS hospital after 26 days without proper nourishment. Martin Ryan, 43, had suffered a stroke which left him unable to swallow. But a 'total breakdown in communication' meant he was never fitted with a feeding tube. It was one of a number of horrific cases where the NHS fatally failed patients with learning difficulties, a health watchdog is expected to rule later this month.

Emma Kemp, 26, was denied cancer treatment that could have saved her life, while 30-year-old Mark Cannon died two months after being admitted to hospital with a broken leg. Three other cases followed similar patterns, with warnings ignored or problems missed until it was too late, often because the patients had difficulty communicating.

Ann Abraham, the Parliamentary and Health Service Ombudsman, is expected to deliver a withering verdict in her report. Sources said the overall picture of neglect that it paints is devastating. Campaigners will seize on the findings as evidence of a wider problem of institutional discrimination in the health service.

The father of one man who died, who was just 20, said: 'People like my son are treated as less than human'. The six cases were first highlighted by the disability charity Mencap in a report entitled Death By Indifference. The charity, which has complained of 'widespread ignorance' in the NHS, says many more cases have emerged since then.

Sources close to the Ombudsman's inquiry said its findings will vindicate Mencap's attack almost totally. One said: 'The Ombudsman will issue a damning verdict in most, though not all, of the cases. 'In some cases the NHS's treatment of vulnerable people was quite shocking - a patient effectively being starved to death is indefensible. 'There will be a lot for NHS trusts and politicians to chew over.'

The report will intensify pressure on ministers to rapidly ensure tighter procedures for the care of such vulnerable patients. Tory spokesman Anne Milton said: 'Unfortunately we are still seeing some pretty shocking cases where people's needs have been neglected and they are not gaining equal access to the NHS. 'Although these might be isolated incidents, every case like this is one too many. 'This is another deeply worrying example of how the Government has yet to get to grips with providing first-class care for everyone, including people with disabilities.'

Mr Ryan, who had Down's syndrome, died in hospital in Kingston-upon-Thames. An internal inquiry by the hospital found that doctors had thought nurses were feeding him through a tube in his nose. By the time they found out this was not happening, he was too weak for an operation to insert a tube into his stomach. He died in agony five days later.

Mr Ryan's distraught family, from Richmond, South-west London, are convinced he could have been saved by the correct treatment. One relative said of him: 'Martin will always be the light of my life. He had a quirky sense of humour and oodles of charm. He was often smiling - he loved to go out, liked the movement of the coach and listening to the music.'

Death by Indifference was published in 2007 as part of Mencap's long-running Treat Me Right! campaign for better healthcare for people with learning disabilities. Mark Goldring, Mencap's chief executive, said: 'Our report exposed the horrific deaths of six people with a learning disability who died unnecessarily in NHS care. 'We have fought and will continue our fight for justice for their families. 'The Ombudsman's reports must condemn the appalling failings of the NHS in these six cases. 'They need to make it impossible for people with a learning disability to continue to die unnecessarily. A failure to do this would be irrational and perverse. 'The reports have a duty to challenge complacency, where it has been shown to exist within the health service, when treating people with a learning disability and must hold individuals to account for their actions.'

The Ombudsman's inquiry, which covers just the six cases, will mirror the findings of a wider investigation into the treatment of vulnerable patients which was ordered by the Government after Mencap's report came out. Chaired by Sir Jonathan Michael, a former chief executive of Guy's and St Thomas' NHS Foundation Trust, it found that the deaths highlighted by the charity were 'not isolated' incidents. A spokesman for the Ombudsman declined to comment before the report is published.

There are 1.5million people with a learning disability in the UK. Mencap says most are treated as ' different' and do not have the same control over their own lives as the rest of society.

Earlier this week the Mail revealed the growing scandal of 'avoidable deaths' in the NHS. Figures showed that the number of patients killed by hospital blunders has soared by 60 per cent in two years to a frightening 3,645.

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Australia: Another birth in a public hospital toilet

Aint government medicine wonderful?

A WOMAN has told how she miscarried "in a blur" in a hospital toilet then cleaned up the area herself. Mother-of-two Jodie Whiteside was 14 weeks pregnant when she felt something was "wrong". After believing her waters had broken, and able to see the leg of her child, Ms Whiteside headed to Maitland Hospital, about 30 minutes drive from her home in the New South Wales Hunter region. "En route my husband phoned up the Maitland Hospital emergency department to say what had happened and that I was on my way," Ms Whiteside said on the Fairfax Radio Network. "It was a blase response, basically that I have to be processed like everyone else and wait to see the triage nurse."

On arrival at the hospital, Ms Whiteside said she was "in a lot of pain, cowering over the counter" while she was being asked for her personal details. A triage nurse then asked Ms Whiteside a series of questions. "I said that I saw the baby coming away and she proceeded to take my blood pressure, I think that she took my temperature and she gave me a plastic pot and said 'I need a urine sample'," she said. "I told her that I was 14 weeks pregnant ... I asked her 'if I'm miscarrying what do I do?' She said there is nothing they can do and instructed me to go to the toilet."

After making her way through a crowded emergency department waiting room, Ms Whiteside reached the women's public toilet. "It's a bit of a blur to me, all I know is I gave birth to the child, I had it in my hands, I was given no other option, I just didn't know what to do ... I put it in the toilet and I had what they call afterbirth everywhere and I was thinking what poor woman wants to come into the cubicle after me," she said. "I tried to tidy it up a bit because it was just a mess."

A short time later Ms Whiteside was found a bed, was given an ultrasound and saw a doctor. She was offered surgery or told she could go home, and was then told that thousands of women had gone through what she had just experienced. Ms Whiteside chose to go home and has since written letters of complaint to the hospital and NSW Health Minister.

Chief executive of the Hunter New England Area Health Service, Nigel Lyons publicly apologised to Ms Whiteside today. "Let me say I'm very distressed to hear about the circumstances of Jodie's care," he said on Fairfax Radio Network. "It's clear that the distress that was caused by Jodie's experience at the hospital is something that we deeply regret and apologise for. "We'll fully investigate this and find out what's occurred and why and what we can do better. But the aspects that come through to me is that it is about the care that we've provided in terms of sensitivity."

Her experience is similar to that of Jana Horska, who miscarried in a Sydney hospital toilet in September 2007 after waiting two hours in the emergency department.

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9 January, 2009

Australian mother dies because of closed government maternity services

Rural doctors have blamed the closure of country maternity wards for a mother's death. The Barooga mother of one, 38, died from heavy bleeding caused by an ectopic pregnancy after allegedly waiting more than two hours at Cobram District Hospital for an ambulance to take her to Shepparton's Goulburn Valley Hospital for emergency surgery. Deaths from ectopic pregnancies, where the fertilised egg grows outside the womb, are rare and the coroner has begun an investigation.

The Cobram hospital's obstetrics unit closed about six years ago and Rural Doctors Association Victoria president Dr Mike Moynihan said a lack of specialists may have cost the woman her life. "On the surface, it would have made a difference if there was a maternity ward if it was a straightforward ectopic," he said. ". . . There are going to be more of these incidents and we have pointed this out to the Government."

The Cobram and Shepparton hospitals declined to comment on the woman's death because of the coronial investigation. But Opposition health spokeswoman Helen Shardey said the Brumby Government had endangered lives by closing 20 country maternity wards, including Cobram's. "John Brumby has breached the trust of Victorian families by closing maternity wards and presiding over an underfunded health system which endangers the lives of Victorian women," Ms Shardey said. "Many country paramedics have told me response times are poor and plenty of rural doctors have warned the Brumby Government time and time again that the closure of maternity units could cost lives. "John Brumby and the Minister for Health will be held accountable for the closure of 20 maternity wards, particularly in light of their flippant claim that Labor has provided record funding for health."

Premier John Brumby said funding was not an issue as it had doubled in the past nine years. "In relation to any local services, whether they're maternity or any other specialist services, it's the local doctors and clinicians who make the decisions about whether those services are provided," he said. "I understand in the case of this hospital (it) took the decision that better services were available elsewhere."

