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21 November, 2007

Sickening Canadian healthcare

There is a good reason Alberta spends more on health than any other province in the nation -- $3,695 per person -- and yet we wait longer for care. The Fraser Institute notes that if an Albertan sees a family doctor -- if you're lucky enough to have a family doctor, which in Alberta is fast becoming a mythical creature on the same order as a unicorn -- and are referred to a specialist, the average wait before actually getting treated is 19.5 weeks. This is not good.

It is not even up to the sad standard set by other Canadian provinces. Our American cousins look at such numbers and are appalled. Yet there is a very good reason for this. It is because the economic model for our health-care system, in Alberta and across the country, would be instantly recognizable to Josef Stalin and Mao Zedong. Mao and Stalin didn't believe in the rights of individuals to make economic decisions on their own, and neither do those who become hysterical and cry like little girls denied tickets to the new Avril Lavigne tour when it is suggested an absolute government monopoly on health care is killing us, financially and literally.

We have taken the economic model of the Soviet and Maoist collective farm -- the result of which was generally widespread starvation -- and applied it to the delivery of health care. Anyone surprised by the fact it doesn't work is probably also surprised Jack Layton isn't prime minister, the sun rises in the east, sticking a knife into a toaster hurts and that you can sit in a Calgary hospital emergency room suffering a serious gallbladder attack for eight hours before getting a shot of Demerol, which happened to the wife of a friend of mine recently.

Despite our institutionalized disdain in this country for all things American, if a U.S. citizen doesn't have health insurance and goes to a county hospital where medical care, as it is in Canada, is "free," the wait for treatment for a gallbladder attack is .... you guessed it ... about eight hours. The average Canadian, with his much-lauded, universal medical system, is treated like the average American without health-care insurance

Countries that provide a compassionate and intelligent mix of private and public health care simply do better. A recent survey of 28 countries that offer universal health care saw Canada place 26th in terms of medical outcomes for every dollar spent, 18th in access to CAT scans and 22nd in infant mortality. Because of the presence of (gasp of horror!) capitalists in the systems outperforming ours, such as Australia, they have embraced the discipline of the free market, which delivers any product -- from iPods to heart surgeries -- more efficiently and effectively. We place so low because if you're not rewarded for efficiency ... you'll be inefficient.

We used to have a mixed system in this country. Some doctors remained in the public system. Others opted out all the way. Some took publicly insured patients and extra-billed them. That has all been taken away in the name of equality -- the same sort of equality lauded by Mao and Stalin -- and the result has been predictable.

This country saw health care costs rising and decided it would .... restore free market discipline? Naw. We decided to limit the number of doctors graduating and, in a peculiarly Alberta solution, blew up a freaking hospital without having built a new one first. So we now have doctor shortages and hospital bed shortages and the only people surprised are the same ones wondering how come the sun rises in the same place every day. It'd be enough to make you sick if you weren't afraid you wouldn't get timely treatment.

Source




Australia: Regulators finally do something about irresponsible health bureaucrats

QUEENSLAND'S former chief health officer, Gerry FitzGerald, faces disciplinary action for his role in the Dr Death scandal at Bundaberg Base Hospital after a dogged two-year pursuit by a doctor with the Royal Flying Doctor Service on the other side of the country. The Medical Board of Queensland, which had been reluctant to launch proceedings against anyone over the Bundaberg hospital disaster, with the exception of surgeon Jayant Patel, is preparing to start disciplinary action against Dr FitzGerald, one of its former members, for failing to act swiftly.

The decision of the board is sensitive because it was initially dismissive of calls for top administrators to be held accountable. It was pressed into an investigation of Dr FitzGerald by a West Australian-based doctor with the RFDS, Simon Evans. Documents obtained by The Australian yesterday show the board has now agreed that Dr FitzGerald received serious complaints about Dr Patel in early 2005 but "failed to take proper action to ensure that Dr Patel was limited to surgical work that he and the hospital could satisfactorily perform". Dr FitzGerald said yesterday he was "very disappointed" with the board's decision. He said he had tried to do his best under difficult circumstances.

Dr Evans hopes the latest decision will send a powerful message to senior bureaucrats and administrators in charge of health systems that they are not immune from disciplinary action usually reserved for clinicians. Dr Evans urged the board two years ago to start disciplinary action against Dr FitzGerald, who had resigned from Queensland Health after giving evidence at a 2005 judicial inquiry into the problems at Bundaberg Base Hospital, as well as other administrators. "They told me they had absolutely no intention of taking any disciplinary action against any administrators adversely named in the report (of the inquiry)," DrEvans said yesterday from his home in Derby, in Western Australia.

Undeterred by the rebuffs, Dr Evans researched the evidence in greater detail, cited legislation and administrative negligence cases from Britain, and wrote several letters accusing the board of failing in its responsibilities. "From my time at Queensland Health as a clinician I could see where the major problems were - they were with senior medical administrators," Dr Evans said.

The board has concluded that Dr FitzGerald "failed to recommend suspension of Dr Patel when he could and should have done, thus exposing patients to undue risk of harm". The matter is to be heard by the Health Practitioners Tribunal. Medical practitioners found guilty of unprofessional conduct face penalties ranging from fines to being struck off as doctors.

Serious concerns relating to Dr Patel's performance at the Bundaberg hospital were not properly addressed until senior nurse Toni Hoffman put her job on the line by going public in 2005 with evidence of unnecessary deaths and injuries resulting from Dr Patel's surgery.

Dr Patel, who has lived in Portland in the US state of Oregon since fleeing Australia in April 2005, will be arrested by US marshals when the paperwork is completed between Australian and US authorities, possibly as early as next month. The extradition request is understood to relate to 16 charges, including manslaughter and grievous bodily harm, arising from his time at Bundaberg Base Hospital.

Tess Bramich, the widow of a patient who died at the hospital, said she had "forgiven" Dr FitzGerald. Mrs Bramich said since Dr FitzGerald was facing disciplinary proceedings, other administrators also needed to be dealt with. A senior source said the board had always been uncomfortable with the prospect of taking action against a former member. The board permitted Dr Patel to practise in Queensland, overlooking his history of serious disciplinary action for botched surgery in the US.

Retired Supreme Court judge Geoff Davies QC, head of a public inquiry in late 2005, made strong findings against Dr FitzGerald for not acting on a clinical audit that showed Dr Patel's complication rate was at alarming levels. The inquiry ruled that Dr FitzGerald's decision to permit Dr Patel to continue to practise "was a course designed to minimise publicity and in effect conceal the truth. The interests of the patients were ignored." Mr Davies told Dr FitzGerald: "You knew he had 25 times the complication rate for a very normal piece of surgery. "What more do you want to protect the potential patients of Bundaberg Hospital?"

Dr FitzGerald, who won support from patients and Ms Hoffman because of his candour and his apologies on behalf of the health system, has denied he set out to conceal information. He now works at the Queensland University of Technology.

Source





20 November, 2007

Britain: Thousands dying ‘because simple screening system has been delayed’

Delays in introducing a screening programme for a deadly blood condition are costing the lives of thousands of men each year, doctors say. Aortic aneurysms — swellings in the main artery of the stomach — can kill without warning and are the third most common cause of death for older men. But the Government has failed to bring in a national screening programme nearly two years after it was urged to do so.

All four UK health departments are considering whether all men in their mid-sixties should be screened for an abdominal aortic aneurysm (AAA), which is found in up to one in ten men aged 65 to 79. About 7,000 men bleed to death every year because of the condition, even though it can be prevented by a simple operation.

Campaigners say that checking whether men are at risk of a ruptured aneurysm would cost 25 million pounds, half the price of the breast cancer screening programme, and would save as many lives — at least 3,000 a year. The UK National Screening Committee recommended the programme in January last year and sketched out how it would work in May this year.

The abdominal aorta carries blood to the intestines and other organs nearby. Aneurysms, in which the arteries weaken, stretch and bulge, are common in this part of the body. Ruptured aneurysms are catastrophic: more than 85 per cent of men die when an unsuspected aneurysm bursts, compared with only 5 per cent of those who have a planned operation. However, those at risk can be assessed by a simple ultrasound scan.

George Hamilton, president of the Vascular Society of Great Britain and Ireland, accused ministers of unnecessary delays in implementing a full screening programme. “Ruptured aneurysm is a common and painful way to die. The evidence in support of screening is incontrovertible,” he said. The test, which involves measuring the diameter of the aorta, is funded in only a few areas, such as Gloucestershire, where a screening programme has been running since 1990. Yet doctors who offer screening to patients privately have been frustrated by criticisms that they are illegally charging for the service. Brian Heather, a vascular surgeon who pioneered screening for AAA cases at the Gloucestershire Royal Hospital, said that the test could be performed with a briefcase-sized portable ultrasound machine.

Factors that can contribute to the likelihood of developing an aneurysm include family history and risk factors for heart disease such as smoking, obesity and high blood pressure.

Derek Kendall-Smith, 77, a former England rugby international and managing director of a jewellery firm, had surgery for an aneurysm two years ago. He said that a 95 pound voluntary test had saved his life. “If I hadn’t been screened I would have had no idea there was ever a problem,” Mr Kendall-Smith, of Marlow Bottom, Buckinghamshire, said.

A Department of Health spokesman said: “This assessment has to take account of the likely impact on existing healthcare services and the infrastructure and staffing requirements.” [Translation: It would cost too much]

Source




Australia: Public hospital staff warned of prison for media leaks

Health authorities in Western Australia say public hospital staff have been warned they could face two years in prison if they leak confidential reports on adverse incidents. The Health Department is investigating the case of a confidential form, leaked to a Perth newspaper last month, that detailed the case of a man who died from a heart attack in Royal Perth Hospital's emergency department. The man had been admitted for a different health complaint, seen by doctors, stabilised and left on a trolley in the emergency ward awaiting a bed. After 11 hours in emergency, he suffered a massive heart attack and was unable to be resuscitated.

Royal Perth's executive director, Philip Montgomery, said it was the first state breach of a 1973 commonwealth law designed to protect the confidentiality of staff making incident reports under the Advanced Incident Management System, or AIMS. He said the hospital was concerned about the leaking of the AIMS form: "The point of the system is to encourage and facilitate staff to report incidents in such a way that their identity is protected, so clinical care can be improved."

Dr Montgomery said the penalty for releasing incident reports was two years in prison. "The consequence is that we've gone back to all our staff and made them aware you can't breach confidentiality." The matter could be referred to the Corruption and Crime Commission. Dr Montgomery said he accepted the man's 11-hour stay in emergency was too long "but we don't believe there has been any inappropriate clinical care".

An emergency staff doctor told The Weekend Australian the number of AIMS reports had dropped off immediately after the media story, because of staff fears of public disclosure.

Source





19 November, 2007

Australia: THE NSW HEALTH DEPT. STORY

Three current stories below:

Barely-disguised corruption from a State government

Labor push to gag hospital inquiry

The NSW Labor Government has moved to shut down a parliamentary inquiry into Royal North Shore Hospital before it hears more damning evidence of malpractice. The Weekend Australian can reveal Labor used its numbers on the inquiry committee to vote down a proposal by Coalition members, at a closed meeting on Wednesday evening, that would have extended the inquiry's reporting deadline past December 14 and also put aside extra days for public hearings.