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Australia: Five-year surgery wait for almost 400 Queenslanders

ALMOST 400 sick Queenslanders have been placed on surgery waiting lists for more than five years, figures released today have shown. Figures obtained by the State Opposition also show 264 people assessed as category two patients - needing surgery within 90 days - have been waiting up to two years for surgery. Opposition Health spokesman Mark McArdle said the government was failing some of the state's sickest people. "These are life threatening illnesses and this government has done nothing to save these people," he said. The figures also showed a blow out in waiting times for a hospital bed, which has grown from four hours and 48 minutes in 2004-05, to nearly six hours in 2007-08.

Australian Medical Association of Queensland (AMAQ) says the figures were unacceptable. AMAQ acting president Mason Stephenson said the figures were not new but once again highlighted a need for more beds. "Beds are on top of the list, then you need more medical man and woman power - more doctors and nurses - then you need the operating time," Mr Stephenson said. "If you look at the 400 waiting for more than five years, they are category three patients - often elderly patients needing prosthetic knees and hip replacements or orthopaedics ... they are suffering to a lesser extent but they are suffering none-the-less and this is unacceptable." He said in past 20 years there has been a reduction in public hospital capacities and now it was up to all governments to reverse this trend and cut waiting lists.

Mr McArdle said the figures were proof the government had mismanaged the health budget throughout the state's most prosperous period. "In the best economic times this state has seen for many years, this government has blown the health budget and has not provided adequate care for Queenslanders," he said. The Liberal National Party would improve the health system by "streamlining" funds to the frontline, but that didn't mean sacking bureaucrats, Mr McArdle said. "We'll move to ensure these (waiting) lists are reduced dramatically and provide an efficient Queensland health system," he said.

"We know that the efficiencies in the Queensland Health department are there to be utilised, we know that there are millions of dollars misspent in Queensland Health that can be redirected to the bottom line - to the doctors to the nurses, allied health professionals." Mr McArdle said the opposition would release its health policy "in near future".

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8 January, 2009

Surgeons who leave operating equipment inside patients cost NHS 9m pounds

Patients who leave operating theatres with surgical equipment accidentally left inside them are being awarded millions of pounds in compensation. About two people a week find surgeons have left behind foreign objects such as surgical swabs, clips and screws, according to Government figures released after a Freedom of Information request. And with the average victim pocketing 17,900 pounds, the mistakes have cost the NHS a total of o9million over the past five years, with payouts made to more than 550 patients.

In the past year, the highest payouts were 115,000 to a person who had the tip of a needle left inside them, 75,000 to a patient who later found a surgical clip and 60,000 to someone who still had `packaging material' inside them after an operation. The total compensation bill during 2007-2008 for such incidents was 2.2million, considerably more than the 1.4million awarded in 2003-2004, even though the number of incidents has not increased. The average payment has also risen from 15,000 just under two years ago. In 2006-2007, the damages reached a record level of 2.6million paid to 149 patients, including 119,000 to one patient found to have had a swab left behind and 100,000 to another who had a clip left inside them.

One victim was grandmother Gladys Condlyffe, 71, from Porthill, Staffordshire, who died in 2005 after surgeons accidentally left a plastic stent - a small pipe - inside her for seven years after a routine gall bladder operation. She died 12 hours after an operation to have it removed at the University Hospital of North Staffordshire. In 2007, two new mothers were sent home from Birmingham's City Hospital with surgical swabs inside them after bungled emergency caesareans.

Experts suggest the level of claims is just the tip of the iceberg, as many people do not discover a mistake unless it causes a problem, often years later. The incidents generally happen as a result of oversights by doctors under pressure in `stressful situations', such as emergency operations. Overweight patients are also more likely to be affected because their extra body mass can make it more difficult to spot tools that have been left behind.

Peter Walsh, chief executive of the patients' charity Action Against Medical Accidents, said the figures were scandalous and disappointing. He added: `These incidents are all easily avoidable. They are only the cases where compensation has been paid. You can safely assume there are many more out there where people have not brought cases for compensation.' And Susie Squire, campaign manager at the TaxPayers' Alliance, said: `All available funds should be put into improving frontline health services, not spent on paying out for costly and easily avoidable cock-ups.'

A list of `never events' - those which are serious and largely preventable - drawn up by the National Patient Safety Agency after Lord Darzi's review of the NHS, is currently out for consultation. It includes objects being left in the body after an operation. Kevin Cleary, the NPSA's medical director, said: `The World Health Organisation has started a Safer Surgery Saves Lives campaign that includes a checklist for surgical teams to help avoid such blunders.'

Source




Australia: Three deaths blamed on public hospital overcrowding

QUEENSLAND Health has linked three deaths of mental patients in the past two months to overcrowding at the crisis-ridden Logan Hospital . "Capacity management" issues have been blamed for the fatalities involving the hospital's mental health unit since late October. A leaked internal report prepared for Queensland Health hierarchy shows that the deaths were "potentially related" to overcrowding, with 16 patients waiting for a bed on December 4. "The number of presentations is consistently higher than the number of discharges," the report said.

The revelations come after a top Logan Hospital doctor enlisted by Premier Anna Bligh to advise her about health issues quit three months ago because the hospital was "too dangerous and dysfunctional".

Health Minister Stephen Robertson ordered independent coroner's and internal investigations into all three deaths. "I always feel very sad when I receive reports of mental health patients who, for one reason or another, treatment doesn't help," Mr Robertson said. "That's why I am keen to have these cases investigated."

The first patient absconded from the busy inpatient unit on October 28 and was later found dead at Brisbane's Fairfield Railway Station. Another patient escaped from the emergency department on November 11 during an assessment and was later found dead. The third on November 25 occurred shortly after a patient was sent to a motel due to "accommodation issues". The patient's family has lodged a complaint but Mr Robertson said his department went beyond what was required as the patient was homeless.

Opposition health spokesman Mark McArdle has questioned why the minister had not been transparent and told the public about the cases, given he had known about them for weeks. "These are people dying and it is this minister's and this Government's inability to plan and resource our public hospitals properly," Mr McArdle said.

Queensland Health has allocated an extra $6.6 million annually since 2007 to fund an extra 53 mental health staff across the southside of Brisbane. A 16-bed community care unit is also being planned.

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7 January, 2009

Deaths from hospital blunders soar 60% in two years as NHS staff 'abandon quality of care to chase targets'

The number of patients killed by hospital blunders has soared by 60 per cent in just two years, the Daily Mail can reveal. Official records show that 3,645 died as a result of outbreaks of infections, botched operations and other mistakes in 2007/08. That was up from 2,275 two years before. Critics say quality of NHS care has suffered as doctors and nurses come under pressure to meet Government waiting time targets. The sharp rise is also down to the fact that more trusts have started to record medical errors - revealing a death toll which in previous years remained hidden under the carpet. But experts say the true toll is certain to be even higher, because many hospitals still do not record all of the 'patient safety incidents' - meaning that lessons which could have been learned are lost. In October last year, the Patients Association warned that one in every 300 NHS patients were killed because of medical blunder.

The latest figures, uncovered by the Liberal Democrats, show that 385 died last year due to botched operations and 156 because scans were read wrongly or patients incorrectly diagnosed. Some 309 died from infection control incidents related to hospital superbugs and 14 due to problems with documentation and records. Another 54 were killed by wrongly-administered drugs and 40 by faulty medical equipment. There were 171 cases of deaths following simple accidents, usually falls. On top of this, 22 died as the result of abuse by hospital staff or visitors, and 135 died because they were not transferred properly between wards or hospitals. Another 487 killed themselves on hospital premises when their depression should have been spotted by doctors. A range of other blunders brought to total toll to 3,645. The figures are certain to rise as hospitals get round to reporting mistakes which took place between April 2007 and March 2008 to the National Patient Safety Agency.