The cave-in preceded a direct plea to the inquiry yesterday by the couple whose tragedy at RNSH led to the inquiry being established. Mark Dreyer, whose wife Jana Horska miscarried in a toilet adjacent to the hospital's emergency unit on September 25, begged committee chairman Fred Nile to extend the committee's deadline in order to do a thorough job. "There is no deadline that applies to our ongoing grief," Mr Dreyer said.

Asked by Mr Nile what he hoped for from the committee, he replied: "I hope you give this inquiry the necessary time it needs and not be pressured to finish it off by the recommended time of December -- that's what I'd like to say to you personally. "You are a man of high moral standards so I've got some trust in you to carry out what's required." Mr Dreyer added it was important to allow anybody with a story ample time to bring it to the inquiry. "We certainly won't fail you," said Mr Nile, fully aware the committee had already done so.

Informed of the secret committee vote last night, Mr Dreyer said: "This was always my fear, based on the track record of this Government. I put a challenge out to Nile today to show his supposed impartiality. "If this is going to be the case and we don't get the extension we desperately need, we have an inquiry that is doing half the job. Why bother?"

In an emotional 30 minutes of testimony, Mr Dreyer and Ms Horska both wept as, speaking on his wife's behalf, Mr Dreyer described the nursing care she received at RNSH as cold, robotic and mechanical. "There was no comfort, no reassurance to either of us ... in the darkest hour of this ordeal -- there was nothing," he said. He said his pleas and those of Ms Horska, who was in agony, to nursing staff for assistance were "like talking to the wall". "It was urgent to us but not to them," he said.

In further shocking testimony, he said that after her miscarriage Ms Horska was placed on a trolley and left for an hour with her dead baby between her legs. He described as "unbelievable" the insensitivity of NSW Premier Morris Iemma in expecting the couple to provide evidence to a committee of senior doctors during the same week they received pathology results confirming their baby was a boy.

He said that on the morning after the miscarriage, his wife received a visit from a hospital bureaucrat engaged in "damage control" before she was allowed to see a gynaecologist. Earlier, RNSH's director of medical services revealed the hospital relied on charity for basic equipment such as lasers and specialist operating tables. Sharon Miskell told the inquiry that only the skill of the hospital's surgeons had prevented "adverse outcomes" resulting from broken or decaying equipment.

Source

NSW: Fix the hospital or we'll quit, warn doctors

SENIOR surgeons are threatening to resign if the Government does not restore Royal North Shore Hospital to its former glory. Their warning came as the couple who sparked the latest inquiry, Mark Dreyer and Jana Horska, broke down as they relived their ordeal of her miscarrying in the hospital's toilet.

Silence fell over the room as Mr Dreyer detailed the night his wife lost their unborn child on September 25, when Ms Horska was 14weeks pregnant. "There is no deadline to our ongoing grief and suffering," Mr Dreyer said. "It has cost both of us terrible grief and we will always be wondering if the outcome would have been different if we had been treated as a priority."

Christian Democrats' leader Fred Nile, the parliamentary inquiry committee's chairman, promised the couple "the inquiry won't fail you". Mr Dreyer said he had no faith in the Government for implementing change. "I think people would have had a lot more respect for (Premier) Morris Iemma to come out and take the politics out of it, take away the political spin which has been very hurtful for us," he said. "The insensitivity has just been unbelievable, they don't understand the pain they cause with this rubbish they peddle."

There is only one more day of public hearings, on Monday, before the committee retires to consider its recommendations. But it has been swamped with damning complaints which doctors from the hospital have said are an embarrassment. The inquiry was told equipment was so inadequate that only the competence of surgeons had prevented harm coming to patients. Director of medical services Dr Sharon Miskell said there had been instances where equipment was broken, inadequate or non-existent. "We are unable to perform surgery, we are delaying surgery," she said.

Three of the hospital's senior surgeons spoke of their embarrassment at the gradual decay of the once marquee hospital. Area director of intensive and critical care Professor Malcolm Fisher warned he was on the brink of quitting. "The findings of this committee and the response of the health department are crucial," he said. "They will determine if we give this a go or walk." Other doctors described the health department's "inept system" as failing patients as well as being the cause of the hospital's loss of staff. Intensive care director Dr Ray Raper said he was embarrassed this week at a patient's recount of a hospital stay. "My colleagues have been telling me for a long time they are embarrassed of the conditions of the hospital," he said.

Source

Oppressive health bureaucracy defeated in court

Angry obstetricians have demanded an apology from a regional health service after a judge last week threw out its attempt to sue one of its own doctors to claw back part of a $7.5 million negligence payout. Birth specialists condemned the case brought by the Greater Southern Area Health Service in southern NSW as a waste of taxpayers' money and "a disgraceful attack" on Wagga Wagga obstetrician George Angus. The GSAHS had claimed Angus should be jointly liable to pay $7.5 million awarded in respect of a birth at the Wagga Wagga Base Hospital in 1995 -- even though he was merely the senior obstetrician on-call and denied ever being consulted about the case.

During the birth the baby's shoulders became stuck and the baby's brain was deprived of oxygen for several minutes. The child has cerebral palsy, epilepsy and moderate intellectual disabilities. The health service admitted liability in the negligence claim brought on behalf of the family, and it was settled in May 2003. The GSAHS's subsequent move to sue Angus sparked alarm among obstetricians throughout NSW.

Justice Michael Adams in the NSW Supreme Court rejected the health service's case, ruling that a more junior doctor did not consult Angus on whether a drug to increase contractions should be given to the mother during labour. The judge also ruled there was nothing to suggest Angus acted in a way that was medically inapppropriate on the basis of the knowledge he had at the time. Adams ordered the health service to pay Angus's costs. Megan Keaney, head of claims in NSW for Angus's insurer, Avant, said she was "confident" total costs for both sides would exceed $500,000.

"The fundamental reason that he (Angus) won was that the court confirmed that he had not seen the patient," Keaney told Weekend Health. "It was the hospital's case that he had. It was always our view that the evidence to support that assertion was very slim. "There's no doubt that this has created a lot of ill-will between obstetricians in rural south-western NSW and NSW Health. That's quite understandable, given their (GSAHS's) approach to this claim."

Christine Tippett, president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, said had the case gone the other way the "implications for doctors on call would have been very serious". "What it would have meant was that any doctor on-call for a public hospital could have been called as a co-defendant on a claim, even if they had not been called (for advice) or provided any service for the patient," Tippett said. "That's quite untenable. We consider that Angus should receive an apology for the distress that this case has caused him."

Albury-Wodonga obstetrician Pieter Mourik, who was previously the representative for the Wagga region on the RANZCOG council, said the case was a "tragedy" and the GSAHS should "hang its head in shame" for bringing the action. While he welcomed the outcome, he said the "damage has already been done" as Wagga's three obstetricians were no longer working at the Base hospital, now served by locums and overseas-trained doctors.

"The NSW Department of Health is also responsible for this disgraceful attack on a capable, rural obstetrician," Mourik said. Angus told Weekend Health the outcome was anticlimactic "because I didn't think they had a case in the first place".

"To be dragged through the court for 10 days, for something I know nothing about, and didn't know anything about -- and then to be told you're not guilty of something that I was not guilty of in the first place -- it was a bit of a hollow victory," Angus said. "The sad thing about this is the fact that all this public money on a court case that had no merit. (Other doctors) are very suspicious of the health service now -- the GSAHS has done itself a disservice."

After the case GSAHS chief executive Heather Gray declined to say if an apology would be forthcoming. A GSAHS spokesman this week declined to add to her comments. "The Greater Southern Area Health Service and NSW Health is still to review in detail the judgment handed down," Gray said in a statement. "The costs are yet to be determined. GSAHS is making no further comment on the matter at this time."

Source





18 November, 2007

Australia: Long wait imposed by public hospital permanently damages baby

No recognition of what the failure to provide prompt treatment could lead to

Another mother has told of her harrowing experience at the Rockhampton Base Hospital, furious over a bungle that caused her four-month-old daughter to lose an ovary. Nicole Simpson yesterday revealed how she waited two months for contact [an appointment] from the hospital after her daughter Jade was referred there with a hernia by their family doctor.

The details of how Jade was treated will stoke the anger that has reverberated around the state after The Courier-Mail reported this week that two-year-old Ryan Saunders from Emerald had waited 30 hours in September before his twisted bowel was diagnosed in Rockhampton Hospital. Ryan died just as he was about to fly to Brisbane for an emergency operation.

Jade Simpson's ordeal came to light as Queensland Health chief health officer Jeannette Young insisted the Rockhampton Hospital was doing a good job. Dr Young spent yesterday at the hospital to hear directly from staff, many of whom are upset over the attention Ryan's case has received. "They have got a very good paediatric service, there is nothing wrong with it at all," she said.

Jade's hernia burst before the hospital made any contact and she spent three days in pain at the hospital waiting to be transferred to Brisbane by the Royal Flying Doctor Service. Mrs Simpson and her daughter were eventually forced to catch a commercial flight, and Jade was operated on 30 minutes after arriving at the Royal Children's Hospital. The operation in March 2006 came too late to save one of Jade's ovaries. "She has only got a 50 per cent chance of having children when she is older and it is all their fault," an angry Mrs Simpson said. "If she had been seen to earlier should would still have two."

Queensland Health is undertaking its own probe, known as a "root cause analysis". However, Mrs Simpson said her daughter's ordeal was also the subject of a "root cause analysis" which she condemned as little better than a cover-up. "All it basically said was 'we did our best, too bad, so sad'," she said. Mrs Simpson said she warned politicians, from local MP Robert Schwarten through to former premier Peter Beattie, of the hospital's shambolic efforts in a bid to prevent further children from suffering. "The main reason for writing to them was so it didn't happen again but it did and this time someone died," she said.

Dr Young yesterday said she was unaware of Jade's case but insisted the hospital was performing well. She met Ryan's parents Donna and Terry on Monday to discuss their son's treatment and hear their concerns. However, she dismissed criticism of Ryan's 20-hour wait for an ultrasound scan after he had been sent from Emerald with a suspected twisted bowel. "It is not a lack of equipment, it is not a lack of staff, it is not a lack of resources," Dr Young said.

Source





17 November, 2007

Australia: More public hospital craziness

This is utterly insane. $702m for just 27 more beds -- or $26 million per bed. And that's just the building cost

Plans to redevelop Royal North Shore Hospital will only mean an extra 27 new beds, which would fall short of meeting future demand, doctors have told a NSW parliamentary inquiry into the hospital. NSW Health Minister, Reba Meagher said this week that a $702 million redevelopment would result in the hospital having 626 beds, including 46 critical care beds and 40 mental health beds.

At the inquiry today, the hospital's director of trauma Tony Joseph said the minister's comments was the first time that number had been revealed. "Thus the new hospital will provide a total of 27 more beds than the current total of 599, which is a concern, given the projected population growth for the northern part of Sydney," Dr Joseph said. He said he had done a recent snapshot survey of the hospital and found that 10 out of 24 wards at the hospital's main clinical services block had been closed or converted to "other non-inpatient services".

The inquiry was set up after Jana Horska, 32, miscarried in the toilets of the hospital's emergency department in September. Ms Horska is to appear before the inquiry this afternoon.

Source





16 November, 2007

Australia: Toddler dies in agony after public hospital negligence

The Queensland government has ordered a review into the death of a three-year-old boy who was allegedly left untreated for 30 hours at a regional hospital. Nationals MP Vaughan Johnson told state parliament today Ryan Saunders was rushed by helicopter from Emerald hospital to Rockhampton hospital "where he lay screaming in agony for over 24 hours with his distraught, traumatised and helpless parents by his side".

Mr Johnson said Ryan was suffering stomach pains and was taken to Emerald hospital by his parents on October 25. He was later transferred to Rockhampton following fears he may have a twisted bowel. Mr Johnson said Ryan was ignored by doctors for more than 24 hours at Rockhampton hospital and died the next day. "They virtually did nothing with him for about 30 hours ... This is just totally unacceptable," Mr Johnson said. The MP called for an investigation into the incident.

Queensland Health Minister Stephen Robertson said the case had been forwarded to the coroner and an independent review would also be carried out. "Central Queensland Health Service District will also be commissioning a root cause analysis to look at the care provided and identify if there are any issues that need to be addressed to improve the care that was provided," Mr Robertson told state parliament. "This analysis will be provided by an expert team external to Central Queensland Health Service District." Mr Robertson said it would be inappropriate to discuss the details of the case but acknowledged "the tragedy that did befall that family".

He said health officials had already met with Ryan's parents and would meet with them again on Friday. "At these meetings, the family will be provided with all available information in relation to the care provided," he said. The minister said the findings and recommendations of the independent review would be made available to the family.

Source





15 November, 2007

Australia: More revelations about NSW public hospital

Amazing that this was ever tolerated

Cockroaches crawled over patients undergoing surgery and theatre staff were forced to catch a falling patient after an operating table collapsed in the middle of a procedure at the Royal North Shore Hospital. The incidents were part of a litany of horror stories about the hospital that were revealed as a NSW parliamentary inquiry into the RNSH began yesterday. In a written submission to the inquiry, Jeffery Sleye Hughes, who was senior orthopaedic consultant at the hospital for 12 years until this year, detailed:

* patients with infected joints and compound fractures being "left to rot" in wards for 18 hours or more because of "inappropriate theatre management";

* patients being lied to about the reason their surgery was delayed, by units in the hospital trying to cover their backs;

* live cockroaches running over operating theatre tables during surgery;

* high-pressure hoses exploding in theatre during operations and injuring staff; and

* operating tables collapsing during surgery, with surgeons forced to catch falling patients.

The inquiry, which is due to report next month, was called following the publicity surrounding the case of Sydney woman Jana Horska, who miscarried in a toilet adjacent to the hospital's emergency unit in September, after waiting hours for treatment.

In another submission, Sydney woman Maureen Cain told how her husband lost both legs after contracting a staph infection at the hospital in 1998. "The family and I were horrified at the filthy conditions but, as we were so occupied with supporting our husband and father, (we) did not do anything at the time," Mrs Cain wrote. "Wards were dirty, bed frame had congealed matter on it, there was no ventilation in the bathroom, syringe left under the bed for three days before I picked it up - I could go on and on."

NSW Health Minister Reba Meagher insisted conditions would improve under new management and stressed the need for better financial management to end budget overruns. "There will be no cuts to nurses, no cuts to doctors and no cuts to beds," Ms Meagher said. "Our investment in frontline services will continue to increase in those important areas, but it is important that the hospital's financial management is improved and there have been a number of ideas floated."

Acting nursing director Linda Davidson told the inquiry nurses at RNSH had been spat at and abused in the street following coverage of problems at the hospital. "I have had it reported to me that some nursing staff in the community are actually undergoing similar situations that their colleagues at Camden and Campbelltown experienced, which was abuse in the streets and actual spitting episodes," she said. "So when that comes back within that environment, the morale does tend to wane accordingly." Nurses at Campbelltown and Camden Hospitals were abused in the streets when the hospitals were at the centre of maltreatment allegations in 2004.

Source





14 November, 2007

Head-in-the-sand health bureaucrats in Australia

Queensland ambulance bosses were warned months ago about chronic understaffing and overworked paramedics suffering severe fatigue on the job. Confidential workplace health and safety documents obtained bt The Sunday Mail reveal that stressed frontline troops raised concerns as long ago as 2005. They warned that driving ambulances while fatigued threatened paramedics, patients and the public.

One said it was not uncommon for paramedics to have micro-sleeps at the wheel. A supervisor submitted a report to the Qeensland Ambulance Service workplace health and safety officer in May, outlining specific problems in Southeast Queensland. He recommended a review of fatigue policies: using other staff to drive fatigued officers back to the station and then home; and communications officers being more vigilant about overtime. He also called for an investigation by an independent agency.

Sources said yesterday that the report was ignored by QAS management. Stanthorpe ambulance Officer Julie Clark last week gave The Sunday Mail details of a nightmare shift of 36 hours. Ms Clark, 43, a trainee paramedic, said there were major safety concerns for all people involved and that someone could have been "in- jured or worse, killed" if she had fallen asleep. Ambulance Commissioner Jim Higgins said long shifts were "rare" but conceded the Clark situation "could have been managed better".

Paramedics were critical of Mr Higgins' claims and said marathon shifts were common. Several recently complained to their supervisor, who filed a report with the QAS workplace health and safety officer. "As the immmediate supervisor of staff who are regularly driving while fatigued, I have great concern about the safety of these officers and the members of the communitv that are exposed to these fiatigued officers." he wrote. "The QAS itself has identified that fatigue as an issue ... (but) this has not translated ... because we are quite regularly working 16 hours plus.

The supervisor said officers strongly believe that the community deserved better than being treated by a fatigued officer who couid possibly make an incorrect decision about the emergency health treatment given, which could lead to long-term ill-health or even death. Emergency Medical Service Protection Association president Prebs Sathiaseelan said it was just the "tip of the iceberg". "QAS management has known about the problem for a longtime. They received documentation through the normal channels of communication, but it was ignored," he said. Emergency Services Minister Neil Roberts said he had asked Mr Higgins to send a notice to all ambulance officers tomorrow reminding them of measures in place to alleviate fatigue.

The above article by Darrell Giles appeared in the Brisbane "Sunday Mail" on November 11, 2007




Australia: Public hospital neglect 'killed mother'

"DON'T leave your loved ones alone at Royal North Shore Hospital." That is Lindy Batterham's advice as, one year after the agonising and preventable death of her mother, Joyce, she struggles to come to terms with the negligent care the 90-year-old received at RNSH, and the cover-up that followed. Left at the hospital overnight, simply so that her heart medication could be assessed in the morning, Joyce was dropped on the floor by a nurse, broke her hip, suffered a stroke during surgery and died six days later. "I'll be traumatised by my mother's last six days for the rest of my life, having flashbacks of witnessing her dying in a nightmare of pain," Ms Batterham, 52, said.

Her account of her mother's last days, revealed to The Australian yesterday, is one more RNSH horror story embattled NSW Health Minister Reba Meagher doesn't need as she prepares to front a parliamentary inquiry into the hospital this morning. The inquiry has been forced on the NSW Labor Government following the case of Jana Horska, who was left to miscarry in a toilet adjacent to the hospital's emergency unit in September. Ms Horska's case provoked an avalanche of complaints against the hospital.

When Ms Batterham left her mother at RNSH around midnight on November 10 last year, Joyce, who lived with Ms Batterham, was alert and in sound health. After arriving by ambulance at RNSH emergency at about 6pm with breathing difficulties that had been successfully treated before, Joyce did not see a doctor until 3am the following morning. Those nine hours were spent in great discomfort.

As the result of a pressure sore and poor circulation causing pain in her good leg, Joyce spent much of the time sitting on the edge of her ambulance stretcher, dangling her leg over the side. The doctor said there was nothing much wrong with Joyce and that she could stay overnight in the hospital's aged-care ward and see a specialist about her medication the following morning. Exhausted, Ms Batterham went home, little imagining she would never speak to her mum again.

"She could still be with us now, but because one nurse tried to move my mum, who was a large woman with only one leg, from her wheelchair to a hospital bed without a rail or anything for my mother to hold on to, she was dropped to the ground, resulting in a broken hip," she said. "When I arrived about an hour after Joyce had been dropped, I found they had put her back in the wheelchair and given her painkillers to address the extreme pain she complained of, then left her, with no access to a buzzer. "It was only after I intervened and insisted she be seen by a doctor and X-rayed for a possible fracture, and laid down on the bed instead of with her leg dangling, that these things finally happened." Three hours after being dropped, Joyce was finally seen by an orthopedic surgeon.

But there were more bungles ahead. Joyce's surgery the next day, Sunday, was postponed - without her or Ms Batterham being told. And when Ms Batterham phoned on the Monday morning to ask when the surgery would happen, she was astounded to hear it had already begun. She was unable to comfort her mother before surgery and was denied the opportunity to speak with her again, since Joyce was unable to communicate following a stroke on the operating table.

But what really angers Ms Batterham, as she prepares to lodge a submission with the parliamentary inquiry, is the hospital's lack of accountability and the way key details were airbrushed out of the written report she finally received on Joyce's death, which is being investigated by the Coroner. There was no mention of the fact Ms Batterham had to beg for her mother's hip to be examined by a doctor. No mention of the fact her pain was misdiagnosed by nurses as being the result of poor circulation. Above all, there was no admission that the attempt by a nurse to lift Joyce by herself, with no handrail, was a dangerous practice.

Source





13 November, 2007

It looks like Britain does not have a monopoly on filthy public hospitals



Cockroaches crawled on operating tables during procedures, the inquiry into Sydney's Royal North Shore Hospital [Australia] has been told. Health Minister Reba Meagher is the first witness to face the inquiry this morning, being held at NSW Parliament. The hospital's doctors and former management are giving evidence into the hopital, which has been the centre of many complaints over the past two months. One doctor, who has since resigned, complained of the filthy conditions in operating theatres.

Nationals state MP Jenny Gardiner told the inquiry the allegations were made in a submission from the doctor who worked at the hospital for 16 years. "He refers to the killing of live cockroaches on operating theatre tables during operations and `no response when I forward a written complaint and response is requested'."

Ms Meagher said that was unacceptable. "That is why the new management has responded to concerns of staff at the hospital and ordered a complete clean of the hospital," Ms Meagher said. Contract cleaners were sent to the hospital on the eve of a tour of the facility by the parliamentary committee. Ms Meagher has denied the clean-up was an attempted cover-up, saying it was done after a request by staff and had been arranged before the committee indicated it would visit.