'These statistics are stark and the trend is shocking,' said LibDem health spokesman Norman Lamb. 'There needs to be a change of culture at the heart of the NHS. We have got far too many targets and there is a real risk that, although they are very effective at addressing a specific issue, they mean trusts do not see safety as a priority.'

Roger Goss of pressure group Patient Concern said: 'This news is shocking. Patients are already extremely nervous when they have to go to hospital, so they need this news like a hole in the head.'

Peter Walsh of pressure group Action Against Medical Accidents, said many incidents are not reported in official 'patient safety' figures. He added: 'We need to make patient safety a much higher priority. Staff need training and there needs to be an overhaul of surgical practice, where many avoidable errors happen. 'Double- checking that you've got the right patient, that you're operating on the right side might seem obvious, but we know that it isn't routinely done at many hospitals. 'Resources and staffing are also an issue. It's no surprise to find that more things go wrong at weekends and at night.'

Concerns around the safety of many surgical operations carried out on the NHS are so serious that the all-party Commons health select committee is looking into the issue, and will report in April.

Clare Bowen, whose five-year-old daughter Bethany died as a result of mistakes made during routine surgery in 2006, said: 'I have no doubt these figures will continue to rise unless hospital trusts, and surgeons in particular, are prepared to learn from their mistakes.' Miss Bowen, whose story is told in today's Good Health section, added: 'Nobody should be afraid to go into hospital. 'But equally, no one should be afraid of asking questions that will make the doctors in charge of their care think carefully about how they behave.'

The rise in avoidable deaths mirrors recent rises in NHS pay-outs for blunders. Around 6,000 cases go to court each year, and compensation to injured patients rose by 18 per cent last year, to 382million. A spokesman for the Department of Health said: 'The NHS sees a million people every 36 hours. Unfortunately, as in any health service, mistakes and unforeseen incidents will occasionally happen. 'Only a tiny number of errors put patients at serious risk and the quality and safety of healthcare is improving all the time.'

Source




How 'gung-ho' surgery by a trainee set off a chain of tragedy that destroyed this little girl's family



When a trainee surgeon was let loose on this little girl, he set off a chain of tragedy that destroyed her family - and reveals the true, brutal cost of hospital blunders.

For Clare Bowen, the single parent of two boys, this Christmas has been particularly bleak. For in the space of about two years, she lost first her eldest child, Bethany, at the age of five, and then, 11 months ago, her husband, Richard. What makes her story particularly harrowing is that this double tragedy was apparently the result of `gung-ho' risk-taking behaviour by surgeons at the John Radcliffe Hospital, Oxford, one of the top hospitals in the UK. `If it hadn't been for the arrogance of the surgeons involved, Bethany would still be alive,' claims Clare, 32. `And if the hospital authorities had faced up to their responsibilities, instead of protecting the doctors at every step, my husband would not have suffered the terrible stress that eventually killed him, too.'

Bethany's death was just one of the thousands that occur each year as a result of medical blunders. In the past two years, the numbers have risen dramatically, by 60 per cent, as the Mail reveals today. In Bethany's case, the surgery should have been straightforward. She was born with a hereditary blood condition called spherocytosis. Though not fatal, it causes anaemia and excessive tiredness. Surgery to remove the spleen to get rid of these symptoms has been a tried-and-tested treatment for decades.

Three generations of Clare's family had already had the operation: most recently Clare's second child William, aged six. Bethany's grandfather had his spleen removed as a child nearly 50 years ago; Clare herself had undergone the same operation when she was Bethany's age. The difference was that when Bethany was due for the operation in July 2006, it was to be performed with keyhole surgery to avoid an unsightly scar on her stomach. Because of this, Clare and Richard, an electrical engineer, had discussed every detail of the operation with the surgeons before signing the consent form - and were confident they had done everything they could to ensure a successful outcome. But their confidence in the surgical team was misplaced.

Even as Richard accompanied Bethany into the anaesthetic room and gave her a last kiss, telling her that Mummy and Daddy would be waiting for her when she woke up, the surgeons were making a controversial decision to test a new piece of equipment on the child. Known as a morcellator, this is a drill with a 20cm-long barrel and a 1cm-wide blade that rotates at up to 1,000 rpm. It was designed for use in hysterectomies, enabling surgeons to cut the uterus into tiny pieces to allow it be removed laparoscopically, through small incisions. Until Bethany's operation, the morcellator had not been used in paediatric surgery in the UK - and it has not been used since. And further, neither the trainee surgeon performing the operation nor the supervising surgeon had been given the training recommended by the manufacturer in using the drill.

During the operation, Richard and Clare were waiting in a tiny room. Suddenly, the door opened and five or six doctors filed in one after the other - Clare remembers noticing that the junior surgeon had blood on his gown. `Something dreadful has happened. I am so sorry,' said the senior surgeon. `Is Beth dead?' Clare asked at last - and the surgeon nodded. `We accidentally cut a blood vessel, resulting in major blood loss,' the surgeon explained. Bethany had bled to death. For nearly an hour, two of the surgeons stayed with her parents while the rest of the team prepared their daughter so they could spend a few precious minutes with her body.

It was agonising,' recalls Clare. `The surgeons seemed in shock themselves. `For months afterwards, I'd get flashbacks of being stuck in that tiny hospital room, suffering once again those intensely desperate feelings as I came to terms with what had happened: that we could never again be the family that we had taken for granted that morning.' A full investigation was promised by the hospital - but within days of their daughter's death, the grieving parents began to suspect a decision had been made to cover up what had happened. Clare says: `I remember meeting the surgeons on the Monday after Beth's death - they were completely obstructive. These were the same doctors that had sat with us for that terrible hour and they were now refusing to discuss what had happened.'

The parents' request to speak to the nurses present during the operation was denied and the Bowens had to instruct a solicitor before a full inquest was held. The couple even discovered that the evidence which should have been retained following an unexpected death had gone missing, including the bag containing the extracted spleen, the swabs, all the blood Bethany had lost and all the disposable parts of the morcellator. `That was the point at which we realised Beth's death could have been avoided. It made us both feel sick.'

Then at a meeting with hospital managers seven months after Bethany's death, a `totally different story' emerged - that the blood loss from the severed blood vessel had been `insignificant' and `the cause of death was unclear'. The managers' apparent indifference to the truth was shocking - though by that time, the Bowens were beyond surprise. It was only through a chance remark by their GP, who'd assumed they'd been told the full facts, that they learned that Bethany's aorta, the main blood vessel that feeds the heart, had been cut in two places. Then, a few weeks after the death, the family found out that a trainee surgeon had operated on their daughter - and that he had used a tool never used on children before. `That was the point at which we realised Beth's death could have been avoided. It made us both feel sick.'

Both parents accepted that new technology has to be used for the first time on a patient. `But it should be done as safely as possible in the interests of the patient,' says Clare. `That was not the case here. `If the operation had gone well, the surgeons would have been celebrated for successfully introducing a new technique into the country. `Their fatal mistake was never to consider the possibility that anything could go wrong. I imagine them walking into the operating theatre thinking in a gung-ho manner: "This is fantastic; it is going to be the next best thing." 'None of the surgical team saw Beth as a little girl, only as a patient to practise on. If just one of them had said: "Hold on a minute, shouldn't we step back here? What if something goes wrong; are we ready for this?" `If there had been a system to prevent spur-of-the-moment decisions that radically alter the risk to patients, then Beth - and Richard - would be alive today.'

A fit man of 31 with no history of heart disease, Richard died suddenly last February, 19 months after his daughter. While going for a run to clear his head, Richard had a heart attack, brought on, the family believe, by stress. `Deep down, Richard felt he should have been able to keep Beth alive,' says Clare. `She was his "little princess". When she died, he couldn't think of anything but her. `He worked late every night, coming to bed in the early hours and then still unable to sleep. His head was full of questions for the hospital, pulling together bits of a story that never made sense. 'He was an intelligent man, able to cope mentally. But all the time the physical stress was slowly killing him. I can't express what a terrible blow it was to lose him.'