Source





12 November, 2007

Medicare whistleblowers under attack

A day after legislation was introduced in the House calling for a moratorium on a controversial Medicare auditing program, the Atlanta-based company at the center of the California fight came out swinging. PRG-Schultz International officials, breaking their silence Friday for the first time since the controversy erupted this summer, disputed charges that it is mishandling the audits. They said that millions of dollars in overcharges they have identified at rehabilitation hospitals are returning money to the Medicare program just as Congress intended – and that only a fraction of its determinations are being overturned on appeal. Even so, they said the company has voluntarily agreed to forgo commissions that it is entitled to under its contract on decisions that are later overturned on appeal.

"They believe we are bounty hunters," N. Lee White, who heads U.S operations for PRG-Shultz International, said of California lawmakers and the California Hospital Association. "I don't appreciate the characterization."

California House members, prodded on the hospital association, have complained about the targeting of rehabilitation hospitals treating elderly patients recovering from knee and hip replacement surgery. More than 90 percent of those claims have been rejected by the auditors on grounds that they are not medically necessary. Auditor decisions have led to millions of dollars being withdrawn from the hospitals, putting some of them in financial jeopardy and altering treatment decisions for future patients.

On Thursday, Reps. Lois Capps, D-Santa Barbara, and Devin Nunes, R-Visalia, introduced a bill that would halt the program for a year while it is studied more deeply by CMS – the Centers for Medicare and Medicaid Services – which oversees it, and by the Government Accountability Office, the auditing arm of Congress. The two lawmakers charged that CMS has failed to answer questions about the program. The agency ordered a "pause" in PRG-Schultz's review of rehabilitation hospitals because of the concerns, but the lawmakers were unable this week to find out if the auditing has resumed.

White said the pause is still in effect, meaning that it has been extended longer than the month that was initially envisioned. The fact that the rejection rate has been so high, he said, is a reflection of how patients are being unnecessarily directed into the high-cost rehabilitation hospitals, taking money out of the Medicare program that otherwise would be going to serve other patients. But White noted that many of the 85 or so rehabilitation hospitals whose claims have been reviewed have had no rejections. "This implies that there are others who are doing it disproportionately wrong," he said. "Our charge is to find the people who have overcharged for whatever reason and recoup the money."

White also disputed critics' charges that it is the only for-profit company doing the audits. PRG-Schultz advertises itself as the largest recovery auditing company in the world, and White said it has many other government agencies and large companies among its client list. "We are a serious company, and we take this seriously," he said. The auditing program is part of a pilot project authorized by Congress that began in 2005 in California, Florida and New York. PRG-Schultz is the contractor selected for California, and it hopes to expand its work to other states when the program begins to expand nationally next year. The program was intended to help control skyrocketing Medicare costs by adding another tool to check for claims errors.

"To date, more than $230 million in overpayments to health care providers have been found in California alone," according to a recent handout the company said was distributed to California lawmakers. One criticism of the program is that it uses "recovery auditors" who are paid commissions. The hospital association said PRG-Schultz receives 25 to 30 cents on every dollar it recoups. In a two-hour meeting with McClatchy Newspapers on Friday, White declined to confirm that rate but didn't dispute it, either.

White acknowledged that auditors have focused heavily on rehabilitation hospitals' work with knee and hip replacement patients. He said that it is examining these claims because the GAO had identified the area as one likely to involve overcharges. "Although some joint replacement patients may need admissions to an inpatient rehabilitation facility, our analysis showed that few of these patients had comorbidities that suggested a possible need for the intensity of services offered by an IRF," the GAO said in an April 2005 report. Comorbidities are medical conditions in addition to the surgery that could complicate a patient's recovery. Because rehabilitation hospitals are prepared to handle the most needy of patients, their rates are much higher than alternative facilities such as nursing homes.

"The issue is not whether a joint replacement patient needs rehabilitation," White said. "It's the level of care needed. The issue is what is medically necessary for that patient."

Capps said in a statement Friday that she and Nunes introduced their bill because the auditing program was hurting health care for the elderly and the Centers for Medicare and Medicaid Services was refusing to answer questions about it. "I'm as concerned about ending Medicare fraud as anyone, but I'm also concerned when a poorly managed government program is running quality providers like the Santa Barbara Rehabilitation Institute out of business for no good reason," she said. Jan Emerson, spokeswoman for the hospital association, said, "We stand by our previously expressed concerns."

Source





11 November, 2007

More fatal bungling from an NHS hospital

The husband of the Jehovah's Witness mom who died after refusing a blood transfusion because of her beliefs is blaming the hospital where she lost her life. Anthony Gough, 24, claims medical staff may have been negligent over wife Emma's death - and legal action could follow. He has told friends Emma, 22, WOULD have submitted to a transfusion - if it had used her OWN recycled blood.

Anthony claims when staff brought in a blood-cell salvage machine for the procedure they were unsure how to use it. It's alleged medics were frantically looking on the internet for instructions as Emma died.

The Sun told this week how Emma died from blood loss after giving birth to twins at at the Royal Shrewsbury Hospital. She had signed a form forbidding a transfusion as they are banned by her religion. Medics urged husband Anthony to overrule her decision but he said he could not. Heating engineer Anthony, 24, of Dawley, Shrops, and his family - who are caring for the motherless boy and girl twins - refused to comment last night.

But a friend of the family said: "Anthony and Emma would not permit a stranger's blood to be used because that would be against their Witness faith. "It was a question of storing blood coming out of Emma and putting it back into her. "But Anthony says the staff on duty didn't know how to operate the machine. He's angry, frustrated and heartbroken."

A coroner has opened an inquest into Emma's death. A spokesman for the Royal Shrewsbury said it had received no complaints about staff conduct, but a full internal inquiry was in progress.

Source




The great NHS wait

One in ten people are still waiting at least a year for NHS outpatient treatment, it was revealed yesterday. Out of 223,670 cases completed by August, 22,212 had been referred for ops by their GP at least 52 weeks earlier, figures show. Thousands more did not have surgery within six months, and nearly half - 44 per cent - waited for longer than the Government's planned new 18-week target.

Ministers have promised that by the end of 2008 nearly all patients will be seen within that deadline. Tories claimed clinical priorities will be distorted to meet the goal. Shadow health secretary Andrew Lansley said: "We need a health service in which professionals are freed from central targets."

Director of NHS Performance David Flory admitted some people would never be treated within 18 weeks as it was not medically appropriate. But he said 90 per cent would be seen within the target. Health minister Ben Bradshaw insisted the NHS was on course to hit the target. He said: "That ten per cent figure is still unacceptable. But ten years ago it was common for people to wait 18 months."

Source





10 November, 2007

Schip Wreck

Oregon voters send a message on HillaryCare

Oregon voters passed judgment Tuesday on a plan that would have made their state children's health insurance program "universal." Sound familiar? It should, because Oregon reproduced the current Schip fracas in D.C. on the state level--and the referendum took a major shellacking, with voters siding three to two against. Oregon's expansion was almost identical to the one backed by Congressional Democrats, so let's conduct a post-mortem, which may also be a portent.

Like Beltway Democrats, Governor Ted Kulongoski and his legislature wanted to broaden eligibility for Oregon's "Healthy Kids" Schip program to 300% of the federal poverty level. They would also allow all families to opt in, regardless of income, though higher earners wouldn't get subsidies. Again like Congress, Salem intended to pay for the expansion with cigarette taxes, which would increase to $2.02 from $1.18 a pack. That would be one of the highest state tobacco levies in the nation.

Democrats couldn't dredge up the three-fifths approval required for a tax increase in the legislature, so they kicked the expansion over to the ballot. And already, Measure 50's defeat is being blamed on $12 million in advertising by Big Tobacco. "What happened was, the tobacco industry bought the election," Governor Kulongoski declared yesterday.

We're surprised the Governor thinks voters in his left-leaning state are so easily gulled--especially in a contest between "healthy kids" and cigarettes. More persuasive is the notion that voters didn't want to pass a state tax increase to finance a health-care expansion that Congress might soon pass, along with buckets of federal dollars. But most likely, voters understood that a tax increase on cigarettes is still a tax increase, and a highly regressive one at that. Only about 20% of Oregonians smoke, and most of those are lower income.

They may also have figured that to the extent tobacco taxes reduce smoking, they will soon not yield enough revenue to pay for ever-growing health costs. An analysis by William Conerly, a member of Governor Kulongoski's own Council of Economic Advisors, found that a straight Schip expansion funded by a tobacco tax was unsustainable, with costs exceeding revenues by $115 million by 2017.

Counting "crowd out"--the migration to public from private insurance--Mr. Conerly predicted a $638 million deficit within the decade. Oregon tried a similar universal health experiment in the 1990s, only to see it raise havoc, and voters may not have been eager for a low-budget sequel

There are political lessons here, in case anyone in Washington is paying attention. Voters are rightly concerned about health care and would like everyone to have insurance, but they realize that government programs are very expensive. Americans also don't seem to want to pay for health-care reforms directly through higher taxes. That accounts for the reliance by politicians on the easier sell of tobacco taxes, and it also explains why Congress has disguised the real cost of its Schip contraption with a $30 billion budget gimmick. (No thanks to GOP Senators Orrin Hatch and Chuck Grassley.)

As for state-level reforms beyond Schip, California may be the next overhyped reform to fail. The last, best hope for Arnold Schwarzenegger's foundering "universal" plan is to imitate Oregon by passing a legislative blueprint and then dumping funding responsibility onto the voters via a referendum. Tuesday's vote doesn't bode well for that prospect.

As for 2008, most of the national press corps has already assumed "universal" coverage will both carry Hillary Clinton to the White House and march easily into law. The message from the Oregon trail is--not so fast, especially if her Republican opponent advances a credible free-market alternative.

Source





9 November, 2007

Australian public hospital kills baby

By way of the usual short-staffing

A mother who accidentally suffocated her newborn baby says she will consider suing a Brisbane hospital after a coroner found nurses failed to follow guidelines. Baby Arisa was less than a day old when her lifeless body was found in mother Yumiko Huber's bed at the Mater Mothers' Hospital in South Brisbane on August 17, 2005. She was revived but was found to be brain dead and died the next day when she was taken off life support.

A report by Deputy State Coroner Christine Clements - made public today - found the first-time mother had been exhausted after a difficult birth, on pain relief medication and antibiotics, and had a fever when she was left breastfeeding her daughter at about 5am. It found staff had left the pair for one hour and 45 minutes before discovering the child and her sleeping mother - contrary to hospital guidelines which required checks on mothers breastfeeding in bed every 15 to 30 minutes. "The evidence was also clear that no specific warning was given to the mother before the baby was placed with her for breastfeeding in bed," the report said.

The report said the midwife should have advised Ms Huber to take care and call for assistance if she or the baby became sleepy.

The parents were too upset to speak today, but a statement released by the father, Philip Huber, was highly critical of the hospital and its nurses, who he blamed directly for his daughter's death. The couple's lawyer Sarah Yellop today said they were considering legal action against the hospital and the two nurses who were on shift that night. "That's something that we've got to consider and, obviously, they are giving some thought too," Ms Yellop told reporters. "Given the findings of the inquest, I'd consider that there would be very strong grounds for compensation claims." But, she said, it was too early to comment on how much compensation might be sought.

The coroner's report recommended better training for nurses and more education for new mothers, especially involving the dangers of having the baby in bed with them. The report also noted "extremely heavy" workloads for nurses and low staffing levels which led to shortcuts being taken.

A statement from the hospital today said the report's recommendations had already been implemented. "Mater Health Services continues to express its deepest sympathies to the Huber family," it said. "Immediately after the death of Arisa Huber, Mater reviewed its policies and procedures in the Mater Mothers' Hospital. "Since the tragic event occurred two years ago, the recommendations made by the coroner in the report have already been implemented by the Mater." The changes included a new education program for staff and patients. [New policies? What about implementing the old ones?]

Source




Australia: Ambulance disaster just waiting to happen



A trainee paramedic who worked virtually 36 hours straight this week is so tired driving her ambulance she sees "little monsters" on the road in front of the vehicle. Stanthorpe ambulance officer Julie Clark blames the marathon shift at the Granite Belt station on chronic understaffing with paramedics regularly working 20 hours straight. Her stint - from 8am on Monday to 8pm on Tuesday - included two quick power naps, two return trips to Warwick and an eight-hour return drive to Brisbane with patients. "Lives are at risk because of this," Ms Clark told The Courier-Mail last night. "I have been so tired I have seen little monsters running all over the road."

The revelations are another embarrassment for the Bligh Government as it investigates why record funding for the Queensland Ambulance Service is resulting in worsening service [The experience of governmenrt medical services worldwide]. The QAS yesterday offered Ms Clark, 43, a transfer to a quieter station after her frustrated partner blew the whistle about the problems and forced the QAS to let her talk.

But Ms Clark insisted a transfer would not solve the problems as eight staff regularly worked 20-hour shifts as their "on-call" time became rush hour. "We love our jobs and we do get overtime but this just isn't safe for me or the patients," said the paramedic of 18 months. "By the time I came home, I was dizzy from very little sleep and I wasn't safe to drive especially long distances, or do my job. "I told the Assistant Commissioner I want to stay here but we just need more staff. That's the problem."

Emergency Services Minister Neil Roberts has requested a report of the situation with rosters over the past five days being checked. A QAS spokesman admitted the station had experienced extraordinary conditions with "a spate of serious, potentially life-threatening incidents in the Stanthorpe area this week". "A dedicated ambulance officer at the Stanthorpe station was called to attend a number of these incidents while rostered on for emergency availability at the time of these incidents," the QAS spokesman said.

But the statements were met with anger from the Ambulance Employees Australia Union and the State Opposition, which both demanded an independent inquiry into the service. Coalition emergency services spokesman Ted Malone said the understaffing was typical of a system in crisis right across Queensland. "She was a danger not only to the patients she was treating but to herself and (this) goes well beyond any workplace health and safety guidelines," Mr Malone said. AEAU secretary Steve Crow said the problem was associated with busy regional stations that had inadequate staff. "Surely there is a way to look after the patients better by actually looking after the paramedics," Mr Crow said

Source





8 November, 2007

Incompetent NHS hospital: British family demands transplant death inquiry

Grieving relatives of a woman who died in the hospital at the centre of an investigation into the high number of heart transplant patient deaths have expressed concerns about her treatment. Carol Smith, 50, is one of seven people who has died at the Papworth Hospital this year within 30 days of being given new hearts. Transplants at the hospital near Cambridge have been suspended while a review is launched into the deaths to look for common factors.

Last night, her family demanded a full inquiry into her death on May 14 and said they were considering taking legal action. They believe she was given two damaged hearts, that some of her treatment was rushed and that air was allowed to get into critical equipment. It has emerged that the Papworth was also criticised just months ago over the high number of deaths among lung transplant patients.

Mother of four Mrs Smith, who also had four grandchildren, suffered from a condition caused by an enlarged heart and underwent her first transplant on March 8. A problem developed with fluid on her new heart and surgeons conducted a second transplant on May 12. She never regained consciousness and died two days later. Her daughter Rachel Russell, a student nurse, told The Daily Telegraph: "We have still got unanswered questions and Papworth hasn't answered anything. I think the second transplant was rushed. We would consider legal action because we want to know what happened."

The cause of her death was given as cardiac failure at an inquest held last week. David Morris, the South and West Cambridgeshire coroner, delivered a verdict that Mrs Smith "was already in a life threatening situation when a re-transplanted heart failed to respond spontaneously".

Her husband Gerry, 51, said: "The hospital made it seem over-simple and we felt let down." Mr Smith, from Canvey Island, Essex, said he was shocked to hear about the other deaths at Papworth. It also emerged that an external review of lung transplants at Papworth found "a significant problem" with airway complications. Six out of 28 patients died as a result of airway complications - a mortality rate of 28 per cent - between April 2005 and March 2006 with another two deaths in the following months.

Coroner David Morris raised concerns with the hospital in a letter seen by The Daily Telegraph, after the deaths of three patients within six months following lung transplants with similar airway complications. A second letter, signed only "A very concerned patient advocate", alleged that there was a "very serious problem that has been happening for quite some time in Papworth Hospital".

The results of the inquiry by the Healthcare Commission into the heart transplant deaths will be sent to the Government by the end of next week. The Papworth said: "Heart transplants are inherently high risk, complex procedures performed on a relatively small number of patients and the number of operations likely to be affected is therefore small." Simon Roberts, the head of business development and marketing at Papworth hospital, said: "At this stage we are not prepared to comment on specific stories. A review is now underway and we need to allow this process to take place."

Source




Surge in medicine errors in major South Australian public hospital

The direction of change is almost invariably for the worse in Australia's public hospitals

HUNDREDS of medication errors have been recorded at the Royal Adelaide Hospital in the past year, hospital documents reveal. In a situation the state's peak medical body yesterday described as "devastating", it can be revealed 728 medication-related mistakes by doctors and nurses at Royal Adelaide Hospital were reported last financial year compared with 611 in 2005-06. Details of the 19 per cent increase in errors is in RAH safety and quality unit documents, obtained by The Advertiser under Freedom of Information laws.

The Patient Incidents - Medication Related reports show the most common errors are omissions, prescribing problems and overdoses. In 46 cases last financial year, the wrong medication was given and in 11 cases medication given to the wrong patients. During the first six months of this year, seven patients suffered "major permanent loss of function or permanent lessening of bodily function" as a result.

Central Northern Adelaide Health Service acute services executive director Kaye Challinger said there were no patient deaths recorded because of medication errors during the past two financial years. She said, in a written statement, the RAH regarded the incidents as "serious" and a "range of initiatives" had been put in place, including a new medication chart and pharmaceutical reforms. Incident reports are phoned through to a contact centre via a 1800 number.

But doctors, nurses and the State Opposition fear most incidents are going unreported. Australian Medical Association state president Dr Peter Ford said there was a lot of pressure, with hospitals running at more than 95 per cent occupancy. "This really is a scenario for mistakes to occur," he said. "It is a devastating finding."

Australian Nursing Federation state secretary Lee Thomas said the errors "reflected a workforce under pressure". Opposition Leader Martin Hamilton-Smith said the figures were "very alarming". "The statistics for all hospitals should now be made publicly available," he said. But Health Minister John Hill said medication errors affected just 0.37 per cent of the total number of patients treated at the hospital in 2006-07.

Source





7 November, 2007

'Loony' Health Tourism

Despite Canada's "free" health care--paid for by their very high taxes--many Canadians have become health care tourists to the private market USA because of Canada's notoriously long waiting times for doctors and facilities plus a lack of advanced medical technologies.

And now, thanks to the falling dollar and the higher valued Canadian dollar (loony as it is referred to there) American health care for Canadians has suddenly become 30% cheaper. Even though Canadians have to pay for it out of pocket, it is still a bargain. Some simple numbers from Dr. Albert Schumacher, past president of the Ontario Medical Association (OMA) and the Canadian Medical Association (CMA) reveal the high price of Canada's "free" health care.

This province just doesn't have the medical staff or the resources to provide the same level of care as the U.S. Essex County, where Schumacher practises, with a population of 400,000, until recently had only two CT scanners and one MRI machine. They just got a second MRI. Across the border in Port Huron, Mich., population 12,000, they had four MRI machines 10 years ago, Schumacher says.

Furthermore, even with a new medical school opening in Ontario the medical future there is not promising:

He points out that despite the new satellite medical school in Windsor, the 2,400 doctors that will be enrolled starting in 2010 will still only give the country 80% of self-sufficiency for doctors. "The simple math is for every five of me practising here, Western Europe has six and we are only training four to replace us, so the crisis gets worse on a daily basis," he says. The OMA estimates this province is short more than 2,000 physicians -- all just numbers and statistics for politicians, perhaps. But for Joanne Thompson and her sister, these figures add up to one thing: Prolonged suffering.

Hey, now just who or what is loony; who or what has a more solid currency? And most importantly, what about the health care? Hillary and Michael Moore, living here, have one answer. The Canadian Ms. Thompson, referred to in the link above, who would have had to wait up to five months for an MRI in Canada but was able to get one the next day in the privatized health care USA, certainly has another.

Source




Australia: NSW government employs drones instead of doctors and nurses

New South Wales Health Minister Reba Meagher rejects claims the clean-up of Royal North Shore Hospital occurred specifically to coincide with a parliamentary inquiry into its performance. RNSH has enjoyed a major spruce-up, with a huge team of cleaners employed to do the job.

The Opposition has been critical of the timing but Health Minister Reba Meagher says she's just trying to improve the hospital. "The concerns about cleaning were raised directly by the nurses to the chief executive and the chief executive has responded to those claims," she said. Royal North Shore has been under siege of late, with patients left to miscarry in emergency and cases of serious misdiagnosis.

Meanwhile, it's claimed 250 nurses could be employed with the money spent on 159 health bureaucrats who are being paid even though they don't have a position. Almost half have had their role made redundant. New South Wales Treasurer Michael Costa has told 2GB's Ray Hadley there is a deadline for these people to find work within the public service. "They're in a different category because they tend to be not highly paid people," he said. "They're given an oppotunity - 12 months - to find an alternate employment opportunity within the public sector. If they fail to find they are given termination and they've got 12 months to get out of the system."

Source

An earlier version of the above article included the following:

The state government has been forced to defend the cost of keeping redundant health workers on the payroll on the same day the inquiry into Royal North Shore Hospital begins. Around $15 million is being spent on health bureaucrats who are without a permanent position but the government insists the workers are not sitting around doing nothing. Opposition Leader Barry O'Farrell says the union-secured deal speaks volumes about the government. "The $45 million a year being paid to 600 people to sit around and do nothing would be better spent employing more teachers, nurses and police."





6 November, 2007

British Paramedics 'refused to run as boy lay dying'

Paramedics refused to run along a beach to a dying boy for fear that they would be in breach of health and safety regulations, the child's father has claimed. James Poynton, 11, suddenly collapsed while walking along Caldy Beach, Wirral, Merseyside, with his family. His parents called an ambulance but when paramedics arrived they walked towards them, according to James's father, Jim, 49. When he asked why they had not broken into a run, they allegedly said that had they tripped they would have been unable to adequately treat James.