Theirs is not an isolated tragedy. Indeed, such reckless lapses by surgeons are now recognised to be a universal problem. Later this month, a study by the World Health Organisation, confirming evidence of `dismayingly variable standards of quality and safety in surgery in even the most prestigious hospitals', is due to be published in The Lancet. `With 250 million operations taking place every year globally, there are also a million deaths and seven million complications, a high proportion of which are unnecessary and occur because of human factors,' says the WHO's lead researcher, Boston surgeon Professor Atul Gawande.

One of the key human factors known to put patients at risk is this tendency to recklessness, a `lack of situational awareness' as it is known in other high-risk, fast-moving activities. In aviation, for instance, pilots have to undergo regular training in situational awareness where they learn to `imagine the unimaginable' before every flight, so that preparing for the worst scenario becomes routine.

Now a checklist for the operating theatre, similar to one that has been mandatory in aviation for 20 years to prevent the consequences of human factors and thereby make surgery safer, is due to be launched on a voluntary basis in the UK later this month. The Safer Surgery checklist, developed by a team headed by Professor Gawande and backed by the Government, takes less than three minutes to perform. It helps surgical teams to prepare for every eventuality - with all members of staff entrusted to speak out to ensure patient safety is the top priority. If such a checklist had been in use at the John Radcliffe, Clare is convinced her daughter would be alive.

Last November, she found the strength to take the family's concerns to the Health Select Committee, which is investigating safety in surgery. The MPs, who are due to publish their report in April, listened with close attention to Clare, her measured voice never once breaking or showing the emotion beneath, as she gave evidence about Bethany's death, based on tape recordings of hospital meetings and the inquest.

Because in Bethany's case most of the physical evidence had gone missing, Clare believes the surgeons' evidence at the inquest, which was held in November 2007, was subjective - yet it was accepted as proper evidence by the coroner. `The surgeons said they applied the tip of the morcellator no more than 3cm into the abdomen. But there is no marking on the barrel of a morcellator to give an indication of how far the device has been pushed in. `Yet the final verdict of the coroner's court, based on testimony given by the doctors, is that the blood vessel was not cut by the morcellator - even though the surgeons admitted that it was the only instrument in use at the time of her sudden blood loss.'

She called for cameras to be attached to the walls of every operating theatre, with the data protected with tamper-proof seals. `When an operation goes wrong, an independent investigation team needs to be given access to all the evidence. The coroner accepted the theory that Bethany's aorta mysteriously and simultaneously burst open in two places,' she says.

However, the trust was forced to admit negligence for failing to obtain consent for use of the morcellator and breaching its duty of care. But the promised report into the `thorough investigation' was repeatedly postponed - and was finally given to the Bowen family only last month. The family was paid 10,000 pounds [It should have been millions] following the admission of negligence, a sum donated to Bethany's school for a new playground.

Clare says: `It was never about money. Nor do we want revenge, which is why I've chosen not to name the doctors concerned - all of whom are still practising. `From the beginning, we have wanted the hospital to acknowledge the mistakes that were made so that lessons could be learned.'

As an unwilling expert in the way hospitals operate, Clare says the public needs to realise what can happen under the current system. `Before Beth died, I would never have believed an NHS surgeon could use equipment they had never been trained to use. Nor did I understand that when doctors make mistakes, it's not in their interests to tell the truth and thereby damage their career, and implicate colleagues with whom they work closely.'

Clare has a particularly pressing reason to make surgery safe. Three-year-old James, her younger son, is already showing the symptoms of spherocytosis, and will need surgery within the year. `I'm taking James to Birmingham Children's Hospital, where I feel that my concerns are being taken seriously.'

The John Radcliffe Hospital says it has investigated what went wrong during Bethany's operation `in great detail' and learnt from the tragedy. `An operation of this nature will never be without risk, particularly when carried out on such a young child,' said Elaine Strachan-Hall, director of nursing and clinical leadership at Oxford Radcliffe Hospitals. She said she would welcome further conversations with Clare about incorporating her views into the trust's ongoing patient safety programme. `Although this will be no consolation to the family, we have learnt from the tragedy and put those lessons into practice,' she said.

Clare wants anyone undergoing surgery to learn from Bethany's death. She says: `Ask the surgeon of their experience, their training in safety procedures, if trainees will be used in the operation, and if new equipment is being used. `The more open your surgeon is, the more likely it is that they are not arrogant enough to believe they cannot make mistakes. I just wish I'd asked these questions when I trusted those surgeons with my little girl.'

Source





6 January, 2009

Teenager died of brain haemorrhage... after NHS doctors denied her a vital scan

When Jenna Lester's parents told doctors she had been suffering severe headaches, bouts of fainting and vomiting, they might have expected their fears of a serious illness to be shared. But medical staff thought the 16-year-old simply had a stomach infection and did not offer a brain scan. A week later she died of a brain haemorrhage.

Now, after a legal battle lasting almost three years, the NHS has admitted that the teenager might still be alive if doctors had acted sooner. Jenna, who had been expected to achieve straight As in her GCSEs, had been taken to the Medway Maritime Hospital in Kent, after collapsing unconscious in the bathroom. Her parents Mark, 42, and Sonia, 40, say they told doctors their daughter had been suffering from splitting headaches for two months. But as Jenna was not considered a 'patient of high priority', she was not sent for a brain scan.

It was only when her condition deteriorated considerably that she was finally given one - five days after she first collapsed. The scan showed that she had a blood clot on her brain, and at that stage one of the doctors turned to her parents and said: 'We should have done the scan days ago.' Jenna, who had been made sports-woman of the year at Fort Pitt Grammar School, Chatham, was transferred to King's College Hospital, London, for an operation to remove the clot. Doctors initially thought the surgery had been successful. But Jenna's brain swelled dramatically and she died on February 17, 2006.

Her parents spent almost three years pursuing the Trust through Health Service complaints procedures. And last week the Medway NHS Foundation Trust admitted it had 'failed to properly assess and investigate' the teenager's condition. Her parents were sent 10,000 in compensation. But Mr Lester, a plumber, who lives with his wife, and teenage son and daughter in Rochester, said the sum could never replace Jenna. 'When we first took Jenna into hospital, we kept telling everybody that she had hit her head when she fell in our bathroom. 'We made sure that the casualty office knew about her two-month history of headaches. 'But no one examined her head, gave her an X-ray or a scan until it was too late. Doctors were convinced that she was suffering from a gastric virus.'

At the inquest, in August 2007, the coroner ruled that Jenna had died from swelling of the brain because of bleeding from a rare condition called arteriovenous malformation. In a narrative verdict, the coroner said her chances of survival would have been 'enhanced' if doctors had got to the blood clot sooner. The condition would have been detected earlier if a scan had been performed.

The NHS Trust expressed its ' sincere apologies to the Lesters for the shortcomings in Jenna's care. 'Whilst nothing can compensate for this tragic experience, lessons have been learnt and robust arrangements are in place to ensure this does not happen again.' [Bulldust, bulldust!]

Source




If You Think Health Care is Expensive...

Health care, says the man most concerned with that 17 percent of America's economy, can be "a nation-ruining issue." As Michael Leavitt ends four years as secretary of health and human services, he offers this attention-arresting arithmetic: Absent fundamental reforms, over the next two decades the average American household's health care spending, including the portion of its taxes that pays for Medicare and Medicaid, will go from 23 percent to 41 percent of average household income.

It is, Leavitt says, "predictable" that today's traumatizing economic turbulence, by heightening Americans' insecurity, will complicate reforming entitlements. This, too, is predictable: By curtailing revenues, today's recession will bring closer the projected exhaustion of the Medicare Part A trust fund, from early 2019 to perhaps 2016. That should get the president-elect's attention.

When Medicare was created in 1965, America's median age was 28.4; now it is 36.6. The elderly are more numerous and medicine is more broadly competent than was then anticipated. Leavitt says that Medicare's "big three" hospital procedure expenses today are hip and knee replacements and cardiovascular operations with stents, which were not on medicine's menu in 1965.