Mr Poynton, a company director, said: "I'm appalled that they wouldn't run. If someone is dying, aren't you supposed to save their life?" Mr Poynton and his wife, Ann, believe that had the paramedics acted with more urgency their son might have lived. James died during an evening walk with his parents, his sister, Claudia, now 15, and a friend, on June 9 last year. Unknown to his family, he was suffering from an undiagnosed heart condition.

George Kokai, a paediatric pathologist, told an inquest in Wallasey that he had only seen the condition, arrhythmogenic right ventricular dysplasia (ARVD), twice in his career. Christopher Johnson, the coroner, recorded a verdict of death by natural causes.

A spokesman for the North West Ambulance Service NHS Trust said the paramedics involved were off duty and could not be contacted. "They carry up to 25kg of equipment, and if it's an uneven terrain, such as a beach, they can't always run with the equipment. "In addition to that, once they reach the patient they need to be in a condition where they can carry out resuscitation techniques. They don't want to arrive so breathless that they can't then help the patient."

Source




Australia: Another disastrously mismanaged public hospital

This time in Victoria. Coverup included, of course

Victoria's leading hospital trauma centre has been in disarray for several years, with top surgeons refusing to operate with its director, Professor Thomas Kossmann. Since 2004, several surgeons working at The Alfred hospital have avoided operating with Professor Kossmann due to concerns about whether his treatment of some patients was excessive. They also complained about his billing arrangements with the Transport Accident Commission - which pays for medical treatment of road crash victims in Victoria.

The Age can reveal the medical department heads and senior managers at the hospital, which last month announced an external review into Professor Kossmann's clinical practices, have dismissed multiple complaints made by surgical staff over the past three years. Staff have told of a culture of fear and silence at the trauma centre, which treats most of the severe road crash victims in the state. Several surgeons who complained to department heads were told to keep quiet. One who confronted Professor Kossmann about his decision to operate on a patient, judged by other doctors to have such serious injuries that surgery was futile, did not get his contract renewed in 2005.

Professor Kossmann has stood down from surgery while the review takes place. He has declined requests to be interviewed, but in a brief statement through the hospital, he said: "I refute the allegations."

The Alfred has declined to release the review's terms of reference. It has also declined to answer questions and told The Age that it had only recently received complaints about Professor Kossmann, who was recruited from a Swiss hospital to head the trauma unit in 2001. However, an internal memo obtained by The Age suggests that problems in the trauma unit are longstanding. The memo, written in February 2005 by the then head of neurology, Professor Jeffrey Rosenfeld, orders surgeons to assist Professor Kossmann in theatre when requested. "It is expected that you will assist Professor Kossmann . in spinal surgery," it says. The memo was written after some surgeons refused to assist him. Several surgeons who still work at The Alfred continue to avoid operating with Professor Kossmann. "It's true. People have chosen not to participate in surgical procedures that he's been involved in," said a doctor with recent experience at The Alfred.

Over the past 12 months, The Alfred conducted a review of its trauma department with a focus on patient care. It is believed doctors raised concerns about Professor Kossmann during this review, which were not acted on. The Age has interviewed more than a dozen medical sources who tell a consistent story about concerns over Professor Kossmann's performance and the hospital's repeated failure to act.

One concern is about his treatment of TAC-funded patients. The commission pays for the medical care of every Victorian injured on the state's roads under the personal injury insurance scheme, paying doctors generous fees for procedures performed on victims. It is believed Professor Kossmann has a deal with the hospital that allows him to receive payments direct from the commission, with a percentage going to The Alfred. This contrasts with many other staff doctors, whose payments are pooled, with the money distributed equally.

It is believed the review into Professor Kossmann was ordered by Alfred chief executive Jennifer Williams after she was recently given a series of patient cases that doctors believed warranted scrutiny. Hospital insiders say Ms Williams is now taking the issue seriously and may not have been aware of all the previous complaints, with senior managers and department heads not passing them on.

Source





5 November, 2007

Dangerous dentistry at a NY Community health center

A dentist was dancing to the song "Car Wash" when the inch-long drill bit he was using during an extraction punctured a woman's sinus cavity and lodged near her eye socket, according to a lawsuit. Brandy Fanning, 31, of Syracuse said she had to undergo emergency surgery and spent three days in the hospital because of the mishap. Fanning said she still suffers facial swelling, nerve damage and chronic infections from the bacteria that seeped into her sinus cavity. Fanning is seeking $600,000 for her medical expenses, pain and suffering in the lawsuit filed against Dr. George Trusty in U.S. District Court in Syracuse last month.

Trusty, 57, a dentist at Syracuse Community Health Center, declined comment. Dr. Ruben Cowart, president and chief executive officer of the health center, also declined to speak about the incident.

Fanning, a mother of three who works for Verizon, said she went to the emergency dental clinic at the health center in October 2004 after pain in a left molar started getting worse. An exposed nerve made it sensitive to heat and cold and a root canal had been ruled out as a possible option, the lawsuit said.

Trusty gave her some Novocain and while he was drilling to break the molar into quadrants before the extraction, Fanning heard a snap, she said. As Trusty was doing the procedure, he was "performing rhythmical steps and movements to the song Car Wash," which was on the radio in the dental suite, according to the lawsuit. Trusty tried to use a metal hook to pull the bit out, but that only pushed it farther up, driving it through the sinus and bone, the lawsuit alleged. When Fanning asked what was happening, Trusty told her it wasn't a big deal and that she'd likely sneeze the drill bit out, the lawsuit said.

She then expressed alarm and Trusty called an oral surgeon, who was a friend, to get Fanning an appointment. Trusty made the call in front of Fanning. When he got off the phone, he told her she needed to get to an emergency room immediately, according to the lawsuit. Fanning said doctors told her later that if she'd sneezed with the bit still inside, she could have blinded her left eye.

Fanning claimed Trusty failed on a promise to pay her medical bills, so she filed the lawsuit. The case is in federal court because the health center operates under federal law, which limits the amount of damages it can agree to settle.

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Doctor banned overseas is finally suspended from NHS

A SOUTH AFRICAN doctor employed by the NHS despite falling foul of the medical authorities on three continents has been suspended after an investigation by The Sunday Times. Maurice Saadien-Raad, who has been working as a psychiatrist treating vulnerable patients, was told by the General Medical Council (GMC) last Friday that he would not be allowed to practise for 18 months while it investigates his practice in Britain. Saadien-Raad, who is 59 and lives in Leamington Spa, Warwickshire, has previously been threatened with removal from the medical register in South Africa for "disgraceful conduct" and banned from practising in Tasmania.

His record also earned him a reprimand by the GMC in Britain in 2004. The council has declined to disclose what Saadien-Raad did in South Africa or what led to his suspension in Britain. The Australian Broadcasting Corporation has reported that he carried out a series of botched surgical procedures before he began to specialise in psychiatry.

The case has raised concerns among health workers and patient groups that the NHS is failing to check foreign doctors adequately. Katherine Murphy, director of communications for the Patients Association, said: "The NHS has a responsibility to the people it is providing a service to. "If it is as easy as this to get a job working as a doctor in Britain then we should not be surprised that there are so many problems with patient safety."

Saadien-Raad was employed as a locum psychiatrist by Bradford District Care Trust between November 2006 and July 2007 working with patients with learning disabilities and mental health problems. As a locum, he would also have worked for other trusts.

The Sunday Times began investigating Saadien-Raad after being alerted by a former colleague of his concern that he was practising in Britain. Saadien-Raad has been in Britain since 2002. After a series of disciplinary hearings in South Africa, he later lied about his record to register as a doctor in Tasmania. He was forced to leave when his deceit was uncovered after complaints about his medical competence.

Saadien-Raad said: "It is ridiculous they are raising this now. This happened a long time ago and it has been dealt with. It is finished and it is wrong to go over it again now." Bradford District Care Trust declined to comment

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4 November, 2007

Killed by a British hospital that just didn't care - a widow recounts her husband's final days

On the last morning of his life, Ian Luck phoned his wife from the hospital bed where, ten days earlier, he had been admitted for a gastric disorder. "He was crying so much I could hardly understand him," says Debra, his widow and mother of his son Ben, now nine. "Ian said he had spent most of the night in agony - the nurses had forgotten his pain-killing injections. "He was covered in his own vomit, he'd been sick on the floor, and when a nurse finally came, she told him he was 'disgusting'."

Debra will never forget that dreadful conversation in June 2002. Not least because just before he rang off, Ian said something so upsetting that it makes Debra cry to talk about it even today. "Ian had been bedridden for almost the entire ten days he'd been in the hospital," she says. "But he said if he could walk, he would have gone to the window and jumped out. He couldn't bear being in that uncaring place for another day."

Less than 24 hours later, Ian, aged just 37, suffered two cardiac arrests and died. A post-mortem showed that he had a ruptured oesophagus caused by continual vomiting. This rare condition causes massive shock and infection, which would have put fatal strain on the heart. According to medical experts, the most likely cause of Ian's excessive vomiting was a bleeding stomach ulcer, a condition that doctors initially picked up and treated. But when Ian's symptoms returned, they failed to carry out a simple exploratory process to diagnose further bleeding, which could have been treated with drugs or surgery.

As if his death wasn't tragedy enough, Debra is haunted by the misery, pain and squalor he endured at the Princess Alexandra Hospital in Harlow, Essex, during the ten days before he died. "An animal would have been treated with more compassion," says Debra. "No one wanted to help us. Every time we asked for pain relief, or to see a doctor, we were told to wait, or that we didn't know what we were talking about."

The final day of Ian's life was spent in misery and humiliation on a geriatric ward, with uncaring nurses and doctors who failed to recognise that he was dying. He had been shunted there from his surgical ward, having been told his bed was needed for a more urgent surgical patient. "That day was a nightmare," says Debra, now 43. "I knew he was dying, his usual happy character had vanished, he was frightened and very low. He looked grey and clammy, his stomach was swollen, he was hallucinating and there was vomit all over his T-shirt. "As fast as I changed him he was sick again. The nurses were not interested in helping me.

"At one point, an old man fell out of the bed next to us and lay there, crying for help. When I ran up to the nurses' station to tell them, they said: 'Just leave him.' "I wasn't strong enough to help him by myself and it was 15 minutes before anyone came to lift him back into bed. He lay there calling for help next to my dying husband. "All the time I could hear the nurses chatting and laughing. It was frustrating, terrifying, horrible. "This was a British hospital in the 21st century, yet it felt as if we were in the Dark Ages."

A fortnight ago, after nearly five years of legal wrangling, the Princess Alexandra Hospital NHS Trust agreed to pay œ200,000 damages to Debra, and a further œ25,000 to her son, Ben, without accepting liability. Although she acknowledges the money will help make Ben's future secure, Debra is disappointed. "No one has been punished or sacked," she says. "No one from the hospital has offered to meet me and tell me how things went so wrong, let alone offered an apology. "For all I know, the same appalling standard of care is still acceptable in that hospital. If that is the case, then there will be more unnecessary deaths."

Sadly, Ian's story of uncaring treatment is one that is all too common in the NHS. While many nurses and other medical professionals rightly take great pride in the high standards of care they offer patients, too often we hear of similar stories of poor nursing. The recent scandal surrounding the lack of hygiene at Maidstone and Tunbridge Wells hospitals - which led to 90 deaths from the superbug C. difficile between 2004 and 2005 - may have grabbed the headlines, but similarly shocking cases elsewhere in the country have surfaced with depressing regularity.

"Although Ian's story sounds dreadful, unfortunately it is not an isolated incident," says Vanessa Bourne, of The Patients' Association. "There has been a profound change in the nursing profession. Nurses no longer seem to want to care, or do the most basic forms of nursing. "Patients often contact us about incidents where they have been left with buzzers unanswered or in dirty bed linen. When they have broached the subject, they have been told off like naughty children."

Debra is emphatic about the "care" her husband received. "I actually feel that Ian was murdered," she says. "He died because people couldn't be bothered to do their job properly." Ian had suffered from gastric problems for two years. He was admitted to the Princess Alexandra Hospital several times in the first half of 2002 to replace the fluids lost through vomiting and diarrhoea. Ian underwent tests and was diagnosed with inflammation of the intestines and stomach, and then with Type 1 diabetes which, it was thought, could be exacerbating his problems. Finally, after a particularly serious bout of vomiting on June 12, 2002, and weak and unable to eat, Ian was again admitted to hospital. This time he had an endoscopy, where a tube with a camera on the end is passed down the throat into the stomach. "The doctor spotted he had quite a large duodenal ulcer, about 3cm in diameter, which he said might have caused the vomiting," explains Debra. "After six days in hospital Ian's condition slightly improved and, hydrated, he was allowed home."

The most common cause of a duodenal ulcer is an infection, which usually clears up with antiobiotics, but these didn't work, so the doctor arranged another endoscopy. On the morning of his appointment on June 20, Ben, who suffers from asthma, was wheezy, and Ian told Debra to stay with their son. He kissed them goodbye and headed to the hospital. It was the last time father and son would see each other. When Debra rang the hospital that afternoon, she was told Ian's ulcer had bled during the endoscopy and he'd had to undergo emergency treatment. "The surgeon told us that if left untreated, a bleeding ulcer was lifethreatening. But although Ian and I were frightened, he reassured us that we were on the surgical ward, right next to theatre, and if the bleeding started again we were in the best possible place to get it fixed."

But the doctor's optimism was not reflected in the remainder of Ian's care. From the day he was admitted to the day he died, Debra feels she struggled to get him even the most basic level of nursing care. "He was vomiting ten times an hour, and there were bowls around his bed to catch it," says Debra. "Often they weren't emptied for more than an hour and they smelled awful. The first time that happened I found a nurse and asked if she could empty them. When she said she was too busy, I offered to do it myself.

"What I've learned since is that his urine and vomit should have been monitored continuously. Both were vital to working out just how ill he was and whether he would need further investigations. The fact that no one kept a record probably added to his lack of correct treatment."

Debra found herself doing other basic nursing tasks, too. "Many times the vomiting came on so suddenly that Ian would vomit over his pillow, bed or T-shirt. It was often ages before someone came along to clean him up. I would arrive in the morning and he would have dried stains on his pillow or a filthy T-shirt. "I started bringing in clean pillow cases and changing them myself. I would leave him at night feeling guilty because I knew he wouldn't be looked after until I came back. "The next day I would walk up the stairs to his ward with my stomach in knots, terrified of what I'd find next."

And all the time, Ian was deteriorating before her eyes. "In the last two days of his life I saw only junior doctors. After four days in hospital he was so weak and he'd stopped eating or drinking because he felt too ill. If he did try to sip water, it would come back up straightaway," she says. The hospital continued to carry out tests. Ian had a CT scan, which indicated looped intestines, although later tests discounted this as a cause of his pain. One junior doctor casually mentioned to the horrified couple that Ian might have pancreatic cancer, although this was never mentioned again. Another junior doctor tried to put a tube down Ian's throat to drain his stomach but gave up after 20 minutes of Ian retching.

By June 27, Ian was receiving six injections of the painkiller penthidine, plus three injections of Maxalon, an anti-sickness drug, each day. Yet despite the battery of tests, there was no definitive diagnosis about whether the ulcer was still bleeding or if his symptoms were caused by something else. "I made two appointments to speak to a consultant during the course of those ten days," she says, "and both times he didn't turn up. When I tried to talk to junior doctors they were either too busy or didn't know enough.

"We had health insurance so I rang our local private hospital and they agreed to take him, but the Princess Alexandra wouldn't release him, saying he wasn't fit enough to travel. I felt at a loss about what to do next. "I really tried," she says plaintively. "But I shouldn't have let them brush me off; I should have shouted until he got the help he needed."

Indeed, according to Vanessa Bourne, making as much fuss as possible is exactly what you should do if you feel that your care is inadequate. "You have to stand up for yourself," she says. "A useful weapon is to state that you are keeping notes of everything. Speak to the sister, then the senior doctor. If they don't help, demand to see the chairman."

During the night of Friday, June 28, Ian was seen by a junior doctor who was sufficiently alarmed about his condition to request an examination by a consultant with a view to carrying out a laparotomy - an exploratory stomach operation. During the night the consultant did visit Ian. He requested more fluids but failed to order the laparotomy. Independent experts later found that had this procedure gone ahead, it probably would have saved Ian's life. The next morning another junior doctor was sufficiently concerned to call for another consultant review. This was never done.

"When I arrived on Saturday morning Ian looked dreadful," remembers Debra. "He was grey and clammy. I stayed for the rest of the day, nursing him, and went home scared."

On Sunday morning, after his emotional call to Debra, Ian was seen by the on-call physician, a geriatric consultant. After considering the notes of the two junior doctors, she found nothing that warranted immediate action. "When we arrived at the hospital around mid-morning Ian was lapsing in and out of consciousness," said Debra. "He was covered in vomit and had wet himself. I changed him, but when I asked for clean surgical stockings the nurse said there were none left in his size. "I couldn't change his T-shirt without help, because of his drip, but I was told by the nurse she was too busy and to leave him dirty."

As night fell, Ian told Debra to go home to Ben. "I was frightened to leave him, but he said he'd hang on until the morning ward round and a doctor would help him. I left in tears." An hour later, Ian was struggling to breathe. A junior doctor suspected a collapsed lung and, while undergoing a chest X-ray, Ian suffered a cardiac arrest and was resuscitated. However, by the time Debra and other family members arrived, Ian had suffered another arrest and died.

"My father was shouting at the staff saying they had murdered Ian," says Debra. "I asked to see a doctor who had been with him when he died, but no one came." Two days after Ian died, Debra told four-year-old Ben that his father had gone to Heaven. He was inconsolable and later saw a psychologist to help him cope with his grief.

A spokesperson for the Princess Alexandra NHS Trust said: "The trust looked into Mrs Luck's complaint thoroughly in 2002 and we have taken on board many of the issues raised, particularly with regard to communication between doctors, nurses and patients. "Since then we have introduced training both for nursing and medical staff and we continue to strive to improve in this area. "The trust offers Mrs Luck and her family best wishes for the future."

This is little consolation to Debra. "If I had that time again I would not let the nurses fob me off, or try to tell me that it was normal to leave patients in filth. "I wouldn't allow the doctors to make me feel I was being a nuisance. I would raise the roof until my loved one got the help he needed and I'd advise anyone else to do the same. "Ian was a kind man who enjoyed helping other people. It is a tragedy that when he needed help, in the very place he should have got it, there was none."

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3 November, 2007

Framing the SCHIP debate

President Bush and congressional Republicans shouldn't worry about political fallout from blocking the Democratic legislation to expand the children's health insurance program known as S-chip. They have a good argument against it that most Americans will buy and a credible alternative. So there's no reason to be anxious.

Supporters of S-chip expansion point to polls that show widespread public backing, including among Republicans. But once a single piece of information is added to a poll question on S-chip, the public's attitude changes. That information: the bill would allow kids in families making up to $61,800 a year to get free, taxpayer-paid health insurance.

Gallup asked this question of adults two weeks ago: "Based on what you have heard or read about this bill, who do you have more confidence in to handle this issue - George W. Bush or the Democrats in Congress?" Bush got 32 percent, Democrats 54 percent. Bush, of course, opposed and then vetoed the Democratic S-chip bill.

That question went to half the polling sample. The other half got this question: "As you may know, the Democrats want to allow a family of four earning about $62,000 to qualify for the program. President Bush wants most of the increases to go to families earning less than $41,000. Whose side do you favor?"

The response was almost the reverse. Bush got 52 percent, Democrats 40 percent. And the response likely would have been more pronounced in opposition to S-chip expansion if Bush, a relatively unpopular and highly polarizing figure, had been left out of the question.

For Republicans, this means they have a winning strategy. Limiting S-chip to its original purpose of providing health insurance to poor children (in families at less than $41,200 income) meets with the public's approval. Expanding S-chip into the middle class doesn't. The key is citing the $61,800 figure.

But that's not enough to win the political fight. Democrats can respond by saying, "There are millions of kids in that $41,200 to $61,800 income bracket without health insurance. What are you going to do about them? Where's the Republican alternative?"

In fact, Republicans have such an alternative. In the Senate, Mel Martinez of Florida and George Voinovich of Ohio have introduced a bill that would offer a $1,400 per child tax credit for health insurance to families in that bracket. The credit would be refundable. Tom Price of Georgia and dozens of other Republicans are sponsoring a House version of the bill.....

Democrats and much of the media have been framing this as an issue of Republicans opposing health care for children rather than engaging in an honest debate on who should be eligible for the program. The ads featuring kids who are already eligible are especially dishonest as are the attacks on conservatives who challenge the ads. What Republicans need to do is run their own ads featuring the facts in the poll and put the Democrats on the defensive where they belong.

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Australia: NSW hospital woes spreading

The state's crumbling public health system is sliding further into crisis, with ambulance crews revealing patients on the Central Coast have died waiting for treatment. As embattled Health Minister Reba Meagher today meets with staff at the beleaguered Royal North Shore Hospital, The Daily Telegraph reports the crisis in our state's health system is engulfing more hospitals.

Paramedics are the latest health workers to speak out, revealing their forced queuing at public hospitals because of a lack of patient beds is costing people their lives. Their warning comes as paramedics on the Central Coast are losing up to 1000 hours a month on the road waiting outside clogged-up hospitals. Documents obtained by the NSW Opposition reveal the seven Central Coast ambulance stations have this year lost the equivalent of 170 days queuing outside Gosford and Wyong Hospitals' emergency departments because there are no beds. Leaked figures from log books show 138 "cases" had to wait more than two hours at both hospitals.

One source said up to 80 per cent of the area's 18 ambulance day crews were regularly off the road and unable to answer triple-0 calls because they were trapped at hospital emergency departments. An ambulance officer with more almost 30 years' experience told The Daily Telegraph jobs were going unanswered. "We sometimes have to get crews from Hornsby or St Ives to answer calls on the Coast because 80 per cent of us will be queuing at the hospital," he said.

Patricia Marshall knows the tragic consequences of our over-stretched public health system - her sister Lynette Salmon died after being forced to wait 20 minutes for an ambulance - despite living just two minutes from an ambulance station. Ms Salmon, 37, suffered an epileptic fit at her Blackwall home last year, dying on her way to hospital. Ms Marshall believes her sister would be alive today if an ambulance had arrived earlier. "What a waste of a life," Ms Marshall said.