After being elected to three terms as Utah's governor, but before coming to HHS, Leavitt headed the Environmental Protection Agency. He came to consider it a public health agency because the surge in Americans' longevity in the last third of the 20th century correlated with cleaner air and fewer water-borne diseases. Longevity is, however, expensive, and demography is compounding the problem.

In the 43 years since America decided that health care for the elderly would be paid for by people still working, the ratio of workers to seniors has steadily declined. And the number of seniors living long enough to have five or more chronic conditions -- 23 percent of Medicare beneficiaries -- has increased. Many of those conditions could be prevented or managed by better decisions about eating, exercising and smoking. The 20 percent of Americans who still smoke are a much larger percentage of the 23 percent who consume 67 percent of Medicare spending. Furthermore, nearly 30 percent of Medicare spending pays for care in the final year of patients' lives.

Suppose, says Leavitt, buying a car were like getting a knee operation. The dealer would say he does not know the final cumulative price, so just select a car and begin using it. Then a blizzard of bills would begin to arrive -- from the chassis manufacturer, the steering-wheel manufacturer, the seat and paint manufacturers. The dealership would charge for time spent there, and a separate charge would cover the salesperson's time.

Leavitt says that until health care recipients of common procedures can get, upfront, prices they can understand and compare, there will be little accountability or discipline in the system: "In the auto industry, if the steering-wheel maker charges an exorbitant price, the car company finds a more competitive supplier. In health care, if the medical equipment supplier charges an exorbitant price, none of the other medical participants care."

Medicare is a price-fixing system for upward of 12,000 procedures and drug codes -- and for hundreds of categories of equipment, the providers of which tenaciously oppose competition. Leavitt began implementing a tiny program of competitive bidding covering just 10 products in 10 cities. Based on the 15 days it lasted before Congress repealed it, savings were projected to be substantial. That is why equipment providers got it repealed.

Rather than ruining the new year by dwelling on Medicare's unfunded liabilities of about $34 trillion (over a 75-year span), ruin it with this fact: In the next 50 years, Medicaid, the program for the poor -- broadly, sometimes very broadly defined -- could become a bigger threat than Medicare to the nation's prosperity.

This is partly because of the cost of long-term care for the indigent elderly, some of whom shed assets to meet Medicaid's eligibility standard -- sometimes as high as income under 200 percent of the federal poverty level. And many states, eager to expand the ranks of the dependent with the help of federal Medicaid money, use "income disregards" to make poverty an elastic concept. For example, they say: A person who gets a raise that eliminates his eligibility can disregard the portion of his income that pays for housing, or transportation.

Governments with powerful political incentives to behave this way will play an increasingly large role in health care. As is said, if you think health care is expensive now, just wait until it is free.

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5 January, 2009

Outrage over British organs ‘sold to foreigners’

Note that the NHS was set up to abolish privileged health access for the rich. Reality is a little different

THE organs of 50 British National Health Service donors have been given to foreign patients who have paid about £75,000 each for private transplant operations in the past two years, freedom of information documents show. The liver transplants took place at NHS hospitals, despite severe shortages that mean many British patients die while waiting for an organ that could save their lives.

The documents disclose that 40 patients from Greece and Cyprus received liver transplants in the UK paid for by their governments. Donated livers were also given to people from non-European Union countries including Libya, the United Arab Emirates, China and Israel. The surgeons who carry out the transplants receive a share of the operation fee — believed to be about 20,000 pounds — as all the work is done privately in NHS hospitals.

It comes as a record 8,000 Britons are on NHS lists waiting for transplant organs. About 260 British patients are waiting for a liver. Last week leading transplant surgeons and patient groups called for an end to the practice. Professor Peter Friend, president of the British Transplantation Society, said it was unethical to give organs to people from abroad while British patients were dying. “While there is a surfeit of UK residents awaiting transplant it is correct that these patients should have priority,” he said. “Were the situation such that there were organs that were not required, it would be appropriate to make them available to other nationals. “We do not have a European organ donation system; it is a UK system and I therefore feel that . . . the system is there essentially for the benefit of residents in the UK.”

Jane Dodd, whose nine-year-old daughter Rebecca died while waiting for a liver transplant, said she was shocked and upset to hear that organs from British donors have been given to overseas patients. Dodd, a part-time bank clerk from Wirral, who also has a 19-year-old son, Matthew, whose life was saved by a liver transplant, said: “I do feel that organs donated in this country should go to people from this country unless there isn’t a suitable recipient. “If you are signing a donor card in this country you expect someone from this country to get the organ.”

The Healthcare Commission, a watchdog body, conducted brief inquiries last summer after being alerted to the practice at King’s College Hospital NHS Foundation Trust in London, but decided it was not breaking any rules. It referred the matter to the Department of Health. The documents show that another hospital, the Royal Free Hampstead NHS Trust in London, has also carried out four liver transplants on foreign patients in the past year, the most recent being in November. Despite the criticism, King’s College hospital said last week that it would be “business as usual” and surgeons would continue to give British organs to overseas patients in private operations. The hospital gave livers from British donors to 19 overseas patients last year.

A spokesman for King’s College hospital said: “We are continuing to treat citizens of the European Union as they have the same entitlement to treatment under the NHS as UK patients under European law." Under European law , patients from member states have a right to seek treatment in other European countries. Britain is not obliged to treat these patients, however, and the decision is left to individual hospital trusts.

If the trusts do decide to perform transplants on patients from elsewhere in Europe, they must give them equal access to British organs as those who live in the UK. When an organ becomes available, a recipient is selected according to the severity of his or her condition and the blood group. Some leading transplant hospitals refuse to carry out such operations. Dr Mervyn Davies, a consultant hepatologist at St James’s University hospital in Leeds, which does not carry out private transplants on overseas patients, said: “There is a shortage of donors and we cannot cater for the whole of the EU. “It is tragic for these patients but the system that we have cannot cope with the UK demand as it is. Extending that to the whole of the EU and beyond we consider is inappropriate.”

EU rules say patients from outside the bloc should be offered an organ only if it is not considered of a high enough standard or suitable for a patient in the UK. Transplant surgeons argue, however, that if livers can save the lives of patients from Israel, Libya and the United Arab Emirates, they must be of a sufficiently high standard to treat a British patient. The Department of Health has admitted there are concerns about the issue and is understood to be in talks with the European commission seeking clarification.

Source




NHS wasting 2.1 billion pounds a year in procurement inefficiencies

The NHS is wasting 2.1 billion a year through poor procurement procedures, a report says. The study uncovered huge inefficiencies, with procedures for buying goods and services little changed since the 1950s. It found no common item codes or descriptions used by the NHS or its suppliers, while in some trusts orders are placed without any tendering process, often without an agreed contract price. The method of buying goods and services varied hugely from trust to trust and different departments within the same trust used numerous systems. Vast quantities of paper-based invoices were being generated, requiring huge numbers of permanent employees in accounts departments to match invoices to orders.

The report, published today by the think tank Policy Exchange, also found that dozens of health service projects and innovations are abandoned before they have any impact on care. Of the 2.7 billion spent on the creation of ideas within the NHS, only a small proportion, 153 million, is actually spent on spreading the innovations down to patient level. By spending nearly 16 times more on invention rather than diffusion, millions of pounds is being wasted in generating ideas that are never implemented.

The report, All Change Please, which interviewed 80 senior healthcare professionals, also highlights the slow uptake of new technologies, devices and drugs in the NHS which contribute to standards of care in UK hospitals falling behind that of comparable countries. Premature deaths from causes that are preventable with prompt and effective healthcare are higher in the UK than in Germany, Canada, Australia and France. It condemned the UK's poor access to CT and MRI scanners and below average uptake of new drugs for treatment of cancers including breast, colorectal and lung cancers.