Head of emergency services for the Central Coast Dr Kate Porges yesterday backed the paramedics' claims. "We see them (ambulances) queuing outside but there is nothing we can do," he said.

Opposition health spokesman Jillian Skinner said ambulance crews were contacting her daily about the problems. "Our hospitals, not just Royal North Shore, are struggling to cope with patients coming through emergency," she said.

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2 November, 2007

Prostate cancer in Britain and the USA

Paul Krugman has attacked Rudy Giuliani for a dishonest ad on health care--or perhaps an ignorant one, as the case may be. This is a test for the media, as well as a scandal in its own right, Paul says. Will those feckless reporters and editors at The New York Times call Giuliani to account for this? Probably not, seems to be Paul's opinion:

OK, Rudy Giuliani has just released an ad claiming that the survival rate from prostate cancer is much higher in America than in Britain, thus proving the failure of socialized medicine.

The problem is that his claim is just plain false. In fact, mortality rates from prostate cancer are almost the same in America and Britain.

So, will this get as much attention as, say, the Edwards haircut or the Hillary laugh? Will it get any coverage at all? Bear in mind that health care is the central domestic issue of this election — and Rudy has just showed that he doesn’t know a thing about it.

Giuliani's claims in the ad are indeed misleading. First, prostate cancer is a very bad example. Worse, in my view, is the implication that his Democratic opponents are proposing "socialised medicine" remotely similar to  Britain's NHS. That can only be a deliberate deception.

To say that prostate cancer survival rates are much higher in the US than in England is not "just plain false", however. It is just plain true. Five-year survival rates are higher in both America and England than Giuliani said. In the United States they stand at close to 100 per cent. In England they are 25 points lower. Figures for prostate cancer are notoriously misleading, though, because early detection (at which the US excels) delivers little improvement in mortality.

Chiefly because of better diagnosis, America records a far higher incidence of prostate cancer--and nearly all of those early-detected cases survive five years. Men with prostate cancer, which develops slowly, often die of something else. If you are a man with prostate cancer, it may not matter very much whether your cancer is diagnosed early, or whether you live in Britain or America.

But does Paul therefore think that cancer survival rates, correctly measured, are similar for all cancers, including those for which early detection is important? If so, he is mistaken. See this report, entitled "Cancer Survival Rates Improving Across Europe, But Still Lagging Behind United States" (and remember that England's rates, not broken out, are among the worst in Europe).

Taking recent figures, female five-year cancer survival rates are 62.9 per cent on average in the US and 52.7 per cent in England. To compare America's privately insured with England's NHS patients, you'd need to bump up that American survival rate a bit (the uninsured most likely have lower survival rates--otherwise why worry about universal coverage) and bump down the English one (because some Brits have private insurance, and so buy better care).

Nationally, American cancer survival rates are significantly better. Certainly not by the 40-point margin Giuliani implied, but still. And the politically salient question is this: If you have cancer, would you rather be an American with insurance or an Englishman without? The answer is obvious.

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Another "overconfident" surgeon still operating in Australia

How many more people will he hurt before they get around to de-registering him?

One of Australia's leading cosmetic surgeons is under investigation for allegedly performing unlicensed operations following the emergency admission to hospital and surgery on a woman who had undergone an extensive makeover in his inner-city clinic. Millionaire doctor, television personality and former president of the Cosmetic Physicians Society of Australia Simon Rosenbaum has been slapped with restrictions on his practice in Queensland and Victoria after medical authorities alleged he posed a "serious potential risk" to "vulnerable persons".

The Brisbane surgery of Dr Rosenbaum, who is under investigation by two state health watchdogs, as well as Medicare, was raided earlier this year as part of the investigation that may soon widen to other cosmetic physicians. Dr Rosenbaum - a 20-year veteran of the cosmetic surgery explosion in Australia - has performed thousands of operations in his clinics in Fortitude Valley, Brisbane, and South Yarra, Melbourne. The procedures are touted as being cheaper than those performed in hospitals because of the lower fixed costs in the clinics.

But for almost a year, authorities have been investigating his practice following post-surgical complications to the woman in Brisbane which required emergency surgery to stop internal bleeding and to drain half a litre of blood. The woman, who worked as a nurse in Queensland, underwent a breast augmentation, mini-abdominoplasty and liposuction in a three-hour operation conducted by Dr Rosenbaum last October in his Australian Clinic for Cosmetic Surgery in Brisbane. The operation cost $20,000.

It is alleged Dr Rosenbaum - a regular guest of the Good Medicine television program - has been "performing complex procedures" in a clinic not licensed to do so and on patients under general anaesthetic, also without an appropriate licence for his clinic. According to documents obtained by The Australian, the woman returned to a hotel room after her operation and soon felt "very unwell and clammy", had a rapid pulse and was unable to remain standing. She called Dr Rosenbaum, who examined her that night, before telling her to visit his clinic the next day where she was put under observation. The Medical Board of Queensland also alleged Dr Rosenbaum put her under observation at his clinic the next day for eight hours - despite "clinical indications that immediate referral to hospital was appropriate" - before taking her to a Brisbane hospital.

In letters to medical authorities, Dr Rosenbaum said he was "not aware of the regulations affecting the administration of anesthesia". [Spare us!] Yesterday, he denied any patient had been put under general anesthesia in his clinics and that his rate of complications was "10 times" better than the average. "The reason I have been singled out is because of professional jealousy by the plastic surgeons," he said. "They ... are very successful in getting government bodies to do their dirty work."

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1 November, 2007

Record numbers of Brits go abroad for health

Record numbers of Britons are flying abroad for medical treatment to escape NHS waiting lists and the rising threat of hospital superbugs. Thousands of "health tourists" are going as far as India, Malaysia and South Africa for major operations - such is their despair over the quality of health services. The first survey of Britons opting for treatment overseas shows that fears of hospital infections and frustration with NHS waiting lists are fuelling the increasing trend.

More than 70,000 Britons will have treatment abroad this year - a figure that is forecast to rise to almost 200,000 by the end of the decade. Patients needing major heart surgery, hip operations and cataracts are using the internet to book operations to be carried out thousands of miles away. India is the most popular destination for surgery, followed by Hungary, Turkey, Germany, Malaysia, Poland and Spain. But dozens more countries are attracting custom. Research by the Treatment Abroad website shows that Britons have travelled to 112 foreign hospitals, based in 48 countries, to find safe, affordable treatment

Almost all of those who had received treatment abroad said they would do the same again, with patients pointing out that some hospitals in India had screening policies for the superbug MRSA that have yet to be introduced in this country.

Andrew Lansley, the shadow health secretary, said the figures were a "terrible indictment" of government policies that were undermining the efforts of NHS staff to provide quality services. The findings come amid further revelations about the Government's mishandling of NHS policies, and ahead of official statistics that will embarrass ministers:

* On Wednesday, figures are expected to show rising numbers of hospital infections. Cases of the superbug Clostridium difficile, which have risen five-fold in the past decade, are expected to increase beyond the 55,000 cases reported last year.

* On the same day, statistics will show that vast sums have been spent on pay, with GPs' earnings rising by more than 50 per cent in three years to an average of more than 110,000 pounds.

* New research shows that growing NHS bureaucracy has left nurses with little time to see patients - most spending long periods dealing with paperwork.

Katherine Murphy, of the Patients' Association, said the health tourism figures reflected shrinking public faith in the Government's handling of the NHS. "The confidence that the public has in NHS hospitals has been shattered by the growth of hospital infections and this Government's failure to make a real commitment to tackling it," she said. "People are simply frightened of going to NHS hospitals, so I am not surprised the numbers going abroad are increasing so rapidly. My fear is that most people can't afford to have private treatment - whether in this country or abroad."

Some foreign hospitals touting for business on the internet offer consultations in hotels in Britain. But other patients are happy to rely on email to discuss their treatment with doctors thousands of miles away. Low prices in India, where flights, hotels and a heart bypass cost less than half the price charged by British private hospitals, explain its top ranking in the survey by Treatment Abroad, a British website providing information on hospitals overseas. Hungary's popularity rests on a boom in dentistry, thanks to a shortage of NHS dentists in Britain.

Mr Lansley said: "Healthcare is an area where Britain could be a world beater because we have some of the best research and best clinicians. If people don't trust the health service, then that is a terrible indictment of this Government, which has turned the NHS into a nationalised bureaucracy, instead of something able to focus on what patients want."

The British Medical Association advised people to be careful when considering treatment abroad, highlighting the dangers of flying soon after surgery, which can cause complications. A spokesman said: "Travelling can place a great deal of stress on the body. Patients travelling abroad for surgery should consider their fitness to fly and get an understanding of an appropriate convalescence period before attempting to return home."

A Department of Health official said the number of patients seeking treatment abroad was a tiny fraction of the 13 million treated on the NHS each year. Waiting times had fallen. Almost half of patients were treated within 18 weeks of seeing a GP. Most people who had hospital care did not contract infections.

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Australia: Whitewash report for disastrous public hospital

It has been just over a month since Jana Horska miscarried in a toilet at Royal North Shore Hospital, and the State Government's handling of the tragedy has only deepened the pain for her and her husband. Mark Dreyer said yesterday he was shocked to hear from a journalist on Friday afternoon that a Government report into the incident had been released; he and Ms Horska they were still waiting to be interviewed for it. Mr Dreyer said the report was a rushed, inaccurate job that had "just added to our tragedy".

The inquiry into Ms Horska's miscarriage on September 25 found staff were not at fault and had followed protocol. The report said the couple had been invited to give their account "on several occasions but they declined". But Mr Dreyer said this was "an out and out lie". He said they were bypassed because they had wanted legal representation at the interview and this did not fit into the Government's October 26 deadline.

One of the authors, Professor Clifford Hughes, said yesterday Ms Horska and Mr Dreyer were telephoned by his co-author, Professor William Walters, on October 3 offering a meeting the next morning at their home so they could be interviewed. But Mr Dreyer said that after their lawyer faxed the professors on October 3 asking for a list of questions, they received a letter from Professor Walters the next day, October 4 - which twice misspelt his name as Draper - saying he and his colleague still wanted to speak with the couple but would have to interview hospital staff first, "given the need for us to progress the review".

He said he and Ms Horska did not hear from them again. He said he had sought legal advice because he did not trust the Government and he and his wife were too distressed to handle it. "That, of course, added time to the inquiry and, as it turned out, we never got to have a say and it angered me and my wife and this has just added to our tragedy," he said.

Professor Hughes said yesterday his inquiry team called the couple's lawyers on October 16 and 18 indicating they wanted to interview the couple. "We got no response to any of these attempts," Professor Hughes said. He said the door was still open. "It's not too late for us to hear their side of the story and if they were to show us other facts that were important . we would draw that to the attention of the director general [of NSW Health]."

The chief of staff of the embattled Health Minister, Reba Meagher, is looking to leave. Tom Forrest applied for a senior position in the Health Department in July, but his application was not successful.

Source