An "alphabet soup" of organisations created by the Government to assist hospital trusts lacked a clear strategy for spreading ideas, it said. Henry Featherstone, head of health and social care at Policy Exchange said: "Procurement practices in some parts of the NHS haven't moved on substantially in the last 60 years. By adopting best practices, as used by other healthcare organisations, the NHS could save up to 2.1 billion each year. "There are also many innovative technologies that are not being taken up uniformly across the NHS. Focusing more funds towards the spread of proven innovations would both improve patient care and reduce costs."

The report recommended the setting up of a central procurement body would have the task of developing common standards for all trusts and performance related bonuses in clinicians' contracts. Managerial incentives should be linked to improving outcomes as well as financial performance.

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4 January, 2009

Australia: Campbelltown public hospital again

See here for another recent case of negligence there

John Haywood will spend this morning in a church chapel watching a video of the life he shared with his wife of 25 years, Marie. He and his 15-year-old son Johnny won't speak at her funeral - the only word they can think of at the moment is "why." Why was she told she was well enough to leave Campbelltown Hospital despite having pneumonia she contracted in there. "My wife went into Campbelltown Hospital two days before Christmas Day for a routine operation and now she is dead," Mr Haywood said yesterday. "She wasn't going in there to die. "They made her sick and they should have made her better. She was only 43."

Her death has sparked a full investigation into events leading to her death on Monday. Mrs Haywood went into hospital to have fluid removed from her stomach; a minor operation done under local anaesthetic. By Christmas Day she was seriously ill with pneumonia as well but Mr Haywood said a specialist, without actually seeing her, decided she was well enough to go home. "One of the staff there told Marie's sister they didn't have a lot of staff on anyway and she'd probably get better care at home," Mr Haywood said. "She didn't want to go home because she knew was still too unwell."

By December 27 Mrs Haywood could not breathe and was rushed back to Campbelltown Hospital where she was immediately put in intensive care. She died on Monday.

Mr Haywood believes the State Government's penny-pinching in health contributed, in a large way, to her death. "Most of the beds and rooms were closed off when we were in there," he said. "We want to know whether it was the system that fell down or the people." The hospital and state Government argue there was enough staff and would not say more as the matter was being investigated.

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Australian Federal government blocks new nursing home provision

There are already lots of frail elderly taking up hugely expensive (State government funded) public hospital beds because they have nowhere else to go and the knowall socialists in Canberra are trying to make that problem worse??? The State Premiers affected should be making Prime Minister Rudd's ears red until he backs down on the stupid regulations dreamed up by his subordinates

The state's main aged-care home operators have boycotted the Federal Government's annual offer of nursing home bed licences, leading some to predict a significant shortage of places in the near future. "In a few years' time we could be back to the bad old days when people were on huge waiting lists for months," said Rod Young, chief executive officer of the Aged Care Association Australia. The operators, including the non-profit and church agencies, say it is uneconomic to build new nursing homes - now known as high-care facilities - under the Federal Government's funding arrangements that prohibit nursing home bonds.

The Government offered licences for 7663 new residential aged-care places across Australia, 2100 of them in NSW; applications closed last month. The number of licences offered each year is based on a strict formula of predicted need. The state's biggest non-profit operator, UnitingCare Ageing, applied for none of the new bed licences; nor did the other big providers, Catholic Healthcare, Illawarra Retirement Trust and Anglican Retirement Villages. Baptist Community Services applied for only a few licences in order to finish a project.

The managing director of Catholic Healthcare, Chris Rigby, said this would prove a "watershed year" in aged care. "My sense is that the number of providers who have applied for high-care bed licences will be minimal," he said. "From talking to our bankers I understand they won't lend for high care on greenfield sites because they can't see how it will work." He said Catholic Healthcare had handed back some approvals it had received in a previous round: "We just can't make the economics work."

The private company Amity has applied for 350 licences. Its chief financial officer, Peter Forsberg, said: "It's barely economic but we had already secured the land." The director of UnitingCare Ageing, Gillian McPhee, said it cost about $200,000 for each new high-care bed in metropolitan Sydney. But the Federal Government allowed operators to recoup only $120,000 for capital funding through a capped accommodation charge to residents of $26.88 a day. "Aged-care providers are not able to make sufficient margins to make it sustainable," she said.

The Federal Government has made clear it will not introduce bonds for entry to high-care facilities, although bonds are permitted for low-care facilities. Critics say the frail elderly should not have to sell their house to finance entry to a nursing home. The issue proved politically sensitive for the Howard government. Some operators are now lobbying for substantial increases in the daily accommodation charge, little changed in real terms since John Howard introduced it in 1997.

Paul Bradley, general manager for residential care for Anglican Retirement Villages, said it was the first time in the past eight years the organisation had not applied for any residential bed licences, even though it had building sites available. Nieves Murray, chief executive officer of Illawarra Retirement Trust, one of the nation's biggest community providers, said the organisation had several sites on coastal NSW, but the capital cost problem was a main reason it had not applied for licences. She said unless the Federal Government tackled the funding problem, the non-profit sector would not build new homes, leaving the field to private operators and "you may end up with a situation like ABC [child care]".

A spokesman for the Minister for Ageing, Justine Elliot, said that over the next four years funding for aged and community care would reach record levels of more than $41.6 billion, $29.5 billion of that on residential care. It would provide an average of $43,000 for every aged-care resident. The Department of Health and Ageing is sifting through the applicants. However, several agency heads told the Herald they believed the offer would be undersubscribed in NSW, Victoria, Tasmania and Western Australia.

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3 January, 2009

What the dreadful treatment of this war hero tells us about compassion in the NHS today

No compasssion or concern even for a man aged 101! Decent people would have treated him with honour, not contempt



No compasssion or concern even for a man aged 101!

John Platt was used to facing life-threatening situations with courage. In World War II he won the Distinguished Service Order for his leadership in one of the fiercest battles of the Italian campaign. But nothing, even in his wartime experience, prepared him for the treatment he received from the NHS.

Aged 101, he was sent away in a taxi to die by Salisbury District Hospital, wearing only a nappy and a set of ill-fitting pyjamas. He was discharged unable to feed himself and clutching a bag of soiled clothing. He was confused and incontinent after a spell in hospital that had left him, according to his family, 'degraded and humiliated'.

During his five days at the hospital, someone stepped on his hearing aid, his false teeth went missing and soiled pyjamas piled up unwashed in a locker. His daughter-in-law said: 'All that he had at the end of his 101 years was his dignity and they took that away from him.'

What kind of institution does that to an old man? What kind of people are forcing a dying patient to undergo an hour's taxi ride in someone else's pyjamas and a nappy tied so tight around his waist it left red marks? Did they think they'd done a good day's work when they went home that night? If criticised will they, like the social workers of Baby P, complacently point to targets reached, meetings attended and boxes ticked? Why has compassion, which after all costs nothing, suddenly become the scarcest commodity in the NHS?

Niall Dickson, chief executive of the King's Fund, an independent health Think Tank, believes the NHS is fast losing its caring attitude towards patients. He said: 'I have very little doubt that we've seen deterioration in the level of compassion that is shown by staff to patients. 'If we can't get compassion into our healthcare, the system is failing.' Sadly, there is plenty of anecdotal evidence to suggest that the system is indeed failing, at all levels. Take, as another example, the case reported by one nurse at a packed meeting at the Royal College of Nursing last summer.

When one of her patients had died, managers rang the staff nurse in charge four times within two hours to see if the bed was free. 'On the final call, one of them said: "Haven't you got rid of that body yet?" ' the nurse recalled. 'It was disgraceful. When a patient dies, they are entitled to respect and dignity.' Indeed they are. But often they get neither. So what is going wrong? Dickson points to shorter stays and sicker patients putting pressure on staff and turning hospitals into 'medical factories'. He blames 'very difficult situations' rather than staff suddenly 'turning into nasty people'.

But it is not just the sheer numbers of patients that is creating this situation. It is the culture of the NHS itself. During a year-long investigation of the NHS that I undertook a little while ago, I met many medical staff who gave their patients outstanding care. But, sadly, they proved to be the exception. I saw far more examples of indifference and disorganisation. As in any institution, from the NHS to your local restaurant, not everyone gives good service all of the time. What sets the NHS apart is its refusal to give anyone the authority to put that right. It is shocking to discover that no one person has the power to oversee all elements of a patient's care, pull them together and take responsibility for that person's wellbeing.

So, for example, there is little incentive for a nurse to check an old lady for bedsores except her own humanity and professionalism. Nor is there any punishment if she forgets or does not bother. As one nurse at the meeting on dignity observed: 'I have seen staff doing full sets of observations on patients without saying anything to them. It is really hard to imagine how you could do that, but it happens.' Over and over again, matrons and sisters complained it was impossible to discipline a nurse for incompetence, let alone for unkindness. In the no-blame culture of the NHS, the emphasis is on making sure it is no one's fault.

Modern management is meant to 'nurture' its employees - even if they have proven woefully inadequate. The errant nurse is offered training, supervision and given chance after chance. This can go on for a year. 'In the meantime,' complained a former matron, 'patients are going through her hands and suffering.' Or as one consultant said: 'We are meant to be the caring profession. But sometimes we put caring for each other above caring for our patients.'

A nurse's training is another bar to compassion, as it has become more theoretical and less about the practicalities of patient care. Twenty years ago nursing turned itself into an academic profession. Nurses became embedded in a power struggle against doctors, the NHS and even patients. Woe betide anyone who asked them to perform any duty that undermined their status. An Irish sister complained that her recently qualified nurses were horrified to discover that 90 per cent of their time 'is doing things for the patient' rather than 'sitting in front of a computer'. She went on: 'I see nurses walk past a patient ignoring his distress-This lack of consistency and authority can have dire consequences for the most vulnerable patients. I saw this for myself staying overnight in hospital to be with a dying friend.

He had slipped into unconsciousness, but at about 6am began to moan with pain. No one came near. The moans turned into screams. The nurses at the nurses' station did not glance his way. Finally, I approached and asked for pain relief. One looked briefly at my friend. 'He's not my patient,' she said. Where was his nurse, I persisted. 'She's giving a bath and cannot be disturbed,' she reproved. It was only by becoming angry that I forced her to fetch something to ease what turned out to be his last few hours. I wondered if she would have treated a howling dog better. It is bad enough being ill and in pain. To be abandoned or treated unkindly is almost insupportable.

In fairness, the Government has responded to public concern by listing compassion as one of six core values in its recent draft constitution of the NHS. It is developing ways of measuring compassion and has even appointed a dignity ambassador, Sir Michael Parkinson. But like the 'Superbug Tsar', another NHS government initiative, will it actually achieve anything or is it a PR sop? Lizzie McLennan of Help The Aged pointed out that health and care providers 'are assessed on lots of things, but dignity and compassion are shamefully not included'. Until the caring professions really start to care again, we have no right to call ourselves a civilised nation.

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Australia: NSW public hospitals not coping with emergencies

Almost one in three people are waiting more than eight hours in emergency departments for a bed, the highest in 18 months, but doctors say the true figures are much worse as hospitals struggle with a surge in the number of patients and a lack of staff, beds and funding. NSW Health figures, released yesterday after the Opposition health spokeswoman, Jillian Skinner, submitted a freedom of information request, show that 29 per cent of people are waiting more than eight hours for a bed, known as access block, up from 19 per cent six months ago, but the figures failed to reveal that some patients could wait up to five days, the president of the Australasian College of Emergency Medicine, Sally McCarthy, said yesterday.

"A patient is only counted when they have been waiting for eight hours or more for a bed, but you can have people waiting for days and days in the emergency department," she said. "There are plenty of cases where management will move a person out of the department when they have been waiting for 7« hours to avoid them being counted as an access block statistic, while someone who has been waiting more than eight hours could be overlooked and left for days because they have already been counted anyway."

About 17 per cent of people who present with imminently life-threatening conditions (triage 2 category) are not being seen within the required 10 minutes and 32 per cent of those with potentially life-threatening conditions (category 3) are not being seen within the necessary 30 minutes, up from 15 per cent and 30 per cent 18 months ago. The number of patients not being seen on time in categories four and five remain the same. There were 153,897 people seen in emergency departments between June and September, up from 137,117 in June 2007, with most of the increase in the middle and lower triage categories.

"Bed numbers have not changed in 10 years but we are seeing about 40 per cent more patients through our emergency departments," Dr McCarthy said. "It is very bad for the proper functioning of any emergency department because once we have 10 per cent of patients not being moved out to a bed, it starts to create problems. We have no space to see new cases, ambulances are delayed, patients get poor treatment and it has been well documented that mortality rates go up."

Mrs Skinner said: "They are the worst emergency department figures I have seen in my 13 years in the job. No wonder the Government tried to hide them. The Garling inquiry was told that stressed ED staff need more doctors, experienced nurses and beds in wards but nothing has been done."

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2 January, 2009

Obama Will Ration Your Health Care

Think of his health plan as a federal HMO

People are policy. And now that President-elect Barack Obama has fielded his team of Tom Daschle as secretary of Health and Human Services and Melody Barnes as director of the White House Domestic Policy Council, we can predict both the strategy and substance of the new administration's health-care reform. The prognosis is not good for patients, physicians or taxpayers. If Mr. Daschle meant what he wrote in his book "Critical: What We Can Do About the Health-Care Crisis," Americans can expect a quick, hard push to build more federal bureaucracy, impose price controls, restrict medicines and technology, boost taxes, mandate the purchase of health insurance, and expand government health care.

In his book, Mr. Daschle proposes a National Health Board to regulate the way health care is provided. This board would have vast powers in regulating the massive federal health-care system -- a system that includes Medicare, Medicaid, and other programs. Under Mr. Obama, it is likely that that system will be expanded and that new government insurance for the nonelderly, nonpoor will be created. Given the opportunity, Mr. Daschle would likely charge the board with determining which treatments and drugs are cost effective and therefore permissible to use for patients covered by the government. And because the government is such a big player in the health-care market (46% of health-care spending comes from the government), the board would effectively set parameters for private insurers.

It is nearly certain that the process of determining which drugs and which treatments would be approved for use would be quickly politicized. The details of health-care policy may not be kitchen table conversation, but the fact that a Washington committee can deny grandma a hip replacement due to her age, or your sister a new and expensive drug, is. Health care is personal and voters will pressure lawmakers on access to care.

Liberal experts, Mr. Daschle included, believe that America needs to ration new technology and drugs. In his book, Mr. Daschle complains about overuse of new technology and praises the United Kingdom's National Institute for Health and Clinical Excellence (NICE), a rationing system that controls government costs. NICE's denial of care is legendary -- from the arthritis drug Abatacept to the lung cancer drug Tarceva. These drugs are effective. It's just that the bureaucrats don't consider them cost effective.

Americans will not put up with such limits, nor will our elected representatives. Mr. Daschle himself proves this. He punts the hard decisions about rationing to an unelected board. Yet his main proposals are not only about expanding subsidized programs to cover more people but about adding the massively expensive benefit categories of mental health, which has a strong lobby behind it, and long-term care, which is important to the broad middle class.

One of the great myths in health care is that the uninsured are responsible for driving up private premiums by shifting costs. Uncompensated care certainly shifts some costs to private payers. Yet these costs are actually quite manageable in the aggregate, akin to what retailers lose due to shoplifting. The major cost shift is from government programs -- Medicare and Medicaid -- to private plans. The government pays doctors to treat Medicare and Medicaid patients. But the rates it pays, on average, are less than the cost for providing care to these patients. This is why Medicaid patients, and increasingly Medicare patients, struggle to find doctors. Putting more people on these programs will destabilize the remaining private system and create a coalition for price and wage controls.

Americans will never tolerate this. Remember our managed-care experiment in the 1990s. It succeeded in its main goal of controlling costs without an aggregate reduction in health quality. But in asking Americans to limit their choices, it prompted a bipartisan act of Congress to provide patients with a Bill of Rights. Now Mr. Daschle proposes nothing less than a giant HMO with a federal bureaucracy setting the benefit plan.

Mr. Daschle's model is Massachusetts. But Massachusetts's plan is an unfolding disaster and demonstrates how Mr. Daschle's private/public model is merely a stalking horse for government-dominated health care. The headline claim is that the program has signed up 442,000 more people for health insurance. The reality is that 80,000 of these were simply put on Medicaid and 176,000 more on the taxpayer-subsidized plans. Costs have exploded, requiring additional tax hikes and the entire system is only possible due to sizable transfers from the federal government. The plans are so unaffordable that in 2007, 62,000 people were exempted from the individual mandate. So much for universal coverage.

The only way the Massachusetts plan will survive is with continued and increasing federal subsidies -- that is, tax revenue from the residents of other states. The only way Mr. Daschle's proposed plan would survive is with massive deficit spending -- that is, with taxpayer money from future Americans, many of whom are not yet born.

Mr. Daschle and the Democrats have spent years developing both the policy and political strategy to make the final push for taxpayer-financed universal health insurance. They have the players on the field, a crisis providing a sense of urgency, and a playbook filled with lessons learned from years of health policy reform disasters -- most recently that of HillaryCare in 1994.

The big questions for believers in private medicine are at this point political and strategic. With employers and most insurers reportedly on board with the new administration's desire for radical overhaul, who will step in to ask the tough questions? Will these issues get raised in time to provoke a meaningful, fact-based debate? Americans could easily find that Mr. Obama's 100-day honeymoon ends with a whole new health-care regime they hadn't quite bargained for.

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1 January, 2009

British ambulancemen ‘decided dying man not worth saving’

Socialist attitudes caught on tape! Most unwise

Two ambulancemen have been arrested by police after they were heard allegedly discussing whether they should bother to resuscitate a disabled man who had collapsed at home and subsequently died. Barry Baker, 59, who lived alone, had dialled 999 saying that he thought he was having a heart attack. An ambulance was sent to his house while a controller kept him talking on the line. By the time the ambulancemen arrived at the house in Patcham, Brighton, Mr Baker had collapsed, but the telephone line was still open and was being recorded.

It is alleged that staff in the control centre heard the two medics making disparaging comments about the state of the house. A police source, who asked not to be named, said that the ambulancemen were then heard discussing Mr Baker and saying “words to the effect that he was not worth saving”. The source said that the two men were allegedly first heard commenting on the untidy state of the house and then saying that it was not worth bothering to resuscitate Mr Baker. They are said to have discussed what to tell ambulance control and decided to say that Mr Baker was already dead when they got there.

The controllers were said to be so shocked by what had allegedly been said that they contacted senior managers, who called the police. “Obviously the crew did not realise that the phone was still connected and, of course, the 999 call was recorded on tape,” the source said. “The tape recording of what the paramedics allegedly said has been handed over to the Sussex Police Major Crime Team as evidence.”

Sussex Police confirmed that two men had been arrested and that a full-scale investigation into the incident was being carried out by the major crime team. A police spokeswoman said: “The men, aged 35 years and 44 years and from the Brighton area, have been arrested and questioned following the death of a man in Brighton. “They were detained on suspicion of wilfully neglecting to perform a duty in public office, contrary to Common Law. They have been released on police bail pending further inquiries.” The two men, who are both based at Brighton ambulance station, have been bailed until a date in January and have been suspended from duty.

Mr Baker, who used sticks to help to him walk after undergoing hip replacement surgery, made the emergency call to the South East Coast Ambulance Service headquarters in Lewes in the early hours of November 29. He told the controller that he was suffering from severe chest pains. The ambulance crew from Brighton was immediately sent to his home with blue lights on.

A spokeswoman for the NHS Trust said: “South East Coast Ambulance Service has suspended two male members of staff from duty as police conduct an investigation into the circumstances surrounding the sudden death of a man at his home in Brighton on Saturday November 29. “The men were arrested by Sussex Police on December 5 on suspicion of wilfully neglecting to perform a duty in public office. “We are giving the police our full cooperation in this matter and are not in a position to comment further at this time due to the police investigation taking place.”

Mr Baker’s funeral has had to be delayed because of the investigation, but a memorial service is due to take place at All Saints Church in Patcham on January 16. Paul Newman, landlord of the Ladies Mile, where a wake is due to be held, said yesterday that Mr Baker was a popular figure. “He used to come to the pub every Sunday morning at opening time. He arrived by bus and met friends here and together they played a few hands of cards. He did it every Sunday without fail and was a really nice chap.”

It is understood that a report on the incident has been sent to the Crown Prosecution Service for a decision on whether the two men should be charged.

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Orszag's Health Warning

Obama's budget chief delivers a reality check on costs.

Democrats are gearing up for a new run at health care next year, which is another way of saying that it's an arms race to promise the most while disguising the costs. So when the expensive realities of "universal" coverage somehow intrude, taxpayers can't afford to let those moments disappear down the Beltway memory hole.

The most recent such moment comes courtesy of Peter Orszag, the former head of the Congressional Budget Office. CBO is the shop responsible for estimating how much legislation will cost the government, and recently it released two important reports on health-care financing that should hit Democrats like a cinderblock, assuming they read them. The executive summary for busy politicians is that liberal health reforms will be extremely costly, while measures intended to "save" money won't even come close to the promises. None of this will come as a revelation anywhere besides Capitol Hill.

Even so, this skepticism is notable because Mr. Orszag has since left CBO to become Barack Obama's budget director. Mr. Orszag's useful work on the unchecked growth of U.S. health spending, especially entitlements, ought to put the cost issue at the center of the 2009 debate. CBO expects government outlays on Medicare and Medicaid to rise as a share of the economy to 6% from 4.2% in a decade -- to $1.4 trillion, or nearly 30% of the entire federal budget -- and eventually ruin federal solvency. If costs grow on pace, U.S. medical spending will rise to 25% of GDP in 2025 from 17% today.

The liberal solution to this looming catastrophe is to add even more obligations. The insurance program for children that Democrats plan to expand in January will cost an extra $80 billion over the next 10 years. Preventing automatic cuts in the reimbursement fees that doctors receive for treating Medicare patients -- as Congress does every few years -- runs to $556 billion.

Those are nothing compared to the centerpiece of the universal health-care agenda -- a "public option" to provide government insurance for Americans of all ages and incomes. In one scenario, CBO finds that allowing the nonpoor to buy into Medicaid would have net costs of $7.8 billion over the next decade. If that sounds like pocket change, keep in mind that Democrats want to make both the public option and private insurance less expensive for beneficiaries by transferring the extra costs onto the government. Just one subsidy plan CBO examined would run to $65.5 billion by 2019. Having the government assume responsibility for high-cost claims would hit $752 billion.

CBO rolls through 115 of these reform options -- and it quickly becomes evident why even Democrats concede that their new health programs will cost $150 billion or even $200 billion per year. The real numbers will be higher. Keep in mind, too, that these are new recurring obligations, not one-time spending like (presumably) the financial bailout. They're politically unrepealable programs that will remain for decades.

Democrats, including Mr. Obama, suggest that covering everyone under a government plan will reduce costs through efficiency. Not according to CBO. It notes that there are "difficult trade-offs between the objectives of expanding insurance coverage and controlling both federal and total costs for health care." CBO also finds that programs designed to trim costs, such as health information technology or comparative effectiveness research, will produce only modest savings.

Mr. Orszag is a centrist liberal, and he supports reforms intended to squeeze waste out of the health markets. But to his credit at CBO he didn't ignore the data. Many Democrats (and a few Republicans) are glad that he's departing and are searching for a CBO replacement who will "score" their bills more favorably. The best outcome would be if Mr. Orszag manages to introduce some health-care sobriety to the Obama White House.

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